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Lane C, Naylor PJ, Shoesmith A, Wolfenden L, Hall A, Sutherland R, Nathan N. Identifying essential implementation strategies: a mixed methods process evaluation of a multi-strategy policy implementation intervention for schools. Int J Behav Nutr Phys Act 2022; 19:44. [PMID: 35413919 PMCID: PMC9004180 DOI: 10.1186/s12966-022-01281-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physically Active Children in Education (PACE) is composed of eight implementation strategies that improves schools' implementation of a government physical activity policy. A greater understanding of each discrete implementation strategy could inform improvements to PACE for delivery at-scale. This study aimed to: (A) measure the dose delivered, fidelity, adoption and acceptability of each strategy using quantitative data; (B) identify implementation barriers and facilitators using qualitative data; and (C) explore the importance of each strategy by integrating both data sets (mixed methods). METHODS This study used data from a cluster randomised noninferiority trial comparing PACE with an adapted version (Adapted PACE) that was delivered with reduced in-person external support to reduce costs and increase scalability. Data were collected from both trials arms for between-group comparison. Descriptive statistics were produced using surveys of principals, in-school champions and teachers; and project records maintained by PACE project officers (objective A). Thematic analysis was performed using in-school champion and project officer interviews (objective B). Both data sets were integrated via a triangulation protocol and findings synthesized in the form of meta-inferences (objective C). RESULTS Eleven in-school champions and six project officers completed interviews; 33 principals, 51 in-school champions and 260 teachers completed surveys. Regardless of group allocation, implementation indicators were high for at least one component of each strategy: dose delivered =100%, fidelity ≥95%, adoption ≥83%, acceptability ≥50%; and several implementation barriers and facilitators were identified within three broad categories: external policy landscape, inner organizational structure/context of schools, and intervention characteristics and processes. All strategies were considered important as use varied by school, however support from a school executive and in-school champions' interest were suggested as especially important for optimal implementation. CONCLUSION This study highlights the importance of both executive support and in-school champions for successful implementation of school physical activity policies. In particular, identifying and supporting an in-school champion to have high power and high interest is recommended for future implementation strategies. This may reduce the need for intensive external support, thus improving intervention scalability.
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Affiliation(s)
- Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia. .,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Kim S, Yoo S, Cho SI, Jung H, Yang Y. Experiences of the First Year Implementation of a Nationwide School-Based Smoking Prevention Program in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3291. [PMID: 33810138 PMCID: PMC8005052 DOI: 10.3390/ijerph18063291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
Encouraged by the Framework Convention on Tobacco Control, Korea has implemented a nationwide School-based Smoking Prevention Program (SSPP) to reduce the prevalence of youth smoking. This qualitative study explored the school contexts of launching the SSPP in Seoul, Korea. Five focus groups were studied with 29 lead teachers in charge of the SSPP. Thematic analysis reveals three key findings. First, while infrastructure was insufficiently prepared due to the abrupt implementation, lead teachers agreed on the purpose of the SSPP. However, they perceived the program as myopic in only targeting smoking students and spending the mandatory budgets as a burdensome task. Second, the SSPP increased experience-based activities, influenced smoking family members, and created a smoke-free school environment. Third, to ensure more effective implementation, school principals should support inducing staff engagement. The teachers also maintained that the SSPP must be institutionalized as part of regular curricula with standardized books. For a more meaningful impact, the SSPP needs instructors and counselors to support smoking cessation programs that reflect school contexts. The teachers urged tobacco prevention measures at community, policy, and society levels. This study provides insights into a nationwide approach to initiating school-based smoking prevention program to achieve a tobacco-free generation.
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Affiliation(s)
- Sookyung Kim
- College of Nursing, Yonsei University, Seoul 03722, Korea;
| | - Seunghyun Yoo
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul 08826, Korea;
| | - Sung-il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul 08826, Korea;
| | - Hanna Jung
- Institute of Health and Environment, Seoul National University, Seoul 08826, Korea; (H.J.); (Y.Y.)
| | - Yeaseul Yang
- Institute of Health and Environment, Seoul National University, Seoul 08826, Korea; (H.J.); (Y.Y.)
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Grady-Dominguez P, Ragen J, Sterman J, Spencer G, Tranter P, Villeneuve M, Bundy A. Expectations and Assumptions: Examining the Influence of Staff Culture on a Novel School-Based Intervention to Enable Risky Play for Children with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031008. [PMID: 33498773 PMCID: PMC7908254 DOI: 10.3390/ijerph18031008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Risky play is challenging, exciting play with the possibility of physical, social, or emotional harm. Through risky play, children learn, develop, and experience wellbeing. Children with disabilities have fewer opportunities than their typically developing peers to engage in this beneficial type of play. Our team designed a novel, school-based intervention to address this disparity; however, our intervention yielded unexpected quantitative results. In the present study, we qualitatively examined divergent results at two of the five schools that participated in the intervention. Specifically, we aimed to explore how staff culture (i.e., shared beliefs, values, and practices) influenced the intervention. To explore this relationship, we employed a retrospective, qualitative, multiple case study. We used thematic analysis of evaluative interviews with staff members to elucidate the cultures at each school. Then, we used cross-case analysis to understand the relationships between aspects of staff culture and the intervention's implementation and results. We found that staff cultures around play, risk, disability influenced the way, and the extent to which, staff were willing to let go and allowed children to engage in risky play. Adults' beliefs about the purpose of play and recess, as well as their expectations for children with disabilities, particularly influenced the intervention. Furthermore, when the assumptions of the intervention and the staff culture did not align, the intervention could not succeed. The results of this study highlight the importance of (1) evaluating each schools' unique staff culture before implementing play-focused interventions and (2) tailoring interventions to meet the needs of individual schools.
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Affiliation(s)
- Patricia Grady-Dominguez
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80528, USA;
- Correspondence:
| | - Jo Ragen
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.V.)
| | - Julia Sterman
- Department of Occupational Therapy, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Grace Spencer
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Paul Tranter
- School of Science, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Michelle Villeneuve
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.V.)
| | - Anita Bundy
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80528, USA;
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.V.)
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Bast LS, Due P, Lauemøller SG, Kjær NT, Christiansen T, Andersen A. Study protocol of the X:IT II - a school-based smoking preventive intervention. BMC Public Health 2019; 19:497. [PMID: 31046721 PMCID: PMC6498574 DOI: 10.1186/s12889-019-6805-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. However, parts of the intervention appeared less appealing to children from families with lower socioeconomic backgrounds. Therefore, the intervention components were modified and an evaluation of the amended intervention X:IT II is needed to show the effect of this revised intervention and whether children from different social backgrounds benefits equally from the current intervention. METHODS Main intervention components are smoke free schools, a curricular component, and parental involvement (smoke free agreements and talks about tobacco). Components have been revised from the first version; 1) previously, schools should be smoke free on the school ground and were encouraged to hide smoking so that it wasn't visible to pupils from the school ground. Now they are encouraged to tighten the rules so that no pupils or teachers smoke during the school day, no matter where they are; 2) the specifically developed educational material (Up in Smoke) has been revised so that all materials are online and all texts has a ARI; 3) the parental involvement is now targeted multiple groups of parents, e.g. parents that are smokers, and parents of children that smoke. Language used is simpler and the website for parents presents very specific examples. X:IT is implemented in 46 Danish public schools from fall 2017 until summer 2020. Data is collected through electronic questionnaires to students and coordinators four times (fall 2017, spring/summer 2018, 2019 and 2020). Further, qualitative interviews and observations are conducted. DISCUSSION Prevalence of smoking among Danish adolescents is high compared to other Nordic countries and there is social inequality in smoking, leaving individuals from the lowest social backgrounds at higher risk. Although there has been an overall decline in smoking among Danish adolescents over the last decades, a recent levelling of this development indicates an urgent need for smoking prevention in Denmark. The X:IT intervention has the potential to prevent uptake of smoking among adolescents. However, there is a particular need for evaluating the effectiveness of the revised X:IT intervention, X:IT II, with focus on the effect across socioeconomic groups of adolescents. TRIAL REGISTRATION Current Controlled Trials ISRCTN31292019 , date of registration 24/10/2017. Retrospectively registered.
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Affiliation(s)
- Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Stine Glenstrup Lauemøller
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Niels Them Kjær
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | | | - Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
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Do organizational conditions influence teacher implementation of effective classroom management practices: Findings from a randomized trial. J Sch Psychol 2019; 72:134-149. [PMID: 30819458 DOI: 10.1016/j.jsp.2018.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 12/13/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022]
Abstract
Although there is a growing evidence base about effective classroom management practices, teacher implementation of these practices varies due to a number of factors. A school's organizational health is one aspect of the broader social environment that has been hypothesized to influence implementation of interventions. Yet, empirical evidence is limited on whether organizational contexts can influence teacher implementation of effective interventions and subsequently, classroom environments and student outcomes. In the present study, teachers in an urban school district were randomly assigned to receive training in the Incredible Years Teacher Classroom Management program (IY TCM), a classroom management intervention. We examined how teacher perceptions of their school environment moderated intervention effects for previously established treatment outcomes - implementation of effective classroom methods, students' social behaviors, emotional regulation, and social competence. Results showed that treatment effects on teacher implementation and student outcomes were moderated by teachers' sense of affiliation to their school. Specifically, main effects on implementation of effective classroom management strategies were only observed among teachers whose perceptions of initial teacher affiliation was low or average; whereas main effects on student outcomes were only found for teachers with initial high levels of affiliation.
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Lisboa OC, Bernardes-Souza B, Xavier LEDF, Almeida MR, Corrêa PCRP, Brinker TJ. A Smoking Prevention Program Delivered by Medical Students to Secondary Schools in Brazil Called "Education Against Tobacco": Randomized Controlled Trial. J Med Internet Res 2019; 21:e12854. [PMID: 30789347 PMCID: PMC6416894 DOI: 10.2196/12854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/28/2018] [Accepted: 01/05/2019] [Indexed: 01/19/2023] Open
Abstract
Background Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. Objective The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. Methods A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. Results From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. Conclusions To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. Trial Registration ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.7134
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Affiliation(s)
| | | | | | | | | | - Titus Josef Brinker
- National Center for Tumor Diseases, German Cancer Research Center, University of Heidelberg, Heidelberg, Germany.,Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
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Jarlstrup NS, Juel K, Pisinger CH, Grønbæk M, Holm S, Andersen S. International Approaches to Tobacco Use Cessation Programs and Policy in Adolescents and Young Adults: Denmark. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Faria BL, Brieske CM, Cosgarea I, Omlor AJ, Fries FN, de Faria COM, Lino HA, Oliveira ACC, Lisboa OC, Klode J, Schadendorf D, Bernardes-Souza B, Brinker TJ. A smoking prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised trial. BMJ Open 2017; 7:e018589. [PMID: 29229659 PMCID: PMC5778310 DOI: 10.1136/bmjopen-2017-018589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents' interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils' altered three-dimensional selfies on tablets were 'mirrored' via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools. METHODS AND ANALYSIS The mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper-pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat. ETHICS AND DISSEMINATION Ethical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites. TRIAL REGISTRATION NUMBER NCT03178227.
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Affiliation(s)
| | - Christian M Brieske
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Ioana Cosgarea
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Albert J Omlor
- Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | - Fabian N Fries
- Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | | | | | | | | | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Titus J Brinker
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
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