Dissemination and implementation of national physical activity, sedentary behaviour, and/or sleep guidelines among community-dwelling adults aged 18 years and older: a systematic scoping review and suggestions for future reporting and research

Exploring the Influence of Interorganization Networks on the Dissemination of National Health Behavior Guidelines

BACKGROUND

Interorganization partnerships are important for the development and knowledge mobilization of national health behavior guidelines. However, little is known about how to improve the dissemination of guidelines across professional networks. Social network analysis may offer unique insight into the social structure of interorganization networks and provide guidance for how network features may be harnessed for effective dissemination. The objectives of this study were to apply social network analysis to (1) analyze the connectedness of organizations and/or subgroups within a national health behavior guideline network and (2) identify organization attributes associated with influential network positions.

METHODS

Organizations involved in the development and dissemination of the Canadian 24-Hour Movement Guidelines for Adults were invited to complete an online survey to examine the connections among health-promoting organizations in Canada. Data were analyzed using UCINET Version 6. Network maps were generated for the interorganization network and its subgroups, and descriptive frequencies were calculated for demographic characteristics. Associations between organization attributes and centrality measures were calculated using Point-Biserial and Spearman rank correlations.

RESULTS

Thirty-four organizations completed the survey and reported 228 organizational ties. Density scores for each dissemination network ranged from 1% to 5%, demonstrating the potential for constrained information sharing (ie, dissemination) between organizations. Five attributes were significantly associated with centrality measures, which included location, sector, size, resource allocation, and previous dissemination of sedentary behavior guidelines.

CONCLUSIONS

Findings demonstrate the utility of social network analysis for understanding knowledge mobilization across networks and offer guidance for how network features may be leveraged to enhance knowledge mobilization outcomes.

'I can't relate to it': Exploring autistic and non-autistic adults' perceptions of the Australian Physical Activity and Sedentary Behaviour Guidelines

BACKGROUND

Despite sufficient physical activity (PA) being strongly associated with better health outcomes, half of the Australian population does not meet the Australian PA and Sedentary Behaviour Guidelines. This shortfall is more pronounced among autistic adults, who exhibit poorer health outcomes and lower PA levels than non-autistic adults. Despite these disparities, there is a limited understanding of how autistic and non-autistic individuals perceive and interpret the PA guidelines.

METHODS

This study investigated how autistic and non-autistic adults perceive and comprehend the Australian PA guidelines. This study used interpretative phenomenological analysis.

RESULTS

A total of 15 autistic and 20 non-autistic adults were interviewed, and 4 themes that were largely similar between both groups were identified: (1) Lack of Awareness and Engagement with the PA Guidelines, (2) Misinterpretation of Key Terms and Concepts, (3) Perceived lack of Relevance and Relatability of the PA Guidelines and (4) Lack of Inclusivity.

CONCLUSION

The findings underscore the importance of crafting health communication and promotion materials that are more visible, clear, inclusive and engaging for non-autistic and autistic individuals in Australia. SO WHAT?: This study highlights the potential for improving the number of people correctly understanding the PA guidelines by addressing dissemination methods, knowledge and interpretation of the guidelines as some components of the multifaceted process required to achieve behaviour change.

Barriers and facilitators to the dissemination of national movement behavior guidelines among health-promoting organizations: a qualitative study

Background

National movement behavior guidelines offer evidence-informed recommendations for how to obtain health benefits. However, their impact on practice and policy has been limited. Factors at multiple levels determine the effective mobilization of knowledge into practice. Historically, little attention has been paid to assessing the social, organizational, and economic factors that influence the uptake of national movement behavior guidelines; potentially contributing to their blunted impact on public health outcomes. The purpose of this study was to explore the barriers and facilitators experienced by intermediary organizations to disseminating national movement behavior guidelines.

Methods

Representatives from organizations involved in the development and dissemination of the Canadian 24-Hour Movement Guidelines for Adults 18-64 Years and Adults 65 Years or Older were invited to participate in semi-structured interviews to explore barriers and facilitators to national movement behavior guideline dissemination. Interview guides were informed by the Consolidated Framework for Implementation Research (CFIR). Fourteen interviews were conducted, and transcripts were analyzed using inductive thematic analysis. Identified barriers and facilitators were mapped onto the CFIR.

Results

Participants identified several elements that have the potential to influence the dissemination of national movement behavior guidelines, such as organizational alignment, resources (i.e., time, human, financial), and ownership of the guidelines.

Conclusion

This study provides insight into the breadth of barriers and facilitators to guideline dissemination that may be experienced by intermediary organizations. Findings may be used to inform interventions designed to improve the dissemination and uptake of national movement behavior guidelines among health-promoting organizations.

"Physical Activity Is Not the Answer to Everything, but It Is to a Lot": Stakeholders' Perceived Determinants of Implementing Physical Activity Interventions for Older Adults

Although many physical activity (PA) interventions for older adults have proven effective in controlled research settings, optimal implementation in real life remains challenging. This study identifies determinants perceived by stakeholders when implementing community-based PA interventions for older adults. We interviewed 31 stakeholders guided by the Consolidated Framework for Implementation Research (CFIR). Results showed that stakeholders are very specific about the role they can play in implementation, making collaboration between stakeholders crucial. Barriers and motivators were identified in the CFIR intervention characteristics domain (relative advantage, complexity and costs, evidence quality and strength, and adaptability and trialability), in the outer setting domain (cosmopolitism, patient needs, and external policy and incentives), in the inner setting domain (implementation climate, relative priority, compatibility and organizational incentives and rewards) and in the individual characteristics domain (knowledge and beliefs, and other personal attributes). An overarching theme was the stakeholders' emphasis on aiming for broad health goals in interventions, as they perceive PA as a means to reach these goals rather than an end in itself. Another overarching theme requiring attention in future implementation efforts is the need to tailor implementation efforts to the specific needs of older adults as the end users of the intervention.

Awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults among adults living in Canada

Awareness and knowledge of national movement behaviour guidelines are needed to influence individual behaviour and public health policies. This study assessed the awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults Aged 18-64 Years and Adults Aged 65 Years or Older (24HMG) recommendations among adults living in Canada across three timepoints. Online surveys were distributed to representative samples of adults living in Canada over a 6-month period. Findings suggest that short-term dissemination efforts were successful in increasing awareness of the 24HMG following guideline release. However, other strategies, such as education, may be needed to influence knowledge of guideline recommendations.

Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review

BACKGROUND

Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries.

METHODS

An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied.

CONCLUSIONS

Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.

Built environment approaches: Extension personnel's preferences, barriers, and facilitators

Introduction

Interventions that modify the built environment can increase population physical activity levels and prevent chronic disease. The national Cooperative Extension System is poised to implement built environment approaches (i.e., pedestrian/bicycle infrastructure and enhanced access to physical activity spaces), but implementation strategies (i.e., methods or techniques to move research to practice) are needed to improve uptake. Effective implementation strategies address relevant barriers and capitalize on facilitators. The purpose of this study was to understand 1) barriers and facilitators to implementing built environment approaches in two state Extension systems, 2) preferences for built environment approaches, and 3) preferences for implementation strategies.

Methods

A cross-sectional online survey was used to understand Extension personnel's preferences for and barriers and facilitators to built environment approaches through a mixed-methods study design. This work was informed by anthropological inquiry as the overall research philosophy, and by the Health Impact Pyramid, Leeman et al.'s classification of implementation strategies, and the Consolidated Framework for Implementation Research as the theoretical frameworks. The survey was distributed to eligible Extension personnel (n = 42) in two states. Quantitative data analysis consisted of numbers/proportions and Friedman tests. Qualitative analysis was completed through a rapid deductive approach to quickly produce actionable results.

Results

Fourteen respondents (33%) completed the survey. Most had not implemented physical activity interventions in their communities or had implemented only individual-level interventions, though were interested in implementing built environment approaches. Benches, playground improvements, and crosswalks were the most desired approaches, while facilitation, assessing community strengths and needs, and technical assistance were desired implementation strategies. The most common barriers were relative priority and available resources; facilitators were external policy and incentives and implementation climate.

Discussion

Extension personnel are receptive to built environment approaches and engaged with community coalitions. Yet, invested parties prefer individual-level interventions, and agents perceive a lack of resources for implementation. Implementation strategies that build capacity in both the Extension system and community coalitions may address these barriers through increasing relative priority and sharing existing resources. This work is a first step toward compiling implementation strategies to address relevant barriers to built environment approaches in community settings.

Contribuições de Documentos Orientadores para a Promoção da Atividade Física no Sistema Único de Saúde na Prevenção e no Controle de Câncer

A prevenção e o controle do câncer são prioridades globais e a prevenção primária tem grande potencial de diminuir tanto os casos novos quanto as mortes por câncer. Entre as ações de prevenção primária, a atividade física (AF) tem sido ressaltada por diferentes instituições como importante aliada para a prevenção e o controle da doença. Assim, o objetivo do presente artigo de opinião é destacar a importância de documentos orientadores para a promoção da AF no Sistema Único de Saúde e suas contribuições para o controle do câncer no Brasil. São abordados os seguintes documentos: Guia de atividade física para a população brasileira; Guia de atividade física para a população brasileira: recomendações para gestores e profissionais de saúde; Dieta, nutrição, atividade física e câncer: uma perspectiva global – um resumo do terceiro relatório de especialistas com uma perspectiva brasileira; Atividade Física e Câncer: recomendações para prevenção e controle. Conclui-se que esses documentos têm o potencial de ampliar conhecimentos e práticas de gestores e profissionais de saúde sobre a relação entre AF e prevenção e controle de câncer, subsidiando a atuação tanto na Atenção Primária à Saúde não apenas com enfoque na prevenção, mas também de pessoas a partir do diagnóstico, como na atenção especializada, e podem contribuir para a mudança do paradigma vigente e favorecer o incremento da atividade física durante e após o tratamento do câncer.

Dissemination and implementation strategies for physical activity guidelines among adults with disability, chronic conditions, and pregnancy: a systematic scoping review

BACKGROUND

Physical activity guidelines for adults with disability, chronic conditions, and pregnancy (i.e., specific populations) have been developed to provide guidance for engaging in physical activity. However, specific populations remain considerably less physically active compared to the general population, presenting a knowledge-practice gap.

PURPOSE

The purpose of this systematic scoping review was to identify and evaluate strategies for disseminating and implementing physical activity guidelines among specific populations and/or stakeholders (e.g., healthcare professionals) in Canada.

METHODS

Five search approaches (peer-reviewed literature databases, grey literature database, custom Google search engines, targeted web-based searches, and content expert consultation) identified records documenting and/or evaluating strategies that had been used to disseminate or implement guidelines from a predetermined list. Systematic and scoping review protocols were followed. Risk of bias assessments were conducted for all studies that evaluated strategies.

RESULTS

Eighty-one records reported dissemination strategies (n = 42), implementation strategies (n = 28), or both (n = 11). Twenty-two studies reporting on 29 evaluated strategies were deemed "serious" or "high" risk of bias. Common guideline dissemination and implementation strategies are deliberated and recommendations for future practice are made.

CONCLUSIONS

Findings may inform future dissemination and implementation efforts for physical activity guidelines in Canada or similar countries.

Implementation Strategies to Support Built Environment Approaches in Community Settings

BACKGROUND

Built environment approaches are recommended to improve population physical activity levels. Implementation strategies are needed to improve uptake, but little is known about effective strategies to translate research to practice in community settings.

PURPOSE

Inform implementation strategies through understanding delivery agents' perceptions of (1) built environment approaches, (2) a toolkit developed to support implementation, and (3) other required implementation strategies.

METHOD

A toolkit was developed to detail the process of partnering to change the built environment and provide examples of built environment approaches (e.g., walking paths, traffic calming). Data were collected through focus groups (N = 3) with Extension Agents (n = 46) in 2020. The semi-structured focus group script was based on the Consolidated Framework for Implementation Research and the Technology Acceptance model. Rapid content analysis techniques and a deductive, grounded theory approach were used to interpret the data. Results. Focus groups generated meaning units coded into themes of perceptions of the intervention (subthemes: barriers, resources needed, and facilitators) and perceptions of the toolkit (subthemes: components to add, positive perceptions, and helpful components). The most common resources needed were coalition guidance and funding.

CONCLUSION

Agents experience barriers and facilitators to implementing built environment approaches and have specific needs for support. Based on the results, we created implementation strategies: (1) Places for Physical Activity toolkit, (2) Coalition Coaching, and (3) Mini-Grants. Future work is needed to investigate the effectiveness of these implementation strategies.

Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review

Background

Many of the world’s population, across all age groups and abilities, are not meeting or even aware of internationally recommended physical activity (PA) and sedentary behaviour (SB) guidelines. In order to enhance awareness and uptake, guidelines should be perceived positively by targeted users. The purpose of this study was to review the literature on end-user and stakeholder perceptions of PA and SB guidelines.

Methods

The electronic databases APA PsycInfo, CINAHL, MEDLINE, and SPORTDiscus, using EBSCOhost Research Platform, and Web of Science were searched from inception to June, 2021 with keyword synonyms for “perceptions”, “PA guidelines”, and “SB guidelines”. Studies of any design that collected stakeholder and/or end-user responses to a PA and/or SB guideline were included and assessed for risk of bias. The PA and/or SB guideline could be any type of official form (e.g., national documents, organizational guidelines, expert consensus statements, etc.) from any country, that targets individuals at the regional, provincial/statewide, national, or international level, and includes all types of guidelines (e.g., strength, aerobic, clinical, nonclinical, screen-time, sitting, etc.). Data were extracted and analyzed using thematic synthesis.

Results

After screening 1399 abstracts and applying citation screening, 304 full-texts were retrieved. A total of 31 articles met the inclusion criteria. End-users and stakeholders for PA guidelines across all age groups expressed the need for simplified language with more definitions, relatable examples and imagery, and quantification of PA behaviours. There was concern for the early years and child PA guidelines leading to guilt amongst parents and the SB guidelines, particularly the recommendations to limit screen-time, being unrealistic. General age group PA guidelines were not perceived as usable to populations with differing abilities, clinical conditions, and socioeconomic status. Guidelines that targeted clinical populations, such as persons with multiple sclerosis and persons with spinal cord injury, were well received.

Conclusions

There is a clear need to balance the evidence base with the pragmatic needs of translation and uptake so that the guidelines are not ignored or act as a barrier to actual engagement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01245-9.

Sociodemographic Factors Associated With Meeting the Canadian 24-Hour Movement Guidelines Among Adults: Findings From the Canadian Health Measures Survey

Background: This study examined associations between sociodemographic factors and meeting versus not meeting the new Canadian 24-Hour Movement Guidelines recommendations. Methods: The study is based on 7651 respondents aged 18–79 years from the 2007 to 2013 Canadian Health Measures Survey, a nationally representative, cross-sectional survey. Sociodemographic factors included age, sex, household education, household income, race, having a chronic condition, smoking status, alcohol consumption, and body mass index. Participants were classified as meeting or not meeting each of the time-specific recommendations for moderate to vigorous physical activity, sedentary behavior, and sleep duration. Results: Being an adult aged 18–64 years, normal weight, nonsmoker, and not having a chronic condition were associated with meeting the integrated guidelines. Being aged 18–64 years, male, normal weight, nonsmoker, not having a chronic condition, having a higher household education, and higher household income were associated with meeting the moderate to vigorous physical activity recommendation; being aged 18–64 years was associated with meeting the sedentary behavior recommendation; and being white, not having a chronic condition, and having a higher household income were associated with meeting the sleep duration recommendation. Conclusions: Few Canadian adults met the 2020 Canadian 24-Hour Movement Guidelines, and disparities across sociodemographic factors exist. Implementation strategies and dissemination approaches to encourage uptake and adoption are necessary.

Stakeholder perspectives on adapting and disseminating Ghana's physical activity guidelines: a qualitative study

BACKGROUND

Ghana is facing the public health "double burden" of both communicable and chronic diseases. To combat increased chronic disease prevalence, physical activity promotion efforts are necessary. The Ministry of Health (MOH) developed physical activity guidelines in 2009, but community members are unaware of the guidelines and sample activities (e.g., ballroom dancing) are not culturally appropriate. The purposes of this study were to investigate 1) dissemination of the physical activity guidelines through MOH and Ghana Health Service (GHS) and 2) culturally appropriate physical activities.

METHODS

Data were collected in urban and rural areas of Ghana through focus groups (N = 2) with community representatives and in-depth interviews (N = 15) with GHS health workers. Focus group and interview questions included recommended types of physical activity; interview questions included dissemination factors based on Diffusion of Innovations. The research team analyzed the data through an inductive, grounded theory approach.

RESULTS

Together, the focus groups and in-depth interviews generated 942 meaning units coded into themes of Physical Activity Perceptions (N = 337 meaning units), Suggested Physical Activities (N = 317), and Dissemination and Implementation Factors (N = 290). Participants had positive perceptions of physical activity but expressed concerns over individual abilities; barriers included the built environment and a lack of time. Suggested physical activities included walking, jogging, football, and dancing for adults; traditional games and football for youth, and walking and daily chores for older adults. Participants noted that guideline implementation was influenced by leadership engagement at multiple levels, relative advantage, and compatibility. Respondents suggested implementation strategies to resolve barriers, including involving partner organizations and developing an implementation plan. Participants were largely unaware of the physical activity guidelines; typical dissemination methods included written materials and the internet.

CONCLUSIONS

The results of this study suggest that physical activity guidelines should include familiar physical activities such as traditional games. Results also suggest that public health workers within GHS experience challenges in disseminating the physical activity guidelines. Adapting, disseminating, and implementing physical activity guidelines is a necessary step in increasing physical activity levels and preventing chronic diseases. These results contribute to understanding translation of physical activity policy to practice.

Knowledge translation of the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older: a collaborative movement guideline knowledge translation process

Establishing a step-by-step process that provides practitioners with a blueprint for translating movement guidelines into action stands to optimize the investment in guideline development, improve guideline promotion and uptake, and ultimately enhance population health. The purpose of this paper is to describe how the Knowledge-to-Action framework and integrated knowledge translation were operationalized to systematically inform our knowledge translation (KT) efforts for the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older. In October 2018, the need for a KT Process, operating in tandem with the Guideline Development Process, led to the establishment of a KT team with a specific structure and terms of reference. The KT team collaboratively agreed on decision-making principles prior to selecting target audiences to focus their efforts. We undertook formative research to assess the local context and determinants of guideline dissemination and implementation efforts among target audiences. Plans for the subsequent steps and research are outlined. We highlight recommendations and lessons learned for applying the process in other settings. Novelty We outline a collaborative and systematic process and research program for the knowledge translation of movement guidelines. This paper provides an innovative and replicable blueprint to optimize future movement guideline knowledge translation efforts.

Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care-Pediatrician Perspectives

PURPOSE

Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians' thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics.

METHODS

The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians.

RESULTS

Despite the pediatricians' beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions.

CONCLUSION

The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.

Evaluation of the Dissemination of the South African 24-Hour Movement Guidelines for Birth to 5 Years

South Africa (SA) launched their 24-h movement guidelines for birth to five years in December 2018. The guideline dissemination plan adopted a “train-the-trainer” strategy through dissemination workshops with community-based organisations (CBOs) working in early childhood development. The aim of this paper is to: (1) document this dissemination process; and (2) report on the feasibility of implementing the dissemination workshops, the acceptability of the workshops (and guidelines) for different end-user groups, and the extent to which CBO representatives disseminated the guidelines to end-users. Fifteen workshops were held in seven of SA’s nine provinces with a total of 323 attendees. Quantitative and qualitative findings (n = 281) indicate that these workshops were feasible for community-based dissemination of the guidelines and that this method of dissemination was acceptable to CBOs and end-users. Findings from follow-up focus groups (6 groups, n = 28 participants) indicate that the guidelines were shared with end-users of CBOs who participated in the focus groups. An additional musical storytelling resource, the “Woza, Mntwana” song, was well-received by participants; sharing via WhatsApp was believed to be the most effective way to disseminate this song. These findings confirm the feasibility and acceptability of culturally appropriate and context-specific community-based dissemination of behavioural guidelines in low-income settings.

Optimal messaging of the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years and older

The Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years and older (“Guidelines”) integrate recommendations for physical activity, sedentary, and sleep behaviours. Given the novelty of these integrated Guidelines, it was important to consider messaging strategies that would be most effective in reaching Canadian adults. The purpose of this study was to examine optimal messaging of the Guidelines as it pertains to communication channels and messages. Representative samples of Guideline end-users (N = 1017) and stakeholders (N = 877) each completed a cross-sectional survey. Descriptive statistics were calculated along with tests of statistical significance. Inductive content analysis was used to code stakeholders’ comments (i.e., suggestions, concerns) on a draft version of the Guidelines. Most end-users had recently referred to online medical resources; family, friends, and co-workers; and physicians as communication channels for information regarding the movement behaviours. End-users and stakeholders felt that generic messages would foster self-efficacy to meet the Guidelines. Stakeholders highlighted a variety of considerations to ensure the Guidelines are inclusive towards diverse groups within the Canadian population. Findings will inform Guideline messaging.

Novelty Most end-users referred to online medical resources; family, friends, and co-workers; and physicians as communication channels. End-users and stakeholders indicated that generic messages would foster self-efficacy to meet the Guidelines. Stakeholders expressed concerns about the inclusivity of the Guidelines for diverse socioeconomic groups.