Identifying essential implementation strategies: a mixed methods process evaluation of a multi-strategy policy...

Area of Science:

• Public Health
• Educational Policy
• Implementation Science

Background:

• The Physically Active Children in Education (PACE) program uses eight strategies to enhance school implementation of physical activity policies.
• Understanding individual strategies is crucial for scaling PACE effectively.

Purpose of the Study:

• To quantitatively measure the dose delivered, fidelity, adoption, and acceptability of PACE strategies.
• To qualitatively identify barriers and facilitators to PACE implementation.
• To integrate quantitative and qualitative data to assess the importance of each strategy.

Main Methods:

• A cluster-randomised trial comparing PACE with an adapted, lower-support version (Adapted PACE).
• Quantitative data collected via surveys (principals, champions, teachers) and project records.
• Qualitative data gathered through interviews (champions, project officers).
• Mixed-methods analysis using a triangulation protocol and meta-inferences.

Main Results:

• High implementation indicators across strategies: 100% dose delivered, ≥95% fidelity, ≥83% adoption, ≥50% acceptability.
• Key barriers/facilitators related to policy landscape, school context, and intervention characteristics.
• All strategies were important, with school executive support and champion interest being particularly crucial.

Conclusions:

• Executive support and in-school champions are vital for successful implementation of school physical activity policies.
• Identifying and supporting high-power, high-interest champions can improve scalability.
• This approach may reduce reliance on intensive external support for intervention delivery.