Visualizing contextual determinants in and across heterogeneous settings: a qualitative study on structured school...

Area of Science:

• Public Health
• Educational Administration
• Implementation Science

Background:

• Schools are vital for promoting equitable health from early life.
• Organizational capacity is key for sustained health promotion efforts.
• Structured improvement approaches like PDSA cycles can strengthen this capacity, but contextual factors influencing their use in schools are not well understood.

Purpose of the Study:

• To examine contextual determinants of PDSA cycle implementability in school health promotion.
• To understand how these determinants differ across diverse school settings.

Main Methods:

• Nine German primary schools were purposively sampled for heterogeneity.
• Semi-structured qualitative group interviews were conducted with school staff and parents.
• The framework method guided by the Consolidated Framework for Implementation Research (CFIR) was used for analysis.
• A color-coded Matrix Heat Map visualized contextual factors for cross-case comparison.

Main Results:

• Fifteen contextual factors emerged across CFIR domains (Outer Setting, Inner Setting, Individual).
• Schools with prior structured process experience reported more facilitators (e.g., communication structures) and fewer barriers (e.g., financial constraints).
• Common barriers included limited parental engagement and staff shortages; leadership support and program compatibility were consistent facilitators.

Conclusions:

• Prior structured experience appears associated with perceived PDSA cycle implementability in schools.
• Findings suggest tailoring implementation support based on schools' prior experience is important for building capacity.
• The combined framework method and Matrix Heat Map approach effectively visualized contextual heterogeneity for future research.