Using EPIS and facilitation to support delivery of classroom-based physical activity interventions: a case study

Youth physical inactivity is a major public health concern, particularly in schools serving socioeconomically disadvantaged children. Classroom-based physical activity (PA) interventions offer structured, equitable opportunities for movement, but adoption-fidelity gaps persist. Implementation science frameworks can support schools in aligning interventions with local context and sustaining delivery.

This study examined the feasibility of using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, paired with facilitation by trained regional school health coordinators, to guide classroom PA implementation in a Michigan elementary school.

An EPIS-aligned implementation guide was developed and refined through a two-phase process to ensure theoretical grounding and practical applicability. Six coordinators were trained and evaluated the training using validated measures of acceptability, appropriateness, and feasibility. One coordinator facilitated InPACT implementation at a single school over 18 months, supporting pre-implementation, rollout, and early sustainment. Implementation was documented using the Hexagon Tool, RE-AIM, Plan-Do-Study-Act cycles, and routine administrative data.

Coordinators rated the training highly on all measures. In the pilot school, teachers delivered an average of three PA breaks per day, with lower-elementary classrooms averaging four and upper-elementary classrooms averaging two. Fidelity was supported through structured ramp-up, teacher training, technical assistance, and classroom tracking. Integration into school systems helped to fill gaps in the school district wellness policy. Behavioral referral data indicated a 34% reduction in minor classroom incidents over the first year of implementation.

EPIS-guided implementation with facilitation is feasible for supporting adoption, fidelity, and early sustainment of classroom PA. Structured pre-implementation planning, phase-specific support, and alignment with school priorities are critical. Multi-site studies are needed to examine grade-specific strategies, fidelity variability, and long-term sustainment.