Background
Methods
Design
Sample & instruments
Analysis
Causal configuration analysis
Results
Research phase A (t0): Campaign inventory & sample
Participating organization | Key activities | Additional activities | |
---|---|---|---|
Educational | Primary schools | - Installment of fruit days & water moments - Teacher leads by example by eating fruit and drinking water - Informing parents about fruit & water consumption | - Distributing promotional materials (e.g. fruit baskets, water cans & crates, coupons for discounts at local enterprises, stickers, posters, banners, window foils, information cards for parents) -Engaging in campaign activities (e.g. the water song, excursions, watching television programs) -Promoting the campaign (displaying posters, banners and information cards) -Involving parents in campaign activities -Organize parent meetings in cooperation with the CJG |
Health care | Centre for Youth & Family (CYF) Youth Health Care (YHC) Maternity/infant center | - Motivating target population to increase fruit & water consumption - Providing parents with advice on how to stimulate fruit and water consumption | - Distributing promotional materials -Promoting the campaign -Organize parent meetings in cooperation with schools |
Social Welfare | Social Welfare organization Library | - Integration of campaign themes within regular activities - Professionals lead by example by eating fruit and drinking water | - Development of new activities related to campaign themes (e.g. decorating water carafes) -Engaging in campaign activities -Distributing promotional materials -Promoting the campaign |
Sports | Sports organizations A& B | - Integration of campaign themes within regular activities - Professionals lead by example by eating fruit and drinking water | - Supplying fruit during sport events in the community -Integration of water theme in the ‘sports activity day’ for all schoolchildren. - Organizing sport activities for youth related to ‘water’ |
Private | Supermarket, household appliance stores | - Providing fruit free of charge to children - Providing discounts on fruit | - Promoting the campaign -Sponsoring of local activities -Selling campaign material |
T1 | T2 | T3 | T4 | T5 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Int | Obs | Int | Obs | Int | Obs | Int | Obs | Int | Obs | |
Educational | ||||||||||
Primary school A | 3 | 2 | 2 | 2 | 2 | 3 | 2 | 2 | PD | |
Primary school B | 7 | 7 | 3 | 2 | 2 | 3 | 2 | 2 | 2 | 2 |
Primary school C | 9 | 9 | 2 | 2 | 2 | 3 | 2 | 2 | PD | |
Primary school D | PD | 1 | 1 | 2 | 3 | 2 | 2 | 2 | 2 | |
Health care | ||||||||||
Centre for Youth & Family | 1 | 1 | 1 | 1 | - | 1 | 1 | 1 | 1 | 1 |
Youth health services | 2 | 1 | 3 | 3 | 1 | 1 | 2 | 2 | 1 | 1 |
Social welfare and sport | ||||||||||
General welfare organization | 1 | 1 | 1 | 1 | 2 | 2 | 1 | 1 | 1 | 1 |
Library | NP | - | 1 | Closed due to budget curtailments | ||||||
Sports organization A | NP | NP | 1 | 1 | 0 | 1 | NP | |||
Sports organization B | NP | NP | 1 | 1 | 0 | 1 | NP | |||
Private | ||||||||||
Supermarket A | NP | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Supermarket B | NP | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Household appliance storeA | NP | 1 | 1 | 0 | 1 | NP | NP | |||
Household appliance store B | NP | 1 | 1 | 0 | 1 | NP | NP | |||
Household appliance store C | NP | 1 | 1 | 0 | 1 | NP | NP |
Research phase B: Evaluation of implementation (t1-t5)
General findings
T1 | T2 | T3 | T4 | T5 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
% Key | % Add | % Key | % Add | % Key | % Add | % Key | % Add | % Key | % Add | |
Educational | ||||||||||
Primary school A | 75 | 29 | 54 | 27 | 17 | 4 | 75 | 32 | ||
Primary school B | 33 | 24 | 83 | 39 | 100 | 33 | 100 | 64 | 50 | 100 |
Primary school C | 63 | 39 | 88 | 39 | 50 | 35 | 42 | 37 | ||
Primary school D | 50 | 33 | 75 | 36 | 100 | 100 | ||||
Health care | ||||||||||
Centre for Youth & Family | 100 | 25 | 100 | 75 | 75 | 100 | 80 | 100 | ||
Youth health services | 83 | 43 | 100 | 71 | 67 | 67 | 75 | 75 | 100 | 100 |
Social welfare and sport | ||||||||||
General welfare organization | 67 | 50 | 0 | 14 | 67 | 17 | 25 | 100 | 100 | 100 |
Library | 50 | 50 | ||||||||
Sports organization A | 0 | 0 | 0 | 0 | ||||||
Sports organization B | 33 | 0 | 0 | 0 | ||||||
Private | ||||||||||
Supermarket A | 100 | 100 | 100 | 100 | 100 | 0 | ||||
Supermarket B | 0 | 0 | 100 | 80 | 33 | 0 | ||||
Household appliance storeA | 100 | 33 | 0 | 0 | ||||||
Household appliance storeB | 100 | 0 | 0 | 0 | ||||||
Household appliance store C | 100 | 0 | 0 | 0 |
Educational | Health care | Private | Welfare & sports | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Int | Mid | Cont | Inta | Mid | Con | Int | Mid | Cont | Int | Mid | Cont | |
Key facilitators | ||||||||||||
Campaign compatible with existing work procedures | ● | ● | ● | ● | ● | |||||||
Possibility to adapt campaign to local needs | ● | ● | ● | ● | ||||||||
↑ ownership for campaign use | ● | ● | ● | ● | ● | ● | ● | ● | ||||
↑ self-efficacy for campaign use | ● | ● | ||||||||||
Uptake of campaign use in daily working routine | ● | |||||||||||
Availability of internal campaign coordinator | ● | |||||||||||
↑ support from campaign manager | ● | ● | ||||||||||
Regular evaluation of campaign implementation | ● | |||||||||||
Campaign use cause advantages | ● | |||||||||||
Compatibility of campaign goals and goals of organization | ● | |||||||||||
Key barriers | ||||||||||||
↓ procedural clarity | ● | ● | ● | |||||||||
Campaign use causes disadvantages | ● | |||||||||||
↓ priority assigned to campaign use | ● | ● | ● | |||||||||
↓ durability of campaign materials | ● | |||||||||||
Lack of campaign reinforcement strategies | ● | ● | ● | |||||||||
Campaign is considered incomplete | ● | ● | ● | |||||||||
Chaotic organization of campaign | ● | ● | ||||||||||
Incompatibility of campaign goals and goals of organization | ● | |||||||||||
↓ participation of target population in campaign | ● | ● | ||||||||||
High turn-over of staff | ● | |||||||||||
Lack of experiencing a shared commitment for campaign use with community partners | ● |
Sector | Phase | Outcome (completeness) | Causal configurationsa | # cases |
---|---|---|---|---|
Educational | Initial implementation | Medium | Campaign perceived as disadvantageous AND ↓ procedural clarity AND (↑ possibility to adapt campaign to local needs OR ↑ ownership for campaign use OR campaign compatible with existing work procedures) | 7 out of 10 cases |
Initial implementation | High | No barriers named AND Possibility to adapt campaign to local needs AND ↑ ownership of campaign use. | 2 out of 2 cases | |
Mid-way implementation | Medium / High | (↓ priority assigned to campaign use OR ↓ durability of campaign materials) AND Possibility to adapt campaign to local needs AND (↑ ownership for campaign OR campaign compatible with existing work procedures) | 9 out of 11 cases | |
Continued implementation | Medium | (A lack of reinforcement strategies OR campaign use not included in task orientation) AND (Possibility to adapt campaign to local needs OR ↑ ownership of campaign use OR ↑ self-efficacy) | 4 out of 4 cases | |
Continued implementation | High | No barriers named AND Uptake of campaign use in daily working routine AND (↑ ownership of campaign use OR ↑ self-efficacy) | 5 out of 6 cases | |
Health Care | Continued implementation | Medium | Campaign perceived as incomplete AND Chaotic organization of campaign AND campaign compatible with existing work procedures | 2 out of 2 cases |
Continued implementation | High | A lack of reinforcement strategies AND campaign compatible with existing work procedures AND ↑ ownership of campaign use | 2 out of 2 cases | |
Private | Continued implementation | Low | ↓ participation of target population in campaign AND Lack of feeling part of collaboration in community | 2 out of 2 cases |
Continued implementation | High | ↓ participation of target population in campaign AND Lack of feeling part of collaboration in community AND (perceiving campaign use as personal duty or obligation) | 2 out of 2 cases | |
Welfare | Initial implementation | Medium / High | (↓ procedural clarity OR campaign perceived as incomplete) AND (campaign compatible with existing work procedures OR ↑ ownership of campaign use) | 3 out of 3 cases |
Continued implementation | Medium / High | A lack of reinforcement strategies AND possibility to adapt campaign to local needs AND Uptake of campaign use in daily working routine | 2 out of 2 cases |
Implementation per sector
We need to plan extra toilet breaks… look, he (student) just peed in his pants and that is just because he drank a lot of water due to the water campaign. (Teacher school B)
We have been so busy the last couple of years, at a certain moment you think ‘I don’t even know the name of this student in my class’. So I think.. Yes, our main priorities lie elsewhere, not with the water campaign. (Teacher school A)
At first, everything was new, they (students) all had their campaign water bottles on their desks and it was very hip and happening! But, yeah, I don’t know, it is just not cool anymore now. (Teacher school C)
It (the campaign) is now part of my job. So I automatically integrate it into my daily work procedures, this makes the execution easier. (CYF, nurse)
It costs quite a lot of time to organize a water or fruit booster. But because we now implement it (campaign activities) during our regular activities, it is working out fine! … we for example organized a community walk yesterday, and we provided children with a healthy snack. So it (campaign objectives) just became a standard procedure. (Social Welfare Organization, Social worker children)
I didn’t understand the campaign method, I thought the mega fruit cup was a hideous thing, that ruined the image of my shop!. … we have to draw a line somewhere, we are a supermarket and not the extension of municipal programs. (Supermarket B, manager)
As i have experienced it, the campaign is very standalone instead of coming together with multiple partners and discussing ‘what are we going to do about it’? I think this would open a window of opportunities. (Supermarket A, manager)
Discussion
Implications of findings
Strengths & weaknesses
Conclusion
Lessons learned
|
• Research plans need to be adapted iteratively to local developments; |
• The translation of research findings into practice could possibly be optimized by the use of participatory action research (PAR); |
• A complete, understandable IACO that is compatible with and considered relevant by practice can facilitate IACO implementation |
• As some determinants appeared in configuration per sector and phase, implementation might benefit from consideration of these determinants in unity, rather than considering single determinants; |
• Implementation plans and strategies should be tailored to sector- and implementation phase specific (combinations of) determinants, and should be based on a mutual adaptation strategy (“stitches in time”). |