Background
Methods
Context
Design and setting
Participants and recruitment
Schools
Teachers
Students
Parents
Randomisation and blinding
Intervention group: implementation strategy
Development and theoretical framework
Implementation strategy | Proposed mechanism of action | Intervention content | |||
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Barriers addressed | COM-B and (TDF) | Intervention functions | BCT Behaviours | Detailed explanation | |
Centralize technical assistance and Provide ongoing consultation | Teachers knowledge, ability or competence Lack of time Perceived priority of the policy in the schools | Psychological capability (beliefs about capabilities; knowledge) Opportunity- social (environmental context and resources) Motivation- reflective (goals) | Enablement Persuasion | Review behaviour goal(s) Review outcome goal(s) | Project officers (a PE teacher and health promotion practitioner) will provide technical assistance to schools throughout the study period, to support policy implementation by working directly with schools and school champions to overcome barriers and provide expertise support and resources. Project officers will provide ongoing consultation to in-school champions via telephone, email or if needed face-to face to support implementing the intervention. The focus of these meetings will be to support school champions brain storm solutions to barriers as they arise, review progress of the schools implementation plan and if necessary modification and re-setting of goals. |
Mandate change | Support from school boards Physical activity considered a lower priority than other subjects | Opportunity- Social (Social influences) Motivation- reflective (Goals) | Enablement | Commitment | Project officers will meet face to face with principals and school executives to communicate the importance and benefits of policy implementation. The school executive will be asked to demonstrate support for the implementation of the policy through the development of a “Sport and Physical Activity Procedures document” (as required by the policy) and to communicate (e.g. via newsletters, assemblies and staff meetings) expectations to staff, students and parents regarding changes to programming of PE, sport and other activities. |
Identify and prepare champions | Lack of time in the curriculum Teachers knowledge, ability or competence | Opportunity- social (environmental context and resources) Psychological and physical capability (beliefs about capabilities) | Modelling; Education; Training | Identification of self as role model Social support (unspecified) Problem solving Instruction on how to perform a behaviour Demonstration of the behaviour | Each school will nominate up to three in-school champions (existing teachers at the school) who will drive implementation of the intervention in their school and with support from project officers overcome indifference/ resistance that the intervention may provoke in the school. They will be encouraged to role model the desired behaviours as it will be an example to other teachers. To prepare in-school champions for their role they will complete a 1-day (5-h) face-to-face workshop run by project officers which will include; education about the policy, instruction and demonstration of physical activity energisers and PE lessons and time to begin action planning which will require in-school champions to identify barriers/ facilitators, to implementation and possible solutions to overcome these via a “if-then-what” plan. The training has been accredited by the state educational authority and provides time towards teachers continuing professional development hours. |
Develop a formal implementation blueprint. | Perceived priority of the policy in the schools | Motivation- reflective (Goals) | Goal setting (behaviour) Action planning Graded tasks | School champions will be supported to develop a plan for the implementation of the policy in their school. The plan will identify what the school is aiming to specifically achieve, the strategies to do so and by when, the resources available or required to implement the plan. The plan will be broken into school terms to allow school champions to break up some of the more complex policy requirements into achievable tasks. | |
Conduct educational outreach visits. | Teachers knowledge, ability or competence | Psychological and physical capability (beliefs about capabilities) | Education; Training | Instruction on how to perform a behaviour Demonstration of the behaviour Instruction on how to perform a behaviour Framing/ reframing Verbal persuasion about capability | Project officers will meet with all teachers (face to face) as a group in each school for 1-2 h to; • Introduce the in-school champion and their role in implementing the intervention and as a point of support in the school; • Educate teachers about the policy with a deliberate aim to reframe policy adoption from “adding to teacher load” but rather easily integrated into existing routines. • Provide verbal persuasion about the teachers capability to implement the policy; • Instruct and demonstrate physical activity energisers and PE lessons; • Prompt habit formation for some of the physical activity practices; |
Develop and distribute educational materials | Teachers knowledge, ability or competence | Psychological capability (beliefs about capabilities; knowledge) | Education; Training | Adding objects to the environment | In-school champions will receive an “intervention manual” which will include policy and timetable templates, exemplar physical activity timetables and physical education curriculum schedules. Classroom teachers will receive various educational materials including practical games and strategies for increasing physical activity in lessons. These materials will be available in print and via an online portal. The portal will also contain professional learning videos for all teachers (including school champions) which reinforces the information they have received via face to face training. |
Capture and share local knowledge | Teachers knowledge, ability or competence Lack of time in the curriculum | Opportunity- social (social influences) Motivation-reflective (belief about consequences) | Modelling; Persuasion | Social comparison | Project officers will develop “case studies” from other intervention schools on how school champions and teachers made “something work” in their setting. This will be utilised during project officers ongoing consultation meetings with in-school champions and included on the online portal as an “infocus school”. |
Change physical structure and equipment | Availability of equipment | Opportunity- physical (environmental context and resources) | Environmental restructuring | Restructuring the physical environment | School champions will be encouraged to develop “physical activity packs” for all teachers to keep in each classroom which includes a class set of basic physical activity equipment e.g. bean bags, balls, hoops etc. from the schools’ existing sports equipment enabling teachers to implement integrated physical activity lessons and PE lessons easily. |
Data collection and measures
Primary trial outcome- mean minutes of planned weekly physical activity scheduled by classroom teachers
Secondary outcomes
Implementation outcomes
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Acceptability- defined as the perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory. At follow-up intervention principals and teachers will be asked to complete, via paper based survey, the Acceptability of Intervention Measure (AIM) [42], developed by Weiner et al., a four-item valid and reliable scale.
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Adoption- defined as the intention, initial decision, or action to try or employ an innovation or evidence-based practice. Based upon a previously developed tool from the research team [43] at baseline and follow-up all intervention and control principals will be asked to report, via paper based survey, their stage of adoption for implementing the physical activity policy.
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Appropriateness- defined as the perceived fit, relevance, or compatibility of the innovation or evidence based practice for a given practice setting, provider, or consumer; and/or perceived fit of the innovation to address a particular issue or problem. At follow-up intervention principals and teachers will be asked to complete, via paper based survey, the Intervention Appropriateness Measure (IAM), a four-item valid and reliable scale.
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Feasibility- defined as the extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting. At follow-up intervention principals and teachers will be asked to complete, via paper based survey, the Feasibility of Intervention Measure (FIM), a four-item valid and reliable scale.
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Fidelity- defined as the degree to which an intervention was implemented as it was prescribed in the original protocol or as it was intended by the programme developers. Project records as well as post-intervention questionnaires completed by intervention principals, school champions and teachers will be used to determine the proportion of schools that received and attended to each of the implementation strategies.
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Implementation cost- defined as the cost impact of an implementation effort; see cost and cost-effectiveness measure below.
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Penetration- defined as the integration of a practice within a service setting and its subsystems will be measured as per the primary trial outcome to assess the proportion of teachers scheduling the required minutes as per the DoE Sport and Physical Activity Policy. Penetration will then be calculated by the number of teachers who meet the policy requirements, divided by the total number of teachers expected to implement the policy.
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Sustainability- defined as the extent to which a newly implemented treatment is maintained or institutionalized within a service setting’s ongoing, stable operations will be measured as per the primary trial outcome approximately 6 months following the completion of the implementation strategy.