Abstract
BackgroundTo achieve real-world impacts, behavior change interventions need to be scaled up and broadly implemented. Implementation is challenging however, and the factors influencing successful implementation are not fully understood. This study describes the nationwide implementation of a complex theory-based program targeting physical activity and sedentary behavior in vocational schools (Lets’s Move It; LMI). The implementation primarily involved a systematic and theory-based training and user manual for school staff. We explore how the perceived acceptability of this training (in line with the Theoretical Framework of Acceptability) relates to (un) successful implementation. The study evaluates (1) the experienced acceptability of the training and anticipated acceptability of later delivering the program; (2) reach and implementation, including adaptations and barriers; (3) whether acceptability ratings predict teachers’ intentions for implementation.MethodsUpper secondary school staff from vocational and high schools (n = 194) enrolled in a two-part training, covering implementation of the LMI program and training in motivational interaction styles. One hundred fifty-one participants attended both parts of the training. Participants reported their perceived acceptability of the training and their implementation efforts in online questionnaires at baseline, after training sessions and at long-term follow-up. Qualitative data (open-ended questions) were analysed with content analysis to collate responses. Quantitative data analyses involved correlations and logistic regression.ResultsParticipants rated the training as highly acceptable on all dimensions (average ratings exceeded 4.0 on a 5-point scale). The implementation reached at least 6100 students and 341 school classes. Most teachers intended to continue program implementation. Acceptability ratings explained 51.7% of teachers’ intentions to implement the student program (훘2 = 30.08; df = 8; p < .001), with affective attitude, perceived effectiveness and self-efficacy the most influential. Teachers commonly reported condensing program content, and reported deficits of time and collegial support as common barriers to implementation.ConclusionHigh acceptability and reach of the training indicate strong potential for implementation success. Multiple facets of acceptability seem important to successful implementation. Future research should explore ways to improve acceptability, thereby promoting successful implementation in real-world settings.
Highlights
To achieve real-world impacts, behavior change interventions need to be scaled up and broadly implemented
The study we report here sheds light on this underresearched area, and focuses acutely on how the acceptability of Continuing Professional Development (CPD) teacher trainings relates to realworld implementation [10, 15]
Adaptations To assess adaptations in delivery (T4), we used the following open-ended questions: “Which parts have you delivered or what kind of changes have you made in the student program?” and “Which parts have you delivered, or what kind of changes have you made in sedentary behavior reduction workshops?” In the analyses of the Let’s Move It (LMI) components delivered by the participants, we investigated what number of different types of components the participants described delivering, and counted how many reports fall under each component
Summary
To achieve real-world impacts, behavior change interventions need to be scaled up and broadly implemented. Given the insufficient levels of physical activity (PA) present among today’s youth [1], and the links between low levels of PA and the incidence of noncommunicable diseases [2], interventions are needed which can increase PA at population level This might be important among adolescents, as the transition into adulthood sets the stage for PA habits which carry into adult life [3]. Further research has demonstrated the importance of teacher engagement in the maintenance of school-based programs [9, 10] Taken together, it appears that numerous implementation-related contextual factors have an additive linear association with implementation [11]
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