Aligning Organizational Priorities and System Policies to Support Implementation Scale-Up of a Tailored Classroom-Based Physical Activity Intervention in Low-Resource Schools.

Abstract

A mismatch between organizational priorities and system-level policies can negatively impact implementation and sustainment of classroom-based physical activity (PA) interventions. The purpose of this study was twofold: (1) present methods to systematically identify organization- and system-level implementation barriers, and (2) align organizational priorities and system policies by designing multi-level implementation strategies. This alignment will support implementation scale-up of a tailored PA intervention in one low-resource intermediate school district (ISD; 16 districts, 32 schools) in central Michigan. Multi-level assessments of organizational readiness were conducted using the Hexagon Discussion and Analysis Tool to assess intervention-context fit, the Wellness School Assessment Tool 3.0 to evaluate district PA policy strength and comprehensiveness, and semi-structured interviews were conducted to assess administrative support and priorities related to PA programming. Our assessments revealed three implementation barriers: limited structural capacity to sustain teacher training, limited resources across districts and school buildings to support teachers, and misalignment of ISD and district PA policies and priorities. Greater attention to organizational capacity and existing infrastructure should be considered a priori to support effective implementation and sustainment of PA interventions in low-resource schools.