Implementation Of Support Strategies Research Articles

Food insecurity and its contributing determinants among rural households in the south-western region of Bangladesh, 2021: A cross-sectional study

IntroductionThe onset of the COVID-19 pandemic has disrupted food access, resulting in substantial consequences for food insecurity and contributing to adverse individual and public health outcomes. To comprehensively evaluate these challenges and grasp their implications for food security, this study aimed to evaluate the contributing determinants of food insecurity among rural households in the southwestern region of Bangladesh. Study designA cross-sectional study was conducted using a validated questionnaire in selected 310 rural household respondents from the southwestern region, of Bangladesh. MethodsHousehold food insecurity status was the outcome variable for the analysis. Multinomial logistic regression analysis was used to explore and predict risk factors correlated with food insecurity among southwestern Bangladeshi households. ResultsWe found that 59% and 27.5% of households were suffering from moderate food insecurity and severe food insecurity. The multinomial regression model revealed that respondents residing in Kusthia (RRR=5.56 CI:2.67–8.4 and RRR=6.65, CI:3.37–9.22) aged between 30–40 years (RRR=2.32, 95% CI:1.84–3.77 and RRR=1.87, 95% CI:1.48–3.97) and 40–50 years (RRR=1.86 95% CI:1.46–3.82 and RRR=1.95, 95% CI:1.75–3.26) were significantly associated with mild-to-moderate and severe food insecurity. Respondents with a monthly family income of <58.96 USD (3.38 times and 2.18 times), had ≥5 family members (2.68 times and 1.89 times), and with poor income during the pandemic (4.25 times and 2.75 times) were more likely to be moderate and severe food insecure. ConclusionThe results emphasized that during the COVID-19 lockdown in Bangladesh, rural households faced diverse levels of food insecurity, ranging from moderate to severe. It suggests that efforts to raise awareness and implement support strategies for those at higher risk should not only focus on income but also consider additional factors such as family size, adults aged 30-40 years, and occupation.

Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder

BackgroundHospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT.MethodsFour state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge.DiscussionInitiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals.Trial registrationNCT04921787.

Workspace in supporting strategy implementation – a study of 25 knowledge-intensive organisations

PurposeOrganisational strategy becomes reality by connecting organisation’s resources and capabilities in daily operations, and physical workspace is one of the environments in which this takes place. This study aims to explore to what extent factors required for successful strategy implementation are considered when designing, using and managing workspaces of knowledge-intensive organisations.Design/methodology/approachFor the study, managers in 25 large and medium-sized knowledge-intensive organisations were interviewed. The semi-structured interviews focused on organisation’s strategy, strategy implementation practices and workspace design and management. To form a comprehensive framework of strategy implementation success factors for the study, the factors of 11 frameworks were analysed, grouped and renamed.FindingsCurrent workspace design, usage and management mainly support human-related strategy implementation factors. However, both organisation- and human-related factors are needed for the strategy implementation to be successful. Therefore, the organisations studied may have unused potential in their workspaces to ensure strategy-aligned operations and behaviour.Practical implicationsDue to the potential imbalance between organisation- and human-related strategy implementation factors, a more holistic, organisational-level approach to workspace design, usage and management is recommended to ensure the success of strategy implementation.Originality/valueWorkspaces have extensively been studied from individual strategy implementation factors’ as well as employees’ perspectives. Prior to this work, there are only few studies exploring workspace in the holistic, strategy implementation context.

Assessment of emotional and professional status in the HoReCa sector: burnout level, impact of incivility and organizational support

The presented study highlights a significant correlation between burnout and lack of workplace civility, with inappropriate behaviors from others (clients or colleagues) contributing tothe impairment of employees' well-being. Regarding organizational support, a negative correlation is observed between burnout and perceived support. Organizational support acts as a buffer against stress, and promoting social interactions is essential for preventing professional exhaustion. Withinthe hypothesis regarding age, it is observed that young individuals in the Horeca industry (18-25 years old) exhibit a higher level of burnout compared to those between 36 and 45 years old. The explanation lies in different stages of professional and personal development, emphasizing the importance of organizational support for all age groups. Shaping the hypothesis that the lack of civility is encountered differently depending on the subjects' tenure in the workforce, the results indicate that those with less than 5 years of experience experience a more pronounced lack of civility. New employees are more vulnerable to stress, and organizations are encouraged to implementsupport strategies, such as team-building activities, to facilitate adaptation and prevent impolite behaviors.

The role of nursing in breastfeeding in hospitalized neonates

Introduction: In this research, the issue of the role of nursing in breastfeeding in hospitalized neonates is addressed. Breastfeeding plays a fundamental role in the health and development of hospitalized neonates, and adequate support from nursing staff is essential to promote and facilitate this practice. Objective: To explore the experiences and perceptions of mothers, fathers and nursing staff in relation to breastfeeding in hospitalized neonates, as well as to evaluate the correlation between a good latch of the neonate and the production of breast milk. Methodology: Through a mixed methodological approach that combines qualitative and quantitative methods, to obtain a complete and holistic understanding of this important issue to improve neonatal care. Through in-depth interviews, focus groups, and structured questionnaires, the experiences and perceptions of mothers, fathers, and nursing staff were explored, as well as the correlation between newborn latch-on and breast milk production. Data analysis revealed that the instruments used in this study showed good reliability, with Cronbach's coefficients higher than 0.8. Results: They showed common challenges in breastfeeding, such as the lack of information and emotional support. A significant correlation was found between a good latch of the newborn and a higher production of breast milk. Conclusion: The training of nursing staff and the implementation of support strategies, such as the use of lactation consultants, were identified as key elements to improve breastfeeding care in the hospital setting. These findings support the importance of the role of nursing in the promotion and support of breastfeeding in hospitalized neonates.

Burnout, resilience, and subjective well-being among Portuguese lecturers' during the COVID-19 pandemic.

Lecturers face a large wide of occupational stressors. If the prolonged stress and the symptomatology associated with the working conditions to which lecturers were exposed were already a concern before the pandemic, the pandemic may have exacerbated this psychosocial vulnerability. Burnout is a psychological syndrome that develops in response to chronic work stress. This study aims to describe burnout amongst lecturers working in Portugal and to analyse potential determinants of burnout during the COVID-19 pandemic. A cross-sectional study was performed using an online questionnaire distributed via social networks. The survey collected sociodemographic and sleep patterns data in addition to applying the Copenhagen Burnout Inventory (personal, work- and student-related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales, and the Satisfaction with Life Scale. The sample included 331 lecturers from 35 different colleges and faculties. Three significant models explained personal (R2 = 54%), work- (R2 = 47%) and student- (R2 = 19%) related burnout. Lower levels of resilience and higher levels of depression and stress were significantly associated with personal and work-related burnout. Changes in sleep patterns were additionally associated with both personal and work-related burnout. Higher education institutions must recognize the impact of the work environment and organizational culture on faculty mental health and take proactive measures to improve this environment. These institutions can implement support strategies such as educational technology training, professional development programmes, emotional support resources, and workload flexibility. Implementing measures to enhance lecturers' resilience and overall life satisfaction could potentially help mitigate burnout and improve the well-being of educators, ultimately contributing to the overall quality of education.

Tailor-Made Development Pathways: A Framework to Enhance Active Participation of Youth in Agriculture

The development of youth to actively engage in agriculture could address the persistent youth unemployment problem. For youth to actively engage in agriculture, adequate access to key productive resources is necessary. The main aim of this article is to develop and validate tailor-made development pathways based on the characteristics of four youth typologies, addressing the constrained access to key livelihood capitals, and to enhance the participation of youth in agriculture. The pathways are developed based on the Modified Sustainable Livelihood Framework (MSLF), which includes six livelihood capitals, namely, physical, natural, social, financial, human and psychological capitals. Four pathways were developed and named Business-oriented, Gender-oriented, Occupation-oriented and Livestock-oriented. Through focus group discussions, the pathways were validated to determine whether they can be used successfully to facilitate the participation of youths in agriculture. The results confirm that tailor-made development pathways can be used to develop youth characterised by the typology that informed that pathway, to actively engage in agriculture. The implementation of support strategies to support youth in agriculture, should therefore, be guided by the specific needs of different typologies. This allows for the coordination and coherence of youth support initiatives to enhance access to resources, which can yield improvements to desired development outcomes compared to initiatives implemented as piecemeals.

Fundamental power of the city – A proposition of a new paradigm and index for city development

Managing a dynamic and complex urban system according to the single concept of city development is insufficient. The study's aim is to present the main concepts of cities development, formulate a new hybrid concept of city, and propose a related index to support strategy implementation and monitoring. The research methods include literature scoping, literature content analysis, and linear ordering as a multivariate method of analysis. The research conclusion identifies a new hybrid concept of a “resilient smart sustainable city” and explains a distinction between weak and strong perception of the concept. The practical part of the research develops synthetic measure “Fundamental Power of the City Index” which allows to select variables representing individual cities' priorities and apply them in every city analysis, development strategy building, and monitoring. The Index is tested for 18 voivodship cities in Poland for the period 2014–2020. The results of this study can support city stakeholders in their efforts in developing “resilient smart sustainable city”.

Co-development of implementation strategies to assist staff of a mental health community managed organisation provide preventive care for health behaviours.

People with a mental health condition are at risk of developing chronic physical disease due to smoking tobacco, inadequate nutrition, high alcohol consumption, low physical activity and poor sleep (SNAPS). Community managed organisations (CMOs) represent an opportune setting to support mental health consumers to improve their health behaviours through providing preventive care. Reporting of methods used to co-develop implementation strategies to assist CMO staff to deliver preventive care for SNAPS are scarce yet warranted. This study aims to: (1) describe a co-development workshop involving CMO staff and researchers to identify preferred implementation support strategies to help staff routinely provide preventive care; (2) describe the strategies that emerged from the workshop; and (3) report staff ratings of the workshop on four co-development principles. A three-hour co-development workshop was conducted on two occasions with staff of one CMO in New South Wales, Australia. Twenty staff participated in the workshops. Participants generated and ranked a total of seven discrete implementation strategies within five categories (training, point of care prompts, guidelines, continuous quality improvement and consumer activation). Training for staff to have difficult conversations about behaviour change was ranked highest in both workshops. Participants rated the workshops positively across four co-development principles. The co-development workshop enabled implementation strategies to be developed within the context in which they were to be delivered and tested, potentially increasing their feasibility, acceptability, appropriateness and impact. SO WHAT?: Implementation strategies selected from the workshops will inform a pilot implementation support trial to assist CMO staff to provide preventive care to people with mental health conditions.

Psychosocial interventions and strategies to support young people at mass gathering events: a scoping review

ObjectivesTo improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes. Study designScoping review. MethodsThis study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria. ResultsTwenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms. ConclusionPsychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.

Adaptations to scale-up an early childhood education and care physical activity intervention for real-world availability — Play Active

BackgroundAdaptations for scale-up are ubiquitous but are rarely described in detail. Adaptations may be a key reason for the “scale-up penalty” which is when there is a reduction in intervention effect size following scale-up. The Play Active intervention consists of a physical activity policy for early childhood education and care (ECEC) services, with accompanying implementation support strategies. It was first implemented with 81 ECEC services in Perth, Western Australia, in 2021 — with significant positive changes in physical activity practice uptake. The aim of this paper is to describe the extent, type, fidelity consistency, goals, size, scope, and proposed impact of proposed adaptations to the implementation support strategies for scaling-up Play Active.MethodsProposed adaptations were defined as planned changes, made prior to making the intervention available. The authors created a list of adaptations from a comparison of the Play Active implementation support strategies, before and after adaptation for proposed statewide availability across Western Australia, Queensland and South Australia, Australia. We used the Framework for Reporting Adaptations and Modifications-Enhanced Implementation Strategies (FRAME-IS) to code adaptations to implementation support strategies. Three authors coded each adaptation and rated their size, scope and proposed impact.ResultsFifty-three adaptations to Play Active were identified. Most (68%) were proposed for the ‘content’ of implementation strategies, including aspects of their delivery. In practice, this involved changing the delivery mode of implementation support strategies from phone call and email support, to website-based delivery. More than half (56%) of adaptations involved ‘adding elements’ for scale-up. Most adaptations were ‘fidelity consistent’ (95%). The main goals for adaptations were related to ‘increasing the acceptability, appropriateness, or feasibility’ (45%), ‘decreasing the costs’ (19%) and ‘increasing adoption of the evidence-based practice’ (19%). Adaptations were small to medium in size, with most proposed to have a positive (87%) or neutral (8%) effect on the effectiveness of the intervention, rather than negative (4%).ConclusionsA large number of small, fidelity-consistent, adaptations were proposed for Play Active scale-up. Overall, the process of reporting adaptations was found to be feasible. To understand the impact of these adaptations, it will be important to re-evaluate implementation, effectiveness and process outcomes, at-scale.

Play Active physical activity policy intervention and implementation support in early childhood education and care: results from a pragmatic cluster randomised trial

BackgroundPolicy interventions to increase physical activity in early childhood education and care (ECEC) services are effective in increasing physical activity among young children. However, a large proportion of ECEC services do not have nor implement a physical activity policy. Play Active is an evidence-informed physical activity policy intervention with implementation support strategies to enable ECEC services to successfully implement their policy. This study examined the effectiveness, implementation, and process outcomes of Play Active.MethodsA pragmatic cluster randomised trial in 81 ECEC services in Perth, Western Australia was conducted in 2021. Services implemented their physical activity policy over a minimum of three months. The effectiveness outcomes were changes in educator practices related to daily time provided for total physical activity and energetic play. Implementation outcomes included changes in director- and educator-reported uptake of policy practices and director-reported uptake of high impact and low effort policy practices. Process evaluation outcomes included awareness, fidelity, reach, and acceptability of the intervention and implementation strategies. Analysis involved descriptive statistics and generalised linear mixed effects models.ResultsThere was a significant increase in the uptake of director-reported policy practices (p = 0.034), but no change in the uptake of the subset of high impact and low effort policy practices. Intervention group educators reported high awareness of the Play Active policy recommendations (90%). Play Active acceptability was high among educators (83%) and directors (78%). Fidelity and reach were high for most implementation support strategies (> 75%). There were no significant changes in the amount of physical activity or energetic play educators provided to children or in the proportion of educators providing the policy recommended ≥ 180 min of physical activity/day or ≥ 30 min of energetic play/day for intervention compared to wait-listed comparison services.ConclusionsPlay Active resulted in significantly higher uptake of physical activity practices. However, there was no change in the amount of physical activity provided to children, which may be explained by the relatively short policy implementation period. Importantly, Play Active had high awareness, fidelity, reach, and acceptability. Future research should investigate the effectiveness of Play Active over longer implementation periods and its scalability potential.Trial registrationAustralian New Zealand Clinical Trials Registry (reference number 12620001206910, registered 13/11/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378304&isReview=true).

Discrepancy between Intention and Realization in an Implementation Research Perspective: When Researcher and Teachers Talk Past Each Other

Abstract This article (an extension of a conference paper presented at CERME12; Østergaard &amp; Jankvist, 2022) discusses influential factors in the longitudinal implementation of an innovation concerning students’ beliefs, especially reflection, in mathematics education. Here, the researcher constantly found herself “talking past” the two involved teachers. In the search for a deeper understanding of the discrepancy between the intended and the realized outcome, qualitative data collected in planning sessions and classroom observations are analyzed by applying theoretical constructs from implementation research. In particular, three influential factors appeared to play a central role in the case presented in the paper: characteristics of the end-users, attributes of the innovation, and implementation support strategies. The findings suggest that some of these factors may even have been contradictive to the intentions of the innovation. Furthermore, the article also contributes to the discussion of whether small-scale, qualitative studies have a role to play in implementation research, illustrating how a deeper understanding of the processes involved can be achieved. The impact sheet to this article can be accessed at 10.6084/m9.figshare.22304629.

Considering the implementation research-to-practice gap: An experimental evaluation of intervention-general methods for assessing and supporting intervention fidelity through coaching

Implementation support through coaching—such as with embedded fidelity assessment, performance feedback, modeling, and alliance building—has been empirically supported as a way to increase and sustain interventionists' fidelity levels. However, education research consistently shows that practitioners struggle to monitor and improve interventionists' fidelity using implementation support strategies. One explanation for this type of implementation research-to-practice gap is that evidence-based coaching strategies have significant limitations with respect to their usability, feasibility, and adaptability. This study is the first to experimentally evaluate an evidence-based set of adaptable materials and procedures designed to assess and support the intervention fidelity of school-based interventions. Using a randomized multiple-baseline-across-participants design, we examined the extent to which these materials and procedures would influence intervention adherence and quality of an evidence-based reading intervention. Across all nine interventionist participants, data revealed that the implementation strategies meaningfully improved intervention adherence and quality, and high levels of intervention fidelity maintained 1 month after removing the support procedures. Findings are discussed with respect to how these materials and procedures address a critical need within school-based research and practice as well as how they may help to inform and address the implementation research-to-practice gap in education.

Transforming Mathematics Instruction Via Primary Historical Sources: A Study of Influential Factors on Implementation of a Curricular Innovation at the Tertiary Level

Abstract The TRansforming Instruction in Undergraduate Mathematics via Primary Historical Sources (TRIUMPHS) project is producing primary source projects (PSPs) for use in teaching core topics from the tertiary mathematics curriculum and investigating the resulting teaching and learning experiences. This article examines factors related to attributes of PSPs, TRIUMPHS’ dissemination and implementation support strategies, and characteristics of individual instructors that have influenced the incorporation of PSPs into their ordinary practice via case studies representative of two types of end users: those who have thus far limited their PSP usage to a single course and those for whom PSP usage has permeated their instructional practice. Findings affirm that pedagogical orientations within individuals’ instructional practices were critical to both initial use and eventual adoption of PSPs, while the observed differences in usage patterns between the cases were influenced by the perceived relative advantages offered by the core features of PSPs and individuals’ intrinsic motivation. The impact sheet to this article can be accessed at 10.6084/m9.figshare.21205292.

Analisis Green Growth Petani Gambir di Kecamatan Bukik Barisan Kabupaten Lima Puluh Kota Sumatera Barat

Green growth strategies need attention to various aspects that can support strategy implementation. Green growth is environmentally friendly economic growth aimed at alleviating poverty along with the reduced availability of natural resources and climate change. One of the most important commodities in the plantation sub-sector which includes green growth is gambier (Uncaria Gambier Roxb). This study aimed to analyze the gambier production process by applying green growth analysis in Bukik Barisan District using quantitative descriptive analysis through questionnaires and interviews distributed in Bukik Barisan District, Lima Puluh Kota Regency. The results of this study indicated that by using two production processes, such as the planting process starts from the land clearing process, seeding, planting, maintenance, picking gambier leaves and processing. The post-harvest gambier production process is carried out from boiling gambier leaves, pressing, precipitation, draining, printing and drying which shows that gambier plants are green growth plants or eco-friendly plants.

Impact of COVID-19 on the mental health of public university hospital workers in Brazil: A cohort-based analysis of 32,691 workers.

In early 2020, the COVID-19 pandemic paralyzed the world and exposed the fragility of health systems in the face of mass illness. Health professionals became protagonists, fulfilling their mission at the risk of physical and mental illness. The study aimed to evaluate absenteeism indirectly related to SARS-CoV-2 infection in a large population of health care professionals. An observational longitudinal repeated measures study was performed, including workers linked to 40 public university hospitals in Brazil. All causes of absenteeism were analyzed, focusing on those not directly attributed to COVID-19. Results for the same population were compared over two equivalent time intervals: prepandemic and during the pandemic. A total of 32,691 workers were included in the study, with health professionals comprising 82.5% of the sample. Comparison of the periods before and during the pandemic showed a 26.6% reduction in work absence for all causes, except for COVID-19 and mental health-related absence. Concerning work absence related to mental health, the odds ratio was 39.0% higher during the pandemic. At the onset of the pandemic, there was an increase in absenteeism (all causes), followed by a progressive reduction until the end of the observation period. Work absence related to mental illness among health care professionals increased during the COVID-19 pandemic, highlighting the need for health care managers to prioritize and implement support strategies to minimize absenteeism.

Study protocol for a cluster-randomized trial of a bundle of implementation support strategies to improve the fidelity of implementation of schoolwide Positive Behavioral Interventions and Supports in rural schools

BackgroundImproving the implementation of evidence-based interventions is important for population-level impacts. Positive Behavioral Interventions and Supports (PBIS) is effective for improving school climate and students’ behavioral outcomes, but rural schools often lag behind urban and suburban schools in implementing such initiatives. Methods/DesignThis paper describes a Type 3 hybrid implementation-effectiveness trial of Rural School Support Strategies (RS3), a bundle of implementation support strategies selected to improve implementation outcomes in rural schools. In this two-arm parallel group trial, 40 rural public schools are randomized to receive: 1) a series of trainings about PBIS; or 2) an enhanced condition with training plus RS3. The trial was planned for two years, but due to the pandemic has been extended another year. RS3 draws from the Interactive Systems Framework, with a university-based team (support system) that works with a team at each school (school-based delivery system), increasing engagement through strategies such as: providing technical assistance, facilitating school team functioning, and educating implementers. The primary organizational-level outcome is fidelity of implementation, with additional implementation outcomes of feasibility, acceptability, appropriateness, and cost. Staff-level outcomes include perceived climate and self-reported adoption of PBIS core components. Student-level outcomes include disciplinary referrals, academic achievement, and perceived climate. Mediators being evaluated include organizational readiness, school team functioning, and psychological safety. DiscussionThe study tests implementation strategies, with strengths including a theory-based design, mixed methods data collection, and consideration of mediational mechanisms. Results will yield knowledge about how to improve implementation of universal prevention initiatives in rural schools.

A cluster randomised effectiveness-implementation trial of an intervention to increase the adoption of PAX Good Behaviour Game, a mental health prevention program, in Australian primary schools: Study protocol

IntroductionImplementation of evidence-based programs in school settings can be challenging, undermining the benefits these programs deliver for children. The primary aim of this study is to assess whether an enhanced implementation intervention increases adoption of the PAX Good Behaviour Game in New South Wales (NSW) primary schools in Australia. A secondary outcome is to investigate the impact of the PAX Good Behaviour Game on children's mental health in the Australian context. Methods and analysisThe study uses a cluster randomised hybrid type 3 effectiveness-implementation design and will involve 40 NSW primary schools. Randomisation will occur at the school level. All NSW primary schools trained in the PAX Good Behaviour Game are eligible for participation. The intervention is a multicomponent implementation strategy that has been iteratively co-designed by our research team and local stakeholders. Intervention schools will have access to eight implementation support strategies in addition to the training received as usual delivery to build knowledge and skills. Research staff will assess implementation and effectiveness outcomes using self-report online surveys with teachers and support staff at baseline, 6-weeks, 6-months and 12-months follow up. Semi-structured interviews with teachers and support staff will be used to examine which implementation strategies worked for whom and under what conditions. DiscussionIf successful, this study will highlight effective strategies schools or education departments can use internationally to improve their translation of evidence-based programs into routine practices. This will lead to better outcomes for children and young people.

Physical education teachers of the basic public education of Minas Gerais in the pandemic of Covid-19: working conditions, health and lifestyle

This study aimed to describe the working and health conditions of physical education teachers in public basic education in the state of Minas Gerais – Brazil during the COVID-19 pandemic. Cross-sectional study, carried out from August to September 2020, via digital form and had the support of the Minas Gerais State Department of Education. The instrument presented variables related to the sociodemographic profile, work and health conditions during the pandemic. The prevalences of the variables were presented. 1,016 physical education teachers participated in the study. Of these, 61.4% were female, 65.8% aged 21 to 40 years and 15.3% worked in the countryside. In relation to working conditions during the pandemic, 99% performed remote activities, 35.7% were dissatisfied with their work, 37% worked much more than they used to and 81.2% presented the interest of students/parents in classes as a difficulty. As for health conditions during the pandemic, 10.3% increased their consumption of alcoholic beverages, 26.1% did not practice physical exercise, 56.5% had increased body weight and 37.8% reported a lot of fear of COVID-19. Physical education teachers of basic education in the state of Minas Gerais were significantly affected by the pandemic, so it is important to implement support strategies.