School Physical Activity Policies Research Articles

Learning Health System to rapidly improve the implementation of a school physical activity policy

BackgroundLearning Health Systems (LHS) – characterised by cycles of evidence generation and application – are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy.MethodsThis body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model’s effectiveness for improving schools’ implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model.ResultsCycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model’s feasibility and efficacy for improving schools’ policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model’s effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect.ConclusionsThrough this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.

Changes to Secondary School Physical Activity Programs and Policy after Emerging from COVID-19 Lockdowns.

The purpose of this study was to explore the adaptations that schools made to physical activity programs and facilities, and disparities by area urbanicity and income, during the first school year after the emergence of the COVID-19 pandemic. In a convenience sample of 132 secondary schools in Canada, school contacts responded to an annual survey in the 2020-2021 school year on changes to physical activity programs and facilities, and related staff training. Content analysis categorized open-ended text responses, and schools were compared based on area urbanicity and median income. Most schools canceled all interschool sports (88.9%) and intramurals (65.9%). New programs were added by 12.6% of schools, and about half (49%) of schools reported some continuing programs, most of which were sports programs, followed by facility and equipment access. Physical activity facilities were closed in 18.1% of schools, while 15.7% had new facilities added, and 11% temporarily converted facilities into learning spaces. Large/medium urban schools were at greater odds of having made any change to their facilities compared to schools in rural/small urban areas (odds ratio (95% confidence interval): 2.3 (1.1, 4.8)). The results demonstrate the considerable scale and nature of the restrictions in school provisions of physical activity opportunities during this period, as well as the resourcefulness of some schools in adding new programs and facilities.

Physical Activity Policy, Systems, and Environment Change Through Extension SNAP-Ed: A Multistate Perspective.

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) provides nutrition education and support for healthy living in SNAP-qualifying communities. SNAP-Ed supports policy, systems, and environmental (PSE) efforts to make the healthy choice an easier choice. SNAP-Ed implementers have widely adopted healthy eating PSE supports. However, physical activity (PA) PSE strategies are less common, with limited awareness between states of how other SNAP-Ed implementers approach PA-focused PSE work. Physical Activity Policy, Research, and Evaluation Network (PAPREN) Rural Active Living Workgroup project members sought to explore how Extension-based SNAP-Ed implements PA-focused PSE approaches. A sample of Extension-based SNAP-Ed program (n = 8) leaders were purposefully recruited from eligible universities in six of the seven SNAP-Ed regions. An interview guide to systematically collect information about current Extension SNAP-Ed implementation focused on PA PSE strategies was developed iteratively by the PAPREN Rural Active Living Workgroup Extension PA PSE project team. PA PSE Extension SNAP-Ed implementation efforts occurred at the state, county, and community levels and/or within local organizations. PA PSEs included school PA policy change, shared-use agreements, active transportation promotion, park development, walking challenges, and PA-promoting signage. All interviews highlighted the importance of partnerships at local, county, and state levels for PSE efforts. Extension-based SNAP-Ed shows potential to bring community partners together to plan and implement PA-focused PSE approaches. With a focus on SNAP-eligible people and substantial geographic reach, Extension SNAP-Ed is uniquely situated as a public health partner to broadly implement PA PSE changes.

The Dissemination and Implementation of Recess Guidelines, Policies, and Practices During the COVID-19 Pandemic

Purpose: There are limited school physical activity policy dissemination and implementation studies. This is a concern given the adverse mental, physical, and socio-emotional effects the COVID-19 pandemic has had on children and adolescents. This study explored New Jersey school administrators’ experiences in disseminating recess guidelines, procedures, and policies as well as implementation strategies in their schools during the pandemic. Methods: A total of 29 elementary school administrators participated in semi-structured interviews. The data were analyzed inductively using a conventional approach to qualitative content analysis. Results: In analyzing the data, five themes were identified: (a) adjustments for recess, (b) communications about recess, (c) successes and challenges of recess, (d) health and well-being among children, and (e) recommendations for recess postpandemic. Discussion/Conclusion: When planning, organizing, and implementing a recess in a postpandemic era, school leaders may want to consider establishing cohorts, developing a handbook, creating a rotation schedule (i.e., blacktop, field, playground), developing a recess committee, utilizing the physical education teacher for staff development, assigning recess equipment and bags, offering a variety of activities, and teaching children how to play.

The Relationship Between Policy Strength and Physical Activity Practices in Arizona Public Elementary Schools.

Many school-based physical activity statutes and regulations have been enacted, with the expectation that schools will comply. However, policy alone does not equate to implementation, and many policies fail for a variety of reasons. The purpose of the study was to determine whether the strength of reported state, district, and school-level physical activity policies were associated with reported recess, physical education, and other school-based physical activity practices at elementary schools in Arizona. A modified Comprehensive School Physical Activity Program(CSPAP) Questionnaire was administered to staff at elementary schools across Arizona (N = 171). Summative indices of the number of school physical activity policies and best practices at the state, district, and school levels were created. Relationships between policy strength and best practices were examined using linear regression analyses stratified by recess, physical education, and other school-based physical activity practices. Stronger physical activity-related policies were associated with a greater number of recess (F1,142 = 9.87, P < .05), physical education (F4,148 = 4.58, P < .05, Adj. R2 = .09), and other school-based physical activity (F4,148 = 4.04, P < .05, Adj. R2 = .07) best practices at all levels while controlling for school-level demographic factors. The strength of policies may improve opportunities for comprehensive physical activity for children in schools. Strengthening policy language (eg,specifying duration and frequency) may contribute to better physical activity practices in schools, improving children's health at the population level.

Optimising a multi-strategy implementation intervention to improve the delivery of a school physical activity policy at scale: findings from a randomised noninferiority trial

BackgroundTo maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an effective strategy (PACE) to assist schools’ implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was “as good as” the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers.MethodsA noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers’ scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at − 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD).ResultsThe posterior estimate for the between group difference at follow-up was − 2.3 minutes (95% credible interval = − 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of − 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school.ConclusionsIt is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.Trial registrationRetrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).

Identifying essential implementation strategies: a mixed methods process evaluation of a multi-strategy policy implementation intervention for schools

BackgroundPhysically Active Children in Education (PACE) is composed of eight implementation strategies that improves schools’ implementation of a government physical activity policy. A greater understanding of each discrete implementation strategy could inform improvements to PACE for delivery at-scale. This study aimed to: (A) measure the dose delivered, fidelity, adoption and acceptability of each strategy using quantitative data; (B) identify implementation barriers and facilitators using qualitative data; and (C) explore the importance of each strategy by integrating both data sets (mixed methods).MethodsThis study used data from a cluster randomised noninferiority trial comparing PACE with an adapted version (Adapted PACE) that was delivered with reduced in-person external support to reduce costs and increase scalability. Data were collected from both trials arms for between-group comparison. Descriptive statistics were produced using surveys of principals, in-school champions and teachers; and project records maintained by PACE project officers (objective A). Thematic analysis was performed using in-school champion and project officer interviews (objective B). Both data sets were integrated via a triangulation protocol and findings synthesized in the form of meta-inferences (objective C).ResultsEleven in-school champions and six project officers completed interviews; 33 principals, 51 in-school champions and 260 teachers completed surveys. Regardless of group allocation, implementation indicators were high for at least one component of each strategy: dose delivered =100%, fidelity ≥95%, adoption ≥83%, acceptability ≥50%; and several implementation barriers and facilitators were identified within three broad categories: external policy landscape, inner organizational structure/context of schools, and intervention characteristics and processes. All strategies were considered important as use varied by school, however support from a school executive and in-school champions’ interest were suggested as especially important for optimal implementation.ConclusionThis study highlights the importance of both executive support and in-school champions for successful implementation of school physical activity policies. In particular, identifying and supporting an in-school champion to have high power and high interest is recommended for future implementation strategies. This may reduce the need for intensive external support, thus improving intervention scalability.

School physical activity policies and associations with physical activity practices and behaviours: A systematic review of the literature.

The development and implementation of school policies is considered a key strategy for the promotion of physical activity (PA) in children and adolescents. This study aimed to systematically review and synthesise existing literature focusing on the associations between formal written school-based PA policies and (a) school PA practices and (b) PA behaviours of school-aged children and adolescents. Fifty-one papers reporting on 52 studies met the eligibility criteria. All but two studies were from high income countries, most used cross-sectional designs and demonstrated fair methodological quality, and just over a third examined language aspects of policies. Findings predominantly indicated a lack of or inconclusive associations between the various characteristics examined and PA outcomes. Inconclusive associations were identified between both PA practice and behaviour outcomes and state level policies, policies focusing on PE and school-day PA, and in studies examining language aspects of policies. Inconclusive associations with both types of outcomes were more likely to be identified compared to a lack of associations in studies using self-report measures and in studies not providing information about the quality of exposure and outcome measures used. Overall, findings highlight the need for further research that acknowledges the complex relationship between school policies and PA outcomes and employs robust methodological approaches to enhance our understanding of this area.

What Recess Policy? Assessing Arizona Schools’ Adherence to Senate Bill 1083

Children’s health is affected by physical activity (PA) opportunities throughout the school day. Schools are a central venue for children meeting physical activity recommendations, and multiple areas, such as recess, have been established to protect against childhood obesity and overweight. Senate Bill 1083 is a law that addresses recess policies in Arizona that calls for students in Grades K–5 receive at least two recess periods per day. The purposes of this study were to explore Arizona charter and public elementary (K–5) school’s adherence to Senate Bill 1083 as well as investigate the barriers, if any, to implementing recess. A modified version of the School Physical Activity Policy Assessment survey was administered to members of the Arizona Health and Physical Education organization. Findings from the survey show that Arizona schools are not providing the recommended number of recess periods per day, and there are multiple barriers to recess implementation. Further investigations and bill modifications are needed.

School policies and practices associated with Thai children's overall and domain specific physical activity.

School has a significant role in providing opportunities for children to engage in physical activity (PA) through policies and practices. This study aimed to identify the prevalence of school policies and practices related to physical activity (PA) and their association with Thai students’ overall and domain specific PA. This cross-sectional analysis included 5,830 students aged 6–17 years from 136 schools recruited though a multi-stage stratified cluster sampling across Thailand. Student’s PA data were assessed using a student survey and school data were collected by a principal survey. Associations between students’ PA and school variables were examined using logistic regressions. Despite a high prevalence of Thai schools reporting many policies and practices promoting PA in different areas, students reported low levels of PA. None of the school PA policies and practices was associated with students’ overall and domain specific activities, with active transport as the one exception. When schools had an active transport policy, students were 40% (OR = 1.40, p = 0.01) more likely to travel actively to/from school. The identified positive relationship between school active transport policy and students’ active travel behavior suggests a potential wider adoption of the policy promoting school active transport aiming to increase student’s PA levels among all Thai schools. Intervention studies are necessary to confirm this finding. Our study also reflected that, for greater levels of children’s school-based PA, strategies to translate the existing school PA policies into effective implementation should be an emphasis for Thai schools.

American Kinesiology Association’s Role in Promoting School Physical Activity Policy

This paper reviews the authors’ evolution as kinesiology scholars to a public health focus via their research on school physical activity (PA) and policy. The authors present key findings from their work, including their recent focus group discussion with 20 school leaders, to substantiate their perspectives about the role that the American Kinesiology Association could play in supporting public health goals and promoting school PA policy. The authors conclude the paper by appealing to American Kinesiology Association to clearly identify PA and its promotion as a central area of study in kinesiology, strengthen its ties to public health, and advocate for putting the “physical” back in the National Physical Education Standards.

Implementation of a School Physical Activity Policy Improves Student Physical Activity Levels: Outcomes of a Cluster-Randomized Controlled Trial.

To assess the impact of a multistrategy intervention designed to improve teachers' implementation of a school physical activity (PA) policy on student PA levels. A cluster-randomized controlled trial was conducted in 12 elementary schools. Policy implementation required schools to deliver 150minutes of organized PA for students each week via physical education, sport, or class-based activities such as energizers. Schools received implementation support designed using the theoretical domains framework to help them implement the current policy. A total of 1,502 children in kindergarten to grade 6 participated. At follow-up compared with control, students attending intervention schools had, measured via accelerometer, significantly greater increases in school day counts per minute (97.5; 95% confidence interval [CI], 64.5 to 130.4; P < .001) and moderate to vigorous physical activity(MVPA) (3.0; 95% CI, 2.2-3.8, P < .001) and a greater decrease in sedentary time (-2.1; 95% CI, -3.9 to -0.4, P = .02) per school day. Teachers in intervention schools delivered significantly more minutes (36.6min) of PA to their students at follow-up (95% CI, 2.7-70.5, P = .04). Supporting teachers to implement a PA policy improves student PA. Additional strategies may be needed to support teachers to implement activities that result in larger gains in student MVPA.

Policy Evaluation Network (PEN): Protocol for systematic literature review examining the evidence for impact of school policies on physical activity

Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity attributes an estimated 9% to this figure. Global responses have included the sustainable development goals and the global action plan on physical activity. Both point to policy action in physical activity (PA) to address change, yet the impact of policy is unknown. The protocol described outlines a systematic literature review that will be undertaken by the Policy Evaluation Network to address this knowledge gap. Protocol: This review of school PA policies is the first of seven planned reviews. The seven best investments for promotion of population PA identified in the Toronto Charter (whole-of-school programmes, transport policy, urban design policy, primary health care policy, public education policy, community programmes and sport programmes) will form the basis of these reviews. Seven individual scientific literature searches across six electronic databases, using key concepts of policy, PA, evaluation and a distinct concept for each area will be conducted. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined categories. Conclusions: The review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, this review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by the ‘Global Action Plan on Physical Activity’. Registration: PROSPERO CRD42020156630 (10/07/2020).

Do student social background and school context affect implementation of a school-based physical activity program?

This study examined the relationship between student- and school- characteristics and different implementation parameters of “Active All Year Round”, a nationwide Danish school-based physical activity program. The study is based on data from multiple sources: questionnaire data from students from 16 fifth-grade school classes (n = 276) and their teachers (n = 16), in-class observations (n = 15) and register data. Predictors included the student-level characteristics of gender, family affluence, immigration background, and perception of school connectedness as well as the school-level characteristics of school size, school parental education level, school physical activity policy and school’s prioritization of health promotion. Implementation was assessed by creating an implementation score from data on program psychological reach, dose delivered, dose received and fidelity. Data were analyzed by multilevel linear regression analysis. Findings indicated that the program was more easily implemented for students with higher school connectedness. To conclude, school-based health promotion programs can be improved by knowing, before the program is implemented, which factors increase the odds of better implementation.

Translating School Physical Education and Activity Policies into Practice: A Case Study.

Public health experts recommend school-based policies as a population based approach to increase youth physical activity. The purpose of this case study is to describe one, largely rural, state's efforts to translate this recommendation into practice. Details about the genesis, implementation and evolution of two state level policies (physical education and physical activity), as well as in-house efforts of a State Department of Education to monitor policy compliance and challenges encountered are described. Two specific years are highlighted, due to policy and monitoring enhancements made during those particular time periods. Data for this paper come from the West Virginia Department of Education for two time periods: 2013-2014 and 2014-2015 (n=369 elementary schools). Descriptive statistics for quantitative data and content analysis for qualitative data were used to document school level compliance and provide context for implementation challenges. Greater than 70% of school principals reported achievement of physical education and physical activity policy expectations for each year. Limited staff was the predominant explanation for nonfulfillment of physical education expectations, followed by lack of time and facilities. Recess and classroom-based physical activity were the primary strategies used to comply with the physical activity expectations. PE and PA policy compliance varied significantly by certain school characteristics in each school year studied. Further investigation is warranted on how states translate public health policy recommendations into practice, including how physical education and physical activity policies are developed and monitored at the state level and how to support states and schools with monitoring and implementation challenges.

Impact on Physical Fitness of the Chinese CHAMPS: A Clustered Randomized Controlled Trial.

Background: School physical activity (PA) policy, physical education curriculum, teacher training, knowledge of physical fitness, and parental support are among the key issues underlying the declining trend of physical fitness in children and adolescents. The Chinese CHAMPS was a multi-faceted intervention program to maximize the opportunities for moderate and vigorous physical activity (MVPA), and increase physical fitness in middle school students. The purpose of the study was to test whether the levels of modification in school physical education policy and curriculum incrementally influenced the changes in cardiorespiratory fitness and other physical fitness outcomes. Methods: This 8-month study was a clustered randomized controlled trial using a 2 × 2 factorial design. The participants were 680 7th grade students (mean age = 12.66 years) enrolled in 12 middle schools that were randomly assigned to one of four treatment conditions: school physical education intervention (SPE), afterschool program intervention (ASP), SPE+ASP, and control. Targeted behaviors of the Chinese CHAMPS were the student’s sedentary behavior and MVPA. The study outcomes were assessed by a test battery of physical fitness at the baseline and posttest. Sedentary behavior and MVPA were measured in randomly selected students using observations and accelerometry. Results: The terms contrasting the pooled effect of SPE, ASP, and SPE+ASP vs. Control, the pooled effect of SPE and SPE+ASP vs. ASP only, and the effect of SPE+ASP vs. ASP on CRF and other physical fitness outcomes were all significant after adjusting for covariates, supporting the study hypothesis. Process evaluation demonstrated high fidelity of the intervention in the targeted students’ behaviors. Conclusions: Chinese CHAMPS demonstrated the impact of varying the amount of MVPA and vigorous physical activity (VPA) on the physical fitness in middle school students in support of the need to increase the opportunity for PA in schools and to introduce high-intensity exercises in school-based PA programs. Modification of school policy, quality of physical education curriculum, and teacher training were important moderators of the improvement in physical fitness. (Trial registration: ChiCTR-IOR-14005388, the Childhood Health; Activity and Motor Performance Study).

Influence of Physical Activity on Elementary School Children: Challenges and Practice

Influence of Physical Activity on Elementary School Children: Challenges and Practice

School Physical Activity Policy

ABSTRACT This article provides a general summary of school physical activity policies, addresses the appeal of policy as means to increase school physical activity, identifies general policy research approaches and findings, and outlines perspectives on future policy research in schools. It begins with an overview of the elementary school physical activity environment, distinguishes policies from practices, and outlines why school physical activity policy can be considered as a viable solution for improving population-level physical activity and health. Next, it describes relevant aspects of policy and provides an overview of policy-related research aims and findings. Lastly, it provides perspectives on policy research efforts that are needed to support evidence-based advocacy efforts.

High School Physical Activity and Nutrition Policy: Summarizing Changes Over Time Using Latent Class Analysis

High school physical activity and nutrition policies can substantially affect student behavior and outcomes. Although public health officials and legislators have advocated for policy improvements, the extent to which policies have changed at local levels is not well understood. This study identifies latent classes of physical activity and nutrition policy environments and explores changes in prevalence of these classes from 2000 to 2016. Data from the School Health Policies and Practices Study, a repeated cross-sectional survey from the Centers for Disease Control and Prevention administered at the school district level in 2000, 2006, 2012, and 2016, were analyzed in 2018. Using latent class analysis, policy environment subgroups were identified, described, and then dichotomized based on satisfaction in meeting recommendations. Associations of latent classes with year and urbanicity were evaluated using logistic regression. Five latent classes were identified each for physical activity and nutrition policy environments, all with distinct characteristics. Physical activity policies improved from 2000 to 2006 (p<0.001) and then plateaued until 2016, whereas nutrition policies improved consistently from 2000 to 2016 (p<0.001, p=0.011, p<0.001). Though significant disparities between urban and rural school districts were found, these disparities narrowed during the studied years, particularly for physical activity policies. The estimated proportion of school districts with satisfactory physical activity and nutrition policy environments increased from 2000 to 2016, possibly because of legislative and policy advocacy efforts. However, many areas for improvement remain. Unsatisfactory latent classes that remained prevalent though 2016 may highlight policy domains that should be targeted by future interventions or subject to further research.

Evaluation of a comprehensive school physical activity program: Be a Champion!

BackgroundComprehensive School Physical Activity Programs (CSPAPs) are widely supported to increase physical activity (PA) in schools, but little has been reported to inform a comprehensive evaluation effort. The purpose of this report is to describe a comprehensive evaluation and monitoring strategy for CSPAP implementation. MethodsThe System for Observing Staff Promotion of Activity and Nutrition (SOSPAN), System for Observing Student Movement in Academic Routines and Transitions (SOSMART), and System for Observing Play and Leisure Activity (SOPLAY) were employed to record student and staff behaviors (2642 total scans). To assess policies, practices, and environments, a CSPAP Policies and Practices questionnaire was used, which included components of the School Health Index, the School PA Policy Assessment, the School Environment and Policies Survey, and the School Health Policies and Practices Study. Youth PA (minutes/day) was assessed using accelerometers. ResultsWorking with school sites to ascertain the number of opportunities that are provided for PA and the amount of PA students engage in is challenging but feasible. The use of systematic observation, accelerometers, and questionnaires can provide a comprehensive representation of policies, practices, and behaviors to aid in establishing targeted PA action items. ConclusionsDeveloping an evaluation framework that was rigorous enough to assess the physical, social, and policy environment of a school in order to answer the overarching research questions of the study but flexible enough to be feasibly streamlined for utilization by a school implementation team proved to be challenging but possible.