Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study
Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study
复制标题
DOI：
10.1186/s12889-018-6368-7
复制
发表时间：
2019-02-15
影响因子：
4.5
通讯作者：
Harrington, J. M.
中科院分区：
文献类型：
--
作者：
Hayes, C. B.;O'Shea, M. P.;Harrington, J. M.
本研究的目的是探讨以学校为基础的饮食和身体活动干预措施的实施，以及其采用、实施和可持续性的障碍和促进因素；执行所需的支助行动和克服已查明障碍的建议。选择了在爱尔兰全国范围内推出的两项干预措施；Food dude是一个鼓励小学生多吃水果和蔬菜的计划；Green Schools Travel （GST）是一个在中小学积极开展的学校旅行计划。训练有素的学校协调员（教师）将这些课程传给其他教学人员。方法采用多案例研究设计，对主要利益相关者进行定性半结构化访谈：中小学教师、学校协调员、项目协调员/管理者、资助者和中介机构。共进行了15次访谈。使用通用分类矩阵对数据进行编码。利用再目标实施框架的采用、实施和维持要素进行了专题分析。结果政府部门、中介机构和学校之间良好的工作关系对干预措施的采用、成功实施和可持续性至关重要。协调员的组织和领导能力是必不可少的。提供参与奖励是激发儿童兴趣的因素。对目标儿童生活的深刻理解是一个重要的背景因素。在不损害核心组成部分的情况下进行适应对提高干预措施可持续性的重要性显现出来。成功的实施受到以下因素的阻碍：资金不安全、学校时间表限制、广泛而非具体的干预核心组成部分，以及对方案评价的进行缺乏一致意见。支持维持生活的行动包括持续的政治支持、可靠的资金和已有的健康生活方式政策。结论学校公共卫生抗肥胖干预措施的成功实施和扩大取决于良好的环境契合度、多层次的参与和领导以及安全的资金。克服障碍的建议包括：在已经过度拥挤的课程范围内提供服务的能力和在概念框架内明确说明干预内容，以促进评价。我们的研究结果可以在不同的背景下推广，并且与那些参与国家公共卫生干预措施的发展或适应、组织或执行的人高度相关：政策制定者、指南制定者和参与当地组织和交付的工作人员。
BackgroundThe aim of the study was to explore the implementation of school based diet and physical activity interventions with respect to the barriers and facilitators to adoption, implementation and sustainability; supportive actions required for implementation and recommendations to overcome identified barriers. Two interventions rolled out nationally in Ireland were chosen; Food Dudes, a programme to encourage primary school children to consume more fruit and vegetables and Green Schools Travel (GST), an active travel to school programme in primary and secondary schools. Trained school coordinators (teachers) cascade the programmes to other teaching staff.MethodsMultiple case study design using qualitative semi-structured interviews with key stakeholders: primary and secondary school teachers, school coordinators, project coordinators/managers, funders and intermediaries. Fifteen interviews were conducted. Data were coded using a common categorization matrix. Thematic analysis was undertaken using the Adoption, Implementation and Maintenance elements of the RE-AIM implementation framework.ResultsGood working relationships within and across government departments, intermediaries and schools were critical for intervention adoption, successful implementation and sustainability. Organisational and leadership ability of coordinators were essential. Provision of participation incentives acted as motivators to engage children's interest. A deep understanding of the lives of the target children was an important contextual factor. The importance of adaptation without compromising core components in enhancing intervention sustainability emerged. Successful implementation was hindered by: funding insecurity, school timetable constraints, broad rather than specific intervention core components, and lack of agreement on conduct of programme evaluation. Supportive actions for maintenance included ongoing political support, secure funding and pre-existing healthy lifestyle policies.ConclusionsSuccessful implementation and scale up of public health anti-obesity interventions in schools is dependent on good contextual fit, engagement and leadership at multiple levels and secure funding. Recommendations to overcome barriers include: capacity to deliver within an already overcrowded curriculum and clear specification of intervention components within a conceptual framework to facilitate evaluation. Our findings are generalisable across different contexts and are highly relevant to those involved in the development or adaptation, organisation or execution of national public health interventions:policy makers, guidelines developers, and staff involved in local organisation and delivery.