A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

Abstract

BackgroundFew children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children’s opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact.MethodsWe adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies.ResultsFive of Canada’s 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children’s PA levels or BMI.ConclusionsThis study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1669-6) contains supplementary material, which is available to authorized users.

A theoretical analysis of the barriers and facilitators to the implementation of school-based physical activity policies in Canada: a mixed methods scoping review

“…Although it has been a decade since the first DPA policy was mandated in Canada, evaluation of its implementation and effectiveness is surprisingly limited [16, 17]. Provincial school policies that have the potential to positively impact the health outcomes of so many Canadian children warrant further investigation as to their current implementation and effectiveness.…”

“…Provincial school policies that have the potential to positively impact the health outcomes of so many Canadian children warrant further investigation as to their current implementation and effectiveness. A recently published review examining the adoption, diffusion, implementation, and impact of DPA policies across Canada rated the strength of each province’s policy based on the language used, the specific time and intensity requirements, and the inclusion of mechanisms for implementation and monitoring [17]. This review highlighted that the implementation of these policies across Canada is inconsistent and suboptimal.…”

The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis

“… M-H M M-H L No information regarding ethics approval. Olstad, et al 2015 [ 73 ] Canada State and provincial level School based physical activity policy (legislation, rules, requirements) All stages of policy process (including implementation) Historical multiple case study. Systematic document review was used (no interviews or observation) NA- no interviews H H H L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.…”

“…The leadership of key individuals was another key theme of influence on obesity prevention policy identified in the included studies [ 51 , 68 ]. Political champions who advocated for and led the development of proposed changes were cited as critical in a number of studies [ 52 , 53 , 65 , 68 , 73 – 75 ]. Such individuals were often Ministers or senior bureaucrats in positions of decision-making authority [ 53 , 65 , 68 , 74 ].…”

Using Intervention Mapping for Program Design and Production of iCHAMPSS: An Online Decision Support System to Increase Adoption, Implementation, and Maintenance of Evidence-Based Sexual Health Programs

“…A sexual health EBP is an “innovation” because it may be “perceived as new by an individual or unit of adoption” ( 17 ). Adoption refers to the decision to use a particular innovation ( 17 , 18 ). Implementation refers to the process of program use, often measured in terms of general use, completeness (how much of the program is taught), and fidelity (adherence to core program elements) ( 19 , 20 ).…”