Identifying Synergies in Multilevel Interventions

Lewis, Megan A.; Fitzgerald, Tania; Zulkiewicz, Brittany; Peinado, Susana; Williams, Pam

doi:10.1177/1090198116673994

Cited by 24 publications

(27 citation statements)

References 30 publications

(50 reference statements)

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“…Recognising our relative inexperience in design, and notwithstanding that the paper provides a powerful template for future projects, improvements may emerge from a more refined design process. Further, while the framework provides a map, it does little to identify how the respective parts interact, nor does it specify the optimal sequence(s) or interactions that need to take place [67]. Future research and practice collaborations will need to investigate the implementation of the framework.…”

Section: Strength and Limitationsmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2020

Int J Behav Nutr Phys Act

128

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Background: UK and global policies recommend whole-school approaches to improve childrens' inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure 'systems' change, a framework is required that identifies all components of a whole-school PA approach. The study's aim was to codevelop a whole-school PA framework using the double diamond design approach (DDDA).Methodology: Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one 'initial' framework. Next, stakeholders reviewed the 'initial' framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.Results: Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers' capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder wholeschool PA.Summary: To the authors' knowledge, this is the first time practitioners, policymakers and researchers have codesigned a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives 'with' schools, while abandoning outdated traditional approaches of implementing interventions 'on' schools.

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Section: Strength and Limitationsmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2020

Int J Behav Nutr Phys Act

128

View full text Add to dashboard Cite

show abstract

“…Recognising our relative inexperience in design, and notwithstanding that the paper provides a powerful template for future projects, improvements may emerge from a more refined design process. Further, while the framework provides a map, it does little to identify how the respective parts interact, nor does it specify the optimal sequence(s) or interactions that need to take place [66]. Future research and practice collaborations will need to investigate the implementation of the framework.…”

Section: Strength and Limitationsmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2019

Preprint

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Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective and sustainable interventions which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies the many components of a whole-school PA approach. The aim of this paper was to co-develop a whole-school PA framework using the double diamond design approach (DDDA); a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Framework development process Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n=9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n=6) stakeholder groupings. Six draft frameworks were created before stakeholders selected one ‘initial’ framework through an individual voting process. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, the original stakeholders voted on eight proposed modifications using an online questionnaire. Following voting, the final Creating Active Schools (CAS) Framework was designed. Summary To the authors knowledge, this is the first time practitioners, policy makers and researchers who understand the powerful driving agents of school systems and teacher and pupil PA behaviour, have co-designed a whole-school PA framework from initial conception. The novelty of the CAS framework resides in formally identifying the multitude of interconnecting elements of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The CAS framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, the CAS framework presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

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“…Yet, much of the responsibility for facilitating the requisite behaviour change lies at the feet of healthcare professionals (HCPs) [4]. Although the evidence base surrounding theoretical frameworks and systems-based approaches to behaviour change point to the powerful impact of concurrently addressing underlying influences on behaviour [5][6][7], unhealthy practices are often socially reinforced [8,9]. Therefore, effective, cost effective, sustainable and implementable strategies that can help alleviate pressure on HCPs and struggling health systems remain in short supply.…”

Section: Introductionmentioning

confidence: 99%

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

Kime

Pringle

Zwolinsky

et al. 2020

BMC Health Serv Res

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Background: Physical activity is recognised as important for diabetes management and improved overall health of individuals with diabetes, yet many adults with diabetes are inactive. Healthcare professionals have been identified as key to promoting physical activity, including individuals with diabetes, but are ill-prepared to deliver this. Our paper evaluates the barriers/facilitators of healthcare professionals' delivery of physical activity guidance to adults with diabetes and aims to inform efforts to investigate and enhance their preparedness to promote physical activity. Methods: A sequential mixed method, two-phase design was adopted involving a purposeful sample of healthcare professionals. Phase one was an online pilot survey designed to test assumptions around healthcare professionals' knowledge, training and preparedness to deliver physical activity guidance. Phase two comprised eighteen semistructured interviews, thematically analysed to provide an in-depth exploration of healthcare professionals' experiences of delivering physical activity guidance to adults with diabetes. Results: Healthcare professionals are committed to promoting physical activity to adults with diabetes and are reasonably confident in giving basic, generic guidance. Yet, significant challenges prevent them from achieving this in their practice, including: lack of education and training around physical activity, diabetes and health; ignorance of recommended physical activity and diabetes guidelines; lack of awareness of referral options; limited time and accessibility to appropriate resources. Nevertheless, healthcare professionals believed discussions around physical activity needed to be an integral part of consultations, incorporating improved communication strategies for conveying key physical activity messages. Conclusions: HCPs have a key role in the promotion of physical activity to people with long-term conditions such as diabetes and they are identified within both the strategic policy context and national interventions for physical activity. Yet, this study indicated that HCPs face multiple and at times complex barriers to physical activity promotion generally and with diabetes patients. Conversely HCPs also reported what works, why and how, when promoting physical activity. Rich information derived from the day-today , working healthcare professional is integral to shaping future practices going forward. The bottom up, iterative design adopted in this study provides an approach to tap into this information.

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Identifying Synergies in Multilevel Interventions

Cited by 24 publications

References 30 publications

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

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