Scale-up of the Internet-based Professional Learning to help teachers promote Activity in Youth (iPLAY) intervention: a hybrid type 3 implementation-effectiveness trial

Abstract

Background Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the ‘Internet-based Professional Learning to help teachers promote Activity in Youth’ (iPLAY) intervention in primary schools using the RE-AIM framework. Methods We conducted a type 3 hybrid implementation-effectiveness study and collected data between April 2016 and June 2021, in New South Wales (NSW), Australia. RE-AIM was operationalised as: (i) Reach: Number and representativeness of students exposed to iPLAY; (ii) Effectiveness: Impact of iPLAY in a sub-sample of students (n = 5,959); (iii) Adoption: Number and representativeness of schools that received iPLAY; (iv) Implementation: Extent to which the three curricular and three non-curricular components of iPLAY were delivered as intended; (v) Maintenance: Extent to which iPLAY was sustained in schools. We conducted 43 semi-structured interviews with teachers (n = 14), leaders (n = 19), and principals (n = 10) from 18 schools (11 from urban and 7 from rural locations) to determine program maintenance. Results Reach: iPLAY reached ~ 31,000 students from a variety of socio-economic strata (35% of students were in the bottom quartile, almost half in the middle two quartiles, and 20% in the top quartile). Effectiveness: We observed small positive intervention effects for enjoyment of PE/sport (0.12 units, 95% CI: 0.05 to 0.20, d = 0.17), perceptions of need support from teachers (0.26 units, 95% CI: 0.16 to 0.53, d = 0.40), physical activity participation (0.28 units, 95% CI: 0.10 to 0.47, d = 0.14), and subjective well-being (0.82 units, 95% CI: 0.32 to 1.32, d = 0.12) at 24-months. Adoption: 115 schools received iPLAY. Implementation: Most schools implemented the curricular (59%) and non-curricular (55%) strategies as intended. Maintenance: Based on our qualitative data, changes in teacher practices and school culture resulting from iPLAY were sustained. Conclusions iPLAY had extensive reach and adoption in NSW primary schools. Most of the schools implemented iPLAY as intended and effectiveness data suggest the positive effects observed in our cluster RCT were sustained when the intervention was delivered at-scale. Trial registration ACTRN12621001132831.

Initial insights into the impact and implementation of Creative Active Schools in Bradford, UK

“…Combined, there is a need for future whole-school physical activity programmes to broaden initial training beyond in-school leads. The challenge persists in how to deliver this at scale with a potential need for online programmes which have been effective in previous school-based physical activity programmes (32).…”

Rethinking children’s physical activity interventions at school: A new context-specific approach

“…Identification of intervention components could be informed by the and (e) the implementation process, that is, how the program is implemented in each school (10,37,56,57). This approach was used to inform the design of the Burn 2 Learn study highlighted above (58) as well as the iPLAY intervention (59,60). While this approach would have less consistency between schools and would require time to adopt, implement, and embed new programs, it would have far greater external validity as it reflects actual practice.…”

“…Identification of intervention components could be informed by the Consolidated Framework for Implementation Research which encourages researchers to think about: (a) innovation characteristics, such as the adaptability of the “intervention” being implemented; (b) outer setting, such as external polices; (c) inner setting, such as school-specific resources; (d) characteristics of participants, such as pupil demographics and activity levels; and (e) the implementation process, that is, how the program is implemented in each school ( 10 , 37 , 56 , 57 ). This approach was used to inform the design of the Burn 2 Learn study highlighted above ( 58 ) as well as the iPLAY intervention ( 59 , 60 ). While this approach would have less consistency between schools and would require time to adopt, implement, and embed new programs, it would have far greater external validity as it reflects actual practice.…”

Initial insights into the impact and implementation of Creating Active Schools in Bradford, UK

“…Despite preliminary evidence on the effectiveness of CAS (25), little is known about the determinants that in uence initial implementation, especially with schools located in diverse, multi-ethnic and underserved areas within a large UK city, such as Bradford (26). Moreover, while CFIR is widely adopted in healthcare research (27)(28)(29)(30), there has only been a limited use within whole-school physical activity and wellness programmes (31,32).…”