Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

Wolfenden, Luke; McCrabb, Sam; Barnes, Courtney; O’Brien, Kate; Ng, Kwok; Nathan, Nicole; Sutherland, Rachel; Hodder, Rebecca K; Tzelepis, Flora; Nolan, Erin; Williams, Christopher M.; Yoong, Sze Lin

doi:10.1002/14651858.cd011677.pub3

Cited by 20 publications

(19 citation statements)

References 227 publications

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“…For the last few decades, the science of how best to implement effective Evidence Based Interventions (EBIs) has become an important focus in health services research (1). Accordingly, we have seen significant improvements in the adoption and implementation of EBIs in both clinical and community settings, leading to improvements in health outcomes and healthcare delivery (2,3). For example, a review by Cassidy et al of 41 studies found that multi-strategy interventions were effective at implementing guidelines in nursing which had positive effects on patient health status outcomes (3).…”

Section: Introductionmentioning

confidence: 99%

Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

Nathan

Shelton

Laur

et al. 2023

Front. Health Serv.

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Section: Introductionmentioning

confidence: 99%

Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

Nathan

Shelton

Laur

et al. 2023

Front. Health Serv.

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“…There are fundamental differences in how the public understands and uses FBDG compared with guideline implementers. Dissemination and implementation science approaches seek to understand how to increase the spread, adoption and integration of evidence-based guidelines, thus providing an opportunity to systematically understand how to increase adoption of such guidelines amongst health care and non-health care professionals (37,38) . For example, a previous trial by the authors found that tailoring dissemination materials according to the theory of planned behaviour can improve intentions to adopt nutrition guidelines by childcare providers and improve the provision of fruit and vegetables on childcare menus (39) .…”

Section: Discussionmentioning

confidence: 99%

An audit of the dissemination strategies and plan included in international food-based dietary guidelines

Yoong,

Turon,

Wong

et al. 2023

Public Health Nutr.

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Objective Food-based dietary guidelines (FBDGs) are an important resource to improve population health, however little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDGs. Design: A cross-sectional audit of FBDGs with a published English-language version sourced from the United Nations Food and Agriculture Organization repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel, and message). For guidelines with a dissemination plan, we described goals, audience, strategies, and expertise and resources according to the Canadian Institute for Health Research guidance. Setting: FBDGs from 53 countries mostly from high-income (n=28, 52.8%), upper-middle income (n=18, 34%) areas were included. Participants: n/a. Results: The source of guidelines were most frequently health departments (79.2%). The message included quantities and types of foods, and physical activity recommendations, and 88.7% included summarised versions of main messages. The most common channel were infographics and information booklets, and the main end-users were the public. For 12 countries (22.6%), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the CIHR, Conclusions: The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDGs had formal dissemination plans and of those, there was limited detailed provided.

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“…Implementation science has recognized the importance of education in the implementation process (94)(95)(96). Still, researchers should pay closer attention to how education can highlight situated knowledge to create resistant power (2).…”

Section: Discussionmentioning

confidence: 99%

Power and resistance in schools: Implementing institutional change to promote health equity for sexual and gender minority youth

et al. 2022

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IntroductionSchools in the United States are hierarchical institutions that actively (re)produce the power relations of the wider social world, including those associated with heteronormativity. Structural stigma, informed by heteronormativity and perpetuated through schools, contributes to the production of academic and health disparities among youth who are lesbian, gay, bisexual, transgender, queer, or of other gender and sexual identities (LGBTQ+). We draw upon 5 years of qualitative data from a cluster randomized controlled trial conducted in New Mexico that used implementation science frameworks to promote the uptake and sustainment of evidence-informed practices (EIPs) to examine how power operates to hinder or promote the ability of school staff to change school environments, disrupt structural stigma, and increase safety and support for LGBTQ+ youth.MethodsData sources included annual individual and small group qualitative interviews with school professionals (e.g., administrators, school nurses, teachers, and other staff), several of whom took part in Implementation Resource Teams (IRTs) charged with applying the EIPs. Other data sources included bi-weekly periodic reflections with implementation coaches and technical assistance experts. Data were recorded, transcribed, and analyzed using deductive and inductive coding techniques.ResultsThe IRTs experienced variable success in implementing EIPs. Their efforts were influenced by: (1) constraining school characteristics, including staff turnover and resource scarcity; (2) community-based opposition to change and concerns about community backlash; (3) the presence or absence of supportive school leadership; and (4) variations in school, district, and state policies affecting LGBTQ+ students and attitudes about their importance. Findings illustrate how diverse power structures operated in and across outer and inner contexts to bound, shift, amplify, and otherwise shape how new practices were received and implemented.ConclusionFindings indicate that the efforts of IRTs were often a form of resistant power that operated within and against school hierarchies to leverage epistemic, discursive, and material power toward implementation. To improve health equity, implementation scientists must attend to the multiple real and perceived power structures that shape implementation environments and influence organizational readiness and individual motivation. Implementers must also work to leverage resistant power to counter the institutional structures and social norms that perpetuate inequities, like heteronormativity and structural stigma.

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Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

Cited by 20 publications

References 227 publications

Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

An audit of the dissemination strategies and plan included in international food-based dietary guidelines

Power and resistance in schools: Implementing institutional change to promote health equity for sexual and gender minority youth

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