Purpose: Implementation science bridges the gap between research and practice to improve individual and population health. This presentation will highlight opportunities for the research, practice and policy communities to develop and apply the implementation science knowledge base to improve the equitable impact of moving our physical activity and nutrition evidence base into practice.  

Methods and Results: First, NCI funding opportunities, research and practice tools for public use, and training opportunities for conducting health equity and implementation science research will be shared. Second, a discussion on key elements for consideration for health equity in implementation science research projects will be discussed including a focus on social determinants of health, highlighting application of models, frameworks and measures and methodological considerations that address equity in power and knowledge translation and dissemination. Opportunities for engagement and participation in the NCI Implementation Science Consortium in Cancer will be shared, including workgroup opportunities and “public goods” to advance the field.

Conclusions: In nutrition and physical activity, implementation science offers a tool to advance health equity by optimizing care delivery strategies, equalize power in the research process through partnership with stakeholders and communities and by building and co-generating capacity in clinical and community settings, as well as monitor and evaluate equitable implementation to reduce health disparities.  As a field, we can start to move as a field to eliminate disparities in physical activity and nutrition outcomes and foster rapid integration of research, practice, policy and equitable implementation.

Purpose: Schools located in lower socioeconomic areas face unique challenges to implementing school physical activity programmes due to their environmental context, resource demands and competing priorities. Modifications during the implementation of school physical activity programmes targeting disadvantaged secondary schools may be essential to maximize their flexibility and effectiveness, reducing the inequities of a ‘one-size fits all’ approach. Despite their potential to help explain the effectiveness of programmes, an understanding of the type and nature of modifications is seldom documented. The aim was to describe modifications made during the delivery of Physical Activity 4 Everyone (PA4E1).

Methods:  The PA4E1 implementation trial, was a two-year randomized controlled trial involving 49 secondary schools from low socio-economic areas of NSW, Australia. Modifications were captured in real-time (during implementation) through regular 30-minute meetings (n=16) of the implementation team. Modifications were initially coded according to Stirman et al’s (2013) framework for modifications, through consensus of the implementation team. Subsequently, Stirman et al’s 2019 expanded framework FRAME was used to create additional codes. An additional code of ‘proposed impact on effectiveness’ was also created. 

Results: All modifications were fidelity-consistent (i.e. core elements of the intervention preserved) (n=20; 100%). Most modifications (n=16; 80%) were proposed to have a positive impact on the effectiveness of the programme. Three-quarters of modifications (n=15; 75%) applied to all schools in the intervention group, the remaining modifications had impacts at the cohort level (a subset of schools sharing a particular characteristic). The main reason modifications were possible was “available resources (funds, staffing, resources, space)” of the programme deliverers (n=14; 70%).  Over half of the modifications were adaptations (i.e. proactive) (n=12; 60%), with the remaining modifications made reactively. Modifications were made to all seven implementation support strategies and to four of seven physical activity practices (the evidence-based intervention). One adaptation was made to the evaluation of the programme.

Conclusion: All modifications were fidelity-consistent and most were suggested to have a positive impact on the intervention. Most modifications were made possible through 'available' implementation team staffing and funding, and future programmes targeting disadvantaged schools may consider budgeting for modifications and tailoring of the implementation support.

Purpose: Myriad evidence-based practices (e.g., wellness practices) promote healthy eating and physical activity in K-12 schools. However, such practices are less likely to be implemented in schools with limited resources, which often serve children of color and/or children living in low-income households. Frameworks such as the Consolidated Framework for Implementation Research (CFIR) identify determinants of implementation in order to develop tailored implementation strategies, but do not explicitly capture upstream, systemic factors (e.g., historical disinvestment, property-tax-based funding) that disproportionately influence wellness practice implementation in under-resourced schools. This presentation draws upon two studies to identify questions/concepts related to these systemic factors that, if integrated into CFIR, could enable implementation strategies that prioritize equity.   

Methods: Semi-structured interviews were conducted with K-12 school staff in two studies: (1) an intervention trial to improve implementation of wellness practices in low/middle-income schools; (2) a national mixed-methods study of wellness practices in rural and urban schools. In both studies, interview guides used CFIR. First cycle coding along the five CFIR domains (inner setting, outer setting, characteristics of individuals, wellness practice characteristics, implementation process) was followed by a second coding cycle, which applied the Getting to Equity for Obesity Prevention framework (Kumanyika, 2019) to identify equity-focused questions within each CFIR domain specific to wellness practices.

Results: Across studies, 62 interviews were conducted with administrators, teachers, and other staff. Emerging equity-focused questions included: Do leaders belong to social groups with different perspectives on the need for wellness practices than staff/students (Inner Setting); What roles do under-resourced schools play in their community that may influence implementation, and could these roles be leveraged (Outer Setting); Which resources (e.g., space, staff) matter for which wellness practices (e.g., classroom-physical activity, water access) (Intervention Characteristics); Should implementation strategies focus on task shifting for existing staff, or address obstacles to hiring specialists (e.g., nurses, physical educators) (Process).

Conclusion: This analysis explores the integration of equity-focused research questions within determinant frameworks. To reduce implementation inequities for wellness-promoting practices in under-resourced schools, it is important to engage school stakeholders to define unique organizational characteristics, and develop strategies to address challenges and leverage assets.