Purpose:  Changing the built environment is one way to promote physical activity among children. However, creating and implementing effective environmental changes is challenging and requires involvement of many different actors. Also evaluating the effect of environmental changes is challenging and e.g. involves using a mixed methods approach using the RE-AIM framework (Glasgow et al 2019). We will present lessons learnt from three projects, ‘When Cities Move Children’, the ‘Activating Schoolyards Study’ and the ‘Move the Neighbourhood study’.

Methods: When Cities Move Children was a natural experiment with a repeat-cross-sectional graded exposure design, The Activating Schoolyards Study and the Move the Neighbourhood study were quasi-experimental mixed methods studies with a pre-post design. Participants wore an accelerometer (ActiGraph GT3X) and a GPS (Qstarz BT-Q1000XT) for seven days to determine the changes in physical activity levels. Participant observation and go-along group interviews were conducted to be able to understand what influenced. Interviews with children, teachers and designers were used to assess adoption, implementation and maintenance.

Results: In When Cities Move Children and the Activating Schoolyards Study participants increased time spent being physically active in the built environments that had been changed. However, there were significant differences by school, gender, type of facility and the overall activity level of the students. In the Move the Neighbourhood study, children spent 15 minutes more in the space post-intervention. However, the space was used fewer days and by fewer children, being less physically active after the intervention. The qualitative findings revealed larger effects at schools where the students experienced their wishes for renewal had been carried out. Our evaluation highlighted challenges associated with how the children were involved, and that a lack of maintenance after the intervention ended impacted activity levels and use.

Conclusions: The results from these three studies show that changing that built environment can lead to device measured changes in children’s physical activity behavior. However, there are large local and individual variations, and much of these differences could be explained by differences in implementation during the design and construction phase of the projects.

Purpose: To describe ‘how to’ embed process, implementation and partnership evaluation into a real-world randomised controlled trial (RCT) incentivising public transport to increase physical activity (PA). Intervention participants receive public transport credit for achieving weekly travel targets, and weekly text messages over four months. This trial was developed in partnership with a public transport provider, local government and state government.

Methods: Evaluation was guided by three frameworks. Process evaluation elements included feedback from pilot study participants assessing participation experiences; individual interviews with partner organisation staff before, during and after trial implementation; and individual interviews with intervention group participants post-trial. Implementation evaluation elements included assessment of fidelity, dose and reach; development of a logic model; and consideration of significant weather events and policy, administrative or service-related changes to assess context. A partnerships analysis tool enabled reflection and strengthening of new and existing partnerships.

Results: Pilot study feedback (process evaluation) resulted in clarification of instructions for technology-based study measures, refinement of travel behaviour measures, and clearer guidance on study time commitments. Feedback from interviews with partner organisation staff resulted in refinements to data capture and exchange systems, and identification of contextual factors of potential. Since commencement (September 2019), implementation evaluation shows that of 179 people who read online study information, 99 were ineligible, and of the 80 who were eligible, 65 have consented and 24 of these have been randomised into the study. The number of partnerships (partnership evaluation) increased from four to 11 between 2018 and 2019.

Conclusions: Unlike traditional RCTs, this study is being conducted in a real-world setting through a research-community partnership. Many potential issues associated with moving an intervention from the research setting to the real-world setting have been negotiated throughout the study design and development process. Factors identified as important in implementation science frameworks, such as leadership motivation and engagement, communication, engaging intervention staff, reflecting and evaluating, and empirical evidence, were critical for successful rollout. Embedded implementation, process and partnership evaluation measures have already been useful for refining and strengthening the study design, participant experience, partnerships and potential for scalability.  

Purpose: Obesity prevention in early life is critical, however few effective interventions have been scaled up and integrated into routine service delivery to achieve population level impact. The infant feeding, active play and nutrition (INFANT) initiative is a previously trialled efficacious healthy lifestyle program delivered via first time parent groups in the first 12 months of the infants’ life utilising a universally delivered maternal and child health service. From 2020, INFANT will be available to all (n=76) local governments across Victoria, Australia. This paper reports on key lessons learnt regarding implementation establishment for the delivery of INFANT ‘at scale’ within real-world settings.

Methods:

This is a 5-year implementation research project involving 10 practice and policy partners ensuring reach to vulnerable communities across Victoria, Australia. Implementation establishment is described using the PRACTIS guide (Koorts et al 2018). Implementation evaluation uses a mixed methods approach using the RE-AIM framework (Glasgow et al 2019).

Results:

PRACTIS guide steps were iterative in nature, with characterisation of the implementation setting and stakeholder engagement occurring concurrently. Evidence from INFANT efficacy trials and ‘small scale’ implementation studies expedited the describing of features and processes of adoption and implementation. The establishment of an implementation advisory group and the use of a co-design approach has been essential to refine implementation strategies. Baseline organisational readiness (RR 53.2%) showed high levels of motivation, commitment and efficacy for implementation. Levels of change capacity however were low with concerns about adequate funding and staffing to enable and sustain INFANT implementation. These and other contextual barriers and enablers explored over the duration of the research project will inform adoption and implementation to maximise opportunities for integration into existing delivery systems.

Conclusions:

The PRACTIS guide was a useful tool to plan and operationalise the adoption and implementation of INFANT within a ‘real world’ context. Engaging practice and policy partners early in these processes has enabled early identification of important barriers and co-design of appropriate solutions, strengthening implementation and scale-up efforts.