Purpose: Motor competence (MC) is important to public health outcomes such as physical activity, fitness and weight status. Yet MC levels are low and are particularly low in girls. Although numerous studies address the effectiveness of MC interventions, less research addresses the implementation and sustainability of the interventions. This study aimed to investigate the extent to which teachers continued implementing an efficacious teacher-led program, which significantly improved MC in girls (12 years), three years post-intervention.

Methods: Teachers’ ongoing implementation and perceptions of program sustainability were examined utilising the UK Medical Research Council (MRC)’s framework, in three specific domains: i)Implementation (post-evaluation) ii) Mechanism of (sustained) change, and; iii) Context (i.e., barriers and facilitators). All teachers who participated in the original trial (n=18) completed questionnaires followed by focus group discussions (FGs). Descriptive statistics analysed questionnaires. FGs were audio recorded, transcribed verbatim, and analysed in NVivo 11 using a framework approach.

Results: All teachers had continued to implement the program, or elements thereof, three years post-intervention. The structure of the intervention, in particular the alignment to the school, subject and unit configuration, emerged as the most influential factor in regards to ongoing implementation. In regards tomechanism of change, improvement, in regards to both teacher practice and student performance, emerged as a driver of change. The adaptations made to the program post evaluation significantly expanded the reach, and appeared highly influential to program sustainability. The demand or need for the intervention appeared as the most predominant facilitator.

Conclusion: Engagement with the end-user (i.e., teacher), to identity individual need and contextual differences in the early stages of intervention development is integral not only to intervention effectiveness in the short term, but also to program sustainability. Framed by implementation science, these findings provide valuable understanding around the translation of research into practice, and useful information in regards to program sustainability and potential scalability.

Purpose: Current guidelines recommend young people engage in muscle-strengthening activities (e.g., resistance training [RT]) on at least three days per week. Despite this, and global declines in muscular fitness, few school-based interventions have focused on the promotion of RT. Furthermore, few school-based physical activity interventions have been implemented at-scale. The purpose of this study was to evaluate the state-wide dissemination of the Resistance Training for Teens (RT for Teens) program using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.

Methods: RE-AIM data were collected using mixed methods, including analysis: school level data (Reach), workshop enrolments (Reach, Adoption), smartphone application (app) usage (Effectiveness, Implementation), session observations (Implementation), and semi-structured interviews (Reach, Implementation, Maintenance).

Results: Reach: Potential program reach was ~200,000 students, maximized by the varied delivery methods of the program. Effectiveness: Self-report data from the purpose-built RT for Teens smartphone app indicated positive findings for students’ muscular fitness. Adoption: To date, 30 workshops have taken place, with 477 teachers, from over 250 schools in attendance. Implementation: Level of implementation varied considerably across schools. Data from the RT for Teens app showed that almost half of participating schools (i.e., schools where at least one teacher had attended the teacher-training workshop) downloaded and used the app as an implementation resource. Process evaluation data indicated most teachers utilized the RT for Teens program resources within their lessons. Maintenance:Interviews with teachers highlighted their intentions to implement the program in the future and share information/resources with fellow staff.

Conclusions: The RT for Teens program had large potential reach, but implementation varied considerably across schools. External support from change agents may be needed to overcome barriers and optimize intervention implementation in schools. Future research is needed to explore the impact and cost-effectiveness of interventions that test different levels of implementation support.

Purpose: Schools were randomly allocated to a control arm (n=25) or the Physical Activity 4 Everyone (PA4E1) program group (n=24). Program schools received implementation support incorporating seven overarching strategies to implement seven physical activity practices over 24 months. We address the fidelity and reach of, and modifications to, the implementation support strategies, as these domains are rarely well described.  Firstly, to understand if the implementation support was delivered as intended, we specify what components of support were actually delivered to schools (fidelity). Secondly, to explore what support may have been useful or relevant to schools, we specify what support schools actually up-took (reach). Finally, we specify modifications to the implementation support provided.

Methods: We coded the seven implementation support strategies of PA4E1 into 23 sub-strategies and devised both fidelity and reach assessment criteria. Data were obtained from project administrative data; surveys with teachers leading the program and Head Teachers of Physical Education; and from a fidelity monitoring log completed monthly by the research team. Descriptive statistics summarise the dose of the implementation support intervention (fidelity and reach), allowing equal weight to sub-strategies (n=23) within each strategy (n=7). Modifications were recorded via consensus at monthly research team meetings according to the FRAME framework.

Results/findings: At 12 months, fidelity across all schools (n=24) was high, 95.6% (SD 6.4; range 86.1-100%). The reach score was 81.5% (SD 7.5; range 69.0 -91.7%), indicating that schools up-took the majority of sub-strategies. Sub-strategies with the lowest reach were: providing feedback reports to school principals (6/24 schools); the school committees responsible for PA4E1, as schools did not form committees, include an executive member or meet termly (10-15/24 schools); in 12 of 24 schools, less than 70% of PE teachers completed online training. Fidelity and reach at 24 months will be reported also. Modifications across the 24 months were mainly to content and context, and both planned and unplanned. Consensus indicated the impact of modifications was minimal, and none were to core program elements.

Conclusions: The majority of the support provided to schools was implemented as intended, at least over 12 months, and schools up-took the majority of what was offered.

PURPOSE: School physical activity policies have been mandated by many jurisdictions internationally however implementation of such policies is poor. Without population wide implementation, the potential benefits of school policies will not be realised. The aim of this paper is to describe how an intervention that increased schools’ compliance with a mandatory physical activity policy was taken from efficacy to scale-up.

METHODS: Optimisation is an emerging field within implementation science involving an iterative, data-driven process to improve the impact of an intervention. The optimisation process involved a series of randomised controlled trials (RCT), undertaken between 2016-2018, with the aim of developing the most effective and scalable implementation strategy, that could be delivered by a service delivery organisation. Intervention effectiveness was measured via schools compliance with the mandatory policy and children’s physical activity levels measured via accelerometer.

RESULTS: Following extensive formative research which included i) literature reviews; ii) interviews with teachers and iii) observations of teachers’ delivery of physical activity the identified barriers/ facilitators to policy implementation were mapped to the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework (TDF). Potential behaviour change techniques and implementation strategies were then identified and presented to an advisory group to assess against the APEASE criteria. Implementation strategies included; executive support, training in-school champions, provision of tools and resources, implementation prompts, reminders and feedback. The findings from each RCT as well as the methods used to modify the implementation strategies of each subsequent trial in terms of behaviour change technique, dose or modality will be presented.

CONCLUSIONS: This is the first study to optimise an implementation intervention to increase schools’ compliance with a mandatory physical activity policy. Given the dearth of research, the findings will be important in informing future implementation efforts in this setting. Furthermore, the methodology used may inform the design of other health promotion programs in schools or other settings more broadly.

Purpose: Physical activity promotion is embedded within complex systems and active recreation represents an opportunity to improve children’s physical activity participation. However, as the factors that influence active recreation are complex, new methodological approaches are required. This study developed an active recreation static systems model by mapping key stakeholders, correlates, and intervention evidence for promoting child and youth active recreation in Victoria, Australia.

Methods: Seven databases were searched for reviews of correlates and interventions of child active recreation, published between January 2013 and July 2018. These were mapped and causal loop diagrams generated. An actor map of stakeholders included six levels of influence: 1) international; 2) government; 3) regulatory and peak bodies, advocacy groups, and industry associations; 3) local government, education, and sport; 4) social environment; 5) individual; and 6) built environment. Stakeholders were invited to face-to-face interviews to provide input to expand and refine the maps and causal loop diagrams.

Results: Three maps and two causal loop diagrams for children and adolescent’s active recreation were developed including relevant actors, correlates, and interventions. Literature searches uncovered correlates at the local (n=9), social (n=28), individual (n=35), and built environment (n=21) level. There were 49 variables at the local (n=9), social (n=13), individual (n=19), and built environment (n=8) targeted in interventions. The actor map identified 125 specific actors in relation to active recreation in Victoria. This included: international (n=10), government (n=19), regulatory body and advocacy group (n=44), local (n=16), social (n=20), individual (n=3), and built environment (n=13) levels of influence. Twenty-three individuals participated from 16 stakeholder organisations ranging from public, private, and not-for-profit groups, government, regulatory or advocacy, education, sport, social, and built environment organisations. Only a small number of stakeholders identified active recreation as their core business. Feedback indicated the positive potential for systems modelling approaches as a policy, appraisal, advocacy, and decision-making tool.

Conclusions: By identifying priorities and action areas likely to have system-level impacts, systems modelling approaches represent a vital step in moving beyond cause-effect models of physical activity promotion and could help identify leverage points to effectively promote active recreation in children and youth.