Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention.
Background: Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption acr...
| Publicado en: | International Journal of Behavioral Nutrition & Physical Activity Vol. 22; no. 1; pp. 1 - 14 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BioMed Central
8/18/2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187384635&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187384635 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14795868 1CR7 jtl: International Journal of Behavioral Nutrition & Physical Activity issn: 14795868 maglogo: N pubinfo: dt: 8/18/2025 vid: 22 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 187384635 187384635 187384635 10.1186/s12966-025-01810-y 187384635 ppf: 1 ppct: 13 formats: tig: atl: Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention. aug: au: Ganakas, Elly Salmon, Jo Ma, Jiani Lamb, Karen E. Barnett, Lisa Bauman, Adrian Telford, Amanda Ridgers, Nicola D. Timperio, Anna Koorts, Harriet affil: https://ror.org/02czsnj07 School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, VIC, Australia sug: subj: Health Promotion Psychosocial Factors Physical Activity In Infancy and Childhood Program Implementation Psychosocial Factors Government Environment School Health Services Victoria Sedentary Behavior Prevention and Control Implementation Science Communication Human Funding Source Retrospective Design Record Review Association (Research) Descriptive Statistics Time Series Communications Media Newsletters School Policies COVID-19 Pandemic Online Education Geographic Factors Chi Square Test Public Sector Confidence Intervals Learning Methods Learning Environment Public Health Health Inequities Victoria Child Child Health Private Sector Child: 6-12 years ab: Background: Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption across meso- and macro-system levels using data from the 2018–2022 state-wide hybrid effectiveness-implementation trial of TransformUs Primary, a whole-school physical activity intervention. Aims were to: (1) assess differences in contextual characteristics between adopting and non-adopting schools and implications for equity, and (2) assess associations between macro-level events and dissemination events with program adoption over time. Methods: Descriptive statistics (number and %) and chi-squared tests were used to assess differences in contextual characteristics between adopting and non-adopting schools (Aim 1). A time-series analysis of daily data was used to explore associations between the number of dissemination events promoting program awareness (e.g., media, newsletters), macro-level policy events (e.g., education department policies), COVID-19-related remote/on-site learning periods, school term dates (i.e., during/outside of school term) and program adoption (i.e., the number of TransformUs Primary registrations per day) (Aim 2). Results: No differences in either school type (i.e., primary, combined, or special) or community level socio-educational advantage between adopting (n = 519) and non-adopting schools (n = 1,423) were identified. A higher proportion of adopting schools were located in major cities (71.7% vs. 54.5%; chi-square p < 0.001) and were government (public sector) schools (80.0% vs. 63.1%; chi-square p < 0.001). Time-series analysis results indicated that the likelihood of adopting TransformUs Primary decreased from the date of program launch to the end of the scale-up period (IRR 0.999, 95% CI 0.999–1.000; p < 0.005). Both school term date (IRR 5.95, 95% CI 4.78–7.41; p < 0.001) and dissemination events (IRR 3.30, 95% CI 2.67–4.06; p < 0.001) increased the likelihood of adopting TransformUs Primary. Results provided little evidence of an association between the number of policy events or COVID-19-related remote and on-site learning periods and adoption. Conclusions: Select meso- and macro-level factors had an impact on TransformUs Primary adoption. Findings inform the need to work with stakeholders in scale-up to prioritize dissemination strategies that have a discernible impact on adoption above others and consider targeted efforts to reach regional/rural and non-government schools. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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