Physical activity implementation in schools: a 4-year follow-up

Background: Action Schools! BC (AS!BC) is a comprehensive school-based model that utilizes a socioecologic approach to provide children with opportunities for physical activity at school in British Columbia.

Purpose: The hierarchy of factors associated with successful implementation of AS!BC was examined 4 years after it was scaled up.

Methods: A cross-sectional multistage survey was administered to principals (n=133; 92% response rate) and Grade 4-7 teachers (n=587; 71% response rate) in 2008-2009. Constructs from the theories of organizational change, social cognitive theory and Rogers's diffusion of innovation model were used to examine characteristics of teachers and schools and attributes of the innovation associated with implementation. Multilevel mixed-effect logistic regression analyses were employed (analyzed in November 2011).

Results: Self-efficacy, outcome expectation, training received, organizational climate/support, level of institutionalization, environmental influence, and attributes of the innovation were associated with implementation. In multivariate analyses, self-efficacy, training, and level of institutionalization remained significant (all p<0.05).

Conclusions: Demonstrating that an intervention "works" is only the first step toward promoting enhanced health at the population level. For wide-scale implementation, teacher-level self-efficacy and ongoing technical support to train teachers were important. At the school level, policies and guidelines provided a necessary, supportive environment for implementation.