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RESEARCH PRODUCT

Acceptability, reach and implementation of a training to enhance teachers’ skills in physical activity promotion

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This is a pre-print of a published study: Renko, E., Knittle, K., Palsola, M. et al. Acceptability, reach and implementation of a training to enhance teachers’ skills in physical activity promotion. BMC Public Health 20, 1568 (2020). https://doi.org/10.1186/s12889-020-09653-x Background: In order to achieve real-world impacts, successful behavior change interventions need to be scaled up and broadly implemented. Implementation is challenging however, and the factors influencing successful implementation are not fully understood. This study describes the nationwide implementation of a complex theory-based program to promote physical activity and reduce sedentary behavior in vocational schools (Let’s Move It; LMI). The implementation primarily involved a systematic and theory-based training intervention and user manual for school staff. This study explores how the perceived acceptability of this training intervention (using the dimensions of the Theoretical Framework of Acceptability) relate to (un)successful implementation. The purpose is to evaluate (1) the experienced acceptability of the training intervention and anticipated acceptability of later delivering the program; (2) the reach and implementation, including adaptations and barriers; (3) the extent to which acceptability ratings predict teachers’ intentions for implementation.Methods: School staff (n=194) enrolled in a two-part training intervention, covering implementation of the LMI program and training in motivational interaction styles. Participants reported their perceived acceptability of the training intervention and their implementation efforts in online questionnaires at baseline, after training sessions and at long-term follow-up. Qualitative data were analysed with content analysis and quantitative data with correlations and logistic regression.Results: School staff rated the acceptability of the training intervention as very high on all assessed dimensions (average ratings exceeded 4.0 on a 5-point scale). The nationwide implementation reached at least 6,100 students and 341 school classes. Most teachers intended to continue program implementation, and higher ratings of acceptability were related to stronger subsequent intentions to implement the program. Teachers commonly reported condensing program content during implementation, and reported lacks of time and collegial support as the most common barriers to implementation. Conclusion: This case study presents the development and evaluation of the national real-world implementation of a physical activity program. Considerably high acceptability and reach of the training intervention indicates high potential for implementation success. The role of addressing the multiple facets of acceptability in implementation projects warrant more research focus.