Mind the gap: Danish school heads' ability to implement a national physical activity school requirement.

In 2014, the Danish government introduced a wide-ranging reform of primary and lower secondary education that applied to all public schools. A distinctive feature was that it became mandatory for schools to provide an average of 45 min of daily physical activity (PA). The capacity for change of local school heads and the schools overall are considered key to fulfilling such a policy-driven requirement. The aim of this study is therefore to explore local school heads' ability to implement the stated requirement of 45 min of daily PA within their local organizational capacity for change. Eleven semi-structured interviews were conducted across 11 schools. Respondents were school staff with management responsibilities (leading teachers with school management responsibilities, deputy heads and school heads). Results indicate that local school heads are central agents in converting the Danish school requirement of 45 min of daily PA into local action. This includes their ability to advance broad aims into concrete goals, secure supportive structures and organize the implementation strategy. Heads also need to support the staff in building sufficient knowledge capacity on how to arrange and incorporate PA into their daily practice, support the widespread dissemination of this knowledge across the school and reserve work hours for such activities. Assigning local PA ambassadors was particularly highlighted as important implementation support, as they can help build and disseminate knowledge while also broadcasting the school head's strategy and focus on integrating and upholding students' PA levels.

Same, Same but Different: Comparing Program Fidelity at Early Versus Late Adopters of a Successful Long-Term School-Based Physical Activity Intervention.

Schools have been identified as a promising setting for promoting physical activity (PA). Yet, to realize changes at the population level, successful school-based PA programs need to go to scale. The Svendborgproject is an effective school-based program promoting additional physical education (PE) lessons. The aim of this study is to determine program fidelity across different school groups, representing early and late adopters of the Svendborgproject, and how these are adapting the intervention. Three different school groups were identified, covering the original intervention schools and two groups of late adopters consisting of four former control schools, and five normal schools without any previous connection to the program. A PE teacher questionnaire (n = 122) was used to determine school fidelity. The results show that, while the original intervention schools have implemented the program with the highest fidelity, all schools have implemented the program with medium to high fidelity. It is suggested that having front-runner schools achieving early success with the program both strengthens political project support and provides strategies to back late adopters' implementation of the program. Furthermore, results from the current study suggest that continual promotion of the program by school heads is less important if support is established at the structural and organizational macro level. Finally, we highlight the importance of scaling up organizational capacity when scaling up program reach to assure a workable balance between fidelity and improving the fit to specific contexts.

In It for the Long Haul: RE-AIM Evaluation of a Preschool Programme Implementing and Maintaining Adult-Initiated Motor Skill Development and Physical Activity across a Two-Year Period.

Good motor skills (MS) are considered important for children's social, psychological and physical development and general physical activity (PA) levels. The Motor skill in Preschool study (MiPS) aimed to optimize children's MS through weekly PA sessions. The aim of this study is to use the RE-AIM framework to report the two-year implementation process of MiPS since the programme's initiation. Data were collected through a staff questionnaire based on the RE-AIM framework. Data were collected at three months, one year and two years after initiation. Results show that the pedagogical staff believes that the programme promotes MS in children. Implementation measures only showed medium to low fidelity concerning the core element of performing adult-initiated PA sessions with a duration of at least 45 min 4 days a week. The largest barrier was finding the time to plan these PA sessions. Still, the content of the PA sessions achieved high fidelity scores and the programme was deemed suitable for staff's everyday practice and in alignment with the stated pedagogical goals. The mandatory competence development course was highly valued as strong implementation support. It is notable that there is a large variation in the implementation among the preschools with some struggling more than others.

Left to Their Own Devices? A Mixed Methods Study Exploring the Impacts of Smartphone Use on Children's Outdoor Experiences.

The growing use of smartphones has been pointed out as one of the main reasons for the decrease in children's outdoor time. However, there is still a gap in our understanding of how smartphone use affects children's outdoor experiences and activities. The aim of the study is to explore children's dependency on their smartphones, what smartphone functions children use when outdoors and how smartphone use affects children's outdoor experiences. The study uses a mixed methods design which implements interviews with a small sample of children (N = 34) in order to help develop a questionnaire for a larger sample (N = 1148). Both datasets are included in the analysis with a complimentary perspective. The results suggest that children are highly dependent on having their smartphones available as an integrated part of their lives. However, smartphones also create favorable conditions for rich and valuable outdoor lives by expanding children's and parents' sense of security, children's outdoor sociality, and children's opportunities to mold their outdoor experiences. We stress that children's passion for the digital world needs to be reconsidered as not 'all bad', but more as a condition in modern children's lives and an asset to embrace in future strategies for actively engaging children in outdoor activities.

A Ban on Smartphone Usage during Recess Increased Children's Physical Activity.

School recess provides a unique opportunity for children to be active. However, many children perceive smartphones as a key barrier for engaging in physical activity during recess. The aim was to investigate if a ban on smartphone usage during recess changed children's physical activity. During August-October 2020, children from grades 4-7 (10-14 years) at six Danish schools were banned from using their smartphones during recess for a four-week period. Questionnaire and systematic observation (SOPLAY) data were collected from 814 children before intervention (baseline) and 828 during the last week of intervention (follow-up). The mean frequency of physical activity significantly increased from baseline to follow-up (odds ratio = 1.370), as did physical activity on a moderate level (odds ratio = 1.387). Vigorous physical activity significantly decreased (odds ratio = 0.851). The increase in physical activity was found among both schools having outdoor and indoor recess, among both boys and girls, and nearly equally among grades 4-7. This suggests that implementing a ban on smartphone usage during recess would improve the everyday conditions for health among a broad range of schoolchildren. Future studies are needed to further investigate the association between recess physical activity and smartphone usage.

The Role of Local Leaders in the Implementation of Adult-Initiated Motor Skill Development and Physical Activity in Preschool-A Case Study.

Good motor skills (MS) and physical activity (PA) are considered important for children's physical, social, and psychological development. The Motor skills in PreSchool (MiPS) study-Denmark aimed to optimize children's MS through weekly PA sessions. The aim of this paper is to explore the role of local preschool leaders and their strategies in influencing the implementation of MiPS into daily practice. Leaders from all seven preschools in the project were interviewed. The results show that preschool leaders used communication (setting an agenda and dedicating speaking time to address the program at staff meetings) and reflective questioning about the pedagogic staff's current practice in relation to the program (adding focus on MS and PA) as their main course of action. Through this form of communication and reflective questioning, the preschool leaders aimed to involve the staff and heighten their sensemaking in the existing practice while also ensuring that the implementation of the program was kept in progress. In sum, future implementation of an MS and PA initiative in preschools should put emphasis on a shared responsibility between leaders and staff combined with an adaptive approach in which the existing practice is reshaped rather than just increasing the workload of the pedagogic staff.

Will the children use it?-A RE-AIM evaluation of a local public open space intervention involving children from a deprived neighbourhood.

Knowledge on how to improve public open spaces in deprived neighbourhoods to increase active living among children is scarce and comprehensively evaluated public open space interventions are needed. Firstly, the aim was to explore if involving 39 local fifth-grade children (10-11 years old) from a deprived neighbourhood in creating playable installations in a public open space influenced their use of this space. Secondly, we wanted to explore if the Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was useful for evaluating different stages in the intervention project. RE-AIM was applied through a convergent mixed-methods triangulation design using survey, accelerometer, GPS, and interviews as data sources. Effectiveness outcomes revealed that on average the space was used less by the 39 children after the intervention. The implementation and maintenance dimensions revealed aspects of why most children involved in the project did not use the space after intervention. The evaluation cast light on children's perceptions of their role, and importance of maintenance when the intervention was completed. In future, all dimensions of built environmental projects would benefit from being planned and evaluated in a collaboration with all project partners using an evaluation framework integrated and applied from the beginning of the project.

Implementation of a successful long-term school based physical education intervention: Exploring provider and programme characteristics.

There is an ongoing need for research focusing on how to implement physical activity programmes into a school setting. This includes documentation of the extent to which programmes are compatible with the basic views of providers and their local practices. The present study explores the Svendborgproject - a programme tripling the amount of physical education in six public schools, sustaining it for 10-years and documenting a decreased incidence of overweight, obesity and cardiovascular risk factors. The aim was to analyse provider and programme characteristics of the Svendborgproject to gain insights into providers motives for adopting, implementing, and maintaining the programme. Six school heads and six teachers were interviewed to explore how they perceived programme compatibility to their school's practice and their own role as providers. Both teachers and school heads found the additional lessons a valuable asset that fitted existing school values and priorities. Additionally, physical education teachers participated in a course providing new perspectives and teaching methods that aided the implementation of the programme. Lastly, school heads stressed that implementation fidelity was heavily dependent on the dedication of physical education teachers and on having simple programme requirements that made it clear what could be expected of the programme.

Implementation of triple the time spent on physical education in pre-school to 6th grade: A qualitative study from the programme managers' perspective.

Schools constitute an important arena for promoting physical activity. However, school-based programmes often face implementation challenges, and the identification of factors influencing the implementation process is considered important in order to secure the effectiveness of future interventions. The aim of this study was to identify factors influencing the various implementation stages during the initial years of a programme tripling the amount of physical education at the primary school level. Document analysis of publicly available programme descriptions and meeting minutes, were conducted. Document analysis was complemented by two semi-structured group interviews with main programme managers to gather in-depth programme experiences and perspectives. Results show that early involvement of schools may ensure the best possible match between programmes and the needs and resources of schools, and that an ongoing shared partnership may help programme managers address program challenges in early stages. It seems that predetermined core elements in programmes are essential. At the same time programmes must be flexible enough for adaptation to individual school contexts. Finally, the implementation of triple the amount of physical education, is supported by teachers receiving a professional development course focusing on how to organise outdoor physical education in different seasons and weather conditions.

Using the RE-AIM framework to evaluate a school-based municipal programme tripling time spent on PE.

Documenting the implementation of effective real-world programmes is considered an important step to support the translation of evidence into practice. Thus, the aim of this study was to identify factors influencing the adoption, implementation and maintenance of the Svendborgproject (SP) - an effective real-world programme comprising schools to implement triple the amount of physical education (PE) in pre-school to sixth grade in six primary schools in the municipality of Svendborg, Denmark. SP has been maintained for ten years and scaled up to all municipal schools since it was initiated in 2008. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was applied as an analytic tool through a convergent mixed method triangulation design. Results show that SP has been implemented with high fidelity and become an established part of the municipality and school identity. The successful implementation and dissemination of the programme has been enabled through the introduction of a predominantly bottom-up approach combined with simple non-negotiable requirements. The results show that this combination has led to a better fit of programmes to the individual school context while still obtaining high implementation fidelity. Finally, the early integration of research has legitimated and benefitted the programme.