School Coordinators' Perceptions of Organizational Readiness Is Associated with Implementation Fidelity in a Smoking Prevention Program: Findings from the X:IT II Study.

School organizational readiness to implement interventions may play an important role for the actual obtained implementation level, and knowledge about organizational readiness prior to intervention start can help pinpoint how to optimize support to the schools. In this study, we applied a novel heuristic, R = MC2 to assess school organizational readiness prior to implementation of a multicomponent smoking prevention program. Furthermore, we examined the association to actual implementation after the first year of study. We used questionnaire data from school coordinators at 40 schools in Denmark who had accepted to implement the multi-component smoking prevention intervention-X:IT II-in the school year 2017-2018 including three main components: (1) Rules on smoke-free school time, (2) A smoke-free curriculum, and (3) Parental involvement. On behalf of the school, a school coordinator answered a baseline questionnaire about the organizational readiness and a follow-up questionnaire about implementation of the three components after first year of study. Readiness was measured by summing aspects of motivation (relative advantage, compatibility, complexity, and priority), general capacity (culture, climate, and staff capacity), and innovation-specific capacity (knowledge, skills, and abilities). Based on school coordinators' perceptions, almost all schools had good general capacity while the other two areas of readiness varied across schools; overall, 56.8% of schools (N = 25) had good motivation for implementing the X:IT II intervention and 61.3% (N = 27) had high innovation-specific capacity. Half of the schools had high overall readiness defined as high motivation and high innovation-specific capacity. Schools with high overall readiness implemented the rules on smoke-free school time, smoke-free curriculum, and parental involvement to a higher degree than schools with low overall readiness. All participating schools possessed sufficient levels of general capacity, e.g., a well-functioning organizational culture and sufficient staff capacity. High levels of motivation and innovation-specific capacity were positively associated with the schools' actual implementation of the main intervention components. This way of conceptualizing and measuring organizational readiness may be useful in future studies, i.e., in studies where enhancing readiness is a main objective.

Increases in Use and Activity Due to Urban Renewal: Effect of a Natural Experiment.

INTRODUCTION: Urban green space and other recreational facilities are associated with physical activity. For adolescents living in multistory housing, public outdoor spaces that support physical activity may play an important role in activity promotion strategies. However, stronger evidence for a relation between the built environment and adolescent physical activity is scarce. DESIGN: A natural experiment with a pre-experimental design was used with data collected in 2010 and 2012 before and after an urban renewal. Data were analyzed in 2016. SETTING/PARTICIPANTS: Adolescents aged 11-16 years spending a minimum of 10 minutes daily within a 400-m buffer of the renewal district were included in the analyses, resulting in 354 adolescents at baseline and 319 post-renewal. INTERVENTION: A multicomponent urban renewal project of approximately 35 million Euros in a disadvantaged neighborhood in the capital of Denmark occurred between 2010 and 2012. MAIN OUTCOME MEASURES: The main outcomes were changes in time spent and physical activity within the area among adolescents, measured by accelerometry (ActiGraph GT3X) and GPS devices (Qstarz BT-Q1000XT). RESULTS: Time spent in the area was greater in 2012 than 2010 with an additional 24.6 minutes per day (p=0.017). Of this time, 7.8 minutes were spent in light and 4.5 minutes in moderate to vigorous physical activity. CONCLUSIONS: The present study indicates that a multicomponent urban renewal strategy in a disadvantaged district has the potential to increase time spent and physical activity in the district for adolescents living in or close to the district.

Children's Physical Activity Behavior during School Recess: A Pilot Study Using GPS, Accelerometer, Participant Observation, and Go-Along Interview.

Schoolyards are recognized as important settings for physical activity interventions during recess. However, varying results have been reported. This pilot study was conducted to gain in-depth knowledge of children's physical activity behavior during recess using a mixed-methods approach combining quantitative GPS and accelerometer measurements with qualitative go-along group interviews and participant observations. Data were collected during three weekdays in a public school in Denmark. Eighty-one children (47 girls) wore an accelerometer (ActiGraph GT3X) and GPS (QStarz BT-Q1000xt), sixteen children participated in go-along group interviews, and recess behavior was observed using an ethnographical participant observation approach. All data were analyzed separated systematically answering the Five W Questions. Children were categorized into Low, Middle and High physical activity groups and these groups were predominantly staying in three different locations during recess: school building, schoolyard and field, respectively. Mostly girls were in the building remaining in there because of a perceived lack of attractive outdoor play facilities. The children in the schoolyard were predominantly girls who preferred the schoolyard over the field to avoid the competitive soccer games on the field whereas boys dominated the field playing soccer. Using a mixed-methods approach to investigate children's physical activity behavior during recess helped gain in-depth knowledge that can aid development of future interventions in the school environment.

Space, body, time and relationship experiences of recess physical activity: a qualitative case study among the least physical active schoolchildren.

BACKGROUND: Increasing recess physical activity has been the aim of several interventions, as this setting can provide numerous physical activity opportunities. However, it is unclear if these interventions are equally effective for all children, or if they only appeal to children who are already physically active. This study was conducted to explore the least physically active children's "lived experiences" within four existential lifeworlds linked to physical activity during recess: space, body, time, and relations. METHODS: The study builds on ethnographic fieldwork in a public school in Denmark using a combination of participatory photo interviews and participant observation. Thirty-seven grade five children (11-12 years old) were grouped in quartiles based on their objectively measured daily physical activity levels. Eight children in the lowest activity quartile (six girls) were selected to participate in the study. To avoid stigmatising and to make generalisations more reliable we further recruited eight children from the two highest activity quartiles (four girls) to participate. RESULTS: An analysis of the least physically active children's "lived experiences" of space, body, time and relations revealed several key factors influencing their recess physical activity: perceived classroom safety, indoor cosiness, lack of attractive outdoor facilities, bodily dissatisfaction, bodily complaints, tiredness, feeling bored, and peer influence. CONCLUSION: We found that the four existential lifeworlds provided an in-depth understanding of the least physically active children's "lived experiences" of recess physical activity. Our findings imply that specific intervention strategies might be needed to increase the least physically active children's physical activity level. For example, rethinking the classroom as a space for physical activity, designing schoolyards with smaller secluded spaces and varied facilities, improving children's self-esteem and body image, e.g., during physical education, and creating teacher organised play activities during recess.

Activating schoolyards: study design of a quasi-experimental schoolyard intervention study.

BACKGROUND: The aim of the Activating Schoolyards Study is to develop, implement, document and assess a comprehensive schoolyard intervention to promote physical activity (PA) during school recess for primary school children (grade 4-8). The intervention is designed to implement organizational and structural changes in the physical environment. METHOD: The study builds on a quasi-experimental study design using a mixed method approach including: 1) an exploratory study aimed at providing input for the developing process; 2) an evaluation of the effect of the interventions using a combination of accelerometer, GPS and GIS; 3) a process evaluation facilitating the intervention development process and identifying barriers and facilitators in the implementation process; 4) a post-intervention end-user evaluation aimed at exploring who uses the schoolyards and how the schoolyards are used. The seven project schools (cases) were selected by means of an open competition and the interventions were developed using a participatory bottom-up approach. DISCUSSION: The participatory approach and case selection strategy make the study design novel. The use of a mixed methods design including qualitative as well as quantitative methods can be seen as a strength, as the different types of data complement each other and results of one part of the study informed the following parts. A unique aspect of our study is the use of accelerometers in combination with GPS and GIS in the effect evaluation to objectively determine where and how active the students are in the schoolyard, before and after the intervention. This provides a type of data that, to our knowledge, has not been used before in schoolyard interventions. Exploring the change in behavior in relation to specific intervention elements in the schoolyard will lead to recommendations for schools undergoing schoolyard renovations at some point in the future.