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      Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: application of the theoretical domains framework

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          Abstract

          Background

          In British Columbia Canada, a Daily Physical Activity (DPA) policy was mandated that requires elementary school teachers to provide students with opportunities to achieve 30 min of physical activity during the school day. However, the implementation of school-based physical activity policies is influenced by many factors. A theoretical examination of the factors that impede and enhance teachers’ implementation of physical activity policies is necessary in order to develop strategies to improve policy practice and achieve desired outcomes. This study used the Theoretical Domains Framework (TDF) to understand teachers’ barriers and facilitators to the implementation of the DPA policy in one school district. Additionally, barriers and facilitators were examined and compared according to how the teacher implemented the DPA policy during the instructional school day.

          Methods

          Interviews were conducted with thirteen teachers and transcribed verbatim. One researcher performed barrier and facilitator extraction, with double extraction occurring across a third of the interview transcripts by a second researcher. A deductive and inductive analytical approach in a two-stage process was employed whereby barriers and facilitators were deductively coded using TDF domains (content analysis) and analyzed for sub-themes within each domain. Two researchers performed coding.

          Results

          A total of 832 items were extracted from the interview transcripts. Some items were coded into multiple TDF domains, resulting in a total of 1422 observations. The most commonly coded TDF domains accounting for 75% of the total were Environmental context and resources ( ECR; n = 250), Beliefs about consequences ( n = 225), Social influences ( n = 193), Knowledge ( n = 100), and Intentions ( n = 88). Teachers who implemented DPA during instructional time differed from those who relied on non-instructional time in relation to Goals, Behavioural regulation, Social/professional role and identity, Beliefs about Consequences. Forty-one qualitative sub-themes were identified across the fourteen domains and exemplary quotes were highlighted.

          Conclusions

          Teachers identified barriers and facilitators relating to all TDF domains, with ECR, Beliefs about consequences, Social influences, Knowledge and Intentions being the most often discussed influencers of DPA policy implementation. Use of the TDF to understand the implementation factors can assist with the systematic development of future interventions to improve implementation.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-4846-y) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Long-term health benefits of physical activity – a systematic review of longitudinal studies

          Background The treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer’s disease and dementia. Methods Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included. Results The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases. Conclusions This review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.
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            Tracking of Physical Activity from Childhood to Adulthood: A Review

            The aim of the article was to review studies on the tracking of physical activity in all phases of life from childhood to late adulthood. The majority of the studies have been published since 2000. The follow-up time in most studies was short, the median being 9 years. In men, the stability of physical activity was significant but low or moderate during all life phases and also in longterm follow-ups. In women, the tracking was lower and in many cases non-significant. Among both sexes, stability seems to be lower in early childhood than in adolescence or in adulthood and lower in transitional phases, such as from childhood to adolescence or from adolescence to adulthood, than in adulthood. However, the differences in the stability of physical activity between age groups and between different phases of life were small. The number of tracking studies utilising objective methods to measure physical activity was so small that systematic differences in stability between self-report and objective methods could not be determined. A factor which caused differences in tracking results was the adjustment of correlations for measurement error and other error variance. Adjusted coefficients were clearly higher than unadjusted ones. However, adjustment was done only in very few studies. If the different methods used for estimating habitual physical activity and the failure to control for important covariates in studies of tracking are taken into account, physical activity appears to track reasonably well also in the longer term, for example from adolescence to adulthood. The results of the tracking studies support the idea that the enhancement of physical activity in children and adolescents is of great importance for the promotion of public health.
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              Is the Canadian childhood obesity epidemic related to physical inactivity?

              This study examined the relation among children's physical activity, sedentary behaviours, and body mass index (BMI), while controlling for sex, family structure, and socioeconomic status. Epidemiological study examining the relations among physical activity participation, sedentary behaviour (video game use and television (TV)/video watching), and BMI on a nationally representative sample of Canadian children. A representative sample of Canadian children aged 7-11 (N=7216) from the 1994 National Longitudinal Survey of Children and Youth was used in the analysis. Physical activity and sport participation, sedentary behaviour (video game use and TV/video watching), and BMI measured by parental report. Both organized and unorganized sport and physical activity are negatively associated with being overweight (10-24% reduced risk) or obese (23-43% reduced risk), while TV watching and video game use are risk factors for being overweight (17-44% increased risk) or obese (10-61% increased risk). Physical activity and sedentary behaviour partially account for the association of high socioeconomic status and two-parent family structure with the likelihood of being overweight or obese. This study provides evidence supporting the link between physical inactivity and obesity of Canadian children.
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                Author and article information

                Contributors
                250 807 8419 , katie.weatherson@ubc.ca
                250 807 9352 , rhyann.mckay@gmail.com
                250 807 9352 , heather.gainforth@ubc.ca
                250 807 9670 , mary.jung@ubc.ca
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                23 October 2017
                23 October 2017
                2017
                : 17
                : 835
                Affiliations
                [1 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Health and Exercise Sciences | Faculty of Health and Social Development, , The University of British Columbia Okanagan, ; ART 360– 1147 Research Road, Kelowna, BC V1V 1V7 Canada
                [2 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Health and Exercise Sciences Faculty of Health and Social Development, , The University of British Columbia Okanagan, ; ART 129– 1147 Research Road, Kelowna, BC V1V 1V7 Canada
                [3 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Health and Exercise Sciences Faculty of Health and Social Development, , The University of British Columbia Okanagan, ; RHS 119­ 3333 University Way, Kelowna, BC V1V 1V7 Canada
                Article
                4846
                10.1186/s12889-017-4846-y
                5654002
                29061140
                a6271ebc-6656-44fd-b0f5-d67f13f305b5
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 March 2017
                : 13 October 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000245, Michael Smith Foundation for Health Research;
                Award ID: 5917
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                school,physical activity,policy,implementation,barriers,facilitators,theoretical domains framework

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