Why Implementation Fails: Perspectives of Teachers who Do Not Implement Classroom-Based Physical Activity (and Those Who Do) Lindsey Turner, PhD Hannah Calvert, PhD Julianne Wenner, PhD Peter Boedeker, PhD Blake Densley, MA
What is CBPA? Classroom-Based Physical Activity Many names: movement integration, classroom physical activity breaks, active learning, active classrooms, energizers, brain boosters The same goal: provide students with periods of physical activity to increase minutes in physical activity each day and reduce sedentary time (CDC, 2013; Institute of Medicine, 2013). Activity Breaks • Brief breaks from instruction for movement Active Lessons • Activity integrated with lessons
CBPA as an EBI Systematic Review and Meta-Analysis Activity Breaks 22 intervention studies; Masini et al 2019 ↑ Physical activity ↑ Time on task ? Acute cognitive benefits inconclusive ? Academic achievement inconclusive Active Lessons 42 studies (27 RCTs); Norris et al 2019 ↑ Lesson-time PA ( d = 2.33) ↑ Overall daily PA ( d = .32) ↑ Lesson-time education outcomes ( d = .81) and overall education outcomes ( d = .36) • No effects on other health outcomes (only 3 studies) Masini A, Marini S, Gori D, Leoni E, Rochira A, Dallolio L. (2019). Evaluation of school-based interventions of active breaks in primary schools: A systematic review and meta-analysis . Journal of Science and Medicine in Sport . doi:10.1016/j.jsams.2019.10.008 Norris E, van Steen T, Direito A, Stamatakis E. (2019). Physically active lessons in school and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis . British Journal of Sports Medicine . doi:10.1136/bjsports-2018-100502
Prior evaluations of CBPA Prevalence is fairly low* • Used by at least some teachers at ¾ of US public elementary schools in 2013-14 • At those schools, principals estimate that ~ half of teachers ever use CBPA, but rarely do teachers provide 10 mins/day • Prevalence lower at schools serving predominantly Latinx students, and lower SES students Many studies have interviewed teachers Nearly 30 peer-reviewed studies describe teacher perceptions about CBPA** They typically use convenience sampling Teacher interviews often find the same barriers Time, resources, intrapersonal (knowledge, skill, confidence), institutional (administrative support), etc. * Turner L & Chaloupka F. (2017). Reach and implementation of physical activity breaks and active lessons in elementary school classrooms . Health Education & Behavior, 44, 370-375. ** Michael RD, et al. (2019). Facilitators and barriers to movement integration in elementary classrooms: A systematic review . Research Quarterly for Exercise & Sport , 90 (2), 151-162
PACE: Physically Active Classrooms Energize! Funded by Institute of Education Sciences 4 development year grant Goal: to study determinants and processes of implementation, and develop/test interventions to increase implementation Institute of Education Sciences, grant R305A150277, 2015 to 2019 Increasing Classroom Teachers' Implementation and Sustained Use of Classroom-Based Physical Activity Breaks as a Strategy to Improve Academic Outcomes.
PACE: Physically Active Classrooms Energize! Fall semester of the 2017-18 school year 5 schools in 1 school district All classroom teachers (n = 83) Interpretive formative evaluation* using sequential explanatory mixed methods * Stetler et al. (2006). The role of formative evaluation in implementation research and the QUERI experience. J Gen Int Med , 21, 1-8. Elwy et al. (in press). Using formative evaluation methods to improve clinical implementation efforts: description and an example. Psych Res , online first
Data collection strategy #1: Tracking Logs
Implementation Outcome: Average Minutes/Week 70 60 Number of Minutes per Week 50 47.3 41.6 40 35.9 All teachers 31.7 30.4 29.4 29.1 29.0 28.2 28.1 28.1 27.7 30 26.8 26.8 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week Number
What happened in weeks 3 & 4?
Implementation Outcome: Average Minutes/Week 70 60 Number of Minutes per Week 50 47.3 41.6 40 35.9 All teachers 31.7 30.4 29.4 29.1 29.0 28.2 28.1 28.1 27.7 30 26.8 26.8 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week Number
Implementation Outcome: Average Minutes/Week 70 67.4 59.5 60 Number of Minutes per Week 52.0 47.2 50 47.3 Higher Implementers 42.2 41.6 41.7 41.5 41.6 40.8 40.4 38.9 39.0 38.8 37.5 40 35.9 All teachers 31.7 30.4 29.4 29.1 29.0 28.2 28.1 28.1 27.7 Lower Implementers 30 26.8 26.8 25.4 22.6 20 16.0 15.3 14.2 12.4 12.4 11.8 10.9 9.9 9.1 8.7 8.8 10 5.9 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week Number
High and Low Implementers 70 67.4 59.5 60 Number of Minutes per Week 52.0 47.2 50 42.2 Higher Implementers 41.6 41.7 41.5 40.8 40.4 38.9 39.0 38.8 37.5 40 Lower Implementers 30 25.4 22.6 20 16.0 15.3 14.2 12.4 12.4 11.8 10.9 9.9 9.1 8.7 8.8 10 5.9 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week Number
Higher and Lower Implementers: Interviews Higher Implementers (HI) 16 identified, interviews with 12 Lower Implementers (LI) 11 identified, interviews with 9 Interviews were conducted in December. Lasted ~30 minutes, teachers were offered a $50 gift card What do you think helped you the most? If you did not use them, what got in the way? What kind of benefits do you see from activity breaks? What challenges do you face in implementing these breaks? What types of things might help you to address these challenges? Transcribed verbatim, coded for macro levels of meaning with Concept Codes (Saldaña, 2015): Perspectives on CBPA Factors supporting CBPA Factors not supporting CBPA
Interview Themes Common themes among HI and LI: • the value of CBPA for student well-being, having fun, and building relationships • finding time is difficult “They’re ready to sit down and focus because they have those ants out of their pants.” “So they’re getting that little bit of wiggles out and then they calm back down.” “Kids need that activity for their brain…and they need to have that activity to keep their brain alert.”
Interview Themes Differences: • HI were more likely to write CBPA into their daily schedule • HI were more likely to have a cool-down routine for allowing students to settle and transition back to schoolwork. “I managed to put it [CBPA] into my schedule. So we did it daily at the same time…So that helped and the kids expected it so if I didn’t remember, they remembered for me.” “I integrated a little yoga move at the end to breathe in…and they knew that that was their signal to start calming down.”
Interview Themes Differences: • HI believed that they had principals who were proactive and explicit supporters of CBPA (LI did not) • HI shared ideas about CBPA with their colleagues “We often talked about different things that we were doing for our brain breaks and we were sharing what worked, what didn’t work…like ‘Oh, this one was fun,’ or ‘This one didn’t work very well.’ ”
Interview Themes Differences: • LI were very focused on time as a barrier; HI had found solutions, LI had not “I couldn’t figure out how to do it without losing a lot of academic time.” “With the pacing of our schedule it was hard to figure out when to put them in.” “It would be like, ‘Oh, I should do one of these today’ and then I’d be at the end of the day and go, ‘Aww, where did the day go?’ We didn’t have time.
High and Low Implementers Differences at baseline (after training session), survey responses Teacher attitudes, M (SE) HI LI School norms (other teachers will use) 4.1 (.3) 3.5 (.3) Perceived hassles 2.2 (.2) 2.7 (.2) Consistent with instructional practice 5.0 (.2) 3.8 (.3) Significantly different at p <.05 or better, No significant differences tests accounted for school clustering Perceived benefits Perceived competence 1 = strongly disagree, 6 = strongly agree
Implications As with other innovations, the implementation of CBPA is facilitated by the presence of proactive leadership/champions. Knowledge about the “why” of behavior change is crucial, but a key barrier seems to be “how” to implement. Coaching teachers in specific strategies for time management (e.g., explicit scheduling) may improve implementation among teachers who would not otherwise do so.
Caveats, Comments, Conclusion Even the “lower implementers” did implement…somewhat (self-monitoring is a very effective intervention!) All of these teachers had resources available… however, for broad scale-up, resources are needed, in addition to other elements of support (training, administrative support) Many curricula exist, often available for free, however very few of those programs include additional implementation support (addressing ways to promote system-wide change, leadership, etc.)* * Calvert HC, et al. (2018). An evaluation of the coverage of theoretically based implementation factors in disseminated classroom physical activity programs . Translational Behavioral Medicine , https://doi.org/10.1093/tbm/iby134
THANK YOU QUESTIONS? lindseyturner1@boisestate.edu
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