Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention
Abstract Background Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adop...
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BMC
2025-08-01
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| Series: | International Journal of Behavioral Nutrition and Physical Activity |
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| Online Access: | https://doi.org/10.1186/s12966-025-01810-y |
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| author | Elly Ganakas Jo Salmon Jiani Ma Karen E. Lamb Lisa Barnett Adrian Bauman Amanda Telford Nicola D. Ridgers Anna Timperio Harriet Koorts |
| author_facet | Elly Ganakas Jo Salmon Jiani Ma Karen E. Lamb Lisa Barnett Adrian Bauman Amanda Telford Nicola D. Ridgers Anna Timperio Harriet Koorts |
| author_sort | Elly Ganakas |
| collection | DOAJ |
| description | Abstract Background Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption across meso- and macro-system levels using data from the 2018–2022 state-wide hybrid effectiveness-implementation trial of TransformUs Primary, a whole-school physical activity intervention. Aims were to: (1) assess differences in contextual characteristics between adopting and non-adopting schools and implications for equity, and (2) assess associations between macro-level events and dissemination events with program adoption over time. Methods Descriptive statistics (number and %) and chi-squared tests were used to assess differences in contextual characteristics between adopting and non-adopting schools (Aim 1). A time-series analysis of daily data was used to explore associations between the number of dissemination events promoting program awareness (e.g., media, newsletters), macro-level policy events (e.g., education department policies), COVID-19-related remote/on-site learning periods, school term dates (i.e., during/outside of school term) and program adoption (i.e., the number of TransformUs Primary registrations per day) (Aim 2). Results No differences in either school type (i.e., primary, combined, or special) or community level socio-educational advantage between adopting (n = 519) and non-adopting schools (n = 1,423) were identified. A higher proportion of adopting schools were located in major cities (71.7% vs. 54.5%; chi-square p < 0.001) and were government (public sector) schools (80.0% vs. 63.1%; chi-square p < 0.001). Time-series analysis results indicated that the likelihood of adopting TransformUs Primary decreased from the date of program launch to the end of the scale-up period (IRR 0.999, 95% CI 0.999–1.000; p < 0.005). Both school term date (IRR 5.95, 95% CI 4.78–7.41; p < 0.001) and dissemination events (IRR 3.30, 95% CI 2.67–4.06; p < 0.001) increased the likelihood of adopting TransformUs Primary. Results provided little evidence of an association between the number of policy events or COVID-19-related remote and on-site learning periods and adoption. Conclusions Select meso- and macro-level factors had an impact on TransformUs Primary adoption. Findings inform the need to work with stakeholders in scale-up to prioritize dissemination strategies that have a discernible impact on adoption above others and consider targeted efforts to reach regional/rural and non-government schools. |
| format | Article |
| id | doaj-art-e492784c83dc4c839e524d98f7bab29f |
| institution | Kabale University |
| issn | 1479-5868 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | International Journal of Behavioral Nutrition and Physical Activity |
| spelling | doaj-art-e492784c83dc4c839e524d98f7bab29f2025-08-20T03:44:01ZengBMCInternational Journal of Behavioral Nutrition and Physical Activity1479-58682025-08-0122111310.1186/s12966-025-01810-yExploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity interventionElly Ganakas0Jo Salmon1Jiani Ma2Karen E. Lamb3Lisa Barnett4Adrian Bauman5Amanda Telford6Nicola D. Ridgers7Anna Timperio8Harriet Koorts9School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversitySchool of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversitySchool of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversityCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of MelbourneSchool of Health and Social Development, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversitySydney School of Public Health, University of SydneyNational School of Education, Australian Catholic UniversityAlliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South AustraliaSchool of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversitySchool of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversityAbstract Background Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption across meso- and macro-system levels using data from the 2018–2022 state-wide hybrid effectiveness-implementation trial of TransformUs Primary, a whole-school physical activity intervention. Aims were to: (1) assess differences in contextual characteristics between adopting and non-adopting schools and implications for equity, and (2) assess associations between macro-level events and dissemination events with program adoption over time. Methods Descriptive statistics (number and %) and chi-squared tests were used to assess differences in contextual characteristics between adopting and non-adopting schools (Aim 1). A time-series analysis of daily data was used to explore associations between the number of dissemination events promoting program awareness (e.g., media, newsletters), macro-level policy events (e.g., education department policies), COVID-19-related remote/on-site learning periods, school term dates (i.e., during/outside of school term) and program adoption (i.e., the number of TransformUs Primary registrations per day) (Aim 2). Results No differences in either school type (i.e., primary, combined, or special) or community level socio-educational advantage between adopting (n = 519) and non-adopting schools (n = 1,423) were identified. A higher proportion of adopting schools were located in major cities (71.7% vs. 54.5%; chi-square p < 0.001) and were government (public sector) schools (80.0% vs. 63.1%; chi-square p < 0.001). Time-series analysis results indicated that the likelihood of adopting TransformUs Primary decreased from the date of program launch to the end of the scale-up period (IRR 0.999, 95% CI 0.999–1.000; p < 0.005). Both school term date (IRR 5.95, 95% CI 4.78–7.41; p < 0.001) and dissemination events (IRR 3.30, 95% CI 2.67–4.06; p < 0.001) increased the likelihood of adopting TransformUs Primary. Results provided little evidence of an association between the number of policy events or COVID-19-related remote and on-site learning periods and adoption. Conclusions Select meso- and macro-level factors had an impact on TransformUs Primary adoption. Findings inform the need to work with stakeholders in scale-up to prioritize dissemination strategies that have a discernible impact on adoption above others and consider targeted efforts to reach regional/rural and non-government schools.https://doi.org/10.1186/s12966-025-01810-yImplementation scienceDisseminationMovementSedentary behaviorChildPublic health |
| spellingShingle | Elly Ganakas Jo Salmon Jiani Ma Karen E. Lamb Lisa Barnett Adrian Bauman Amanda Telford Nicola D. Ridgers Anna Timperio Harriet Koorts Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention International Journal of Behavioral Nutrition and Physical Activity Implementation science Dissemination Movement Sedentary behavior Child Public health |
| title | Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention |
| title_full | Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention |
| title_fullStr | Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention |
| title_full_unstemmed | Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention |
| title_short | Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention |
| title_sort | exploring meso and macro level contextual factors associated with inequalities in program adoption during statewide scale up of transformus primary a whole school physical activity intervention |
| topic | Implementation science Dissemination Movement Sedentary behavior Child Public health |
| url | https://doi.org/10.1186/s12966-025-01810-y |
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