A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

BACKGROUND : Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children\u27s opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact. METHODS: We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies. RESULTS: Five of Canada\u27s 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children\u27s PA levels or BMI. CONCLUSIONS: This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies

Promotion of physical activity in rural, remote and northern settings: a Canadian call to action

Introduction: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings. Methods: We conducted a “synopses of syntheses” scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action. Results: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the priority-setting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities. Conclusion: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action

Why public health matters today and tomorrow: the role of applied public health research.

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow's public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support "innovative population health research that improves health equity for citizens in Canada and around the world." We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein

Correction to: Why public health matters today and tomorrow: the role of applied public health research.

The article "Why public health matters today and tomorrow: the role of applied public health research," written by Lindsay McLaren et al., was originally published Online First without Open Access

Relating Built Environment to Physical Activity: Two Failures to Validate

The Irvine-Minnesota Inventory (IMI) is an audit tool used to record properties of built environments. It was designed to explore the relationships between environmental features and physical activity. As published, the IMI does not provide scoring to support this use. Two papers have since been published recommending methods to form scales from IMI items. This study examined these scoring procedures in new settings. IMI data were collected in two urban settings in Alberta in 2008. Scale scores were calculated using the methods presented in previous papers and used to test whether the relationships between IMI scales and walking behaviors were consistent with previously reported results. The scales from previous work did not show expected relationships with walking behavior. The scale construction techniques from previous work were repeated but scales formed in this way showed little similarity to previous scales. The IMI has great potential to contribute to understanding relationships between built environment and physical activity. However, constructing reliable and valid scales from IMI items will require further research

Active Aging: Hiking, Health, and Healing

This article examines the illness and recovery experiences and perceptions of physically active middle aged and older adults participating in hiking groups. These perceptions are examined within the local milieu of their group and the larger social context of biomedical norms of healthy older bodies. Discourse on the body was viewed through the lens of medical anthropology and data were analyzed using embodied ethnography. There were 15 participants (53 percent female) and all were of European descent. The hiking group provided participants with meaningful spaces and places where they could explore all aspects of their health with the support of others who had undergone similar life experiences. The physical activities they engaged in as a group were therapeutic and transformational for several members. Their group activities created a deep sense of community and aided in their healing processes. Holistic health programs such as hiking groups could provide an alternative or ancillary treatment options. However, cost, location, opportunities for socialization, and the physical abilities of potential participants should be seriously considered before adopting a hiking program for this demographic

Exploring facilitators and barriers to individual and organizational level capacity building: outcomes of participation in a community priority setting workshop

This article explores facilitators and barriers to individual and organizational capacity to address priority strategies for community-level chronic disease prevention. Interviews were conducted with a group of participants who previously participated in a community priority-setting workshop held in two Alberta communities. The goal of the workshop was to bring together key community stakeholders to collaboratively identify action strategies for preventing chronic diseases in their communities. While capacity building was not the specific aim of the workshop, it could be considered an unintended byproduct of bringing together community representatives around a specific issue. One purpose of this study was to examine the participants’ capacity to take action on the priority strategies identified at the workshop. Eleven one-on-one semi-structured interviews were conducted with workshop participants to examine facilitators and barriers to individual and organizational level capacity building. Findings suggest that there were several barriers identified by participants that limited their capacity to take action on the workshop strategies, specifically: (i) organizations’ lack of priorities or competing priorities; (ii) priorities secondary to the organizational mandate; (iii) disconnect between organizational and community priorities; (iv) disconnect between community organization priorities; (v) disconnect between organizations and government/funder priorities; (vi) limited resources (i.e. time, money and personnel); and, (vii) bigger community issues. The primary facilitator of individual capacity to take action or priority strategies was supportive organizations. Recognition of these elements will allow practitioners, organizations, governments/funders, and communities to focus on seeking ways to improve capacity for chronic disease prevention

Mechanisms for understanding the facilitators and barriers to capacity building for chronic disease prevention activities: an illustration

This study explored facilitators and barriers to capacity building for chronic disease prevention (CDP) activities with participants in community-based workshops on environments related to CDP. Three phases of research were conducted. Worksheet analysis (Phase A) indicated that participants (n = 34) identified priority strategies related to the physical environment as a primary focus for CDP, followed by sociocultural, economic, and political environments. Questionnaire completion (Phase B; n = 17) indicated that individuals’ capacity was inhibited by a lack of organizational infrastructure (particularly, resources and public and research support). Interviews (Phase C; n = 11) revealed five factors that limited participants’ capacity: (a) organizations’ lack of competing priorities, (b) priorities secondary to the organizational mandate, (c) disconnect between organizational and government or funder priorities, (d) limited resources, and (e) larger community issues. Implications for research and practice are discussed