Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior.This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes.Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303).Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances.The Netherlands National Trial Register NTR3961 . Registered 18 April 2013

Awareness about developmental coordination disorder

The present paper is designed to promote awareness of DCD outside the academic world. With a prevalence of 5–6% it is one of the most common disorders of child development. It is therefore surprising that so little is known about it among professionals in child healthcare and education. Parents have expressed frustration about this lack of awareness, including the general public. The general aim of this paper was to describe those critical aspects of DCD that will promote awareness

Promoting participation in DCD : Physical activity levels and the social network

Purpose of Review Physical inactivity is a worldwide problem, also affecting children with motor problems, such as developmental coordination disorder. We try to understand what motivates children to start, continue, and stop having an active lifestyle and explore the role that the social network of the child can have to stimulate an active lifestyle. Recent Findings Social network theory is useful for understanding individual and group behavior related to physical activity. Social networks, ranging from peers and parents to teachers and medical professionals were shown to play an important role in bringing about sustainable behavioral change. Up to now, little systematic research has been done into how social networks can be used to keep children with developmental coordination disorder (DCD) physically active and motivated. Summary Future studies should more systematically examine and target the social network of the child with DCD. This social network can then be used to develop interventions for a sustained physical active lifestyle leading to increased participation in the society

The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study

BackgroundParticipation in organized sports and other forms of active living have important health benefits in adolescence and adulthood. Unfortunately, the transition to secondary school has been shown to be a barrier to participation. Social networks can play important roles in activating adolescents, and information and communication technology (ICT) interventions can augment this role. To date, there are few insights into what adolescents themselves think and feel about barriers to and motivators for active living, the role of their social networks in active living, and the potential of ICT for physical activity (PA). ObjectiveThis study aimed to gather insights into the perspectives of adolescents aged 12 to 14 years on active living and sports participation, motivators and demotivators for active living, and the potential roles of their social network and of ICT. MethodsA total of 26 adolescents aged 12 to 14 years from different levels of Dutch secondary schools participated in 1 of 5 semistructured focus group interviews, in which they talked about sports and PA, their social networks, their ICT use, and the role of social networks and ICT in PA. All interviews were transcribed and analyzed using a thematic qualitative approach. ResultsThe study showed that all participants were physically active, although the transition to secondary school made this difficult, mostly because of time constraints. Participants saw positive physical and mental health effects as important benefits of active living. They regarded social benefits as strong motivators for active living: being together, making friends, and having fun together. However, the social network could also demotivate through negative peer judgment and negative feedback. Participants were willing to share their own positive experiences and hear about those from close peers and friends but would not share their own (and were not interested in others’) negative experiences or personal information. Participants were mainly interested in descriptive norms set by others and obtained inspiration from others for PA. With respect to using ICT for active living, participants stated a preference for social challenges among friends, personalized feedback, goals, activities, and rewards. Competition was seen as less important or even unattractive. If mentioned, participants felt that this should be with friends, or peers of a similar level, with fun being more important than the competition itself. ConclusionsThis study shows that adolescents feel that their social network is and can be a strong driver of active living. They are willing to use ICT-based solutions that make use of social networks for PA as long as these solutions involve their current (close) network and use an approach based on being together and having fun together

The roles of declarative knowledge and working memory in explicit motor learning and practice among children with low motor abilities

Effective learning methods are essential for motor skill development and participation in children with low motor abilities. Current learning methods predominantly aim to increase declarative knowledge through explicit instructions that necessitate sufficient working memory capacity. This study investigated the roles of declarative knowledge and working memory capacity in explicit motor learning of children with low motor abilities. We studied both acquisition performance (i.e., performance during practice) and learning (i.e., the improvement in performance from pretest to posttest). After practice with explicit instructions, children with low motor abilities showed significant learning, albeit that improvement was relatively small. However, working memory capacity and declarative knowledge did not predict learning. By contrast, working memory capacity and declarative knowledge did predict performance during practice. These findings suggest that explicit instructions enhance motor performance during practice, but that motor learning per se is largely implicit in children with low motor abilities

Relation between sport or physical activity on social norms, social networks or social inclusion

A scoping revie

The role of working memory capacity in implicit and explicit sequence learning of children: differentiating movement speed and accuracy

Contains fulltext : 214519.pdf (Publisher’s version ) (Closed access)This study investigated the role of working memory capacity on implicit and explicit motor sequence learning in young children. To this end, a task was utilized that required a gross motor response (flexing the elbow) and that could differentiate between movement speed (i.e., reaction time and movement time) and movement accuracy. Children aged 7-9 years practiced a serial reaction time task that involved the production of a fixed sequence of elbow flexions of prescribed magnitude across two consecutive days. Children in the explicit group were informed about the presence of the sequence and were shown this sequence, while children in the implicit group were not made aware of the sequence. Additionally, children's verbal and visuospatial working memory capacity was assessed. Results of day 1 regarding movement speed revealed no evidence of sequence learning for either group, but movement accuracy results suggested that sequence learning occurred for the implicit group. For both groups, only improvements in movement accuracy were consolidated on day 2, indicating both general and sequence specific learning. Working memory capacity did not correlate with learning in either of the groups. Children in the explicit group accumulated more sequence knowledge compared to children in the implicit group, but this knowledge did not translate to more or better sequence learning. The minimal differences found between the implicit and explicit condition and the absence of a role for working memory capacity add to the increasing evidence that the observed differences between implicit and explicit sequence learning in adults may be less distinct in children.15 p

Motor learning and movement automatization in typically developing children: The role of instructions with an external or internal focus of attention

The aim of the current study was to examine the effects of an external focus of attention (i.e., on the movement outcome) versus an internal focus of attention (i.e., on the movement itself) on motor learning in typically developing children. We examined both immediate motor performance (i.e., practice effect, when focus instructions are given) as well as motor performance after one week (i.e., learning effect). In addition, we examined if an external and an internal focus of attention differently affected movement automatization, as measured using a dual-task paradigm. Finally, we explored whether the effect of attentional focus instructions on motor learning was influenced by children’s working memory capacity. Participants were 8–12 year old (N = 162) typically developing children. Participants practiced a new motor task (i.e., ‘Slingerball throwing task’). Results showed that an external focus of attention led to higher throwing accuracy during practice, but this beneficial effect did not extent to the retention test one week later. Furthermore, movement automatization did not differ after external or internal focus of attention instructions, and working memory capacity did not predict motor learning in children in either of the instruction conditions. This is the first study to show that the beneficial effects of an external focus of attention on discrete motor tasks found in previous studies with a child population seem to be short lived and decline after a one-week interval

The influence of errors during practice on motor learning in young individuals with cerebral palsy

Contains fulltext : 145065.pdf (publisher's version ) (Closed access)The aim of this study was to investigate the effect of errors during practice on motor skill learning in young individuals with cerebral palsy (CP). Minimizing errors has been validated in typically developing children and children with intellectual disabilities as a method for implicit learning, because it reduces working memory involvement during learning. The present study assessed whether a practice protocol that aims at minimizing errors can induce implicit learning in young individuals with CP as well. Accordingly, we hypothesized that reducing errors during practice would lead to enhanced learning and a decrease in the dependency of performance on working memory. Young individuals with CP practiced an aiming task following either an error-minimizing (N=20) or an error-strewn (N=18) practice protocol. Aiming accuracy was assessed in pre-, post- and retention test. Dual task performance was assessed to establish dependency on working memory. The two practice protocols did not invoke different amounts or types of learning in the participants with CP. Yet, participants improved aiming accuracy and showed stable motor performance after learning, irrespective of the protocol they followed. Across groups the number of errors made during practice was related to the amount of learning, and the degree of conscious monitoring of the movement. Only participants with relatively good working memory capacity and a poor initial performance showed a rudimentary form of (most likely, explicit) learning. These new findings on the effect of the amount of practice errors on motor learning in children of CP are important for designing interventions for children and adolescents with CP