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Table 3 Quotes for intervention cases

From: Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project

Facilitating factors
 Adoption
  Staff expertise for implementation “.. all of those decisions were very practically driven and very much…what will work on the ground, what do we do know from our experience, [name] is a former teacher as well so the two of us can be really advocating for teachers and explaining how schools operate and what would…and knowing what would work and what would not.” [Ireland, Food Dudes Healthy Eating Programme]
  Training for implementation “… of course, we trained the employees in regard to the different modules and the structure of the intervention, as well as, certainly, regarding goals and main objectives, or target group. All of this was practiced in a four-day-workshop at the time, if I remember it correctly.” [Germany, IDEFICS]
  Communication and collaboration “Within the Flemish Government, we have a very good collaboration for this project, which is a positive thing. […] Within the Government, we work together with different policy domains, but we also have private organisations such as VIGEZ (Flemish expertise center for health promotion and disease prevention) that are connected with the department of health, but actually it is a private organization.” [Belgium, Tutti Frutti] “…now some local authorities are brilliant, like the Road Safety Officers would have their job in schools and talk about road safety and they’ve really teamed up with us, they go into our schools and talk about road safety.” [Ireland, Food Dudes Healthy Eating Programme]
 Implementation
  Delivery characteristics: dose & fidelity “This means that activities or measures which had been implemented in the settings were scrutinized for completeness and that [the documentation forms] were completed together with all participants of each monthly round table meeting in order to be able to keep close track of the processes and the implementation of activities and to determine afterwards what had been implemented and what had already been part of the curriculum.” [Germany, IDEFICS]
  Adjustments and customizations “…with special schools it’s been very much about working with the teachers in those schools to apply the principles behind the programme, em but to match them to the needs of the children and their specific need. So even within a class in a special school there might be different children who are being rewarded for doing different things…for some if they have a terrible aversion to em to bananas or yellow foods, then just to even have the banana in the same room as them might be a huge (prompt) step forward and it’s about edging them closer and closer to eating.” [Ireland, Food Dudes Healthy Eating Programme] “They have the freedom to use their own logo, house style, communication strategies and even another intervention ‘name’.” [Belgium, 10,000 steps] “We designed a system whereby the rewards would be packaged and labelled per phase and per day. So phase 1 box would arrive…it could be packed per classroom as well. So the teacher would open the box for his or her own classroom inside that would be all the phase 1 rewards, clearly packaged and labelled day 1 reward, day 2 reward, day 3 and so forth for the 16 days and that they would have if they had 28 in their class, they’d have 28 pencils or 28 sharpeners or they’d have …the number predefined. Em and then the same for phase 2 that everything was clearly labelled.” [Ireland, Food Dudes Healthy Eating Programme] “We have a few children that maybe just wouldn’t kind of like fruit and veg at all. And they actually did try it, because they really wanted the prize”. [Ireland, Food Dudes Healthy Eating Programme]
  Characteristics of the setting affecting delivery/ implementation “I think engagement of both principals and teachers is important.” [Belgium, Tutti Frutti] “… what settings we address, what setting is probably not quite appropriate. Keywords here are e.g.: child day care centers which had a different pedagogical approach, e.g., day care centers for children with speech problems, Waldorf or Montessori kindergartens. These are day care centers which could only to a small extent identify with our concept. The selection and the tips, of course, were given to us in the round table meetings because representatives from these settings were already present.” [Germany, IDEFICS] “Internal attitude, this inner motivation, the awareness of the importance of the programme (...) You have to catch the bug yourself, even just taking the lifestyle.” [Poland, European Schools for Healthy Food – Slow Food in the Canteen]
  Implementation process evaluation “Yes, there have been 2 evaluations already. One in 2006 and 2007. So before it became a European story. That was a process evaluation and effect evaluation.” [Belgium, Tutti Frutti] “We have a monitoring survey every 3 years in which the following is checked: how is education for physical activity taken care of? What type of methods do you adopt? What are your facilitating factors? For 10,000 Steps, we also ask about the adoption rate and the degree of anchoring.” [Belgium, 10,000 steps]
 Maintenance
  Dissemination “We keep on informing the schools. Every school year, we send a newsletter to the schools with information about the project. This is also available on our website. We have the Facebook-page which gives some ludic information, some nice recipes, some activities that are being carried out, or some schools who organize activities and send us the pictures of these activities. In this way, we try to pass on as much information as possible.” [Belgium, Tutti Frutti] “We managed to organize a conference, where we invited representatives from the local government. It was also attended by health and safety representatives (…) we prepared a recording of it for the TV station.” [Poland, European Schools for Healthy Food – Slow Food in the Canteen]
Obstacles
 Adoption
  Communication and collaboration “Often, only the sport services are implementing ‘10,000 Steps’, while the other sectors are even not aware of this. So this means that a part of the evidence-based character of the intervention is not fulfilled, as there should be strategies in all contexts in which physical activity can occur: home, work, leisure and transport. Without communication between the sectors, not all contexts are being targeted properly.” [Belgium, 10,000 steps]
 Implementation
  Adjustments and customizations “… the accompanying materials were in some cases considered not as very fitting [the needs of the target group] by some colleagues.” [Germany, IDEFICS] “It is not the case that we have ready-to-use materials for each and every single group: ‘OK, you work with this group? Here you have this to use’, it is not like that.” [Belgium, 10,000 steps]
  Accessibility and time issues “It might have been wrongly judged, as the e-portal is not very easy for everyone, especially not for schools.” [Belgium, Tutti Frutti] “We have lost members of our round table meetings because the strict requirements for documentation were so time-consuming that some lost their enthusiasm at some point or another.” [Germany, IDEFICS] “We are an infant school so we have a limited number of hours every day in an already overloaded curriculum so. That was the concern that we had going into it.” [Ireland, Food Dudes Healthy Eating Programme]
  Cultural context “…it’s not the boys are more expendable but they are expected to do slightly dangerous things. Girls are expected not to. They are expected to be on the pink bike going around the park with their pals not out on the road.” [Ireland, Green Schools Programme - Travel theme] “... changes to the norms or family values, that is a big challenge in DEIS (disadvantaged) schools, if you give people fruit and veg in a school and then they go home and their mammies give them a batter burger and chips.” [Ireland, Food Dudes Healthy Eating Programme]
  Costs and funding/ resources needed for delivery “In small municipalities there is for example no health promotion department and therefore a lack of time and manpower to implement the intervention. Also the crisis can cause a lack of funding.” [Belgium, 10,000 steps] “The reach of the intervention decreases when there is no guaranty that the consumer will have step counters. This is the biggest threat for the intervention, especially in disadvantage groups, as there is often a need for external funding to implement step counters”. [Belgium, 10,000 steps]
  Characteristics of the settings affecting delivery/ implementation “A switch in personnel can be ‘deadly’. If someone implementing the intervention is leaving, a lot of knowledge and networking contacts can be lost if a new staff member is not oriented soon.” [Belgium, 10,000 steps] “The internal organization of the schools, which is also a problem. That is something that we have known for a while now. But we cannot do anything about it with the Flemish Government.” [Belgium, Tutti Frutti] “Particularly academic stakeholders, such as teachers, are always more difficult. Kindergarten educators, for example, a large group, proved much more cooperative than persons higher in the social hierarchy such as teachers, who were very discerning to the point that some of them left altogether.” [Germany, IDEFICS] “If we had more money we could have a proper kitchen (...) the lady [the cook] has to finish preparing lunch and so they [students] have to meet up in the afternoon or early in the morning so that they are not interrupting their normal work. They would need a place for themselves, with equipment so that they could cook for themselves.” [Poland, European Schools for Healthy Food – Slow Food in the Canteen] “…not just in the rural environment, in some urban schools too…children have to travel right out of their estates along a main road to the school as opposed to having permeability through their local estates.” [Ireland, Green Schools Programme - Travel theme] “…because this is quite a new school, em there was em difficulties with getting the pathways and the roadways finished outside. And so everything inside the school was done, pathways and cycle lanes and cycle huts and stuff, but it was outside on the road here. So it was difficult for us to be promoting something until that really had changed.” [Ireland, Green Schools Programme - Travel theme]