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Table 3 Quotations illustrating factors hindering adoption, implementation and maintenance of the interventions

From: Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren– a DEDIPAC case study

(RE)AIM Parameters (Bold)  
Adoption
 Collaboration and Communication “…the Department insisted that there should be targets… so they asked Green Schools for targets. Green Schools said well just on the basis of programme, this is what we’re getting so far, those targets were extrapolated… Ambitious targets but what the department told them at the time was that you won’t be bound by those targets” [Intermediary State Agency B Management Official]
 Community use “…rural schools can be challenging like if there is… a real lack of infrastructure and if they are in a real busy place it can be really challenging…they don’t have as many options open to them, like carpooling can be hard to just kind of get off the ground. You will often have parent concerns about just picking up other people’s children… There is always kind of questions around insurance” (GSTO).
 Training “We also ran a cycle course for parents who want to cycle with their children but we didn’t have a very good response there were only two parents who came” [GSTO].
Implementation
 Cultural context …“we’ve gone to a situation where no one is walking to school…this is to facilitate working parents” [Intermediary Agency B, Management Official]
  “parents are so afraid of roads and road safety… that maybe they are reluctant to let teenagers or their kids out and learn…often it’s just sort of a perceived danger that isn’t really there” [GSTO].
  “They (girls) are expected to be on the pink bike going around the park with their pals not out on the road” [Civil Servant, Government Department B].
  “It’s uncool yeah” (to wear cycling helmets) [GSTO].
  “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” [Civil Servant, Government Department A].
 Characteristics of setting “We discussed how we were going to get fruit and veg into schools…obviously no school canteen, so it couldn’t go in that way”. [FD Project Management Company Official].
  “Our biggest problem is getting the children to come to school, not to talk about how they travel to school.” (GSTO in socio-economically deprived school catchment area).
 Costs, resources and funding needed for implementation …“last year was very stressful, like at one point we didn’t know if we would get our funding renewed” [Intermediary Agency A, NGO, Green Schools Management Official].
 Implementation delivery, protocols, fidelity (including dose) …“it’s very hard for me to go around and check and see, if they are implementing phase 2 properly … I can’t stand there and say, are you actually checking their lunchboxes and things like that”. [FD School Coordinator / Primary School Teacher].
 Process evaluation “(NGO) results would indicate that there is far more walking and cycling than we would think there is in reality” [Civil Servant, Government Department B].
 Time issues “We are an infant school so we have a limited number of hours every day in an already overloaded curriculum… that was the concern…” [FD School Coordinator/ Primary School Teacher].
“I think a lot of the teachers find it’s long, if it’s a chart it could be nearly a meter long this chart with days and ticking and bronze cert and silver cert and gold certs and all these different certificates and children’s’ names have to be written in”. [T].
  “there was quite a bit of timing in all this because you’ve got the school year, you’ve got the calendar year, you’ve got the [name of agency] year, EU funding year and they are all a little bit different so you are trying to manage your money…” [Civil Servant, Government Department A]
  …“I should be developing the programme and analysing how we can...make it better, however a lot of my time is spent securing funding” [Intermediary Agency A, NGO, Green Schools Management Official].
 Translation of research into practice “We expected to be told, how to implement this programme and it had been researched very thoroughly in the UK…but each research group required a number of PHD students going into the classroom, weighing out the fruit and veg, recording how much they had been eating…So we had a couple of challenges” [FD PMC Official].
Maintenance/Sustainability
 Dissemination and Transferability …“We have a difficulty in getting clear data as to what is the actual full impact of the Green Schools programme in a school” [Civil Servant, Government Department B].
  “…information relating to ideas that have worked on the ground should be put into hardcopy” (GSTO).
  ...“the (UK) government had said if you don’t have a school travel plan...you will not qualify for funding for the school, so it’s very easy for a headmaster to say ...we’ll get a school travel plan together. As opposed to our programme which is by invitation only, we’re trying to go in and persuade... there was no comparing like with like.” [Intermediary Agency B, Management Official]