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Table 1 Implementation determinants identified by stakeholders

From: IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) – study protocol for a cluster-randomized trial

CFIR domain Determinants of implementation Example of notes made by workshop participants
Intervention characteristics (HSS) 1. Program supported by guidelines and curriculum “The content/purpose can be linked to the curriculum”
2. Involvement of parents “Children and parents can get support for a healthier lifestyle and parents can get help with strategies to reach them. Good with MI for self-motivation”
3. Consensus on healthy lifestyle “Very good with increased and equal knowledge to students and parents about diet, exercise, and health, regardless of background and resources
4. Clarity of material and instructions for use “Get a teaching plan for an important part of the student’s development towards a healthy life”
Outer setting (municipality) 5. Societal action and cooperation “That these social institutions work together on the health of the population. Can increase understanding of each other’s mission but also that we share the health mission to reduce social health inequalities”
6. Environmental factors “In disadvantaged settings, it can be an economic issue, fruits and vegetables are relatively expensive, junk food cheaper, parents can’t afford to let children practice sports”
7. Local policies “Link to activities and policies that are decided upon”
Inner setting #1 (school) 8. Common goals and collaboration in school “That the school works towards common goals, school health care and teachers work with health promotion and start from the same point of departure and “language” when talking to children and parents”
9. Communication and collaboration between school-home “Good to have increased consensus between school staff and parents regarding good nutrition and practices around this”
10. Continuity in staffing and work routines “That there may be staff changes that make implementation difficult both within school health care and teachers”
11. Leadership in school “Important that all principals endorse the project at their school”
12. Visible priority of health “That the school works towards a common goal and is consistent in its communication with parents”
Inner setting #2 (primary care) 13. Communication within and between primary health care units “It will be a challenge to communicate to all primary health care centres and to all its individual employees about what the project is about and what help should be offered to those who contact them”
14. Time for administration in primary health care “Fear that there will be a lot of administrative work for the caregivers. Important to avoid”
15. Collaboration between primary care and school “Proposal to address IMPROVE at an annual meeting between primary care and school health care”
16. New target groups “At the primary health care centre you can find other health risks in the parents if they have high blood sugar”
17. Early prevention “A good opportunity for primary care to work more with prevention and to reach risk groups in time”
Intervention recipients (parents) 18. Family consensus on healthy lifestyle “Very good with increased and equivalent knowledge to students and parents about diet, exercise and health regardless of background and preconditions”
19. Parents’ knowledge and skills “Parents are included in their children’s homework and together they learn about good habits. Teachers follow up and remind about the homework”
20. Socioeconomic and cultural factors, language “Socio-economically weak areas - risk of lower adherence to homework being completed - high risk of attrition”
21. Parents’ perceived need and readiness “Children with overweight/obesity often have parents with the same problems. Difficult to motivate for lifestyle changes”
22. Parents’ engagement in children’s schoolwork “Poor adherence to homework. The resourceful do tasks with the children but not those who need them”
Individual providers (school and primary care staff) 23. Providers’ attitudes towards the program “Motivated preschool teachers who are happy to be involved in development”
24. Providers’ competence and self-efficacy “Great increase in skills for staff, raising equality”
25. Providers’ experience of workload and responsibility “Can be experienced by school staff as an increased workload. A change in working routines is always demanding”
Process 26. Time for planning and executing program in school “It is important that time is given for planning and that it is clear how much time is required for all steps”
27. Communication and collaboration within school regarding process “That all material from Karolinska Institutet is sent out before the work at the schools takes place, which creates time for good planning in the classes”
28. Sustainability of program “That the project continues, that it is not dependent on individuals but can continue regardless of what the organisation looks like in schools and in the central administration”