Table 4 Qualitative results for theme: dissemination and implementation factors (N = 290)

Contextual factors (N = 128)

Leadership engagement (N = 26)

Guidelines of such nature should be made available to the critical staff, e.g. NCD [non-communicable disease] coordinator, Nutrition Officer.

Relative advantage (N = 26)

 Alternative guidelines not available (N = 20)

 Alternative guidelines available (N = 6)

I do not know anything of such [plans of physical activity in the region].

Compatibility (N = 24)

 Compatible with policies and programs (N = 19)

 Unsure (N = 5)

There may be no complications. The guidelines will and can be easily integrated with work at the GHS.

Executing (N = 17)

 Agency disconnect (N = 6)

 Agency role (N = 5)

 Funding (N = 4)

 Agency structure (N = 2)

But we have not been engaged at the implementation level and that is the disconnect concerning the dietary and physical activity guidelines.

Knowledge and beliefs (N = 16)

Thus [exercise/physical activity is] very important and should be a priority to all.

Relative priority (N = 8)

But because initially we did not have over-nutrition as a problem in Ghana so we were not really addressing it but now is coming up, all surveys and researches are pointing out that over-nutrition, diabetes, hypertension and all other diet related conditions are now becoming a big problem so there is an urgent need for GHS to come out with a program and a document like this will be a backbone for such a particular problem. So as we move forward this should be a way we should go. Currently I think there is an urgent need for that because we have heard on the double burden of malnutrition in Ghana, i.e. over nutrition and undernutrition

Engaging (N = 6)

But if you want a place where the implementation will take place then it will be at the community level

Planning (N = 3)

Yes. In developing the guidelines, we were part of it; all relevant stakeholders or technocrat within the nutrition fraternity, including academia, research and relevant international or donor agencies and the Ghana Health Service came together to put these documents together.

Reflecting and evaluating (N = 2)

This guideline was developed in 2009 and it is about 10 years old now; new issues are emerging in public health and I think the document need to be reviewed and updated with current trends; obviously, there are new strategies, the situation 10 years ago is not the same today; looking at rates of obesity and disease prevalence, there have been changes.

Implementation strategies and suggestions (N = 64)

Involve partner organizations (N = 33)

 Education (N = 24)

 Employment (N = 6)

 Health care (N = 3)

All schools should make physical activities compulsory in a well-structured form which will not compete with academics.

Implementation plan (N = 11)

When implementing a program, you should have an implementation framework. When you formulate a documents as such, you should have another document which will have the plan on how it is going to be disseminated and utilized and everything should be clearly spilled out; how is its implementation going to be monitored, at what point do you need to re-visit the strategy and do a review on it and the stakeholders who have come together to formulate this documents, how are they going to implement it in their various activities.

Train stakeholders (N = 6)

Stakeholders will have to be trained.

Change policies (N = 4)

All these things [built environment, parks, physical activity breaks] are policy issues that need to be addressed.

Hire staff (N = 4)

These should be personnel appointed [to see to it that is implemented].

Create unit (N = 2)

There would have been a unit of such; a team that will reflect the essence of the program and they will go through as the normal program; is not going to be a project but a program which is more sustainable.

Capacity building (N = 2)

People capacity should be built on how to use the guidelines; I do not know if that was done but I cannot speak to that because I am not in the lead agency but all I know was I was not part of any capacity building team.

Resources (N = 2)

Strong advocacy for more resources to be allocated to those programmes.

Communication channels and sources (N = 50)

Written materials (N = 16)

I think pamphlets will do [to incorporate physical activity guidelines into the health system].

Internet (N = 11)

Any physical activity I talk [about] or recommend to people are materials I read online.

Colleague (N = 9)

It [physical activity guidelines] was an information I heard from a friend. He said is some kind of exercise activities.

Training (N = 8)

Through dissemination meetings, when such documents are developed there is usually dissemination meeting where stakeholders who will be working with the documents are called to share with them what it entails and the new directions.

Email (N = 3)

Emails [are a common way to learn about new guidelines or policies].

Media (N = 3)

Seeing it on the various WhatsApps platforms.

Innovation-decision process (N = 48)

Knowledge (N = 40)

 Unaware of guidelines (N = 29)

 Aware of guidelines (N = 11)

What I want to add is that we those who have gathered here, you asked us whether we know/have heard about the guidelines and we said we have not.

Implementation (N = 8)

 Have not used guidelines (N = 7)

 Have used guidelines (N = 1)

Though I have never used the guideline.