Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 18;22(1):111.
doi: 10.1186/s12966-025-01810-y.

Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention

Elly Ganakas  1 , Jo Salmon  2 , Jiani Ma  2 , Karen E Lamb  3 , Lisa Barnett  4 , Adrian Bauman  5 , Amanda Telford  6 , Nicola D Ridgers  7 , Anna Timperio  2 , Harriet Koorts  2
Affiliations

Exploring meso- and macro-level contextual factors associated with inequalities in program adoption during statewide scale-up of TransformUs Primary, a whole-school physical activity intervention

Elly Ganakas et al. Int J Behav Nutr Phys Act. .

Abstract

Background: Contextual influences on program implementation exist across micro (individual), meso (organization), and macro (government/environment) system levels, yet macro factors are less frequently explored in implementation research. This retrospective study explored differences in adoption across meso- and macro-system levels using data from the 2018-2022 state-wide hybrid effectiveness-implementation trial of TransformUs Primary, a whole-school physical activity intervention. Aims were to: (1) assess differences in contextual characteristics between adopting and non-adopting schools and implications for equity, and (2) assess associations between macro-level events and dissemination events with program adoption over time.

Methods: Descriptive statistics (number and %) and chi-squared tests were used to assess differences in contextual characteristics between adopting and non-adopting schools (Aim 1). A time-series analysis of daily data was used to explore associations between the number of dissemination events promoting program awareness (e.g., media, newsletters), macro-level policy events (e.g., education department policies), COVID-19-related remote/on-site learning periods, school term dates (i.e., during/outside of school term) and program adoption (i.e., the number of TransformUs Primary registrations per day) (Aim 2).

Results: No differences in either school type (i.e., primary, combined, or special) or community level socio-educational advantage between adopting (n = 519) and non-adopting schools (n = 1,423) were identified. A higher proportion of adopting schools were located in major cities (71.7% vs. 54.5%; chi-square p < 0.001) and were government (public sector) schools (80.0% vs. 63.1%; chi-square p < 0.001). Time-series analysis results indicated that the likelihood of adopting TransformUs Primary decreased from the date of program launch to the end of the scale-up period (IRR 0.999, 95% CI 0.999-1.000; p < 0.005). Both school term date (IRR 5.95, 95% CI 4.78-7.41; p < 0.001) and dissemination events (IRR 3.30, 95% CI 2.67-4.06; p < 0.001) increased the likelihood of adopting TransformUs Primary. Results provided little evidence of an association between the number of policy events or COVID-19-related remote and on-site learning periods and adoption.

Conclusions: Select meso- and macro-level factors had an impact on TransformUs Primary adoption. Findings inform the need to work with stakeholders in scale-up to prioritize dissemination strategies that have a discernible impact on adoption above others and consider targeted efforts to reach regional/rural and non-government schools.

Keywords: Child; Dissemination; Health inequities; Implementation science; Movement; Public health; Sedentary behavior.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for this project was granted by Deakin University Human Ethics Advisory Group [HEAG-H 28_2017]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Total setting-level registrations per day, key events and other contextual factors
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, Muñoz NE, Mora-Gonzalez J, Migueles JH, et al. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports Med. 2019;49(9):1383–410. - PubMed
    1. Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc. 2019;42:146–55.
    1. Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput J-P, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6):S197–239. - PubMed
    1. Álvarez-Bueno C, Pesce C, Cavero-Redondo I, Sánchez-López M, Martínez-Hortelano JA, Martínez-Vizcaíno V. The effect of physical activity interventions on children’s cognition and metacognition: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(9):729–38. - PubMed
    1. World Health Organization. WHO guidelines on physical activity and sedentary behaviour. WHO. 2020. https://www.who.int/publications/i/item/9789240015128. Accessed 10 Apr 2024. - PubMed

LinkOut - more resources