title: Physical activity implementation in schools: a 4-year follow-up.
abstract: BACKGROUND
  Action Schools! BC (AS!BC) is a comprehensive school-based model that utilizes a socioecologic approach to provide children with opportunities for physical activity at school in British Columbia.
  
  
  OBJECTIVE
  The hierarchy of factors associated with successful implementation of AS!BC was examined 4 years after it was scaled up.
  
  
  METHODS
  A cross-sectional multistage survey was administered to principals (n=133; 92% response rate) and Grade 4-7 teachers (n=587; 71% response rate) in 2008-2009. Constructs from the theories of organizational change, social cognitive theory and Rogers's diffusion of innovation model were used to examine characteristics of teachers and schools and attributes of the innovation associated with implementation. Multilevel mixed-effect logistic regression analyses were employed (analyzed in November 2011).
  
  
  RESULTS
  Self-efficacy, outcome expectation, training received, organizational climate/support, level of institutionalization, environmental influence, and attributes of the innovation were associated with implementation. In multivariate analyses, self-efficacy, training, and level of institutionalization remained significant (all p<0.05).
  
  
  CONCLUSIONS
  Demonstrating that an intervention "works" is only the first step toward promoting enhanced health at the population level. For wide-scale implementation, teacher-level self-efficacy and ongoing technical support to train teachers were important. At the school level, policies and guidelines provided a necessary, supportive environment for implementation.
authors.affiliation: Department of Pediatrics, University of British Columbia, L408-4480 Oak Street, Vancouver, BC, Canada. lmasse@cfri.ubc.ca
authors.forename: Louise C
authors.initials: LC
authors.lastname: Mâsse
authors.forename: Heather
authors.initials: H
authors.lastname: McKay
authors.forename: Maria
authors.initials: M
authors.lastname: Valente
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
authors.forename: Patti-Jean
authors.initials: PJ
authors.lastname: Naylor
mesh_terms: D001955:British Columbia; D002648:Child; D003430:Cross-Sectional Studies; D003625:Data Collection; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006291:Health Policy; D006801:Humans; D016015:Logistic Models; D008297:Male; D017146:Models, Organizational; D015999:Multivariate Analysis; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools; D020377:Self Efficacy