title: A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools.
abstract: BACKGROUND
  Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children's opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact.
  
  
  METHODS
  We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies.
  
  
  RESULTS
  Five of Canada's 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children's PA levels or BMI.
  
  
  CONCLUSIONS
  This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.
authors.affiliation: Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. dana.olstad@deakin.edu.au.
authors.forename: Dana Lee
authors.initials: DL
authors.lastname: Olstad
authors.affiliation: School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada. ejcampbe@ualberta.ca.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Campbell
authors.affiliation: School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada. kim.raine@ualberta.ca.
authors.forename: Kim D
authors.initials: KD
authors.lastname: Raine
authors.affiliation: School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada. candace.nykiforuk@ualberta.ca.
authors.forename: Candace I J
authors.initials: CI
authors.lastname: Nykiforuk
mesh_terms: D002170:Canada; D002648:Child; D002652:Child Behavior; D003479:Curriculum; D015444:Exercise; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D010806:Physical Education and Training / Q000458:organization & administration*; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools / Q000458:organization & administration