Time to Adoption of TransformUs at Scale: Role of School Characteristics, Organizational Readiness, and Implementation Climate

ABSTRACT Introduction Globally, children are insufficiently active for health. Schools are a setting in which interventions can be implemented; however, many factors influence program adoption decisions. TransformUs is a school-based program to increase physical activity and decrease sedentary time, available to all primary schools in Victoria, Australia. The aims of this study were to 1) compare school-level characteristics between adopting and non-adopting schools, and 2) explore the relationship between school characteristics, school implementation climate, and school organizational readiness with time to intervention adoption. Methods School leaders and teachers completed an online survey of their current practice, perceptions of TransformUs, organizational readiness, and implementation climate. Reach and adoption were captured via online registrations and publicly available data on Victorian primary schools. School characteristics were reported descriptively and compared between adopting and non-adopting schools using chi-square analyses or independent t-tests. Regression analyses assessed the relationship between implementation climate and organizational readiness, and time to adoption. Results In the first 24 months, 116 school leaders and 666 teachers from 342 schools registered for TransformUs; 49 school leaders and 232 teachers completed surveys. Although 85% of adopting schools had physical activity policies, only 58% of school leaders agreed that physical activity is a priority at the school. A majority (80%) of adopting schools were government-funded and located in major cities (71%). Adopting schools had significantly more teachers and student enrollments but received less funding than non-adopters. Academic achievement did not differ between adopting and non-adopting schools. Linear regression models were not statistically significantly in relation to time to adoption for organizational readiness for change and implementation climate. Conclusions This study presents evidence on the adoption of a scaled-up school-based physical activity program over a 24-month period in the Australian education sector. Future implementation and scale-up efforts should focus on reaching schools that are under-represented in independent and Catholic sectors, as well as regional schools.