Visualizing patterns of factors influencing school health promotion implementation

Abstract Background The school setting offers a special opportunity for health-promotion (HP) interventions, as children spend 1/3 of their daily time there. Yet, implementing HP remains challenging due to the complexity of schools and unique contextual factors influencing implementation. While common influencing factors have been described, the aim of this study is to explore how influencing factors co-occur within and vary across schools, forming potential patterns of barriers and facilitators. Methods As part of a school HP program involving 258 institutions across Germany, nine schools were selected using maximum heterogeneity sampling for in-depth interviews on influencing factors by employing the Consolidated Framework for Implementation Research (CFIR). The interviews were transcribed verbatim and analyzed deductively using the CFIR as category system. Identified influencing factors were quantified [-5; +5] whether being a major barrier (-5) or a major facilitator (+5). To visualize potential patterns, a matrix heat map (MHM) displaying all influencing factors across all schools was created. Preliminary results Influencing factors in almost all CFIR categories were identified and all schools reported factors as barriers, such as parental engagement or (in)sufficient time. From the MHM, patterns of influencing factors, co-occurring within and differing across schools, emerged. For instance, some schools found the physical environment to be a barrier, while others considered it a facilitator, often in conjunction with financing as another facilitator. Conclusions Qualitative analysis and visualization of results with a MHM served as a way to navigate the complexity of the school setting and to highlight patterns of factors influencing implementation. Understanding these patterns can enhance tailoring implementation strategies, thereby improve implementation of school HP interventions and, ultimately, foster child health outcomes. Key messages • Influencing factors for school HP implementation manifest in varied patterns of barriers and facilitators across schools, which has implications for tailoring implementation strategies. • Using qualitative analysis guided by the CFIR and a MHM for visualization can aid in navigating the complexity of schools.