International school-based physical activity promotion programmes for children in socio-economically disadvantaged contexts in high-income countries: a narrative review and structured analysis

Background School-based physical activity (PA) interventions can contribute to reducing social inequalities in health. However, implementation in socio-economically disadvantaged school settings remains challenging due to organisational, material and social constraints. Objective To identify implementation conditions associated with the successful delivery of PA interventions in primary schools in socio-economically disadvantaged contexts in high-income countries, focusing on adoption, local ownership and integration into school routines. Methods School-based PA interventions were identified through a search of six bibliographic databases conducted iteratively between 2022 and 2024 and covering studies published up to early 2022 using predefined eligibility criteria. Programmes were analysed across three dimensions: school entry modalities (top-down, bottom-up or hybrid); stakeholder involvement (school staff, students, families and community actors); and the level of contextual and socio-cultural adaptation, coded exclusively from explicitly reported information. Implementation conditions were synthesised using the Consolidated Framework for Implementation Research (CFIR). Results Sixteen interventions met inclusion criteria. Top-down (public authority initiated) approaches facilitated targeting disadvantaged schools but were associated with limited local ownership. Bottom-up (school-initiated) approaches promoted local engagement but were prone to selection bias. Hybrid models, combining institutional targeting and local adaptation, documented implementation effectiveness (adoption, organisational compatibility and support). Highly adapted programmes relied on dedicated resources, flexibility and integration into school routines whereas standardised models produced transient effects. Conclusion In socio-economically disadvantaged school settings, PA intervention effectiveness depends on contextual fit and implementation conditions. Findings apply to disadvantaged contexts in high-income countries and highlight the need for future research integrating implementation analyses and long-term follow-up.