Unpacking “implementation climate:” mixed methods exploration of climate for wellness initiatives in U.S. elementary schools

HANNAH G. LANE
Duke University

Evidence-based initiatives that promote wellness (e.g., healthy food access, physical activity, and social emotional well-being) during school are critical to improve child health and reduce inequities. Such initiatives are not always prioritized for a range of reasons, including implementation context. This explanatory mixed methods study explores how having a “climate for wellness” influences implementation of wellness initiatives in schools.

Elementary schools participating in a national mixed methods surveillance study of wellness policy implementation. The purposeful qualitative sample of schools (n=39; 19 urban, 20 rural) is nested within the quantitative sample (n=521). In total, 50 informants (20 principals, 9 physical education teachers, 21 other staff; 80% female) participated in interviews.

An informant from each school completed a survey during the 2019-2020 school year to investigate determinants of and strategies used to implement wellness initiatives, including 6 climate items (?=.90) adapted from the from the Wellness Readiness Assessment Tool (scored on a 3-point Likert scale, max score=12). Informants from rural and urban schools were invited to participate in semi-structured interviews informed by the Consolidated Framework for Implementation Research. Interviews explored schools’ implementation climate by investigating inner setting factors of culture, communication networks, external policy/pressure, leadership engagement, relative priority, social capital, and tension for change. For mixed methods analysis, climate scores were summed then dichotomized into higher (>6) or lower (<6) climate. Qualitative comparative analysis was used to identify discrepant themes between high and low climate schools.

In the full sample, schools were 28.6% rural, 13.8% town, 20.9%urban, and 36.7% suburban. Over half (60.3%) had higher climate scores, 39.7% had lower scores (Mean=7.4; SD=3.3; range=0-12). In the qualitative sample, 24 (61.5%) had higher climate scores and 15 (38.5%) had lower scores (Mean=8.0; SD=3.2; range=2-12). Across all schools, the overlapping presence of a “culture of wellness,” explicit support from leadership, and communication networks that included families aided implementation of wellness initiatives. Discrepant themes among lower climate schools included: limited engagement of parents and community members in wellness-promoting culture, wellness initiatives driven by a few champions rather than a school-wide effort, and misalignment of the priorities of school leaders and teachers, staff and parents.

Practical and relevant implementation strategies that are tailored to schools’ baseline climate for wellness are needed. Strategies should address gaps at the intersection of culture, leadership and communication. Future research is needed to empirically investigate the influence of climate on wellness implementation processes and outcomes.