Co-designing a framework of the influences for the implementation of whole school approaches to Physical Education, School Sport and Physical Activity (PESSPA) in UK primary schools: development of the PESSPA Improvement Framework (PIF)

Abstract Background Reducing sedentary behaviour and achieving 60 min or more of moderate-to-vigorous physical activity daily provides physical and mental health benefits for children, however recommendations are not typically met. Whole-school approaches (WSA) are suggested to support children achieve these guidelines and emphasise the importance of multiple layers of a system working together to create change. Influencing factors over the implementation of WSAs to children’s physical activity provision is, however, still an emerging field. Methods Regional multi-stakeholder exploratory workshops and interviews, and an online survey explored the development of an early framework that described influences of WSAs to physical education, school sport and physical activity (PESSPA) in UK primary schools. The double diamond design approach was employed as the underpinning design tool alongside a participatory research design using co-design. Three stages of data collection took place; (1) interviews and workshops to explore barriers and enablers to WSAs, (2) repeated the same processes, however identified and refined a working framework, and (3) employed an online survey to provide final framework refinement. Framework analysis was used during analysis. Framework layers and constructs were analysed in relation to the Theoretical domains framework (TDF) to aid understanding of key influences uncovered within the framework. Results Participants identified a range of interrelated influences over the implementation of WSAs to PESSPA across multiple layers of a system. Central influences included senior leadership team (SLT) values and ethos, trust between stakeholders, school mindset, and school alignment of PESSPA in wider school priorities. Breadth and depth of school relationships and perceived opportunities and threats to PESSPA provision were highlighted as moderators, alongside circumstantial influences such as cultural and physical barriers and facilitators. Local, regional and national policy were also emphasised as key drivers to the implementation of WSAs to PESSPA provision. These findings informed the co-design of the PESSPA Improvement Framework (PIF). Conclusion The PIF describes an initial, theory informed framework, highlighting key constructs that may impact the implementation of a WSA to PESSPA in UK primary schools. The PIF emphasises the importance of a multi-layered systems approach, working concurrently across PIF layers, to tackle physical inactivity in UK primary schools through the adoption of WSAs to PESSPA. TDF analysis highlights emerging influences over the implementation, or not, of a WSA to PESSPA, providing an early framework for targeted effort to improve the uptake of WSAs to PESSPA. In addition, future intervention design should focus on factors up-stream of local implementation, and how such interventions cascade down to a local level. Future research should build upon the PIF through collaboration with additional regional inputs as well as investigate causal relationships and established interactions of constructs between PIF layers.