Understanding The Role Of Context In Implementation - A Scoping Review Of Theory-based Implementation Strategies For Health Interventions In School - Info and Reading Options

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Young people are a key target group for health promotion and the prevention of non-communicable diseases (NCDs). Since schools reach the majority of young people, they serve as a critical arena for health promotion and prevention efforts (Pulimeno, Manuela et al, 2020). The implementation of health interventions in school context, however, is a complex process, with context playing a crucial role in that. To effectively implement health interventions in schools, it is essential to understand the role of context in shaping these efforts, Theoretical approaches, such as implementation science theories, models, and frameworks (TMFs), are often employed to navigate implementation complexities. TMFs serve distinct purposes in implementation: process models guide the translation of research into practice, frameworks typically evaluate the implementation process, and theories aim to understand and explain the factors influencing the implementation process and outcomes (Nilsen, 2015). Due to TMFs distinct purposes, they also provide varying and thus complementary understanding to context and its influence on implementation. However, also deficiencies exist, as not all TMFs clearly take context into account, and those which do, may define context in distinct ways and emphasize some contextual layers (such as individual) over the others thus lacking a holistic approach to how contextual factors may work as facilitator and barrier to implementation (Linnansaari, 2023; Nilsen, 2015). Therefore, other theoretical approaches, such as organizational theories and cultural theories may provide a complementary perspective for understanding the context and its role on implementation. In this review focused on school setting, we define context as a multi-level construct consisting of individual, social, organizational/school level factors as well as the wider environment (e.g. cultural and societal factors) (Linnansaari, 2023). This scoping review with qualitative synthesis aims to explore studies that have used theoretical approaches considering multi-level context and its influence on implementing health interventions in schools. By analyzing these approaches and how they have been applied in planning, delivery, maintenance, or evaluation, we seek to develop theory-driven strategies to enhance implementation in school settings. Ultimately, our goal is to strengthen the implementation of these interventions to better support young people's health and well-being.

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