Table 1_Understanding school frontline workers’ early implementation behavior: insights from the generation healthy kids study in Denmark.docx

IntroductionChildhood obesity is a growing global public health issue, with significant implications for children’s physical and psychological well-being. Schools offer a structured environment for implementing health-promoting interventions to address this challenge. This study examines how organizational conditions within schools influence frontline workers’ (e.g., teachers and pedagogic staff) early implementation behavior in a school-based health intervention. Insights aim to inform strategies for enhancing the sustainability and effectiveness of such programs.
MethodsThe study utilizes a qualitative design, conducting 11 focus group interviews across 11 of the 12 intervention schools participating in the Generation Healthy Kids (GHK) intervention program in Denmark. Using the Consolidated Framework for Implementation Research (CFIR) and the COM-B Model for Behavior Change, the interviews explored organizational factors shaping frontline workers’ capabilities, opportunities, and motivation for implementing GHK components. Thematic analysis, guided by predefined theoretical constructs, was applied to identify key patterns in the data.
ResultsThe findings highlight organizational conditions within schools as critical to frontline workers’ early implementation behavior. Capability was linked to training and resources, though time constraints hindered effective application. Opportunity was shaped by structural factors such as limited access to facilities, causing logistical challenges. Motivation was influenced by alignment with existing workflows, reflective beliefs about the program’s relevance, and tension for change due to perceived pupil needs. Leadership emerged as a cross-cutting factor, with engaged leaders enhancing implementation through active support and resource coordination.
DiscussionThe study underscores the interplay between organizational conditions and frontline workers’ behaviors in implementing health programs. Addressing logistical barriers, fostering supportive leadership, and ensuring alignment with school priorities are essential for successful implementation. These findings highlight the need for adaptive, school-specific implementation strategies to sustain health-promoting interventions like GHK and suggest stakeholder engagement to further optimize implementation processes.

引言 儿童肥胖已成为日益严峻的全球公共卫生问题，对儿童的身心健康均造成深远影响。学校为开展健康促进干预以应对该挑战提供了结构化的实施场景。本研究旨在探究学校内部的组织环境如何影响一线工作人员（如教师与教学人员）在校园健康干预项目中的早期实施行为，研究结论可为提升此类项目的可持续性与实施成效提供策略参考。
方法 本研究采用质性研究设计，对丹麦参与“健康一代儿童（Generation Healthy Kids, GHK）”干预项目的12所试点学校中的11所开展了11场焦点小组访谈。本研究借助《综合实施研究框架（Consolidated Framework for Implementation Research, CFIR）》与行为改变COM-B模型（COM-B Model for Behavior Change），通过访谈探究影响一线工作人员实施GHK项目各模块的能力、机会与动机的组织因素。研究采用基于预设理论框架的主题分析法，以识别数据中的核心模式。
结果 研究结果显示，学校内部的组织环境是影响一线工作人员早期实施行为的关键因素。研究能力与培训及资源供给相关，但时间限制阻碍了其有效应用。实施机会受设施获取不足等结构性因素影响，进而引发后勤保障难题。实施动机则受到与现有工作流程的契合度、对项目相关性的反思性认知，以及因感知到学生需求而产生的变革张力的影响。领导力作为贯穿各环节的核心因素，积极投入的管理者可通过主动支持与资源协调推动项目实施。
讨论 本研究强调了在健康项目实施过程中，学校组织环境与一线工作人员行为之间的相互作用。解决后勤保障障碍、培育支持性的管理文化，以及确保项目与学校核心工作相契合，是实现项目成功实施的关键要素。本研究结果表明，需制定适配性强且针对各校具体情况的实施策略，以维持如GHK这类健康促进干预项目的可持续性，并建议通过利益相关方参与进一步优化实施流程。