Readiness of school staff to implement an intervention to promote health in preschool class children in Sweden

Abstract: Background: A Healthy School Start (HSS) is an evidence-based family-support program in the school setting aiming to promote health-related behaviors and prevent childhood obesity. However, there is a research gap how to implement programs effectively and what indicators to use for evaluation of implementation success.  Aim: This thesis aimed to investigate how four constructs and indicators of implementation called organizational readiness for change, acceptability, appropriateness, and feasibility among deliverers of the HSS differed at baseline between teachers, school nurses, and principals in Swedish schools, and if they were related to staff and school characteristics.  Methods:  Participants (n=79) answered validated short questionnaires in the fall of 2021. One-way ANOVA was used to analyze the mean scores in implementation indicators. Univariate linear regression was used to investigate associations between the staff and school characteristics and each indicator.  Results: There was no significant difference in any score between the professions. Teachers had non-significantly higher organizational readiness for change, and principals expressed somewhat higher acceptability, appropriateness, and feasibility while school nurses scored lowest overall. The number of students at the school was positively and significantly related to organizational readiness for change in the total sample, and higher parental education was associated with higher  acceptability, appropriateness, and feasibility. The readiness constructs were positively associated with the implementation indicators. Conclusion: School staff were overall positive at baseline towards implementing the HSS program. These results can be used when developing implementation strategies to support staff delivering health promotion programs in the school setting involving different school professions.