Exploring the factors affecting the implementation of tobacco and substance use interventions within the secondary school setting

Student thesis: Doctoral Thesis

Abstract

Background
The secondary school provides a key opportunity to target health related behaviour change for adolescents. Detrimental behaviours, such as tobacco or substance use, adopted during adolescence, can have a significant impact across the life-course. As the majority of adolescents attend school until at least 16 years of age, research has identified that interventions modifying risky behaviours can be effectively introduced within schools. However, there are currently no defined pathways in the UK around how to implement such school-based interventions.

Aim
The aim of this PhD study was to explore the factors affecting the implementation of tobacco or substance use interventions within the secondary school setting, in order to inform the development of an implementation model.

Methods
In order to explore the above aim the following research methods were chosen:
1) A review of the implementation science literature was undertaken to increase the understanding around the relevant implementation literature.
2) A systematic review synthesised the literature around the implementation of tobacco or substance use interventions in a secondary school.
3) Semi-structured interviews were conducted with school staff and local authority practitioners to explore the factors affecting school-based implementation.
4) These findings informed the development of an implementation process model.

Results
The systematic review synthesised 19 quantitative and qualitative papers, which focused on both tobacco or substance use interventions, delivered by differing providers. Key facilitating factors for implementation were positive organisational climate, adequate training, and teachers and pupil’s motivation. Barriers included heavy workloads, budget cuts, and insufficient resources or support.
Twenty-three interviews with school staff and Local Authority staff were undertaken. Although there was a large degree of heterogeneity apparent across the different schools and local authorities, five overarching themes were identified: provider factors; young people factors; school factors and wider factors, which were proposed to categorise the factors affecting implementation.
These findings were triangulated to inform the development of an implementation process model.

Conclusions
There has been limited previous research focusing on implementation within UK secondary schools. Therefore, the assessment of factors affecting implementation will be useful to both researchers and practitioners undertaking school-based tobacco or substance use implementation. By undertaking this study, the findings informed the development of an implementation model, which aims to be relevant and accessible, and is the first of its kind to offer a practice focused approach to improve school-based implementation.
Date of Award15 Feb 2019
LanguageEnglish
Awarding Institution
  • School of Health & Social Care
  • Teesside University
SponsorsFuse - UKCRC Centre for Translational Research in Public Health
SupervisorDorothy Newbury-Birch (Supervisor), Tracy Finch (Supervisor) & Emma L. Giles (Supervisor)

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