The impact of an implementation strategy on the delivery of health promotion initiatives developed by regional and rural communities using system dynamics: the Action-RESPOND pilot RCT

Purpose: Childhood obesity remains a global public health challenge. Community-based system dynamics (CBSD) approaches have been widely applied, to support the development of locally appropriate child health promotion initiatives. Given the diversity of actions generated as part of these initiatives; implementation science may help enhance implementation processes and promote more equitable outcomes across communities. Methods: This was a pilot RCT (ACTRN12623000719639) assessing the impact of a multi-component implementation support strategy on the delivery of child health promotion actions generated by communities using CBSD. Implementation support was provided across a 12-month period (between Jun 2023 and Sep 2024) to five intervention communities (with five controls) in North-East Victoria, Australia. The support included seven implementation strategies informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework.Health promotion team members from intervention and control communities reported on the primary outcomes via an online survey, which included implementation fidelity (i.e. the extent and frequency of initiative delivery) and community stakeholders’ ‘intention-to-adopt’. Both were scored on a 7-point Likert scale. Practitioners from intervention communities scored the acceptability and appropriateness of the implementation support using validated measures on a 5-point Likert scale. Only post-intervention scores (mean (range)) are presented, with higher scores indicating more favourable outcomes. Results: The implementation support focused on a variety of actions, including nature walking tours, nutrition education, community gardens and promotion of existing community sports programs. Implementation fidelity and intention-to-adopt scores were similar between groups, with intervention communities reporting 4/7 (1–6) for both outcomes, while control communities scored 5/7 (2–6) for fidelity and 5/7 (5–6) for intention-to-adopt. Intervention communities rated all strategies as highly acceptable [4/5 (3–5)] and appropriate [4/5 (2–5)] for supporting implementation. Conclusion: This pilot study provides useful insights into the design and application of implementation strategies for the delivery of CBSD-informed health promotion initiatives in regional and rural communities. There remains a need to understand how best to support selection of actions, conceptualisation of implementation barriers and design of implementation strategies, to harness the potential benefits of incorporating implementation science in systems-informed interventions.