P-10 Forebygging av kreft via skolen – et systemperspektiv på implementering og effekt av tiltak for å fremme sunne helsevaner.

Understanding adoption and implementation of primary prevention in schools as dynamic processes in complex systems could improve population impact by increased adoption and quality of implementation.

Background: Establishing lifelong healthy habits (diet, physical activity, non-smoking, etc.) from an early age is important for primary cancer prevention as well as reduction in social inequalities in health. School-based interventions are considered an important strategy to achieve these goals. Research has provided evidence of effective interventions through randomised controlled trials. However, the uptake into practice requires better understanding of the factors influencing adoption and implementation to ensure the population impact on the behaviours, the social inequalities and reduction in non- communicable diseases. Furthermore, these processes should be acknowledged as part of a complex system of public health policy. This project will generate new knowledge on adoption, implementation and impact of school-based primary prevention interventions through combining implementation science and system dynamics using the Norwegian School Fruit Scheme (NSFS) as a case.

Methods: The overarching methodology is system dynamics drawing on theories about adoption, implementation and behaviour change using a mixedmethods approach. Contextual factors related to adoption and implementation, as well as barriers and facilitators to implementation overall, will be informed by existing and highly applied implementation science frameworks, such as the context and implementation of complex interventions and the consolidated framework for implementation research. The system dynamics approach adopts computer simulation models to portray feedback mechanisms within complex interventions. System dynamics emphasise involving stakeholders, because to develop a computer simulation model we also need to access the stakeholders’ mental models of how they understand and make decisions about the problem. Simulation is a low-cost virtual lab that facilitates learning. It is also a great tool to communicate with policy makers and other stakeholders.

Results: The results from interviews about adoption and implementation of the NSFS will inform the development of qualitative system maps describing adoption and implementation as dynamic processes. There will be a quantitative system dynamics model for simulating the impact of the scheme under various scenarios. Together these parts will be used to develop recommendations for the scheme and for adoption and implementation of primary cancer prevention in schools together with user groups and researchers.

Conclusions: The project will have impact on adoption, implementation, and population impact of evidencebased interventions in schools promoting healthy habits and address social inequalities in general and with a particular potential to determine leverage points for increased adoption, implementation and impact of the NSFS.