The black box of large-scale dissemination: Building an evidence base documenting the complexity of national movement behaviour guideline dissemination to inform research, practice, and policy

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Kauffeldt, Kaitlyn D.
24-Hour Movement Behaviour Guidelines , Knowledge Mobilization , Complexity
National movement behaviour guidelines are important for public health. However, they have had little influence on practice and policy. This dissertation is composed of four studies that aim to build an understanding of the multi-level influences on the large-scale dissemination of national movement behaviour guidelines. Manuscript 1 assessed the (1) awareness and knowledge of national movement behaviour guideline recommendations among adults living in Canada and (2) the demographic correlates associated with guideline awareness. Findings highlight that the short-term dissemination efforts for the Canadian 24-Hour Movement Guidelines for Adults Aged 18-64 Years and Adults Aged 65 Years or Older (24HMG) had a modest impact on awareness (i.e., 31% at a population level). Long-term dissemination efforts may be needed to observe further increases. Manuscript 2 applied the Reach Effectiveness Adoption Implementation and Maintenance framework to evaluate the dissemination of the 24HMG. The approach used to disseminate the 24HMG resulted in a large reach to target audiences and short-term improvements in guideline awareness. At an organizational level, the dissemination performed for the 24HMG peaked in the first 4-months post-guideline release. Findings yield insight into the process and impact of national movement behaviour guideline dissemination and suggest that more coordinated and scalable approaches may be needed. Manuscript 3 explored the potential barriers and facilitators experienced by intermediary organizations to disseminating national movement behaviour guidelines using the Consolidated Framework for Implementation Research. Multi-level factors were identified as having an influence on guideline dissemination. Capacity-building strategies may be needed if intermediary organizations are to play a central role in future guideline initiatives. Lastly, Manuscript 4 used social network analysis to explore network features that may influence the dissemination of national movement behaviour guidelines. Findings demonstrate the potential for constrained information sharing among organizations. Efforts to improve information sharing among this network may be needed to enhance future guideline dissemination. The studies within this dissertation serve as a possible explanation for why national movement behaviour guidelines have had a limited influence on important dissemination outcomes. Future initiatives may benefit from embracing the complexity of guideline dissemination and working in partnership to facilitate the integration of guidelines into practice and policy.
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