Implementing the Physical Literacy Component of the 2015 Ontario Health and Physical Education Curriculum: Is the Stage Set?

Introduction: Current physical activity levels among children and youth are alarmingly low; a mere 7% of children and youth are meeting the Canadian Physical Activity Guidelines (Colley et al., 2011), which means that the vast majority of this population is at risk of developing major health problems in adulthood (Janssen & Leblanc, 2010). These high inactivity rates may be related to suboptimal experiences in sport and physical activity stemming from a lack of competence and confidence (Lubans, Morgan, Cliff, Barnett, & Okely, 2010). Developing a foundation of physical literacy can encourage and maintain lifelong physical activity, yet this does not always occur naturally as a part of human growth (Hardman, 2011). An ideal setting to foster the growth and development of physical literacy is physical education class. Physical education class can offer all children and youth an equal opportunity to learn and practice the skills needed to be active for life (Hardman, 2011). Elementary school teachers are responsible for delivering the physical education curriculum, and it is important to understand their will and capacity as the implementing agents of physical literacy development curriculum (McLaughlin, 1987). Purpose: The purpose of this study was to explore the physical literacy component of the 2015 Ontario Health and Physical Education curriculum policy through the eyes of key informants, and to explore the resources available for the implementation of this new policy. Methods: Qualitative interviews were conducted with seven key informants of the curriculum policy development, including two teachers. In tandem with the interviews, a resource inventory and curriculum review were conducted to assess the content and availability of physical literacy resources. All data were analyzed through the lens of Hogwood and Gunn’s (1984) 10 preconditions for policy implementation. Results: Participants discussed how implementation is affected by: accountability, external capacity, internal capacity, awareness and understanding of physical literacy, implementation expertise, and policy climate. Discussion: Participants voiced similar opinions on most issues, and the overall lack of attention given to physical education programs in schools will continue to be a major dilemma when trying to combat such high physical inactivity levels.

Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.