Journal Article

Using the R = MC2 heuristic to assess whole-of-school physical activity implementation in elementary schools: a cross-sectional study

Pfledderer, Christopher D., Pavlovic, Andjelka, Injil, Jizyah, Craig, Derek W., Onadeko, Kempson, DeFina, Laura F., Walker, Timothy J., Lanza, Kevin, Heredia, Natalia I.

2025

Overview

Background Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach successfully are not well understood. The R = MC 2 heuristic, which defines readiness for implementation as a combination of an organization’s motivation and capacity to implement, can enhance our understanding of implementation in the school setting. This study examines associations between constructs from the R = MC 2 heuristic and schools’ implementation of a WOS approach. Methods We conducted a secondary analysis of cross-sectional data from U.S. elementary schools participating in the NFL PLAY60 FitnessGram Project during the 2022–23 school year. From surveys administered to school staff, we created a WOS index (range = 0–12) comprising six physical activity practices: physical education, recess, before and after-school programs, classroom-based approaches, and active transport. We also assessed how six constructs from the R = MC 2 heuristic (i.e., culture, implementation climate, leadership, priority, resources utilization, resource availability) impact physical activity implementation using a series of questions measured on a 5-point Likert scale. We used linear regression models to determine associations between R = MC 2 constructs (independent variables) and WOS index scores (dependent variable), controlling for school-level characteristics (student enrollment, percentage of race/ethnicity and economically disadvantaged students served) and state-level clustering. Results The analytic sample consisted of 132 schools across 18 states. On average, school staff rated leadership (mean = 4.1, range = 1.5–5) and organizational culture (mean = 4.0, range = 2.25–5) the highest. The mean WOS index score was 6.1. Partially adjusted models indicated significant positive associations between each R = MC 2 construct and WOS index scores. Fully adjusted regression models revealed priority ( b  = 0.88; p  = 0.010; 95% CI = 0.19–1.56) and implementation climate ( b  = 0.69; p  = 0.047; 95% CI = 0.07–1.32) were positively and significantly associated with WOS index scores. Conclusions Our study provides insights into key implementation constructs associated with providing school-based physical activity opportunities. These findings can support the development of resources and implementation strategies which, in turn, can help schools address implementation-related disparities. This will help schools improve the quality and accessibility of opportunities for physical activity provided to students across the United States.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: active transport / After school programs / Behavioral Sciences / Beliefs, opinions and attitudes / Classrooms / climate / Clinical Nutrition / Corporate culture / cross-sectional studies / education / Elementary schools / Employees / Exercise / Exercise for children / Health aspects / Health promotion / Health Promotion and Disease Prevention / Heuristic / Implementation / leadership / Likert scale / Management / Medicine / Medicine & Public Health / Methods / motivation / nationalities and ethnic groups / Organizational readiness / Physical activity / Physical education / Physical fitness / Physical fitness for children / Polls & surveys / regression analysis / School enrollment / School environment / Schools / Social aspects / Students / Teachers / United States