Introduction: Rural and aging populations in Nova Scotia experience high burdens of chronic disease linked to insufficient physical activity and excessive sedentary time. Communities on the Move (CoM) is a four-year (2022-2026) community-wide initiative designed to increase opportunities for low-barrier, less-structured movement (e.g., walking, wheeling, cycling, gardening, etc.) through policy, built-and socia-environment actions and cross-sector partnerships. Objectives: To describe the CoM Phase 1 actions across four Nova Scotian communities, detail the participatory evaluation approach, and share early implementation insights. Methods: CoM applies a socio-ecological and participatory approach. Four communities were selected via a competitive application process assessing readiness and investments for active transportation. Communities received funding, communication support, and access to a multisectoral network to develop and implement action plans. A multi-phase, mixed-methods evaluation (Phase 1: Fall 2022-Spring 2023) tracked activities and outcomes. Results: Phase 1 findings show that three communities formed leadership teams, delivered social programs, improved infrastructure, and initiated a public engagement campaign to promote a culture of movement. One community experienced a delay in leadership formation due to staff leave; however, existing leaders and partners were leveraged to drive project actions. Feedback from communities shows early indicators that CoM has strengthened community capacity for cross-sector collaboration and resource mobilization. Conclusion: This community case study offers guidance for others to consider when implementing and evaluating community movement initiatives. Early findings align with existing evidence which suggest that pairing environmental changes with social supports and sustained partnerships to be feasible and promising for implementation potential in rural, aging contexts. Phase 1 evaluation concentrated on process outputs that establish the groundwork for future outcome assessments. Subsequent phases will build on these foundations to further examine changes in movement behaviors, participation, and community capacity.

Health Promoting Schools (HPS) is a whole school model that strengthens and maintains a healthy school environment. While a key component of HPS is the engagement of students, there is little known about the strategies for, facilitators of, and barriers to, student engagement. The purpose of this scoping review was to summarize and characterize the evidence on the process of student engagement in school health promotion, with a focus on whole school models like HPS. This scoping review followed the Joanna Briggs Institute guidelines and the Arksey and O’Malley scoping review framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guided reporting. Eligibility included sources examining the process of student engagement in school health promotion for children and youth (ages 5–19) in any country, who attended a private or public school. Both published and unpublished sources were included. Databases searched were: CINAHL, ERIC, MEDLINE, Scopus, and Google Scholar. Relevant organisational websites and sources identified by experts were also reviewed. Two independent reviewers screened the title, abstract, and full text of the sources. Descriptive analysis was conducted for quantitative data, and content analysis was employed for qualitative data. 1740 sources were screened, 133 citations were eligible for full text review and a total of 50 sources were included: 38 peer-reviewed publications, 7 grey literature sources, 2 peer-reviewed publications from reference-checking and 3 sources recommended by experts. The majority of articles reported on primary research (n = 34), employed qualitative methods (n = 28) and over half of all sources were published from European institutions/organizations (n = 26). Process strategies for student engagement predominantly related to participatory mechanisms including reflection and visioning, determining priorities and action-oriented learning. A wide range of intersecting facilitators and barriers were identified, with school structures largely acting as a barrier and adult approaches to engagement being a facilitator. This scoping review described the strategies, facilitators and barriers involving the process of student engagement in school health promotion. The results can inform the development and implementation of future student engagement strategies to strengthen school health promotion actions.

Parents influence and support children’s healthy movement behaviours (physical activity, sedentary time, sleep). During the COVID-19 pandemic, families spent even more time together. Thus, parents likely had greater influence on their child’s movement behaviours than usual. This study assessed the associations between parent and child movement behaviours and compliance with movement behaviour guidelines at two time points during the COVID-19 pandemic. National samples of parents of children and adolescents (5–17 years) living in Canada completed online surveys about their own and their child’s movement behaviours in October 2020 (n = 1,568, 58

Continuous quality improvement (CQI) has become a widely accepted approach to optimize health services while lowering healthcare costs (Quintuple Aim) and has expanded from clinical interventions to health promotion. Retail food environments (e.g. hospital cafeterias, cafes) are of interest given the increased adoption of healthy eating policies and interventions to influence diet (e.g. price, promotion, placement and product). However, there is a lack of understanding of what organizational and policy processes are necessary to implement CQI for health promotion in healthcare. This research uses a qualitative multiple exploratory case study design to explore the barriers and facilitators of CQI for health promotion in healthcare retail food environments. This research occurred in a healthcare setting with an organizational Healthy Eating Policy applicable to staff, patients and visitors. We collected semi-structured interview data with 12 healthcare staff working in Nutrition & Food Services in a Canadian provincial health authority from January to June 2023. We used directed content analysis to analyze the data. We used the Inside out model to interpret cross-cutting organizational barriers and facilitators. Four cases of quality improvement interventions (Plan-Do-Study-Act (PDSA) cycles) were identified. Barriers included expertise to interpret nutrient criteria, lack of data, conflicting benchmarks (e.g. finance and health), third-party vendors, past negative experiences, and a lack of time to monitor and evaluate. Facilitators included an organizational Healthy Eating Policy, understanding community context, local knowledge, partnerships with researchers and leadership. This study revealed how overarching policies, accompanied by organizational support, facilitated quality improvement and engagement in CQI but also created barriers to routine practice and sustainability of health-promoting interventions.

BACKGROUND:The United Nations Convention on the Rights of the Child affirms the human right of children to have their voices heard about issues affecting their lives. The One Chance to be a Child (One Chance) report provided an evidence-informed data profile of the well-being of children and youth in Nova Scotia (NS). To promote the report, we engaged youth from across the province in a knowledge mobilization (KMb) project. The purpose of this research is to outline the methods of the project, as well as the priority areas identified by youth. METHODS:10 NS youth (grades 7-12) were recruited to take part in a three-phased KMb approach: (1) A sense-making workshop to learn and discuss the report, (2) The planning and delivery of a youth-led forum to engage decision-makers in dialogue around the report, and (3) A participatory data analysis workshop to identify priority areas from the report. Data were collected through audio-recordings, note-taking, and pictures of all materials. RESULTS:Five priority areas were identified by youth: (1) Access to Care- high-quality care in a timely manner, (2) Community Care- inclusive community solutions, (3) Open Minded Education- school curricula that reflects their needs, (4) Quality of Life and Basic Needs- living wages and healthy workplace policies, and (5) Youth Empowerment- youth voice embedded throughout all actions. CONCLUSION:Engaging youth around the findings of the One Chance report supported their voices being heard, and their well-being needs to be considered by decision-makers.

Weight stigma negatively impacts people with higher weights across the lifespan as well as social contexts and can lead to weight discrimination. As weight is not a protected identity in Canadian human rights legislation, it is important to better understand how weight discrimination is being argued in Canada’s legal system. The purpose of this environmental scan was to examine and describe Canadian case law and scholarly articles pertaining to the argumentation of weight discrimination in Canada. A three-step search process was taken to identify relevant cases and articles that included; (1) Boolean keyword searches in HeinOnline, WestLaw, and LexisPlus; (2) citation searching within all results that met inclusion criteria; and (3) a keyword search in CanLII. These searches yielded a total of 33 documents that were included for analysis, including 8 scholarly articles and 25 cases. Scholarly articles highlighted consistent criticisms of existing human rights protections for higher-weight people in Canada, mostly pertaining to Limitations of disability protections. Of the 25 cases included, 16 were unsuccessful and 9 were successful, with most cases related to employment (n = 19). Our findings point to significant gaps in Canada’s legal system for identifying and correcting instances of weight discrimination. Current Canadian disability protections are inadequate for those who experience weight discrimination, especially those who do not experience disability due to their weight. Our results highlight that weight ought to be a bona fide human rights issue, independent from disability protections.

Healthy eating is influenced by a myriad factors ranging from individual to societal. Healthcare organizations have recently adopted healthy eating policies to improve food environments; however, how such policies shape practice is still unknown. This qualitative study explores perspectives on continuous quality improvement (CQI) among healthcare staff and managers working in hospital foodservices post-implementation of a healthy eating policy aimed at improving food environments. We conducted semi-structured interviews with 12 foodservices staff at Nova Scotia Health. Participants varied in role (administrative, point-of-sale) and location (rural/urban). We analyzed findings using directed content analysis. Participants' approach to quality revealed a range of definitions of healthy eating, from health promotion efforts directed towards individual behavior change management to a broader emphasis on supportive food environments. This research also highlighted the complexity of the healthcare food environment in which health promotion was being implemented, a 'setting' as per the 'settings approach' to health promotion, but also revealing a 'setting within a setting': food environments within healthcare environments. These nested environments are alternatively more business or healthcare service-centric, within the larger healthcare environment. Healthcare practitioners' views on effective implementation of the policy also spanned many scales of healthy eating, informed by concepts within their core healthcare practice (dietetics: nutrients), the organization (historical nutrition contexts) and broader food culture (food trends and choice). This study has demonstrated that CQI for a healthier food environment within healthcare needs a broader focus to advance benchmarks for health promotion.

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains ( Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment ). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles ( n = 108), mostly related to Retail ( n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

We examined students’ perspectives on well-being and youth engagement in schools using a Youth Participatory Action Research approach. Students (N = 11) trained as peer researchers and then interviewed their peers. Interviews (N = 21) were analyzed using reflexive thematic analysis and six themes were developed: desire for versus reality of a healthy school, insufficient school strategies to promote well-being and mitigate harm, listening to and actioning students’ ideas, diverse opportunities for student engagement, pre-conceived ideas of student capability, and importance of a support role. Through this project, we peered deeper into students’ viewpoints about well-being and youth engagement in their schools.

BackgroundAchieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions.MethodsPurposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration.ResultsEleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed.ConclusionOur findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

Introduction Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not.Methods and analysis Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities.Ethics and dissemination This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Research has demonstrated various negative effects of poor sleep on overall health in children. Engaging in physical activity during the day is often recommended to help children sleep better. Limited research has examined this recommendation for preschool children, although physical activity is generally supported as a healthy sleep practice. When measuring physical activity and sleep, objective measures (e.g., accelerometers) are recommended as opposed to subjective measures (e.g., parental reports). The purpose of the current study was to examine the relationship between objectively measured sleep (key variables included sleep efficiency, sleep onset latency, and sleep duration) and physical activity (operationalized as mean daily total physical activity) among preschool-aged children in Nova Scotia, Canada. Children (n = 29) wore a wrist accelerometer to objectively measure sleep and wore an accelerometer on their waist to measure physical activity for nine consecutive days. Overall, linear regression analyses demonstrate physical activity as a predictor of sleep efficiency but not total sleep time or sleep onset latency among preschool-aged children. Future research should examine the causal relationships between sleep efficiency and physical activity by conducting interventions to increase physical activity and determining the impact on sleep efficiency.

OBJECTIVE The purpose of this review is to describe how health service and delivery systems support health equity and to identify strategies and indicators being used to measure health equity. INTRODUCTION It is widely acknowledged that a population health and equity approach is needed to improve the overall health of the population. The health service and delivery system plays an important role in this approach. Despite this, system transformation to address health inequities has been slow. This is due, in part, to the lack of evidence-based guidance on how health service and delivery systems can address and measure health equity integration. Most studies focus on health equity integration in the public health sector at a provincial or national level, but less is known about integration within the health service and delivery system. More information is needed to understand how that transformation is occurring, or could occur, to make a meaningful contribution toward improving population health outcomes. INCLUSION CRITERIA This scoping review will identify studies that describe the strategies and indicators that health service and delivery systems are using to integrate health equity and how progress is measured. Evidence from qualitative, quantitative, mixed method studies, and gray literature will be included. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews. A comprehensive search strategy, developed with a librarian scientist, will be used to identify relevant sources. Titles, abstracts, and full texts will be evaluated against inclusion criteria. Information will be extracted by two independent reviewers. Data will be synthesized and presented narratively, with tables and figures where appropriate.

Background: Children and youth benefit from outdoor play; however, environments and policies to support outdoor play are often limited. The purpose of this paper is to describe a case study of the development of a municipal outdoor play policy in Nova Scotia, Canada. The outdoor play policy was developed by the Town of Truro with support from the UpLift Partnership, a School-Community-University Partnership in Nova Scotia, Canada. UpLift supports the health and well-being of school-aged children and youth using a Health Promoting Schools approach which identifies the important role of municipal government in creating healthy school communities. The UpLift Partnership and the municipality hosted online workshops for municipal staff, community leaders and partners that included content about the importance of outdoor play, barriers and facilitators to outdoor play, best practices for youth engagement, the policy development process, and how policy actions can support outdoor play. Workshop participants developed policy actions for their community of Truro, Nova Scotia to increase opportunities for outdoor play for children and youth. Following the workshops, a small team from the municipality and UpLift drafted an outdoor play policy and submitted it to Truro town council for approval. The outdoor play policy was adopted in Fall 2021 and has since informed recreation and municipal planning decisions. By presenting a case study of the development of this outdoor play policy, we hope other communities may be inspired to develop and adopt their own outdoor play policies to benefit children and youth in their communities.

IntroductionHealth-focused communities can promote physical activity for children by providing them with safe and supportive environments to move. Across the COVID-19 pandemic many community spaces and services were closed due to public health restrictions. During the pandemic, Atlantic Canada uniquely implemented an agreement between four provinces to restrict travel and reduce the spread of the virus. The “Atlantic bubble” led to fewer cases of COVID-19 and restrictions to community spaces and services. With restrictions now removed, community spaces and services likely play a critical role in facilitating the recalibration of children’s movement. Perspectives from families who experienced the “Atlantic bubble” may offer valuable insights to the use of these spaces during and after the removal of restrictions.ObjectiveThis study explored the role of community spaces and services on their child’s physical activity across the COVID-19 pandemic from the perspectives of Nova Scotia caregivers.MethodsWe employed a qualitative description approach and conducted semi-structured interviews with 14 caregivers of children aged 5–11 years who lived in Nova Scotia, Canada. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis.ResultsFour themes were generated: (1) Public health restrictions limited community movement behaviors and social connections, (2) Spaces, locations, and environments influenced how families experienced physical activity during public health restrictions, (3) Virtual realities: screens supported a new sense of community for children throughout the pandemic, and (4) “Facilitated” and “forced adaptability”: public health restrictions changed family dynamics, routines, and movement behaviors.ConclusionDespite living in the “Atlantic bubble,” Nova Scotian caregivers shared that COVID-19 related public health restrictions shifted their family’s dynamics, routines, and ability to engage in physical activity within their communities. Community spaces and services can be leveraged to recalibrate children’s movement as pandemic-related restrictions are reduced. In future public health crises, community spaces and services should remain in place to whatever extent possible to reduce the collateral consequences of public health restrictions on children’s health.

As cities work to support greater uptake and equity in cycling, the terminology 'All Ages and Abilities' (or AAA) is increasingly common in cycling research and practice vernacular. However, it is unclear the values that underlie this. We undertook a policy scan of Canadian municipal and regional policy documents to understand: the language used to describe 'All Ages and Abilities'; the infrastructure specified; how municipalities and regions define a cycling network; and how equity and priority populations are incorporated into these plans. Of 35 plans, 25 mentioned 'All Ages and Abilities'. Fourteen mentioned specific 'All Ages and Abilities' infrastructure, with cycle tracks, local street bikeways, and multi-use paths most frequent. Reference to the idea of a network was common (32 plans), with some defining this as a minimum grid. Within plans that used 'All Ages and Abilities' language, children and older adults were the most common populations mentioned (e.g. 'Ages'), but there was more ambiguity around who was being referred to with 'Abilities'. As use of this terminology continues, clarity is needed on the meaning and values that underpin it. A lack of specificity in design standards and whom this infrastructure serves is a barrier to concrete, consistent implementation.

Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10–12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.

Cycling is one of the most sustainable modes or urban transportation and cities around the world are taking steps to create safe cycling infrastructure to accelerate cycling uptake across all ages and abilities. There is considerable variability in how cycling infrastructure is planned, implemented and funded. In this commentary, we compare the actions and experiences of the Canadian city of Halifax and the Spanish city of Seville. We identify three lessons to implement a minimum grid to promote cycling. The first lesson is to invest and mobilize sufficient funds to build a complete network quickly. The second is to create institutional bodies with sufficient authority to implement the network. The third is to use best practice designs from the start. Comparing the processes of these two cities helps to illustrate some of the institutional and bureaucratic barriers that other cities can learn from.

Abstract Background Physical activity participation among preschoolers in childcare settings are low, and interventions to increase physical activity levels have produced mixed results. The Physical Literacy in the Early Years (PLEY) project implemented a six-month childcare-based outdoor loose parts play intervention in childcare centres in Nova Scotia, Canada. The purpose of this study was to examine the impact of the PLEY project on the development of domains of physical literacy (physical activity, physical competence, confidence and motivation, knowledge and understanding) in preschoolers attending childcare centres using mixed-methods. Methods Preschoolers (3–5 years) were recruited from 19 childcare centres in Nova Scotia and centres were randomized (parallel design) to the outdoor loose parts play intervention group (n = 11) or control (n = 8) group for 6 months. Participants, early childhood educators, and assessors were not blinded to group assignment. Quantitative and qualitative measures were used to comprehensively assess the impact of the PLEY project on all domains of physical literacy. At 3- and 6-months, early childhood educators participated in focus groups to assess how the intervention supported the development of 4 physical literacy domains: physical activity, physical competence, confidence and motivation, and knowledge and understanding. Physical activity and physical competence were also assessed with accelerometry and the Test of Gross Motor Development-3, respectively. Results Two hundred and nine preschoolers participated in the study (intervention group: n = 115; control group: n = 94). Accelerometer data showed that while baseline physical activity was similar between groups, children in the intervention group had higher physical activity at 3- (F(1,187) = 8.30, p = 0.004) and 6-months (F(1,187) = 9.90, p = 0.002) post-intervention. There was no intervention effect on physical competence scores. Thematic analysis of focus group data revealed that outdoor loose parts play contributed to development in all 4 physical literacy domains, including increased movement repertoires, social development, and enjoyment of physical activity. No adverse events or side effects of the intervention were reported. Conclusions Participation in the PLEY project was associated with increased development of various domains of physical literacy and perceived physical literacy among preschoolers, and outdoor loose parts play may be encouraged as an effective strategy to increase physical literacy in early learning settings. Trial registration Biomed Central (ISRCTN14058106), 20/10/2017.