Table 6.

Factors from Greenhalgh et al’s Diffusion of Innovations framework[27]that were common across all cases

Factor	Definition and theoretically predicted impact on adoption and implementation	Study findings	Influence on adoption and implementation as reported by managers
Attributes of the ANGCY
Observability	If the benefits of the ANGCY are visible to potential adopters they will be adopted more easily [27].	Managers anticipated few visible positive outcomes from adoption: “There’s variety. But a positive outcome, because we have variety, I couldn’t tell you. Like it’s not something that’s a visual thing that I can tell you that I see”. Negative outcomes were expected and were highly visible because sales decreased significantly and many children continued to purchase unhealthy items.	Barrier to adoption and caused adopters to limit the extent of implementation to avoid larger negative financial consequences.
Task Issues	Innovations that are relevant to the performance of the user’s work, that improve task performance and are feasible to use are more readily adopted [27].	The recreation sector had not typically incorporated nutritional considerations within its programming and services, and thus managers perceived some incompatibilities between the ANGCY and staff tasks.	Barrier to adoption and implementation.
Trialability	Innovations that can be experimented with on a limited basis are more likely to be assimilated [27].	All managers perceived that that they could “test drive” the ANGCY: “I would say we wrote the policy knowing that we would be trying to change it, based on how things went with our contracts. That was sort of the test, I guess, is measuring over the three years whether it was feasible to have them, whether there was public acceptance or backlash.”	Facilitator of adoption.
Adaptability	Diffusion research suggests that innovations are not fixed entities and that innovations will be adopted more readily if potential adopters can modify them to suit their own needs [27].	All managers felt free to adapt the ANGCY and recognized that they could implement them to a greater (ie. restrictive format) or lesser extent (ie. choice-based format) to suit their own needs. This perceived flexibility was important as managers attempted to balance competing priorities of a health and financial nature.	Facilitator of adoption and implementation.
Augmentation	Innovations are more easily assimilated if training and support are provided to staff [27].	The Alberta government did not provide training nor did recreational facilities train their staff to implement the ANGCY.	No impact on adoption or implementation.
Organizational antecedents for the ANGCY
Centralization	Extent to which decision making authority is concentrated or dispersed within an organization [45]. Negatively associated with organizational innovativeness [45].	Centralized decision making was present in all facilities.	Facilitator and barrier to adoption. It was not the hierarchical structure per se, but the priorities of those at the top of the hierarchy that mattered.
Managerial receptivity to change	Extent to which managers or members of dominant coalition favour change [45]. Positively associated with organizational innovativeness [45].	Adopters regarded the ANGCY as an opportunity for organizational growth. The manager of the non-adopter facilities also demonstrated a strong commitment to change in other areas.	Facilitator of adoption and implementation.
Slack resources	An organization’s resources beyond minimal requirements to maintain operations [45]. Positively associated with organizational innovativeness [45].	Managers’ and employees’ time was fully occupied with their primary duties and responsibilities. Managers felt they had no spare resources to commit to ANGCY implementation.	Barrier to adoption and implementation.
Organizational readiness for the ANGCY
Assessment of implications	Innovations are more likely to be assimilated if their implications are fully assessed and anticipated [27].	All managers recognized the potential for revenue loss. Adopters selected a choice-based format to limit negative financial repercussions. The non-adopter chose not to adopt the ANGCY for this reason.	Barrier to adoption.
Resource availability	Innovations are more likely to be assimilated if there is an adequate and continuing allocation of resources [27,29].	There were few tools available to support implementation. There was limited availability of ANGCY-compliant products in the marketplace.	Barrier to adoption and implementation.
Linkage
Linkage at the adoption and implementation stage	Linkage agents can facilitate adoption of innovations by enhancing knowledge exchange between developers and users [46].	The provincial government hired Health Promotion Coordinators were hired to support ANGCY adoption and implementation, however they did not have an influential role in any of the facilities in this study.	No impact on adoption or implementation.
Outer context
Socio-political context	The organization’s decision to adopt an innovation and efforts to implement it may be influenced by social norms and prevailing political ideologies.	Managers all believed to varying extents that it was up to individuals to “develop some personal choice skills where they [make] personal choices that are good for them.” While adopters felt their role was “to make sure that [patrons] have those healthy choices in our facilities and hope that they help themselves”, the non-adopter did not think it feasible to make healthy options available in all contexts.	The personal responsibility ethic was a barrier to adoption for the non-adopter and shaped how adopters implemented the ANGCY (ie. it was a barrier to a restrictive format).

ANGCY: Alberta Nutrition Guidelines for Children and Youth.