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Fathi LI, Walker J, Dix CF, Cartwright JR, Joubert S, Carmichael KA, Huang YS, Littlewood R, Truby H. Applying the Integrated Sustainability Framework to explore the long-term sustainability of nutrition education programmes in schools: a systematic review. Public Health Nutr 2023; 26:2165-2179. [PMID: 37548226 PMCID: PMC10564612 DOI: 10.1017/s1368980023001647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This review aimed to identify and synthesise the enablers and barriers that influence the long-term (≥ 2 years) sustainment of school-based nutrition programmes. DESIGN Four databases (PubMed, Cochrane Library, Embase and Scopus) were searched to identify studies reporting on the international literature relating to food and nutrition programmes aimed at school-age (5-14 years) children that had been running for ≥ 2 years (combined intervention and follow-up period). Eligible studies were analysed using the Integrated Sustainability Framework (ISF), which involved deductive coding of programme enablers and barriers. A quality assessment was completed, using the Mixed-Methods Appraisal Tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. SETTING International school-based nutrition programmes. SUBJECTS Individuals involved with the implementation of school-based nutrition programmes. RESULTS From the 7366 articles identified, thirteen studies (seven qualitative, five mixed methods and one quantitative descriptive) were included, from which the enablers and barriers of eleven different nutrition-related programmes were analysed. Thirty-four factors across the five domains of the ISF were identified that influenced the sustained implementation of programmes. The most common barrier was a lack of organisational readiness and resources, whereas the most common enabler was having adequate external partnerships and a supportive environment. CONCLUSIONS These findings have application during the initiation and implementation phases of school-based nutrition programmes. Paying attention to the 'outer contextual factors' of the ISF including the establishment and maintenance of robust relationships across whole of government systems, local institutions and funding bodies are crucial for programme sustainment.
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Affiliation(s)
- Leila Isabella Fathi
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Jacqueline Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
- Health and Wellbeing Queensland, Brisbane, Australia
| | - Clare Frances Dix
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Jessica Rose Cartwright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Suné Joubert
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Kerri Amelia Carmichael
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Yu-Shan Huang
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
- Health and Wellbeing Queensland, Brisbane, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
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Calvert HG, Lane HG, McQuilkin M, Wenner JA, Turner L. Elementary Schools' Response to Student Wellness Needs during the COVID-19 Shutdown: A Qualitative Exploration Using the R = MC 2 Readiness Heuristic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:279. [PMID: 35010539 PMCID: PMC8750629 DOI: 10.3390/ijerph19010279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
During spring of 2020, the COVID-19 pandemic and accompanying public health advisories forced K-12 schools throughout the United States to suspend in-person instruction. School personnel rapidly transitioned to remote provision of academic instruction and wellness services such as school meals and counseling services. The aim of this study was to investigate how schools responded to the transition to remote supports, including assessment of what readiness characteristics schools leveraged or developed to facilitate those transitions. Semi-structured interviews informed by school wellness implementation literature were conducted in the spring of 2020. Personnel (n = 50) from 39 urban and rural elementary schools nationwide participated. The readiness = motivation capacity2 (R = MC2) heuristic, developed by Scaccia and colleagues, guided coding to determine themes related to schools' readiness to support student wellness in innovative ways during the pandemic closure. Two distinct code sets emerged, defined according to the R = MC2 heuristic (1) Innovations: roles that schools took on during the pandemic response, and (2) Readiness: factors influencing schools' motivation and capacity to carry out those roles. Schools demonstrated unprecedented capacity and motivation to provide crucial wellness support to students and families early in the COVID-19 pandemic. These efforts can inform future resource allocation and new strategies to implement school wellness practices when schools resume normal operations.
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Affiliation(s)
- Hannah G. Calvert
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA; (M.M.); (L.T.)
| | - Hannah G. Lane
- Department of Population Health Sciences, School of Medicine, Duke University, 705 Broad Street, Durham, NC 27705, USA;
| | - Michaela McQuilkin
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA; (M.M.); (L.T.)
| | - Julianne A. Wenner
- Department of Teaching and Learning, College of Education, Clemson University, 405 Gantt Circle, Clemson, SC 29634, USA;
| | - Lindsey Turner
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA; (M.M.); (L.T.)
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Markham CM, Peskin MF, Baumler ER, Addy RC, Thiel MA, Laris BA, Baker K, Hernandez B, Shegog R, Coyle K, Emery ST. Socio-Ecological Factors Associated With Students' Perceived Impact of an Evidence-Based Sexual Health Education Curriculum. THE JOURNAL OF SCHOOL HEALTH 2020; 90:604-617. [PMID: 32510609 DOI: 10.1111/josh.12908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/03/2019] [Accepted: 01/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although schools often implement evidence-based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. METHODS Using student-reported perceived impact measures as a proxy for program effectiveness, we employed a socio-ecological approach to examine student, teacher, school, and district factors associated with greater perceived impact of It's Your Game (IYG), an evidence-based middle school sexual health education program. The student sample was 58.7% female, 51.8% Hispanic, mean age 13.2 years, from 73 middle schools. We assessed students' (N = 4531) perceived impact of IYG on healthy decision-making (α = 0.75) and sexual communication (α = 0.71); satisfaction with IYG activities and teacher; and demographics. We assessed teachers' (N = 56) self-efficacy to teach IYG, perceived administrative support, implementation barriers, and demographics. School and district data were abstracted from state records. We used multilevel logistic regression to estimate associations between independent variables and student-reported perceived impact. RESULTS In final multivariate models, students' demographics (sex, β = 0.06, SE = 0.015), satisfaction with IYG (β = 0.21, SE = 0.012), and their IYG teacher (β = 0.18, SE = 0.013) (all p = .000) were significantly associated with perceived impact on healthy decision-making. Similar findings resulted for sexual communication. No other variables were significantly associated with perceived impact. CONCLUSIONS Helping schools select age-appropriate, culturally relevant programs, and facilitate supportive learning environments may enhance the perceived impact of sexual health education programs.
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Affiliation(s)
- Christine M Markham
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Melissa F Peskin
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | | | - Robert C Addy
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | | | - B A Laris
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066
| | - Kimberly Baker
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Belinda Hernandez
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Ross Shegog
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Karin Coyle
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066
| | - Susan Tortolero Emery
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
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Love P, Booth A, Margerison C, Nowson C, Grimes C. Food and nutrition education opportunities within Australian primary schools. Health Promot Int 2020; 35:1291-1301. [DOI: 10.1093/heapro/daz132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Schools are regarded as a key setting for obesity prevention, providing an opportunity to reach a large number of children, frequently and over a prolonged period, through formal and informal opportunities to learn about health behaviours. However, the low value placed on health versus academic achievement is a barrier to effective implementation of food and nutrition (F&N) education. This study used a qualitative exploratory approach to explore the views of teachers and key health and education sector stakeholders regarding opportunities for F&N education within the Australian primary school setting. To the best of our knowledge, this is the first study to explore this topic from the perspectives of state-level coordination and development through to local-level implementation and support within the Australian primary school context. Only 2.6% of the Victorian Curriculum related to F&N education, taught through two (of seven) learning outcomes: Health and Physical Education, and Technologies. While stakeholders considered child health a priority, and schools an ideal setting for F&N education, barriers included a lack of strategic policy alignment, limited leadership and coordination, a ‘crowded curriculum’ and poor availability of shelf-ready resources with explicit curriculum links. A cross-curriculum approach was considered essential for F&N education to become embedded as a core component of the curriculum.
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Affiliation(s)
- Penelope Love
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong Campus, Victoria 3216, Australia
| | - Alison Booth
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood Campus, Victoria 3125, Australia
| | - Claire Margerison
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood Campus, Victoria 3125, Australia
| | - Caryl Nowson
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong Campus, Victoria 3216, Australia
| | - Carley Grimes
- Faculty of Health, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood Campus, Victoria 3125, Australia
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McIsaac JL, Warner G, Lawrence L, Urquhart R, Price S, Gahagan J, McNally M, Jackson LA. The application of implementation science theories for population health: A critical interpretive synthesis. AIMS Public Health 2018; 5:13-30. [PMID: 30083567 PMCID: PMC6070464 DOI: 10.3934/publichealth.2018.1.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Over the last decade, the field of implementation science (IS) has yielded an array of theoretical approaches to clarify and understand how factors influence the application and scaling-up of evidence-based practice in health care. These developments have led to questions about whether IS theories and frameworks might be of value to population health researchers and decision makers. The purpose of this research was to conduct a critical interpretive synthesis to explore, if, and how, key IS theories and frameworks might inform population health interventions aimed at reducing the burden of illness across populations. METHODS An initial list of theories and frameworks was developed based on previous published research and narrowed to focus on theories considered as formative for the field of IS. A standardized data extraction form was used to gather key features of the theories and critically appraise their relevance to population health interventions. RESULTS Ten theories were included in the review and six deemed most applicable to population health based on their consideration of broader contextual and system-level factors. The remaining four were determined to have less relevant components for population health due to their limited consideration of macro-level factors, often focusing on micro (individual) and meso (organizational) level factors. CONCLUSIONS Theories and frameworks are important to guide the implementation and sustainability of population health interventions. The articulation of meso level factors common in IS theories may be of value to interventions targeted at the population level. However, some of the reviewed theories were limited in their consideration of broader contextual factors at the macro level (community, policy or societal). This critical interpretive synthesis also found that some theories lacked provision of practical guidance to address interventions targeting structural factors such as key social determinants of health (e.g., housing, income).
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Affiliation(s)
- Jessie-Lee McIsaac
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Education, Mount Saint Vincent University, Canada
| | - Grace Warner
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Logan Lawrence
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Robin Urquhart
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Medicine, Dalhousie University, Canada
| | - Sheri Price
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Jacqueline Gahagan
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Mary McNally
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Medicine, Dalhousie University, Canada
- Faculty of Dentistry, Dalhousie University, Canada
| | - Lois A Jackson
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
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