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Slater J, Katz A, Pilli B, Hinds A, Urquia ML, Sanguins J, Green C, Cidro J, Chateau D, Nickel N. Geographic Comparison of Dietary Intake and Quality in Manitoba Adolescents. CAN J DIET PRACT RES 2024:1-9. [PMID: 38456655 DOI: 10.3148/cjdpr-2024-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Purpose: The Food and Nutrition for Manitoba Youth (FANS) study examined dietary intakes, food behaviours, food security status, health indicators, and body mass index of a cohort of grade 9 students. This paper describes regional differences and similarities in dietary intake (food and nutrients) and quality of youth participants in the FANS study.Methods: Grade 9 students completed a web-based survey on dietary intakes (24-hour recall), food behaviours, self-reported health indicators, and sociodemographic variables. Nutrient intakes were compared with national guidelines and diet quality was assessed using a modified Healthy Eating Index.Results: A total of 1587 students participated from northern, rural, and urban regions in Manitoba. Northern and rural students had higher intakes of sugar, sodium, and saturated fat compared with urban. Northern students consumed fewer grain products compared to urban, and more servings of "other" foods compared with rural and urban. While most participants were classified into the "needs improvement" or "poor" Healthy Eating Index categories, significantly more northern participants were in the "poor" category.Conclusions: Most adolescents in the study are at nutritional risk; however, there are additional vulnerabilities for those in rural and northern communities. Dietitians can use results to advocate for and plan interventions to improve adolescent nutrition.
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Affiliation(s)
- Joyce Slater
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Bhanu Pilli
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB
| | - Aynslie Hinds
- Department of Psychology, University of Winnipeg, Winnipeg, MB
| | - Marcelo L Urquia
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | | | - Chris Green
- Winnipeg Regional Health Authority, Winnipeg, MB
| | - Jaime Cidro
- Department of Anthropology, University of Winnipeg, Winnipeg, MB
| | - Dan Chateau
- Research School of Population Health, Australian National University, Canberra ACT
| | - Nathan Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
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Reeve E, Bell C, Sacks G, Mounsey S, Waqa G, Peeters A, Thow AM. Lessons for strengthening policymaking for obesity and diet-related noncommunicable disease prevention: A narrative synthesis of policy literature from the Western Pacific Region. Obes Rev 2024; 25:e13651. [PMID: 37905309 DOI: 10.1111/obr.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/28/2023] [Accepted: 09/09/2023] [Indexed: 11/02/2023]
Abstract
Obesity and diet-related noncommunicable diseases (NCDs) have a profound impact on individuals, households, health care systems, and economies in low- and middle- income countries (LMICs), with the Western Pacific Region experiencing some of the highest impacts. Governments have committed to improving population diets; however, implementation challenges limit effective policy action. We undertook meta-narrative synthesis of the academic literature and used theories of policymaking and implementation to synthesize current knowledge of issues affecting the adoption and implementation of policies to prevent obesity and diet-related NCDs in LMICs in the Western Pacific Region. We found that political leadership and management of food and nutrition policies often diluted following policy adoption, and that nutrition and health advocates find it difficult to enforce policy compliance from actors outside their sectors. Opportunities for strengthening implementation of food and nutrition policies in the Western Pacific include (1) improved and earlier engagement between health policymakers and implementing agencies; (2) focusing on the need for increased accountability from governments, including through effective engagement and organization of actor networks, knowledge sharing, and in highlighting where stronger action is required; and (3) identifying and building the strategic capacities of policy actors in framing, advocacy, coalition-building, knowledge translation, and leadership.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sarah Mounsey
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Randby JS, Ogden T, Lien N. Implementation and effectiveness of a school-based intervention to increase adherence to national school meal guidelines: a non-randomised controlled trial. Public Health Nutr 2024; 27:e25. [PMID: 38164650 PMCID: PMC10830359 DOI: 10.1017/s1368980023002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. DESIGN The study was a school-based hybrid implementation effectiveness trial with a pre-post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. SETTING Primary schools and after-school services in two counties in south-east Norway. PARTICIPANTS School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. RESULTS There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, seB = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school's socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (r s = 0·48) with the change scores in the intervention group, indicating that principals' support is important for gaining the largest intervention effects. CONCLUSIONS A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.
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Affiliation(s)
- Jorunn Sofie Randby
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
- Department of Child and Adolescent Health, Norwegian Directorate of Health, Pb. 220 Skøyen, 0213Oslo, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, P.b. 7053 Majorstuen, 0306Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
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Moore SE, Brennan SF, Lavelle F, Dean M, McKinley MC, Olgacher D, McCole P, Hunter RF, Dunne L, O’Connell NE, Elliott CT, McCarthy D, Woodside JV. Capturing the whole-school food environment in primary schools. Public Health Nutr 2023; 26:1671-1678. [PMID: 37272413 PMCID: PMC10410367 DOI: 10.1017/s1368980023001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations. DESIGN SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion. SETTING Primary schools. PARTICIPANTS An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16). RESULTS The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %). CONCLUSIONS The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.
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Affiliation(s)
- Sarah E Moore
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Sarah F Brennan
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Lavelle
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Moira Dean
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Michelle C McKinley
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Dilara Olgacher
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Patrick McCole
- Queen’s Management School, Queen’s University Belfast, BelfastBT9 5EE, United Kingdom of Great Britain and Northern Ireland
| | - Ruth F Hunter
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Niamh E O’Connell
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Chris T Elliott
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Danielle McCarthy
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Jayne V Woodside
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Erzse A, Karim SA, Rwafa-Ponela T, Kruger P, Hofman K, Foley L, Oni T, Goldstein S. Participatory prioritisation of interventions to improve primary school food environments in Gauteng, South Africa. BMC Public Health 2023; 23:1263. [PMID: 37386466 PMCID: PMC10308686 DOI: 10.1186/s12889-023-16101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In South Africa, overweight and obesity affect 17% of children aged 15-18. School food environments play a vital role in children's health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model. METHODS A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or 'very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5). RESULTS We identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) "regulate what kinds of foods can be sold at schools", 2) "train school staff through workshops and discussions to improve school food environment", and affix 3) "compulsory, child-friendly warning labels on unhealthy foods". CONCLUSION Prioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa's childhood obesity epidemic effectively.
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Affiliation(s)
- Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Safura Abdool Karim
- University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Teurai Rwafa-Ponela
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Petronell Kruger
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Susan Goldstein
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Meshkovska B, Gebremariam MK, Atukunda P, Iversen PO, Wandel M, Lien N. Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2023; 4:73. [PMID: 37370179 DOI: 10.1186/s43058-023-00454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs. METHODS The following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis. RESULTS We identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies. CONCLUSION This review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds. REGISTRATION PROSPERO ID: CRD42022296159.
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Affiliation(s)
- Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway.
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, 0450, Oslo, Norway
| | - Prudence Atukunda
- Center for Crisis Psychology, University of Bergen, Møllendalsbakken 9, 5009, Bergen, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Margareta Wandel
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
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McCrossan E, Fornaro EG, Servello S, Hawes P, Erdem E, Struloeff K. "A Growing Relationship": Cultivating Organizational Readiness to Influence Implementation of Policy, Systems, and Environmental (PSE) Change Programming in SNAP-Ed Funded School-Community Partnerships. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:394-403. [PMID: 37074256 DOI: 10.1016/j.jneb.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Provide a nuanced understanding of how Supplemental Nutrition Assistance Program-Education (SNAP-Ed) implementers decide what programming a school is ready to implement and the organizational factors that facilitate the initial implementation of programming in schools. DESIGN Case studies conducted at schools during 2018-19. SETTING Nineteen School District of Philadelphia schools receiving nutrition programming funded by SNAP-Ed. PARTICIPANTS Interviews were conducted with 119 school staff and SNAP-Ed implementers. A total of 138 hours of observations of SNAP-Ed programming were completed. PHENOMENON OF INTEREST How do SNAP-Ed implementers decide what PSE programming a school is ready to implement? What organizational factors can be developed to facilitate the initial implementation of PSE programming in schools? ANALYSIS Interview transcripts and observation notes were coded deductively and inductively on the basis of theories of organizational readiness for programming implementation. RESULTS Supplemental Nutrition Assistance Program-Education implementers focused on schools' existing capacity when determining readiness for programming. CONCLUSIONS AND IMPLICATIONS Findings suggest that if SNAP-Ed implementers only focus on a school's existing capacity when assessing its readiness for programming, the school might not receive the programming it needs. Findings suggest SNAP-Ed implementers could develop a school's readiness for programming by concentrating efforts on cultivating relationships, program-specific capacity, and motivation at schools. Findings have equity implications for partnerships in underresourced schools that may have limited existing capacity and consequentially could be denied vital programming.
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Affiliation(s)
- Erin McCrossan
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA.
| | - Elisabeth G Fornaro
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Soula Servello
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Peter Hawes
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Ebru Erdem
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Katrina Struloeff
- Catalyst @ Penn GSE, University of Pennsylvania Graduate School of Education, Philadelphia, PA
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Ausenhus C, Gold JM, Perry CK, Kozak A, Wang ML, Jang SH, Leong J, Rodriguez E, Duggan C, Ko LK. Factors impacting implementation of nutrition and physical activity policies in rural schools. BMC Public Health 2023; 23:308. [PMID: 36765324 PMCID: PMC9921364 DOI: 10.1186/s12889-023-15176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Rural Latino children have higher rates of obesity compared to non-Latino Whites. Schools are in a unique position to address rural childhood obesity through policies. While evidence exists on factors that promote or impede school-based physical activity (PA) and nutrition policies, only a fraction has been in rural communities. This study seeks to understand 1) the knowledge and perceptions of school nutrition and PA policies and 2) barriers and facilitators to their implementation among rural school stakeholders from Washington State. METHODS We conducted 20 semi-structured, in-depth interviews with school stakeholders (e.g., principals and school nutrition directors) from four K-12 school districts in the Lower Yakima Valley of Eastern Washington State. Thematic analysis was conducted using inductive, constant comparison approach to identify themes around knowledge and perceptions of policies and barriers and facilitators of policy implementation. RESULTS Three main themes were identified: perceptions and knowledge of school PA and nutrition policies, barriers to policy implementation, and facilitators of policy implementation. The majority of stakeholders were supportive of school-based policies promoting PA and a healthy diet, even when lacking a specific understanding of these policies. Four subthemes were identified as barriers to policy implementation: viewing PA as a low priority, misuse of recess time, funding constraints, and lack of strong leadership. Facilitators of implementation included strong leadership at the district level, creating healthy norms through school-community linkages and pooling community resources to improve nutrition and PA among children. CONCLUSIONS Schools provide a unique setting to promote healthy diet and PA behaviors among children and their families. Study findings show that while knowledge of specific nutrition and PA policies may vary, support for such policies were high among rural stakeholders. Study findings can inform policy development and support strategies for policy implementation in rural settings. Future studies may want to examine whether implementation of strategies addressing the barriers and enhancing facilitators lead to success in rural school settings.
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Affiliation(s)
- Caryn Ausenhus
- grid.270240.30000 0001 2180 1622Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98109 USA
| | - Joshua M. Gold
- grid.270240.30000 0001 2180 1622Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98109 USA
- grid.34477.330000000122986657Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Cynthia K. Perry
- grid.5288.70000 0000 9758 5690Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239 USA
| | - Andrea Kozak
- grid.261277.70000 0001 2219 916XDepartment of Psychology, Oakland University, 654 Pioneer Drive, Rochester, MI 48309 USA
| | - Monica L. Wang
- grid.189504.10000 0004 1936 7558Department of Community Health Sciences, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118 USA
| | - Sou Hyun Jang
- grid.222754.40000 0001 0840 2678Department of Sociology, Korea University, 145 Anam-Ro, Anam-Dong, Seongbuk-Gu, Seoul, South Korea
| | - Judy Leong
- grid.413919.70000 0004 0420 6540U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, 1660 S. Columbian Way, Seattle, WA 98108 USA
| | - Edgar Rodriguez
- grid.270240.30000 0001 2180 1622Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98109 USA
| | - Catherine Duggan
- grid.270240.30000 0001 2180 1622Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98109 USA
| | - Linda K. Ko
- grid.34477.330000000122986657Department of Health Systems and Population Health, University of Washington, Seattle, USA
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Preliminary Effectiveness of a Strategy to Promote Healthy Lifestyle Habits in Schoolchildren. CHILDREN 2022; 9:children9091402. [PMID: 36138711 PMCID: PMC9497957 DOI: 10.3390/children9091402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
Purpose: To measure the preliminary effectiveness of a strategy to promote healthy lifestyle habits in schoolchildren, aged 6 to 12 years, living in the Andean region of Colombia, 2018–2021. Design and Methods: This is a Nursing Methodological Research, developed in phases: (1) Context and schoolchildren characterization; (2) Strategy design guided by the Whittemore and Grey criteria and the Bronfenbrenner ecological conceptual model; (3) Strategy validation with 11 experts; (4) Trial to evaluate preliminary effectiveness. We applied the strategy in seven different schools with the educational community including 955 schoolchildren between 6 and 12 years of age, 551 parents, 130 teachers and 7 members of the food staff. Results: Our health promotion strategy “Prosalud” has five components: citizenship feeding and nutrition, physical activity, and rest; environment protection, and directing one’s own life. It includes all the participants of the educational community. Conclusions: According to experts, the health promotion strategy “Prosalud” is valid to help promoting healthy lifestyle habits among schoolchildren. This strategy demonstrates its preliminary effectiveness in a group of school children from 6 to 12 years of age, their parents, teachers, and school food staff, in the Andean region of Colombia.
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School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127460. [PMID: 35742706 PMCID: PMC9224334 DOI: 10.3390/ijerph19127460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.
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Lobczowska K, Banik A, Forberger S, Kaczmarek K, Kubiak T, Neumann-Podczaska A, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Bekker MPM, Zeeb H, Luszczynska A. Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity. BMC Public Health 2022; 22:1055. [PMID: 35619065 PMCID: PMC9137101 DOI: 10.1186/s12889-022-13340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. Methods Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. Results Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). Conclusions These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13340-4.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Krzysztof Kaczmarek
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Agnieszka Neumann-Podczaska
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, bode 60, 6700 EW, Wageningen, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland. .,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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D'Souza E, Vandevijvere S, Swinburn B. The healthiness of New Zealand school food environments: a national survey. Aust N Z J Public Health 2022; 46:325-331. [PMID: 35298061 DOI: 10.1111/1753-6405.13210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the healthiness of New Zealand school food environments. METHODS In 2016, primary and secondary schools were invited to complete a cross-sectional questionnaire. School nutrition policies were analysed using an adapted Wellness School Assessment Tool. Canteen menus were analysed using the National Food and Beverage Classification System, and a sample of menus (n=54) were validated using fieldworker observations. RESULTS In total, 819 schools (response rate 33%) participated. Forty per cent had a nutrition policy, and those analysed (n=145) lacked comprehensiveness and contained weak statements. Seventy-one per cent sold food and beverages during the school day. The school food service offered mainly unhealthy items. Many schools (81%) used food and beverages for fundraising with 90% of them using 'less healthy' items. Most had vegetable gardens (80%), included nutrition education in the curriculum (90%), were not sponsored by food and beverage companies (94%) and did not have commercial advertising on school grounds (97%). CONCLUSION New Zealand school nutrition policies are weak, and canteen and fundraising items are largely unhealthy, which undermine other positive efforts. IMPLICATIONS FOR PUBLIC HEALTH This study provides evidence of unhealthy school food environments and supports the need for stronger national-level policy.
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Affiliation(s)
- Erica D'Souza
- School of Population Health, The University of Auckland, New Zealand
| | | | - Boyd Swinburn
- School of Population Health, The University of Auckland, New Zealand
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Meshkovska B, Scheller DA, Wendt J, Jilani H, Scheidmeir M, Stratil JM, Lien N. Barriers and facilitators to implementation of direct fruit and vegetables provision interventions in kindergartens and schools: a qualitative systematic review applying the consolidated framework for implementation research (CFIR). Int J Behav Nutr Phys Act 2022; 19:11. [PMID: 35101084 PMCID: PMC8805256 DOI: 10.1186/s12966-022-01246-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although children's intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR). METHODS A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR. RESULTS The following CFIR constructs were found relevant: 1) intervention characteristics domain: 'design quality and packaging', 'adaptability' 'cost'; 2) outer setting: 'cosmopolitanism', 'external policy and incentives' 'patients' needs and resources'; 3) inner setting: 'implementation climate', 'readiness for implementation' and 'structural characteristics'; 4) characteristics of individuals: 'individual stage of change', 'knowledge and beliefs about the intervention' 5) process: 'engaging', 'executing' and 'reflecting and evaluating'. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts. CONCLUSIONS CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group. PROSPERO REGISTRATION CRD42020167697.
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Affiliation(s)
| | - Daniel A. Scheller
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | - Hannah Jilani
- Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan M. Stratil
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - on behalf of the PEN Consortium
- Department of Nutrition, University of Oslo, Oslo, Norway
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
- Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
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Lobczowska K, Banik A, Brukalo K, Forberger S, Kubiak T, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Wieczorowska-Tobis K, Bekker MPM, Zeeb H, Luszczynska A. Meta-review of implementation determinants for policies promoting healthy diet and physically active lifestyle: application of the Consolidated Framework for Implementation Research. Implement Sci 2022; 17:2. [PMID: 34991624 PMCID: PMC8734337 DOI: 10.1186/s13012-021-01176-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although multiple systematic reviews indicate that various determinants (barriers and facilitators) occur in the implementation processes of policies promoting healthy diet, physical activity (PA), and sedentary behavior (SB) reduction, the overarching synthesis of such reviews is missing. Applying the Consolidated Framework for Implementation Research (CFIR), this meta-review aims to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings. METHODS A meta-review of published systematic scoping or realist reviews (k = 25) and stakeholder documents (k = 17) was conducted. Data from nine bibliographic databases and documentation of nine major stakeholders were systematically searched. Included reviews (72%) and stakeholder documents (100%) provided qualitative synthesis of original research on implementation determinants of policies promoting healthy diet or PA or SB reduction, and 28% of reviews provided some quantitative synthesis. Determinants were considered strongly supported if they were indicated by ≥ 60.0% of included reviews/stakeholder documents. RESULTS Across the 26 CFIR-based implementation determinants, seven were supported by 66.7-76.2% of reviews/stakeholder documents. These determinants were cost, networking with other organizations/communities, external policies, structural characteristics of the setting, implementation climate, readiness for implementation, and knowledge/beliefs of involved individuals. Most frequently, published reviews provided support for inner setting and individual determinants, whereas stakeholder documents supported outer and inner setting implementation determinants. Comparisons between policies promoting healthy diet with PA/SB policies revealed shared support for only three implementation determinants: cost, implementation climate, and knowledge/beliefs. In the case of healthy diet/PA/SB policies targeting school settings, 14 out of 26 implementation determinants were strongly supported. CONCLUSIONS The strongly supported (i.e., systematically indicated) determinants may guide policymakers and researchers who need to prioritize potential implementation determinants when planning and monitoring the implementation of respective policies. Future research should quantitatively assess the importance or role of determinants and test investigate associations between determinants and progress of implementation processes. TRIAL REGISTRATION PROSPERO, # CRD42019133341.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Katarzyna Brukalo
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, Bode 60, 6700 EW, Wageningen, the Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland.
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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Jensen ML, Gonzalez W, Bolaños-Palmieri C, Monge-Rojas R, Frongillo EA. Implementation of a regulatory food policy to reduce availability of energy-dense foods in Costa Rican high schools. Public Health Nutr 2021; 24:6499-6511. [PMID: 34407907 PMCID: PMC11148610 DOI: 10.1017/s1368980021003013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the extent to which mandatory Guidelines to improve the school food environment were being implemented in Costa Rican high schools and to explore the perspectives of key policy actors towards the Guidelines. DESIGN Semi-structured interviews and site observations. Interviews were recorded, transcribed verbatim and imported to NVivo 12 for analysis. Inductive and deductive themes were identified, and elements of the RE-AIM framework and the social process framework were used when classifying these themes. SETTING Sixteen public high schools in San José, Costa Rica. PARTICIPANTS High school principal and kiosk concessionaires. RESULTS Products that did not adhere to the Guidelines were still widely available in schools, and amongst the most prevalent challenges to implementation that emerged from our interviews, were a lack of understanding of the policy content, a lack of monitoring and accountability, and competing values amongst actors which affected their views on the role that the school must have in offering a healthy food environment. CONCLUSION Most products offered in high schools did not meet the criteria required by the mandatory Guidelines, and several contextual factors were found to influence implementation. Strengthening the implementation of the Costa Rican Guidelines will require further actions at the governmental and school levels.
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Affiliation(s)
- Melissa L Jensen
- School of Nutrition, University of Costa Rica, Ciudad de la Investigación, Finca 2, San José, Sabanilla, Costa Rica
- Rudd Center for Food Policy, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT06103, USA
| | - Wendy Gonzalez
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | | | - Rafael Monge-Rojas
- Nutrition and Health Unit, Costa Rican Institute of Research and Education on Nutrition and Health, Tres Ríos, Costa Rica
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Implementing Food Environment Policies at Scale: What Helps? What Hinders? A Systematic Review of Barriers and Enablers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910346. [PMID: 34639646 PMCID: PMC8507658 DOI: 10.3390/ijerph181910346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022]
Abstract
Background: Policies that support healthier food environments, including healthy retail food availability and promotion, are an important strategy for obesity prevention. The aim of this systematic review was to examine the evidence for barriers and enablers to successful implementation of healthy food and drink policies, delivered at scale. Methods: MEDLINE, SCOPUS and INFORMIT were searched to May 2019 for peer-reviewed studies. Google and Google Scholar were searched for grey literature. Studies of any design relating to a healthy food and drink policy delivered at scale (≥10 sites) in non-commercial food settings, for specific retail outlets (e.g., vending machines, cafes, cafeterias, school canteens), and that reported on implementation barriers and/or enablers were included. Studies in commercial food retail environments (e.g., supermarkets) were excluded. Studies were appraised for quality and key information was extracted and summarised. Extracted information on barriers and enablers was further grouped into overarching themes relating to perceptions of the policy itself, organisational and contextual factors influencing policy implementation, stakeholder responses to the implemented policy and perceived policy impacts. Results: Of 19 studies, 16 related to policies implemented in schools, two in hospital/health facilities and one in a sport/recreation setting. Most studies were conducted in North America or Australia, and policy implementation occurred mainly at state/regional or federal levels. The most commonly cited barriers across overarching themes and intervention settings were: lack of stakeholder engagement or prioritisation of the policy (11 studies); resistance to change from school stakeholders or customers (8 studies); and concern over profitability, revenue and/or commercial viability (8 studies). Few studies reported on mitigation of barriers. Enablers most commonly raised were: stakeholder engagement, whole-school approach and/or prioritisation of the policy (9 studies); policy level or higher-level support in the form of information, guidance and/or training (5 studies); and leadership, school/policy champion, management commitment and/or organisational capacity (4 studies). Conclusions: Key considerations for policy implementation ranged from building stakeholder support, prioritising policy implementation within organisations, to implementing strategies that address financial concerns and implementation barriers.
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Thorpe CP, Boelsen-Robinson T, Cameron AJ, Blake MR. Business outcomes of healthy food service initiatives in schools: A systematic review. Obes Rev 2021; 22:e13264. [PMID: 33960610 DOI: 10.1111/obr.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Fear of unfavorable business outcomes, including negative financial impacts, deters implementation of school food service initiatives to support healthy student eating behaviors. There have been no systematic reviews to guide feasible long-term healthy school food initiatives. This review aimed to synthesize evidence on the effect of school food service initiatives on business outcomes, including commercial viability, stakeholder perceptions, customer perceptions, and initiative maintenance and scale-up. Business, education, and health peer-reviewed databases, and grey literature were systematically searched. Eligible studies reported on the business impact of initiatives encouraging sales of healthier foods within school cafeterias, canteens, vending machines, or online canteens. Synthesis incorporated a count of studies addressing business outcomes, health behavior outcomes, and the favorability of those outcomes. Of 5173 studies screened, 16 studies were included for analysis. Commercial viability was the most frequent theme (n = 12/16 studies), followed by stakeholder perceptions (n = 9/16), customer perceptions (n = 6/16), and initiative maintenance and scale-up (n = 2/16). Favorable business outcomes were identified in cafeterias/canteens (n = 8/10) and online canteens (n = 1/1). All vending machine initiatives (n = 7/7) reported unfavorable, mixed, or neutral outcomes. Future research should determine which types of healthy food retail initiatives deliver the most favorable business outcomes long-term for schools while optimizing student nutrition outcomes.
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Affiliation(s)
- Courtney P Thorpe
- Geelong, Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Tara Boelsen-Robinson
- Geelong, Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Adrian J Cameron
- Geelong, Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Miranda R Blake
- Geelong, Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Sobers NP, Bishop L, Ng SW, Soares-Wynter S, Greaves NS, Murphy MM. Understanding the need for a whole-of-society approach in school nutrition policy implementation: a qualitative analysis. Implement Sci Commun 2021; 2:79. [PMID: 34274014 PMCID: PMC8285724 DOI: 10.1186/s43058-021-00184-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Only three of twenty Caribbean Community (CARCICOM) countries have mandatory school nutrition policies despite one third of the region's children being overweight or obese. In Barbados, there are nutrition guidelines which lack the legal mandate of a formal policy. We aim to assess the comprehensiveness of current national nutrition guidelines and to understand the factors operating in the inner and outer school setting that may influence the implementation of a mandatory school nutrition policy from the perspectives of school administrators. METHODS A documentary analysis of existing nutritional guidelines was conducted along with qualitative semi-structured interviews in primary (elementary) and secondary (high) schools in Barbados. We purposively sampled six primary and four secondary school administrators (principals, deputy principals or senior teachers) to explore their knowledge and views on the National School Nutrition Guidelines. The deterministic implementation paradigm, Consolidated Framework for Implementation (CFIR), was used to explore the complexities within the inner and outer settings of schools. Documentary analysis used a theory-based framework informed by the Wellness School Assessment Tool-school policy analysis questionnaire. Interview transcripts were team coded using thematic analysis with constant comparison facilitated by NVIVO software version12. RESULTS School administrators were unaware of the existing National School Nutrition Guidelines which documentary analysis found to be restrictive and weak for implementation. Administrators envisioned a government-led (outer setting), whole of society approach as the most effective strategy for the development and implementation of a proposed mandatory school nutrition policy. School administrators identified lack of financial and human resources as barriers to nutrition policy implementation. Formal and informal food vendors are institutionalized in schools and are influential determinants of the school food environment. Schools have individually reached into the outer setting to work with civil society organizations and private individuals to provide financial support and nutrition expertise to their institutions. Mass media campaigns in the outer setting may influence child and parental food choices. CONCLUSION School administrators describe that government-led, CSO supported policy development using a whole-of-society approach has implications for improving nutrition policy implementation. Our findings demonstrate the use of a deterministic implementation framework in the pre-implementation phase of school nutrition policy development.
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Affiliation(s)
- Natasha P Sobers
- George Alleyne Chronic Disease Research Unit, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados.
| | - Lisa Bishop
- George Alleyne Chronic Disease Research Unit, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
| | - Shu Wen Ng
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Suzanne Soares-Wynter
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Kingston, Jamaica
| | - Natalie S Greaves
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Unit, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
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Nutrition across the curriculum: a scoping review exploring the integration of nutrition education within primary schools. Nutr Res Rev 2021; 35:181-196. [PMID: 33926596 DOI: 10.1017/s0954422421000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers' programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.
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Vine MM, Vermeer J, Romano L, Harrington DW, Butler AE, Patte KA, Godin KM, Leatherdale ST. Secondary School Nutrition Policy Compliance in Ontario and Alberta, Canada: A Follow-Up Study Examining Vending Machine Data from the COMPASS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3817. [PMID: 33917414 PMCID: PMC8038734 DOI: 10.3390/ijerph18073817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
(1) Objective: To longitudinally assess food and beverages sold in vending machines in secondary schools (grades 9-12) participating in the COMPASS study (2015/2016 and 2018/2019) and (2) to examine if patterns and trends observed in previous years (2012/2013 to 2014/2015) are consistent with lack of policy compliance in Ontario and Alberta, Canada. (2) Methods: Policy compliance was assessed through comparing nutritional information on drink (e.g., sports drinks) and snack (e.g., chocolate bars) products in vending machines to Policy and Program Memorandum (P/PM) 150 in Ontario (required policy) and the Alberta Nutrition Guidelines for Children and Youth (recommended policy). Longitudinal results and descriptive statistics were calculated. (3) Results: Longitudinal results indicate that between Y4 (2015/2016) and Y7 (2018/2019), snack and drink vending machines remained mostly non-compliant in Ontario and Alberta, with a small proportion of Ontario drink machines changing from non-compliant to compliant. At the school level, descriptive results indicate the proportion of Ontario schools with policy-compliant snack and drink machines decreased between Y4 and Y7. Alberta schools were non-compliant for drink and snack machines. (4) Conclusions: Secondary schools continue to be non-compliant with provincial policies. School nutrition policies need to be simplified in order to make it easier for schools to be compliant. Enforcement of compliancy is also an area that deserves consideration.
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Affiliation(s)
- Michelle M. Vine
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.V.); (L.R.); (D.W.H.); (A.E.B.); (S.T.L.)
| | - Julianne Vermeer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.V.); (L.R.); (D.W.H.); (A.E.B.); (S.T.L.)
| | - Leonardo Romano
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.V.); (L.R.); (D.W.H.); (A.E.B.); (S.T.L.)
| | - Daniel W. Harrington
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.V.); (L.R.); (D.W.H.); (A.E.B.); (S.T.L.)
| | - Alexandra E. Butler
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.V.); (L.R.); (D.W.H.); (A.E.B.); (S.T.L.)
| | - Karen A. Patte
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada;
| | | | - Scott T. Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.V.); (L.R.); (D.W.H.); (A.E.B.); (S.T.L.)
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Patte KA, Cole AG, Qian W, Magier M, Vine M, Leatherdale ST. Are closed campus policies associated with adolescent eating behaviours? Health Promot Chronic Dis Prev Can 2021; 41:73-84. [PMID: 33688693 PMCID: PMC8011479 DOI: 10.24095/hpcdp.41.3.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The effectiveness of school nutrition regulations may be undermined by food environments surrounding schools. Given challenges in regulating external retail, some have recommended policies that ensure students are unable to leave school property during the day (closed campus policies; CCP). We aimed to examine whether CCP are associated with student eating behaviours. METHODS We used student and school-administrator survey data from the 60 610 Grades 9 to 12 students and 134 Canadian secondary schools that participated in Year 7 (2018/19) of the COMPASS study. Multiple ordinal regression models tested school CCP as a predictor of weekday dietary behaviours (0-5 days), controlling for student-level (grade, sex, spending money, ethnicity) and school-level (urbanicity, province, area median household income, vending machines) covariates. RESULTS CCP were reported by 16 schools. Students who attended CCP schools reported eating lunch purchased from fast food outlets or other restaurants and drinking sugar-sweetened beverages (SSBs; soft drinks and sports drinks; sweetened coffee or tea drinks) on fewer weekdays, but consumed snacks from school vending machines on more weekdays, relative to students at open campus schools. No significant differences were observed in student reports of eating home-packed or school cafeteria lunches or snacks purchased off-campus. CONCLUSION CCP may help improve adolescent diets by reducing SSB and lunchtime fast food consumption on weekdays; however, students already purchasing food may shift from off-campus to within-school options, highlighting the importance of ensuring healthy school food environments and encouraging students to bring home-prepared lunches. Future studies using experimental longitudinal designs are needed to determine the effect of CCP on various health behaviours and outcomes.
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Affiliation(s)
- Karen A Patte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Adam G Cole
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Megan Magier
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Michelle Vine
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Reeve E, Thow AM, Bell C, Soti-Ulberg C, Sacks G. Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa. BMC Public Health 2021; 21:246. [PMID: 33514338 PMCID: PMC7844953 DOI: 10.1186/s12889-021-10203-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/10/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite global recommendations to prioritise policies that create healthy food environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa subsequent to the 2012 introduction of a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts. METHODS We used a qualitative case study approach, underpinned by policy science theory. In 2018, we conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle, supplemented by other policy theories relevant to policy process. RESULTS Samoa's school food policy operationalizes international 'best practice' recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted the policy's effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, vendor knowledge and capacity, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community-level leaders as potentially pivotal stakeholders, particularly where school governance arrangements draw heavily on community representation. CONCLUSIONS Sustained and effective implementation of healthy school food policies requires continued engagement from political and community leaders, beyond initial commitment. There is potential to capitalize on political will for diet-related NCD prevention by more clearly demonstrating the institutional and operational requirements for effective and sustained implementation. Strong incentives for compliance and effective enforcement mechanisms are also likely to be crucial to success.
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Affiliation(s)
- Erica Reeve
- Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Locked Bag 20001, Geelong, Victoria 3220 Australia
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Level 2, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
| | - Colin Bell
- Deakin University, School of Medicine, 1 Gheringhap Street, Geelong, Victoria 3220 Australia
| | | | - Gary Sacks
- Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Locked Bag 20001, Geelong, Victoria 3220 Australia
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Grady-Dominguez P, Ragen J, Sterman J, Spencer G, Tranter P, Villeneuve M, Bundy A. Expectations and Assumptions: Examining the Influence of Staff Culture on a Novel School-Based Intervention to Enable Risky Play for Children with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031008. [PMID: 33498773 PMCID: PMC7908254 DOI: 10.3390/ijerph18031008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Risky play is challenging, exciting play with the possibility of physical, social, or emotional harm. Through risky play, children learn, develop, and experience wellbeing. Children with disabilities have fewer opportunities than their typically developing peers to engage in this beneficial type of play. Our team designed a novel, school-based intervention to address this disparity; however, our intervention yielded unexpected quantitative results. In the present study, we qualitatively examined divergent results at two of the five schools that participated in the intervention. Specifically, we aimed to explore how staff culture (i.e., shared beliefs, values, and practices) influenced the intervention. To explore this relationship, we employed a retrospective, qualitative, multiple case study. We used thematic analysis of evaluative interviews with staff members to elucidate the cultures at each school. Then, we used cross-case analysis to understand the relationships between aspects of staff culture and the intervention's implementation and results. We found that staff cultures around play, risk, disability influenced the way, and the extent to which, staff were willing to let go and allowed children to engage in risky play. Adults' beliefs about the purpose of play and recess, as well as their expectations for children with disabilities, particularly influenced the intervention. Furthermore, when the assumptions of the intervention and the staff culture did not align, the intervention could not succeed. The results of this study highlight the importance of (1) evaluating each schools' unique staff culture before implementing play-focused interventions and (2) tailoring interventions to meet the needs of individual schools.
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Affiliation(s)
- Patricia Grady-Dominguez
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80528, USA;
- Correspondence:
| | - Jo Ragen
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.V.)
| | - Julia Sterman
- Department of Occupational Therapy, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Grace Spencer
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Paul Tranter
- School of Science, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Michelle Villeneuve
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.V.)
| | - Anita Bundy
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80528, USA;
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; (J.R.); (M.V.)
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Application of Multi-Objective Evolutionary Algorithms for Planning Healthy and Balanced School Lunches. MATHEMATICS 2020. [DOI: 10.3390/math9010080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A multi-objective formulation of the Menu Planning Problem, which is termed the Multi-objective Menu Planning Problem, is presented herein. Menu planning is of great interest in the health field due to the importance of proper nutrition in today’s society, and particularly, in school canteens. In addition to considering the cost of the meal plan as the classic objective to be minimized, we also introduce a second objective aimed at minimizing the degree of repetition of courses and food groups that a particular meal plan consists of. The motivation behind this particular multi-objective formulation is to offer a meal plan that is not only affordable but also varied and balanced from a nutritional standpoint. The plan is designed for a given number of days and ensures that the specific nutritional requirements of school-age children are satisfied. The main goal of the current work is to demonstrate the multi-objective nature of the said formulation, through a comprehensive experimental assessment carried out over a set of multi-objective evolutionary algorithms applied to different instances. At the same time, we are also interested in validating the multi-objective formulation by performing quantitative and qualitative analyses of the solutions attained when solving it. Computational results show the multi-objective nature of the said formulation, as well as that it allows suitable meal plans to be obtained.
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Budd EL, Franz DJ, Kelly NR, Giuliani NR. Oregon Parents' Perceptions of the Supportiveness of the School Environment for Their Children's Health Behaviors. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:975-981. [PMID: 32171670 DOI: 10.1016/j.jneb.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe Oregon parents' perceptions of their children's school regarding health behaviors; examine how perceptions vary by parent, child, and community characteristics; and identify recommendations for improving school environments. METHODS Oregon parents with an elementary school-aged child completed an electronic survey. RESULTS Over 90% of parents (n = 814) described their child's school as supportive of healthy eating and physical activity. Parents who ate ≥5 fruits/vegetables per day more often perceived their children's school as unsupportive of healthy eating (P < 0.001) and physical activity (P < 0.05) relative to others. Parents of children eligible for free/reduced-price lunch more often perceived the school as unsupportive of physical activity (P < 0.05) relative to others. Parental recommendations included improving school meals and providing short physical activity breaks. CONCLUSIONS AND IMPLICATIONS Parents' suggested school improvements can inform school wellness committees' and administrators' quality-improvement efforts and, in turn, better support children's healthy behaviors.
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Affiliation(s)
- Elizabeth L Budd
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR; Prevention Science Institute, University of Oregon, Eugene, OR.
| | - Daschel J Franz
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR
| | - Nichole R Kelly
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR; Prevention Science Institute, University of Oregon, Eugene, OR
| | - Nicole R Giuliani
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR; Prevention Science Institute, University of Oregon, Eugene, OR; Department of Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR
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Emley E, Dial L, Koerten H, Musher-Eizenman D. Variation in School District Nutrition Policies and Practices: Community Context Matters. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1795753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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School readiness to adopt a school-based adolescent nutrition intervention in urban Indonesia. Public Health Nutr 2020; 24:s72-s83. [PMID: 32375906 PMCID: PMC10071219 DOI: 10.1017/s1368980020001299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify school community readiness to adopt a school-based adolescent nutrition intervention. DESIGN Cross-sectional study: mixed-methods design. The community readiness model was used to guide instrument development and qualitative analysis. Quantitative data are presented using descriptive statistics. Each statement was rated on a seven-point Likert scale, thereby producing scores between 1 (strongly disagree) and 7 (strongly agree). SETTING Ten of the twenty current public secondary schools in Bogor, Indonesia. PARTICIPANTS Ninety teachers and ten school principals. RESULTS Eating behaviour problem awareness was present among all participants; awareness of efforts to improve eating habits was also present, but these efforts were perceived as having low efficacy; support from the City Education Authority and Health Authority was present, but the support type did not match the perceived needs; nutrition education had not been implemented across the entire school community due to competing priorities; existing nutrition policies did not provide concrete scenarios and clear guidelines for nutrition-friendly schools; the availability and accessibility of healthy foods at schools were considered to be key factors in improved adolescent nutrition; positive attitudes existed among respondents towards the implementation of various nutrition programmes, and the median and mode were seven in all types of school-based intervention. CONCLUSIONS The school community readiness level regarding school-based adolescent nutrition interventions is currently in the action phase, implying that community leaders have begun organising efforts to address issues in adolescent nutrition and are aware of their consequences. Future support should be directed towards improving existing efforts and offering concrete ideas and clear policy guidelines for implementation.
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Gillies C, Farmer A, Maximova K, Willows ND. Alexander First Nations Parents' Perceptions of a School Nutrition Policy. CAN J DIET PRACT RES 2019; 81:66-71. [PMID: 31512509 DOI: 10.3148/cjdpr-2019-026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: A school nutrition policy (SNP) is one promising school-based health promotion strategy to improve the food environments of First Nations children. The aim of this study was to explore First Nations parents' perceptions of a SNP. Methods: A process evaluation of policy implementation was conducted using a mixed-methods design. Parents (n = 83) completed a 19-question survey to capture their perceptions of the policy. Survey responses informed questions in an 11-question semi-structured interview guide. Transcripts from interviews with parents (n = 10) were analyzed using content analysis to identify barriers and facilitators to policy implementation. Results: Parents were supportive of the SNP and the school's food programs, which they perceived as helping to address community concerns related to nutrition. However, some parents opposed the restriction of unhealthy foods at school celebrations and fundraisers. In addition, despite being aware of the SNP, parents were unable to demonstrate an understanding of the SNP content. Finally, parents struggled to provide their children with healthy foods to bring to school due to lack of affordable and accessible food in the community. Conclusions: Although SNPs may be well-received in First Nations communities, their implementation must be supported by parent involvement and consideration of wider socioeconomic conditions.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | -
- Alexander Research Committee, Morinville, AB
| | - Anna Farmer
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | | | - Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
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The Association between Perceived Adequacy and Capacity for School Food Policy Implementation with Food Availability and Policy Adherence in Nova Scotia, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111974. [PMID: 31167362 PMCID: PMC6604017 DOI: 10.3390/ijerph16111974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/24/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022]
Abstract
Supporting the implementation of school food and nutrition policies is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and promote healthier eating. The purpose of this study was to explore the association between perceived adequacy of facilities or equipment and capacity of staff to support policy implementation with food availability and policy adherence in the province of Nova Scotia (NS), Canada, one of the first regions in Canada to launch a comprehensive school food and nutrition policy (SFNP). A cross-sectional online survey was conducted in 2014-2015 to provide a current-state assessment of policy implementation and adherence. Adequacy and capacity for food policy implementation was used to assess policy adherence through the availability of prohibited 'minimum' nutrition foods. An exploratory factor analysis was conducted on a selection of available foods, and 'slow'- and 'quick'-service food composition measures were dichotomized for food availability. Schools with above-average perceived adequacy and capacity for policy implementation had greater odds (OR = 3.62, CI = 1.56, 8.40) of adhering to a lunch policy, while schools that adhered to a snack and lunch policy had lower odds (OR = 0.48, CI = 0.23, 1.01 and OR = 0.18, CI = 0.08, 0.41) of serving quick-service foods. This study identified the need for appropriate adequacy of facilities or equipment and capacity of staff for policy implementation to ensure policy adherence and improve the school food environment. These findings highlight the relationship between school food and nutrition policies, suggesting that better supporting their implementation could increase the likelihood of their success.
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Understanding System-Level Intervention Points to Support School Food and Nutrition Policy Implementation in Nova Scotia, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050712. [PMID: 30818856 PMCID: PMC6427736 DOI: 10.3390/ijerph16050712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Such policies can improve equitable access, resources, and supports for healthy eating. However, despite the potential impact of SFNPs, several implementation barriers have been reported. This study sought to examine the system-level intervention points within a school food system using a complex systems framework. We conducted semi-structured interviews with various stakeholders working to influence the school food system in Nova Scotia, Canada. We sought to understand their roles and experiences with the SFNP by applying the Intervention Level Framework (ILF), a novel, solutions-oriented approach to better understand how complex systems function. Participants (n = 33) included teachers, parents, cafeteria workers, public health staff and non-profit organizations. Interview transcripts were first coded, then themed and finally analyzed using the ILF, resulting in three intervention points within the school food system. These were defined as: (1) Actors and Elements, (2) System Regulation and Interconnections and (3) Purpose and Values. We concluded that understanding the interactions between these system levels and stakeholder roles can help to inform the development of relevant policy strategies that better support healthier school food environments in this jurisdiction.
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