Abstract
BackgroundAlthough 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).MethodsA 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.ResultsThe 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.ConclusionsCFIR 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 registrationCRD42020167697.
Highlights
Our objective is to systematically review qualitative results reporting on the determinants to implementation of interventions that entail the action of 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)
Description of included interventions The 14 papers included in this review [17, 18, 25–36] are based on 12 interventions—two papers are based on the Boost intervention [26, 36] while one paper refers to the pilot, and one to the full roll out of the Northern fruit and vegetable program in Ontario, Canada [25, 30]
The third type of interventions are farm to school, USA [27, 33–35] and garden programs, USA [28]. They are primarily characterized by their flexibility in the design of intervention components and implementation but are particular in their involvement of the wider community where they are put into practice
Summary
A higher fruit and vegetables consumption is significantly associated with lower risk of all-cause mortality [1]. A systematic review and meta-analysis found that interventions in the school setting which directly provide fruit and vegetables to children, increase fruit intake by 0.27 servings and vegetables intake by 0.04 servings per day [5] These findings were included in a recent umbrella review that concluded there is evidence showing effectiveness of interventions in the school settings on fruit and vegetables consumption [6]. For such school based interventions to meet their intended goals, what is important to consider is not merely their content, and their implementation. 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)
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