Abstract
BackgroundPrimary schools are valuable settings to implement healthy lifestyle (healthy eating and physical activity) interventions, aimed at targeting childhood obesity. This study explored school staff perceptions of factors that hinder and enable successful implementation and sustainability of healthy lifestyle interventions in primary schools. Qualitative data was pooled and analysed from two evaluations carried out in primary schools in North England: a feasibility study of a nutrition and physical activity educational programme (PhunkyFoods Feasibility Study), and an evaluation of a healthy eating programme (The Food Dudes Evaluation).MethodsSixty-five qualitative semi-structured interviews were conducted with head teachers, teachers, catering managers, designated school-based programme coordinators and programme staff supporting schools with programme delivery, at 14 schools involved in both evaluations. Thematic analysis was undertaken and emergent themes categorised using a framework for successful implementation by Durlak and Dupre (2008).ResultsOverall, all schools were delivering a range of healthy lifestyle programmes, often with overlapping content. Perceived challenges to implementation of individual programmes included: limited time, timing of implementation, limited training and support, insufficient resources, capacity and facilities, staff perceptions of intervention and perceived skill-proficiency (for cooking and physical activities). Short-term funding, lack of external and internal support were perceived to hinder sustainability. Staff recommendations for successful implementation of future programmes included: extended training and planning time, sufficient capacity, external support for delivery, good resources (interactive, practical and adaptable), and facilities for cooking, healthy eating, gardening and physical activities. Head teachers need to prioritise delivery of a few key healthy lifestyle programmes, in an overcrowded curriculum. Schools need to employ strategies to engage participation of staff, pupils and parents long term.ConclusionsEffective implementation of school-based healthy lifestyle programmes was thought to be aided by flexible and adaptable programmes, enabling good contextual fit, well-resourced programmes and effective leadership at multiple levels, pupil (pupils support delivery) and parent involvement. To facilitate sustainability, it was perceived that programmes need to be integrated within the curriculum and school policies long term, with sustained support from head teachers and staff. These findings are relevant to programme developers, policy makers and those involved in delivering interventions.
Highlights
Primary schools are valuable settings to implement healthy lifestyle interventions, aimed at targeting childhood obesity
Our study explores the perspectives of a range of school stakeholders, relating to factors facilitating and hindering successful implementation and sustainability of healthy eating and physical activity programmes in the primary school setting
Schools were recruited for the PhunkyFoods Feasibility Study (PFS) by inviting all primary schools within a town in the North of England, except independent and special schools, and schools with only Key Stage 2 pupils to participate
Summary
Primary schools are valuable settings to implement healthy lifestyle (healthy eating and physical activity) interventions, aimed at targeting childhood obesity. Latest data from the National Child Measurement Programme (NCMP) in England in 2016–17, indicated that almost a quarter of children starting primary school (aged 4–5 years), were already overweight or obese. This increased to over a third of children by the end of primary school (aged 10– 11 years) [3]. A key component of this is to target the key determinants of obesity (nutrition and physical activity), through complex, multi-component interventions implemented in schools [10]. Schools hold much potential for influencing healthy eating and physical activity behaviours, because children have long-term contact and spend much of their waking hours at school [15, 16]
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