Abstract
BackgroundSchool wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming.MethodsAs part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR).ResultsPaired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy.ConclusionsThe results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.
Highlights
School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; research is needed on methods that can help schools implement and sustain such programs on their own
Qualitative data demonstrated that factors within the outer setting facilitated programming
In 2010 the United States Department of Agriculture (USDA) enacted the Healthy Hunger Free Kids Act [8] which stipulates expectations for school nutrition standards pertaining to breakfast and lunches and wellness policy enhancement, increasing the emphasis on schools as health-promoting environments
Summary
School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; research is needed on methods that can help schools implement and sustain such programs on their own. In 2010 the United States Department of Agriculture (USDA) enacted the Healthy Hunger Free Kids Act [8] which stipulates expectations for school nutrition standards pertaining to breakfast and lunches and wellness policy enhancement, increasing the emphasis on schools as health-promoting environments. In 2016 the USDA introduced the Final Rule mandate [9] which stipulated that school wellness policies must be evaluated every 3 years in regard to the level of policy implementation, and progress to be reported to the school community and stakeholders These policies mark major advances in school wellness programming potential, yet little is known about how schools are trained and prepared to fulfil such responsibilities in the United States. Few initiatives and programs have been developed to provide schools with professional development on building and sustaining programming, highlighting gaps between policy and practice [10, 11]
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