Implementation of a large-scale school-based obesity prevention intervention: Challenges and achievements

Abstract

Aim: This study examines processes, barriers and contextual factors which may have influenced the implementation of health promotion strategies in a large-scale school-based intervention implemented across four Victorian communities. Method: Project officers assisted in implementing intervention activities in schools with an aim to establish health promoting environments over 12—18 months. Comparison schools were randomly selected across Victoria. Evaluation included school environment assessments (containing open and closed-ended items conducted with a small group of teaching staff post-intervention) and reviewing project officer’s process reports. Results: Assessments from 26 primary (9 intervention, 17 comparison) and 22 secondary (8 intervention, 14 comparison) schools were collected. The number of healthy eating activities implemented in schools was (mean± SD): 2.9± 1.4 (primary intervention), 1.5± 1.2 (primary comparison), 4.6± 1.8 (secondary intervention), 0.8± 1.6 (secondary comparison). The number of physical activity-related activities implemented was: 3.0± 1.2 (primary intervention), 2.4± 2.0 (primary comparison), 2.5± 1.3 (secondary intervention) and 2.5± 1.7 (secondary comparison). Teachers reported the most common barrier to implementation was time pressures. Challenges reported by project officers included working within schools; lack of engagement; and insufficient implementation time. Contextual factors included community socioeconomic status, student ethnicity and being a farming community. Enablers included participant enjoyment, staff capacity building, extending existing partnerships, embedding activities into existing infrastructure, using well recognised programs and delivering consistent health-related messages through a variety of means. Conclusion: The most effective ways of supporting schools to implement health promotion initiatives that are considerate of the pressures and context of the school and community, remains to be determined. Having a designated project officer to facilitate the process and coordinate activities appears to be an important enabler. A deeper m