Abstract
To explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts. Using purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses. State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance. Results confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.
Highlights
The scope and consequences of pediatric obesity in the United States are well documented.[1,2] Schools are a strategic organizational setting for obesity prevention, but schoolbased interventions addressing lifestyle behaviors to prevent obesity have had mixed success,[3,4] which has led to calls for comprehensive approaches to obesity prevention that address multiple 8 levels in schools or in after-school settings.[4,5] Multi-component approaches for obesity prevention may place unknown demands on organizational systems, including schools, when evidence-based interventions are implemented on a wide scale
Results confirm the importance of gaining faculty and staff support
Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance
Summary
There is, limited available information about how contextual factors influence implementation and sustainability of school-based multi-component interventions. Previous research has determined that employing district level coordinators, having administrative support, having an effective program champion, and employing a team approach are important for intervention implementation,[6,7,8,9,10,11] yet only limited evaluations examining the implementation processes have been conducted.[4] Qualitative research methods are ideally suited to explore the process of implementing school-based health promotion programs, and the objective of this case study was to use qualitative research methods to explore barriers and facilitators to implementing and sustaining a multi-component intervention school-based intervention
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