Process Evaluation of the Smarter Lunchrooms Randomized Controlled Trial (RCT): Year 3

Abstract

The purpose of this study was to conduct process evaluation of the Smarter Lunchrooms RCT, redesigned to examine effectiveness of environmental strategies promoting fruit, vegetable, and unsweetened milk consumption in New York State middle schools that self-selected intervention components, compared with schools that were assigned an intervention protocol. Participating schools were randomized to receive no intervention (control schools, n= 4), a six-week intervention in which food service staff selected protocol items (self-selection schools, n=3), or an assigned protocol mirroring that of a self-selection school with similar sociodemographic characteristics (matched schools, n=5). The research team partnered with Cornell Cooperative Extension (CCE) agents to deliver the intervention. An adapted RE-AIM framework guided process evaluation designed to monitor fidelity to intervention protocols, determine the extent to which protocols were maintained post-intervention, and identify facilitators and barriers to successful implementation and maintenance. Measures included training documentation, school nutrition environment assessments, cafeteria audits, CCE school contact logs, and post-intervention interviews with CCE and food service staff. Implementation fidelity and maintenance were higher than in previous iterations of this RCT, though no consistent differences were observed among self-selection and matched schools. Non-compliance was associated with limitations in school food offerings, restrictive serving line structures, and changes to staff routines that proved difficult to maintain in busy serving periods. Staff motivation and effective intervention support facilitated successful implementation. Leveraging staff motivation and providing support for managing barriers to implementation proved effective in enhancing implementation fidelity. These data will inform analyses of intervention outcomes and may prove valuable for other environmentally-focused interventions in school cafeterias.