The Smarter Lunchrooms Randomized Controlled Trial: 2014-2015 Process Evaluation Results

Abstract

To evaluate the implementation and maintenance of a Smarter Lunchrooms (SL) study protocol designed to improve fruit, vegetable, and unflavored milk selection and consumption in middle school cafeterias via low- or no cost environmental changes. Process evaluation utilizing an adapted RE-AIM framework was conducted to monitor fidelity to intervention protocol in 12 New York State public middle schools using a crossover design (6 treatment, 6 control in Fall 2014; 6 maintenance, 6 treatment in Spring 2015). The evaluation also served to determine the extent to which protocol was maintained post-intervention and identify barriers and facilitators to successful implementation. Using cafeteria audits, fidelity scores were calculated at baseline, intervention, and two weeks post-intervention for all schools. Fall 2014 treatment schools were monitored for maintenance during the Spring 2015 intervention period. Additional measures included nutrition environment assessments and post-intervention interviews with food service staff. Qualitative analyses were used to identify barriers and facilitators. Fidelity scores for most protocol items increased during intervention periods. However, post-intervention cafeteria audits revealed poor maintenance across all schools. Limited compliance and maintenance were associated with constrained serving line structures, varied staff motivation, and staff-perceived intervention ineffectiveness. Environmental assessments revealed nutrition programming that could support SL changes but that may have impacted study outcomes. While protocol items were generally feasible to implement, efforts to enhance staff buy-in are necessary to support SL work. Results will enhance analyses of forthcoming study outcomes and will inform future intervention delivery. Findings may also prove valuable for other environmentally-focused interventions in school cafeterias.