Barriers and Facilitators to High School Meal Program Participation: A Qualitative Study of Students and Their Caregivers

Abstract

BACKGROUND:The school food environment is a critically important area to target the health of millions of students, especially those experiencing food insecurity. However, both students and caregivers have noted significant barriers to participation in the school meal program, including taste, lunchroom experience, and limited availability of fresh, healthy foods. There is a lack of qualitative research which considers both caregiver and adolescent perspectives, particularly among youth of color.METHODS: Forty-seven students (77% Black) and 24 caregivers across 4 midwestern high schools participated in focus groups and key informant interviews assessing barriers and facilitators to school meal participation. We conducted thematic analysis of the data using matrix intersection queries and reviewing frequencies of relevant nodes to identify themes. RESULTS:Themes about the importance of freshness and quality of the foods served in the lunchroom emerged from both students and caregivers.CONCLUSIONS: Future research may explore differences in meal participation depending on types of vender, farm to school program status, and other local variations in public schools and determine whether they increase participation, reduce food insecurity, and increase diet quality.

Evaluation of health and economic effects of United States school meal standards consistent with the 2020–2025 dietary guidelines for Americans

“…We identified greater dietary impacts of the 2020 DGA-aligned nutrition standards among elementary and middle school than high-school students, largely because of the lower participation rates in school meals among high-school students [ 48 ]. Identified barriers to school meal participation may include the taste and quality of school meals and the stigma of receiving free or reduced price school meals [ 49 ], and high-school students may be more sensitive to these barriers compared to younger age groups [ 48 ]. Interestingly, the SNMC study found that healthier school meals (measured by the Healthy Eating Index) were associated with higher overall participation rates than less healthy school meals [ 50 , 51 ], suggesting that improvements in nutritional quality may increase participation.…”

A Spatial Analysis of Food Insecurity and Body Mass Index with Income and Grocery Store Density in a Diverse Sample of Adolescents and Young Adults

“…Data included in this study came from two separate studies [ 14 , 15 ]. We included data from both studies to increase our sample size and to be able to include participants from across the adolescent—early adult developmental period.…”

High School Student and Caregiver Preferred Communication Method Regarding School Meals: A Qualitative Approach

“…Study materials were available in both English and Spanish translation to ensure inclusivity of students and caregivers of ethnically diverse backgrounds. Focus groups were held for about 60 minutes and focused on 3 main areas of interest: (1) school communication preferences and opinions about digital health tools, (2) daily school meal participation and decision‐making about school meals, 33 and (3) overall nutrition knowledge. The current paper explores the results from the first area of interests related to communication preferences and digital health tools.…”

“…Respondents also suggested that the app could be used to gather feedback on the food and menu options, which could be important for increasing participation in NSLP as previous research has shown that perceptions of school lunch quality and taste can be a barrier to participation. 33 Some respondents identified potential barriers related to accessibility due to lack of internet connectivity in schools and also raised concerns around the schools' ability to afford an incentivized mobile application. Future research pertaining to specific barriers and facilitators around the development digital interventions is necessary to gain full understanding.…”

“…While previous research has suggested that preordering can increase the selection of healthy foods, 28 more research is needed to determine how this selection translates to actual consumption of healthy food. Respondents also suggested that the app could be used to gather feedback on the food and menu options, which could be important for increasing participation in NSLP as previous research has shown that perceptions of school lunch quality and taste can be a barrier to participation 33 …”