Barriers to implementation of a healthy canteen policy: A survey using the theoretical domains framework

Abstract

Issue addressed Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework. Methods A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5‐point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian. Results Of the 184 participants, 20% (n = 36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n = 117, 65%), skills (n = 105, 57%), beliefs about capabilities (n = 100, 55%), reinforcement (n = 95, 52%) and goals (n = 95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR = 0.39; 95% CI 0.16‐0.95, P = 0.038). Conclusions This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. So what? For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies.

Barriers to the implementation of clinical guidelines for maternal alcohol consumption in antenatal services: A survey using the theoretical domains framework

“…Mean domain scores were used to categorise whether a domain was a potential barrier . To account for any social desirability in responses, a cut‐off of less than 4 was used to indicate potential barriers, which is consistent with previous studies applying the TDF . Condensed response categories were created for years providing antenatal care; years managing antenatal services; current position (Midwifery: registered midwife, clinical midwife specialist, community liaison midwife, clinical midwife educator; Medical: staff specialist, registrar, fellow, junior medical officer); and years in current position.…”

Measurement Methods Used to Assess the School Food Environment: A Systematic Review

“…Amongst these articles the vast majority featured one measurement method including menu analysis (n = 5), direct observation (n = 3), self-completed questionnaire (n = 11) and surveys (n = 8). Four articles (15%) featured two approaches including surveys and canteen menu audits [65] or observations [60] menu analysis and telephone interviews [22] and self-reported survey and menu audits [66].…”

“…These were studies conducted in high income countries (e.g., Norway and New Zealand) and included all four dimensions of the school food environment. Seven studies were rated as 'medium' quality [22,28,38,46,60,65,71] and twenty-nine studies were rated as 'low' quality [37,[39][40][41][42]44,45,[47][48][49][50][51][52][54][55][56][57][58][59][61][62][63][64][66][67][68][69][70]. The number of methods which were assessed was 49, as a number of studies applied more than one methodological approach to measure to school food environment.…”

“…Only one study solely assessed the policy environment via principal interviews [37]. Twelve studies (29%) approached the school principal about their school food policy, one study questioned teachers [43], two canteen managers [65,66] and one examined online school menus to determine if food items available for purchase in canteens were compliant with guidelines [70]. Three studies determined if the school food policy was compliant with a government-mandated policy [28,65,70].…”

Prescribing physical activity and nutrition

“…Healthy canteen policy in primary schools in the Hunter region of New South Wales was the setting for two studies. Kathryn Reilly and colleagues investigated the range of barriers to the implementation of canteen healthy eating policy as reported by canteen managers, while a randomised controlled trial by Wolfenden and colleagues assesses long‐term adherence to policy after a multi‐strategic implementation.…”