District-level implementation of British Columbia’s school food and beverage sales policy: a realist evaluation exploring intervention mechanisms in urban and rural contexts

Levay, Adrienne; Chapman, Gwen E.; Seed, Barbara; Wittman, Hannah

doi:10.17269/s41997-018-0159-x

Cited by 10 publications

(16 citation statements)

References 16 publications

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“…Despite positive ndings regarding Student Needs and Resources (outer setting), schools reported challenges when ensuring scheduled time for students to engage in SWITCH programming. The physical education and lunchroom settings were cited numerous times as areas for needed improvement and communication; such ndings align with prior research on SWITCH and other comprehensive health promotion interventions and policies (11,20,(46)(47)(48). As such, it seems that school stakeholders agreed on the "need" for school health and wellness promotion, but school-level schedules and policies did not seem to re ect this mission.…”

Section: Discussionsupporting

confidence: 76%

Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability

McLoughlin

Sweeney

Liechty

et al. 2021

Preprint

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BackgroundThe need for sustainable and scalable comprehensive school wellness interventions is evident, and the lack of attention toward capacity-building models warrants investigation. Furthermore, there is a dearth of understanding regarding implementation determinants grounded in dissemination and implementation (D&I) frameworks. This study sought to address: 1) implementation determinants of adoption, fidelity, and penetration for school-wide wellness programming; and 2) nuanced determinants between schools with prior experience and those new to the program, to enhance tailored implementation support and sustainability.MethodsThe School Wellness Integration Targeting Child Health (SWITCH®) capacity-building intervention was adopted in 52 elementary and middle (22 new; 30 experienced) schools across Iowa, United States in the 2019–2020 academic year. Mixed methods data collection and analysis procedures followed the Consolidated Framework for Implementation Research (CFIR) protocols, adapted to school settings. Implementation outcomes included: 1) fidelity/compliance to established quality elements; 2) adoption of best practices in multiple settings; and 3) penetration of behavior change practices across classrooms and grade levels. Assessed determinants comprised organizational readiness/capacity and CFIR constructs via interviews and surveys. Interview data were scored using a systematic process; each CFIR domain was assigned a score (ranging between -2 and +2) to denote either a positive or negative influence on implementation. Independent t-tests were conducted to capture potential differences between new and experienced schools, followed by Pearson bivariate correlation analyses to determine relationships between CFIR determinants and implementation outcomes. ResultsExperienced schools reported insignificantly higher fidelity (t=-1.86 p=.07) and higher rates of adoption (t=-2.03 p=.04) compared to new schools. Correlation analyses revealed positive relationships between implementation outcomes and CFIR determinants including innovation source, culture and relative priority, and leadership engagement. Negative relationships were observed in tension for change and networks and communications. Specific negative relationships for new schools between determinants and outcomes included relative advantage, engaging key stakeholders, and reflecting/evaluating, among others. ConclusionsFindings highlight the specific relationships between implementation outcomes and determinants; nuanced challenges for new schools highlight the need for a more tailored approach to implementation support and offer insights for sustainability. Adapted CFIR protocols provide opportunities for replication in other school-and community-based projects.

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Section: Discussionsupporting

confidence: 76%

Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability

McLoughlin

Sweeney

Liechty

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The search identified nine research papers (four evaluations 21 , 22 , 23 , 24 and five reviews 25 , 26 , 27 , 28 , 29 ) describing seven interventions in nutrition and dietetics that applied a realist approach. All were included in the narrative synthesis.…”

Section: Resultsmentioning

confidence: 99%

Using realist approaches in nutrition and dietetics research

Jenkins

Maugeri

Palermo

et al. 2021

Nutrition & Dietetics

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Aim The aim of this study was to explore the use and future potential of realist approaches to research in nutrition and dietetics. Methods A targeted literature review was used to search key journals (n = 7) in nutrition and dietetics to identify existing research using a realist approach. A narrative synthesis was conducted to explore findings in relation to the research aim. Results Nine research papers (four realist evaluations, five realist reviews) describing seven nutrition interventions were found, which revealed the application of realist research in nutrition and dietetics has focused on public health interventions. Realist research provided a deeper, more nuanced understanding of varied outcomes including the role of context, and contributed to the development of theory about how and why interventions work. As a theory‐driven research method, realist research was able to assist in overcoming methodological shortcomings to contribute to meaningful, transferable findings. Conclusion The results highlight the potential contribution of the realist research in nutrition and dietetics to evaluate interventions and inform future practice.

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“…Finally, the findings reported here focus on school-level stakeholders. In another component of the same study, we examined key mechanisms influencing district-level implementers' engagement with the same policy (44) . There were some similarities in mechanisms apparent at the two levels, particularly regarding the mandatory nature of the policy and the motivations and involvement of private vendors.…”

Section: Discussionmentioning

confidence: 99%

“…The analyses presented in this paper are part of a larger study of the implementation of British Columbia (BC), Canada's school food and beverage sales policy at the district and school levels. Here, we focus on the school-level experience; the experience of school districts is reported elsewhere (44,45) . In particular, we explore the way in which key mechanisms and contexts influence how school-level stakeholders engage in implementation activities.…”

mentioning

confidence: 99%

Examining school-level implementation of British Columbia, Canada’s school food and beverage sales policy: a realist evaluation

Levay

Chapman

Seed³

et al. 2020

Public Health Nutr.

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Objective:To identify key school-level contexts and mechanisms associated with implementing a provincial school food and beverage policy.Design:Realist evaluation. Data collection included semi-structured interviews (n 23), structured questionnaires (n 62), participant observation at public events (n 3) and scans of school, school district and health authority websites (n 67). The realist heuristic, context + mechanism → outcome configuration was used to conduct the analysis.Setting:Public schools in five British Columbia (BC), Canada school districts.Participants:Provincial and regional health and education staff, private food vendors and school-level stakeholders.Results:We identified four mechanisms influencing the implementation of BC’s school food and beverage sales policy. First, the mandatory nature of the policy triggered some actors’ implementation efforts, influenced by their normative acceptance of the educational governance system. Second, some expected implementers had an opposite response to the mandate where they ignored or ‘skirted’ the policy, influenced by values and beliefs about the role of government and school food. A third mechanism related to economics demonstrated ways vendors’ responses to school demand for compliance with nutritional Guidelines were mediated by beliefs about food preferences of children, health and food. The last mechanism demonstrated how resource constraints and lack of capacity led otherwise motivated stakeholders to not implement the mandatory policy.Conclusion:Implementation of the food and beverage sales policy at the school level is shaped by interactions between administrators, staff, parent volunteers and vendors with contextual factors such as varied motivations, responsibilities and capacities.

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District-level implementation of British Columbia’s school food and beverage sales policy: a realist evaluation exploring intervention mechanisms in urban and rural contexts

Cited by 10 publications

References 16 publications

Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability

Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability

Using realist approaches in nutrition and dietetics research

Examining school-level implementation of British Columbia, Canada’s school food and beverage sales policy: a realist evaluation

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