Effective implementation of primary school-based healthy lifestyle programmes: a qualitative study of views of school staff

Abstract

Background Primary schools are valuable settings to implement healthy lifestyle (healthy eating and physical activity) interventions, aimed at targeting childhood obesity. This study explored school staff perceptions of factors that hinder and enable successful implementation and sustainability of healthy lifestyle interventions in primary schools. Qualitative data was pooled and analysed from two evaluations carried out in primary schools in North England: a feasibility study of a nutrition and physical activity educational programme (PhunkyFoods Feasibility Study), and an evaluation of a healthy eating programme (The Food Dudes Evaluation). Methods Sixty-five qualitative semi-structured interviews were conducted with head teachers, teachers, catering managers, designated school-based programme coordinators and programme staff supporting schools with programme delivery, at 14 schools involved in both evaluations. Thematic analysis was undertaken and emergent themes categorised using a framework for successful implementation by Durlak and Dupre (2008). Results Overall, all schools were delivering a range of healthy lifestyle programmes, often with overlapping content. Perceived challenges to implementation of individual programmes included: limited time, timing of implementation, limited training and support, insufficient resources, capacity and facilities, staff perceptions of intervention and perceived skill-proficiency (for cooking and physical activities). Short-term funding, lack of external and internal support were perceived to hinder sustainability. Staff recommendations for successful implementation of future programmes included: extended training and planning time, sufficient capacity, external support for delivery, good resources (interactive, practical and adaptable), and facilities for cooking, healthy eating, gardening and physical activities. Head teachers need to prioritise delivery of a few key healthy lifestyle programmes, in an overcrowded curriculum. Schools need to employ strategies to engage participation of staff, pupils and parents long term. Conclusions Effective implementation of school-based healthy lifestyle programmes was thought to be aided by flexible and adaptable programmes, enabling good contextual fit, well-resourced programmes and effective leadership at multiple levels, pupil (pupils support delivery) and parent involvement. To facilitate sustainability, it was perceived that programmes need to be integrated within the curriculum and school policies long term, with sustained support from head teachers and staff. These findings are relevant to programme developers, policy makers and those involved in delivering interventions.

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

“…Moreover, differences in characteristics related to the working group members, i.e., interpretation of the approach, the degree of practice-oriented thinking, the presence of one or more champions, and the dynamics within the working group, but also the differing degrees of influence of factors within the outer setting (i.e., support from the school board, national health-promoting trends, and the presence of and the capacity to collaborate with potential partners) resulted in different implementation processes. Other studies also found these contextual factors to facilitate and hinder implementation of school health-promoting interventions [33][34][35][36][37][38][39][40][41].…”

Effects of the KEIGAAF intervention on the BMI z-score and energy balance-related behaviors of primary school-aged children

“…Schools experienced children's nutrition behavior as being more difficult to change at school than physical activity [34]. This is because collaboration between school and parents is important in creating a healthy nutrition-promoting environment, but this collaboration is difficult to achieve [58]. Parents have a big influence on children's nutrition consumption, also at school, because Dutch children bring home-packed lunches and drinks to school [12].…”

The Impact of an Educational Institution on Development of Healthy Lifestyle Skills for Prevention of Obesity in Adolescents

“…According to results of the researches conducted in Northern England, it has been noted that educational institutions should utilize strategies as to long-term engagement of school employees, schoolchildren and their parents. In order to provide sustainability, it has been noted that the programs should be integrated in long-term curricula and school policy, with steady support of principals and staff [15].…”