Evaluating the Implementation of the SWITCH® School Wellness Intervention and Capacity-Building Process through Multiple Methods

Abstract

Background: School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming. Methods: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). Results: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed positive, non-significant variances between implementation group and gains in school capacity (F[2,24] = 1.63; p = .21), class capacity (F[2,24]=0.20 p=.82), lunchroom capacity (F[2,24]=0.29; p=.78), and physical education (F[2,24]=1.45; p=.25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy. Conclusions: The results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.

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

“…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.…”

“…The moderate-high rates of Penetration also correspond with self-reported Adoption of program best practices across the school setting. Implementation data from adoption, delity, and penetration measures highlight the differences between new and returning schools, a result that aligns with preliminary ndings from prior evaluations (11). However, the nding that all schools struggled to engage parents despite increased efforts in the 2020 academic year re ects a wealth of prior research documenting this lack of engagement problem (8, 38, 39).…”

“…Parents have been reported as the most di cult stakeholder group to engage in school-wide initiatives, and in previous cycles of SWITCH (11,28,38); however, some schools reported that when they did hold an event at school or at another academic-related event (i.e., parent-teacher conference), parents showed great interest. The most commonly cited outreach practice was disseminating newsletters (developed by SWITCH team) to parents, with events held less frequently.…”

“…In a recent evaluation of SWITCH, we found that implementation outcomes (i.e., delity to quality elements and best practices) were related to school readiness at baseline and that schools who had at least one year of experience with the program reported that they were able to better navigate SWITCH and its core components (11). We also found that factors within the Inner Setting (i.e., culture, relative priority) and Implementation Process (i.e., planning, engaging) domains were particularly salient among stakeholders.…”

“…The cyclical training (fall) and implementation (spring) process of SWITCH across the academic year facilitates a continuous quality improvement process (31), whereby feedback from schools and implementation outcome data drive modi cations to the program each year. More information about the training process can be found in Additional File 1, our previously published article (11), and the program website (https://www.iowaswitch.org/). Brie y, schools were asked to form a wellness team which comprised three members of staff across different school settings (e.g., classroom teachers, physical education, food service, other teachers, administration, counselors, nurses, etc.)…”