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: Findings suggest a potential relationship between implementation and capacity change, which is the primary goal of SWITCH. The results document the importance of allowing schools to adapt programming to meet their local needs.

A Systematic Review of School Health Policy Measurement Tools: Implementation Determinants and Outcomes

“…Several tools only measured delity and/or adoption as the implementation outcomes, which draws concern for addressing constructs such as feasibility and sustainability, among others. Only 8 measures addressed feasibility, with 7 of those within unique tools; this is somewhat contradictory to the extant literature on school-based programming, as many studies have reported low feasibility for implementing policies and health promoting interventions (26,(59)(60)(61). Further, through qualitative and mixed-methods research it has transpired that, despite providing nancial and logistical support to schools, districts, and states/provinces, most policies are di cult to sustain in absence of such support (61)(62)(63).…”

“…Within this broader construct, non-training resources was the most common determinant assessed; provision of nancial resources and personnel support have been cited as supportive factors for policy and innovation implementation in school research (9,74,75). Following this, leadership for implementation was very prevalent in the measures, which again re ects extant knowledge that new innovations require a leader to succeed (61,76,77). Finally, the prevalence of items measuring communication of policy demonstrated the importance of engaging stakeholders in policy implementation through enhancing awareness of such initiatives.…”

Self-control Training for Young Children

“…Tangney et al shows that self-control is closely related to students' performance and academic success [16]. Vazou et al further discuss that self-control and other cognitive functions can be nurtured through intervention [17]. For example, Meichenbaum and Goodman proposed training children to talk to themselves improves ability to control their emotions [18].…”