Implementing a Multicomponent School-Based Obesity Prevention Intervention: A Qualitative Study
Open accessAbstract
Objective To explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts.Methods Using purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses.Results State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance.Conclusions and implications Results confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.
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Some school-based research carried out in older children has identified general themes e.g. commitment and leadership within schools as enabling strategies and a lack of time and external resources as barriers.
“Some school-based research carried out in older children has identified general themes e.g. commitment and leadership within schools as enabling strategies and a lack of time and external resources as barriers [16–19],”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [17]
This commitment by the schools, and buy in from staff members and students has also been noted previously as a key facilitator.
“This commitment by the schools, and buy in from staff members and students has also been noted previously as a key facilitator [16–19].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [17]
Previous qualitative research has sought only the opinions of school personnel.
“However previous qualitative research has sought only the opinions of school personnel [16–18].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [17]
Previous research in this area is limited to a recent cross-sectional study of primary schools in Malaysia and to studies conducted with staff in schools with different target age groups, 9-13 year-olds (middle schools) in the US and to teenagers in the Netherlands.
“Previous research in this area is limited to a recent cross-sectional study of primary schools in Malaysia [19] and to studies conducted with staff in schools with different target age groups, 9–13 year-olds (middle schools) in the US [16, 17] and to teenagers in the Netherlands [18].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [17]
This facilitating factor has been noted in a previous study and suggested to be important for on-going sustainability.
“This facilitating factor has been noted in a previous study [18] and suggested to be important for on-going sustainability [17].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [17]
Barriers associated with budgetary limitations and time constraints have previously been noted.
“Barriers associated with budgetary limitations [17] and time constraints [17, 19] have previously been noted.”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [17]
Cites
(2008) · Springer eBooks · doi:10.1007/978-0-387-77282-0_6 · Cited by 17,410 · see citing works
(1996) · Cited by 11,584 · see citing works
An ecological perspective on health promotion programs
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988) · Health Education Quarterly · doi:10.1177/109019818801500401 · Cited by 8,502 · see citing works
Guest, G., MacQueen, K., & Namey, E. (2012) · doi:10.4135/9781483384436 · Cited by 7,924 · see citing works
Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008
Ogden, C. L. (2010) · JAMA · doi:10.1001/jama.2009.2012 · Cited by 3,200 · see citing works
Qualitative Research Design: An Interactive Approach
Pitman, M. A. (1998) · Anthropology & Education Quarterly · doi:10.1525/aeq.1998.29.4.499 · Cited by 2,404 · see citing works
Chatzopoulou, E. (2023) · Routledge eBooks · doi:10.4324/9781003107774-12 · Cited by 1,573 · see citing works
Reducing Obesity via a School-Based Interdisciplinary Intervention Among Youth
Gortmaker, S. L., Peterson, K. E., Wiecha, J. L., Sobol, A. M., Dixit, S., Fox, M. K., & Laird, N. M. (1999) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.153.4.409 · Cited by 1,335 · see citing works
Self-citationStory, M. T., Nanney, M. S., & Schwartz, M. B. (2009) · Milbank Quarterly · doi:10.1111/j.1468-0009.2009.00548.x · Cited by 833 · see citing works
Examining the Role of Implementation Quality in School-Based Prevention Using the PATHS Curriculum
Kam, C.-M., Greenberg, M. T., & Walls, C. T. (2003) · Prevention Science · doi:10.1023/a:1021786811186 · Cited by 516 · see citing works
Bauer, K. W., Yang, Y. W., & Austin, S. B. (2004) · Health Education & Behavior · doi:10.1177/1090198103255372 · Cited by 279 · see citing works
Self-citationHoelscher, D. M. (2004) · Preventive Medicine · doi:10.1016/j.ypmed.2003.11.017 · Cited by 202 · see citing works
Progress in Preventing Childhood Obesity: How Do We Measure Up?
(2006) · Obesity Management · doi:10.1089/obe.2006.2.232 · Cited by 175 · see citing works
Katz, D. L. (2009) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.031308.100307 · Cited by 169 · see citing works
Peterson, K. E., & Fox, M. K. (2007) · The Journal of Law Medicine & Ethics · doi:10.1111/j.1748-720x.2007.00116.x · Cited by 142 · see citing works
Self-citationLevine, E., Olander, C., Lefebvre, C., Cusick, P., Biesiadecki, L. A., & McGoldrick, D. (2002) · Journal of Nutrition Education and Behavior · doi:10.1016/s1499-4046(06)60076-6 · Cited by 65 · see citing works
Austin, S. B., Spadano-Gasbarro, J. L., Greaney, M. L., Richmond, T. K., Feldman, H. A., Osganian, S. K., Hunt, A. T., Mezgebu, S., & Peterson, K. E. (2010) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2010.05.017 · Cited by 60 · see citing works
Self-citationThaker, S., Steckler, A., Sánchez, V., Khatapoush, S., Rose, J., & Hallfors, D. D. (2007) · Health Education Research · doi:10.1093/her/cym025 · Cited by 58 · see citing works
Process evaluation results from the HEALTHY physical education intervention
Hall, W. J., Zeveloff, A., Steckler, A., Schneider, M. L., Thompson, D. I., Pham, T., Volpe, S. L., Hindes, K., Sleigh, A. E., McMurray, R. G., et al. (2011) · Health Education Research · doi:10.1093/her/cyr107 · Cited by 57 · see citing works
School health index: A self-assessment and planning guide.
(2013) · PsycEXTRA Dataset · doi:10.1037/e303052004-001 · Cited by 49 · see citing works
Austin, S. B., Fung, T. T., Cohen-Bearak, A., Wardle, K., & Cheung, L. (2006) · PubMed · Cited by 35 · see citing works
Self-citationCollaborative School‐Based Obesity Interventions: Lessons Learned From 6 Southern Districts
Jain, A., & Langwith, C. (2013) · Journal of School Health · doi:10.1111/josh.12017 · Cited by 22 · see citing works
Austin, S. B., Fung, T. T., Cohen-Bearak, A., Wardle, K., & Cheung, L. (2006) · Preventing Chronic Disease · Cited by 19 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Shoesmith, A., Hall, A. E., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S. L., Lane, C., et al. (2021) · Implementation Science · doi:10.1186/s13012-021-01134-y · Cited by 218 · see citing works
“Twenty-five articles (ten qualitative [36, 39, 41, 46, 47, 49, 52, 55, 60, 63], five quantitative [50, 51, 56, 57, 59], nine mixed-methods [37, 38, 42–45, 48, 54, 65], and one summary article [62]) identified 74 facilitators that promoted intervention sustainment within schools which covered all five Integrated Sustai…”
BackgroundInfluentialDariotis, J. K., Mirabal‐Beltran, R., Cluxton‐Keller, F., Gould, L. F., Greenberg, M. T., & Mendelson, T. (2016) · Psychology in the Schools · doi:10.1002/pits.21979 · Cited by 86 · see citing works
Abu-Omar (2018) · doi:10.1186/s12889-018-6368-7 · Cited by 67 · see citing works
Seaton, C. L., Holm, N. G. L., Bottorff, J. L., Jones-Bricker, M., Errey, S., Caperchione, C. M., Lamont, S., Johnson, S. T., & Healy, T. (2017) · American Journal of Health Promotion · doi:10.1177/0890117117710875 · Cited by 73 · see citing works
“In total, 13 studies focused on a single collaboration (with a minimum of 2 partners).(13,16,18,19,22,26,27,29,30,32,34,35,37) In contrast, 12 studies examined multiple cases of collaboration.”
BackgroundMethodInfluentialSustaining obesity prevention in communities: a systematic narrative synthesis review
Whelan, J., Love, P., Millar, L., Allender, S. E., & Bell, C. (2018) · Obesity Reviews · doi:10.1111/obr.12675 · Cited by 71 · see citing works
“Champions were referred to as program champions (30,36,47,60), school champions (41,75) and community champions (14).”
BackgroundInfluentialNorman, Å., Nyberg, G., Elinder, L. S., & Berlin, A. (2015) · BMC Public Health · doi:10.1186/s12889-016-2701-1 · Cited by 63 · see citing works
“This is in line with results from previous studies in implementation of health promotion interventions in schools, showing that components which are easy for teachers to use, do not require much time to prepare and that fit the rest of their school work, have been found successful [7–9, 29].”
BackgroundResultRecommendations for Administrators’ Involvement in School-Based Health Promotion: A Scoping Review
Webster, C. A., Glascoe, G., Moore, C., Dauenhauer, B. D., Egan, C. A., Russ, L. B., Orendorff, K. L., & Buschmeier, C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17176249 · Cited by 35 · see citing works
Implementation Science and Nutrition Education and Behavior: Opportunities for Integration
Swindle, T., Curran, G. M., & Johnson, S. L. (2019) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2019.03.001 · Cited by 33 · see citing works
Craig, D. W., Walker, T. J., Cuccaro, P. M., Sharma, S. V., Heredia, N. I., Robertson, M. C., & Fernández, M. E. (2024) · BMC Public Health · doi:10.1186/s12889-024-17744-2 · Cited by 23 · see citing works
“Consistent with past studies, our findings also indicate the importance of good working relationships when implementing school-based physical activity opportunities [19, 44, 45].”
ResultChildhood Overweight and Obesity: Affecting Factors, Education and Intervention
Se, W., & Jl, G. (2018) · Journal of Childhood Obesity · doi:10.21767/2572-5394.100049 · Cited by 24 · see citing works
“Other studies have also included sleep duration and/or screen time [55,57-59].”
BackgroundFathi, L. I., Walker, J. L., Dix, C. F., Cartwright, J. R., Joubert, S., Carmichael, K. A., Huang, Y.-S., Littlewood, R., & Truby, H. (2023) · Public Health Nutrition · doi:10.1017/s1368980023001647 · Cited by 30 · see citing works
Musuuza, J., Roberts, T. J., Carayon, P., & Safdar, N. (2017) · BMC Infectious Diseases · doi:10.1186/s12879-017-2180-8 · Cited by 22 · see citing works
Burgermaster, M., Contento, I. R., Koch, P. A., & Mamykina, L. (2018) · Translational Behavioral Medicine · doi:10.1093/tbm/ibx029 · Cited by 20 · see citing works
“childhood obesity prevention interventions [14], are”
Burgermaster, M., Gray, H. L., Tipton, E., Contento, I. R., & Koch, P. A. (2016) · Prevention Science · doi:10.1007/s11121-016-0736-2 · Cited by 19 · see citing works
“This may reflect the barriers (e.g., testing pressures, unwillingness to use the program) explored by Greaney et al. (2014) in their examination of teacher implementation of a school-based childhood obesity prevention intervention.”
Fair, K. N., Williams, K. D. S., Warren, J. L., McKyer, E. L. J., & Ory, M. G. (2018) · Journal of School Health · doi:10.1111/josh.12626 · Cited by 19 · see citing works
Almutairi, N., Burns, S. K., & Portsmouth, L. (2022) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2022.2135197 · Cited by 14 · see citing works
“…behaviours to prevent obesity have had mixed success (Kain et al., 2004; Katz, 2009; Mo-Suwan et al., 1998; Peterson & Fox, 2007) which has led to calls for comprehensive approaches to obesity prevention that address multiple levels in schools or in after-school settings (Greaney et al., 2014).”
BackgroundWerkhoven, T. (2020) · Journal of Health Psychology · doi:10.1177/1359105319901310 · Cited by 15 · see citing works
“When surveyed, some health educators are receptive to their roles in schools (Greaney et al., 2014), open to the idea that early childhood education is an opportune time to conduct obesity prevention strategies in schools (Walker, 2011).”
BackgroundFarewell, C. V., Puma, J. E., Bergling, E., Webb, J., Quinlan, J., Shah, P. Y., & Maiurro, E. (2020) · Health Education Research · doi:10.1093/her/cyaa038 · Cited by 12 · see citing works
Bergling, E., Pendleton, D., Shore, E., Harpin, S. B., Whitesell, N. R., & Puma, J. E. (2022) · Journal of School Health · doi:10.1111/josh.13153 · Cited by 13 · see citing works
Scherr, R. E., Jones, A. M., Colorafi, R., Klisch, S. A., Linnell, J. D., & Soule, K. E. (2020) · Health Promotion Practice · doi:10.1177/1524839920920305 · Cited by 10 · see citing works
“In a qualitative evaluation of Massachusetts nutrition education programs, teachers found that state-mandated testing, budget limitations, and time were the largest barriers, while teacher buy-in and support were seen as facilitators (Greaney et al., 2014).”
BackgroundIsmail, M. R., Gilliland, J., Matthews, J. I., & Battram, D. S. (2021) · Health Education Research · doi:10.1093/her/cyab023 · Cited by 12 · see citing works
Burgermaster, M., Koroly, J., Contento, I. R., Koch, P. A., & Gray, H. L. (2017) · Journal of School Health · doi:10.1111/josh.12556 · Cited by 10 · see citing works
Bergling, E., Pendleton, D., Owen, H., Shore, E., Risendal, B., Harpin, S. B., Whitesell, N. R., & Puma, J. E. (2021) · Health Education Research · doi:10.1093/her/cyab027 · Cited by 8 · see citing works
Craig, D. W., Walker, T. J., Sharma, S. V., Cuccaro, P. M., Heredia, N. I., Pavlovic, A., DeFina, L. F., Kohl, H. W., & Fernández, M. E. (2023) · Translational Behavioral Medicine · doi:10.1093/tbm/ibad055 · Cited by 5 · see citing works
Implementation Leadership in School Nutrition: A Qualitative Study
Machado, S. S., Brewster, A. L., Shapiro, V. B., Ritchie, L. D., Magee, K., & Madsen, K. A. (2021) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2021.08.011 · Cited by 8 · see citing works
de Zwarte, D., Kearney, J. M., Corish, C. A., Glennon, C., Maher, L., & Molloy, C. J. (2018) · Journal of Public Health · doi:10.1093/pubmed/fdy173 · Cited by 5 · see citing works
Stiehl, E., Borg, A., Cullen, J. P., Mendiola, A., Dominguez, O., Pester, D. A., Qiao, S., Gandhi, P., Kuiper, N. M., Minkah, P. A., et al. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.127474 · Cited by 4 · see citing works
Gonzalez, D. A., Padilla, K. A. B., Grijalva, M. I., & Ortega, M. I. F. (2021) · Revista Chilena de Salud Pública · doi:10.5354/0719-5281.2020.61270 · Cited by 4 · see citing works
Domains of Capacity Building in Whole-Systems Approaches to Prevent Obesity—A “Systematized” Review
Jayasinghe, S. U., Soward, R., Dalton, L., Holloway, T. P., Murray, S. L., Patterson, K. A. E., Ahuja, K., Hughes, R., Byrne, N. M., & Hills, A. P. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191710997 · Cited by 4 · see citing works
Rosenthal, A., & Caruso, C. C. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813617-1.00012-5 · Cited by 4 · see citing works
When a “One Size” Model Doesn't Fit All: The Building Healthy Schools Program
Hivner, E. A., Hoke, A. M., Francis, E. B., Ricci, T., Zurlo, C., & Kraschnewski, J. L. (2019) · Journal of Physical Education Recreation & Dance · doi:10.1080/07303084.2018.1546629 · Cited by 4 · see citing works
Process of Evaluation of an EFNEP-Enhanced PSE Intervention in Urban Schools
Lepe, S. (2017) · doi:10.23860/thesis-lepe-silvia-2017 · Cited by 3 · see citing works
“3, 7, 15 Recently, more school-based interventions have begun to include process evaluation in their studies.(15-28) Given that some school-based interventions have only achieved moderate success in changing dietary behaviors, process evaluations measuring how well strategies were implemented can help provide directio…”
BackgroundApplication of an Implementation Framework Using Mixed Methods in Preschool Settings
Farewell, C. V., Bergling, E., Maiurro, E., & Puma, J. E. (2021) · Health Promotion Practice · doi:10.1177/15248399211053583 · Cited by 2 · see citing works
“D&I methodologies have been successfully employed to evaluate child care and school-based health promotion programs (Bisset et al., 2013; Greaney et al., 2014; Lyn et al., 2014; Wolfenden et al., 2017).”
Williams, S. E., & Hardie, D. (2019) · American Journal of Health Education · doi:10.1080/19325037.2019.1590257 · Cited by 1 · see citing works
“In addition to PA, there are some that include other components including Health Education and the examination of behavioral change.(23-26)”
BackgroundShoesmith, A., Hall, A. E., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775643
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775634
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775622
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775631
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775637
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775628
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Powell, B. J., Brown, H., McCrabb, S., Sutherland, R., Yoong, S., Lane, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14775625
- Authors
- Greaney, M. L., Hardwick, C. K., Spadano-Gasbarro, J. L., Mezgebu, S., Horan, C. M., Schlotterbeck, S., Austin, S. B., & Peterson, K. E.
- Affiliations
- University of Rhode Island (US)
- Harvard University (US)
- Massachusetts Department of Public Health (US)
- Harvard Pilgrim Health Care (US)
- Brown University (US)
- Boston Children's Hospital (US)
- Corresponding author
- Greaney, Mary L.
- Venue
- Journal of Nutrition Education and Behavior
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 46
- Issue
- 6
- Pages
- 576-582
- ISSN
- 1499-4046 (ISSN-L)
- OpenAlex
- W2098409946
- Cited by
- 41
- References
- 23
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 13 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 2 · 2015: 1
- FWCI
- 5.22
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Journal of Nutrition Education and Behavior (publishedVersion)
- PubMed (publishedVersion)
- Journal of Media Literacy Education (submittedVersion, cc-by)
- Funders
- Massachusetts Department of Public Health
- Leadership Education in Adolescent Health Project, Maternal and Child Health Bureau, HRSA (6t71-MC00009)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity prevention, school-based intervention, healthy choices, implementation barriers, intervention sustainability, staff buy-in, technical assistance, junior high school, state-mandated testing, school budget constraints, school partnerships, multicomponent intervention
- MeSH terms
- Workforce, Adolescent, Adolescent Behavior, Child, Child Behavior, Child Nutritional Physiological Phenomena, Diet, Health Plan Implementation, Humans, Health Knowledge, Attitudes, Practice, Massachusetts, Motor Activity, Obesity, Patient Compliance, Schools, Adolescent Nutritional Physiological Phenomena, Nutrition Policy
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