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Cited by 23School Health and Nursing EducationHealth Policy Implementation ScienceNutrition, Health and Food Behavior

Implementation of strategies to increase adolescents’ access to fruit and vegetables at school: process evaluation findings from the Boost study

Open access
Aarestrup, Anne Kristine, Jørgensen, Thea Suldrup, Jørgensen, Sanne Ellegaard, Hoelscher, Deanna M, Due, Pernille, Krølner, Rikke·2015·BMC Public Health
DOI 10.1186/s12889-015-1399-9PMC PMC4334355
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Abstract

BACKGROUND: Access to fruit and vegetables (FV) is associated with adolescents' FV consumption. However, little is known about implementation of strategies to increase access to FV at schools. We examined the implementation of two environmental components designed to increase access to FV at Danish schools. METHODS: We used data from 20 intervention schools involved in the school-based multicomponent Boost trial targeting 13-year-olds' FV consumption. The environmental components at school included daily provision of free FV and promotion of a pleasant eating environment. Questionnaire data was collected by the end of the nine-month intervention period among 1,121 pupils (95%), from all school principals (n = 20) and half way through the intervention period and by the end of the intervention among 114 teachers (44%). The implementation of the components was examined descriptively using the following process evaluation measures; fidelity, dose delivered, dose received and reach. Schools with stable high implementation levels over time were characterised by context, intervention appreciation and implementation of other components. RESULTS: For all process evaluation measures, the level of implementation varied by schools, classes and over time. Dose received: 45% of pupils (school range: 13-72%, class range: 7-77%) ate the provided FV daily; 68% of pupils (school range: 40-93%, class range: 24-100%) reported that time was allocated to eating FV in class. Reach: The intake of FV provided did not differ by SEP nor gender, but more girls and low SEP pupils enjoyed eating FV together. Dose delivered: The proportion of teachers offering FV at a daily basis decreased over time, while the proportion of teachers cutting up FV increased over time. Schools in which high proportions of teachers offered FV daily throughout the intervention period were characterized by being: small; having a low proportion of low SEP pupils; having a school food policy; high teacher- and pupil intervention appreciation; having fewer teachers who cut up FV; and having high implementation of educational components. CONCLUSIONS: The appliance of different approaches and levels of analyses to describe data provided comprehension and knowledge of the implementation process. This knowledge is crucial for the interpretation of intervention effect. TRIAL REGISTRATION: Current Controlled Trials ISRCTN11666034.

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  • The 75% compliance rate is lower than the 80% often applied as a sufficient compliance rate.

    “This is lower than the 80%, which is often applied as a sufficient compliance rate.2,10,11”

    From Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment. (2024) · cites this paper as [11]

    The Methods section (page unavailable) defines 80% or more as a high implementation level in the Boost study. It says this cutoff was chosen pragmatically, not that 80% is often applied as a sufficient compliance rate. The cited paper also does not establish the citing document’s 75% rate. (LLM, conf=0.85)

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Authors
Aarestrup, A. K., Jørgensen, T. S., Jørgensen, S. E., Hoelscher, D. M., Due, P., & Krølner, R.
Affiliations
  • University of Southern Denmark (DK)
  • Michael & Susan Dell Center for Healthy Living (US)
Corresponding author
Aarestrup, Anne Kristine
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2015-02-06
Volume
15
Issue
1
Pages
86-86
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-015-1399-9
PMC
PMC4334355
OpenAlex
W1998444580
Cited by
23
References
58
Citations by year
2026: 2 · 2025: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 1
FWCI
5.12
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
  • Texas ScholarWorks (Texas Digital Library) (submittedVersion, other-oa)
  • Texas Digital Library (University of Texas)
Funders
  • Syddansk Universitet
  • TrygFonden
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 › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
fruit and vegetable intake, adolescents, school-based intervention, implementation, eating environment, school nutrition policy, socioeconomic status, intervention fidelity, delivered dose, REACH regulation
MeSH terms
Adolescent, Consumer Behavior, Denmark, Diet, Environment, Female, Fruit, Humans, Inservice Training, Male, Schools, Sex Factors, Socioeconomic Factors, Vegetables

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