Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012–2014

Blaine, Rachel E.; Franckle, Rebecca L.; Ganter, Claudia; Falbe, Jennifer; Giles, Catherine; Criss, Shaniece; Kwass, Jo-Ann; Land, Thomas; Gortmaker, Steven L.; Chuang, Emmeline; Davison, Kirsten K.; MA-CORD Project Group

doi:10.5888/pcd14.160381

Cited by 90School Health and Nursing EducationObesity, Physical Activity, DietHealth Policy Implementation Science

Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012–2014

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Blaine, Rachel E., Franckle, Rebecca L., Ganter, Claudia, Falbe, Jennifer, Giles, Catherine, Criss, Shaniece, Kwass, Jo-Ann, Land, Thomas +4 more·2017·Preventing Chronic Disease

DOI 10.5888/pcd14.160381PMC PMC5234440

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Abstract

INTRODUCTION: Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts' capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing "Eat Well and Keep Moving" and "Planet Health" behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts. METHODS: The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability. RESULTS: MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district's staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers. CONCLUSION: Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.

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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 [16]
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 [16]
Presence of an in-school 'champion' was one of the strongest reported facilitators to organisational readiness to adopt and sustain the intervention in the Massachusetts Childhood Obesity Demonstration Project in two low income districts, which appeared to offset implementation barriers.
“Presence of an in-school ‘champion’ was one of the strongest reported facilitators to organisational readiness to adopt and sustain the intervention in the Massachusetts Childhood Obesity Demonstration Project in two low income districts, which appeared to offset implementation barriers [16].”
From Barriers, facilitators and capacities for childhood obesity prevention in 12 European nations: results of a policy-maker survey (2018) · cites this paper as [16]
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 [16]
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 [16]

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Additional file 7 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
Shoesmith, 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
Additional file 1 of Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component
Lambrinou, C.-P., Androutsos, O., Karaglani, E., Cardon, G., Huys, N., Wikström, K., Kivelä, J., Ko, W., Karuranga, E., Tsochev, Κ., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12257732
Additional file 5 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
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
Additional file 1 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
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
Additional file 1 of Relationship between the inner setting of CFIR and the delivery of the Healthy School Recognized Campus initiative: a mixed-methods analysis
Schaefers, A., Xin, L., Butler, P. W., Gardner, J., Uribe, A. M., Rethorst, C. D., Rolke, L. J., Seguin‐Fowler, R. A., & Szeszulski, J. (2024) · Figshare · doi:10.6084/m9.figshare.26946159
Additional file 6 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679914
Additional file 4 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679908
Additional file 4 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
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
Additional file 6 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
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
Additional file 1 of A cluster RCT and process evaluation of an implementation optimisation intervention to promote parental engagement enrolment and attendance in a childhood obesity prevention programme: results of the Optimising Family Engagement in HENRY (OFTEN) trial
Bryant, M., Burton, W., Collinson, M., Farrin, A., Nixon, J., Stevens, J., Roberts, K., Foy, R., Rutter, H., Copsey, B. J., et al. (2021) · Figshare · doi:10.6084/m9.figshare.16943559
Additional file 3 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
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
Additional file 2 of Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review
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
Additional file 3 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679905
Additional file 7 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679917
Additional file 5 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679911
Additional file 1 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679899
Additional file 2 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679902
Additional file 8 of Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review
Butscher, F., Ellinger, J., Singer, M., & Mall, C. (2024) · Figshare · doi:10.6084/m9.figshare.26679920
Web-based education on Metabolism and Obesity is associated with improved lifestyle and health behaviours among Brazilian school teachersPreprint
Evangelista-Silva, P. H., Coutinho, C. P., Correia, C. C. M., Moraes, T., Ferreira, A. F. F., Komino, A. C. M., Ramos, J. K. N., Affini, L., Furlan, R. L. A., & Carvalho, C. R. D. O. (2026) · medRxiv · doi:10.64898/2026.06.09.26355322

Track 6: Actions, interventions and policies
(2016) · Obesity Reviews · doi:10.1111/obr.12403 · Cited by 1 · see citing works
Using school staff members to implement a childhood obesity prevention intervention in low-income school districts
Blaine, R. E., & Ganter, C. (2017) · Cited by 2 · see citing works
Self-citation
Evaluation of a pragmatic trial of a collaborative school-based obesity prevention intervention in a low-income urban district
Long, M. W., Weber, M. R., Allan, M. J., Ma, Y., Jin, Y., Aldous, A. M., Elliot, A. J., & Burke, H. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106020 · Cited by 7 · see citing works
Untitled work
Abu-Omar (2018) · doi:10.1186/s12889-018-6368-7 · Cited by 67 · see citing works
Collaborative 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

Authors: Blaine, R. E., Franckle, R. L., Ganter, C., Falbe, J., Giles, C., Criss, S., Kwass, J.-A., Land, T., Gortmaker, S. L., Chuang, E., Davison, K. K., & MA-CORD Project Group
Affiliations: California State University, Long Beach (US)
Harvard University (US)
Heidelberg University (DE)
University of California, Berkeley (US)
Furman University (US)
Massachusetts Department of Public Health (US)
University of California, Los Angeles (US)
Corresponding author: Blaine, Rachel E.
ORCID: Blaine, Rachel E.
Franckle, Rebecca L.
Falbe, Jennifer
Criss, Shaniece
Gortmaker, Steven L.
Chuang, Emmeline
Davison, Kirsten K.
Venue: Preventing Chronic Disease
Publisher: Centers for Disease Control and Prevention - Preventing Chronic Disease
Published: 2017-01-12
Volume: 14
Pages: E03-E03
ISSN: 1545-1151 (ISSN-L)
DOI: 10.5888/pcd14.160381
PMC: PMC5234440
OpenAlex: W2570817754
Cited by: 90
References: 32
Citations by year: 2026: 1 · 2025: 1 · 2024: 13 · 2023: 27 · 2022: 1 · 2021: 23 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 2
FWCI: 12.89
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: public-domain
Locations: Preventing Chronic Disease (publishedVersion, public-domain)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
eScholarship (California Digital Library) (submittedVersion)
eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders: American Heart Association (#14POST20140055)
National Institutes of Health
Centers for Disease Control and Prevention (U18DP003370)
National Heart, Lung, and Blood Institute (T32HL098048)
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007703)
National Center for Chronic Disease Prevention and Health Promotion (U18DP003370)
Topics: Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords: childhood obesity prevention, school-based intervention, school staff, low-income school districts, implementation outcomes, teacher professional development, school leadership, principal turnover, teacher burnout, school nurses, intervention sustainability
MeSH terms: School Teachers, Child, Child Health Services, Child Nutritional Physiological Phenomena, Child, Preschool, Curriculum, Female, Humans, Male, Massachusetts, Poverty, Research, School Health Services, Schools, Health Behavior, Exercise, Pediatric Obesity

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Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012–2014

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