Background Primary schools are valuable settings to implement healthy lifestyle (healthy eating and physical activity) interventions, aimed at targeting childhood obesity. This study explored school staff perceptions of factors that hinder and enable successful implementation and sustainability of healthy lifestyle interventions in primary schools. Qualitative data was pooled and analysed from two evaluations carried out in primary schools in North England: a feasibility study of a nutrition and physical activity educational programme (PhunkyFoods Feasibility Study), and an evaluation of a healthy eating programme (The Food Dudes Evaluation). Methods Sixty-five qualitative semi-structured interviews were conducted with head teachers, teachers, catering managers, designated school-based programme coordinators and programme staff supporting schools with programme delivery, at 14 schools involved in both evaluations. Thematic analysis was undertaken and emergent themes categorised using a framework for successful implementation by Durlak and Dupre (2008). Results Overall, all schools were delivering a range of healthy lifestyle programmes, often with overlapping content. Perceived challenges to implementation of individual programmes included: limited time, timing of implementation, limited training and support, insufficient resources, capacity and facilities, staff perceptions of intervention and perceived skill-proficiency (for cooking and physical activities). Short-term funding, lack of external and internal support were perceived to hinder sustainability. Staff recommendations for successful implementation of future programmes included: extended training and planning time, sufficient capacity, external support for delivery, good resources (interactive, practical and adaptable), and facilities for cooking, healthy eating, gardening and physical activities. Head teachers need to prioritise delivery of a few key healthy lifestyle programmes, in an overcrowded curriculum. Schools need to employ strategies to engage participation of staff, pupils and parents long term. Conclusions Effective implementation of school-based healthy lifestyle programmes was thought to be aided by flexible and adaptable programmes, enabling good contextual fit, well-resourced programmes and effective leadership at multiple levels, pupil (pupils support delivery) and parent involvement. To facilitate sustainability, it was perceived that programmes need to be integrated within the curriculum and school policies long term, with sustained support from head teachers and staff. These findings are relevant to programme developers, policy makers and those involved in delivering interventions.

Background Vitamin D deficiency has been highlighted as a serious public health problem in the United Kingdom. One in four toddlers are not achieving the recommended intake for their healthy development. This study uses quantitative and qualitative methods to explore parents’ perceptions, awareness and behaviours around vitamin D intake, and the acceptability of and factors affecting purchasing of food and drink fortified with Vitamin D in children aged 0–2 years old. Methods One hundred and ninety-four parents completed an online questionnaire, advertised to parents with one child aged up to 2 years on popular social media websites. The majority of participants were mothers, White-British ethnic background, aged 25–44 years. Participants provided an email address if they wanted to be contacted about the focus groups. Recruitment posters advertising the focus groups were placed in community centres. Eighteen participated in 5 focus groups (13 parents), and 5 individual interviews. A thematic analysis methodology was applied. Results Fifty-seven percent ( n = 110) of parents reported receiving information about vitamin D during pregnancy and 52% ( n = 100) after the birth of their child. Parents reported a low level of satisfaction with vitamin D information: many thought it was limited and recommendations on supplements were unclear. Parents wanted more information about vitamin D requirements for their child (80%, n = 153 out of 192 respondents, 2 non-response), about vitamin D and breastfeeding (56%, n = 108) and vitamin D and pregnancy (49%, n = 94). The recommendations were for simpler, easier to read, with specific and clearer guidelines; delivered regularly during routine appointments, at timely stages throughout pregnancy and after the birth. 23% ( n = 45, out of 194 respondents) of parents did not know why vitamin D is important for health. Only 26% ( n = 49, out of 192 respondents) of parents reported giving their youngest child a vitamin D supplement on most days of the week. The majority of parents (interview/focus group) wanted more information about foods/drinks fortified with vitamin D. Conclusion Parents were generally not aware of the importance of vitamin D, dietary requirements including supplementation and the availability of vitamin D fortified foods. Major improvements are required for the effective promotion of vitamin D information to parents. Electronic supplementary material The online version of this article (10.1186/s12889-019-7340-x) contains supplementary material, which is available to authorized users.

Structured Abstract:Purpose This paper presents findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The paper examines the place of facilitated peer support within a men's mental health programme, and explores implications for resilience building approaches for men. DesignThe paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men's perceived resilience, to consider project processes concerning peer support, and to situate these within wider environments. FindingsThe programme significantly raised the perceived resilience of participants. Project activities promoted trusting informal social connections, gains in social capital arose through trusting relations and skillsharing, and peer-peer action-focused talk enhanced resilience. Practical and social implicationsThe paper discusses gender-sensitive approaches to engage men and build resilience by focusing on doing and talking and peer support, and highlights the need to consolidate gains with a focus on individual and community resilience. Originality/valueThe paper adds fresh evidence of gendered intervention approaches with a specific focus on facilitated peer support, including effects on male resilience.

BackgroundThis study aims to evaluate the feasibility and acceptability of the PhunkyFoods Programme, a primary school-based intervention to promote healthy nutrition and physical activity knowledge and behaviours to assess outcomes to inform a phase 3 trial.MethodsThe cluster randomised feasibility trial recruited eight primary schools from the North of England. Elibility criteria included all primary schools in one town, excluding independent and special schools and schools that comprised of only key stage 2 pupils (years 3–6). Eight schools agreed to participate. Randomisation to intervention or control arms was in a 1:1 ratio. Intervention schools received PhunkyFoods over 17 months. Control schools continued with usual curriculum. Assessors were blinded to group assignment. Measures comprised of a Healthy Lifestyle Knowledge Questionnaire and Synchronised Nutrition and Activity Program to assess diet and physical activity, height, weight, and psychological wellbeing. Feasibility outcomes were recruitment, attrition rates, interviews with teaching staff, focus groups with pupils to explore the acceptability of outcome measures, implementation, intervention content, and programme fidelity.ResultsThree hundred fifty-eight pupils, aged 6–9 years from eight schools were recruited at baseline (control n = 170, intervention n = 188); 337 (94.1%) at 6 months (control n = 163, intervention n = 181); and 331 (92.5%) at 18 months (control n = 152, intervention n = 179), and 6 pupils opted out. Trends in increased knowledge of healthy lifestyle behaviours, healthier eating, and liking of fruit and vegetables were reported in the intervention compared to the control group. Year 4 intervention pupils had significantly higher healthy balanced diet knowledge scores compared to control pupils, mean difference 5.1 (95% CI 0.1 to 10.1, p=0.05). At 18 months, the mean percentage of vegetables liked was higher (intervention 53.9% vs. 43.0% control). Similarly, percentage of fruits liked was also higher (intervention 76.9% vs. 67.2% control). Qualitative data showed that delivery of the intervention was feasible and acceptable to teachers and pupils. Lessons were learned to inform the phase 3 trial around the dietary assessment measure and timing of recruitment.ConclusionsWhilst the study was not powered to detect a definitive effect, results suggest a potential to increase knowledge of healthy lifestyle behaviours and dietary behaviours, suggesting that with minor changes, a phase 3 trial is likely to be deliverable.Trial registrationISRCTN, ISRCTN15641330. Registered 8 May 2015—retrospectively registered, 10.1186/ISRCTN15641330

Structured Abstract: Purpose This paper presents findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of activities within a multidimensional men's mental health programme, and exploring interactions between social context factors and models of change. DesignThe paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men's perceived resilience, to consider project processes concerning activities, social support and coping strategies, and to situate these within wider environments. FindingsThe programme significantly raised the perceived resilience of participants. Activities were engaging for men, while the complex intersection between activities, social networking, and coping strategies course provided opportunities for men to develop resilience in contexts resonant with their male identities. Practical implicationsThe paper discusses emerging considerations for resilience building, focusing on gender-sensitive approaches which can engage and retain men by focusing on doing and talking, in the contexts of men's life-course, highlighting embodied (male) identities not disembodied 'mental states', and facilitating social support. There are challenges to recruit men despite stigma, support men to speak of feelings, and facilitate progression. Social implicationsPotential exists for gender-aware programmes to sustain salutogenic change, co-producing social assets of peer support, male-friendly activities, and context sensitive course provision. Originality/valueThe paper adds fresh evidence of gendered intervention approaches, including effects on male resilience. Application of a context-sensitive change model leads to multi-component findings for transferring and sustaining programme gains.