Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study

Abstract

Health-related behaviours in children can be influenced by parental support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a parental support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and noncoordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified "Creating commitment in an overburdened work situation" as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation support, and (4) implementation process. When implementing a parental support programme to promote physical activity and healthy dietary habits for 5-to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.

IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) – study protocol for a cluster-randomized trial

“…The program is fully integrated into school routines and is moderately effective in improving dietary habits and physical activity in children and in one trial BMI in children with obesity was also reduced [ 34 ]. Process evaluations have consistently shown that the program is well received among teachers, parents, children and school nurses [ 16 , 38 – 40 , 52 ]. For these reasons, the HSS program is well-positioned for implementation research that aims to develop and test strategies that facilitate its uptake and use as part of routine practice in the school setting.…”

“…Exploration of context-specific implementation barriers and facilitators was based on previous process evaluations of the HSS program [ 16 , 38 , 39 , 41 ] and on two preparatory stakeholder workshops in each of the two municipalities participating in IMPROVE (Implementation strategy 1: Assess for readiness and identify barriers and facilitators). The CFIR framework was used as a guiding determinant framework due to its multilevel structure and its applicability to the municipality setting [ 20 ].…”

“…During previous evaluations of the HSS program the following implementation barriers were encountered: low priority given to health promotion in schools relative to achievement of learning outcomes [ 38 ], lack of positive leadership [ 39 ], lack of preparation time [ 40 ], the need for clear communication and collaboration between teachers and parents, especially regarding the children’s home assignments [ 41 ], and difficulty to engage parents in low-income areas due to stressful everyday life and lack of knowledge and parenting skills [ 16 , 39 ]. Furthermore, it was found that commitment among staff is important for high intervention fidelity [ 38 ]. Addressing these barriers could be achieved through the establishment of an implementation team [ 38 ], and by receiving resources and support from external partners such as public health teams [ 42 , 43 ].…”

“…Furthermore, it was found that commitment among staff is important for high intervention fidelity [ 38 ]. Addressing these barriers could be achieved through the establishment of an implementation team [ 38 ], and by receiving resources and support from external partners such as public health teams [ 42 , 43 ]. Ultimately, there are numerous barriers that impact the successful implementation of school-based health programs like the HSS that warrant tailored approaches that target these determinants to achieve high fidelity.…”

Contextual factors in the implementation of the family support program A Healthy School Start in three municipalities in Sweden

“…Effective school-based programs are characterized by active parental involvement, especially for younger children (3,4). Health promotion and prevention programs in schools involving parents can be challenging to implement since some school principals are uncertain about whether it is the role of the school to provide health guidance to parents (5) in addition to teaching children. Teachers describe barriers like the dense curriculum, lack of planning time, lack of support from principals and other personnel, and how projects come and go without feedback or sustainability (6), in addition to lack of parental engagement (5).…”