Process Evaluation of a Policy, Systems, and Environmental Change Intervention in an Urban School District

Abstract

Objective: To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention. Design: Quasi-experimental, mixed methods. Setting: Low-income urban school district. Participants: Fifth-grade students in 4 schools assigned to 2 intervention and 2 comparison schools (intervention, n = 142; comparison, n = 170). Intervention: Both groups received a nutrition curriculum delivered by classroom teachers. Intervention schools also received 10 PSE lessons taught by paraprofessional educators. Main Outcome Measures: Quantitative data were obtained from fidelity and observation checklists, grading rubrics and self-reported student surveys. Focus group and interviews provided qualitative data. Quantitative measures included assessments of PSE and fruit and vegetable knowledge, as well as assessment of times fruits and vegetables (FV) were consumed yesterday. Analyses: Qualitative data were analyzed using inductive content analysis. Quantitative data were analyzed using repeated measures analysis of variance and analysis of co-variance. Results: Fidelity, dose, reach, and acceptance of PSE intervention were high; students felt more empowered, although PSE lessons were considered lengthy and complicated. Intervention PSE and FV knowledge scores were significantly higher than comparison scores (F 37.56 , P < .001; and F 3.94 , P < .05, respectively). However, issues in communication were identified between school staff and researchers. Conclusions and Implications: Policy, systems, and environmental classroom interventions commented on the differences between quantitative and qualitative assessments, and this suggests the need for more sensitive quantitative assessments. Future research should look at long-term outcomes as this study only looked at short-term outcomes.

Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review

“…The screening process identified 48 papers meeting the criteria for inclusion in the review, representing 39 unique interventions. An additional five papers were identified during the full text review that pertained to included interventions, for a total of 53 papers used in the data extraction process [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , …”

“…Nutrition education interventions delivered in a classroom setting where adults were the population trained to deliver the intervention was the largest group in our categorization system ( n = 19 unique interventions). Teachers were the primary population trained, though in some instances, graduate students, volunteers, or assistants were also trained as co-teachers [ 22 , 49 , 50 , 51 , 54 , 56 , 57 , 69 ]. In five of the interventions, the authors describe an initial training with follow-up trainings or regular meetings with teachers during the intervention to provide support or resolve any issues that arose [ 22 , 28 , 29 , 30 , 31 , 32 , 45 , 46 , 47 , 51 ].…”

“…In three instances, homework was included in the intervention design that was meant to facilitate students engaging with their family about the nutrition information [ 34 , 37 , 49 , 50 ]. Four interventions also involved a connection to school meals, often engaging students in advocating for healthy meal options they would enjoy [ 45 , 54 , 56 , 57 , 69 ].…”

“…Our second dimension focused on the intervention content. We found fruit and vegetable consumption [ 24 , 25 , 26 , 34 , 37 , 48 , 49 , 50 , 52 , 53 , 54 , 60 , 68 , 69 ], healthy beverages [ 23 , 33 , 34 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 59 , 61 , 66 ], and healthy breakfast [ 23 , 33 , 38 , 40 , 45 , 48 , 49 , 50 , 52 , 53 , 54 , 61 , 68 ] to be common topics. Beyond basic nutrition information, the interventions in this review commonly included goal setting [ 38 , 49 , 50 , 51 , 60 ], building skills to identify healthy options (including reading food labels) [ 52 , 53 , 54 , 59 , 60 ], and developing strategies to make healthy choices through an awaren...…”

“…For process evaluation, six of the interventions included observations of a portion of the classroom lessons by research staff to assess fidelity and student engagement [21,[28][29][30][31][32]45,61,69,72,73]. Four of the interventions held student focus groups post-intervention to gain qualitative feedback [22,27,54,69], and two used a student satisfaction survey [28][29][30][31][32][33]. Table 2 [21,35,38], and the remaining one trained undergraduate university students [59].…”