School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

Abstract

School-based interventions are essential to prevent pediatric obesity and type 2 diabetes. School environmental factors influence implementation of these interventions. This article examines how school factors acted as barriers to and facilitators of the HEALTHY intervention. The HEALTHY study was a cluster-randomized trial of a multicomponent intervention implemented in 21 schools. Interview data were analyzed to identify barriers and facilitators. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehavior, classroom management problems, communication equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Contextual barriers and facilitators must be taken into account in the design and implementation of school-based health interventions. KEYWORDSSchool, Intervention, Prevention, Health behavior, Diabetes, Obesity Type 2 diabetes is a chronic and progressive disease with complications that can include heart disease, stroke, kidney failure, loss of vision, and limb amputation [1]. The alarming prevalence of overweight and obesity among American children and adolescents and the connection with type 2 diabetes represent a serious public health concern for the twenty-first century [2,3]. Researchers estimated that approximately one in three children born in the year 2000 in the United States will develop diabetes in their lifetime [4].Recent findings on activity and dietary patterns of children and adolescents in the United States demonstrate the presence of problematic health behaviors. Findings from the National Survey of Children's Health and the Youth Risk Behavior Survey showed that approximately 78 % of youth did not eat fruits or vegetables five or more times per day [5], 29 % of youth drank a nondiet soda at least once per day [5], 64 % of youth did not engage in 20 min of daily vigorous physical activity for most days of the week [6], and 50 % of youth engaged in sedentary behaviors, such as playing video games or watching television for multiple hours a day [6].In light of the prevalence of unhealthful dietary and activity patterns among youth and their connections with overweight, obesity, and type 2 diabetes, population-level approaches to improve environmental contexts by promoting physical activity and healthful diet are essential. Schools are ideal settings for basing public health interventions aimed at preventing the development of serious health conditions because of the existing resources and infrastructure, and aside from the home, Implications Practice: School-based obesity interventions should take into account student interests and involvement, classroom skills of teachers delivering the interv...

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