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To study the implementation of a school-based healthy eating (HE) model one year after scale-up in British Columbia (BC). Specifically, to examine implementation of Action Schools! BC (AS! BC) and its influence on implementation of classroom HE activities, and to explore factors associated with implementation.
Diffusion of Innovations, Social Cognitive and Organizational Change theories guided our approach. We used a mixed-methods research design including focus group interviews (seven schools, sixty-two implementers) and a cross-sectional multistage survey to principals (n 36, 92 % response rate) and teachers of grades 4 to 7 (n 168, 70 % response rate). Self-reported implementation of classroom HE activities and reported use of specific AS! BC HE activities were primary implementation measures. Thematic analysis of focus group data and multilevel mixed-effect logistic regression analyses of survey data were conducted.
Elementary schools across BC, Canada.
Thirty-nine school districts, thirty-six principals, 168 grade 4 to 7 teachers.
Forty-two per cent of teachers in registered schools were implementing AS! BC HE in their classrooms. Users were 6·25 times more likely to have delivered a HE lesson in the past week. Implementation facilitators were school champions, technical support and access to resources; barriers were lack of time, loss of leadership or momentum. Implementation predictors were teacher training, self-efficacy, experience with the physical activity component of AS! BC, supportive school climate and parental post-secondary education.
Our findings reinforce that continued teacher training and support are important public health investments that contribute to successful implementation of school-based HE models after scale-up.
To assess agreement among three nutrient profiling systems used to evaluate the healthfulness of vending machine products in recreation and sport settings in three Canadian provinces. We also assessed whether the nutritional profile of vending machine items in recreation and sport facilities that were adhering to nutrition guidelines (implementers) was superior to that of facilities that were not (non-implementers).
Trained research assistants audited the contents of vending machines. Three provincial nutrient profiling systems were used to classify items into each province’s most, moderately and least healthy categories. Agreement among systems was assessed using weighted κ statistics. ANOVA assessed whether the average nutritional profile of vending machine items differed according to province and guideline implementation status.
Eighteen recreation and sport facilities in three Canadian provinces. One-half of facilities were implementing nutrition guidelines.
Snacks (n 531) and beverages (n 618) within thirty-six vending machines were audited.
Overall, the systems agreed that the majority of items belonged within their respective least healthy categories (66–69 %) and that few belonged within their most healthy categories (14–22 %). Agreement among profiling systems was moderate to good, with κw values ranging from 0·49 to 0·69. Implementers offered fewer of the least healthy items (P<0·05) and these items had a better nutritional profile compared with items in non-implementing facilities.
The policy outcomes of the three systems are likely to be similar, suggesting there may be scope to harmonize nutrient profiling systems at a national level to avoid unnecessary duplication and support food reformulation by industry.
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