Blaine Rachel E, Franckle Rebecca L, Ganter Claudia, Falbe Jennifer, Giles Catherine, Criss Shaniece, Kwass Jo-Ann, Land Thomas, Gortmaker Steven L, Chuang Emmeline, Davison Kirsten K
Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd. FCS FA-15, Long Beach, California 90840. Email:
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Prev Chronic Dis. 2017 Jan 12;14:E03. doi: 10.5888/pcd14.160381.
Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts' capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing "Eat Well and Keep Moving" and "Planet Health" behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts.
The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability.
MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district's staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers.
Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.
尽管在学校环境中存在基于证据的预防儿童肥胖的干预措施，但很少有研究确定能增强学区开展此类工作能力的因素。我们描述了一项基于学校的干预措施的实施情况，该措施使用基于现有“吃得健康，坚持运动”和“地球健康”行为改变干预措施的课堂教学以及全校范围的活动，针对两个低收入学区的5144名四至七年级儿童。
该干预措施是马萨诸塞州儿童肥胖研究示范（MA - CORD）项目的一部分，这是一项从2012年至2014年实施的多部门社区干预措施。我们采用混合方法，对关键实施成果进行了操作化定义，包括可接受性、采用情况、适宜性、可行性、实施保真度、感知实施成本、覆盖范围和可持续性。
MA - CORD在两个面临资源限制和相互竞争的优先事项的学区被采用。尽管在基线时两个社区都有强有力的领导支持，但一个学区的工作人员报告说全校的准备情况和承诺度较低。因此，较少有教师报告参与培训、授课或计划在MA - CORD之后继续开展课程。访谈表明，校长和学监的更替、全州范围的测试以及教师倦怠限制了实施；学校中热情的健康倡导者似乎抵消了实施障碍。
未来的干预措施应在领导和工作人员层面评估采用准备情况，在上课时间提供课程培训，利用学校护士或健康教师作为健康倡导者来支持教师，并提供诸如工作人员津贴或游乐设备等激励措施，以鼓励学校参与和持续开展干预活动。
