A Systems Approach Helps Explain Significant Improvements in Local Wellness Policies Among SNAP-Ed-Supported School Districts.

OBJECTIVE

To assess changes in written local wellness policies (LWPs) across time within Supplemental Nutrition Assistance Program Education (SNAP-Ed)-participating districts.

DESIGN

Sequential, explanatory mixed methods.

SETTING

From October 1, 2015 to September 30, 2016, SNAP-Ed agencies submitted LWPs from partner school districts in Arizona. They received back scores and customized recommendations. To assess changes, LWPs were rescored between October 1, 2017 and September 30, 2018.

PARTICIPANTS

Sixteen local SNAP-Ed agencies worked with 57 districts.

INTERVENTIONS

Districts' LWP revisions supported by SNAP-Ed agencies during the 2-year pre-post period.

MAIN OUTCOME MEASURES

Policy comprehensiveness and strength from 0 (worst) to 100 (best), measured by the Wellness School Assessment Tool.

ANALYSIS

Paired t test to compare pre-post scores. Content analysis of State Educational Agency administrative reviews and thematic analysis of SNAP-Ed narrative reports to explore causation.

RESULTS

Total scores increased (comprehensiveness: +12.4, P < .001, 95% confidence interval, 8.1-16.7; strength: +13.5, P < .001, 95% CI, 9.3-17.7). Improvements were also found for comprehensiveness by section, except Nutrition Education, and for strength across all sections. Qualitative findings suggest that SNAP-Ed interventions combined with state and federal influence contributed to the improvements.

CONCLUSIONS AND IMPLICATIONS

Local wellness policies in SNAP-Ed-supported districts improved over time. State and federal LWP guidelines can work synergistically with SNAP-Ed interventions to influence improvements.