Department of Nutrition, University of Oslo, Oslo, Norway.
Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany.
Int J Behav Nutr Phys Act. 2022 Jan 31;19(1):11. doi: 10.1186/s12966-022-01246-8.
Although children's intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR).
A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR.
The following CFIR constructs were found relevant: 1) intervention characteristics domain: 'design quality and packaging', 'adaptability' 'cost'; 2) outer setting: 'cosmopolitanism', 'external policy and incentives' 'patients' needs and resources'; 3) inner setting: 'implementation climate', 'readiness for implementation' and 'structural characteristics'; 4) characteristics of individuals: 'individual stage of change', 'knowledge and beliefs about the intervention' 5) process: 'engaging', 'executing' and 'reflecting and evaluating'. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts.
CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group.
CRD42020167697.
尽管儿童摄入水果和蔬菜的量最近有所上升，但仍有近一半的青少年每天甚至不吃一片水果或蔬菜。解决这个问题的一种方法是通过干预措施，直接向幼儿园和学校的儿童提供水果和蔬菜。为了使这些干预措施达到预期目标，除了影响外，实施情况也是需要考虑的重要因素。我们的目标是系统地回顾定性结果报告，这些报告涉及在幼儿园和学校环境中直接提供水果和蔬菜的干预措施的实施的决定因素（障碍和促进因素），并使用实施研究综合框架（CFIR）对这些结果进行框架分析。
设计并于 2019 年 11 月在以下数据库中进行了系统检索：MEDLINE（Ovid）、Embase（Ovid）、PsychINFO（Ovid）、ERIC（Ovid）、Cochrane 图书馆评论和 Cochrane 图书馆试验。还完成了对期刊《实施科学》的关键词搜索。对标题和摘要（n=5427）和全文（n=227）进行筛选，最终纳入 14 篇文章。使用框架方法和 CFIR 进行编码和分析。
发现以下 CFIR 结构与实施相关：1）干预特征领域：“设计质量和包装”、“适应性”、“成本”；2）外部环境：“世界主义”、“外部政策和激励措施”、“患者需求和资源”；3）内部环境：“实施氛围”、“实施准备”和“结构特征”；4）个体特征：“个体变化阶段”、“对干预措施的知识和信念”；5）过程：“参与”、“执行”和“反思和评估”。该研究强调了父母作为实施的支持者和干预目标的双重作用，这可能对未来水果和蔬菜干预措施的设计和实施产生影响。几项研究报告称，儿童对干预措施的价值的积极看法以及由于干预措施而感知到的行为改变是实施的相关促进因素，在未来的设计工作中应予以考虑。
CFIR 为确定和组织幼儿园和学校环境中干预措施的实施障碍和促进因素提供了一种系统的方法。鼓励进行修订，为各种实施行为者和目标群体留出足够的空间来表达看法。
PROSPERO 注册号：CRD42020167697。
