Evaluating the Implementation of the SWITCH® School Wellness Intervention Through Mixed Methods.
Background: School wellness programming is important for promoting academic achievement and healthy lifestyles in youth; however, research is needed on methods that can help schools implement and sustain programs on their own. The purpose of this study was to investigate factors within and outside the school environment that impacted school capacity for implementation and potential sustainability of wellness programming.
Methods: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N=30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR).
Results: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA analyses revealed positive, non-significant variances between implementation group and gains in school capacity (F[2,24]=1.63; p=.21), class capacity (F[2,24]=0.20 p=.82), lunchroom capacity (F[2,24]=0.29; p=.78), and physical education (F[2,24]=1.45; p=.25). Qualitative data demonstrated factors within the outer setting (i.e., engaging community partners) that facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) significantly affected implementation. Implementation process construct themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors impacting sustainability, such school culture and knowledge of school wellness policy.
Conclusions: Findings suggest a modest but important impact of implementation on capacity change which is the primary goal of SWITCH. The results document the importance of allowing schools to adapt programming to meet their local needs.
This submitted article is by McLoughling, G.M., Candal, P., Vazou, S., Lee, J.A., Dzewaltowski, D.A., Rosenkranz, R.R., Lanningham-Foster, L., Gentile, D.A., Liechty, L., Chen, S., Welk, G.J., (2020) Evaluating the Implementation of the SWITCH® School Wellness Intervention Through Mixed Methods. Research Square. DOI:10.21203/rs.3.rs-33855/v1.