Table 3.
Characteristics of included studies (n 24) that explored enablers and barriers to implementation and compliance of school-based healthy food and beverage policies
| Author(s) (year), country | Policy (type, year) | Aim(s) | Setting | Design and methods | Participants |
|---|---|---|---|---|---|
| Abery & Drummond (2014), Australia | Right Bite Healthy Food and Drinks Strategy for South Australian Schools and Preschools (governmental (state) level, 2008) | To elicit the perspectives of the broad range of stakeholders likely to be impacted | Primary schools | Qualitative (semi-structured interviews, focus groups, observation) | Interviews: school principals (n 2), canteen managers (n 2), parents (n 12); focus groups: students (n 36) |
| Agron et al. (2010), USA | Wellness Policy (federal, district level, 2006–7) | To understand the wellness environment in school districts across the country and to identify challenges districts face and needs they have in order to effectively implement, monitor and evaluate school wellness policies | All schools participating in federal nutrition programmes | Mixed methods* (survey, focus groups, key informant interviews) | Survey: school board members (n 2350), Action for Healthy Kids team members (n 527), members of the Association of State and Territorial Public Health Nutrition Directors (n 24); focus groups: school board members (n 37), policy/government directors (n 10), conference attendees (n 50); key informant interviews: stakeholders from school districts |
| Ardzejewska, Tadros & Baxter (2012), Australia | Fresh Taste @ School: NSW Healthy School Canteen Strategy (governmental (state) level, 2006) | To investigate the barriers and facilitators to, and the extent of the implementation of, the NSW ‘Healthy School Canteen Strategy’ | Government primary and secondary schools | Mixed methods* (audit, semi-structured interviews) | Audit: primary (n 2) and secondary (n 2) schools; interviews: school principals (n 4), canteen managers (n 3) |
| Barratt et al. (2004), USA | CDC’s Guidelines for School Health Programs to Promote Lifelong Healthy Eating (local level, 1996) | To determine the extent to which North Carolina school districts had coordinated nutrition policies consistent with the CDC’s Guidelines for School Health Programs; to discover ways in which existing nutrition policies could be improved; to explore barriers to designing and implementing policies | Public school districts | Quantitative (survey) | Food service directors (n 106) |
| Chan et al. (2018), Malaysia | School-based obesity prevention policies (governmental level) | To assess the awareness, facilitators and barriers to policy implementation related to obesity prevention for primary school children | Primary schools | Quantitative (online survey) | School administrators (n 447): assistant headmasters (56·6 %), headmasters (36·9 %), PE teachers (6·5 %) |
| Cornish, Askelson & Golembiewski (2016), USA | Healthy, Hunger-Free Kids Act (governmental, national level, 2010) | To understand how rural food service directors perceive the new federal lunch requirements, the barriers they experience to implementing the requirements, and the support they use to implement the requirements | Rural school districts participating in National School Lunch Program | Mixed methods* (interviews, online and telephone survey) | Interviews: food service directors (n 67); online and telephone survey: food service directors (n 57) |
| Downs et al. (2012), Canada | ANGCY (governmental level, 2008) | To explore the barriers associated with the adoption of ANGCY in schools according to characteristics of the innovation (guidelines) and the organisation (schools) | Schools | Mixed methods* (survey with open- and closed-ended questions) | Mainly school principals, teachers, office administrators, health promotion coordinators, food service providers, curriculum coordinators (n 357) |
| Fernandes et al. (2019), USA | Food as a Reward Policy and In-School Celebrations Policy (local, district level) | To assess how educators felt about implementing food as a reward and in-school celebrations policies | Public elementary and middle schools | Qualitative (semi-structured interviews) | Facilitators (n 14), administrators (n 12) and teachers (n 41) |
| Fournier et al. (2018), Arctic Canada | Junk Food Policy (local level, 2002) | To articulate the actions taken that facilitate the successful implementation and maintenance of the school food policy for policy learning | Public kindergarten to grade 12 schools | Qualitative (in-depth interviews) | School staff (n 14) |
| Holthe, Larsen & Samdal (2011), Norway | Norwegian National Guidelines for Healthy School Meals (governmental, national level) | To investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students | Primary and secondary schools | Qualitative (semi-structured interviews, focus groups) | Interviews: school principals (n 3), project leaders (n 3); focus groups: teachers (n 11), students (n 15) |
| Longley & Sneed (2009), USA | Wellness Policy (federal, district level, 2006–7) | To examine the process of wellness policy development in school districts in the United States following the 2004 mandate | Public school districts | Mixed methods* (telephone interviews, survey) | Telephone interviews: food service directors (n 21); survey: food service directors (n 363) |
| MacLellan et al. (2010), Canada | SNP (governmental, district level, 2006–7) | To explore parent and student perceptions of barriers and facilitating factors influencing the implementation of SNP | Elementary and consolidated schools | Qualitative (focus groups, interviews) | Focus groups: students (n 41); interviews: parents (n 12) |
| Masse, Naiman & Naylor (2013), Canada | Food and Beverage Sales in Schools Guidelines (adhere to 2007 Canada’s Food Guide) (governmental, state level, 2007–8) | To explores the factors that impeded or facilitated the implementation of publicly mandated school-based PE and nutrition guidelines in the province of British Columbia | Elementary and high schools | Qualitative (semi-structured interviews) | School principals (n 17), teachers/school informants (e.g. cafeteria staff, home economics teachers) (n 33) |
| Brown et al. (2004), USA | School Nutrition Policy (not specified) | To determine: (a) California school board members’ attitudes, perceptions and motivations related to enacting policies that support healthful eating in high schools; (b) mitigating barriers to adopting school policies that support healthful eating | High schools | Quantitative (survey) | School board members (n 174) |
| McCormack Brown, Henry & Pitt (2001), USA | School Nutrition Policy (not specified) | To determine: (a) policymakers’ attitudes, perceptions and motivations related to the enactment of policies that support healthy eating in high schools; (b) mitigating barriers to the adoption of school policies that support healthy eating | High schools | Mixed methods* (survey, key informant interviews) | Survey: school board members (n 38); key informant interviews: policymakers (n 57) |
| McKenna (2003), Canada | Food and Nutrition Policy for New Brunswick Schools (governmental level, 1990–1) | To examine the issues surrounding implementation, issues that may help explain why nutrition policies are not widespread in Canada | Schools | Qualitative (semi-structured interviews) | Participants involved in policy process (e.g. school principals, teachers, nutritionists, food service representatives, parents) (n 47) |
| Moore et al. (2010), UK | Appetite for Life (A4L) (governmental, national level, 2007–8) | (a) To explore the pragmatic influences on formal or informal LEA and primary school policies that affect the food available during school mealtimes; (b) to explore the professional practices of school catering staff that influence the food made available and served at lunch time | Primary schools | Qualitative (semi-structured interviews) | Headteachers (n 11), cooks-in-charge (n 10) |
| Patel et al. (2014), USA | Healthy, Hunger-Free Kids Act (governmental, national level, 2010) (Water in schools regulation) | To describe free drinking water access in schools by source and school location, as well as to examine school-level characteristics associated with schools that have excellent drinking water access; to explore barriers to improving water availability that would inform the recommendations for ways to increase drinking water access in school settings | Public schools | Quantitative (survey) | School principals, managers, food service directors (n 240) |
| Pettigrew et al. (2013), Australia | Healthy Food and Drink Policy (governmental, state level, 2007) | To identify school principals’ perceptions of factors that influence schools’ compliance with the new school nutrition policy and factors related to parents’ beliefs about whether their children’s diets are healthier as a result of the policy | Government primary and secondary schools | Mixed methods* (focus groups, interviews, survey) | Focus groups: parents (n 32); interviews: school stakeholders (principals, canteen managers, teachers) (n 48); survey: parents (n 1152), school principals (n 263) |
| Pettigrew, Pescud & Donovan (2012), Australia | Healthy Food and Drink Policy (governmental, state level, 2007) | (a) To evaluate the policy to assess whether the concerns expressed in the immediate post-implementation period were well founded and to identify any implications for future policy development; (b) to investigate school principals’ comparisons of canteen outcomes between 2006 and 2008 | Government primary and secondary schools | Mixed methods* (interviews, survey) | Interviews: school principals (n 10); survey: school principals (n 310) |
| Quintanilha et al. (2013), Canada | ANGCY (governmental level, 2008) | To investigate how the motivation shown by school administration and stakeholders for ANGCY influenced the early adoption and implementation of the guidelines | Elementary and secondary schools | Qualitative (semi-structured interviews, direct observations) | Interviews: school principals, teachers, members of parent council, community worker, food service managers (n 18); direct observations: three schools |
| Rana & Alvaro (2010), Australia | Eat Well South Australia Schools and Preschools Healthy Eating Guidelines (governmental, state level, 2004) | To describe the implementation of the CREATE program in sixty-eight schools in South Australia | Government and non-government primary, secondary and combined schools | Mixed methods* (audit, interviews, focus groups) | Menu audits: schools (n 10); interviews: principals, canteen staff, teachers, nutritionists and others (n 254) |
| Reeve et al. (2018), Philippines | The Department of Education’s Policy (‘Orders’) (governmental level) | To identify (a) barriers and enablers to effective school food policy development and implementation in the Philippines; (b) opportunities to develop more comprehensive policy frameworks in the area | Schools | Qualitative (semi-structured interviews) | National-level policymakers from health, education and agriculture (n 9), municipality-level health and education officers (n 3), school principals (n 4), food providers (n 3), a senior nutrition researcher and representative of the food regulatory authority |
| Roberts et al. (2009), USA | Texas Public School Nutrition Policy (governmental, state level, 2004) | To gain information about experiences with the Texas Public School Nutrition Policy from the perspective of principals and food service directors | Public schools | Qualitative (semi-structured interviews) | School principals (n 24), food service directors (n 10) |
| Sánchez et al. (2014), USA | Wellness Policy (federal, district level, 2004) | To examine school nutrition and physical activity policy implementation in two school districts in a northern New Mexico town | Public schools | Qualitative (interviews, focus groups) | Interviews: school-level administrators (n 9); focus groups: middle school students (n 16) |
| Stang et al. (1997), USA | The US Dietary Guidelines (governmental, national level, 1996–7) | (a) To determine what changes food service personnel had already instituted in school menus to meet US Dietary Guidelines; (b) to identify self-perceived barriers that prevented food service staff from making changes to menus; (c) to identify self-perceived training needs of food service staff; (d) to determine the amount and type of nutrition education food service personnel provide in schools; (e) to identify self-perceived barriers that prevented food school service staff from providing nutrition education | All schools | Quantitative (survey) | Food service personnel (n 628) |
| Taylor et al. (2011), Canada | SNP (governmental level) | (a) To assess elementary school principals’ perceptions of the extent to which their schools are implementing the key components of a school nutrition policy; (b) to assess how closely elementary schools are following policy regulations concerning the types and frequency of foods offered at school; (c) to explore the key enablers and barriers to policy implementation from the principals’ perspective | Elementary schools | Mixed methods* (survey, in-depth interviews) | Survey: school principals (n 41); interviews: school principals (n 9) |
| Vine & Elliott (2013), Canada | School Food and Beverage Policy (PPM 150) (governmental level, 2011) | To explore how local-level factors shape policy implementation in Ontario, Canada | Secondary schools | Qualitative (in-depth, semi-structured interviews) | Key informant interviews (members of local public health units, school level participants) (n 22) |
CDC, Centers for Disease Control and Prevention; PE, physical education; ANGCY, Alberta Nutrition Guidelines for Children and Youth; SNP, School Nutrition Policy.
*
Qualitative data were extracted from mixed-methods studies that explored enablers and/or barriers to implementation and adherence to healthy food and beverage policies.