Table 4.

Contextual influences on implementation of the 10 selected Generation Healthy Kids school-based intervention components

Individual level		Barriers and facilitators related to the intervention recipients
Child characteristics	Age	As the children were about to change their teeth, it was difficult for them to bite into the large buns and fruit served as midmorning snack and to chew some of the food served for lunch ‘The Digital Barometer’ was difficult to understand and complete for children in 1st grade, and some questions were not relevant for 1st graders. Also, the recommended time allocated for the assignment was too sparse for children this age
	Body weight	Some FIT FIRST 10 exercises were not suitable/optimal for children with a high body weight
	Taste preferences	Most children did not like the buns served as midmorning snack A few children were very picky Too little variety and too much unfamiliar food served for lunch There was not enough of the food that the children liked (best) to make them full, so some children (over time more and more) brought packed lunches from home as a supplement
	Behavioral issues	Some children disrupted the FIT FIRST 10 sessions by e.g., disturbing the other children and doing other things than they were told (also see ‘Social dynamics’)
Class level		Barriers and facilitators related to the school class
Social dynamics		It was easier for school staff to follow the health pedagogical principles during the lunch meal in school classes with a low level of noise and conflicts compared to classes with higher levels of noise and conflicts (also see ‘Behavioral issues’)
Class size		(see ‘Number of school staff members in the class’)
School level		Barriers and facilitators related to the intervention provider context
School resources	Physical facilities	The old plumbing system at school caused yellow/brown water in the cold-water dispenser As the only water outlet was next to the toilets, the cold-water dispenser was placed at a non-appealing location
	Time	Overall, scarcity of school staff’s time was the main challenge for implementation of the intervention components
	Number of school staff members in the class	Being only one school staff member present made it difficult to conduct the FIT FIRST 10 sessions with an entire school class at a time Being only one school staff member present during the lunch meal challenged the adherence to the health pedagogical principles
School staff characteristics	Commitment	Committed school staff adhered to a large extent to the health pedagogical principles during lunch and the FIT FIRST manual; they encouraged the children to drink water; and they facilitated that the intervention also reached parents with another ethnic background than Danish (through school staffs’ voluntary participation in after school events, taking on the role as interpreter, and actively encouraging this group of parents to participate) On the contrary, lack of commitment from school staff clearly caused e.g., low level of adherence to health pedagogical principles during lunch
	Capability	The intervention period was too short for the school staff to get familiar with all the health pedagogical principles; too little time to make them a routine Some FIT FIRST 10 exercises were too technical for the school staff to understand and to conduct with the children Some school staff members adapted intervention components to facilitate delivery and acceptability
Interaction between school staff and research group		Insufficient communication between school staff and research team limited maintenance of the cold-water dispenser and use of the loose play and sports equipment for school recess