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Background: Childhood obesity is a public health problem in the United States. Schools have been identified as organizations that can combat childhood obesity in communities nationally. As such, federal acts such as the Federal Child Nutrition and WIC Reauthorization Act of 2004, and the Healthy, Hunger-Free Kids Act of 2010, have mandated that schools participating in federal meals programs develop a School Wellness Policy that outlines guidelines for nutrition consistent with those of the USDA, and also for physical activity. The Healthy Schools Program (HSP), created by the Alliance for a Healthier Generation (an organization founded by the Clinton Foundation and the American Heart Association), is both a policy planning tool and a program to help schools comply with these federal mandates. To date, HSP implementation has been evaluated in traditional public schools. Charter schools, a unique and growing type of public school, have organizational, financial, and academic performance differences that may affect HSP implementation differently than in traditional schools. Objective: To determine the extent to which HSP is being implemented in select New Jersey charter schools, and factors impacting implementation. Methods: Using a multiple-case study design, research was conducted at four K-8 independent, New Jersey charter schools. Three types of data collection were used: 1) interviews; 2) document review; and 3) school environment observations. Level of HSP implementation was measured by the six steps of HSP implementation. The characteristics of an innovation (relative advantage, compatibility, complexity, trialability, and observability) of the Diffusion of Innovation theory were used as the analytical framework to explain how and why implementation had occurred in the manner it had. Results: All schools were partially implementing HSP, but no school was fully implementing the program. Schools were more successful at meeting the HSP/USDA nutrition guidelines, but were not meeting the HSP/New Jersey state guidelines for physical activity. This was due to not having time to schedule physical activity or lacking the infrastructure (gym or playground) or the staff to manage physical activity. Using the Diffusion of Innovation analytical framework, all study schools stated that HSP was compatible with their school mission and charter. However, sources of incompatibility were due to: 1) lack of leadership support for HSP due to prioritizing academics over HSP implementation; 2) lack of cultural relevance in HSP content; and 3) lack of parental support due to culture, economics, and education. In terms of complexity, participants at all study schools stated that HSP’s templatized format was easy to follow but that schools needed more support—both a person with health expertise to guide program implementation and evaluation, and more people generally, as HSP is designed for implementation at larger traditional public schools that have district-level, central office support. Participants at all study schools stated that HSP was better than other obesity prevention programs (relative advantage). Schools were also implementing HSP in pieces (trialability). Participants stated they had observed the nutritional value of school meals had improved since implementing HSP and students had more energy. There were also broader social and environmental factors in the community (e.g., poverty, violence, infrastructure) that affected HSP implementation. Conclusions: The two factors most affecting HSP implementation were school leadership support and parental support. HSP was being most implemented in schools that already a culture of health promotion, with a school leadership that already prioritized health. In schools that did not have a culture of health, senior leadership prioritized academics over health promotion. Program developers should consider developing an integrated curriculum to bridge the gap between health and academics. HSP did not fit the needs of these independent charter schools. HSP needs to be tailored to better fit the cultural needs and organizational structures of independent charter schools. Schools also needed more support. HSP developers should consider providing in-person technical support to independent charter schools, similar to the support offered to traditional public schools. Future research should be conducted to better understand the social and environmental factors affecting implementation, with particular focus on understanding parent health behaviors, education, and needs. Future research should also be conducted at more schools in New Jersey and in other states to determine if this study’s findings hold in other populations. Findings could guide further program development more compatible with this unique population of public schools.

ETD_9574

Dr.P.H.

Includes bibliographical references

doi:10.7282/t3-13tp-qv63

ETD doctoral

The author owns the copyright to this work.