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Location: Children's Nutrition Research Center

Title: Process evaluation results from the HEALTHY nutrition intervention to modify the total school food environment

item Volpe, Stella
item Hall, William
item Steckler, Allan
item Schneider, Margaret
item Thompson, Deborah - Debbe
item Mobley, Connie
item Pham, Trang
item El Ghormli, Laure

Submitted to: Health Education Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/10/2013
Publication Date: 11/1/2013
Citation: Volpe, S.L., Hall, W.J., Steckler, A., Schneider, M., Thompson, D.J., Mobley, C., Pham, T., El Ghormli, L. 2013. Process evaluation results from the HEALTHY nutrition intervention to modify the total school food environment. Health Education Research. 28(6):970-978.

Interpretive Summary: Process evaluation is an important part of the evaluation component of a research study because it identifies the degree to which an intervention was carried out as planned. This is important because if a study is effective at changing behavior, and the study was carried out as planned, that means the results (i.e., behavior change) can be attributed to the study. However, if the study was not carried out as planned, that means something else contributed to the behavior change. This is important to others who may want to implement the study in the future. This article describes the process evaluation results of the nutrition component of the HEALTHY study, which is a school-based study designed to reduce risk of type 2 diabetes and obesity in middle school students. Results indicated the degree to which the nutrition component was carried out improved from the beginning to the end of the study. The most difficult change to carry out was serving high fiber foods, while the easiest were offering lower fat foods and healthier beverages. This research provides insight into ways to enhance nutrition in a school-based environment.

Technical Abstract: The process evaluation of HEALTHY, a large multi-center trial to decrease type 2 diabetes mellitus in middle school children, monitored the implementation of the intervention to ascertain the extent that components were delivered and received as intended. The purpose of this article is to report the process evaluation findings concerning the extent to which the HEALTHY nutrition intervention was implemented during the HEALTHY trial. Overall, the observed fidelity of implementing nutrition strategies improved from baseline to the end of the study. By the last semester, all but two nutrition process evaluation goals were met. The most challenging goal to implement was serving high fiber foods, including grain-based foods and legumes. The easiest goals to implement were lowering the fat content of foods offered and offering healthier beverages. The most challenging barriers experienced by research dietitians and food service staff were costs, availability of foods and student acceptance. Forming strong relationships between the research dietitians and food service staff was identified as a key strategy to meet HEALTHY nutrition goals.