背景:应用世界卫生组织健康促进学校模式的综合学校计划有可能发起和维持行为改变并影响健康。然而,因为它们通常包括对学校政策的干预努力,物理环境,课程,医疗保健,涉及父母和社区,他们显著地“侵入”一个主要针对教育的复杂系统,不是健康促进。因此,需要对其采用更多的见解和具体战略,实施,和维持进程,以应对在主要教育环境中可持续实施HPS举措的挑战。因此,这项研究评估了采用率,从多利益相关者的角度出发,阿姆斯特丹跳入健康营养HPS干预的实施和维持过程。
方法:我们与所有相关利益相关者进行了半结构化访谈和焦点小组(n=131),即,跳入健康促进专业人员(n=5),学校校长(n=7),在校跳入协调员(n=7),教师(n=20),来自10所小学的父母(n=50,9组)和儿童(n=42,7组)在2016-2017学年入学。包括在内的学校超重和/或肥胖的患病率高于荷兰人的平均水平,并且它们都位于阿姆斯特丹的SEP低社区。使用定向内容分析对数据进行分析,其中创新决定因素模型用于获得基于理论的预定代码,补充了数据中出现的新代码。
结果:在采用干预措施期间,所有利益攸关方都强调了父母支持的重要性,以及伴随的研讨会和宣传材料。此外,家长和老师表示,对儿童健康的共同责任和健康信息的细致入微框架很重要。在实施过程中,所有利益攸关方都需要明确的指导方针和支持结构。老师和孩子们强调了同伴影响的重要性,社会规范,和统一应用准则。学校工作人员还发现,进一步调整干预措施和应对财务限制很重要。对于长期干预维持,根据健康促进专业人员的说法,将干预政策纳入学校章程至关重要。
结论:这项定性评估为影响采用的因素提供了有价值的见解,实施,以及饮食干预的维持过程,例如透明和一致的干预准则的重要性,关于干预指南背后的理由的明确沟通,and,利益相关者参与决策。
BACKGROUND: Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school\'s policies, physical environment, curriculum, health care and involving parents and communities, they significantly \'intrude\' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam\'s Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective.
METHODS: We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam\'s low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data.
RESULTS: During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children\'s health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals.
CONCLUSIONS: This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders\' involvement in decision-making.