To explore the barriers associated with the adoption of the Alberta Nutrition Guidelines for Children and Youth in schools according to characteristics of the innovation (guidelines) and the organization (schools).
Cross-sectional telephone survey.
Schools in Alberta, Canada. Principals from 357 schools.
Barriers to adopting the nutrition guidelines.
A 19-question telephone survey, including open- and closed-ended questions, was used to obtain information regarding schools' characteristics and barriers to adopting the guidelines. Qualitative data were coded according to common themes a priori, based on constructs from the Diffusion of Innovations framework.
Schools reported many barriers related to the relative advantage, compatibility, and complexity of adopting the guidelines. Parents' resistance to change and cost were the key reported barriers. Lack of knowledge, student preferences, the physical location of the school, and barriers related to the provision of healthful food were also reported.
Disseminating guidelines without providing adequate support for their implementation may not promote change within the school setting. School nutrition initiatives need to involve the parents and have access to sufficient financial and human resource support.
"Managers’ commitment to the nutrition guidelines did not extend to using scarce resources to facilitate implementation. Despite the importance of supporting guideline implementation with additional financial and human resources [15,32,58,61,70], we were unable to secure these. The lack of nutritional knowledge and reliance on personal knowledge documented in previous studies [58,71] were also identified in the present study; furthermore, the limited training provided, while valued, was insufficient to enable cooks to modify menus and recipes without the continued support of the study dietitian. "
[Show abstract][Hide abstract] ABSTRACT: Background
Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation.
We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT.
Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring).
The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualizing barriers to implementation; robust links with behavior-change theories would further increase the practical utility of NPT.
[Show abstract][Hide abstract] ABSTRACT: In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination.
[Show abstract][Hide abstract] ABSTRACT: Childhood obesity is a global health issue. To identify research trends and gaps of childhood obesity research, we reviewed MEDLINE publications from January 2011 to May 2012 and qualitatively analyzed the major domains and themes of research focus. Major domains are: measurements, obesity correlates, prevention interventions, treatment interventions, and policy issues. Key advances and innovations are highlighted within each domain. Emerging areas include the advancement of measurement methodologies that simultaneously capture individual and contextual information across time, analysis of policy problems, and the development of multilevel, community interventions. However, few effective and sustainable interventions are exemplified; some strategies are promising. Recommendations for future research includes the adoption of a systems approach that integrates individual, environmental, and policy change, the scale up and diffusion of innovations, studies of intended and unintended policy impacts, and the design and testing of effective social marketing strategies.
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