Background
Methods
Study design and case selection
Intervention selection
Intervention description
Food Dudes healthy eating programme
Green Schools Travel
Case study sites and sampling
Data collection
FD | GST | Total | |
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Total number of interviews | 7a | 8b | 15 |
Total number of participants | 9 | 9 | 18 |
Major stakeholders (Funders, intermediaries) | 4 (3 female, 1 male) | 6 (5 female, 1 male) | 10 |
School Teachers | 4 (all female) | 3 (all female) | 7 |
Academic researcher | 1 (male) | N/A | 1 |
Data analysis
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Factors facilitating adoption, implementation and maintenance
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Factors hindering adoption, implementation and maintenance
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Supportive actions for adoption, implementation and maintenance
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Recommendations to overcome barriers to adoption, implementation and maintenance
Results
Description of interview participants
Factors facilitating adoption, implementation and maintenance (Table 2)
Adoption
(RE)AIM Parameters (Bold) | |
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Adoption
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Collaboration and Communication | …“these Travel Officers and other officers in (NGO) already have an open door into these schools. They have built up a relationship” (Civil Servant, Government Department B). |
…“Officers around the country would come up with different things and then at our meetings we show them to each other… Then we have a shared database that we all link into” [GSTO]. | |
Implementation
| |
Characteristics of settings | …“the class teachers were very, like they were really good like we just said this is all happening, this is invading your classroom…and they were like yeah grand and they all just hopped to it” [FD School Coordinator/Teacher] |
…“we have a lady that kind of goes around with our school would get fruit...and some sandwiches as well delivered (and)…kind of sorted that out into baskets, so she also did the em fruit and veg for us”. [FD School Coordinator/Teacher] | |
Implementers characteristics | …“it’s really about how interested the coordinator is within the school… they’re the people, the drivers within the school that really push the theme through” [Intermediary Agency A, Management Official].
“I also think the travel theme is one where the chidren are really, really central. It’s driven by the chidren as well, like we have to make sure tht the ideas that we’ll say we’ll do happen” [GS Coordinator].
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Implementation delivery, protocols, fidelity (including dose) | “…There would be phone calls on day 4 and day 5 where the programme changes…so the first school days of the programme the children have to take a bite in order to be rewarded. But from day 5 through to day 16, you have to eat a portion... So there would be phone calls just to check that the coordinators would remind all teachers…There would be visit again on day 16… depending on the degree of support that the teachers needed and if they had extra queries… and then we’d have a visit approximately 4 to 6 weeks later,… for phase 2, to see how they are getting on.” [FD PMC Official] |
…“Like schools would have walk to school days, WoW (Walk on Wednesdays) days or CoW (Cycle on Wednesdays) days and where it’s … recorded” [GSTO]. | |
Adaptation and customisation | “We have a few children that maybe just wouldn’t kind of like fruit and veg at all. And they actually did try it, because they really wanted the prize”. [FD School coordinator/ Primary School Teacher] |
…“with special schools it’s been very much about working with the teachers in those schools to apply the principles behind the programme, em but to match them to the needs of the children and their specific need. So even within a class in a special school there might be different children who are being rewarded for doing different things…for some if they have a terrible aversion to em to bananas or yellow foods,… it’s about edging them closer and closer to eating”. [FD PMC Official]
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“It’s about kind of… meshing it into this fabric of the school day…by doing it during our little break and big break and kind of doing the video then” [FD School Coordinator)
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“I know the paperwork has kind of come down the last couple of themes, it is more tick the box or list out which is great for the kids… because it did feel like writing essays at one stage” [Green Schools Coordinator] | |
Incentives and rewards | …“it’s about the class and about their attitude in terms of the Golden Boot (award) you know you’re putting them one step away from getting the Golden Boot. Yeah but also like they (pupils) want to (achieve it).” [GSTO]. |
Process evaluation | ...“it’s hands up surveys in schools which is fine and you don’t expect young kids to lie” [Civil Servant, Government Department B] |
Simplicity of the intervention | “We designed a system whereby the rewards would be packaged and labelled per phase and per day …it could be packed per classroom as well. So the teacher would open the box for his or her own classroom inside that would be all the phase 1 rewards, clearly packaged and labelled day 1 reward, day 2 reward, day 3 and so forth… and then the same for phase 2…” [FD PMC Official]. |
Training | …“we just step in and out and give them the lead and support and run a demonstration or a workshop” [Intermediary Agency A, NGO, Green Schools Management Official]. |
Maintenance
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Integration into existing structures | ...“we would have healthy eating in place for years…there was a survey done and the parents wanted a healthy eating policy” [FD School Coordinator / Primary School Teacher] |
Implementation
Maintenance/transferability
Factors hindering successful adoption, implementation and maintenance (Table 3)
(RE)AIM Parameters (Bold) | |
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Adoption
| |
Collaboration and Communication | “…the Department insisted that there should be targets… so they asked Green Schools for targets. Green Schools said well just on the basis of programme, this is what we’re getting so far, those targets were extrapolated… Ambitious targets but what the department told them at the time was that you won’t be bound by those targets” [Intermediary State Agency B Management Official] |
Community use | “…rural schools can be challenging like if there is… a real lack of infrastructure and if they are in a real busy place it can be really challenging…they don’t have as many options open to them, like carpooling can be hard to just kind of get off the ground. You will often have parent concerns about just picking up other people’s children… There is always kind of questions around insurance” (GSTO). |
Training |
“We also ran a cycle course for parents who want to cycle with their children but we didn’t have a very good response there were only two parents who came” [GSTO].
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Implementation
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Cultural context | …“we’ve gone to a situation where no one is walking to school…this is to facilitate working parents” [Intermediary Agency B, Management Official] |
“parents are so afraid of roads and road safety… that maybe they are reluctant to let teenagers or their kids out and learn…often it’s just sort of a perceived danger that isn’t really there” [GSTO]. | |
“They (girls) are expected to be on the pink bike going around the park with their pals not out on the road” [Civil Servant, Government Department B]. | |
“It’s uncool yeah” (to wear cycling helmets) [GSTO]. | |
“changes to the norms or family values, that is a big challenge in DEIS (disadvantaged) schools, if you give people fruit and veg in a school and then they go home and their mammies give them a batter burger and chips” [Civil Servant, Government Department A]. | |
Characteristics of setting | “We discussed how we were going to get fruit and veg into schools…obviously no school canteen, so it couldn’t go in that way”. [FD Project Management Company Official]. |
“Our biggest problem is getting the children to come to school, not to talk about how they travel to school.” (GSTO in socio-economically deprived school catchment area). | |
Costs, resources and funding needed for implementation | …“last year was very stressful, like at one point we didn’t know if we would get our funding renewed” [Intermediary Agency A, NGO, Green Schools Management Official]. |
Implementation delivery, protocols, fidelity (including dose) | …“it’s very hard for me to go around and check and see, if they are implementing phase 2 properly … I can’t stand there and say, are you actually checking their lunchboxes and things like that”. [FD School Coordinator / Primary School Teacher]. |
Process evaluation | “(NGO) results would indicate that there is far more walking and cycling than we would think there is in reality” [Civil Servant, Government Department B]. |
Time issues | “We are an infant school so we have a limited number of hours every day in an already overloaded curriculum… that was the concern…” [FD School Coordinator/ Primary School Teacher]. “I think a lot of the teachers find it’s long, if it’s a chart it could be nearly a meter long this chart with days and ticking and bronze cert and silver cert and gold certs and all these different certificates and children’s’ names have to be written in”. [T]. |
“there was quite a bit of timing in all this because you’ve got the school year, you’ve got the calendar year, you’ve got the [name of agency] year, EU funding year and they are all a little bit different so you are trying to manage your money…” [Civil Servant, Government Department A] | |
…“I should be developing the programme and analysing how we can...make it better, however a lot of my time is spent securing funding” [Intermediary Agency A, NGO, Green Schools Management Official].
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Translation of research into practice | “We expected to be told, how to implement this programme and it had been researched very thoroughly in the UK…but each research group required a number of PHD students going into the classroom, weighing out the fruit and veg, recording how much they had been eating…So we had a couple of challenges” [FD PMC Official]. |
Maintenance/Sustainability
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Dissemination and Transferability | …“We have a difficulty in getting clear data as to what is the actual full impact of the Green Schools programme in a school” [Civil Servant, Government Department B]. |
“…information relating to ideas that have worked on the ground should be put into hardcopy” (GSTO). | |
...“the (UK) government had said if you don’t have a school travel plan...you will not qualify for funding for the school, so it’s very easy for a headmaster to say ...we’ll get a school travel plan together. As opposed to our programme which is by invitation only, we’re trying to go in and persuade... there was no comparing like with like.” [Intermediary Agency B, Management Official] |
Individual/family level barriers
Barriers within the school setting
Structural and external barriers
Supportive actions around adoption, implementation and maintenance (Table 4)
Adoption
(RE)AIM Parameters (Bold)) | |
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Adoption
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Collaboration and Communication | “She (FD Programme Managerl) came and she spoke to me about any concerns, any queries…She was at the end of the phone if there was any issues”. [FD School Coordinator] |
…“Some County Councils are very supportive and have provided material resources such as maps which are useful...” [GSTO]. | |
Training | …“we developed a course called” Get in Gear“... it’s simply just showing them skills it takes to get back on their bike and bring them out for a cycle, and then we evaluate how they feel about cycling after...” [Intermediary Agency A, Management Official]. |
Implementation
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Characteristics of setting | …“very dependent on a number of different factors, the delivery on time, the caretaker letting it in, the parents arriving…no problems, as long as the machine was well oiled it was all fine” [FD School Coordinator]. |
Implementers’ charcteristics | …“you will often have a few teachers… who commute in by bike so it’s great to kind of harness in on those” [GSTO]. |
Adaptation and customisation | …“they wanted feedback from the schools…they were told that there was water in the pineapple bag or the cucumber bag… it puts them off the food completely….”[FD School Coordinator]. |
“If there is a child who has never tasted this or would never eat it in a millions years at home then you have to adapt it to the child involved. You kind of say ‘Right just eat one piece’ or ‘Taste it” [FD School Coordinator]. | |
…“If it is a rural school and they don’t have footpaths or infrastructure then you might be looking at carpooling or maybe park and stride” [GSTO]. | |
Costs, resources and funding needed for implementation | …“we’ve got a load of resources…which we have developed over the years, based on problems we’ve faced (and) schools have faced and we’ve come up with an option for them, a solution” [Intermediary Agency A, Management Official]. |
Implementation
Transfer-dissemination
Recommendations from stakeholders to overcome barriers (Table 5)
Adoption
(RE)AIM Parameters (Bold) | |
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Adoption
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Collaboration and Communication | “maybe if we had like a sit down every quarter or whatever and just talk through the issues” [GSTO]. |
Implementation
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Training | …“they (boys) had to have their cycle training, they had to disclose it to myself, they had to do their bike maintenance, they had to wear a helmet and they had to have permission from their parents …their cycling numbers went up significantly” [Green Schools Coordinator (Teacher)]. |
Maintenance/Sustainability
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Cost reduction, other | “…it proved much easier to sustain a budget, a net budget of XXX.” [Government Department A, Civil Servant] |
…“from the publication of the focused policy assessment there was a question whether we should just close the programme…but I think the view from the Department would be that it is a good programme” [Government Department B, Civil Servant]. |