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School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

  • Original Research
  • Published:
Translational Behavioral Medicine

ABSTRACT

School-based interventions are essential to prevent pediatric obesity and type 2 diabetes. School environmental factors influence implementation of these interventions. This article examines how school factors acted as barriers to and facilitators of the HEALTHY intervention. The HEALTHY study was a cluster-randomized trial of a multicomponent intervention implemented in 21 schools. Interview data were analyzed to identify barriers and facilitators. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehavior, classroom management problems, communication equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Contextual barriers and facilitators must be taken into account in the design and implementation of school-based health interventions.

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Acknowledgments

This study was completed with funding from the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health grant numbers U01-DK61230, U01-DK61249, U01-DK61231, and U01-DK61223, with additional support from the American Diabetes Association. In addition, an award from the Anne Linda Furstenburg Fund supported William J. Hall during data analysis and writing.

We wish to thank the administration, faculty, staff, students, and their families at the middle schools and school districts that participated in the HEALTHY study. HEALTHY intervention materials are available for download at http://www.healthystudy.org/.

The following individuals and institutions constitute the HEALTHY Study Group (* indicates principal investigator or director): Study Chair, Children's Hospital Los Angeles: F.R. Kaufman. Field Centers, Baylor College of Medicine: T. Baranowski*, L. Adams, J. Baranowski, A. Canada, K.T. Carter, K.W. Cullen, M.H. Dobbins, R. Jago, A. Oceguera, A.X. Rodriguez, C. Speich, L.T. Tatum, D. Thompson, M.A. White, and C.G. Williams. Oregon Health & Science University: L. Goldberg*, D. Cusimano, L. DeBar, D. Elliot, H.M. Grund, S. McCormick, E. Moe, J.B. Roullet, and D. Stadler. Temple University: G. Foster* (Steering Committee Chair), J. Brown, B. Creighton, M. Faith, E.G. Ford, H. Glick, S. Kumanyika, J. Nachmani, L. Rosen, S. Sherman, S. Solomon, A. Virus, S. Volpe, and S. Willi. University of California at Irvine: D. Cooper*, S. Bassin, S. Bruecker, D. Ford, P. Galassetti, S. Greenfield, J. Hartstein, M. Krause, N. Opgrand, Y. Rodriguez, and M. Schneider. University of North Carolina at Chapel Hill: J. Harrell*, A. Anderson, T. Blackshear, J. Buse, J. Caveness, A. Gerstel, C. Giles, J. Hall, W. Hall, A. Jessup, P. Kennel, R. McMurray, A-M. Siega-Riz, M. Smith, A. Steckler, and A. Zeveloff. University of Pittsburgh: M.D. Marcus*, M. Carter, S. Clayton, B. Gillis, K. Hindes, J. Jakicic, R. Meehan, R. Noll, J. Vanucci, and E. Venditti. University of Texas Health Science Center at San Antonio: R. Treviño*, A. Garcia, D. Hale, A. Hernandez, I. Hernandez, C. Mobley, T. Murray, J. Stavinoha, K. Surapiboonchai, and Z. Yin. Coordinating Center, George Washington University: K. Hirst*, K. Drews, S. Edelstein, L. El Ghormli, S. Firrell, M. Huang, P. Kolinjivadi, S. Mazzuto, T. Pham, and A. Wheeler. Project Office, National Institute of Diabetes and Digestive and Kidney Diseases: B. Linder*, C. Hunter, and M. Staten. Central Biochemistry Laboratory, University of Washington Northwest Lipid Metabolism and Diabetes Research Laboratories: S.M. Marcovina*.

Author information

Authors and Affiliations

  1. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7460, USA

    William J. Hall MSW, Allan Steckler DrPH, John M. Hall BS & M. Randall Fisher BS, RN,

  2. Department of Planning, Policy and Design, University of California at Irvine, Irvine, CA, 92697-7075, USA

    Margaret Schneider PhD

  3. USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, 77030, USA

    Deborah Thompson PhD

  4. Department of Nutrition Sciences, Drexel University, Philadelphia, PA, 19104, USA

    Stella L. Volpe PhD

Authors
  1. William J. Hall MSW
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  2. Margaret Schneider PhD
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  3. Deborah Thompson PhD
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  4. Stella L. Volpe PhD
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  5. Allan Steckler DrPH
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  6. John M. Hall BS
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  7. M. Randall Fisher BS, RN,
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Consortia

the HEALTHY Study Group

Corresponding author

Correspondence to William J. Hall MSW.

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Implications

Practice: School-based obesity interventions should take into account student interests and involvement, classroom skills of teachers delivering the intervention, teacher/staff attitudes, and engagement concerning intervention delivery, menu and product ordering systems, and buy-in from school leadership.

Policy: Policymakers should set higher standards and increase resources for obesity-related professional development for faculty/staff, high-tech school-wide communication systems for health messages, healthful foods and beverages in schools, PE equipment and facilities, and PE and health education programs.

Research: Process evaluation data on contextual barriers and facilitators should be collected and reviewed during the implementation of health interventions.

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Hall, W.J., Schneider, M., Thompson, D. et al. School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes. Behav. Med. Pract. Policy Res. 4, 131–140 (2014). https://doi.org/10.1007/s13142-013-0226-z

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  • DOI: https://doi.org/10.1007/s13142-013-0226-z

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