Elementary Schools’ Response to Student Wellness Needs during the COVID-19 Shutdown: A Qualitative Exploration Using the R = MC2 Readiness Heuristic

During spring of 2020, the COVID-19 pandemic and accompanying public health advisories forced K-12 schools throughout the United States to suspend in-person instruction. School personnel rapidly transitioned to remote provision of academic instruction and wellness services such as school meals and counseling services. The aim of this study was to investigate how schools responded to the transition to remote supports, including assessment of what readiness characteristics schools leveraged or developed to facilitate those transitions. Semi-structured interviews informed by school wellness implementation literature were conducted in the spring of 2020. Personnel (n = 50) from 39 urban and rural elementary schools nationwide participated. The readiness = motivation capacity2 (R = MC2) heuristic, developed by Scaccia and colleagues, guided coding to determine themes related to schools’ readiness to support student wellness in innovative ways during the pandemic closure. Two distinct code sets emerged, defined according to the R = MC2 heuristic (1) Innovations: roles that schools took on during the pandemic response, and (2) Readiness: factors influencing schools’ motivation and capacity to carry out those roles. Schools demonstrated unprecedented capacity and motivation to provide crucial wellness support to students and families early in the COVID-19 pandemic. These efforts can inform future resource allocation and new strategies to implement school wellness practices when schools resume normal operations.

Strategies to Improve School Meal Consumption: A Systematic Review

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability

BackgroundThe need for sustainable and scalable comprehensive school wellness interventions is evident, and the lack of attention toward capacity-building models warrants investigation. Furthermore, there is a dearth of understanding regarding implementation determinants grounded in dissemination and implementation (D&I) frameworks. This study sought to address: 1) implementation determinants of adoption, fidelity, and penetration for school-wide wellness programming; and 2) nuanced determinants between schools with prior experience and those new to the program, to enhance tailored implementation support and sustainability.MethodsThe School Wellness Integration Targeting Child Health (SWITCH®) capacity-building intervention was adopted in 52 elementary and middle (22 new; 30 experienced) schools across Iowa, United States in the 2019–2020 academic year. Mixed methods data collection and analysis procedures followed the Consolidated Framework for Implementation Research (CFIR) protocols, adapted to school settings. Implementation outcomes included: 1) fidelity/compliance to established quality elements; 2) adoption of best practices in multiple settings; and 3) penetration of behavior change practices across classrooms and grade levels. Assessed determinants comprised organizational readiness/capacity and CFIR constructs via interviews and surveys. Interview data were scored using a systematic process; each CFIR domain was assigned a score (ranging between -2 and +2) to denote either a positive or negative influence on implementation. Independent t-tests were conducted to capture potential differences between new and experienced schools, followed by Pearson bivariate correlation analyses to determine relationships between CFIR determinants and implementation outcomes. ResultsExperienced schools reported insignificantly higher fidelity (t=-1.86 p=.07) and higher rates of adoption (t=-2.03 p=.04) compared to new schools. Correlation analyses revealed positive relationships between implementation outcomes and CFIR determinants including innovation source, culture and relative priority, and leadership engagement. Negative relationships were observed in tension for change and networks and communications. Specific negative relationships for new schools between determinants and outcomes included relative advantage, engaging key stakeholders, and reflecting/evaluating, among others. ConclusionsFindings highlight the specific relationships between implementation outcomes and determinants; nuanced challenges for new schools highlight the need for a more tailored approach to implementation support and offer insights for sustainability. Adapted CFIR protocols provide opportunities for replication in other school-and community-based projects.

Using Local School Wellness Policies to Build a Culture of Health for Students With Chronic Health Conditions: The School Nurse Role

Local school wellness policies (LWP) guide school districts’ efforts to establish school environments that promote students’ health, well-being, and ability to learn that include school U.S. Department of Agriculture nutrition and physical activity requirements. Looking through the lens of the Whole School, Whole Community, Whole Child model and NASN’s Framework for 21st Century School Nursing Practice™, LWP can be expanded beyond the tradition focus of nutrition and physical activity to address the health and academic needs of students with chronic health conditions. School nurses need to be actively involved on district wellness councils as schools prepare to conduct their required triennial assessment of current LWP equipped with an understanding of the Alliance for a Healthier Generations’ updated model wellness policy and NASN’s supplemental wellness policy language to address management of students with chronic health conditions.

Brief Motivational Interviewing Training for Outreach in School Health Programming

This study assessed a brief 6-week motivational interviewing (MI) training program for extension field specialists (EFS) involved in supporting a statewide school wellness initiative called SWITCH. A total of 16EFS were instructed in MI principles to support the programming and half (n = 8) volunteered to participate in the hybrid (online and in-person) MI training program. Phone calls between EFS and school staff involved in SWITCH were recorded and coded using the Motivational Interviewing Treatment Integrity (MITI) system to capture data on utilization of MI principles. Differences in MI utilization between the trained (n=8) and untrained (n=8) EFS were evaluated using Cohen’s d effect sizes. Results revealed large differences for technical global scores (d=1.5) and moderate effect sizes for relational global components (d=0.76) between the two groups. This naturalistic, quasi-experimental study indicates a brief MI training protocol is effective for teaching the spirit and relational components of MI to EFS.

An Assessment of Schools’ Wellness Policies and Teachers’ Perspectives and Confidence in Teaching Nutrition in Elementary Schools in Jeddah, Saudi Arabia

Objectives This study aimed to evaluate the content of school wellness policies and understand teacher perspectives about teaching nutrition education at their schools in Jeddah, Saudi Arabia. Methods In 2020, electronic surveys were used to evaluate the wellness policies in 11 elementary all-female government schools and teachers’ perspectives about the nutrition education offered in three elementary all-female government schools. Sixty-one teachers and eleven principals participated in this study. Fisher's exact tests were used to test the differences between teachers’ perspectives and their confidence level and characteristics. A P-value of less than 0.05 was considered statistically significant. Results Results showed that most schools (N = 10) have a formal school wellness policy that provides a healthy environment for students and ensures facilitate their access to healthy eating and exercise. Many teachers (55.2%) agreed that there are adequate resources are available to them to teach nutrition in the schools, and (58.6%) of them agreed that they have had adequate training from qualified people on nutrition education. Most teachers (94.7%) were confident in teaching nutrition and physical activity to their students. Teachers between 30–50 years of age were more interested in teaching nutrition than teachers whose age is more than 50 years old (P < 0.05). Conclusions In summary, schools operated very efficiently to offer nutritional education for students, and most teachers are confident and interested in teaching nutrition. There is a need for further studies investigating nutrition education in schools in Saudi Arabia. Funding Sources No funding sources