Facilitators and Barriers to Implementing Healthy School Canteen Intervention among Malaysian Adolescents: A Qualitative Study.
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SUBMITTER: Azizan NA
PROVIDER: S-EPMC8471853 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.
| S-EPMC8471368 | biostudies-literature
Project description:Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
| S-EPMC7536333 | biostudies-literature
Project description:ObjectiveEffectiveness of behavioural obesity treatments in adolescents is modest. Thus, incorporating participant feedback may lead to improvement of intervention acceptability. This qualitative study's objective was to assess perceived barriers/facilitators to weight loss and healthy lifestyles among diverse adolescents with overweight/obesity (OW/OB).MethodsAdolescents ages 14-19 with BMI ≥ 85th percentile participated in focus groups and identified perceived barriers/facilitators to weight loss and healthy lifestyles.ResultsTen sex-stratified focus groups (n = 41; n = 13 males, n = 28 females) were conducted in 2018 and 2019. Females reported experiencing weight struggles, whereas males often stated no struggles with weight, despite all participants meeting criterion for OW/OB. Barriers included eating behaviours, family members and internal motivation, with additional barriers of physical activity, friends, time and support cited in females. Facilitators included parental, familial and peer support of healthy eating and exercise, modelling behaviours, internal motivation and organized sports. Two additional findings regarding adolescents' perceived barriers/facilitators include substantial overlap and sex differences of perceived barriers/facilitators.ConclusionsAdolescent males and females with OW/OB experience weight status differently, affecting their perceived barriers/facilitators to weight loss and healthy lifestyles. Tailoring weight management interventions to the unique needs of adolescent females versus adolescent males has the potential to improve intervention quality and effectiveness.
| S-EPMC7746964 | biostudies-literature
Project description:ObjectivesRecruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community.DesignQualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban-rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity.ParticipantsFamilies were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families.ResultsThree interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences.ConclusionsWhile participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.
| S-EPMC7478027 | biostudies-literature
Project description:BackgroundThe Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals' implementation behaviour within the pilot site.MethodsIndividual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development.ResultsEight TDF domains were identified as important areas influencing CURE implementation; 'environmental context and resources' (physical opportunity), 'social influence' (social opportunity), 'goals', 'professional role and identity' and 'beliefs about consequences' (reflective motivation), 'reinforcement' (automatic motivation), 'skills' and 'knowledge' (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of 'beliefs about consequences' and 'knowledge', which were highlighted as facilitators of CURE. Participants suggested that 'environmental context and resources' was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context.ConclusionsThis qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts.
| S-EPMC8136754 | biostudies-literature
Project description:BackgroundThere is an urgent need to align human diets with goals for environmental sustainability and population health. The OPTIMAT™-intervention study was developed to implement and evaluate a nutritionally adequate and climate-friendly 4-week lunch menu in Swedish primary schools. This study aimed to explore pupils' and kitchen staff's experiences of the intervention and to identify barriers and facilitators to successful implementation of sustainable school meals.MethodsAn inductive manifest qualitative method was used. Nine focus group discussions (FGDs) were conducted, six with pupils in grades 5 (ages 10-11) and 8 (ages 14-15) (n = 29) and three with kitchen staff (n = 13). Data were analyzed using qualitative content analysis.ResultsFive main categories and 11 subcategories at a manifest level emerged. The five main categories were: 1) Experiences with the new menu, unfolding variations in how the new menu was received and kitchen staff's experiences of working with it; 2) The meaning of diet sustainability, comprising pupils' and kitchen staff's perceptions about diet sustainability as a concept and part of their everyday lives; 3) Factors influencing plant-based food acceptance, covering aspects such as the influence of sensory factors, habits and peer pressure; 4) Opportunities to increase plant-based eating, including factors related to pupils' and kitchen staff's ideas for how to increase plant-based food acceptance; and 5) Need for a supportive environment to achieve dietary change, comprising pupils' and kitchen staff's thoughts on the importance of more knowledge, resources and involvement of stakeholders to eat more plant-based meals in schools.ConclusionsSuccessful implementation of sustainable school meals would require more knowledge among pupils and kitchen staff. Staff also need more training in cooking of sustainable meals. Barriers among pupils could be tackled by introducing new plant-based meals more gradually and by more carefully considering the seasoning, naming and aesthetics of dishes. An increased leadership support for change and involvement of stakeholders from multiple levels within society will be key in the transition to sustainable school meals at scale.Trial registrationThe trial registration for the OPTIMAT™-intervention may be found at clinicaltrials.gov ( NCT04168632 Fostering Healthy and Sustainable Diets Through School Meals (OPTIMAT)).
| S-EPMC8254978 | biostudies-literature
Project description:OBJECTIVE:The objective of this study was to explore barriers and facilitators to healthy eating among low-income Latino adolescents using an intervention development framework. METHODS:Semi-structured interviews (n?=?30) were conducted with Latino youth ages 13-17 who had overweight or obesity at a safety-net clinic in San Francisco, CA. Adolescent beliefs and attitudes regarding healthy eating and individual, family, and community level barriers and facilitators were elicited. Interviews were analyzed using an inductive approach and the Capability-Opportunity-Motivation (COM-B) model. RESULTS:Participants had capability gaps; while they demonstrated basic nutrition knowledge, they also held significant misconceptions about healthy eating, equating "organic" with healthy and failing to recognize sugar in a number of beverages and foods. Families were a source of support through role modeling and purchasing fresh produce, yet in many cases also undermined adolescents' healthy eating goals through purchases of high calorie low nutrient food, an opportunity facilitator and challenge. By contrast, peers were mostly a negative influence due to frequent consumption of high calorie low nutrient food. The school environment posed opportunity challenges as participants found school lunch unpalatable and had ready access to unhealthy options nearby. Participants were motivated to improve their eating habits but often not resilient in the face of obstacles. CONCLUSIONS:Interventions to promote healthy eating among low-income Latino adolescents should address common nutritional misconceptions, target families as well as teens, consider peer influences, and advocate for policy approaches that improve the school food environment.
| S-EPMC6628719 | biostudies-literature
Project description:BackgroundOver the past decade several physical activity (PA) interventions have been shown to be efficacious in a controlled research setting, however there is a continued lack of evidence for how to successfully implement these PA interventions in real-world settings such as the community. This review aims to explore the barriers and facilitators that affect the implementation of community-based PA interventions and make recommendations to improve implementation from the included studies.MethodsA systematic literature search of EBSCOhost, Scopus, PUBMED and Web of Science was conducted to identify articles that reported qualitative data on the implementation factors of community-based interventions where PA was a primary outcome. Data were extracted using the Consolidated Framework for Implementation Research (CFIR) as a guide. Implementation factors and recommendations were then mapped onto the 5 domains of the CFIR and synthesised thematically.ResultsFrom 495 articles, a total of 13 eligible studies were identified, with 6 studies using a mixed methods approach, and 7 reporting qualitative methods only. There were 82 implementation factors identified, including 37 barriers and 45 facilitators, and a further 26 recommendations from the papers across all 5 domains of the CFIR. More barriers than facilitators were identified within the CFIR domain inner setting, in contrast to all other domains where facilitator numbers outweighed barriers.ConclusionsThis review identified many facilitators and barriers of implementing physical activity interventions in the community. A key finding of this review was the impact of implementation strategies on successful implementation of community PA interventions. From the evidence, it was clear that many barriers to implementation could have been negated or reduced by an implementation plan in which several strategies are embedded. The findings of this review also suggest more attention to individual' skills and involvement is needed to improve self-efficacy and knowledge. The role of individuals across all organisational levels, from providers to leaders, can impact on the implementation of an intervention and its success.Trial registrationPROSPERO - CRD42020153821 .
| S-EPMC8422651 | biostudies-literature
Project description:BackgroundFood/drinks available to adolescents in schools can influence their dietary behaviours, which once established in adolescence, tend to remain over time. Food outlets' influence near schools, known to provide access to unhealthy food/drinks, may also have lasting effects on consumption behaviours. This study aimed to gain a better understanding of the consumption habits of adolescents in the school arena by comparing different personal characteristics and purchasing behaviours of infrequent and regular school canteen users to those never or seldom using the canteen.MethodsA convergent mixed methods design collected qualitative and quantitative data in parallel. A cross-sectional quantitative study including 742 adolescents was conducted, with data collected at schools via an online questionnaire. Focus group interviews with students and interviews with school administrators formed the qualitative data content. Quantitative data were analysed using descriptive statistics and logistic regression; thematic content analysis was used to analyse qualitative data.ResultsSixty-seven percent of adolescents reported never/rarely using the school canteen (NEV), whereas 13% used it ?2 times per week (OFT). When the two groups were compared, we found a significantly higher proportion of the NEV group were female, having parents with a high education, and with a high self-efficacy, whilst a significantly higher proportion of the OFT group consumed salty snacks, baked sweets, and soft-drinks ?3 times per week, and breakfast at home <?5 days in the school week. The OFT group had significantly higher odds of purchasing food/drink from shops near school during school breaks and before/after school compared to the NEV group (adjusted odds ratio (aOR)?=?1.80, 95% CI 1.07-3.01, and aOR?=?3.61, 95% CI 2.17-6.01, respectively). The interviews revealed most students ate a home packed lunch, with the remainder purchasing either at the school canteen or at local shops.ConclusionsStudents using the canteen often are frequently purchasing snacks and sugar-soft drinks from shops near school, most likely owing to availability of pocket money and an emerging independence. School authorities must focus upon satisfying canteen users by providing desirable, healthy, and affordable items in order to compete with the appeal of local shops.
| S-EPMC6192152 | biostudies-literature
Project description:BACKGROUND:The 'Eat Right, Be Positive About Your Body and Live Actively' (EPaL) intervention programme was developed to prevent overweight and disordered eating in Malaysian adolescents. This study aimed to evaluate the effectiveness of the EPaL programme on knowledge, attitudes and practices on healthy lifestyle and body composition (body mass index z-score [zBMI], waist circumference [WC] and body fat percentage [BF%]) among adolescents. METHODS:All measures were taken at three time points: before intervention (Pre), after intervention (Post I) and 3?months after intervention (Post II). The intervention group (IG) participated in the EPaL programme for 16?weeks, whereas the comparison group (CG) received no intervention. Seventy-six adolescents (IG: n?=?34; CG: n?=?42) aged 13-14?years were included in the final analysis. Repeated measures analysis of covariance (ANCOVA) was used to assess the impact of the EPaL intervention programme on the measures between groups (IG and CG) at Post I and Post II. RESULTS:The IG reported significantly higher knowledge scores at both Post I (adjusted mean difference?=?3.34; 95% confidence interval [CI]?=?0.99, 5.69; p?=?0.006) and Post II (adjusted mean difference?=?2.82; 95% CI?=?0.86, 4.78; p?=?0.005) compared with the CG. No significant differences between the IG and CG were found at either Post I or Post II in attitudes, practices, zBMI, WC and BF%. The proportion of participants who were overweight or obese was consistent from Pre to Post II in the IG (35.3%) and increased from 26.2% at Pre to 28.5% at Post II in the CG, but the difference was not statistically significant. The proportion of participants who had abdominal obesity in the IG decreased from 17.6% at Pre to 14.7% at Post II and increased from 16.7% at Pre to 21.4% at Post II in the CG, but the differences were not statistically significant. CONCLUSION:Despite no significant reduction of body composition, this programme shows the positive effect on the adolescents' knowledge regarding healthy lifestyle. This study contributes to the evidence on the effectiveness of school-based health interventions in Malaysian adolescents. TRIAL REGISTRATION:UMIN Clinical Trial Registration UMIN000024349. Registered 11 October 2016.
| S-EPMC7071695 | biostudies-literature