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Table 4 Quotes for policy cases

From: Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project

Facilitating factors
 Adoption
  Training for implementation “We organized individual meetings with each group of implementers. We also conducted a content and organizational training. In terms of the implementation of the programme, we showed what the programme should look like in terms of what we require. We had further training delivered by specialists from the Medical University and the University of Life Sciences.” [Poland, Fit Student]
  Adoption in physical environment “The fact that there was a type of subscription scheme maybe also was a factor that supported the implementation of free school fruit.” [Norway, Free school fruit program] “This programme functions well because there is a range of other already-existing programmes that accompany it, e.g. ‘The Health-promoting Schools’.” [Poland, Fit Student] “It is like this, in [name of city] we served as vanguard for the expansion of full-time schools in Germany. In the course of the expansion the issue of school meals entered the discussion at an early stage. The idea of implementing a central point of contact for these issues came up even before this federal and federal state project.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
  Governmental and legal involvement “In the elections 2005 in the campaign some focus on school meals. One party wanted free hot school meals and two other parties wanted a free school meal. When the three parties formed a coalition I think free school fruit came. Because they didn’t get free school meals they had to come with something.” [Norway, Free school fruit program] “The development and expansion of full-time schools in the federal state is, of course, a big influential component.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
  Collaboration and communication “Ähm, clearly, it is beneficial that we are not primarily ecotrophologists. We have one colleague and she comes from ecotrophology, another one is a teacher and I am originally a teacher and a trained cook myself. This combination helps us getting perceived as partners by kitchen staff, caterers, and meal service providers.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “The topic ‘school meals’ is so multi-layered that it is necessary to cooperate with other professions and other partners or else you will not make any progress.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “We invited representatives of the Medical University, the University of Natural Sciences, health-promoters, school nurses and behavioural nurses, nutritionists. Together we designed the programme and planned activities. So there was a multi-sectoral collaboration: scientific, academic, educational and it all helped in developing a more realistic delivery of the programme.” [Poland, Fit Student]
 Implementation
  Delivery characteristics “... when the Nordic countries meet there is a certain instinct for competition, so it’s like If they can do it, so can we.” [Norway, Keyhole] “The participants who regularly took part in the workshop received different prizes from our partners: tickets to sport halls, cultural and pro-health places as well as some gadgets. We notice that the mere fact of rewarding is very important (...) it is a good motivational system for them.” [Poland, Fit City]
  Simplicity of the policy “For both the industry and the government, because we knew that the Keyhole, sort of, worked more or less in Sweden. It was 20 years old or something.” [Norway, Keyhole] “We know from the last consumer research that one in two people say that the labelling makes it easier to choose healthy [products].” [Norway, Keyhole]
  Costs and funding/ resources needed for delivery “I think it had not been this successful had we not had long term funding of 5 years then and now three additional years. This is crucial in attempting to motivate people to cooperate and to commit themselves to this kind of quality. Long-term funding definitely was a good thing.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “We did our [evaluation] with such [consumer] inquiries. Lots of questions on what it means and so on ... But in other ways ...? Yes, they follow the product development, I think.” [Norway, Keyhole]
 Maintenance
  Long-term funding and political support “There has been control campaigns with the other Nordic countries, and now it is a part of the control [made by The Norwegian Food Safety Authority] ... It is necessary that we [The Norwegian food Safety Authority] prioritise the labelling.” [Norway, Keyhole] “From the Federation we get the message that the VNS is the most successful of the entire INFORM campaign and that there are several ministers stating that – depending on election cycles – they would like to pursue this project in some fashion.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
Obstacles
 Adoption
  Adoption in physical environment “The fact that the education system is public and not private [was the obstacle] because it meant that the financing was very limited. Wanting to equip the kitchen, the management of a particular [educational] institution will not ask the parents for the money to get a new oven, they can only inform the parents about it.” [Poland, Tasty, Healthy, Valuable] “There is no room in the canteen, the capacities are not sufficient. Plus, it is political, too. When children wish to seize a full-time school program and the head of school has to admit that they do not have the capacities. Or if you find out that children having been accepted into full-time school programs have to eat their meals in the classrooms.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
  Governmental and legal involvement/ collaboration and communication “Regulations - we had to get EU’s approval, and that took three to 4 months. But that was probably not the worst part. The worst part was reaching an agreement between Norway and Sweden on the criteria.” [Norway, Keyhole] “And that is, yeah, yeah, I said it in the beginning, the range of consultations offered is very broad. But there are quite a lot of people, many stakeholders who have their word in this, as well, and who have the authority to make decisions in other places.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “Of course, the success of the VNS [Federal state offices coordinating networks for the provision of healthy food options in schools] or the gaining of sponsorship/financial carriers depends on the political atmosphere in the federal state. Considering [name of city], where one financial carrier is very committed, the impact and significance of the VNS is quite different. This is one factor sometimes impeding work in some federal states.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “To me it was a little bit puzzling that it was so little thought through the implementation and that it was not planned more collaboration and involvement from all partners.” [Norway, Free school fruit program]
  Community use “In schools there are no contact persons for this topic, and too few people are responsible. This makes it difficult to address the proper persons who may be able to put something into action.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “After 5 years, we indeed have schools where neither the school principal nor the parents have an interest in the topic.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
 Implementation
  Costs and funding/ resources needed for delivery “The amount allocated by a ministry, particularly at the federal state level, does not increase. One is somehow dependent on good will from the ministries and that they will put money into this project and not into another measure.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools] “There were really some misunderstandings. Some municipalities believed that they didn’t get funding anymore. They thought that they had to have free school fruit but that they didn’t get any money from the State anymore. They misunderstood.” [Norway, Free school fruit program] “With three full time positions in charge of 3300 schools we are unable to provide counselling to every single school.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
  Implementation process evaluation “There are no financial means for any type of evaluation. Of course, evaluation of our work is mandatory. We keep documentation of our counselling activities and events. It is possible for participants to evaluate our events, but these are issues that we were left alone with.” [Germany, Federal state offices coordinating networks for the provision of healthy food options in schools]
  Other factors “... no real opportunity to sanction, other than making complaints and then you were on the blacklist and there were some in the media.” [Norway, Free school fruit program]