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Table 3 Perceived factors facilitating implementation and sustainability of healthy lifestyle programmes at the primary schools

From: Effective implementation of primary school-based healthy lifestyle programmes: a qualitative study of views of school staff

  Illustrative quotations
Factors facilitating implementation
 Contextual appropriateness and adaptabilityIII “Every school is different, this is what works for one school, this is what works for another school, and until you find you’re actually there in that specific school, how we work out (our programme), this will work better for us” (Behaviour change specialist, FDE)
“… I felt like I was jumping over hurdles for the sake of a certificate (for the Food for Life Programme). It has been trimmed down now and is more appropriate for the school” (Head teacher, school 6, PFS)
“We did it (The Food Dudes programme) a little bit differently. We continued a scheme at playtime where children would tick off their level cards when they had fruit. We gave rewards out in the classroom, as all the children have their school dinners at different times, so we couldn’t do it in the dining room” (Programme coordinator, school 11, FDE)
We aren’t delivering it in the here’s a lesson, we deliver it every week, because it needs to fit with what’s right for the children in the school … and in addition to this, we’ve then done it as a club” (Head teacher, school 1, PFS)
“I left it very much to the individual classes to run it how they felt, which actually worked better I think for them” (Programme coordinator, school 11, FDE)
 Availability and quality of resources (personnel and facilities)IV “We need staff capacity to run programmes, like the healthy schools award” (Programme coordinator, school 9, FDE)
 Availability and quality of programme activity resourcesIII “We could probably do with some more (resources), a lot of it is DIY and maybe some sort of scheme to run to … a bit of guidance on which way it goes” (Year 4 teacher, school 8, PFS)
“In terms of delivery, I think the more hands on activities the children can do, like first-hand experiences the better” (Year 2 teacher, school 3, PFS)
 Integration of new programmes (in the curriculum, school structures and food policies) III and IV “Keeping it within the curriculum, make it integral not a bolt on or after school club and everyone gets it. Keep it within the curriculum so everyone receives it” (Year 2 teacher, school 7, PFS)
 Teacher characteristics (perceived need for and benefit of innovation)II “… where they (staff) can see a relevant link to what the children are learning, I think they’re more positive about it and the staff are very good at taking things on and running with it really” (Head teacher, school 2, PFS)
 Shared vision (commitment and staff buy-in), leadership, programme coordinator (champion) and managerial/ administrative supportIV “It (the Food Dudes programme) was successful because we have a strong team of senior and non-teaching staff coordinating the programme” (Programme coordinator, school 9, FDE)
“The head gets involved as much as possible and introduced ‘meat free Mondays’” (Catering manager, school 10, FDE)
“… and that (success) was the staff encouraging it … our ultimate, is to make sure those children have a healthy diet when they are with us … there was a buzz around it (programme), support around it, excitement around it and a lot of focus on it” (Programme coordinator, school 9, FDE)
“We’ve had lots of staff meetings about it, I know XX (programme coordinator) has been kind of the drive behind the initiative. She’s done really well with showing us and demonstrating all the resources” (Year 2 teacher, school 5, PFS)
 Training and technical supportV “I think doing a hands on training and giving people the time in a training session to go away and sort of plan it, yeah and just some dedicated time” (programme coordinator, school 1, PFS)
“… those contacts and that ability for people to do those key aspects is very important as part of the programme … sometimes having somebody to contact and say look I want you to do this, can you put me in contact with, that is a very important element” (Programme coordinator, school 3, PFS)
“You’ve got to be wary, yes you want schools to engage with you, with the programme, but also they’re going to have priorities that you know, you’ve got to be careful to get the balance right, so you are not seen as invasive” (Programme provider, PFS)
 Formulation of tasks (teams, effective human resource management)IV “… it was about finding a member of staff who could supervise them (pupils) … I think that’s quite an important thing to make sure there is a consistent member of staff who can do that” (Head teacher, school 9, FDE)
“We have thought about using specialist teachers, with more time to deliver them (programmes) and who might be passionate about delivering healthy lifestyle messages” (Head teacher, school 10, FDE)
“I need another member of staff, giving me somebody from half past nine, to take the pressure off me” (Catering manager, school 9, FDE)
 Parent and community participation (shared decision making)IV “… we need parents to understand how to work with fruit and veg, knowledge of fruit and veg, do cooking (with them), we need to focus on the parents” (Programme coordinator, school 9, FDE)
“Parents are on the school nutrition action committee group, so parents have been spoken to about healthy eating in school, they’ve been surveyed” (Head teacher, school 1, PFS)
“… within that garden area, there’s allotments and we try and encourage parents and the community to come and grow fruit and veg and they can take that produce away with them … the children are also involved in that” (Head teacher, school 8, PFS).
“… we had highlighted we needed support workers to help embed the programme in local communities” (Community support worker, PFS)
 Pupil characteristics, engagement and motivationa “We have food ambassadors working in the hall, giving other children stickers for healthy food behaviours” (Head teacher, school 10, FDE)
“Year 6 did a lot for us, they were monitoring the cards (level cards) and monitoring the prizes, because we didn’t have time for that” (Catering manager, school, 12, FDE
Factors facilitating sustainability
 Sustained engagement in programmes and integration long-term “In order for it to be sustained it has to keep coming round because if parents don’t buy things at home, then children lose the taste for it and they go back to not liking it and everything else” (Head teacher, school 12, FDE)
“… I think the most important thing is making it sustainable because if you have a big push to begin with and it wanes, then the impact is going to be much less. I think it’s important when we’re weaving it in, it becomes a sustainable part of what we do.” (Head teacher, school 2, PFS)
“I think more time needs to be spent over it, extended rather than focused in one week for example” (Reception teacher, school 6, PFS)
 Head teacher commitment “… all programmes are sustainable because I am interested in leading on them and passing them onto other people. I will make them sustainable at the school” (Head teacher, school 10, FDE)
 Communication about programmes “We need to reflect on these things at different part of the year, make sure we have the skills in, people share what’s worked well” (Head teacher, school 4, PFS)
“Communication within staff talking about things really (is important for sustaining programmes)” (Year 4 teacher, school 3, PFS)
  1. Superscript roman numerals refer to categories within the Durlak and Dupre model of factors affecting implementation [26]:
  2. I Community Level Factors
  3. II Provider Characteristics
  4. III Characteristics of the Innovation
  5. IV Factors Relevant to the Prevention Delivery System: Organisational Capacity
  6. V Factors Related to the Prevention Support System
  7. a Factors influencing implementation not identified in the model by Durlak and Dupre [26]