title: Implementing a multicomponent school-based obesity prevention intervention: a qualitative study.
abstract: OBJECTIVE
  To explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts.
  
  
  METHODS
  Using purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses.
  
  
  RESULTS
  State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance.
  
  
  CONCLUSIONS
  Results confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.
authors.affiliation: Department of Kinesiology, University of Rhode Island, Kingston, RI. Electronic address: mgreaney@mail.uri.edu.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Greaney
authors.affiliation: Commonwealth Community Care, Springfield, MA.
authors.forename: Cary K
authors.initials: CK
authors.lastname: Hardwick
authors.affiliation: Nutrition Department, Public Health Nutrition, Harvard School of Public Health, Boston, MA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Spadano-Gasbarro
authors.affiliation: Division of Health Promotion and Disease Prevention, Massachusetts Department of Public Health, Boston, MA.
authors.forename: Solomon
authors.initials: S
authors.lastname: Mezgebu
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Horan
authors.affiliation: Alpert Medical School, Brown University, Providence, RI.
authors.forename: Sara
authors.initials: S
authors.lastname: Schlotterbeck
authors.affiliation: Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.affiliation: Nutrition Department, Public Health Nutrition, Harvard School of Public Health, Boston, MA; Human Nutrition Program, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D017195:Adolescent Nutritional Physiological Phenomena; D002648:Child; D002652:Child Behavior; D002664:Child Nutritional Physiological Phenomena; D004032:Diet / Q000009:adverse effects; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation / Q000191:economics; D006801:Humans; D008404:Massachusetts; D009043:Motor Activity; D018673:Nutrition Policy; D009765:Obesity / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D010349:Patient Compliance; D012574:Schools / Q000191:economics; D000078329:Workforce
keywords: intervention; obesity prevention; qualitative; school