title: School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes.
abstract: School-based interventions are essential to prevent pediatric obesity and type 2 diabetes. School environmental factors influence implementation of these interventions. This article examines how school factors acted as barriers to and facilitators of the HEALTHY intervention. The HEALTHY study was a cluster-randomized trial of a multicomponent intervention implemented in 21 schools. Interview data were analyzed to identify barriers and facilitators. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehavior, classroom management problems, communication equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Contextual barriers and facilitators must be taken into account in the design and implementation of school-based health interventions.
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Hall
authors.affiliation: Department of Planning, Policy and Design, University of California at Irvine, Irvine, CA 92697-7075 USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Schneider
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030 USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Thompson
authors.affiliation: Department of Nutrition Sciences, Drexel University, Philadelphia, PA 19104 USA.
authors.forename: Stella L
authors.initials: SL
authors.lastname: Volpe
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 USA.
authors.forename: Allan
authors.initials: A
authors.lastname: Steckler
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hall
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 USA.
authors.forename: M Randall
authors.initials: MR
authors.lastname: Fisher
keywords: Diabetes; Health behavior; Intervention; Obesity; Prevention; School