title: A mixed-methods exploration of implementation of a comprehensive school healthy eating model one year after scale-up.
abstract: OBJECTIVE
  To study the implementation of a school-based healthy eating (HE) model one year after scale-up in British Columbia (BC). Specifically, to examine implementation of Action Schools! BC (AS! BC) and its influence on implementation of classroom HE activities, and to explore factors associated with implementation.
  
  
  METHODS
  Diffusion of Innovations, Social Cognitive and Organizational Change theories guided our approach. We used a mixed-methods research design including focus group interviews (seven schools, sixty-two implementers) and a cross-sectional multistage survey to principals (n 36, 92 % response rate) and teachers of grades 4 to 7 (n 168, 70 % response rate). Self-reported implementation of classroom HE activities and reported use of specific AS! BC HE activities were primary implementation measures. Thematic analysis of focus group data and multilevel mixed-effect logistic regression analyses of survey data were conducted.
  
  
  METHODS
  Elementary schools across BC, Canada.
  
  
  METHODS
  Thirty-nine school districts, thirty-six principals, 168 grade 4 to 7 teachers.
  
  
  RESULTS
  Forty-two per cent of teachers in registered schools were implementing AS! BC HE in their classrooms. Users were 6·25 times more likely to have delivered a HE lesson in the past week. Implementation facilitators were school champions, technical support and access to resources; barriers were lack of time, loss of leadership or momentum. Implementation predictors were teacher training, self-efficacy, experience with the physical activity component of AS! BC, supportive school climate and parental post-secondary education.
  
  
  CONCLUSIONS
  Our findings reinforce that continued teacher training and support are important public health investments that contribute to successful implementation of school-based HE models after scale-up.
authors.affiliation: 1School of Exercise Science,Physical and Health Education,University of Victoria,Box 3015,STN CSC,Victoria,BC V8W 3P1,Canada.
authors.forename: Patti-Jean
authors.initials: PJ
authors.lastname: Naylor
authors.affiliation: 2Department of Family Practice and Department of Orthopedics,Centre for Hip Health and Mobility,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Heather A
authors.initials: HA
authors.lastname: McKay
authors.affiliation: 3Department of Pediatrics and School of Population and Public Health,Centre for Community Child Health Research,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Valente
authors.affiliation: 3Department of Pediatrics and School of Population and Public Health,Centre for Community Child Health Research,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Mâsse
mesh_terms: D000293:Adolescent; D001955:British Columbia; D002648:Child; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy; D005069:Evaluation Studies as Topic; D015444:Exercise; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010865:Pilot Projects; D012574:Schools; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Healthy eating; Implementation; Scale-up; School-based