title: "Reforms Looked Really Good on Paper": Rural Food Service Responses to the Healthy, Hunger-Free Kids Act of 2010.
abstract: BACKGROUND
  The Healthy, Hunger-Free Kids Act of 2010 (HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes.
  
  
  METHODS
  Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data.
  
  
  RESULTS
  Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference.
  
  
  CONCLUSIONS
  Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success.
authors.affiliation: School of Health, Physical Education, & Leisure Services, University of Northern Iowa, Cedar Falls, IA. disa.cornish@uni.edu.
authors.forename: Disa
authors.initials: D
authors.lastname: Cornish
authors.affiliation: Department of Community and Behavioral Health, University of Iowa, Iowa City, IA. natoshia-askelson@uiowa.edu.
authors.forename: Natoshia
authors.initials: N
authors.lastname: Askelson
authors.affiliation: Public Policy Center, University of Iowa, Iowa City, IA. elizabeth-golembiewski@uiowa.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Golembiewski
mesh_terms: D000288:Administrative Personnel / Q000523:psychology*; D001294:Attitude to Health; D005522:Food Services / Q000458:organization & administration* / Q000592:standards; D019983:Guideline Adherence; D006293:Health Promotion / Q000379:methods; D006801:Humans; D018673:Nutrition Policy; D009765:Obesity / Q000517:prevention & control; D019035:Rural Health Services / Q000458:organization & administration; D012574:Schools / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States
keywords: nutrition & diet; policy change; rural schools; school food services