title: Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.
abstract: Ecological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity.
  
  
  
  A total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized.
  
  
  
  Respondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community.
  
  
  
  Project leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts.
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr South, Los Angeles, California 90095-1772. Email: emchuang@ucla.edu.
authors.forename: Emmeline
authors.initials: E
authors.lastname: Chuang
authors.affiliation: Los Angeles, Fielding School of Public Health, Los Angeles, California.
authors.forename: Julian
authors.initials: J
authors.lastname: Brunner
authors.affiliation: San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California.
authors.forename: Jamie
authors.initials: J
authors.lastname: Moody
authors.affiliation: Clínicas de Salud del Pueblo, Inc., Brawley, California.
authors.forename: Leticia
authors.initials: L
authors.lastname: Ibarra
authors.affiliation: San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California.
authors.forename: Helina
authors.initials: H
authors.lastname: Hoyt
authors.affiliation: San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: McKenzie
authors.affiliation: Imperial County Public Health Department, El Centro, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Binggeli-Vallarta
authors.affiliation: San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California.
authors.forename: Griselda
authors.initials: G
authors.lastname: Cervantes
authors.affiliation: San Diego State University Research Foundation, Institute for Behavioral and Community Health, and San Diego State University, Graduate School of Public Health, San Diego, California.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Finlayson
authors.affiliation: San Diego State University Research Foundation, Institute for Behavioral and Community Health, and San Diego State University, College of Health and Human Services, San Diego, California.
authors.forename: Guadalupe X
authors.initials: GX
authors.lastname: Ayala
mesh_terms: D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D010290:Parents; D063766:Pediatric Obesity / Q000517:prevention & control*; D016730:Program Development / Q000592:standards*; D012111:Residence Characteristics; D012574:Schools