title: Factors associated with the implementation of a vegetable and fruit program in a population of Australian elementary schools.
abstract: Implementation of vegetable and fruit programs in schools is less than optimal. This study aimed to identify, using a theoretical framework, factors associated with implementation of a school vegetable and fruit program; that provides a time in class for children to consume a piece of vegetable or fruit they have brought from home. Three hundred and three randomly selected school principals across the state of New South Wales, Australia responded to a 25-min telephone survey. Principals were asked if their school had implemented a vegetable and fruit program, and which of 12 factors from Damschroder's consolidated framework for implementation research had facilitated or impeded implementation. Multiple logistic regression models examined the association between such factors and program implementation. Seventy-eight percent of schools had a vegetable and fruit program. Schools were significantly more likely to implement the program if the principal believed that: the program was effective (OR = 2.97; P < 0.02); they had sufficient resources to implement the program (OR = 4.22; P < 0.0001); the program would not be difficult to implement (OR = 10.16; P< 0.0001) and that the program was as important as other school priorities (OR = 2.45; P < 0.02). Realizing the intended benefits of vegetable and fruit programs requires widespread implementation by schools. Consideration of principal beliefs about the program effectiveness, resources, difficultly and relative importance in program implementation strategies appear key to increasing program implementation.
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Nathan
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Wiggers
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Wyse
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Williams
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Sutherland
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Yoong
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Lecathelinais
authors.affiliation: Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia.|Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia.|Hunter Medical Research Institute, Newcastle, NSW 2300, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Wolfenden
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005638:Fruit; D006293:Health Promotion / Q000379:methods*; D006295:Health Resources; D006801:Humans; D008297:Male; D009517:New South Wales; D015397:Program Evaluation; D012574:Schools / Q000706:statistics & numerical data*; D014675:Vegetables