RE-AIM analysis of a community-partnered policy, systems, and environment approach to increasing consumption of healthy foods in schools serving low-income populations

Abstract

Prevalences of childhood overweight and obesity represent major public health concerns. School-based policy strategies represent one approach to increasing access to healthy foods; however, overall health impact of such initiatives is often overlooked. We undertook program evaluation of a school wellness policy focused approach in low-income, multiracial communities in southeast Los Angeles. We convened groups of key stakeholders including superintendents, principals, teachers, school staff, and parents to prioritize school-level implementation of wellness policy items to improve access to healthy foods, including healthier classroom celebrations. The purpose is to synthesize these findings within the RE-AIM framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to describe cumulative impact of this health system-led community-partnered effort to promote healthy eating throughout the school day. We evaluated reach by comparing students reached by the intervention relative to the eligible population. We assessed effectiveness by examining changes in nutrition in wellness policy quality and after school program practices pre- and post-intervention interviews). We evaluated adoption by comparing sites that approved participation in the intervention and its evaluation versus completing evaluation assessments. We evaluated implementation as the number of schools convening a wellness council. Finally, we examined maintenance by evaluating changes in wellness policy and afterschool practices for those sites with pre- and post-test assessment. We reached 43.5% of the priority student population. We noted improvement in wellness policy quality and after school practices pre- to post-intervention (effectiveness). We found that 42.9% of after school programs completed the assessment while 40.0% of school districts triggered a post-intervention wellness policy evaluation (adoption). Eleven of 19 schools convened wellness councils (implementation) while in the subset of sites that completed pre- and post-test evaluation some improvements were noted (maintenance). We use this application of the REAIM framework to extract lessons learned from districts and after school programs that participated throughout the grant period. Through our partnership with schools we learned that our program evaluation filled an information gap for districts working to meet USDA's wellness policy requirement. Finally, while the wellness policy is an important lever in striving towards health equity in districts disproportionately impacted by obesity, additional policy, system, and environmental approaches are required to build a culture of health.

Keywords: Health promotion; Medically underserved; Obesity prevention; Program evaluation; RE-AIM model.