Barriers and facilitators to implementation of direct fruit and vegetables provision interventions in kindergartens and schools: a qualitative systematic review applying the consolidated framework for implementation research (CFIR)

International Journal of Behavioral Nutrition and Physical Activity

Nanna Lien¹  Biljana Meshkovska¹  Marie Scheidmeir²  Janine Wendt³  Daniel A. Scheller³  Jan M. Stratil⁴  Hannah Jilani⁵ 

[1] Department of Nutrition, University of Oslo, Oslo, Norway;Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany;Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany;Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany;Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany;

关键词: Fruit;    Vegetables;    Intervention;    Implementation;    Barrier;    Facilitator;    Determinant;    Consolidated framework for implementation research;   

DOI  :  10.1186/s12966-022-01246-8

来源: Springer

【 摘 要 】

BackgroundAlthough children’s intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR).MethodsA systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR.ResultsThe following CFIR constructs were found relevant: 1) intervention characteristics domain: ‘design quality and packaging’, ‘adaptability’ ‘cost’; 2) outer setting: ‘cosmopolitanism’, ‘external policy and incentives’ ‘patients’ needs and resources’; 3) inner setting: ‘implementation climate’, ‘readiness for implementation’ and ‘structural characteristics’; 4) characteristics of individuals: ‘individual stage of change’, ‘knowledge and beliefs about the intervention’ 5) process: ‘engaging’, ‘executing’ and ‘reflecting and evaluating’. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts.ConclusionsCFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group.PROSPERO registrationCRD42020167697.

【 授权许可】

CC BY