Date of Award

2021

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Michelle Nichols

Second Advisor

Susan D. Newman

Third Advisor

Robert N. Stevens

Abstract

Purpose: This dissertation explores the perceptions and experiences of South Carolina (SC) public school administrators and personnel regarding barriers and facilitators to school-based interventions, with a focus on physical activity (PA) and healthy eating behaviors, to address childhood obesity. An integrative review was completed to identify challenges and supports to school-based weight management interventions.1-35 Findings from the integrative review provided the framework for the dissertation study, which used a concurrent multi-methodological design to investigate the barriers and facilitators regarding awareness, selection, and implementation of school-based interventions addressing PA and healthy eating behaviors in the SC education system and to examine how the coronavirus disease 2019 (COVID-19) pandemic affected these interventions. Problem: In SC, approximately 37% of children and adolescents are overweight or obese, and the state ranks 3rd in the nation for the number of youth ages 10-17 who are obese.36,37 Behaviors that lead to excess weight gain include inadequate participation in PA and consumption of high-calorie, low-nutrient foods.38 Substantial negative health outcomes are associated with obesity, including increased rates of chronic illnesses, diminished quality of life, and shorter life span.38-42 Childhood obesity is also linked to psychological and social problems, such as anxiety, depression, and stigmatization.38,43,44 School-based weight management interventions have successfully improved PA and eating behaviors; however, not all schools offer these types of interventions and some interventions are not implemented to their fullest extent.45-49 It is important to understand the factors that hinder and promote the delivery of school-based interventions. The following research question guided the study: What do public school administrators and personnel in South Carolina perceive and experience as barriers and facilitators regarding awareness, selection, and implementation of school-based interventions addressing physical activity and healthy eating behaviors? The specific aims of the dissertation were: • Aim 1: Describe actual and perceived barriers and facilitators public school administrators and personnel in South Carolina encounter regarding awareness, selection, and implementation of school-based physical activity and healthy eating interventions. ‒ Aim 1a. Identify actual and perceived concerns and experiences within school settings regarding the use of weight-related terminology and any stigma that may exist. ‒ Aim 1b. Assess ability to recruit and engage public school administrators and personnel in South Carolina to participate in an exploratory study on school-based interventions. • Aim 2: Identify greatest challenges and supports, priority focal areas, and school-based interventions that have been implemented along with their outcomes. Design: A concurrent multi-methodological study, informed by the Social Ecological Model (SEM)50-54 and the Steps in Quality Intervention Development (6SQuID) Model,55,56 was completed to form a comprehensive understanding of the phenomena.57,58 The qualitative descriptive component included one-time Key Informant Interviews (KIIs) with SC public school administrators. The quantitative descriptive component involved conducting a needs assessment survey of SC public school personnel. Findings: KII participants (N = 28) reported that negative beliefs, comments, and bullying behaviors were more prevalent toward students perceived as being overweight. School administrators also indicated that school-based interventions addressing PA and healthy eating behaviors were present in schools. Participants identified insufficient time as the main barrier and adequate support as the primary facilitator to school-based interventions. These factors inhibited or enhanced intervention implementation, based on the extent to which they were present. Survey respondents (N = 1311) reported the foremost barriers as insufficient time for PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating behaviors (n = 271, 20.7%). The key facilitators were adequate support from school-level administrators for PA (n = 264, 20.1%) and adequate support from cafeteria staff for healthy eating behaviors (n = 234, 17.8%). Both interview and survey participants described the COVID-19 pandemic as causing changes in school-based interventions addressing PA and healthy eating behaviors and in academic delivery impacting PA and healthy eating behaviors. Responses revealed that schools’ abilities to address PA and healthy eating behaviors were negatively affected by COVID-19, and the pandemic was predicted to disrupt future school-based interventions related to PA and healthy eating behaviors. Conclusions: Information from this dissertation provides the foundation for future studies on mitigating barriers and maximizing facilitators to school-based interventions addressing PA and healthy eating behaviors, with the ultimate goal of decreasing rates of childhood obesity. Additionally, findings may help school systems to adapt school-based interventions to changes from the COVID-19 pandemic so that students can still receive and benefit from content on healthy lifestyle practices.59,60 A promising opportunity for interprofessional collaboration exists for health care and education professionals to work together on school-based interventions that address students’ health and academic needs.

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