A Systems Approach Helps Explain Significant Improvements in Local Wellness Policies Among SNAP-Ed-Supported School Districts.

OBJECTIVE: To assess changes in written local wellness policies (LWPs) across time within Supplemental Nutrition Assistance Program Education (SNAP-Ed)-participating districts. DESIGN: Sequential, explanatory mixed methods. SETTING: From October 1, 2015 to September 30, 2016, SNAP-Ed agencies submitted LWPs from partner school districts in Arizona. They received back scores and customized recommendations. To assess changes, LWPs were rescored between October 1, 2017 and September 30, 2018. PARTICIPANTS: Sixteen local SNAP-Ed agencies worked with 57 districts. INTERVENTIONS: Districts' LWP revisions supported by SNAP-Ed agencies during the 2-year pre-post period. MAIN OUTCOME MEASURES: Policy comprehensiveness and strength from 0 (worst) to 100 (best), measured by the Wellness School Assessment Tool. ANALYSIS: Paired t test to compare pre-post scores. Content analysis of State Educational Agency administrative reviews and thematic analysis of SNAP-Ed narrative reports to explore causation. RESULTS: Total scores increased (comprehensiveness: +12.4, P < .001, 95% confidence interval, 8.1-16.7; strength: +13.5, P < .001, 95% CI, 9.3-17.7). Improvements were also found for comprehensiveness by section, except Nutrition Education, and for strength across all sections. Qualitative findings suggest that SNAP-Ed interventions combined with state and federal influence contributed to the improvements. CONCLUSIONS AND IMPLICATIONS: Local wellness policies in SNAP-Ed-supported districts improved over time. State and federal LWP guidelines can work synergistically with SNAP-Ed interventions to influence improvements.

A Case Study of a New State Model for Assessing Local Wellness Policies.

BACKGROUND: In 2016, the United States Department of Agriculture issued a final rule to strengthen local wellness policies (LWPs). As school districts pursue compliance, states can provide critical guidance by leveraging support from intermediary programs such as the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). After Arizona SNAP-Ed piloted a statewide model for assessing LWPs, we evaluated that model by exploring local SNAP-Ed agency experiences with the pilot. Our case study objectives were to determine the model's feasibility and utility from the perspective of local agencies supporting school districts during LWP review and revision. METHODS: We used open-ended semistructured interviews with the 13 local SNAP-Ed agencies who engaged in each LWP assessment phase and analyzed data using constant comparative analysis. RESULTS: Participants found the model feasible and useful. Five themes emerged, 3 of which tracked strongly with successful LWP review and revision: local agency staff comprehension, the openness of local agency staff and district/school personnel to the process, and the local agency's engagement of the district/school throughout the process. CONCLUSIONS: Leveraging local agency support can be an effective strategy to improving LWPs, given understanding, buy-in, and staff engagement. Findings can inform agencies seeking to engage intermediaries in LWP assessment and revision.

Reliability of a Kid's Activity and Nutrition Questionnaire for School-Based SNAP-Ed Interventions as Part of a Tiered Development Process.

OBJECTIVE: To assess the reliability of the Kids' Activity and Nutrition Questionnaire (KAN-Q) as part of a tiered process for developing Supplemental Nutrition Assistance Program-Education tools. METHODS: The KAN-Q was administered at 2 time points to assess internal consistency using standardized values of Cronbach α and test-retest reliability using the intraclass correlation coefficient for continuous variables, Cohen's kappa (κ) statistic for categorical variables, and the weighted κ statistic for ordinal data. RESULTS: Data were collected from 119 fourth graders. Cronbach α was adequate for behavior (.71) and knowledge (.72) scales and nutrition behavior (.78) and nutrition knowledge (.75) subscales. Test-retest reliability was generally acceptable, with intraclass correlation coefficients from 0.40 to 0.75 and κ coefficients showing fair to substantial agreement (0.30 to 0.72). CONCLUSIONS AND IMPLICATIONS: The KAN-Q is a practical and reliable questionnaire for school-based administration that aligns directly with Supplemental Nutrition Assistance Program-Education evaluation priorities.

Using learning theory, interprofessional facilitation competencies, and behavioral indicators to evaluate facilitator training.

Despite the increasing need for faculty and preceptors skilled in interprofessional facilitation (IPF), the relative novelty of the field poses a challenge to the development and evaluation of IPF programs. We use learning theory and IPF competencies with associated behavioral indicators to develop and evaluate six key messages in IPF training and experience. Our mixed methods approach included two phases: quantitative data collection with embedded qualitative data, followed by qualitative data collection in explanatory sequential fashion. This enabled triangulated analyses of both data types and of facilitation behaviors from facilitator and student perspectives. Results indicate the competency-based training was effective. Facilitators felt comfortable performing behaviors associated with IPF competencies; student observations of those behaviors supported facilitator self-reported performance. Overall, students perceived more facilitation opportunities than facilitators. Findings corroborate the importance of recruiting seasoned facilitators and establishing IPF guidelines that acknowledge variable team dynamics and help facilitators recognize teachable moments.