Abstract
Little is known about the role of organizational or administrative support in implementation of health promotion interventions, particularly outside of school settings. The purpose was to determine the change in fruit and vegetable (FV) intake among children living in residential children’s homes (RCHs) and assess the relationships among change in organizational support, intervention implementation, and child nutrition outcomes. Data were collected from 29 RCHs and 614 children living in RCHs, as part of a group randomized design with delayed intervention, at three cross-sectional waves: 2004, 2006, and 2008. RCH staff made environmental changes to increase intake of FV. Implementation and organizational support data were collected from staff at the RCHs. Child FV intake were measured via 24-h dietary recalls. A two-way (condition by time) repeated measures ANOVA was conducted to test whether FV intake increased in response to the intervention. A two-level path analysis with a robust maximum likelihood estimator was used to explore the relationships among organizational support, intervention implementation fidelity, and child FV intake. There was a significant increase in FV intake within all RCHs from 2004 to 2006 (P = 0.022 for the intervention group, P = 0.015 for the control group). This increase was maintained in both groups from 2006 to 2008 (post-intervention mean servings: intervention = 3.2 vs control = 3.4). Increases in organizational support resulted in greater overall implementation fidelity. When RCH staff, supervisors, and the RCH CEO were perceived to be supportive of the intervention, more environmental changes were made to encourage eating FV. Fostering organizational support may improve implementation of interventions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Baranowski, T., & Stables, G. (2000). Process evaluations of the 5-a-day projects. Health Education and Behavior, 27(2), 157–166. https://doi.org/10.1177/109019810002700202.
Baxter, S. D., Thompson, W. O., Litaker, M. S., Guinn, C. H., Frye, F. H., Baglio, M. L., & Shaffer, N. M. (2003). Accuracy of fourth-graders’ dietary recalls of school breakfast and school lunch validated with observations: in-person versus telephone interviews. Journal of Nutrition Education and Behavior, 35(3), 124–134.
Berta, W., Cranley, L., Dearing, J. W., Dogherty, E. J., Squires, J. E., & Estabrooks, C. A. (2015). Why (we think) facilitation works: insights from organizational learning theory. Implementation Science, 10, 141. https://doi.org/10.1186/s13012-015-0323-0.
Birken, S. A., Lee, S. Y., Weiner, B. J., Chin, M. H., & Schaefer, C. T. (2013). Improving the effectiveness of health care innovation implementation: middle managers as change agents. Medical Care Research and Review, 70(1), 29–45. https://doi.org/10.1177/1077558712457427.
Cohen, D. A., Scribner, R. A., & Farley, T. A. (2000). A structural model of health behavior: a pragmatic approach to explain and influence health behaviors at the population level. Preventive Medicine, 30, 146–154.
Dominick, G. M., Saunders, R. P., Dowda, M., Kenison, K., & Evans, A. E. (2014). Effects of a structural intervention and implementation on physical activity among youth in residential children’s homes. Evaluation and Program Planning, 46, 72–79. https://doi.org/10.1016/j.evalprogplan.2014.05.011.
Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3–4), 327–350. https://doi.org/10.1007/s10464-008-9165-0.
Evans, A., Dowda, M., Saunders, R., Buck, J., Hastings, L., & Kenison, K. (2009). The relationship between the food environment and fruit and vegetable intake of adolescents living in residential children’s homes. Health Educ.Res., 24(3), 520–530.
Foster, G. D., Sherman, S., Borradaile, K. E., Grundy, K. M., Vander Veur, S. S., Nachmani, J., et al. (2008). A policy-based school intervention to prevent overweight and obesity. Pediatrics, 121(4), e794–e802. https://doi.org/10.1542/peds.2007-1365.
Kelder, S. H., Mitchell, P. D., McKenzie, T. L., Derby, C., Strikmiller, P. K., Luepker, R. V., & Stone, E. J. (2003). Long-term implementation of the catch physical education program. Health Education and Behavior, 30(4), 463–475. https://doi.org/10.1177/1090198103253538.
Kristal, A., & Satia, J. (2001). Evaluation of nutrition interventions. In A. Coulston, C. Rock, & E. Monsen (Eds.), Nutrition in the treatment and prevention of disease. San Diego, CA: Academic Press.
Lau, E. Y., Saunders, R. P., & Pate, R. R. (2016). Factors influencing implementation of a physical activity intervention in residential children’s homes. Prevention Science, 17(8), 1002–1011. https://doi.org/10.1007/s11121-016-0692-x.
McBride, N. (2000). The Western Australian School Health Project: comparing the effects of intervention intensity on organizational support for school health promotion. Health Education Research, 15(1), 59–72. https://doi.org/10.1093/her/15.1.59.
Moore, L. V., Thompson, F. E., & Demissie, Z. (2017). Percentage of youth meeting federal fruit and vegetable intake recommendations, youth risk behavior surveillance system, United States and 33 States, 2013. Journal of the Academy of Nutrition and Dietetics, 117(4), 545–553.e543. https://doi.org/10.1016/j.jand.2016.10.012.
Muthen, L. K., & Muthen, B. O. (2007). Mplus user’s guide. Los Angeles, CA: Muth‚n & Muth‚n.
Rhoades, L., & Eisenberger, R. (2002). Perceived organizational support: a review of the literature. Journal of Applied Psychology, 87(4), 698–714.
Saunders, R. P., Evans, A. E., Kenison, K., Workman, L., Dowda, M., & Chu, Y. H. (2013). Conceptualizing, implementing, and monitoring a structural health promotion intervention in an organizational setting. Health Promotion Practice, 14(3), 343–353. https://doi.org/10.1177/1524839912454286.
Saunders, R. P., Evans, M. H., & Joshi, P. (2005). Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promotion Practice, 6(2), 134–147.
Scaccia, J. P., Cook, B. S., Lamont, A., Wandersman, A., Castellow, J., Katz, J., & Beidas, R. S. (2015). A practical implementation science heuristic for organizational readiness: R = Mc2. Journal of Community Psychology, 43(4), 484–501. https://doi.org/10.1002/jcop.21698.
Steckler, A., & Linnan, L. (2002). Process evaluation for public health interventions and research: An overview. In Process Evaluation for Public Health Interventions and Research (Vol. 1st) (pp. 1–23). San Francisco: Jossey-Bass.
Stevens, J., Murray, D. M., Catellier, D. J., Hannan, P. J., Lytle, L. A., Elder, J. P., et al. (2005). Design of the Trial of Activity in Adolescent Girls (TAAG). Contemporary Clinical Trials, 26(2), 223–233. https://doi.org/10.1016/j.cct.2004.12.011.
Thapa, A., Cohen, J., Guffey, S., & Higgins-D’Alessandro, A. (2013). A review of school climate research. Review of Educational Research, 83(3), 357–385. https://doi.org/10.3102/0034654313483907.
United States House of Representatives. (2004). Child Nutrition and WIC Reauthorization Act of 2004, Public Law 108–4981.
Varkey, P., & Antonio, K. (2010). Change management for effective quality improvement: a primer. American Journal of Medical Quality, 25(4), 268–273.
Wanless, S. B., Patton, C. L., Rimm-Kaufman, S. E., & Deutsch, N. L. (2013). Setting-level influences on implementation of the responsive classroom approach. Prevention Science, 14(1), 40–51. https://doi.org/10.1007/s11121-012-0294-1.
Funding
This article is based on work supported by The Duke Endowment.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human Rights
All procedures and data collection methods were approved by the Institutional Review Board at the authors’ institution and the individual residential children’s homes. Informed consent was documented for minor children by residential children’s home staff.
Welfare of Animals
This article does not contain any studies with animals performed by any of the authors.
Disclaimer
Any opinions, findings, conclusions, or recommendations contained herein are those of the authors and do not necessarily reflect the views of The Duke Endowment.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gay, J.L., Saunders, R.P., Rees-Punia, E. et al. Role of Organizational Support on Implementation of an Environmental Change Intervention to Improve Child Fruit and Vegetable Intake: a Randomized Cross-Over Design. Prev Sci 20, 1211–1218 (2019). https://doi.org/10.1007/s11121-019-01043-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-019-01043-z