School community readiness for policy, system, and environment change implementation and its implications for nutrition interventions and student behaviors

Background: Childhood obesity is a significant public health issue with adverse health and economic impacts. In the United States, the prevalence of childhood obesity has more than tripled since the 1970s, likely due to multifactorial causes. The Social Ecological Model (SEM) guides obesity prevention initiatives, emphasizing the influence of individual, social, cultural, economic, and environmental factors. Oklahoma State University’s Community Nutrition Education Programs (CNEP) aim to improve health through direct nutrition education and policy, system, and environmental (PSE) interventions. Despite these efforts, Oklahoma remains among the unhealthiest states, possibly due to a lack of readiness for change in communities. This study assessed how an elementary school community’s readiness for PSE implementation affected the extent of nutrition PSE interventions and changes in students’ nutrition behaviors. Methods: Recruitment began for this quasi-experimental study in spring 2023, targeting Oklahoma elementary schools participating in CNEP’s 3rd-4th grade direct education. Inclusion criteria for schools required an OSU CNEP paraprofessional to provide direct education and students to complete pre- and post-surveys regarding nutrition behaviors. Eleven schools were recruited, with four schools completing all program requirements. Four control schools were selected based on demographics similar to those of the completing schools. The Organizational Readiness for Implementing Change (ORIC) instrument measured readiness. Statistical analysis included independent t-tests to compare readiness scores between schools that completed the project and those that did not and regression analysis to explore the relationship between readiness scores and project completion. Paired t-tests assessed changes in readiness scores between pre- and post-intervention, and independent t-tests compared student nutrition behaviors between intervention and control schools. Results: Findings indicated no significant relationship between school readiness, intervention implementation, and student nutrition behaviors. Conclusions: This study highlights the complexity of implementing wellness initiatives in school settings and underscores the need to explore further factors influencing PSE intervention success and student nutrition behavior outcomes.