Well Wisconsin: A Mixed-Methods Study of Statewide School Wellness Efforts to Prevent Childhood Obesity

Introduction: In Wisconsin, nearly 15% of children are obese (Joyner et al., 2018) and nationwide, childhood overweight and obesity continues to climb (Skinner et al., 2018), signifying an immediate need for policies that prevent obesity. In 2016, the Healthy Hunger Free Kids Act Final Rule was enacted that required changes to school wellness policies (SWP). SWP are a set of district-level practices that govern nutrition and physical activity for students during the school day and are required if a district participates in federal child nutrition programs. The purpose of this mixed-methods study was to examine change in Wisconsin SWP quality prior to and following the enactment of the HHFK Act Final Rule. We also present themes related to policy improvement derived from interviews with districts that made positive policy changes after the Final Rule.

Methods: Wisconsin SWP were evaluated in two Waves. Wave I policies were collected during the 2016 – 2017 academic year and reflect those policies written prior to the Final Rule. Wave II policies were collected during the 2017 – 2018 academic year and included SWP updated after the Final Rule enactment. Policy quality was evaluated using a well-validated quantitative coding scheme (Schwartz et al., 2009), and assessed for comprehensiveness, or the extent to which obesity-prevention best practices were included in the policy, and strength, or the extent to which best practices were required. Researchers reached interrater reliability prior to coding independently. After completing the quantitative analysis, 20 districts with the highest strength change scores were invited to interview about their wellness efforts including the processes by which districts made change, encountered obstacles, and implemented policies. Framework analysis (Gale, et al., 2013) was utilized to discover themes related to policy improvement.

Results: In Wave I, we received 399 (90.3%) SWP. In Wave II, 232 (52.5%) districts updated their policies, 182 (41.2%) did not, and 28 (6.3%) did not respond. From Wave I to Wave II, SWP quality significantly increased in both comprehensiveness, t(215) = -9.33, p<.001, d = 0.80, and strength, t(215) = -10.85, p<.001, d = 0.98. Data regarding changes to specific obesity prevention practices are also provided. Local dissemination activities included individualized district reports, interactive online data dashboards, and collaboration with various local government offices to leverage data for interventions and grant opportunities. Findings from interviews with school professionals revealed that having diverse wellness committee representation, focusing on staff wellness, and garnering buy-in from the school community all led to positive policy change. District staff reported staff resistance to change and competing school priorities as barriers to the policy improvement process.

Conclusions: Policy strength and comprehensiveness increased among districts that updated their policy after the enactment of a federal mandate that expanded policy requirements. Improvements were not shared equally among districts in Wisconsin. Districts that showed the greatest improvement provided lessons learned to improve policy strength and implementation in other districts.