Implementation and evaluation of a tri-state school-based multimodal obesity prevention initiative

Background: School-based interventions play a crucial role in ameliorating childhood obesity. Grounded in the coordinated school health model (CSHM), the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) Initiative aims to promote wellness in schools in order to mitigate rising rates of childhood obesity. Purpose: Evaluators assessed each school's progress in implementing HEROES key components. Supports and barriers for implementation were identified to provide recommendations for strengthening implementation. Significance: HEROES serves as a model CSHM program, and this study provides a valuable framework for evaluation. Given the large-scale nature of HEROES, evaluation results may be generalizable to school systems in other locales. Methodology: Site visits were conducted at each of 22 schools to assess the extent to which each implemented the initiative. A comprehensive site visit protocol was used to examine each facet of the implementation process and to calculate an overall implementation score for each school. The protocol included several interviews and observational indices at each site. Findings/Results: Implementation of HEROES varied between schools, especially in regards to their abilities to increase physical activity opportunities, access to healthy foods, and staff wellness events. Elementary schools more successfully implemented several domains of the model and garnered school-level support from a variety of stakeholders. Conclusions/Recommendations: Implementation of multimodal obesity prevention programs in schools relies heavily on the support of administrators and the ability to leverage broad-based involvement from essential stakeholder groups. These efforts can be supported through technical assistance, financial support, and networking among participating schools.