A Mixed-Methods Comparison of Classroom Context During Food, Health & Choices, a Childhood Obesity Prevention Intervention

Abstract

Background: Schools are frequent settings for childhood obesity prevention; however, intervention results are mixed. Classroom context may hold important clues to improving these interventions.

Methods: We used mixed methods to examine classroom context during a curriculum intervention taught by trained instructors in fifth grade classrooms. We identified classrooms with high and low buy-in using cluster analysis and compared intervention delivery and reception, student energy balance-related behavior, and student perceptions about supports and barriers to energy balance.

Results: Delivery and reception did not differ between the groups. Between-group differences in unhealthy behaviors were smaller at posttest, due to improvement in low buy-in classes. Although student perceptions of supports and barriers to energy balance were similar across groups, students in high buy-in classes indicated food preferences as a support while students in low buy-in classes indicated food preferences as a barrier. Neighborhood environment emerged as a universal barrier.

Conclusions: Trained instructors may improve intervention delivery and reception regardless of classroom context. Social norms could explain high levels of unhealthy behavior in low buy-in classes at baseline; improvement at posttest suggests that the curriculum may have motivated change. All children need more strategies and supportive policies to overcome a challenging food environment.

Keywords: childhood obesity; energy balance; mixed methods; nutrition education.

Figure 1

Mixed Methods Study Flow Note. FHC=Food, Health & Choices Nutrition Science Curriculum Intervention, QUANT=Quantitative, QUAL=Qualitative, NYCDOE=New York City Department of Education

Figure 2

Lesson Activity Used to Collect Data about Student Recall of Food, Health & Choices (FHC) Energy Balance-related Behavior (EBRB) Goals and Supports and Barriers to Following These Goals

Figure 3

Relationship between Teacher Interest and Class Engagement During the Food, Health & Choices (FHC) Curriculum by Cluster Note. FHC= Food, Health & Choices Nutrition Science Curriculum Intervention. Each classroom is represented by a number. Clusters calculated using k-means, represented by rectangles (clusters included in comparative analysis) and ovals (clusters not included in comparative analysis). Class engagement and teacher interest data are from feedback forms (N=611) and are scored on 1–3 scale. Class engagement is the mean of student participation and student behavior for each class; teacher interest is the mean of teacher participation and teacher attitude for each class.