Process Evaluation of a Policy, Systems, and Environmental Change Intervention in an Urban School District

Objective: To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention. Design: Quasi-experimental, mixed methods. Setting: Low-income urban school district. Participants: Fifth-grade students in 4 schools assigned to 2 intervention and 2 comparison schools (intervention, n = 142; comparison, n = 170). Intervention: Both groups received a nutrition curriculum delivered by classroom teachers. Intervention schools also received 10 PSE lessons taught by paraprofessional educators. Main Outcome Measures: Quantitative data were obtained from fidelity and observation checklists, grading rubrics and self-reported student surveys. Focus group and interviews provided qualitative data. Quantitative measures included assessments of PSE and fruit and vegetable knowledge, as well as assessment of times fruits and vegetables (FV) were consumed yesterday. Analyses: Qualitative data were analyzed using inductive content analysis. Quantitative data were analyzed using repeated measures analysis of variance and analysis of co-variance. Results: Fidelity, dose, reach, and acceptance of PSE intervention were high; students felt more empowered, although PSE lessons were considered lengthy and complicated. Intervention PSE and FV knowledge scores were significantly higher than comparison scores (F-37.56, P < .001; and F-3.94, P < .05, respectively). However, issues in communication were identified between school staff and researchers. Conclusions and Implications: Policy, systems, and environmental classroom interventions commented on the differences between quantitative and qualitative assessments, and this suggests the need for more sensitive quantitative assessments. Future research should look at long-term outcomes as this study only looked at short-term outcomes.