School participation in a health behavior program: qualitative perspectives from schools that did and did not adopt the iAmHealthy program.

Background: Childhood overweight/obesity in rural areas is a public health concern. Schools provide access to youth/families for health behavior programming but have adoption challenges.

Purpose: To explore school adoption of a family-based behavioral obesity program (iAmHealthy) from the perspective of three groups: (i) schools adopting iAmHealthy ("adopters"; took part in the iAmHealthy program), (ii) schools failing to adopt iAmHealthy ("initial adopters"; initially signed up for the iAmHealthy program, but could not continue), and (iii) schools that did not adopt iAmHealthy ("non-adopters"; never signed up for the iAmHealthy program).

Methods: Semi-structured interviews were conducted with rural school representatives (N = 33; n = 12 adopters, n = 9 initial adopters, and n = 12 non-adopters). Interviews were analyzed thematically and aligned with constructs and domains from the Consolidated Framework for Implementation Research (CFIR).

Results: Five themes emerged: (i) Regardless of the extent of healthy lifestyle programming schools offered, iAmHealthy would not compete and would benefit families, (ii) School representatives perceived a varied need for healthy behavior programming but challenges regarding limited resources were widespread, (iii) Partially due to concerns about stigma, school representatives preferred school-wide approaches that included integration with the curriculum and the community, (iv) School representatives considered many factors when deciding to participate in a health behavior program, and (v) School representatives expressed concerns about health behavior programming not being a priority for families. CFIR constructs within the domains of innovation, inner setting, outer setting, and individual characteristics aligned with the themes. Specifically, commonly cited barriers often aligned with the CFIR constructs of relative priority and local attitudes.

Conclusion: Findings indicate health behavior programming would fill an unmet need, but that there are adoption barriers, including limited resources, weight-related stigmatization concerns, and differing priorities across schools, communities, and families.