Implementation Experiences of a School-Based Adolescent Nutrition Education Intervention: A Post-Intervention Qualitative Study Guided by Consolidated Framework for Implementation Research and the Social Ecological Model

Background/Objectives: School-based nutrition education provides a platform that could help in the promotion of healthy eating habits among adolescents. Nonetheless, information about the factors influencing the success of these interventions in low- and middle- income countries is still lacking. The objective of the study was to identify facilitators and barriers to effective implementation of school-based nutrition education by applying the Consolidated Framework for Implementation Research (CFIR) and interpreting findings across levels of the Social Ecological Model (SEM). Methods: A qualitative study was conducted after eight to ten weeks of nutrition education intervention in an urban school setting. Data were collected through two focus group discussions with sixteen students (eight students in each group), in-depth interviews with four teachers, six parents and key informant interviews with two school administrators. A semi-structured, CFIR- and SEM-based guide was used to conduct the data collection. Thematic analysis was conducted following Braun and Clarke’s six-phase approach, with deductive and inductive coding conducted independently by two researchers and reconciled through consensus. Results: Five themes were aligned with CFIR domains, including intervention characteristics, outer setting, inner setting, character of individuals, and implementation process. In general, the stakeholders agreed to the importance of relevance and contextualization of the intervention and the use of multi-mediums (classroom-based and online) to deliver the intervention, which they perceived to support improved knowledge of nutrition among adolescents. Implementation of the programme faced challenges arising from the incongruence between messages delivered in classrooms and those served in the school canteens, economic hurdles from home, cultural practices related to food consumption, social influence on peers and media, lack of time among staff, and largely passive parent participation. Conclusions: Nutrition education was perceived as inadequate on its own to support sustainable behaviour related dietary change. Factors that may influence whether nutrition messages can be translated into practice were identified by the study participants and include the school food environment (canteen), the development of the curriculum, policy integration, and shift in parental participation from passive learning to active collaboration.