Increasing the Potential Effectiveness of Universal School Meals through Community- Engaged Implementation Mapping: A Qualitative Case Study.

INTRODUCTION: Universal School Meals (USM) serve as a first line of defense for students facing hunger in marginalized communities. Despite this, school meal uptake remains low across the district due to several barriers in the inner and outer school setting. Community- and school-led interventions and strategies are an underutilized approach for enhancing USM implementation and student uptake but may yield a more sustainable impact on addressing food insecurity. The aims of this study are to 1) engage in a structured implementation mapping process with a diverse array of school and district representatives grounded in implementation science and health equity frameworks, and 2) understand the key constraints and supports of implementation mapping from the lens of policy implementers and recipients.

METHODS: We recruited 4 schools (2 intervention, 2 waitlist) to engage in the mapping process. Meetings covered tasks 1-4: steps 1) needs assessment, 2) identify target objectives, 3) select strategies for enhancement, and 4) prepare an implementation plan over 4-5 planning meetings in partnership with school food service, students, parents, and teachers, and administrators of each school. Transcripts were deductively coded using the Exploration, Preparation, Implementation and Sustainment (EPIS) and Getting to Equity (GTE) frameworks and inductively by the research team.

RESULTS: We engaged 19 participants across the 2 intervention schools (3 teachers, 2 food service, 2 parents, 2 administrators, 10 students). Data from the mapping meetings were primarily coded to Culture from the EPIS framework and Increase Healthy Options from the GTE framework. Code relations analysis between both frameworks highlighted factors such as school and district operations and social drivers of health among school communities impacting equitable USM implementation. Thematic coding yielded four primary themes: Infrastructure/Material Barriers, Communication, Stigma & Social Drivers, and Autonomy & Decision Making. These themes highlight the facilitators and barriers to implementation, mapping, and changing school meals on a systems level.

CONCLUSION: Engaging school and district partners is an essential step for building lasting changes in the health of underrepresented communities. We successfully engaged a group of representatives to facilitate implementation mapping and implementation strategy development. This is one example of how community-partnered research can be leveraged to potentially facilitate change in school systems.

REGISTRATION: ClinicalTrials.gov, NCT06579079, Registered on 07082024.