Federal legislation mandated that school systems receiving federal funding have a local wellness policy (LWP) in place beginning in July 2006 (Child Nutrition and WIC Reauthorization Act, 2004). In 2010, the Healthy, Hunger-Free Kids Act (HHFKA) further required that LWPs emphasize implementation, increase community/parent engagement, and improve transparency through public monitoring and reporting (Healthy Hunger-Free Kids Act, 2010). This was reinforced by an HHFKA final rule released in 2016, which requires participating schools to meet expanded LWP requirements beginning in 2017 (Food and Nutrition Service, U.S. Department of Agriculture, 2016).

Local wellness policies are integral to improving health and wellness in schools. LWPs can contribute to the prevention of childhood obesity (Agron, Berends, Ellis, & Gonzalez, 2010) as children spend a significant part of their day in schools. Child health has been linked to school food and physical activity environments. For example, access to à la carte snacks and vending machines not only have an inverse association with fruit/vegetable consumption, and a positive association with fat intake (Kubik, Lytle, Hannan, Perry, & Story, 2003) but also have been associated with higher body mass index among elementary school students (Fox, Dodd, Wilson, & Gleason, 2009). Additionally, targeted wellness programming in schools has been shown to increase time spent in physical activity, without deterring from academics (Bublitz & Rhodes, 2017).

Policies that target environmental changes have been highly effective in improving nutrition-related problems, such as obesity (Dietz, Bland, Gortmaker, & Molloy, 2002). Strong LWPs can improve facets of the school nutrition and physical activity environment, including policies that require nutritionally healthy meals, limit access to energy-dense snacks and sugar-sweetened beverages, and set standards for the timing and intensity of physical activity (Story, Nanney, & Schwartz, 2009). Studies have shown significant increases in the number of fresh fruits served and the percentage of schools requiring healthy foods at class parties after LWP implementation (Belansky et al., 2010).

Recent studies have shown that LWP implementation levels in schools are low, inconsistent, or nonexistent (Hager et al., 2016; Sánchez et al., 2014). Some factors linked to discrepancies in LWP implementation, which can serve as barriers or enablers, include funding, time, resources, programming support, administrative support (Agron et al., 2010; Sánchez et al., 2014), and cafeteria choices (Sánchez et al., 2014). Additional factors include staff and parent understanding of how to apply LWPs, as well as accountability for enforcing LWPs in the school setting (Sánchez et al., 2014). Poorly written LWPs, with limited strength and comprehensiveness, can also be a barrier (Lucarelli et al., 2015; Schwartz et al., 2012).

Although research has examined factors that could influence the implementation process, little is known about whether socioeconomic disparities exist in implementation. A recent study examined the role of a majority low-income or majority Hispanic/African American student body in LWP implementation. After adjusting for school system clustering, both low-income and majority Hispanic/African American schools demonstrated lower LWP implementation, compared to schools that were majority White and higher income (HI; Hager et al., 2016). Schools with a higher percentage of lower income (LI) students were less likely to have a lunch serving of fresh fruit/vegetables (Finkelstein, Hill, & Whitaker, 2008; Profili et al., 2017), recommended health services, and physical activity resources (Balaji, Brener, & McManus, 2010). A greater understanding of the barriers and enablers to LWP implementation among schools with differing school-level socioeconomic characteristics and how barriers/enablers differ by these characteristics is needed.

To gain a better understanding of the factors that may be associated with the implementation process, we examine how the economic context of schools (majority low or high-income student body) relates to the perceptions of schools/administrators, which in turn relate to LWP implementation. Specifically, we assessed (1) school administrator perceptions of barriers/enablers to LWP implementation and (2) commonalities and differences in barriers/enablers among schools with a majority HI or LI student body.

There were several similarities and differences in the identification of barriers/enablers across quantitative and qualitative methodologies. Figures 1 and 2 provide a visual comparison of quantitative and qualitative barriers/enablers by HI and LI schools. As shown in Figure 1, staff, time, funding, and parents/families were identified as barriers to LWP implementation both quantitatively and qualitatively. Food service staff was identified as a barrier qualitatively but not quantitatively, and several items emerged as barriers quantitatively that were not discussed in interviews: federal/state regulations, the community, and food served at parties. Figure 2 shows that staff was the only common enabler in both methods, and funding was identified as an enabler in interviews but not in quantitative surveys. The school system, teachers, food service, and physical education (PE) curricula and resources were uniquely identified as enablers quantitatively and not in interviews. Below, barriers and enablers identified via quantitative analyses are presented, followed by qualitative results. Qualitative themes are presented as barrier-related themes, followed by themes that serve as both barriers and enablers (no themes were identified solely as enablers).

The results of this study reveal many commonalities in barriers and enablers identified to LWP implementation for all schools, including staff, time, and funding. Findings also indicated differences in HI and LI administrator perceptions of barriers and enablers to LWP implementation, such that federal/state regulations and à la carte snack items were more prominent barriers for HI administrators, and parents/families were more prominent for LI administrators. In relation to enablers, the school system was more prominent for HI administrators compared to LI administrators. It is of note that no barrier or enabler item was endorsed by a majority of participants, illustrating that there was not consensus across respondents and barriers/enablers might vary by the local context.

All schools, regardless of economic context, noted the importance of support from staff, students, and the community as well as resources such as time and funding. School staff play an essential role in wellness, regardless of the socioeconomic makeup of the school. The identification of staff as both a barrier and an enabler in quantitative and qualitative results is not surprising. Properly trained staff are a resource for policy implementation that can facilitate the capacity for action (De Boer & Bressers, 2011). For example, as demonstrated in interviews with HI schools, personnel with a designated role for wellness activities, such as a “wellness champion” can be instrumental in enhancing LWP implementation as well as serving as a bridge between the school, community, and school system (Hager et al., 2016). As demonstrated by quantitative results, staff can also serve as a barrier (Schwartz et al., 2012), which was reinforced during interviews, in that staff have competing job requirements.

Time was a common barrier for all administrators in surveys and for HI schools in interviews due to competing activities, curricular requirements, and the focus on teaching evaluations. Time as a limitation to wellness activities has been supported by other mixed-methods and qualitative studies (Agron et al., 2010; Sánchez et al., 2014). Although PE and nutrition education resources were endorsed as top enablers among all schools, interviews revealed that curriculum requirements in general were a major barrier to LWP implementation due to time limitations in the school day. This finding indicates that PE and nutrition education resources may be helpful, as long as there is time and space to incorporate them into the daily schedule.

Funding, a common theme for both HI and LI schools and throughout the literature (Agron et al., 2010; Budd, Schwarz, Yount, & Haire-Joshu, 2012; Schwartz et al., 2012), can serve as a barrier or an enabler within a school. For example, HI administrators expressed that limited funding can make establishing and maintaining high nutrition standards challenging for food service staff (Agron et al., 2010), and LI administrators mentioned having funding for specified wellness activities (i.e., purchasing exercise equipment, professional development, free/subsidized meal programs) as essential for enhancing opportunities for wellness, particularly in low-income communities (Belansky et al., 2010).

Schools serving a predominantly LI student body are at higher risk for not fully implementing their school system’s LWP compared to schools serving an HI population (Finkelstein et al., 2008; Hager et al., 2016), highlighting the need for a better understanding of the mechanisms that are associated with implementation for schools with limited resources. Parents and families emerged as a top barrier for all schools both in surveys and in interviews. Qualitative results highlight differences in perceptions of parental feeding practices at home, as well as the potential benefits of further involvement from parents in wellness-related volunteer roles. Although parents were perceived as barriers by LI schools, parents from LI communities themselves likely experience barriers, such as lack of child care and transportation (Yoder & Lopez, 2013), and have few health-related resources (e.g., access to affordable, nutrient-dense foods, and safe space for play; Davison & Birch, 2001), which can limit their knowledge and capacity to be supportive of LWPs in the school setting. HI schools, on the other hand, may have a greater capacity for LWP implementation due to the support and resources they acquire from informal sources in the community and school system, as well as formal sources within the school, such as designated wellness coordinators, as evidenced in interviews (e.g., PE department chair, health director).

Barriers for HI schools related to federal and state regulations may be linked to the lack of funding associated with wellness policy mandates, as well as the limited authority federal regulations have on foods sold outside of federal meal programs (Longley & Sneed, 2009). Because LI schools tend to have a high proportion of students participating in federally subsidized meal programs, it is possible that federal and state regulations present as a barrier for HI schools as they did not have clear nutritional standards for foods sold outside of federal programming. This may also provide some explanation for the challenges related to à la carte snack items noted among HI administrators prior to the implementation of Smart Snacks (Nutrition Standards in the NSLP and School Breakfast Programs Rule, 2012). On the other hand, HI schools noted school system support as an enabler, as school systems and district health councils can serve as a support to facilitate policy development at the school level (French, Story, & Fulkerson, 2002).

When examined by school type, results show that food served at class parties were more frequently identified by respondents in elementary schools, PE curriculum was more frequently identified as an enabler for elementary and middle schools, and à la carte snack items were more frequently endorsed as an enabler for high schools. These findings align with prior research that shows that certain practices might be more common by school type, such that higher grade levels (middle schools and high schools) tend to have less healthy food environments compared to elementary schools (e.g., more access to vending machines and à la carte items; Finkelstein et al., 2008). Interestingly, more high schools indicated à la carte snack items were an enabler. It is of note that just over one third of high schools endorsed this as an enabler, possibly because revenue from competitive foods such as à la carte items is often used to support other food services or school programming. However, wellness policy implementation rates have been similar across grade levels (Schwartz et al., 2012), further indicating that improvements are needed across all grade levels.

There are several limitations of the present study. As this was a cross-sectional study, causality cannot be established. Furthermore, the quantitative sample may not be representative of the views of other schools, as the study took place in one state and results may not be generalizable. The qualitative sample was small, with higher representation of administrators from HI schools (n = 12) compared to LI schools (n = 8). It is of note that significant chi-square results had small effect sizes and should be interpreted with caution. Other potential factors that may be related to LWP implementation, such as school system–level policies, school size, and other demographics were not included in the study, and the contribution of these elements should be explored in future research. We presented information on differences in barriers/enablers by school type using quantitative data to provide additional context to findings; however a full mixed-methods analysis of the manner by which barriers/enablers differ by school type, inclusive of in-depth interviews, was outside the scope of this article. Studies should also explore variations in barriers/enablers by geographic location, as schools in rural, urban, and suburban settings may have distinct experiences with LWP implementation. Finally, the policy context of this study should be noted. The survey and interviews took place focusing on the 2012-2013 school year, therefore following the National School Lunch Program meal pattern changes in 2012 stemming from the HHFKA (Nutrition Standards in the NSLP and School Breakfast Programs Rule, 2012), but before Smart Snacks in 2014 (NSLP and School Breakfast Program: Nutrition Standards for All Foods Sold in School Rule, 2014). Smart Snacks stipulate nutritional standards for competitive foods, such as à la carte snack items and foods served at class parties. Consequently, respondents’ perceptions of these items as barriers in this study should be interpreted with caution, and future research should reassess the role of snack foods as barriers/enablers in light of this legislation.

There are also many strengths of the present study. Prior studies have reported on barriers and enablers to LWP, relying on either quantitative or qualitative methods, not both. They have shed light on the effectiveness of LWPs based on their strength and comprehensiveness (Lucarelli et al., 2015), the role of external factors such as school system support (Hager et al., 2016) and the community (Sánchez et al., 2014), as well as barriers/enablers in rural communities (Sánchez et al., 2014). This study advances the school wellness promotion field by incorporating a statewide mixed-methods triangulation design, and by elucidating the entities that shape implementation in both HI and LI socioeconomic settings. The investigation of the similarities and differences in barriers and enablers reported by HI/LI schools serves as an example of the merits of considering socioeconomic factors to LWP implementation.

Similarities in barriers and enablers suggest that all schools, regardless of income level, require system-level support, including funding, personnel with time dedicated to LWPs, PE and nutrition education curricula and resources, and support for healthier food options. Regardless of the economic context, all schools would benefit from interventions that allow additional time and space for wellness activities. Given the barrier of competing curriculum requirements, schools may benefit from PE and nutrition education resources that uniquely integrate into existing curricular requirements to support teachers in their current roles. For example, existing research has found support for integrating physical activity within classroom instruction (Martin & Murtagh, 2015). Additional funding to support wellness programming as well as a designated wellness coordinator may help provide support to address barriers associated with time and staffing, as it would allow teachers and administrative staff to remain focused on their existing roles and responsibilities. Having a specific school-level health council or wellness team with a designated coordinator has been recommended to enhance school wellness (Centers for Disease Control and Prevention, 2013).

Although proper funding is essential for all schools, LI schools may benefit from additional funding as administrators discussed specific areas of need, such as purchasing exercise equipment. Higher rates of funding for LI school communities may be particularly beneficial as safe places for play and physical activity are often limited or nonexistent in low-income communities (Davison & Birch, 2001). Furthermore, funding may also serve as an enabler for LI communities to facilitate family and community involvement by way of provisions for transportation, meals, and childcare.

The importance of supports from the surrounding community as a whole is evidenced through HI schools that noted supports from the community and the school system as enablers. This indicates that enhancing supports and programming to facilitate the involvement of communities, school systems, and parents and families may be instrumental in enhancing LWP implementation levels for LI schools as well.

Gaining an initial understanding of implementation barriers and enablers from administrator perspectives is an essential first step in understanding top-down policy initiatives such as the Child Nutrition and WIC Reauthorization Act and the HHFKA. Future research should examine the perceptions of those in roles other than administrators, with an emphasis on perceptions of families and community affiliates. Research should also examine LWP implementation disparities by other socioeconomic characteristics such as variations in local, state, and federal per-pupil funding. Efforts should be undertaken to test interventions that minimize barriers and promote enablers in relation to the perspectives and resources available to both HI and LI schools.