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UBC Theses and Dissertations

A realist implementation evaluation of British Columbia's school food and beverage sales policy Levay, Adrienne Vanessa


This dissertation explores social processes related to implementation of British Columbia’s (BC) school food and beverage sales policy as a food environment intervention. Using a realist approach to evaluation, the first phase of the research focused on development of a retrospective program theory. This was used to create the framework for an implementation evaluation conducted in the second phase. I used a multiple case study approach with three urban and two rural BC school districts to explore what about this intervention is working, in what contexts, and for whom. Data collection included semi-structured interviews and questionnaires with relevant heath, education, and private industry stakeholders, observations, document analysis and website scans. Data analysis focused on identifying (i) mechanisms influencing if and how stakeholders engage in implementation activities and (ii) specific dimensions of context influencing these mechanisms. I identified four mechanisms. The mandatory mechanism refers to the ways that the mandatory nature of the policy is effective for triggering implementation efforts, influenced by a normative acceptance of the education system hierarchy. The scofflaw mechanism refers to an opposite response to the mandate whereby expected implementers may ignore and/or ‘skirt’ around the policy, influenced by beliefs about the role of government, school food, and food in general. The money mechanism refers to the way in which vendors respond to school and district demand for compliant options, influenced by beliefs about food preferences of children, health and food, and the existence of competition. The resource constraint mechanism refers to how a lack of capacity triggers otherwise motivated stakeholders to not implement. These findings helped refine the initial program theory to include an articulation of specific dimensions of context influencing implementation, an emphasis on the mandatory nature of school food environment policy, and the role of private industry. Interventions to support implementation could include: monitoring systems and incentive schemes, targeted resources to motivated school communities, initiatives to increase availability of compliant options, and to improve the private food vending environment in the vicinity of schools. There is a need to reconsider the implications of using nutrient-based standards that enable reformulation and/or finding loopholes.

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