A qualitative exploration of the sustainability of a whole-school nutrition programme in Queensland,Australia: ‘keep the money coming!’

Theoretical framework and design

An exploratory qualitative approach was used to construct an interview guide informed by the most significant change method ⁷ and the Consolidated Framework for Implementation Research (CFIR), ⁸ which would investigate the factors that influenced the implementation and sustainability of POTC. The CFIR was used to better understand the changes that had eventuated from POTC, as well as the factors that enabled and hindered the initiative’s implementation and sustainability. Semi-structured interviews were conducted from March 2023 to May 2023.

Ethics approval was obtained from The University of Queensland (2022/HE000716), and approval was received from Queensland Department of Education (Ref. 550/27/2400). Full informed consent was provided by the participants. This study builds on the initiative’s primary evaluation. ⁹

Participants and recruitment

Twenty-two schools who had implemented POTC were eligible to participate in the study. Eligible schools had to be in their third year of implementation, without external funding from Health and Wellbeing Queensland, and had to have provided consent to be involved in the evaluation. ‘School champions’ who were leading the implementation of POTC at their school were recruited with their roles defined as a teacher, a school principal or individuals who held dual roles. Purposive sampling was conducted to recruit school champions from schools in the following regions of Queensland, Australia: Bowen and Burdekin (n = 8); Bundaberg and Wide Bay (n = 9) and Logan (n = 5). The regions were chosen due to their level of socio-educational disadvantage, according to the Index of Community Socio-Educational Advantage (average percentile of schools in these regions falling below the 50th percentile) and the latter two regions having strong connections to the agricultural sector. POTC schools vary in their degree of remoteness, ranging from metropolitan to regional, remote and rural. ¹⁰ All potential participants were invited to join the study via email, and if no response was obtained, a follow-up phone call to the school was made. No reimbursement was offered for participation.

Data collection

Consenting participants were involved in a 30- to 45-min semi-structured interview that was conducted via teleconference (via the platforms Zoom or Teams). The first author, LF, informed participants about the purpose of the research and the process involved. Background questions in the interview guide were informed by the Most Significant Change method, ¹¹ and the body of the interview guide was informed by domains of the CFIR ⁸ (refer to Supplementary File 1). The Most Significant Change theory was used to assess the impact of the initiative by collecting and analysing personal stories of observed change and understanding their mechanisms and significance within the initiative context. If a school was not involved in the previous evaluation, the participant was asked to describe the main change that had resulted from POTC since its initial implementation. The domains of the CFIR ensured that implementation factors were explored that spanned the ‘inner setting’ (the school), ‘outer setting’ (external to the school environment), ‘individuals’ (end-users and innovation implementers), ‘innovation’ (the POTC initiative components) and ‘implementation process’. All participants were given the opportunity to provide any further comments at the conclusion of the interview. The interviews were recorded using the recording function on the teleconference platform, which were used for verbatim transcription. Transcription was conducted with the transcription feature on Word, and all transcripts were de-identified. Transcripts were checked for accuracy; however, they were not returned to participants for verification.

Data analysis

Transcripts were uploaded to NVivo 12 Plus, a software that streamlines qualitative analysis. Qualitative analysis involved using the constructs of the updated CFIR to conduct deductive coding. ⁸ An iterative approach was also utilised, whereby inductive coding was used if a unit of meaning did not align clearly with a CFIR construct. Coding was conducted by two experienced researchers, which involved LF undertaking the primary analysis and MR verifying the analysis. Any uncertainties were resolved through discussion until a consensus was reached. Thematic analysis was then used to contextualise the codes and to develop main themes and sub-themes (conducted by LF). All themes were verified by MR.

Implementation facilitators

The roles of the regional coordinator and school champion, in addition to having high-level support from the school principal, were considered crucial to the long-term success and sustainability of POTC. Participants identified supportive roles of the regional coordinator, which included the following: support with co-developing action plans; establishing connections with farmers and growers (including alternatives if such settings were not accessible); identifying grant opportunities to supplement funding from HWQld; providing educational resources and engaging with school champions when extra support was required. However, it was also noted that school champions struggled with the lack of support during changes to regional coordinator staffing, and many participants expressed that POTC would not be able to continue without the support of a regional coordinator.

I think it’s been really beneficial to have the Pick of the Crop [. . .] support person who do check in emails, check in visits and assist in writing the action plan. One of the things in a small school is that we have such limited time and limited resources, and to have that external person who also has connections to growers and dietitians and even ideas when it comes to sourcing, funding or donations, it’s really good to have those connections. So that would probably be the most vital thing that’s kept our pick of the crop going. (Participant 9, principal)

School champions were identified to have key capabilities that included engaging other school staff to more widely implement POTC activities, creating motivation within the school and committing to improving the wellbeing of students and organising activities.

So my role was really just maintaining those beds and maintaining student interest in it and generating further interest. (Participant 1, teacher)

School principals were considered a significant enabling or impeding influence on the implementation of POTC, whereby if they saw the initiative as a priority for the school, they had the position of influence to allocate more funding and encourage wide-spread support. However, if the school principal did not view the initiative as a priority, the intended activities were limited in their reach and implementation.

So the principal here has been right behind it. She’s all for us, nurturing the whole child. She’s the driving force. (Participant 7, teacher)

Compatibility with education priorities

Programme champions reported that POTC was more likely to be sustained if there were clear curriculum links between food and nutrition-based education to units of the curriculum. Participants reported connections being more commonly applied to science, technology, engineering or maths (STEM-based subject areas), as well as health and physical education. However, due to time constraints and an already demanding curriculum, participants reported a need for sample unit plans that could be tailored and adapted, to avoid teachers feeling overwhelmed.

And we need to make connections to, you know, to the soil, to the farmers, to composting, to closing the gap, to reducing our carbon footprint, all that stuff comes together and then it can come together through pick of crop. So it’s I think because pick of the crop is bigger than just introducing kids to fresh fruit and vegetables, there’s a way larger scope that pick of the crop could be involved in. (Participant 3, teacher)

POTC was found to align and deliver on various school strategies and priorities. Strategies and priorities identified included wellbeing strategies (including social, emotional, health and physical development) and learning frameworks such as ‘Deep Learning and the 6Cs’ to prepare students for available 21st-century careers (in addition to exploring local employment opportunities), addressing character, citizenship, collaboration, communication, creativity and critical thinking. One school saw an opportunity to embed ‘Little Dreamers’ within POTC, which has a focus on supporting young people who are a caregiver for a family member living with disadvantage.

It was more the small group with the Little Dreamers that could go down there and do some picking which is like part, not therapy, but it is a form of therapy and just using that as a tool to keep, you subtly get them talking and talking about life and things like that with the guidance officers and the chaplains. So yeah, the curriculum’s really important. But the second part about it is that general wellness and health message. And to particularly target and support a group of kids within the school. (Participant 10, teacher)

The principal and I both want it to be what the school is known for. For that whole child, health and wellness approach, which includes, you know, the garden, getting out in nature. Eating fresh, healthy produce straight from the garden, no chemicals, no nothing. (Participant 7, teacher)

Schools were identified to have strong cultures of being student-centred despite the curriculum not always catering to the diverse and complex needs of students, especially when students have learning disabilities or emotional dysregulation. POTC was found to accommodate to students’ emotional needs, and this sustained enthusiasm for the initiative.

[. . .] last year I had a young boy that was a bit of a problem in my classroom. He was a lovely little kid, but through the gardening he actually found a great interest in the garden. He actually started a garden at home and mum would bring in photos of his garden that were growing. He would take home sweet potato slips and take home corn seeds and whatever we were growing here. He’d take them and grow them at home and right to the very last day of school he was helping out in the garden, pulling out weeds and when he gave me a little gift at the end of the year, it was full of seed packets and one of the one of those little seed packets was flowers that says ‘forget me not’, so it was actually so cute. (Participant 3, teacher)

[. . .] it’s all pretty much about boosting their self-esteem, most. The garden is part of that and the yoga is part of that, and the mindfulness is part of that. We’re trying to teach them that they are precious little beings you know? And the curriculum I find, is not a positive thing for kids like this. (Participant 7, teacher)

Generation and use of funding

All participants expressed that initial setup funding from HWQld was helpful in implementing POTC actions, especially activities that were more resource intensive such as the establishment of vegetable and fruit gardens, purchasing fruit trees and bus rides for excursions. Participants expressed that the funding helped with sustainability, whereby schools established garden beds and irrigation systems to ensure it could be maintained once funding ceased in the third year of implementation.

It depends on what schools are going to use it for. In our case, with the establishment of the sensory garden, we used the whole grant to do that. And the school kicked in a little bit. But we needed it to be set up properly for long term value and so that was why it probably costs more than it needed to, but all the irrigation is in place and that sort of thing. My concern initially was I didn’t want to do something and plant something that wasn’t going to live. (Participant 8, teacher)

When there was a desire for the grant funding to be supplemented, other avenues for funding were sought. Other options included applying for external funding from local grants or generating funding internally through adjusting school budgets (e.g. using funding from a wellbeing strategy), ‘parent and community’ groups or by generating income through fundraisers (such as plant sales, fruit drives). Alternative sources of funding were deemed crucial to the initiative’s longevity, otherwise scaling down had to be considered.

I put it under our health and well-being program, so we use that that funding to help facilitate our well-being our, you know, student resilience programs. Um. At Stephanie Alexander, we used some of their references as well. Yeah, so I put a bucket of money aside and, you know, I’ll make sure that all those boxes are ticked because it’s just so important and even for children who are struggling a little bit [. . .] (Participant 4, principal)

[. . .] in terms of getting additional, you know, support and funding from the school, I don’t see the principal choosing to get involved with that. I would see it be coming from the parent community instead, which we do have an active P&C (parent and community body for the school) here and they raise some reasonable money because it’s a middle class area. (Participant 1, teacher)

Partnerships and connections with community

Participants reported a lack of concern for sustaining POTC when strong relationships were established with their local community. Partnerships and connections involved neighbouring schools, parents, farmers and growers, community organisations, sporting groups and retirees. Having strong relationships assisted in the provision and mobilisation of physical and human resources, which helped with the maintenance of vegetable and fruit gardens and helped to decrease barriers to implementation. Schools that did not have strong relationships with community expressed concern that POTC would struggle to be sustained.

We’ve had a substantial donation with seedlings and gardening equipment, that sort of stuff from our local hardware store which had been fantastic and then we’ve had another school, a larger school was able to you know, part of end of last year they did the Fruit Feast Fiesta, I think it was called. So we were able to access lots of different fruit that the kids hadn’t tried for some time. So those sorts of things are always invaluable. Some of the smaller schools, we even trade seedlings at times so if I’ve got you know, lots of tomato seedlings might trade them down the road for something that they’re growing so try and work together as much as we can because it does become expensive at times, so it’s important that we tap into those sources. (Participant 4, principal)

[. . .] we can talk to the kids about, you know, healthy eating and well-being and but when it comes from an external person who’s big TV or play sport or, you know, has represented Australia in in whatever and it just seems to have that more powerful message for the kids, which is great because we need those messages to come not just from us, but from the community around us as well. (Participant 4, principal)

For smaller schools, it was beneficial to establish a sense of community, which POTC facilitated. Spare produce would be provided to community members, parents and caregivers, improving food security within more disadvantaged neighbourhoods.

[. . .] have excess, we used to leave it out the front and the community come and took whatever they would like to. For us, it is a community based thing as well. (Participant 2, principal)

And the extensive community, I mean, we’re a small school, so the sense of community that it’s built I think is being more far reaching even possibly than what I know because I hear other people in the community, ‘Ohh, [name of the school]’, and ‘You’re pick of the crop and you do this’, and so yeah. I think that’s good too. (Participant 8, teacher)

Programme impact

For POTC champions, observing the impact that it was having on students was motivating. These included students being more open to try new vegetables and fruit, demonstrating increased knowledge of healthy eating, increasing skills (e.g. cracking eggs, peeling and cutting vegetables, knife skills, food safety), increasing parental and caregiver knowledge, improving the nutrition of lunch boxes and improving equity and food security.

Well, they love it and their parents love it. Ok, the children, yes, it has. What is that noticeable impact? They know more about gardening and where their food comes from. They try things out at the garden more readily than if you just sort of offered food that they had never tried before. So it’s been really good for that, really good for getting, and we have kids that have fussy eating and have issues, and yeah, they’ll even try some things sometimes, which is really good. I that’s a positive thing, yeah. (Participant 7, teacher)

Kids are more happy to try things [. . .] like we had celery, and we had all these other different fruits and the kids just swarmed the tables and just, you know, ate the fruit and stuff like that. That’s a big difference with these kids that are you know, low socio-economic [. . .] The leftover bean, the leftover potatoes and stuff we gave to their families at the end so that we sustained those people as well. So that’s a big difference. So we’ve fed our community. (Participant 6, teacher)

Impacts on students’ mental and emotional wellbeing were also observed. The vegetable and fruit gardens, along with sensory gardens at some schools, provided additional opportunities for cooperative learning and helped students re-engage in the classroom, due to the garden’s calming environment. Developing gardening skills was also associated with increasing the students’ skill sets for pursuing careers in agriculture and their self-esteem.

Pick of the crop is amazing. It needs to keep going. It is just so beneficial on levels that you wouldn’t even think of, and I only had this the other day. The kids were weeding the garden with me and then the big weed and this little kid couldn’t pull it out. So he got a friend to help him. So they had to talk and then they worked together and cooperated to dig the weed out. All that sort of incidental learning just wouldn’t be happening if we didn’t have the garden. (Participant 8, teacher)

[. . .] it’s just so important and even for children who are struggling a little bit, they might come in, you know, had a rough morning, whatever it might be. And then, you know, they’re in the garden and weeding something. And yeah, everything seems happy. And, you know, we can get on with our days. So it really is almost, such a benefit for their well-being knowing that they can go out and do a bit of gardening and then come back when they when they’re settled and ready to learn. (Participant 4, principal)

[. . .] a lot of our kids will end up working on farms around here. So it’s, you know, it’s more than just an interest or a hobby. It’s something that they could end up, you know, gaining employment in the ag(ricultural) industry, there’s a lot around [name of region], so it sort of gives them a bit of a grounding there. (Participant 7, teacher)

Strengths and limitations

This study has comprehensively explored the enablers and barriers related to the long-term implementation and sustainability of POTC and builds on a preliminary evaluation that explored its initial two years of implementation and impact. ⁹ Beyond POTC, there is a limited body of literature on the factors that influence a school nutrition programme’s sustainability past two years of implementation. This research, therefore, furthers understanding of the implementation and sustainability literature. This study’s focus on a whole-school initiative reflects real-world contexts, challenges and learnings, making the findings particularly relevant for education settings looking to implement similar interventions.

There are limitations that should be considered in interpreting results. It was not possible to capture child or parent perspectives due to restrictions that limited direct access to parents. The Bowen and Burdekin regions had principals as participants, and naturally, they hold more authority to make influential decisions around funding and support for POTC, compared to school champions who only hold a teaching role. Furthermore, the CFIR did not account for specific factors pertaining to the education system, which is vital to understand the factors within a school environment that are influential on the sustainability of health-promoting school-based nutrition programmes.

Implications for research, practice and policy

Interestingly, an unexpected outcome of this study was the perceived impact of POTC on improving students’ emotional regulation and mental health and the positive impact it had on cooperative learning and equity. Researchers should thus explore the long-term impacts of POTC and other similar initiatives on student mental health and indicators of value to school staff, such as cooperative learning and engagement in class. These findings emphasise the necessity of integrating nutrition initiatives within education structures and systems and demonstrating how they can add value. To enhance programme sustainability, it is encouraged that diverse funding sources and models are explored and that regional coordinators are consistently employed to establish and help maintain partnerships between schools and the community in which they are located, recognising that collective efforts are vital to the success of health initiatives in education. ⁴ Policymakers need to consider strategies that address the whole-school food environment, equity and the benefits of connecting schools to local growers, farmers and agri-businesses as partners within a health-promoting school context that supports capacity building of programme implementers in the ‘inner setting’ of the CFIR framework. The findings of this study can be translated to non-Australian contexts for nutrition programmes that have in-built capacity for flexibility and local adaptation and use a whole-school approach consistent with the World Health Organization’s Health Promoting Schools framework. ¹⁸