Dissemination and Use of a School-Based Nutrition Education Program for Secondary School Students
Olson, Christine M., Devine, Carol A., Frongillo, Edward A., Jr., Journal of School Health
With the link between diet and the major chronic diseases now well-recognized, nutrition intervention constitutes an important component of health promotion and disease prevention program.[1-3] School health programs, by promoting positive lifestyles and developing effective decision-making skills, play a critical role in improving the health status of Americans. Not surprisingly, the health objectives for the year 2000 include the following objective on school-based nutrition education:
Increase to at least 75 percent the proportion of
the Nation's schools that provide nutrition education from
preschool through 12th grade, preferably as part of
quality school health education.
Kolbe observed the impact of any health promotion program depends on multiplicative function of its effectiveness, dissemination, and maintenance. While effectiveness of school-based nutrition education programs in improving students' knowledge, attitudes, and behavior has been demonstrated Basch called for discovery of efficient ways to disseminate and implement these health and nutrition education programs if the value of resources to develop such programs is to be realized. However, five years after Basch's call for discovery, Anderson and Portnoy noted that dissemination remains virtually ignored: "Researchers have sought funds to develop and evaluate health promotion materials, little attention has been given to the future distribution, implementation and maintenance of materials."
Parcel et al rioted they could find few descriptions or empirical investigations of processes by which schools, and presumably teachers, could be encouraged to adopt health promotion interventions. For this study only four empirical investigations were found that compare effectiveness of various strategies in disseminating health or nutrition-related programs to teachers and schools. Two focused on tobacco use,[8,10-12] And the results apparently are not published. One involved environmental education and the other a nutrition-fitness curriculum. Few additional studies provide information on levels of dissemination and use achieved with one particular strategy.
Besides the need for data on effectiveness of dissemination approaches, a need exists for theoretical, and conceptual models of program diffusion. Best's  stated: "We need a conceptual model to chracterize factors which influence the diffusion process for school health promotion programs." Parcel et al[10,11] adapted Rogers five-stage diffusion of innovation model to understand diffusion of the Smart Choices tobacco curriculum. The model's four stages include: 1) dissemination (making schools aware and knowledgeable of the program and motivating,them to adopt it), 2) adoption (making a policy decision committing the school to using the program), 3) implementation (using the program), and 4) maintenance (continuing use of the program). Parcel et al[10,11] then used social learning theory-based methods to achieve the desired outcomes at each stage of the diffusion-process. This project represents one of the few theoretically-based studies to date on the diffusion of a school-based health promotion program and the results are not published.
Given the paucity of research on diffusion of school-based nutrition education programs, and the importance of this issue to achieving the health objectives for the year 2000, this paper 1) describes the strategy that was use to dissiminate an effective nutrition education program (Nutrition For Life) to junior and senior high school health and home economics teachers in New York State, 2) documents the extent of program dissemination and use by these teachers, 3) identifies factors associated with the extent of program dissemination and use, and 4) discusses implications of results for planning program dissemination efforts. Program effectiveness was demonstrated in a study published earlier. …