The perception of school food-service professionals on the implementation of the Healthy, Hunger-Free Kids Act of 2010: a mixed-methods study.

OBJECTIVE: To: (i) understand the nutrition attitudes, self-efficacy, knowledge and practices of school food-service personnel (SFP) in Nebraska and (ii) identify potential barriers that schools face in offering healthy school meals that meet the US Department of Agriculture (USDA) nutrition standards. DESIGN: Convergent parallel mixed-methods study. SETTING: Kindergarten-12th grade schools in Nebraska, USA.ParticipantsSFP (260 survey participants; fifteen focus group participants) working at schools that participate in the USDA National School Lunch Program. RESULTS: Mixed-methods themes identified include: (i) 'Mixed attitudes towards healthy meals', which captured a variety of conflicting positive and negative attitudes depending on the situation; (ii) 'Positive practices to promote healthy meals', which captured offering, serving and promotion practices; (iii) 'Mixed nutrition-related knowledge', which captured the variations in knowledge depending on the nutrition concept; and (iv) 'Complex barriers', which captured challenges with time, support and communication. CONCLUSIONS: The study produced relevant findings to address the barriers identified by SFP. Implementing multicomponent interventions and providing training to SFP may help reduce some of the identified barriers of SFP.