RESUMO
BACKGROUND: The Final Rule of the Healthy Hunger Free Kids Act, published in 2016, required school districts participating in the federal Child Nutrition Programs to update their local wellness policies to reflect the more stringent requirements effective June 30, 2017. OBJECTIVE: Our aim was to investigate whether Wisconsin school wellness policies (SWPs) were updated after the Final Rule, measure policy quality change, and describe mechanisms of successful policy change. DESIGN: From 2016 through 2018, an explanatory sequential mixed-methods study examined change in SWP quality before and after the Final Rule was published. SWPs were collected in 2 waves reflecting policies written before and updated after the July 21, 2016 publication of the Final Rule. Semi-structured key-informant interviews were conducted with districts that demonstrated significant policy improvement. PARTICIPANTS/SETTING: Quantitative analysis examined 442 Wisconsin school districts' SWPs. Semi-structured interviews were conducted with 14 school districts that demonstrated significant change between waves. MAIN OUTCOME MEASURES: WellSAT 2.0 strength and comprehensiveness scores measured SWP quality among districts that updated their policies. Themes from interviews were identified using framework analysis. STATISTICAL ANALYSIS PERFORMED: First, we calculated the proportion of Wisconsin school districts participating in federal Child Nutrition Programs for which SWPs were obtained at both waves of policy collection (n = 192 districts, 43.4%). Among districts that updated SWPs in wave II, repeated-measure analysis of variance tests described policy quality and policy quality change, respectively. RESULTS: Among the 192 districts that updated their SWPs, policy quality increased overall and for 5 of 6 domains. Nutrition education scores did not show significant change. Interviewees commonly cited wellness leadership, support and resources, and buy-in and culture change as key components of policy improvement. CONCLUSIONS: Fewer than half of Wisconsin school districts updated their policies in the 10 months after the Final Rule was published. SWP from these districts showed policy quality improvement in most areas. Interviews with successful districts indicate the common need for empowered leaders and supportive environments to facilitate culture change around student wellness.