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Community-Engaged Implementation Mapping Universal School Meals (USM): Findings from a Mixed Methods Needs Assessment
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Community-Engaged Implementation Mapping Universal School Meals (USM): Findings from a Mixed Methods Needs Assessment

Gabriella M McLoughlin, Molly Kerstetter, Yerusalem Yohannes, Jennifer O. Fisher, Shiriki K Kumanyika, Alex Dopp, Omar Martinez and Ross C. Brownson
Implementation science : IS, v 20, pp 64-64
20 Jun 2025
DOI: https://doi.org/10.1186/s13012-025-01433-8 (S149)
url
https://doi.org/10.1186/s13012-025-01433-8View
Published, Version of Record (VoR)CC BY-NC-ND V4.0,  Open

Abstract

Background Policies, such as Universal School Meals (USM), are essential for preventing inequities in chronic disease among economically marginalized populations. Implementing USM reduces food insecurity and obesity risk, among other academic/health outcomes; unfortunately, across the nation student participation (i.e., reach) is lower than expected, limiting its public health impact. The aims of this study were to 1) understand implementation determinants of USM and 2) Identify key elements to address in an implementation strategy. Methods As part of Implementation Mapping, a needs & assets assessment was undertaken in the 2023-2024 academic year with the School District of Philadelphia to address implementation-related challenges for USM. 8 schools (6 middle; 2 high) participated in a mixed methods study comprising qualitative interviews, quantitative surveys, and observations of mealtimes. Data collection was grounded in the Consolidated Framework for Implementation Research (CFIR) and Health Equity Measurement Framework (HEMF). Interviews were recorded and transcribed verbatim, following deductive analysis through the CFIR and quantitative scoring. Barriers were coded negatively (−1 or -2), supports coded positively (+1 or +2), and neutral determinants coded as 0. Findings 193 participants participated in the study comprising teachers (29%), parents (26%), middle (14%) and high school students (10%), administrators (13.5%), and food service personnel (11%). Participants identified as Black/African American (43%), White (26%), Hispanic/Latino (20%), Asian (5%), Middle Eastern/North African (1.8%), and other (3.8%). The strongest facilitators were Individuals – Mid-level leaders (M=1.29±0.83), High-Level leaders (M=0.96±0.79), and Implementation Process – Adapting (M=0.97.47); negative determinants were Outer Setting – Market Pressure (M=−1.35±0.66), Inner Setting – Relative Priority (M=−1.17±0.39), and Available Resources (i.e., Time (M=−1.10±0.88). Overarching challenges comprise culture of school meals and stigma of participating, alignment of meals to the background of students/families, and ensuring students have enough time to eat. Implications for D&I Research: Conducting in-depth needs assessments grounded in health equity research is essential to developing equity-focused implementation strategies, but data analysis workload and building a community advisory board to ensure equitable partnerships takes longer which may impede “rapid” change in implementation. Findings inform key implementation roles and barriers/ facilitators to address through development of an implementation strategy to be tested in a clinical trial.

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