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Objective: To explore barriers and facilitators to implementing and sustaining Healthy Choices, a three-year multi-component obesity prevention intervention implemented in middle schools in Massachusetts.

Methods: Using purposive sampling, 56 in-depth interviews were conducted with middleschool employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses.

Results: State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers while staff buy-in and technical assistance were seen as facilitating implementation. Respondents felt that intervention sustainability was dependent on external funding and expert assistance.

Conclusions and Implications: Results confirm the importance of gaining faculty and staff support. Schools implementing large scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.


Mary L. Greaney has a dual appointment with the Department of Health Studies and the Department of Kinesiology.