In this study, information gathered from site visits enabled the community–academic research team to determine priorities for a school-based obesity prevention program that would help LAUSD to translate district obesity prevention policy (e.g., the Cafeteria Improvement Motion) into practice within schools. Specifically, site visits helped the community–academic research team generate ideas to increase NSLP participation, envision programs to assist students to make healthy food and beverage choices, and gather input about cafeteria programs from students, cafeteria staff, and school administrators.
Although an increasing number of states and school districts have adopted policies to improve the healthfulness of school food environments, such policies may not be implemented at the local school level. As evidenced by this study, site visits can provide researchers, policymakers, schools, and communities with a useful tool for assessing whether obesity-related policies are being implemented in schools as intended.
In addition to its utility in assessing the implementation of school obesity-related policies, site visits can also help researchers and policymakers, stakeholders who typically work outside of the school realm, to gain an understanding of the school food environment. For example, after speaking with cafeteria staff at the four schools during site visits, the community–academic team had a greater knowledge of barriers, such as cost and understaffing, that many schools face when trying to provide nutritious and palatable meals to students. The team therefore sought to design an intervention that would bring LAUSD obesity policy into action, while also taking into account such concerns and increasing intervention feasibility and sustainability. For example, based on student feedback, the community–academic team decided to offer an additional variety of presliced fruit or vegetable in the cafeteria daily. Rather than asking already understaffed cafeteria employees to manually slice fruit or vegetables for the intervention, presliced fruit was ordered from cafeteria distributors.
This study has limitations. The qualitative nature of the study limits the extent to which the current findings can be quantified, even though terms such as “most” or “the majority” are sometimes used to describe results. Because site visits were limited to only four schools within one region of Los Angeles, specific observations may be less applicable outside of LA or even beyond the areas of LAUSD where they were collected. For example, even though the four schools included in this study were in compliance with LAUSD policies regarding foods and beverages that can be sold in district schools, in 2008, when auditors from LAUSD’s Inspector General’s Office visited 70 randomly selected schools in the district, many schools were found to be noncompliant with some LAUSD food and beverage policies, such as LAUSD nutritional specifications for competitive food and beverages (i.e., food and beverage items sold outside of the NSLP), that are permitted to be sold in schools.28
This paper highlights how site visits were used to translate a specific policy (LAUSD Cafeteria Improvement Motion) into practice within schools in one geographic area of LA. Site visit methodology may be applied to other settings targeted in CBPR efforts. For example, site visits may prove useful in workplaces, which have served as the setting for recent CBPR studies.29–31
In one study, site visits helped researchers identify useful practices to promote healthy weight among employees of small and medium-sized U.S. worksites.32
Other potential contexts for applying site visit methodology to develop interventions could, for example, include partnerships with faith-based organizations, parks and recreation centers, tribal communities, or neighborhood housing developments.