Using Theory to Evaluate the Implementation and Integration of an Expanded School Breakfast Program in Rural Midwestern High Schools

Objective: Use Normalization Process Theory to evaluate the implementation and integration of the expanded School Breakfast Program (SBP). Design: Interviews were conducted during the 2014–2015 school year. Normalization Process Theory guided the interview questions. Setting: Rural high schools in Minnesota. Participants: Interviews were conducted with 12 foodservice directors and 11 principals from the Project Break–Fueling Academics and Strengthening Teens intervention. Four of the 12 schools were in their first year of providing the expanded SBP program to their students whereas 8 were in their second year. Phenomenon of Interest: Normalization Process Theory was used to evaluate the implementation and integration of the expanded SBP into rural Midwestern high schools. Analysis: Three members of the research team used NVivo 10 software to code and analyze the interviews. Emerged themes were reported. Results: Modifying the SBP aligned with values of the study participants (coherence). Support was obtained from staff, students, and community members (cognitive participation). Operational work occurred in each school to establish and integrate the modified SBP (collective action). The SBP expansion was assessed through student participation rates (reflexive monitoring). Conclusions and Implications: Normalization Process Theory can be used to evaluate the implementation, embedding, and integration of a modified SBP into a school program. This evaluation can support other schools in modifying and embedding their SBPs into their school environment.