The perception of school food-service professionals on the implementation of the Healthy, Hunger-Free Kids Act of 2010: A mixed-methods study

Objective To: (i) understand the nutrition attitudes, self-efficacy, knowledge and practices of school food-service personnel (SFP) in Nebraska and (ii) identify potential barriers that schools face in offering healthy school meals that meet the US Department of Agriculture (USDA) nutrition standards.Design Convergent parallel mixed-methods study.Setting Kindergarten-12th grade schools in Nebraska, USA.Participants SFP (260 survey participants; fifteen focus group participants) working at schools that participate in the USDA National School Lunch Program.Results Mixed-methods themes identified include: (i) 'Mixed attitudes towards healthy meals', which captured a variety of conflicting positive and negative attitudes depending on the situation; (ii) 'Positive practices to promote healthy meals', which captured offering, serving and promotion practices; (iii) 'Mixed nutrition-related knowledge', which captured the variations in knowledge depending on the nutrition concept; and (iv) 'Complex barriers', which captured challenges with time, support and communication.Conclusions The study produced relevant findings to address the barriers identified by SFP. Implementing multicomponent interventions and providing training to SFP may help reduce some of the identified barriers of SFP.