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The Norwegian School Fruit Program is financed by parents or local municipalities. The aim of this study was to explore contextual barriers and facilitators that influence the adoption of the program by schools using the Context and Implementation of Complex Interventions (CICI) framework. We conducted semi-structured interviews with 21 participants (mainly principals) from 20 lower secondary schools (classes 8–10). We analyzed the data using a deductive qualitative approach based on the CICI framework. We compared findings across schools offering the program (1) with no-parental-payment, (2) by parental subscription, and schools that (3) discontinued or (4) never offered the program. Economic costs were perceived as the main barrier to adoption across all schools. Although most schools recognized the need for such a program, some preferred to make their own arrangements. Except for schools offering the parental subscription option, many schools perceived asking parents to pay for the program as unfair, not in line with Norwegian values, and unlikely to allow the program to reach those who need it the most. Further barriers were the lack of legislation making the program obligatory and potential political changes causing uncertainty regarding the programme’s continuation from one year to the next. Social aspects of eating together were recognized as a facilitator. Food provision programs should be compatible with school priorities such as academic performance and mental health. Context and setting are dynamic and should be continuously evaluated to ensure they are in line with evolving school priorities and needs.
Meshkovska et al. (Tue,) studied this question.