Assessment of school wellness policies implementation by benchmarking against diffusion of innovation framework.
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BACKGROUND: The School Wellness Policy (SWP) mandate marks one of the first innovative and extensive efforts of the US government to address the child obesity epidemic and the influence of the school environment on child health. However, no systematic review has been conducted to examine the implementation of the mandate. The study examines the literature on SWP implementation by using the Diffusion of Innovations Theory as a framework. METHODS: Empirically based literature on SWP was systematically searched and analyzed. A theory-driven approach was used to categorize the articles by 4 diffusion stages: restructuring/redefining, clarifying, routinizing, and multiple stages. RESULTS: Twenty-one studies were identified, and 3 key characteristics of the reviewed literature were captured: (1) uniformity in methodology, (2) role of context in analyzing policy implementation, and (3) lack of information related to policy clarification. Over half of the studies were published by duplicate set of authors, and only 1 study employed a pure qualitative methodology. Only 2 articles include an explicit theoretical framework to study theory-driven constructs related to SWP implementation. CONCLUSIONS: Policy implementation research can inform the policy process. Therefore, it is essential that policy implementation is measured accurately. Failing to clearly define implementation constructs may result in misguided conclusion.