Enhancing Implementation and Impact of Universal School Meals: Initial Acceptability, Feasibility, and Sustainability of Equity-Focused Implementation Strategies
1
Department of Social and Behavioral Sciences, Temple University, Philadelphia, United States
2
RAND, Santa Monica, United States
3
Epidemiology and Biostatistics, Temple University, Philadelphia, United States
4
Fox Chase Cancer Center, Temple University Health, Philadelphia, United States
5
College of Medicine, University of Central Florida, Orlando, United States
6
Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
7
Siteman Cancer Center, Washington University in St. Louis, St. Louis, United States
8
School of Public Health, Washington University in St. Louis, St. Louis, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Provision of Universal free School Meals (USM) is a critical policy approach to address food insecurity and obesity risk in school-aged children. Equity-focused solutions that center the needs of those tasked with implementation and reach the most vulnerable recipients are necessary to ensure effectiveness and longevity. This study aimed to assess the acceptability, feasibility, and sustainability of co-created equity-focused implementation strategies to enhance the uptake of USM in urban public schools.
METHODS:
This study examined outcomes of a community-engaged implementation mapping process in an ongoing hybrid implementation-effectiveness trial with 4 schools in the School District of Philadelphia (2 intervention; 2 comparison). Surveys and observations were conducted in Fall 2025 to document practitioners’ (n=19) perceptions of implementation strategies co-created with the research team in prior phases of the process. Survey data were analyzed descriptively; qualitative data were analyzed deductively using the Exploration, Preparation, Implementation, and Sustainment (EPIS) and Getting to Equity (GTE) frameworks.
RESULTS:
Survey data from teachers (50%), food service staff (16.7%), climate staff (16.7%), community coordinators (11%), and principals (11%) revealed 84% of participants felt strategies were feasible and acceptable. For sustainability, 68% agreed there is a plan for implementation long-term and 79% agreed strategies had been integrated into school operations. Qualitative data reflected challenges of organizational capacity within EPIS inner setting such as staffing changes/limitations. Facilitators related to increasing access to healthy options in the GTE framework, such as improving access for English language learners through menu promotion, and financial and logistical support from the school district (EPIS outer context).
CONCLUSIONS:
Our study shows potential for acceptable, feasible, and sustainable strategies to build capacity in school systems to address food insecurity. Results highlight the importance of investing in implementation capacity, not only policy adoption, to ensure that USM programs effectively reach students most vulnerable to food insecurity.
Provision of Universal free School Meals (USM) is a critical policy approach to address food insecurity and obesity risk in school-aged children. Equity-focused solutions that center the needs of those tasked with implementation and reach the most vulnerable recipients are necessary to ensure effectiveness and longevity. This study aimed to assess the acceptability, feasibility, and sustainability of co-created equity-focused implementation strategies to enhance the uptake of USM in urban public schools.
METHODS:
This study examined outcomes of a community-engaged implementation mapping process in an ongoing hybrid implementation-effectiveness trial with 4 schools in the School District of Philadelphia (2 intervention; 2 comparison). Surveys and observations were conducted in Fall 2025 to document practitioners’ (n=19) perceptions of implementation strategies co-created with the research team in prior phases of the process. Survey data were analyzed descriptively; qualitative data were analyzed deductively using the Exploration, Preparation, Implementation, and Sustainment (EPIS) and Getting to Equity (GTE) frameworks.
RESULTS:
Survey data from teachers (50%), food service staff (16.7%), climate staff (16.7%), community coordinators (11%), and principals (11%) revealed 84% of participants felt strategies were feasible and acceptable. For sustainability, 68% agreed there is a plan for implementation long-term and 79% agreed strategies had been integrated into school operations. Qualitative data reflected challenges of organizational capacity within EPIS inner setting such as staffing changes/limitations. Facilitators related to increasing access to healthy options in the GTE framework, such as improving access for English language learners through menu promotion, and financial and logistical support from the school district (EPIS outer context).
CONCLUSIONS:
Our study shows potential for acceptable, feasible, and sustainable strategies to build capacity in school systems to address food insecurity. Results highlight the importance of investing in implementation capacity, not only policy adoption, to ensure that USM programs effectively reach students most vulnerable to food insecurity.
| eISSN: | 2654-1459 |
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