Appendix B3.
SFA
Director In-Depth
Interview Guide
Introduction: Thank you for taking the time to talk to me today for the study on “Successful Approaches to Reduce Sodium in School Meals” and providing your valuable insight. My name is [name of interviewer] and I’m a researcher from [2M Research Services or abt associates]. This is [name of note taker], also a researcher from [2M Research Services or abt associates], and s/he will be taking notes during our conversation to ensure that we accurately capture all of the opinions and insights you provide us. 2M Research Services and Abt Associates were contracted by U.S. Department of Agriculture (USDA) Food and Nutrition Service, referred to as FNS, to conduct an assessment of the challenges and successes your school and school district have experienced while working to meet the sodium standards. There is a small risk of loss of privacy, but the research team has taken many steps to reduce this risk. Your identity and any information attributable to you will not be released to anyone outside of the research team. Neither you nor your SFA will be identified individually in any reports or published materials resulting from this study. With your permission, we would like to record this interview. The recording of your interview will be deleted at the end of the study, after all data have been analyzed.
Do we have your permission to record this interview?
Yes Great. Thank you. Do you have any questions before we begin?
No
Okay. That is not a
problem at all. We would like to ask for your patience, as we will
need a little more time to note your responses by hand to ensure we
accurately capture your insights. Do you have any questions before we
begin?
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number. The valid OMB control number for this information collection is XXXX-XXXX. It will take you, on average, 65 minutes to complete this interview. |
USDA is
interested in gaining a better understanding of the challenges and
successes your SFA has experienced while working toward meeting the
sodium standards, and wants to hear what your strongest
recommendations are for other SFAs striving to meet sodium Target 1.
[Interviewer note: please refer to SODIUM TARGET TABLE throughout the interview as needed.]
Table 1. USDA Sodium Targets
Grades |
Target 1: July1, 2014
SY 2014–2015 (mg) |
Target
2:
SY 2017–2018 (mg) |
Target
3:
SY 2022–2023 (mg) |
School Breakfast Program1 |
|||
K–5: 6–8: 9–12: |
≤ 540 ≤ 600 ≤ 640 |
≤ 485 ≤ 535 ≤ 570 |
≤ 430 ≤ 470 ≤ 500 |
National School Lunch Program2 |
|||
K–5: 6–8: 9–12: |
≤ 1,230 ≤ 1,360 ≤ 1,420 |
≤ 935 ≤ 1,035 ≤ 1,080 |
≤ 640 ≤ 710 ≤ 740 |
1 Baseline of sodium levels offered in foods for the School Breakfast Program were 573 mg (elementary schools), 629 mg (middle/junior high schools), and 686 mg (high schools).
2 Baseline of sodium levels offered in foods for the National School Lunch Program were 1,377 mg (elementary schools), 1,520 mg (middle/junior schools), and 1,588 mg (high schools).
Source: U.S. President Final Rule. Nutrition Standards in the National School Lunch and School Breakfast Programs. Federal Register 77, no. 17, (January 26, 2012). https://www.gpo.gov/fdsys/pkg/FR-2012-01-26/pdf/2012-1010.pdf |
|||
Background
Q1. How long have you been the SFA Director at [INSERT NAME HERE]?
We would like to discuss your SFA’s success in achieving the Target 1 sodium standards. The Target 1 sodium standards became effective for school year 2014–2015, with limits on average daily sodium amounts for breakfasts and lunches offered. [interviewer note: Refer to Sodium Target Table above for reference, as needed]
Q2. You previously told us that your SFA has successfully met Target 1 for school meals offered at all schools in your SFA. Did your SFA meet the Target 1 sodium standards before implementation was required in school year 2014–2015?
Yes
No [IF NO, GO TO Q3]
Q2A. How soon before school year 2014–2015 did your SFA meet the standards?
Q3. During the past month, what was the average daily breakfast participation in your school?
Q4. During the past month, what was the average daily lunch participation in your school?
Q5. For the next question, I would like to ask you about the specific sodium content levels of your school meals (breakfast and lunch) by school type (elementary, middle/junior high, high school, and “other school”).
[Remind participant of the following when necessary: elementary schools (i.e., schools composed of any span of grades from kindergarten through 6th grade); middle or junior high schools (i.e., schools that have no grade lower than 6 and no grade higher than 9); or high schools (i.e., schools that have no grade lower than 9 and continue through 12th grade). If any school does not meet the definition for elementary, middle/junior high, or high school, please include it in the “other school” column.]
What is your current average daily sodium content for breakfast and lunch by school type in the 2016–2017 school year? [Probe for: the average daily amount is based on a five day week of menus for each school type.] [INSERT SODIUM CONTENT AMOUNTS]
SCHOOL TYPE |
BREAKFAST |
LUNCH |
||
a. Elementary School |
______ mg |
N/A ☐ |
______ mg |
N/A ☐ |
b. Middle/Junior High |
______ mg |
N/A ☐ |
______ mg |
N/A ☐ |
c. High School |
______ mg |
N/A ☐ |
______ mg |
N/A ☐ |
d. “Other School” |
______ mg |
N/A ☐ |
______ mg |
N/A ☐ |
Approaches to Reduce Sodium
Q6. You previously provided us with information about some of the key strategies your SFA uses to meet the Target 1 sodium standards. [Suggest the respondent look at the list provided in the advance email with top five strategies selected in Prescreening Web Survey] The top five tools and best practices you selected included: [PLEASE REVIEW THESE STRATEGIES WITH RESPONDENT—this will be pre-populated based on responses to the prescreening web survey].
Is that correct? [if not correct, revise list and go to Q6A. If correct, go to Q6A]
Q6A. Could you please describe any additional tools and best practices your SFA primarily used to meet the current sodium standards (Target 1) that have not been mentioned today?
Successes and Lessons Learned
Q6B. Focusing on what you consider to be the top five strategies, including any new ones mentioned today [REPEAT THeSE BACK TO RESPONDENT, INCLUDE strategies listed in Prescreening web survey and additional strategies], which of these strategies were implemented specifically to reduce sodium, and which of these strategies resulted in sodium reduction as a by-product of a different goal?
Which strategies do you think were most effective in helping your SFA meet the Target 1 sodium standards?
Why were these effective?
Can you provide additional details about how you employed this/these strategies?
Let’s start with [Category Name].
[Probe for: specifics on practices mentioned in above questions]
[Note to interviewer: Select appropriate probes FOR EACH CATEGORY below based on responses to categories indicated in Q6 and Q6A]
Utilizing alternative purchasing techniques:
DoD’s Fresh Fruit and Vegetable Program
Farm-to-school program
Food buying co-op or group purchasing
USDA food purchases
[If “Other (Specify)” indicated in web screener, ask for details about this here]
How has utilizing this/these purchasing technique(s) enabled you to meet the Target 1 sodium standards? Are there cost advantages? Do you have greater accessibility to unique products by using these alternative purchasing techniques?
learning about and Purchasing lower sodium products:
Asking vendors for lower sodium products
Attending trade shows
Discussing student acceptance of lower sodium products with vendors
Working with vendors to gain information about the sodium content in food products
[If “Other (Specify)” indicated in web screener, ask for details about this here]
What specifically did you discuss with vendors? Did you make requests for certain lower sodium products? Did you provide vendors with new product specifications? Were you able to give vendors information about student feedback? Did the vendor conduct or facilitate any taste tests with students or staff? Did you find out about new products through vendor discussions?
Using effective menu planning:
Implementing a self-serve condiment station or providing individual condiment packets
Limiting popular higher sodium items to certain days of the week
Providing students with more food choices for each meal
Serving new/unfamiliar items on multiple days to encourage uptake
Using lower sodium products
Using more fresh and/or frozen fruits and vegetables
[If “Other (Specify)” indicated in web screener, ask for details about this here]
Can you describe the process of changing your menu planning methods? Were these changes done gradually over time or all at once? Do any of these techniques require additional labor? Do you have additional storage needs (such as freezers)? Can you discuss the effects of providing students with more choices? Can you discuss the effects of other changes to the menu?
Changing food preparation methods:
Cooking with more herbs and spices
Decreasing the portion size of higher sodium items
Maintaining or increasing use of scratch cooking
Roasting vegetables
[If “Other (Specify)” indicated in web screener, ask for details about this here]
How did you accomplish changing your food preparation methods? Did you hire more staff? Did you change food suppliers? Who was involved in creating the new recipes/menus? Did this require obtaining new equipment? Was there an effect on your budget? Did you have financial help from grants or other sources of funding?
involving students, staff, and/or parents in changes to gain acceptance:
Conducting taste tests with students, staff, and/or parents
Bringing chefs into the schools to teach about cooking
Hosting food tasting parties to expose students, staff, and/or parents to different foods
Obtaining feedback from students, staff, and/or parents on new menu items
Sampling of vendor’s products by students, staff, and/or parents
Other nutrition education activities at the school level (please specify) _______
[If “Other (Specify)” indicated in web screener, ask for details about this here]
Can you describe the facilitation of the taste tests? Who was involved? How did students provide feedback? What types of items were taste tested (lower sodium products, new or modified recipes [entrée dish, side])?
usING available resources:
Modifying recipes already in use by the school district
Using Healthier U.S. Challenge’s Smarter Lunchroom techniques
Using recipes available through State agency and/or USDA
[If “Other (Specify)” indicated in web screener, ask for details about this here]
What specific HUSSC Smarter Lunchroom techniques did you utilize? Did you attend webinars or workshops to learn about these and other resources? If so, can you describe the workshop or webinar(s)?
training staff on lower sodium food preparation:
Bringing in local chefs for training
Conducting in-house training
Sending school nutrition staff to culinary training
[If “Other (Specify)” indicated in web screener, ask for details about this here]
Was the training internal or external? Who attended? What feedback, if any, did you receive in response to this effort?
Q6C. Since the Target 1 sodium standards were required in school year 2014–2015, has your SFA done anything differently to continue to meet the standards, or to begin working toward your next Target (e.g., 2 OR 3)? [INTERVIEWER NOTE: REFER TO SODIUM TARGET TABLE ON PAGE 1 OF THIS GUIDE FOR REFERENCE AND REVIEW WITH RESPONDENT IF NEEDED] Please describe.
Q7. What key strategies would you suggest to other schools and SFAs to help them meet the Target 1 sodium standards? Why?
Challenges
Q8. Can you discuss the greatest challenges faced by your SFA when working toward meeting the sodium standards?
Q8A. What strategies did you use to overcome these challenges?
[probe for:
Finding and accessing lower Sodium products
modifying menus or recipes
staff/parents/students resistant to change, etc.]
Q9. What impact, if any, do you think the size of your district has on your ability to meet the Target 1 sodium standards?
[Probe for:
Access to Desired, lower sodium products/foods
access to newly developed or reformulated food products/foods
cost of transport for desired products due to physical location or specific characteristics of your SFA
ability
to purchase lower sodium food products locally]
Q10. What impact do you think your geographic location in the U.S. [Northeast, Northwest, Midwest, Southwest, Southeast, etc.] has on your SFA’s ability to meet the Target 1 sodium standards?
[Probe for:
Access to desired, lower sodium products/foods
access to newly developed or reformulated food products/foods
cost of transport for desired products due to physical location or specific characteristics of your SFA
ability to purchase lower sodium food products locally]
[If
any barriers were described above, ask Q10A. otherwise, go to Q10B]
Q10A. Can you describe how you were able to overcome the barrier(s) you described related to your geographic location?
Q10B. Do you feel that the type of area (such as urban, rural, suburban) where your SFA is located plays a role in your SFA’s ability to meet the Target 1 sodium standards? [If no, GO to q11. Otherwise, go to q10c]
Q10C. Please describe how the type of area you described affects your SFA’s ability to meet the Target 1 sodium standards.
[If type of location is unclear, probe for more details (urban, rural, suburban).]
[Also probe for: availability/accessibility of products, population size related to demand, etc.]
Q10D. What role, if any, do you think district infrastructure, including district staffing, management, experience, and/or support, play in helping make the changes necessary to achieve Targets 2 and 3?
[Probe for:
district Staff understanding/awareness of nutrition regulations
training of new staff to acknowledge updated nutrition regulations
Experience of district level staff to approve and help provide necessary inputs to meet updated regulations]
Q11. Is it easier to implement the Target 1 sodium standards at the elementary, middle, or high school levels within your SFA? Why or why not?
Communication
Q12. Does your SFA communicate the health benefits of sodium reduction to staff and students? [if yes, probe for: What types of health benefits are communicated? how is this done? How often? If no, probe for: why not?] [If yes, go to Q12A, If no, go to Q13.]
Q12A. What methods have you found to be effective for informing staff and students of the benefits of sodium reduction? [Probe: Please describe.]
Support and Guidance
Your responses to the next few questions will help us understand the type of support and guidance you may have received from FNS, your State agency, or the food industry/manufacturers/vendors.
Q13. Did you receive assistance or support from USDA, FNS, or your State CN director when working toward meeting the Target 1 sodium standards? [If no, GO to Q14]
Q13A. Could you describe the support, resources, and guidance that you received from USDA, FNS, or the State CN director? What did you find most helpful?
[Probe for:
Technical assistance
Training, such as the Team Up for school nutrition success initiative
Web materials (provided by Team Nutrition, Institute of Child Nutrition, [formerly the National Foodservice Management Institute])
State Child nutrition agency trainings or materials from other State agencies
Healthier U.S. School Challenge
Other resources?]
Q14. What guidance or resources would be beneficial to assist schools in implementing sodium standards?
Q14A. Would you have liked more guidance or resources from USDA or FNS to help you meet the Target 1 sodium standards? [If no, GO to Q15]
Q14B. What additional resources would have been helpful? [Probe for: technical assistance (Federal, State agency training, online resources)]
Q15. Do you use the Department of Defense Fresh Fruit and Vegetable Program? Do you think the use of the Department of Defense Fresh Fruit and Vegetable Program helped your SFA to meet the Target 1 sodium standards? In what way?
Q16. Do you use USDA Foods, commercially purchased food, or both, to meet the Target 1 sodium standards?
Q16A. [If yes to USDA Foods used in Q15]: What specific USDA Foods or types of foods have you found to be most helpful to your SFA in meeting the Target 1 sodium standards?
Q16B. [If yes to commercially purchased foods used in Q15]: What are the primary types of commercially purchased food that help you meet the Target 1 sodium standards?
Q17. Now turning to support from the food industry, including manufacturers, distributors, and producers: How has the food industry provided support for your SFA to meet the Target 1 or future sodium standards? [Probe for: conducting taste tests with students and/or staff at schools, providing menus, providing recipes, tip sheets, etc.]
Q17A. Have you met with any food producers or people from the food industry, such as food distributors, to discuss reformulating menus or products to meet the Target 1 sodium standards or future sodium standards? If so, how responsive have you found them to be? Can you give me any examples?
Purchasing Foods
Q18. Which of the following methods of food purchasing and receiving does your SFA use? [Check all that apply]
SFA-level purchasing
Food Service Management Company
Purchasing by individual schools
Co-op
State-level purchasing
Consortium of States
Department of Defense Fresh Fruit and Vegetable Program
Q18A. [For each method that the respondent replied yes, ask]: Do you believe that this method of purchasing and receiving food for your schools or SFAs affects your ability to purchase lower sodium foods? Why or why not?
Q19. Do you require product specifications for your food purchasing? Have you created particular specifications to ensure the foods you procure are lower in sodium? Which types foods must meet sodium specifications?
Q20. Can you describe any challenges you've faced in finding and purchasing lower sodium foods (that meet your specifications)? [If no challenges, GO to Q21]
Q20A. What reasons might explain why you may have had difficulty purchasing lower sodium foods for your SFA? What solutions may exist that are worth exploring?
[Probe for:
availability and variety on the market
cost of lower sodium items
increased or different preparation methods
acceptability to students]
Q21. Do you feel that certain types of lower sodium products are more difficult to procure than others? If so, which types of products are difficult to procure? Why?
Q22. Are there certain foods that are not currently available in a lower sodium version that would be helpful to have to help meet the sodium requirements?
Recipes, Meals, and Menu Characteristics
The next few questions focus on recipes, meals, and menu characteristics relating to the Target 1 sodium standards.
[NOTE TO INTERVIEWER: review the response provided for Question 22. If the respondent lists a few types of foods that are difficult to find in a lower sodium version, repeat these foods back to respondent when asking Q23].
Q23. Are there specific components of meals or specific menu items that you believe are driving up the average daily sodium amount for school lunches or breakfasts? [If no, GO to Q24]
Q23A. Are these components or menu items available through USDA Foods, other food manufacturers, or both?
Q23B. Are you aware of any plans to reformulate these components or menu items to lower the level of sodium? If so, are you working with the food industry to develop or reformulate menus or products?
[Note to interviewer: prior to asking this next series of questions (Q24–Q25), review responses to Q6. The SFA Director may have already answered this question when asked to discuss strategies used to reduce sodium in school meals. If so, you can use this opportunity to ask for specific examples.]
Scratch Cooking
These next few questions ask about cooking from scratch. For the purposes of this study, we define “cooking from scratch” or “scratch cooking” as making your own menu items from basic, fresh ingredients in your school or district kitchens. Scratch cooking does not include assembling foods, such as with a sandwich, or adding a jar of sauce to a pre-prepared food.
Q24. Do your schools cook from scratch? What role has this played, if any, in reducing sodium content of school meals?
Q24A. Has your SFA faced challenges associated with scratch cooking? [if yes, Probe for: what are they? How did your SFA overcome these barriers?]
Q24B. What practices have you found to be effective for employee trainings around scratch cooking? [if yes, Probe for: Please describe.]
Q24C. Do you plan to do more cooking from scratch in your SFA’s schools?
Q24D. What other changes in meal preparation methods have been used in your SFA to reduce sodium in school meals?
[PROBE FOR:
INCREASED USE OF FRESH OR FROZEN FRUITS AND VEGETABLES
USING HERBS AND SPICES TO REPLACE SALT
USING DIFFERENT COOKING TECHNIQUES SUCH AS ROASTING
USING
SPECIFIC LOWER SODIUM RECIPES FROM USDA OR STATE AGENCY]
Recipe Modification
Q25. Recipe modification is a strategy that may help lower sodium in school meals. Has your SFA attempted to modify recipes in order to meet the Target 1 sodium standards? [If yes, go to Q25a; if no, go to Q25b]
Q25A. Was this effective? [If yes, go to Q25a1, if no, go to Q25a2]
Q25A1. Can you discuss the success you had with recipe modification in more detail? What modifications did you make? Were there other factors that made them successful? [Probe for: examples]
Q25A2. Can you discuss why recipe modification was not an effective method of reaching the Target 1 sodium standards?
Q25B. What is the reason your SFA did not attempt to modify recipes in order to meet the Target 1 sodium standards? Are there resources that might have assisted with modifying recipes?
Acceptance
These next few questions ask about how students in your SFA have accepted lower sodium meals and what your SFA has done to address student acceptance.
Q26. Which lower sodium menu items, products, or types of products have gained the most student acceptance? [Probe for the following if respondent does not mention: Entrées such as pizza, mixed dishes, and meat products; baked goods; condiments; breakfast items; snack foods]
Q26A. For those items that have gained the most acceptance, how did you determine these items were popular with students?
[Probe for:
Observations from cafeteria staff (student or parent feedback)
DEcreased food waste
Student selection of offered foods (what is being taken, what is refused)]
Q27. Which lower sodium menu items, products, or types of products have gained the least student acceptance? [Probe for the following if respondent does not mention: Entrées such as pizza, mixed dishes, and meat products; baked goods; condiments; breakfast items; snack foods]
Q27A. For those items that have gained the least acceptance, how did you determine these items were not popular with students?
[Probe for:
Observations from cafeteria staff (student or parent feedback)
Increased food waste
Student selection of offered foods (what is being taken, what is refused)]
Q28. Which specific strategies, tools, and resources have been used in your schools to gain student acceptance of lower sodium foods? Which ones were most effective?
[Probe for the following if not mentioned by the respondent:
Marketing methods such as on-site signage, student educational materials, parent handouts
Involving students in planning school meal menus
getting student input about lower sodium offerings in school meals
Conducting taste tests
Attending a Parent-Teacher Association/Organization or other parent group meeting to discuss school meals, specifically the new sodium targets
Conducting a nutrition education activity RELATED TO SODIUM in the classroom or in the food service area
Setting up a booth at a school event to inform on the sodium standards (such as at a family night or parent-teacher conference night)
Serving items on multiple days
using smarter lunchroom strategies
Emphasizing positive overall nutritional messaging rather than an emphasis on sodium reduction.
[note to interviewer: Refer to prescreening web survey responses to Q8—probe for more information relating to respondent’s web screener selection(s)]:
Good nutrition in general is advertised, but sodium specifically is not
SFAs/Schools work hard to not bring attention to sodium reductions
Sodium standards have not been communicated]
Future Efforts to Reach Sodium Targets 2 and 3
These last few questions ask about achieving the next sodium standards, Targets 2 and 3.
Q29. Thinking toward achieving the next sodium standard (Target 2), is your SFA actively working toward meeting Target 2? [INTERVIEWER NOTE: REFER TO SODIUM TARGET TABLE ON FIRST PAGE OF THIS GUIDE]
Q30. What role will recipe modification or product reformulation play in your SFA’s ability to meet the future Target 2 and/or 3 sodium standards? [If none or one or the other, GO to q31; if both, go to q30A]
Q30A. If both will play a role, which strategy do you think will have more of an impact on lowering sodium in school meals?
Q31. What other strategies that you have already found to be successful will you continue to employ to help you reach Target 2? [Check all that apply]
Modifying menus and recipes
Strategically planning menus
Using Healthier U.S. Challenge’s Smarter Lunchroom techniques
Using recipes available through State agency and/or USDA
Involving students to receive continued feedback
Additional strategies—please describe:
___________________________________________________________
Q32. Can you think of additional resources that would be helpful for your SFA to have while working toward meeting Target 2 sodium standards for school meals?
Q32A. Can you think of additional resources that would be helpful for your SFA to have while working toward meeting Target 3 sodium standards for school meals?
Q33. Do you think your SFA is prepared to be able to meet the Sodium Target 2? Why or why not?
Q33A. Do you think your SFA is prepared to be able to meet the Sodium Target 3? Why or why not?
[Probe for respondent to discuss the feasibility of Target 3, and to describe specific barriers, and potential ways to overcome these challenges]
Q34. Do you have any questions or anything else to add regarding your experiences with meeting the sodium standards that we have not already discussed?
We appreciate the time you have taken to answer our questions. Your input is very valuable. Do you have any questions or any additional information you would like to share before we end [if site visit: this portion of] this interview?
[if telephone interview:] If you have additional questions following this interview, you may contact us at [contact information]. Thank you again.
[if site visit:] Next, if available, we would like to take a look at any posters, signs, or letters provided by manufacturers related to sodium, agendas or notes from meetings with the school/school district or community stakeholders, and any other related materials. Do you have any of these materials that you would be willing to share with us?
Yes We will be documenting what we see using a checklist but, with your permission, we would also like to take photographs of these items. We will not photograph any personnel. Do we have your permission to photograph?
Yes Thank you. Do you have any questions before we begin? [note to interviewer: proceed to Site Visit Observational Instrument.]
No Okay. No problem. We will not take photographs, but would like to take notes about the content of the signage related to sodium reduction. [note to interviewer: proceed to Site Visit Observational Instrument] Reason: ___________________________________________
Thank you again for your time. If you have additional questions following this interview, you may contact us at: [contact information].
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Amy Wieczorek, MPH |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |