Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR)

Analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Barriers and facilitators were mapped to CFIR constructs across intervention characteristics, outer setting, inner setting, characteristics of individuals, and process domains. Available resources were the most prevalent barriers across studies. Most constructs were predominantly barriers except for target group needs and resources, knowledge and beliefs, and engaging, which were predominantly facilitators. The review noted that many included papers focused on actions targeting areas of low socio-economic background, and that schools facing resource challenges sometimes made premises available to external actors and food industry whose interests were rarely aligned with nutrition-related actions. Limitations include that CFIR was not used in the original included studies, variable quality of included articles, and uneven distribution of research across action types and countries.