Previous studies have shown that many kids arrive to school underhydrated.  Because of the benefits of adequate hydration, providing safe and appealing water to children at school is important. The purpose of this study was to identify facilitators associated with excellent water quality and accessibility in schools. In a purposive sample of California elementary, middle and high schools (n= 15), key informants were recruited using the snowball sampling method and were interviewed to identify facilitators to providing excellent water quality and access. Thirty-four interviewees (including maintenance and facilities personnel, teachers, nutrition services staff and other district employees) participated, and data was collected either through email correspondence or semi-structured interviews. Data was analyzed using both deductive and inductive coding. Six themes emerged as facilitators to a school’s success in promoting healthy hydration for students: active and engaged champions, school culture and policy promoting water intake, shared interest and coordination between groups (i.e., smooth information flow between groups and valuing diverse roles and skills of various stakeholders), community influences promoting water intake, existing assets and additional resources, and commitment to environmentalism. This study showed that policy can help achieve minimum standards for drinking water in school, but it is important to have committed staff (i.e., champions) to promote the benefits of water, which could help reduce disparities in the future.
Study strengths:  This is the first in-depth qualitative study to explore factors influencing a school’s ability to meet excellence in water access and quality. Additionally, this study interviewed individuals from multiple disciplines which is one of the tenets of the Collective Impact Approach.
Study limitations: Since hydration is reinforced by parents/guardians of children, it is also important to address their perspectives in future studies. Additionally, this sample size was limited to California schools in a purposive selection, results may not be generalizable. Social desirability response bias may have also been present during interviews.
What this means for your practice: As health professionals, you can help children stay hydrated and healthy by encouraging their parents/guardians to serve water more often. When talking with them about drinking water, promote behaviors such as using reusable water bottles, serving as healthy role models, and limiting access to sugary drinks. Finally, as respected healthcare professionals in the community, you can be a ‘hydration champion’ for local schools to encourage drinking water excellence.
Original citation: Cooper, A. Y., Altman, E., Hecht, C. E., Bruce, J., & Patel, A. I. (2020). Stories of success: a qualitative examination of contributors to excellence in school drinking water access. Public Health Nutrition, 23(10), 1800-1809.

About the Author:  Chenin Treftz, Ph.D., R.D.N., is a member of the research faculty at the University of Nevada, Reno.  Dr. Treftz has expertise in research, community nutrition, and higher education. Dr. Treftz has been a member of the Rethink Your Drink team since 2012.
The goal of Rethink Your Drink Nevada is to promote healthy beverages and reduce sugary drinks. To support this goal, free educational resources are available to eligible medical and dental care practices in Nevada.  For more information, please visit or e-mail

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