A randomized controlled trial to assess the potential efficacy, feasibility and acceptability of an m-health intervention targeting parents of school aged children to improve the nutritional quality of foods packed in the lunchbox ‘SWAP IT’

Abstract

Background Scalable interventions that improve the nutritional quality of foods in children’s lunchboxes have considerable potential to improve child public health nutrition. This study assessed the potential efficacy, feasibility and acceptability of an m-health intervention, ‘SWAP IT’, to improve the energy and nutritional quality of foods packed in children’s lunchboxes. Methods The study employed a 2X2 factorial cluster randomized-controlled trial design . Twelve primary schools in New South Wales, Australia were randomly allocated to one of four groups: (i) no intervention;(ii) physical activity intervention only;(iii) lunchbox intervention only; or(iv) physical activity and lunchbox intervention combined. The two intervention strategies were evaluated separately. This paper focuses on the effects of the lunchbox intervention only. The lunchbox intervention comprised four strategies: 1) school nutrition guidelines; 2) lunchbox lessons; 3) information pushed to parents via a school-communication app and 4) parent resources addressing barriers to packing healthy lunchboxes. Outcome measures were taken at baseline and immediately post-intervention (10 weeks) and included measures of effectiveness (mean energy (kJ) packed in lunchboxes, total energy and percentage energy from recommended foods consistent with Australian Dietary Guidelines), feasibility (of delivering intervention to schools, parent app engagement and behaviour change) and acceptability to school staff and parents. Linear mixed models were used to assess intervention efficacy. Results Of the 1915 lunchbox observations, at follow-up there was no significant differences between intervention and control group in mean energy of foods packed within lunchboxes (− 118.39 kJ, CI = -307.08, 70.30, p = 0.22). There was a significant increase favouring the intervention in the secondary outcome of mean lunchbox energy from recommended foods (79.21 kJ, CI = 1.99, 156.43, p = 0.04), and a non-significant increase in percentage of lunchbox energy from recommended foods in intervention schools (4.57%, CI = -0.52, 9.66, p = 0.08). The views of the messages pushed via the app ranged from 387 to 1550 views per week (mean views =1025 per week). A large proportion (71%) of parents reported awareness of the intervention, making healthier swaps in the lunchbox (55%), and pushed content was helpful (84%). Conclusion The study is the first RCT to assess the potential of a multi-component m-health lunchbox intervention. The intervention was feasible, acceptable and potentially effective in improving the nutritional quality of foods packed within children’s lunchboxes. Trial registration Australian Clinical Trials Registry ACTRN: ACTRN12616001228471 .

A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children’s nutrition

“…This review suggests that nutrition promotion websites and apps can achieve small to moderate changes in fruits, vegetables and nutrient-poor foods and drinks [31-34, 36, 38, 39], albeit with more studies needed to further substantiate their effectiveness. A recent Australian study, which included lunchbox messages provided to parents via a school communication app as part of a multicomponent school-based intervention, found small improvements in the energy intake from recommended foods in the lunchbox [68]. Promisingly, 89% of parents downloaded the app, 71% recalled receiving health promotion messages and most found the messages acceptable and helpful, indicating feasibility and acceptability [68].…”

“…A recent Australian study, which included lunchbox messages provided to parents via a school communication app as part of a multicomponent school-based intervention, found small improvements in the energy intake from recommended foods in the lunchbox [68]. Promisingly, 89% of parents downloaded the app, 71% recalled receiving health promotion messages and most found the messages acceptable and helpful, indicating feasibility and acceptability [68]. Digital interventions delivered to parents in other contexts support the use of apps and websites as an effective intervention mode for improving health behaviours.…”

A repeated cross-sectional survey assessing changes in diet and nutrient quality of English primary school children’s packed lunches between 2006 and 2016

“…Educational activities for parents and children are important, but need to be part of a wider package, as information or education for parents on its own is unlikely to make a sustained difference 34. A good example of engaging parents is through the use of social media; one Australian study reported improvements in diet quality of lunchboxes 41. A recent systematic review of interventions to improve quality of packed lunches included 10 programmes mainly from the UK, the USA and Australia.…”

From demonstration project to changes in health systems for child obesity prevention: the legacy of ‘Good for Kids, Good for Life’

“…The program achieved high community awareness (60%) significant reach (e.g. For example, trials conducted by HNELHD staff have identified effective scalable interventions to improve student physical activity, 6,7 and to improve the packing of healthy student lunch-boxes; 8 and effective strategies to improve implementation of dietary guidelines by childcare services 9 and healthy school canteen policies. 3,4 Rigorous controlled evaluations of the service delivery models provided evidence for 'how' community settings could be re-oriented to more effectively deliver obesity prevention services at scale.…”

“…The capacity of health service staff, built during the demonstration project, has also spawned further innovation. For example, trials conducted by HNELHD staff have identified effective scalable interventions to improve student physical activity, 6,7 and to improve the packing of healthy student lunch-boxes; 8 and effective strategies to improve implementation of dietary guidelines by childcare services 9 and healthy school canteen policies. 10 These successful interventions and implementation support strategies have subsequently been adopted as routine service delivery practice by HNELHD in supporting 420 primary schools and 350 childcare services to promote healthy eating and physical activity.…”