Effectiveness of a multicomponent intervention to enhance implementation of a healthy canteen policy in Australian primary schools: a randomised controlled trial

Abstract

BackgroundThe implementation of school nutrition policies, which govern the provision of food in schools, is recommended as a public health strategy to support the development of healthy dietary behaviours in school-aged children. Despite this, research internationally and in Australia indicates that few schools implement such policies. This study aims to examine whether a theoretically designed, multi-strategy intervention was effective in increasing the implementation of a healthy canteen policy in Australian primary schools.MethodsA parallel group randomised controlled trial was conducted with all government and Catholic primary schools within one region in New South Wales, Australia who had an operational canteen that provided food to primary school aged children (5–12 years) and were not currently receiving an intervention to change their canteen practices. Schools randomised to the intervention arm received a 9-month multicomponent intervention including ongoing support, provision of resources, performance monitoring and feedback, executive support and recognition. The primary outcomes were the proportion of the schools with a canteen menu that: i) did not include ‘red’ or ‘banned’ items according to the healthy canteen policy; and ii) had more than 50 % ‘green’ items. The primary outcome was assessed via menu audit at baseline and follow up by dietitians blinded to group allocation.ResultsFifty-three eligible schools were randomised to either the intervention or control group (28 intervention; 25 control). Analyses with 51 schools who returned school menus found that intervention schools were significantly more likely relative to control schools to have a menu without ‘red’ or ‘banned’ items (RR = 5.78 (1.45–23.05); p = 0.002) and have at least 50 % of menu items classified as green (RR = 2.03 (1.01–4.08); p = 0.03).ConclusionsThis study found that a multi-component intervention was effective in improving primary schools’ compliance with a healthy canteen policy. Given the lack of evidence regarding how best to support schools with implementing evidence-based policies to improve child diet, this trial for the first time provides high quality evidence to practitioners and policy makers seeking to improve nutrition policy implementation in schools.Trial registrationThis trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614001148662) 30th October 2014.

Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents—A Qualitative Exploration

“…This highlights the necessity of supportive school food environment for enabling adolescents to make healthy choices. Promising avenues in this regard range from peer-led nutrition promotion program, school meal program or subsidized canteens serving healthy foods, regulation of food vending within and beyond school boundaries and so forth [79][80][81]. Like the neighboring country India, schools in Bangladesh are yet to define and adopt school food policies, whereas many Western countries have that in place [82].…”

Measurement Methods Used to Assess the School Food Environment: A Systematic Review

“…Canteen menu analysis was utilized by six studies, which involved either obtaining a school menu online or from canteen managers [22,55,61,65,70,71]. Although menu review is an objective measure, it may not be a reliable tool for food provision assessment, as the actual food available may differ from the planned menu and insufficient information may limit the account of portion sizes, types of foods, or pricing [64].…”

“…These were studies conducted in high income countries (e.g., Norway and New Zealand) and included all four dimensions of the school food environment. Seven studies were rated as 'medium' quality [22,28,38,46,60,65,71] and twenty-nine studies were rated as 'low' quality [37,[39][40][41][42]44,45,[47][48][49][50][51][52][54][55][56][57][58][59][61][62][63][64][66][67][68][69][70]. The number of methods which were assessed was 49, as a number of studies applied more than one methodological approach to measure to school food environment.…”

Interventions to Improve Medicines Management for People with Dementia: A Systematic Review

“…This is a recognised problem, with many authors who cite theory as guiding their intervention failing to describe how this was achieved [45]. However, there is evidence that theorybased interventions are effective in assisting behaviour change, provided theory is used appropriately [45,46].…”