School-based intervention that integrates nutrition education and supportive healthy school food environment among Malaysian primary school children: a study protocol

Abstract

BackgroundMalnutrition among school children may contribute to adverse health consequences such as non-communicable diseases, poor cognitive performance, psychological distress and poor quality of life that may persist into adulthood. In order to prevent childhood malnutrition, an intervention programme that integrates nutrition education and healthy school food environment is needed to provide nutrition information and reinforce the skills on healthy eating behaviours in schools. This paper describes a study protocol of a school-based intervention programme that integrates nutrition education and healthy school food environment, namely School Nutrition Programme (SNP). The SNP is a primary prevention programme that promotes healthy lifestyle among primary school children in light of the high prevalence of malnutrition in Malaysian children.Methods/designThis quasi-experimental study aimed to evaluate the effectiveness of the SNP between intervention and comparison groups before and after the SNP, and after a 3-month follow-up. The SNP consisted of two main components, whereby three nutrition education sessions were implemented by trained teachers using three standardised modules, and healthy school food environment was implemented by the canteen food handlers with the provision of healthy menu to children during school recess times. Children from intervention group participated in the SNP, in addition to the standard Physical and Health Curriculum. The comparison group attended only the standardised Physical and Health Curriculum and the school canteen food handlers were reminded to follow the standard canteen guidelines from the Ministry of Education Malaysia. The assessment parameters in evaluating the effectiveness of the programme were knowledge, attitude and practice on nutrition, eating behaviours, physical activity, body composition, psychological distress, cognitive performance and health-related quality of life. Assessments were conducted at three time points: pre-intervention, post-intervention and 3-month follow-up.DiscussionIt was hypothesised that the SNP would be effective in promoting healthy lifestyle among school children, and further contributes in preventing malnutrition problem, enhancing cognitive performance and improving health-related quality of life among school children. Findings of the present study can be expanded to other schools in future on ways to improve nutrition education and healthy school food environment.Trial registrationUMIN Clinical Trial Registration UMIN000032914 (Date of registration: 7th June 2018, retrospectively registered).Protocol version16th September 2019 & Version 4

The Impact of an Educational Institution on Development of Healthy Lifestyle Skills for Prevention of Obesity in Adolescents

“…Important indicators of level of development of healthy lifestyle skills are eating behavior and physical activity. For effective prevention of obesity, it is necessary to combine limited foodstuffs with high number of calories, sufficient physical activity and consumption of healthful foodstuffs [2,11,12].…”

Impacts of a School-Based Intervention That Incorporates Nutrition Education and a Supportive Healthy School Canteen Environment among Primary School Children in Malaysia

“…In addition, the SNP promoted a healthy school canteen environment that served different types of healthy meals every school day during morning tea snacking period (school recess time), which is an important time to provide energy to help the children to continue their studies, to practice classroom nutrition education messages, to increase attendance, or to decrease absenteeism. The healthy canteen significant reduced the availability of processed food, high energy density food, and sugary drinks to primary school children [19,25,31,[54][55][56][57]. The school canteen from the intervention group served the healthy menu to the school children during the intervention period.…”

“…To date, there is no existing intervention program that incorporates both nutrition education and a supportive healthy school canteen environment in promoting school nutrition among Malaysian children [30]. The food available in the school canteen must reflect what has been taught in the nutrition education, which can exert a strong influence on children's food decisions [19,30,31]. Therefore, the present study proposed a school nutrition program (SNP) that comprised two main components, namely (i) nutrition education and (ii) a healthy school canteen environment [30].…”

Impact of a behaviourally focused nutrition education intervention on attitudes and practices related to eating habits and activity levels in Indian adolescents

“…Using the simplified formula, n 16/ δ 2 , where δ represents the standardised effect size (57,58) , the required sample size was calculated as 178 in each comparison group. Considering a non-response rate of 20 %, as indicated in previous studies (33,59,60) , the total sample size for the study was estimated as 214 (EG) þ 214 (CG) = 428.…”