School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

Abstract

Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. Mohammadi et al. A Study Protocol of School-Based Intervention Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.

Facilitators and Barriers to Implementing Healthy School Canteen Intervention among Malaysian Adolescents: A Qualitative Study

“…The intervention was developed based on data obtained from two related systematic reviews [ 6 , 21 ], reports of the MyHeART study [ 22 ] and a related qualitative study [ 23 ]. In addition, the framework for the development and evaluation of complex intervention by the UK Medical Research Council (MRC) was adapted for the current intervention [ 24 , 25 ]. This intervention study aimed to explore the feasibility of conducting an intervention in different types of schools (urban or rural) and its potential to show effectiveness for improving healthy eating practices in adolescents from different socioeconomic backgrounds.…”

“…This coupon entitled them to get free vegetables, fruits and low-energy dense kuih that were subsidised for them at the canteen once a day during recess. Further details of the intervention are reported elsewhere [ 25 ]. Before the start of the intervention, the food vendor operators had received basic information on healthy canteens from the Ministry of Health (MOH) equally, which means that all of them had similar levels of information on healthy eating and a handbook about healthy canteens.…”

“…The semi-structured interview guides were designed to seek the school administrators and food vendor operators’ views on the healthy canteen intervention programme and their views on the changes and barriers they discovered after the intervention programme. The questionnaire guides were developed based on a thorough systematic review and discussion among the teams and had been pre-tested [ 21 , 25 ]. A trained facilitator (MHA) experienced in conducting qualitative research facilitated the interviews which were conducted in Malay.…”

Outcome Evaluation on Impact of the Nutrition Intervention among Adolescents: A Feasibility, Randomised Control Study from Myheart Beat (Malaysian Health and Adolescents Longitudinal Research Team—Behavioural Epidemiology and Trial)

“…The control arm continued the regular food service operation without any intervention. The details of this study protocol with summary diagram of dietary intervention were described in a previous paper [15]. The study was registered at the ISRCTN registry with the code: ISRCTN 89649533.…”

“…The second objective was to assess the effect of subsidization and healthy cooking preparation training to canteen and convenience shop operators on adolescents' dietary intakes compared to no intervention. It reports outcomes of the interventional part of the MyHeART BEaT (Malaysian Health and Adolescents Longitudinal ResearchTeam Behavioural Epidemiology and Trial) project [15][16][17][18][19].…”