Two‐year follow‐up of a randomised controlled trial to assess the sustainability of a school intervention to improve the implementation of a school‐based nutrition policy

Abstract

Issue addressed School‐based nutrition policies can have a positive effect on the school food environment. The primary aim of this study was to assess the primary school adherence to a mandatory state‐wide healthy canteen policy 12 months after an effective multi‐strategic implementation intervention concluded. Methods Primary schools were randomised to (a) a 12‐14 months multi‐strategic intervention or (b) no‐intervention (control). The intervention aimed to improve implementation of a state‐wide canteen policy by encouraging schools to remove unhealthy food and beverages (classified as ‘‘red’’ or ‘‘banned’’) from canteen menus and replace with healthy items (classified as ‘‘green’’). No implementation support was provided to either group by the research team between the 12 and 24 months data collection period. Results Seventy schools participated, of which 56 schools were assessed at 24‐month follow‐up. Intervention schools were less likely to have a menu which contained ‘‘red/banned’’ items at 24‐month follow‐up (RR = 2.28; 95% CI: 1.18‐4.40; P = 0.01). Intervention schools, however, were not more likely than controls to have a menu which contained >50% ‘‘green’’ items at 24‐month follow‐up (RR = 1.29; 95% CI: 0.98‐1.70; P = 0.10). Intervention schools were more likely to adhere to both policy components (no red/banned items and >50% green items on the menu) than control schools (RR = 2.61; 95% CI: 1.29‐5.29; P = 0.006). Among intervention schools that were fully adherent to the policy following implementation support (12‐month post baseline), all were also adherent at the 24‐month follow‐up. Conclusion The intervention was effective in achieving long‐term school adherence to a state‐wide canteen policy at 24‐month follow‐up. So what? The findings suggest that sustained improvements in implementation of school nutrition policies is possible following a period (12 months) of comprehensive implementation support.

Secondary school canteens in Australia: analysis of canteen menus from a repeated cross-sectional national survey

“…This is consistent with qualitative research involving canteen stakeholders suggesting that lack of support and resources negatively impact compliance (25,27,31) . In a randomised controlled trial in one region of NSW, canteen menus in schools provided with additional implementation support were more likely to be policy-compliant, which was maintained at postprogramme follow-up (32,33) . In schools provided with implementation support, canteen sales were lower in fat than in control schools and revenue was not negatively impacted (32) .…”

A Comprehensive School-Based Nutrition Intervention to Improve the Implementation of Healthy School Canteen Policy: A Systematic Review

“…Second, executive and community support in order to improve better services are another quite significant factor. The involvement of headmaster, parents committee, canteen manager that will promote the implementation of the healthy canteen policy in a longterm basis, as well as contribute improvement to the implementation of the school cross population nutrition policy (Wolfenden et al, 2019). In addition, reward and regular training workshop also constitutes an innovation with positive impact for healthy school canteen.…”

A cluster randomised effectiveness-implementation trial of an intervention to increase the adoption of PAX Good Behaviour Game, a mental health prevention program, in Australian primary schools: Study protocol

“…Barriers to program implementation at the teacher-level include time constraints, lack of training, lack of buy-in, and burnout, while at the school-level include lack of administrative support, logistics, staff turnover and financial resources [ [10] , [11] , [12] , [13] ]. Implementation science is being increasingly used to develop strategies to overcome such barriers [ [14] , [15] , [16] , [17] ]. Training and coaching has been found to enhance the fidelity of the PAX GBG in a RCT, which in turn was associated with better student outcomes [ 18 ].…”

“…Training and coaching has been found to enhance the fidelity of the PAX GBG in a RCT, which in turn was associated with better student outcomes [ 18 ]. In broader school-based research other promising implementation strategies include audit and provision of feedback [ [19] , [20] , [21] ], executive (administrative) support [ 15 , [22] , [23] , [24] ] and the use of school ‘program’ champions, when used in combination with other strategies [ 19 , [25] , [26] , [27] ].…”