A Mixed-Methods Exploration of Implementation of a Healthy School Canteen Program after a Year Intervention

Abstract

Background: Previous studies have shown that adolescents prefer less healthy food and their eating habits will affect their nutritional status in adulthood and old age. School canteen is a part of food retailing and provisioning that influence the diet quality of the adolescents. Healthy school canteen intervention is recommended as one of the public health strategies in supporting the development of healthy diet behavior. 
 Objectives: To evaluate the effects of a healthy school canteen intervention program among middle school children. 
 Methods: A mixed-methods research design including focus group interviews for teachers and principal, observation on school canteen, a survey for food handlers and food testing for hazardous chemicals. Thematic analysis of focus group data and descriptive analyses of survey data were conducted. Four schools were selected as intervention groups and four schools as positive control groups. Data collection phase took place between April 22 and May 2, 2019. 
 Results: Only one school out of eight schools that had written commitment and a food safety team. In intervention school 50% of food handlers use personal protective equipment and 25% of food handlers received training. In the positive control group, none of the food handlers used personal protective equipment and they had not received any training. Food handlers in the positive control group have a higher rate of correct answers. Only 2 out of 4 schools in the intervention group had nutritious foods available in the canteen and 3 out of 4 schools in the positive control group. None of the school canteens were found positive for metanil yellow. Higher positive findings for Rhodamin B, Formaldehyde and Borax (33.3%, 60.0%, 33.3%, respectively) in the control group compared to the control group (28.6%, 27.3%, and 28.6%, respectively). 
 Conclusions: Intervention groups have been slightly more successful in creating healthy school canteens, as they had a slightly better total score in the observation sheet compared to the schools from the positive control group. Collaboration with another stakeholder such as Primary Health Center (PHC) can be thought of as a solution to train food handlers about healthy practice while handling the food.