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

Nicole Nathan,Sze Lin Yoong,Renee Reynolds,Lisa Janssen,Tessa Delaney,Rachel Sutherland,Luke Wolfenden,Li Kheng Chai,Kathryn Reilly,Christophe Lecathelinais,Katie Robertson,John Wiggers

doi:10.1186/s12966-016-0431-5

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.

Highlights

The 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 schoolaged children
Utilising a ‘traffic light’ food classification system, the policy classifies foods and beverages sold in school canteens as either ‘red’, ‘amber’ or ‘green’ based on their nutritional content (See Tables 1 and 2 below)
For all foods sold in the canteen at recess and lunch the policy requires schools to remove all red foods from regular sale and to fill the menu [35] with green foods and to not let amber foods dominate the menu

Summary

Introduction

The 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 schoolaged children. Evidence suggests that a large proportion of children in high income countries, including the United States [5, 6], United Kingdom [7], and Australia [8] do not meet national dietary guidelines [5,6,7,8]. School healthy eating policies and guidelines have been implemented by various jurisdictions including Canada [20], the United States [21], New Zealand [22], and Australia [23]. New Zealand schools are encouraged to develop school canteen menus which are mostly made up of ‘every day’ foods and beverages, to not let ‘sometimes’ foods and beverages dominate the menu and that occasional foods and beverages not be sold at all [24]

Objectives

Methods

Results

Discussion

Conclusion