Abstract
BackgroundApproximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security.Methods/DesignSixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.DiscussionThis randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.Trial Registration NumberAustralian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235
Highlights
55,000 children in New Zealand do not eat breakfast on any given day
This paper presents the study protocol for a stepped wedge cluster randomised controlled trial to investigate the effects of a free school breakfast programme on students’ school attendance, academic achievement, psychosocial function, dietary habits and food security
Assuming an intra-cluster coefficient (ICC) of 0.05, this sample size will provide at least 85% power, with a significance level of a = 0.05, to detect a 10% absolute increase in the proportion of students with a school attendance rate of 95% or higher
Summary
The breakfast intervention trial described in this paper is the first of its kind in Australasia and amongst only a very small number conducted in high income countries to date. Results from this research will provide valuable, much needed information on the effects of free school breakfast programmes in high income countries on school attendance, achievement, psychosocial function, and nutrition. This trial provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluation of pragmatic public health interventions. All too often such initiatives do not undergo robust evaluation due to difficulties in aligning the implementation timetable and rollout strategy with trial design and recruitment [32]. This trial provides a useful illustration of simultaneous implementation and rigorous evaluation of a public health intervention programme
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