Abstract
BackgroundOne of the largest school feeding programs in the world is the National School Feeding Program of Brazil. However, results from the 2012 National School Health Survey indicated that only 22.8% of 9th grade students in Brazilian public school system consumed school meals. The literature presents few studies aiming to promote healthy food consumption in the school environment from interventions, which found inconclusive results. Thus, this study aims to present a protocol to evaluate the effectiveness of multi-component school-level interventions to increase adherence and acceptance to school feeding.MethodsSchool-based multi-component clinical trial with students from 4th-9h grade from 3 municipal schools of Sumidouro, Rio de Janeiro, Brazil, in 2019. The study design will be parallel, with 3 arms: Control group (without intervention); Intervention group 1 (changes in school environment) and Intervention group 2 (changes in menu and school environment). Interventions in the environment will be based on the principles of choices architecture and, the modification in the dishes that make up the menus offered to the students, on the factors that contribute to poor adherence and acceptance to school feeding, identified by focus groups. Adherence to school feeding will be assessed through a specific question in the questionnaire directed to the frequency of consuming school meals in the week, applied by researchers in three moments. Acceptance will be assessed from the acceptability test application with dishes served to students during the year. Statistical analyses will be performed using generalized linear models, which will be used to assess the impact of the intervention, and will include 3 main variables: intervention, time and the intervention x time interaction.DiscussionThis study will investigate if the impact of the implementation of interventions in the environment and in the dishes served to students may increase adherence and acceptance to school feeding. Positive results could show the effect of implementing interventions throughout Sumidouro’s public school system, as well as throughout the country, aiming to improve the consumption of school meals.Trial registrationBrazilian Registry of Clinical Trials, RBR-7mf794. Date of registration: December 27, 2018.
Highlights
One of the largest school feeding programs in the world is the National School Feeding Program of Brazil
Intervention strategies to promote healthy food consumption in the school environment, based on choices architecture, which include changes in the environment, such as the use of messages and images of incentives and changes in the positioning of foods offered to students [45,46,47] and in the presentation of foods, by offering pre-cut fruits, using containers with attractive colors and by creating playful names for dishes [46, 47], have been conducted in developed countries with inconclusive results in modifying eating behaviors [26]
A multi-component intervention based on the theory of choices architecture and results observed from focus groups will be tested, with the aim of increasing adherence and acceptance of the food served in the municipal schools of Sumidouro-RJ, Brazil
Summary
The literature presents few studies aiming to promote healthy food consumption in the school environment from interventions, which found inconclusive results. This study aims to present a protocol to evaluate the effectiveness of multi-component school-level interventions to increase adherence and acceptance to school feeding. Methods: School-based multi-component clinical trial with students from 4th-9h grade from 3 municipal schools of Sumidouro, Rio de Janeiro, Brazil, in 2019. Interventions in the environment will be based on the principles of choices architecture and, the modification in the dishes that make up the menus offered to the students, on the factors that contribute to poor adherence and acceptance to school feeding, identified by focus groups. An economic advance on the world stage is observed, the United Nations Food and Agriculture Organization has published in its report that since 2015 the number of undernourished people has increased. 34,7 million were located in Latin America, highlighting the great challenge of meeting the goal number 2 of the Sustainable Development Goal (SDG), which predicts zero hunger by 2030 [2]
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