Scale up of a multi-strategic intervention to increase implementation of a school healthy canteen policy: findings of an intervention trial

Kathryn L Reilly,John Wiggers,Luke Wolfenden,Sze Lin Yoong,Nicole Nathan

doi:10.1186/s12889-018-5786-x

Abstract

BackgroundImplementation interventions delivered in schools to improve food provision have been found to improve student diet and reduce child obesity risk. If the health benefits of food availability policies are to be realised, interventions that are effective need to be implemented at scale, across an entire population of schools. This study aims to assess the potential effectiveness of an intervention in increasing the implementation, at scale, of a healthy canteen policy by Australian primary schools.MethodsA non-controlled before and after study was conducted in primary schools located in the Hunter New England region of New South Wales, Australia. Schools received a multi-component intervention adapted from a previous efficacious and cost-effective randomised control trial. The primary trial outcome was the proportion of canteen menus compliant with the state healthy canteen policy, assessed via menu audit at baseline and follow-up by dietitians. Secondary outcomes included policy reach and adoption and maintenance policy implementation.ResultsOf the 173 schools eligible for inclusion in the trial, 168 provided menus at baseline and 157 menus were collected at follow-up. At follow-up, multiple imputation analysis found 35% (55/157) of schools compared to 17% (29/168) at baseline (OR = 2.8 (1.6–4.7), p = < 0.001) had menus compliant with the state healthy canteen policy. As an assessment of the impact of the intervention on policy reach, canteen manager and principal knowledge of the policy increased from 64% (n = 76) and 38% (n = 44) respectively at baseline to 69% (n = 89) and 60% (n = 70) at follow-up (p = 0.393, p = 0.026). Adoption of the policy increased from 80% (n = 93) at baseline to 90% (n = 104) at follow-up (p = 0.005) for principals, and from 86% (n = 105) to 96% (n = 124) (p = 0.0001) for canteen managers. Multiple imputation analysis showed intervention effects were maintained six-months post intervention (33% of menus compliant OR = 2.6 (1.5–4.5), p = < 0.001 compared to baseline).ConclusionsThis study found school canteen compliance with a healthy food policy increased in association with a multi-strategy intervention delivered at scale. The study provides evidence for public health policy makers and practitioners regarding strategies and modes of support required to support improvement in nutrition policy implementation across entire populations of schools.

Highlights

Implementation interventions delivered in schools to improve food provision have been found to improve student diet and reduce child obesity risk
Participants and characteristics Of the 338 schools in the study region identified as having an operational canteen, 173 schools were deemed eligible for participation
At baseline 168 (97%) schools provided their menu for assessment and 125 (72%) principals and 122 (71%) canteen managers completed their respective telephone interviews

Summary

Introduction

Implementation interventions delivered in schools to improve food provision have been found to improve student diet and reduce child obesity risk. If the health benefits of food availability policies are to be realised, interventions that are effective need to be implemented at scale, across an entire population of schools. This study aims to assess the potential effectiveness of an intervention in increasing the implementation, at scale, of a healthy canteen policy by Australian primary schools. Schools are recommended by the World Health Organisation (WHO) as a critical setting to improve public health nutrition and to reduce the risk of unhealthy weight gain in childhood [7]. Policies have been introduced in the school setting in a number of jurisdictions internationally that support the provision of food in line with national dietary guidelines [8, 9]. In Australia, where children can purchase foods and drinks over the counter from a canteen or tuckshop [11], all states and territories have introduced mandatory healthy canteen policies that promote the purchase of healthy foods and restrict the sale of less healthy foods [9]

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