Healthy Lunchbox Research Articles

245 - Identifying school barriers and enablers to adoption of an evidence-based healthy lunchbox program

245 - Identifying school barriers and enablers to adoption of an evidence-based healthy lunchbox program

A collaborative network trial to evaluate the effectiveness of implementation strategies to maximize adoption of a school-based healthy lunchbox program: a study protocol.

An important impediment to the large-scale adoption of evidence-based school nutrition interventions is the lack of evidence on effective strategies to implement them. This paper describes the protocol for a "Collaborative Network Trial" to support the simultaneous testing of different strategies undertaken by New South Wales Local Health Districts to facilitate the adoption of an effective school-based healthy lunchbox program ('SWAP IT'). The primary objective of this study is to assess the effectiveness of different implementation strategies to increase school adoption of the SWAP across New South Wales Local Health Districts. Within a Master Protocol framework, a collaborative network trial will be undertaken. Independent randomized controlled trials to test implementation strategies to increase school adoption of SWAP IT within primary schools in 10 different New South Wales Local Health Districts will occur. Schools will be randomly allocated to either the intervention or control condition. Schools allocated to the intervention group will receive a combination of implementation strategies. Across the 10 participating Local Health Districts, six broad strategies were developed and combinations of these strategies will be executed over a 6 month period. In six districts an active comparison group (containing one or more implementation strategies) was selected. The primary outcome of the trial will be adoption of SWAP IT, assessed via electronic registration records captured automatically following online school registration to the program. The primary outcome will be assessed using logistic regression analyses for each trial. Individual participant data component network meta-analysis, under a Bayesian framework, will be used to explore strategy-covariate interactions; to model additive main effects (separate effects for each component of an implementation strategy); two way interactions (synergistic/antagonistic effects of components), and full interactions. The study will provide rigorous evidence of the effects of a variety of implementation strategies, employed in different contexts, on the adoption of a school-based healthy lunchbox program at scale. Importantly, it will also provide evidence as to whether health service-centered, collaborative research models can rapidly generate new knowledge and yield health service improvements. This trial is registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12623000558628).

Exploring motivations for engagement with the Healthy Lunch Box campaign on social media.

Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people's motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people's decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations.

Parental attitudes and high caloric share of ultra-processed foods in children’s lunchboxes

This study analyzed the caloric share of ultra-processed foods in preschoolers' lunchboxes and associated parental attitudes. The snacks were registered and classified according to the NOVA classification: In Natura or Minimally Processed Foods; Processed Foods; Ultra-processed Foods and Culinary Ingredients. A questionnaire was applied to the parents to identify parental attitudes. Pearson's Chi-Square, Student's t-tests, and Beta regression models were used. The caloric share of ultra-processed Food in lunchboxes was 55%, being 7% for In Natura or minimally processed foods. There was a significant association between the caloric share of ultra-processed food and parental attitudes: only sending snacks that kids like (p=0,005), choosing foods with the child's favorite TV characters(p=0,03), convenience(p=0,01), being able to buy all snacks at the supermarket(p=0,002), not reading the food label(p=0,025), not having information to prepare a healthy lunchbox(p=0,016), and the mother not being the person who prepares the lunchbox(p=0,002). Parental attitudes are strongly associated with the children's eating habits, which is why it is important strengthening public policies that regulate the provision of ultra-processed foods.

Development and piloting of a Community of Practice to support learning and improvement in health promotion practice within NSW local health district.

Health Promotion Units within New South Wales (NSW) local health districts (LHDs) frequently collaborate and test innovations to address priority health issues or approaches to support the implementation of a health promotion program in a way that is consistent with the needs, resources, and contexts of their regions. Compatible with learning health system approaches, mechanisms to facilitate the exchange of evidence and expertise across districts could improve the collective impact of health promotion services across the state. This study aimed to assess the use of a health promotion Community of Practice (CoP) model as a strategy to achieve this. Type of program or service: This paper describes and shares experiences from the development and piloting process of a CoP model to develop, evaluate and exchange learnings to improve approaches to support the adoption of an effective healthy lunchbox program ('SWAP IT') across three LHDs. The functioning of the CoP was supported by key activities, funding and infrastructure over a 2-year period, including: planning workshops, implementation check-ins, and knowledge exchange meetings. A particularly novel aspect of the CoP was the harmonised evaluation of different, locally developed strategies to facilitate program adoption across the three LHDs. The alignment of the CoP with local and state priorities, as well as the operation of the CoP in a way that did not impose significant time demands, was seen as important for the sustainability of the CoP. Findings from the piloting process suggest that a formalised CoP shows promise as an effective model to enhance health promotion collaboration, information sharing and practice across LHDs, which may be suitable for broader application across the state.

Acceptability, Helpfulness, and Utility of the Healthy Lunch Box Booklet (HLBB) for Parents and School-Age Children.

Purpose: School lunches are of poor nutritional quality in Canada. Parents play an important role in the preparation of school lunches for young children. This study aimed to evaluate the acceptability and helpfulness of the Healthy Lunch Box Booklet (HLBB) to support parents in packing healthy school lunches for their children.Methods: The HLBB was distributed at four schools in London, Ontario to students in full-day Kindergarten to Grade three. Parents were asked to complete an online survey from April to November 2019.Results: Parents (n = 58) reported the HLBB to be helpful (96.3%) and found the sections on new school lunch and snack ideas and nutritional information (e.g.,label reading) particularly useful. Some parents also stated that the HLBB created opportunities to interact with their children regarding school lunch preparation. In terms of perceived impacts, parents reported increased confidence (68.6%) and learning something new (79.6%) about school lunch preparation and felt that their children's diet was impacted accordingly.Conclusions: The HLBB was found to be an acceptable and useful nutrition resource that supports parents in packing healthy school lunches for their children and therefore warrants further study.

New models to support parents to pack healthy lunchboxes: Parents acceptability, feasibility, appropriateness, and adoption of the SWAP IT m-Health program

ObjectivesThis report aims to evaluate the acceptability, appropriateness, feasibility, and adoption of a healthy lunchbox program (SWAP IT), from the parent perspective. MethodsSWAP IT is an mobile health (m-Health) program aimed to support parents in swapping out discretionary foods for healthier alternatives. Following receipt of the program, parents completed validated scales assessing the Acceptability (AIM), Intervention Appropriateness (IAM), and Feasibility (FIM) via a computer-assisted telephone interview (CATI). Parents were asked about their awareness of strategies in SWAP IT and whether the program supported them to make lunchbox swaps from discretionary to everyday foods. ResultsOf the 679 parents who consented, 413 completed the CATI (61% response rate). Parent’s mean AIM score (out of a total score of 5) was 4.22 (SD 0.48); FIM score was 4.27 (SD 0.54); and IAM score was 4.24 (SD 0.54). Most parents reported receiving the lunchbox messages (54%), with 45% reporting opening all 10 messages and 64% of parents reporting the program helped swap out discretionary foods. ConclusionThe m-Health lunchbox program, SWAP IT, is highly acceptable, easy to adopt, appropriate, and feasible to parents. Implications to public healthNot only is SWAP IT effective, but favourable implementation factors highlight the potential scalability of the program in improving child nutrition.

Changes in Student's Breakfast and Snack Consumption during the Second COVID-19 Lockdown in Portugal: A Five-Wave Study.

The circumstances of the COVID-19 lockdown affected many students' life spheres, including their feeding patterns and snack intake. The main goals of the present study were to: (a) analyze the changes in students' breakfast and snacking consumption during lockdown, and (b) analyze changes in the content of the students' snacks using the Healthy Eating Index. This study analyzed data from a sample of 726 students from 36 classes from the late elementary (i.e., fifth grade) through high school (i.e., twelfth grade) from two public schools in the north of Portugal. Data were collected in five moments during the 2020/2021 school year, pre-, during, and post-second lockdown moments. Throughout the five moments, almost 90% of the students ate breakfast, and the majority brought snacks from home to eat in school. Surprisingly, there was an increase in the quality of the snacks consumed during lockdown compared to the pre-lockdown moments (e.g., consumption of more whole and total fruits and less consumption of food with added sugar, saturated fats, refined grains, and fatty acids). Suggestions for healthy behavior promotion will be discussed, such as improving the school food environment and teaching children to prepare healthy lunch boxes.

Impact of Maternal Nutrition Education on Dietary Practices of School Going Children (3-6 years of age)

Nutrition (Nutritional) education is a kind of education that is important to improve the health status of people. School children are undergoing rapid mental and physical development. Therefore, an appropriate diet is critical throughout this stage of life to ensure normal and healthy growth. As a result, nutrition education should begin at a young age for children Objective: To evaluate the impact of nutrition education of mothers on the dietary habits of school-going children aged 3-6 years Methods: A Quasi-Experimental study was executed on 77 children of class playgroup to class 1 studying in the Government girl’s school of Garhi Shahu, Lahore. Firstly, anthropometric data were collected through the children and secondly socio-demographic and dietary knowledge of mothers of selected children were noted through pre-designed questionnaires and interview method. The mothers were then given 45 minutes of nutrition education and a dietary change course, and some informative dietary guidelines leaflets and a weekly healthy kid’s school lunch planner were given to the mothers which they were requested to implement in the daily routine of children. After three months again the anthropometrics and questionnaires were assessed and compared with the initial findings Results: After nutrition education, the percentage of children who followed the servings of healthy food groups and avoided consumption of harmful meals (fast, fried, processed foods), unhealthy beverages (carbonated drinks), and intake of fruits and vegetables increased dramatically. After the intervention, the percentage of children who followed recommended nutritional, lifestyle, and physical activity guidelines, as well as healthy school lunch practices, improved statistically significantly (P<0.005). The percentage of children who skipped meals on daily basis was 20% decreased to 8%. Before the intervention, 63% of mothers say that their children consumed breakfast regularly and after the intervention, it increases to 75%. The children's anthropometric status improved significantly, with a P<0.005 significance level Conclusions: In this study, nutrition education had a significant impact on the school-going children in their anthropometry measurements, healthy school lunch boxes, and awareness of their mothers about healthy eating practices. Seminars and camps should be arranged in schools to educate the mothers and the students at a young age regarding their health and healthy eating to reduce the nutritional deficiencies and diseases

An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children's Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial.

BackgroundInterventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level.ObjectiveThis study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes.MethodsA cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics.ResultsData on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively).ConclusionsThe intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379

Breakfast and lunchboxes provided to foundation phase learners: do caregivers’ knowledge and attitude reflect their practices?

Background: This study was conducted to determine nutritional knowledge, and to identify whether caregivers’ knowledge and attitudes related to their breakfast and lunchbox food-providing practices. Methods: A cross-sectional descriptive study was conducted. Questionnaires were used to collect the data. The study population included 1286 caregivers of foundation phase learners in Quintile 5 schools from Bloemfontein, South Africa. Results: The median score for knowledge regarding breakfast and lunchboxes of caregivers was 55.6% and 73.1%, respectively. Knowledge on breakfast and lunchbox foods was higher for caregivers older than 35 years (breakfast median 55.6, p = 0.0479 and lunchbox median 76.9, p < 0.0001) and who possessed a tertiary qualification (breakfast median 55.6, p = 0.0009 and lunchbox median 76.9, p < 0.0001). The attitudes of caregivers were generally positive towards providing healthy breakfast and lunchbox foods (breakfast median 71.4% and lunchbox median 82.5%). The primary objective of caregivers’ provision of a lunchbox was health considerations (n = 658, 54.2%) followed by being filling (n = 277, 22.8%). The median score to rate the provision of healthy breakfast foods was 26.7% and 35.6% for lunchbox foods. Healthier breakfasts and lunchboxes were provided by caregivers with a tertiary qualification. Conclusions: A need to educate caregivers on the provision of healthy breakfast and lunchbox foods has been identified.

A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness-Implementation Hybrid Cluster Randomized Controlled Trial.

BackgroundThere is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted.ObjectiveThis study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school.MethodsA type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness.ResultsA total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes.ConclusionsThe SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs.Trial RegistrationAustralian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=trueInternational Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-7725-x

Enhancing the potential effects of text messages delivered via an m-health intervention to improve packing of healthy school lunchboxes.

The aim of the study was to assess the impact of different lunchbox messages on parents' intention to pack a healthy lunchbox. This study employed an experimental design. A series of messages were developed to align with the six constructs of the Health Belief Model. Messages were also developed that were (and were not) personalised and varied based on the source of the information provided (university, school, dietitian and health promotion service). During a telephone survey, participants were read the content of each message and asked about their intention to pack a healthy lunchbox. Parents of primary school-aged children were randomised to receive different messages to encourage the packing of healthy lunchboxes. The study was completed by 511 parents. Linear mixed regression analyses identified significant differences (P < 0·05) in intention scores between variant messages targeting the same behavioural constructs for 'susceptibility', 'severity', 'benefits' and 'barriers' but not 'cues to action' or 'self-efficacy'. The highest mean behavioural intention score was for 'benefits', whilst the lowest mean score was for 'barriers'. There were no significant differences in intention scores of parents receiving messages from a dietitian, university, health promotion team or school (P = 0·37). Intention scores did not differ in which messages were personalised based on child's name (P = 0·84) or grade level (P = 0·54). The findings suggest that messages that focus on the benefits of packing healthy lunchboxes may be particularly useful in improving intentions of parents to pack healthy foods for their children to consume at school.

A cross-sectional study to determine the energy density and nutritional quality of primary-school children's lunchboxes.

The present study describes the energy content of primary-school children's lunchboxes and the proportion of lunchbox foods considered discretionary. Subgroup analyses by sex, socio-economic status, age and weight status were undertaken. A cross-sectional study was conducted. Mean kilojoule content, number of items and categorisation of foods and drinks in lunchboxes as 'everyday' (healthy) or discretionary (sometimes) foods were assessed via a valid and reliable lunchbox observational audit. Twelve Catholic primary schools (Kindergarten-Grade 6) located in the Hunter region of New South Wales, Australia. Kindergarten to Grade 6 primary-school students. In total, 2143 children (57 %) had parental consent to have their lunchboxes observed. School lunchboxes contained a mean of 2748 kJ, of which 61·2 % of energy was from foods consistent with the Australian Dietary Guidelines and 38·8 % of energy was discretionary foods. The proportion of lunchboxes containing only healthy foods was 12 %. Children in Kindergarten-Grade 2 packed more servings of 'everyday' foods (3·32 v. 2·98, P < 0·01) compared with children in Grades 3-6. Children in Grades 3-6 had a higher percentage of energy from discretionary foods (39·1 v. 33·8 %, P < 0·01) compared with children in Kindergarten-Grade 2 and children from the most socio-economically disadvantaged areas had significantly higher total kilojoules in the school lunchbox compared with the least disadvantaged students (2842 v. 2544 kJ, P = 0·03). Foods packed within school lunchboxes may contribute to energy imbalance. The development of school policies and population-based strategies to support parents overcome barriers to packing healthy lunchboxes are warranted.

Protocol for an effectiveness- implementation hybrid trial to assess the effectiveness and cost-effectiveness of an m-health intervention to decrease the consumption of discretionary foods packed in school lunchboxes: the \u2018SWAP IT\u2019 trial

BackgroundAt a population level, small reductions in energy intake have the potential to contribute to a reduction in the prevalence of childhood obesity. In many school systems, there is the potential to achieve a reduction in energy intake through modest improvements in foods packed in children’s school lunchboxes. This study will assess the effectiveness and cost-effectiveness of a multi-component intervention that uses an existing school-based communication application to reduce the kilojoule content from discretionary foods and drinks consumed by children from school lunchboxes whilst at school.MethodsA Type I hybrid effectiveness-implementation cluster randomised controlled trial will be conducted in up to 36 primary schools in the Hunter New England, Central Coast and Mid North Coast regions of New South Wales, Australia. Designed using the Behaviour Change Wheel, schools will be randomly allocated to receive either a 5-month (1.5 school terms) multi-component intervention that includes: 1) school lunchbox nutrition guidelines; 2) curriculum lessons; 3) information pushed to parents via an existing school-based communication application and 4) additional parent resources to address common barriers to packing healthy lunchboxes or a control arm (standard school practices). The study will assess both child level dietary outcomes and school-level implementation outcomes. The primary trial outcome, mean energy (kJ) content of discretionary lunchbox foods packed in children’s lunchboxes, will be assessed at baseline and immediately post intervention (5 months or 1.5 school terms). Analyses will be performed using intention to treat principles, assessing differences between groups via hierarchical linear regression models.DiscussionThis study will be the first fully powered randomised controlled trial internationally to examine the impact of an m-health intervention to reduce the mean energy from discretionary food and drinks packed in the school lunchbox. The intervention has been designed with scalability in mind and will address an important evidence gap which, if shown to be effective, has the potential to be applied at a population level.Trial registrationAustralian Clinical Trials Registry ACTRN:12618001731280 registered on 17/10/2018. Protocol Version 1.

Programa loncheras saludables en los hábitos alimentarios y el estado nutricional de los estudiantes de una institución educativa de Huánuco

Objetivo. Determinar los efectos del programa Loncheras Saludables enlos hábitos alimentarios y el estado nutricional de los estudiantes del nivelprimaria de la institución educativa San Vicente de la Barquera de Huánuco,al 2018 Métodos. Se realizó un estudio con diseño pre-experimental conaplicación de un estímulo en el programa de loncheras escolares, con pruebaantes y después, en un solo grupo en 179 escolares del nivel primaria; para locual se usó una guía de entrevista en la recolección de los datos y una fcha deregistro para el estado nutricional. En el análisis inferencial se utilizó la pruebade chi cuadrado de independencia con una signifcancia estadística p ≤ 0,05.Resultado. En la variable hábitos alimentarios, después de la intervenciónel valor de signifcancia fue p=0,000 con cambios en 25,1 %; en la variableestado nutricional después de la intervención el valor de signifcancia fuep=0,026, con cambios en un 14,5 % en los estudiantes del nivel primaria enestudio. En consecuencia, se rechaza la hipótesis nula y se acepta la hipótesisde investigación en donde se afrma que el programa de Loncheras Escolarestiene efecto positivo sobre los hábitos alimentarios y el estado nutricional enla muestra en estudio. Conclusiones. El programa Loncheras Escolares tieneefecto positivo sobre los hábitos alimentarios y el estado nutricional en losestudiantes del nivel primaria de la institución educativa San Vicente de laBarquera.

A randomized controlled trial to assess the potential efficacy, feasibility and acceptability of an m-health intervention targeting parents of school aged children to improve the nutritional quality of foods packed in the lunchbox \u2018SWAP IT\u2019

BackgroundScalable interventions that improve the nutritional quality of foods in children’s lunchboxes have considerable potential to improve child public health nutrition. This study assessed the potential efficacy, feasibility and acceptability of an m-health intervention, ‘SWAP IT’, to improve the energy and nutritional quality of foods packed in children’s lunchboxes.MethodsThe study employed a 2X2 factorial cluster randomized-controlled trial design. Twelve primary schools in New South Wales, Australia were randomly allocated to one of four groups: (i) no intervention;(ii) physical activity intervention only;(iii) lunchbox intervention only; or(iv) physical activity and lunchbox intervention combined. The two intervention strategies were evaluated separately. This paper focuses on the effects of the lunchbox intervention only. The lunchbox intervention comprised four strategies: 1) school nutrition guidelines; 2) lunchbox lessons; 3) information pushed to parents via a school-communication app and 4) parent resources addressing barriers to packing healthy lunchboxes. Outcome measures were taken at baseline and immediately post-intervention (10 weeks) and included measures of effectiveness (mean energy (kJ) packed in lunchboxes, total energy and percentage energy from recommended foods consistent with Australian Dietary Guidelines), feasibility (of delivering intervention to schools, parent app engagement and behaviour change) and acceptability to school staff and parents. Linear mixed models were used to assess intervention efficacy.ResultsOf the 1915 lunchbox observations, at follow-up there was no significant differences between intervention and control group in mean energy of foods packed within lunchboxes (− 118.39 kJ, CI = -307.08, 70.30, p = 0.22). There was a significant increase favouring the intervention in the secondary outcome of mean lunchbox energy from recommended foods (79.21 kJ, CI = 1.99, 156.43, p = 0.04), and a non-significant increase in percentage of lunchbox energy from recommended foods in intervention schools (4.57%, CI = -0.52, 9.66, p = 0.08). The views of the messages pushed via the app ranged from 387 to 1550 views per week (mean views =1025 per week). A large proportion (71%) of parents reported awareness of the intervention, making healthier swaps in the lunchbox (55%), and pushed content was helpful (84%).ConclusionThe study is the first RCT to assess the potential of a multi-component m-health lunchbox intervention. The intervention was feasible, acceptable and potentially effective in improving the nutritional quality of foods packed within children’s lunchboxes.Trial registrationAustralian Clinical Trials Registry ACTRN: ACTRN12616001228471.

Assessing the preliminary effectiveness of an m-health intervention to support parents to pack healthy school lunchboxes

Assessing the preliminary effectiveness of an m-health intervention to support parents to pack healthy school lunchboxes

Cluster randomised controlled trial of an m-health intervention in centre-based childcare services to reduce the packing of discretionary foods in children’s lunchboxes: study protocol for the ’SWAP IT Childcare' trial

IntroductionIn many developed nations, including Australia, a substantial number of children aged under 5 years attend centre-based childcare services that require parents to pack food in lunchboxes. These lunchboxes often...

Improving the nutrient content of the lunch boxes of children in Early Childhood Development Centers in Nelson Mandela Bay, South Africa through parent programs: Baseline nutrition survey results

BACKGROUND Earlier research from Early Childhood Development (ECD) Centers in Nelson Mandela Bay (NMB) showed a double burden of both chronic underweight and overweight in the same vulnerable communities. Lunch boxes that parents pack for children attending ECD centers have been noted to fall short of the recommended dietary standards. Despite this, no similar research has been done with the parents concerning the content of the lunchboxes and if nutrition education strategies can improve the lunchbox content. The primary aim of the study is to improve the nutrient content of the lunchboxes of the preschool children through parent programs. It is hoped that this will help increase access to healthy lunch boxes among preschool children in Nelson Mandela Bay. METHODS Ethical approval for this study was obtained from Nelson Mandela University. During February 2018, 485 participants from preschools in underprivileged areas were weighed and measured by trained fieldworkers to determine the weight-for-age Z-score, height-for-age Z-score and weight-for-height Z-score using the WHO Anthro. RESULTS The baseline nutrition survey results from 381 participants (age range 5-60 months) showed that 2.4% (n=9) of the participants were wasted, 14.5% (n= 55) stunted, 3.7% severely stunted (n=14) and 14.9% (n=57) underweight. The most wasted age group of the children was between 36-47 months 5.2% (n=6) while the most severely stunted age group was between 6-11 months 12.5% (n=8). Similarly, the same age group (6-11 months) registered the highest underweight percentage 12.5% (n=8). On the other hand, 37.2% (n=141) of the children were overweight. The overweight children were between 12-23 months of age. Findings indicate a double burden of disease in the form of stunting and overweight present in the same geographical populations. Conclusion This implies that any nutrition intervention should be targeted to the needs of specific individuals. In addition, urgent preventative strategies are needed to investigate the causes of this double burden and the potential contribution that parents can make to prevent this.