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Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial

Wolfenden, Luke, Nathan, Nicole, Janssen, Lisa M., Wiggers, John, Reilly, Kathryn, Delaney, Tessa, Williams, Christopher M., Bell, Colin, Wyse, Rebecca, Sutherland, Rachel, Campbell, Libby, Lecathelinais, Christophe, Oldmeadow, Chris, Freund, Megan and Yoong, Sze Lin 2017, Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial, Implementation science, vol. 12, pp. 1-11, doi: 10.1186/s13012-016-0537-9.

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Title Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial
Author(s) Wolfenden, Luke
Nathan, Nicole
Janssen, Lisa M.
Wiggers, John
Reilly, Kathryn
Delaney, Tessa
Williams, Christopher M.
Bell, ColinORCID iD for Bell, Colin orcid.org/0000-0003-2731-9858
Wyse, Rebecca
Sutherland, Rachel
Campbell, Libby
Lecathelinais, Christophe
Oldmeadow, Chris
Freund, Megan
Yoong, Sze Lin
Journal name Implementation science
Volume number 12
Article ID 6
Start page 1
End page 11
Total pages 11
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017-01
ISSN 1748-5908
Keyword(s) Canteens
Children
Healthy eating
Implementation
Nutrition
Policy
School
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
AUSTRALIAN PRIMARY-SCHOOLS
PREVENTION PROGRAM
BEHAVIOR-CHANGE
FOOD
DISSEMINATION
OBESITY
ENVIRONMENT
GUIDELINES
DIFFUSION
Summary Background
Internationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children’s canteen purchases and on schools’ canteen revenue was also assessed.

Methods
Australian primary schools with a canteen were randomised to receive a 12–14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as ‘red’ or ‘banned’) from regular sale and encouraged schools to ‘fill the menu’ with healthy items (classified as ‘green’). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015).

Results
Seventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without ‘red’ or ‘banned’ items (RR = 21.11; 95% CI 3.30 to 147.28; p ≤ 0.01) and to have at least 50% of menu items classified as ‘green’ (RR = 3.06; 95% CI 1.64 to 5.68; p ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = −1.51 g; 95% CI −2.84 to −0.18; p = 0.028) compared to controls, but not in energy (difference = −132.32 kJ; 95% CI −280.99 to 16.34; p = 0.080) or sodium (difference = −46.81 mg; 95% CI −96.97 to 3.35; p = 0.067). Canteen revenue did not differ significantly between groups.

Conclusion
Poor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools.
Language eng
DOI 10.1186/s13012-016-0537-9
Field of Research 111104 Public Nutrition Intervention
11 Medical And Health Sciences
08 Information And Computing Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30092781

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.