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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Research

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

Authors: Luke Wolfenden, Nicole Nathan, Lisa M. Janssen, John Wiggers, Kathryn Reilly, Tessa Delaney, Christopher M. Williams, Colin Bell, Rebecca Wyse, Rachel Sutherland, Libby Campbell, Christophe Lecathelinais, Chris Oldmeadow, Megan Freund, Sze Lin Yoong

Published in: Implementation Science | Issue 1/2017

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Abstract

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.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12613000311​752)
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Metadata
Title
Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial
Authors
Luke Wolfenden
Nicole Nathan
Lisa M. Janssen
John Wiggers
Kathryn Reilly
Tessa Delaney
Christopher M. Williams
Colin Bell
Rebecca Wyse
Rachel Sutherland
Libby Campbell
Christophe Lecathelinais
Chris Oldmeadow
Megan Freund
Sze Lin Yoong
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-016-0537-9

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