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Murphy M, Coffey A, Pallan M, Oyebode O. Changing the food environment in secondary school canteens to promote healthy dietary choices: a qualitative study with school caterers. BMC Public Health 2024; 24:1970. [PMID: 39044155 PMCID: PMC11267781 DOI: 10.1186/s12889-024-19513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Typical adolescent diets do not meet current dietary recommendations. There is a need to address these dietary patterns to reduce the risk of obesity and other diet-related diseases. Schools provide an opportune setting to do so, as students consume a substantial proportion of their daily dietary intake whilst at school. There is a developing evidence base on the use of choice architecture (food choice cues) to promote healthy eating in school contexts. It is necessary to understand the acceptability and feasibility of implementing such interventions. We aimed to explore these factors from the perspectives of secondary school caterers. METHODS We conducted qualitative interviews with caterers from secondary schools across the West Midlands, UK and national/regional catering representatives. A semi-structured topic guide and visual aid were used to guide interviews. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12. RESULTS Twelve participants took part. Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Limits of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as they require minimal reflective motivation. Salient cues included enhancing the placement, presentation and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity. Student engagement was considered important. Some catering decision drivers conflicted with healthy food cues, and many felt that their role in healthy eating was limited due to the overwhelming influence of external food environments, adolescent resistance, and features of the secondary school canteen setting e.g. short duration of lunchtime, lack of space. However, caterers appeared motivated to implement healthy food cues and identified key opportunities for implementation, including integration into whole-school approaches to healthy eating. CONCLUSIONS Interventions using healthy food cues appeared acceptable to secondary school caterers, key potential implementers of these strategies. Future interventions could incorporate strategies relating to placement, presentation and pricing to prompt healthy selections, and actions to engage the student body and improve the dining environment. Evaluations should consider potential impacts upon food purchasing, consumption and waste to address caterers' concerns about these issues.
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Affiliation(s)
- Marie Murphy
- Institute of Applied Health Research, University Birmingham, Birmingham, UK.
| | - Alice Coffey
- Institute of Global Sustainable Development, University of Warwick, Coventry, UK
| | - Miranda Pallan
- Institute of Applied Health Research, University Birmingham, Birmingham, UK
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Wendt J, Scheller DA, Banik A, Luszczynska A, Forberger S, Zeeb H, Scheidmeir M, Kubiak T, Lien N, Meshkovska B, Lobczowska K, Romaniuk P, Neumann-Podczaska A, Wieczorowska-Tobis K, Steinacker JM, Mueller-Stierlin AS. Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour. BMC Public Health 2023; 23:1259. [PMID: 37380979 DOI: 10.1186/s12889-023-15775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/27/2023] [Indexed: 06/30/2023] Open
Abstract
Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.
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Affiliation(s)
- Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Piotr Romaniuk
- Department of Health Policy, Medical University of Silesia, Katowice, Poland
| | | | | | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Annabel S Mueller-Stierlin
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany.
- Department of Psychiatry & Psychotherapy II, Ulm University, Günzburg, Germany.
- Institute for Epidemiology & Medical Biometry, Ulm University, Ulm, Germany.
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Ahrens W, Brenner H, Flechtner-Mors M, Harrington JM, Hebestreit A, Kamphuis CBM, Kelly L, Laxy M, Luszczynska A, Mazzocchi M, Murrin C, Poelman MP, Steenhuis I, Roos G, Steinacker JM, van Lenthe F, Zeeb H, Zukowska J, Lakerveld J, Woods CB. Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN). Eur J Public Health 2022; 32:iv114-iv125. [PMID: 36444106 PMCID: PMC9706119 DOI: 10.1093/eurpub/ckac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and unhealthy dietary behaviours, which in turn are driven by upstream factors that have not yet been addressed effectively by prevention approaches. Thus, successful policy interventions are required that target entire populations and tackle the 'causes of the causes'. To advance our knowledge on the effective implementation of policies and their impact in terms of improving health behaviours, PEN focused on five research tasks: (i) Adaptation and implementation of a Food Environment Policy Index (Food-EPI) and development of a Physical Activity Environment Policy Index (PA-EPI); (ii) Mapping of health-related indicators needed for policy evaluation and facilitating a harmonized pan-European approach for surveillance to assess the impact of policy interventions; (iii) Refining quantitative methods to evaluate the impact of public policies; (iv) Identifying key barriers and facilitators of implementation of policies; and (v) Advance understanding the equity impact of the development, implementation and evaluation of policies aimed at promoting physical activity and a healthy diet. Finally, and in order to provide concrete evidence for policymaking, existing exemplary policies, namely sugar-sweetened beverages taxation, active transport policies and school policies on nutrition and physical activity were assessed in consideration of these five tasks. At the end of the PEN project's formal runtime, considerable advancements have been made. Here, we present an overview of the most important learnings and outputs.
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Affiliation(s)
- Wolfgang Ahrens
- Correspondence: Wolfgang Ahrens, Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, 28359 Bremen, Germany, Tel: +49 421 218 56822, e-mail:
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Department of Medicine, University Hospital Ulm, Ulm, Germany
| | - Janas M Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Michael Laxy
- Technical University of Munich, Professorship of Public Health and Prevention, Munich, Germany
| | | | - Mario Mazzocchi
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Ingrid Steenhuis
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute De Boelelaan 1085, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gun Roos
- Consumption Research Norway, Oslo Metropolitan University, Oslo, Norway
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, University Hospital Ulm, Ulm, Germany
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Human Geography and Public Health, Utrecht University, Utrecht, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
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