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Bryant M, Burton W, O'Kane N, Woodside JV, Ahern S, Garnett P, Spence S, Sharif A, Rutter H, Baker T, Evans CEL. Understanding school food systems to support the development and implementation of food based policies and interventions. Int J Behav Nutr Phys Act 2023; 20:29. [PMID: 36907879 PMCID: PMC10009978 DOI: 10.1186/s12966-023-01432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice. METHODS Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. RESULTS The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. CONCLUSIONS Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO150DD, UK
- Hull York Medical School, University of York, York, YO150DD, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO150DD, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Sara Ahern
- Bradford Institute of Health Research, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Phillip Garnett
- School for Business and Society, University of York, York, YO10 5DD, UK
| | - Suzanne Spence
- Human Nutrition Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amir Sharif
- Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, BD7, 1DP, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK
| | - Tim Baker
- Charlton Manor Primary School, Indus Road, Charlton, London, SE7 7EF, UK
| | - Charlotte E L Evans
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
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