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Exploratory analysis of a cluster randomized controlled trial of a multi-strategy intervention delivered via online canteens on improving the nutritional quality of primary school students' pre-ordered foods & drinks at recess. Appetite 2023; 185:106528. [PMID: 36907518 DOI: 10.1016/j.appet.2023.106528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/12/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
School canteens are a recommended setting to deliver public health nutrition strategies given their wide reach, and frequent use by children. Online canteens, where users (i.e. students or their carers) pre-order and pay for food and drinks online, represent attractive systems to deliver strategies that encourage healthier food choices. There have been few studies exploring the efficacy of public health nutrition interventions in online food ordering environments. Therefore, this study aims to assess the efficacy of a multi-strategy intervention implemented in an online school canteen ordering system in reducing the energy, saturated fat, sugar, and sodium content of students' online recess orders (i.e. foods ordered during the mid-morning or afternoon snack period). This was an exploratory analysis of recess purchases for a cluster randomized controlled trial that initially sought to examine the efficacy of the intervention on lunch orders. A total of 314 students from 5 schools received the multi-strategy intervention (involving menu labelling, placement, prompting and availability) that was integrated into the online ordering system, and 171 students from 3 schools received the control (usual online ordering). Analysis of main outcomes found that the mean energy (difference: -269.3 kJ; P = 0.006), saturated fat (difference: -1.1 g; P = 0.011) and sodium (difference: -128.6 mg; P = 0.014) content per student recess order was significantly lower in the intervention group than the control group at 2-month follow-up. Findings suggest that embedding strategies to encourage healthier choices within online canteen ordering systems can improve the nutrient composition of student recess purchases. These results add to the current evidence base suggesting that interventions delivered via online food ordering systems represent an effective strategy for improving child public health nutrition in schools.
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Botha E, van der Merwe D, Burnett RJ, Bester P. Predictors of parents' infant vaccination decisions: A concept derivation. Health SA 2021; 26:1697. [PMID: 34691766 PMCID: PMC8517795 DOI: 10.4102/hsag.v26i0.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/28/2021] [Indexed: 11/03/2022] Open
Abstract
The myths surrounding coronavirus disease 2019 (COVID-19) vaccines have prompted scientists to refocus their attention on vaccine hesitancy, which is fuelled by the spread of misinformation. The scientific investigation of behavioural concepts relating to vaccine hesitancy can be enhanced by the examination of behavioural concepts from the field of consumer sciences. South African consumer scientists study personal decisions that contribute to individuals' well-being, including the decisions to prevent ill health. Current data on the predictors of vaccination decisions do not incorporate consumer science constructs imperative in decision-making, which could provide fresh insights in addressing vaccine hesitancy. This study aimed to investigate and illustrate the analogy between concepts of the Health Belief Model (HBM) as parent model, and consumer behaviour that could affect parents' infant vaccination decisions, by applying a concept derivation approach. The HBM was analysed within the context of public health, including literature from consumers' vaccination decisions, medical decisions, paediatrics, vaccinology, virology and nursing. Through a qualitative, theory derivation strategy, six main concepts of the HBM were redefined to consumer sciences, using four iterative concept derivation steps. Concept derivation resulted in consumer behaviour concepts that could be possible predictors of parents' infant vaccination decisions, including consumers' values; risk perception; consideration of immediate and future consequences; self-efficacy; cues to action; demographics; personal information and knowledge. These predictors could be a starting point for a context- and product-specific consumer primary preventive healthcare decisions model. Our findings highlight the opportunities for interdisciplinary collaboration in investigating consumer primary healthcare-related behaviour. CONTRIBUTION This study introduced interfaces between consumer science and health science literature. Through interdisciplinary collaboration, a better understanding of influences to promote primary preventive healthcare can be achieved.
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Affiliation(s)
- Eloïse Botha
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Daleen van der Merwe
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Rosemary J. Burnett
- Department of Virology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Petra Bester
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Lichtenstein AH, Petersen K, Barger K, Hansen KE, Anderson CAM, Baer DJ, Lampe JW, Rasmussen H, Matthan NR. Perspective: Design and Conduct of Human Nutrition Randomized Controlled Trials. Adv Nutr 2020; 12:4-20. [PMID: 33200182 PMCID: PMC7849995 DOI: 10.1093/advances/nmaa109] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
In the field of human nutrition, randomized controlled trials (RCTs) are considered the gold standard for establishing causal relations between exposure to nutrients, foods, or dietary patterns and prespecified outcome measures, such as body composition, biomarkers, or event rates. Evidence-based dietary guidance is frequently derived from systematic reviews and meta-analyses of these RCTs. Each decision made during the design and conduct of human nutrition RCTs will affect the utility and generalizability of the study results. Within the context of limited resources, the goal is to maximize the generalizability of the findings while producing the highest quality data and maintaining the highest levels of ethics and scientific integrity. The aim of this document is to discuss critical aspects of conducting human nutrition RCTs, including considerations for study design (parallel, crossover, factorial, cluster), institutional ethics approval (institutional review boards), recruitment and screening, intervention implementation, adherence and retention assessment, and statistical analyses considerations. Additional topics include distinguishing between efficacy and effectiveness, defining the research question(s), monitoring biomarker and outcome measures, and collecting and archiving data. Addressed are specific aspects of planning and conducting human nutrition RCTs, including types of interventions, inclusion/exclusion criteria, participant burden, randomization and blinding, trial initiation and monitoring, and the analysis plan.
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Affiliation(s)
| | | | - Kathryn Barger
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Karen E Hansen
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Cheryl A M Anderson
- Division of Preventive Medicine, Department of Family Medicine of Public Health, University of California, San Diego, La Jolla, CA, USA
| | - David J Baer
- Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, USDA Agricultural Research Service, Beltsville, MD, USA
| | - Johanna W Lampe
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Helen Rasmussen
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Wyse R, Delaney T, Gibbins P, Ball K, Campbell K, Yoong SL, Seward K, Zoetemeyer R, Rissel C, Wiggers J, Attia J, Oldmeadow C, Sutherland R, Nathan N, Reilly K, Reeves P, Wolfenden L. Cluster randomised controlled trial of an online intervention to improve healthy food purchases from primary school canteens: a study protocol of the 'click & crunch' trial. BMJ Open 2019; 9:e030538. [PMID: 31492788 PMCID: PMC6731886 DOI: 10.1136/bmjopen-2019-030538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION School canteens are the most frequently accessed take-away food outlet by Australian children. The rapid development of online lunch ordering systems for school canteens presents new opportunities to deliver novel public health nutrition interventions to school-aged children. This study aims to assess the effectiveness and cost-effectiveness of a behavioural intervention in reducing the energy, saturated fat, sugar and sodium content of online canteen lunch orders for primary school children. METHODS AND ANALYSIS The study will employ a cluster randomised controlled trial design. Twenty-six primary schools in New South Wales, Australia, that have an existing online canteen ordering system will be randomised to receive either a multi-strategy behavioural intervention or a control (the standard online canteen ordering system). The intervention will be integrated into the existing online canteen system and will seek to encourage the purchase of healthier food and drinks for school lunch orders (ie, items lower in energy, saturated fat, sugar and sodium). The behavioural intervention will use evidence-based choice architecture strategies to redesign the online menu and ordering system including: menu labelling, placement, prompting and provision of feedback and incentives. The primary trial outcomes will be the mean energy (kilojoules), saturated fat (grams), sugar (grams) and sodium (milligrams) content of lunch orders placed via the online system, and will be assessed 12 months after baseline data collection. ETHICS AND DISSEMINATION The study was approved by the ethics committees of the University of Newcastle (H-2017-0402) and the New South Wales Department of Education and Communities (SERAP 2018065), and the Catholic Education Office Dioceses of Sydney, Parramatta, Lismore, Maitland-Newcastle, Bathurst, Canberra-Goulburn, Wollongong, Wagga Wagga and Wilcannia-Forbes. Study results will be disseminated through peer-reviewed publications, reports, presentations at relevant national and international conferences and via briefings to key stakeholders. Results will be used to inform future implementation of public health nutrition interventions through school canteens, and may be transferable to other food settings or online systems for ordering food. TRIAL REGISTRATION NUMBER ACTRN12618000855224.
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Affiliation(s)
- Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Pennie Gibbins
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Kylie Ball
- School of Exercise & Nutrition Science, Deakin University, Burwood, Victoria, Australia
| | - Karen Campbell
- School of Exercise & Nutrition Science, Deakin University, Burwood, Victoria, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Kirsty Seward
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Rachel Zoetemeyer
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Chris Rissel
- New South Wales Office of Preventive Health, Liverpool, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Chris Oldmeadow
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Kathryn Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Health Research Economics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Priority Research Centre - Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Unit, New Lambton, New South Wales, Australia
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Clinton-McHarg T, Gonzalez S, Milner S, Sherker S, Kingsland M, Lecathelinais C, Hall A, Doran C, Wiggers J, Wolfenden L. Implementing health policies in Australian junior sports clubs: an RCT. BMC Public Health 2019; 19:556. [PMID: 31088417 PMCID: PMC6515613 DOI: 10.1186/s12889-019-6873-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background This pilot study aimed to test the potential effectiveness and acceptability of an intervention to support the implementation of 16 recommended policies and practices to improve the health promotion environment of junior sporting clubs. Reported child exposure to health promoting practices at clubs was also assessed. Methods A cluster randomised trial was conducted with eight football leagues. Fourty-one junior football clubs belonging to four leagues in the intervention group received support (e.g. physical resources, recognition and rewards, systems and prompts) to implement 16 policies and practices that targeted child exposure to alcohol, tobacco, healthy food and beverages, and participation in physical activity. Thirty-eight clubs belonging to the four control group leagues did not receive the implementation intervention. Study outcomes were assessed via telephone interviews with nominated club representatives and parents of junior players. Between group differences in the mean number of policies and practices implemented at the club level at follow-up were examined using a multiple linear regression model. Results While the intervention was found to be acceptable, there was no significant difference between the mean number of practices and policies reported to be implemented by intervention and control clubs at post-intervention (Estimate − 0.05; 95% CI -0.91, 0.80; p = 0.90). There was also no significant difference in the proportion of children reported to be exposed to: alcohol (OR 1.16; 95% CI 0.41, 3.28; p = 0.78); tobacco (OR 0.97; CI 0.45, 2.10; p = 0.94); healthy food purchases (OR 0.49; CI 0.11, 2.27; p = 0.35); healthy drink purchases (OR 1.48; CI 0.72, 3.05; p = 0.27); or participation in physical activity (OR 0.76; CI 0.14, 4.08; p = 0.74). Conclusions Support strategies that better address barriers to the implementation of health promotion interventions in junior sports clubs are required. Trial registration Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617001044314). Electronic supplementary material The online version of this article (10.1186/s12889-019-6873-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tara Clinton-McHarg
- Priority Research Centre for Health Behaviour (PRCHB), School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Sharleen Gonzalez
- Priority Research Centre for Health Behaviour (PRCHB), School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Sharin Milner
- Alcohol and Drug Foundation, Melbourne, VIC, 3051, Australia
| | - Shauna Sherker
- Alcohol and Drug Foundation, Melbourne, VIC, 3051, Australia
| | - Melanie Kingsland
- Priority Research Centre for Health Behaviour (PRCHB), School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | | | - Alix Hall
- Priority Research Centre for Health Behaviour (PRCHB), School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Chris Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, QLD, 4000, Australia
| | - John Wiggers
- Priority Research Centre for Health Behaviour (PRCHB), School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Luke Wolfenden
- Priority Research Centre for Health Behaviour (PRCHB), School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. .,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.
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Reilly K, Nathan N, Grady A, Wu JHY, Wiggers J, Yoong SL, Wolfenden L. Barriers to implementation of a healthy canteen policy: A survey using the theoretical domains framework. Health Promot J Austr 2018; 30 Suppl 1:9-14. [PMID: 30382610 DOI: 10.1002/hpja.218] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
ISSUE ADDRESSED Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework. METHODS A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian. RESULTS Of the 184 participants, 20% (n = 36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n = 117, 65%), skills (n = 105, 57%), beliefs about capabilities (n = 100, 55%), reinforcement (n = 95, 52%) and goals (n = 95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR = 0.39; 95% CI 0.16-0.95, P = 0.038). CONCLUSIONS This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. SO WHAT?: For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies.
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Affiliation(s)
- Kathryn Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
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Reilly KL, Nathan N, Wiggers J, Yoong SL, Wolfenden L. Scale up of a multi-strategic intervention to increase implementation of a school healthy canteen policy: findings of an intervention trial. BMC Public Health 2018; 18:860. [PMID: 29996817 PMCID: PMC6042415 DOI: 10.1186/s12889-018-5786-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/02/2018] [Indexed: 01/15/2023] Open
Abstract
Background Implementation interventions delivered in schools to improve food provision have been found to improve student diet and reduce child obesity risk. If the health benefits of food availability policies are to be realised, interventions that are effective need to be implemented at scale, across an entire population of schools. This study aims to assess the potential effectiveness of an intervention in increasing the implementation, at scale, of a healthy canteen policy by Australian primary schools. Methods A non-controlled before and after study was conducted in primary schools located in the Hunter New England region of New South Wales, Australia. Schools received a multi-component intervention adapted from a previous efficacious and cost-effective randomised control trial. The primary trial outcome was the proportion of canteen menus compliant with the state healthy canteen policy, assessed via menu audit at baseline and follow-up by dietitians. Secondary outcomes included policy reach and adoption and maintenance policy implementation. Results Of the 173 schools eligible for inclusion in the trial, 168 provided menus at baseline and 157 menus were collected at follow-up. At follow-up, multiple imputation analysis found 35% (55/157) of schools compared to 17% (29/168) at baseline (OR = 2.8 (1.6–4.7), p = < 0.001) had menus compliant with the state healthy canteen policy. As an assessment of the impact of the intervention on policy reach, canteen manager and principal knowledge of the policy increased from 64% (n = 76) and 38% (n = 44) respectively at baseline to 69% (n = 89) and 60% (n = 70) at follow-up (p = 0.393, p = 0.026). Adoption of the policy increased from 80% (n = 93) at baseline to 90% (n = 104) at follow-up (p = 0.005) for principals, and from 86% (n = 105) to 96% (n = 124) (p = 0.0001) for canteen managers. Multiple imputation analysis showed intervention effects were maintained six-months post intervention (33% of menus compliant OR = 2.6 (1.5–4.5), p = < 0.001 compared to baseline). Conclusions This study found school canteen compliance with a healthy food policy increased in association with a multi-strategy intervention delivered at scale. The study provides evidence for public health policy makers and practitioners regarding strategies and modes of support required to support improvement in nutrition policy implementation across entire populations of schools.
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Affiliation(s)
- Kathryn L Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW, 2308, Australia. .,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
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8
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Grady A, Yoong S, Sutherland R, Lee H, Nathan N, Wolfenden L. Improving the public health impact of eHealth and mHealth interventions. Aust N Z J Public Health 2018; 42:118-119. [PMID: 29384248 DOI: 10.1111/1753-6405.12771] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alice Grady
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Serene Yoong
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Hopin Lee
- School of Medicine and Public Health, University of Newcastle, New South Wales.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton Heights, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
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Milner S, Sherker S, Clinton-McHarg T, Dray J, Zukowski N, Gonzalez S, Kingsland M, Ooi JY, Murphy A, Brooke D, Wiggers J, Wolfenden L. Cluster randomised controlled trial of a multicomponent intervention to support the implementation of policies and practices that promote healthier environments at junior sports clubs: study protocol. BMJ Open 2018; 8:e018906. [PMID: 29362260 PMCID: PMC5786080 DOI: 10.1136/bmjopen-2017-018906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/06/2017] [Accepted: 11/30/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A large proportion of children and adolescents participate in organised sport, making community sports clubs a promising setting to support healthy behaviours. To date, however, there have been few interventions conducted in junior sports clubs that have targeted health-promoting practices. The primary aim of this pilot study is to assess the potential effectiveness of an intervention to implement health-promoting policies and practices in junior sporting clubs targeting alcohol and tobacco practices, healthy food and beverage availability, and physical activity via participation in sport. A secondary outcome is to assess the impact of such strategies on child exposure to alcohol and tobacco use at the club, purchasing behaviours by/for children at the club canteen and child sports participation opportunities. METHODS AND ANALYSIS The study will employ a cluster randomised controlled trial design and be conducted in metropolitan and regional areas of two Australian states. Randomisation will occur at the level of the football league. Community football clubs with over 40 junior players (players under 18 years) within each league will be eligible to participate. The intervention will be developed based on frameworks that consider the social, cultural and environmental factors that influence health behaviours. Intervention clubs will be supported to implement 16 practices targeting alcohol management, tobacco use, nutrition practices, new player recruitment activity, equal participation for players and the development of policies to support these practices. Trained research staff will collect outcome data via telephone interviews at baseline and follow-up. Interviews will be conducted with both club representatives and parents of junior players. ETHICS AND DISSEMINATION The study has been approved by the University of Newcastle Human Research Ethics Committee (H-2013-0429). The results of the study will be disseminated via peer-reviewed publications and presentations at conferences. TRIAL REGISTRATION NUMBER ACTRN12617001044314; Pre-results.
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Affiliation(s)
| | | | - Tara Clinton-McHarg
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julia Dray
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Nadya Zukowski
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Sharleen Gonzalez
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
| | - Jia Ying Ooi
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Allan Murphy
- Alcohol and Drug Foundation, Melbourne, Australia
| | - Daisy Brooke
- Alcohol and Drug Foundation, Melbourne, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
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Delaney T, Wyse R, Yoong SL, Sutherland R, Wiggers J, Ball K, Campbell K, Rissel C, Lecathelinais C, Wolfenden L. Cluster randomized controlled trial of a consumer behavior intervention to improve healthy food purchases from online canteens. Am J Clin Nutr 2017; 106:1311-1320. [PMID: 28971849 DOI: 10.3945/ajcn.117.158329] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background: School canteens represent an opportune setting in which to deliver public health nutrition strategies because of their wide reach and frequent use by children. Online school-canteen ordering systems, where students order and pay for their lunch online, provide an avenue to improve healthy canteen purchases through the application of consumer-behavior strategies that have an impact on purchasing decisions.Objective: We assessed the efficacy of a consumer-behavior intervention implemented in an online school-canteen ordering system in reducing the energy, saturated fat, sugar, and sodium contents of primary student lunch orders.Design: A cluster-randomized controlled trial was conducted that involved 2714 students (aged 5-12 y) from 10 primary schools in New South Wales, Australia, who were currently using an online canteen ordering system. Schools were randomized in a 1:1 ratio to receive either the intervention (enhanced system) or the control (standard online ordering only). The intervention included consumer-behavior strategies that were integrated into the online ordering system (targeting menu labeling, healthy food availability, placement, and prompting).Results: Mean energy (difference: -567.25 kJ; 95% CI: -697.95, -436.55 kJ; P < 0.001), saturated fat (difference: -2.37 g; 95% CI: -3.08, -1.67 g; P < 0.001), and sodium (difference: -227.56 mg; 95% CI: -334.93, -120.19 mg; P < 0.001) contents per student lunch order were significantly lower in the intervention group than in the control group at follow-up. No significant differences were observed for sugar (difference: 1.16 g; 95% CI: -0.50, 2.83 g; P = 0.17).Conclusions: The study provides strong evidence supporting the effectiveness of a consumer-behavior intervention using an existing online canteen infrastructure to improve purchasing behavior from primary school canteens. Such an intervention may represent an appealing policy option as part of a broader government strategy to improve child public health nutrition. This trial was registered at www.anzctr.org.au as ACTRN12616000499482.
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Affiliation(s)
- Tessa Delaney
- Hunter New England Population Health, Wallsend, New South Wales, Australia; .,School of Medicine and Public Health and.,Priority Research Center for Health Behavior, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Rebecca Wyse
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health and.,Priority Research Center for Health Behavior, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health and.,Priority Research Center for Health Behavior, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health and.,Priority Research Center for Health Behavior, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health and.,Priority Research Center for Health Behavior, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia; and
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia; and
| | - Chris Rissel
- New South Wales Office of Preventive Health, South West Sydney Local Health District, Liverpool Hospital, Liverpool New South Wales, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health and.,Priority Research Center for Health Behavior, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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