Poster Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2024

Identifying school barriers and enablers to adoption of an evidence-based healthy lunchbox program (#231)

Demi Herdegen 1 2 3 4 , Courtney Barnes 1 2 3 4 , Raachel Sutherland 1 2 3 4 , Jannah Jones 1 2 3 4 , Lisa Janssen 1 2 3 4 , Katie Robertson 1 , Molly Parkinson 1 4 , Stephanie Mantach 1 4 , Elise Porter 1 , Jess Zorba 1 , Luke Wolfenden 1 2 3 4
  1. Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
  2. Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  3. National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, Australia
  4. University Of Newcastle, Waratah West, NSW, Australia

Overweight and obesity is a major burden amongst children both nationally and internationally. Children consume 30-50% of their daily dietary intake at school, however studies have highlighted that food consumed at school is inconsistent with national dietary guidelines. Systematic revies have found school-based programs targeted at improving the dietary intake of children to be effective, but few have shown effectiveness at large scale. SWAP IT is an effective, school-based nutrition program targeted at improving the dietary intake of children through lunchboxes. SWAP IT represents a highly scalable, effective and cost-effective intervention with significant potential to improve population-level dietary intake of children and therefore overweight and obesity prevalence. In order to effectively scale-up SWAP IT, frameworks and models highlight the need to identify determinants of end users to adoption. 

 

A cross-sectional study was conducted with school principals across 11 NSW Local Health Districts (LHDs). Principals were invited to complete an online/telephone survey to identify perceived barriers and enables to adopting SWAP IT. Findings were analysed using descriptive statistics and mapped to the relevant constructs of adoption by Wisdom and colleagues. Strategies were developed to address each relevant adoption construct and embed behavioural change techniques.  

 

160 principals participated in the survey. Barriers most frequently identified by school principals included: “Expected workload for staff” (n=52, 32%), “Perception that parents and caregivers don’t think it is the school’s place to provide this information” (n=31, 19%), “Food insecurity is a greater priority” (n=13, 8%) and "No barriers" (n=13, 8%). The most frequently identified enablers included: “Keep the program free” (n=60, 38%), “Show evidence that the SWAP IT supports the development of healthy habits in children” (n=18, 11%) and “Make the registration process easy” (n=12, 8%). Findings from this study have informed the development and selection of scale-up strategies to maximise the adoption of SWAP IT.

  1. A randomized controlled trial to assess the potential efficacy, feasibility and acceptability of an m-health intervention targeting parents of school aged children to improve the nutritional quality of foods packed in the lunchbox ‘SWAP IT’ R. Sutherland, N. Nathan, A. Brown, S. Yoong, M. Finch, C. Lecathelinais, et al. International Journal of Behavioral Nutrition and Physical Activity 2019 Vol. 16 Issue 1 DOI: 10.1186/s12966-019-0812-7
  2. A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness–Implementation Hybrid Cluster Randomized Controlled Trial R. Sutherland, A. Brown, N. Nathan, S. Yoong, L. Janssen, A. Chooi, et al. Journal of Medical Internet Research 2021 Vol. 23 Issue 6 Pages e25256 DOI: 10.2196/25256
  3. The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis N. Nathan, L. Janssen, R. Sutherland, R. K. Hodder, C. E. L. Evans, D. Booth, et al. International Journal of Behavioral Nutrition and Physical Activity 2019 Vol. 16 Issue 1 DOI: 10.1186/s12966-019-0798-1