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Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial

BACKGROUND: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these...

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Autores principales: Wyse, Rebecca, Delaney, Tessa, Stacey, Fiona, Zoetemeyer, Rachel, Lecathelinais, Christophe, Lamont, Hannah, Ball, Kylie, Campbell, Karen, Rissel, Chris, Attia, John, Wiggers, John, Yoong, Sze Lin, Oldmeadow, Christopher, Sutherland, Rachel, Nathan, Nicole, Reilly, Kathryn, Wolfenden, Luke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456336/
https://www.ncbi.nlm.nih.gov/pubmed/34491207
http://dx.doi.org/10.2196/26054
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author Wyse, Rebecca
Delaney, Tessa
Stacey, Fiona
Zoetemeyer, Rachel
Lecathelinais, Christophe
Lamont, Hannah
Ball, Kylie
Campbell, Karen
Rissel, Chris
Attia, John
Wiggers, John
Yoong, Sze Lin
Oldmeadow, Christopher
Sutherland, Rachel
Nathan, Nicole
Reilly, Kathryn
Wolfenden, Luke
author_facet Wyse, Rebecca
Delaney, Tessa
Stacey, Fiona
Zoetemeyer, Rachel
Lecathelinais, Christophe
Lamont, Hannah
Ball, Kylie
Campbell, Karen
Rissel, Chris
Attia, John
Wiggers, John
Yoong, Sze Lin
Oldmeadow, Christopher
Sutherland, Rachel
Nathan, Nicole
Reilly, Kathryn
Wolfenden, Luke
author_sort Wyse, Rebecca
collection PubMed
description BACKGROUND: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. OBJECTIVE: This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. METHODS: The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. RESULTS: From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups. CONCLUSIONS: Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-030538
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spelling pubmed-84563362021-10-18 Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial Wyse, Rebecca Delaney, Tessa Stacey, Fiona Zoetemeyer, Rachel Lecathelinais, Christophe Lamont, Hannah Ball, Kylie Campbell, Karen Rissel, Chris Attia, John Wiggers, John Yoong, Sze Lin Oldmeadow, Christopher Sutherland, Rachel Nathan, Nicole Reilly, Kathryn Wolfenden, Luke J Med Internet Res Original Paper BACKGROUND: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. OBJECTIVE: This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. METHODS: The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. RESULTS: From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups. CONCLUSIONS: Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-030538 JMIR Publications 2021-09-07 /pmc/articles/PMC8456336/ /pubmed/34491207 http://dx.doi.org/10.2196/26054 Text en ©Rebecca Wyse, Tessa Delaney, Fiona Stacey, Rachel Zoetemeyer, Christophe Lecathelinais, Hannah Lamont, Kylie Ball, Karen Campbell, Chris Rissel, John Attia, John Wiggers, Sze Lin Yoong, Christopher Oldmeadow, Rachel Sutherland, Nicole Nathan, Kathryn Reilly, Luke Wolfenden. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.09.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Wyse, Rebecca
Delaney, Tessa
Stacey, Fiona
Zoetemeyer, Rachel
Lecathelinais, Christophe
Lamont, Hannah
Ball, Kylie
Campbell, Karen
Rissel, Chris
Attia, John
Wiggers, John
Yoong, Sze Lin
Oldmeadow, Christopher
Sutherland, Rachel
Nathan, Nicole
Reilly, Kathryn
Wolfenden, Luke
Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial
title Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial
title_full Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial
title_fullStr Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial
title_full_unstemmed Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial
title_short Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial
title_sort effectiveness of a multistrategy behavioral intervention to increase the nutritional quality of primary school students’ web-based canteen lunch orders (click & crunch): cluster randomized controlled trial
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456336/
https://www.ncbi.nlm.nih.gov/pubmed/34491207
http://dx.doi.org/10.2196/26054
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