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

Tessa Delaney; Jacklyn Jackson; Christophe Lecathelinais; Sze Lin Yoong; Luke Wolfenden; Rachel Sutherland; Emily Webb; Rebecca Wyse

doi:10.1016/j.appet.2023.106528

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 Jun 1:185:106528. doi: 10.1016/j.appet.2023.106528. Epub 2023 Mar 10.

Authors

Tessa Delaney¹, Jacklyn Jackson², Christophe Lecathelinais², Sze Lin Yoong³, Luke Wolfenden², Rachel Sutherland², Emily Webb⁴, Rebecca Wyse²

Affiliations

¹ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia. Electronic address: Tessa.Delaney@health.nsw.gov.au.
² School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
³ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia; Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.
⁴ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.

PMID: 36907518
DOI: 10.1016/j.appet.2023.106528

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.

Keywords: Choice architecture; Healthy eating; Intervention; Menu labels; Nudging/Nudges; Online canteen; Online food delivery; RCT; School.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Child
Food Services*
Humans
Nutritive Value
Schools
Sodium
Students

Substances

Sodium