- Title
- Improving population wide implementation of a healthy food policy in primary schools
- Creator
- Reilly, Kathryn Louise
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background and Aims: Nutrition risk factors are the leading cause of the global disease burden. To reduce this burden, the World Health Organization recommends the population-wide implementation of policies to improve the relative availability of healthy foods at schools. To ensure the potential benefits of school healthy eating policies are realised, identification of strategies that are effective in improving implementation of healthy school canteen or nutrition policies is required. While a number of relevant theories and frameworks exist to guide efforts to implement effective interventions at scale, at present, the evidence base regarding the impact of strategies to increase school implementation of healthy eating policies is limited. This thesis sought to address a number of evidence gaps to better guide efforts to improve the implementation of school nutrition policies. Specifically it aimed to: • Assess the effectiveness of a theoretically designed multi-strategy intervention in increasing the implementation of a healthy canteen policy in Australian primary schools. • Evaluate the most effective and cost-effective means of implementing a healthy school canteen policy through pooling data from three random controlled trials (RCTs) of implementation interventions. • Describe the validity of four methods of assessing school menu compliance with canteen policies and report the direct cost and time to administer each. Such information is required to support rigorous research in the field and facilitate implementation monitoring. • Assess the effectiveness of an intervention to support implementation, at scale, of a healthy canteen policy in Australian primary schools. • Assess the potential impact of front-of-pack labelling on canteen manager’s intentions regarding products they would make available for sale in their canteen. • Provide recommendations for future research and practice regarding increasing the implementation of healthy canteen policies in primary schools. Results: A small randomised control trial with 53 schools found that a multi-strategic intervention involving training, performance monitoring and feedback, telephone and text messaging support can improve schools’ implementation of a healthy school canteen policy (intervention vs comparison: RR 4.29; 95% CI 1.04-17.68, p=0.02). An economic evaluation of three RCTs of different implementation interventions of various intensity levels, identified that both ‘medium’ and ‘high’ intensity interventions were potentially more cost-effective in supporting schools to improve implementation of a healthy canteen policy than a ‘low’ intensity approach. The thesis demonstrated that a quick menu audit represents an inexpensive pragmatic and valid method to assess healthy canteen policy implementation on a large scale. Using this quick menu audit approach the thesis found that the effectiveness of a multi-strategic implementation intervention can be maintained when delivered at scale across an entire region covering over 150 schools (baseline vs follow-up: OR 2.7; 95% CI 1.6-4.7, p<0.001). Finally, through an additional RCT, the thesis found that the inclusion of product nutritional rating information has the potential to improve the availability of ‘healthier’ items on canteen menus and contribute to improving implementation of a healthy canteen policy. Conclusion: This thesis provides a comprehensive suite of implementation-focused research on improving implementation of a state based healthy canteen policy with the aim of reducing childhood obesity. Furthermore, it provides a framework of implementation strategies proven to improve policy implementation at a population level.
- Subject
- policy implementation; healthy eating policy; childhood obesity; schools; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1394380
- Identifier
- uon:33689
- Rights
- Copyright 2018 Kathryn Louise Reilly
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Thesis | 15 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 1 MB | Adobe Acrobat PDF | View Details Download |