Implementation of a multi-component school lunch environmental change intervention to improve child fruit and vegetable intake: a mixed-methods study

Hamdi, Nader

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https://hdl.handle.net/2142/110795 Copy

Description

Title

Implementation of a multi-component school lunch environmental change intervention to improve child fruit and vegetable intake: a mixed-methods study

Author(s)

Hamdi, Nader

Issue Date

2021-04-16

Director of Research (if dissertation) or Advisor (if thesis)

Prescott, Melissa

Committee Member(s)

• Ellison, Brenna
• Miller, Michael

Department of Study

Food Science & Human Nutrition

Discipline

Food Science & Human Nutrition

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

M.S.

Degree Level

Thesis

Keyword(s)

• child nutrition
• nudge
• implementation

Abstract

The National School Lunch Program (NSLP) reaches roughly 32 million children each day, and children participating in the consume up to half of their daily energy intake through school meals. Children waste up to 80% of their vegetables at school meals, and environmental change interventions are low-cost strategies that are implemented widely in school meal programs with the goal of improving dietary intake, and to subsequently mitigate food waste. The literature review examined peer-reviewed articles to outline the factors influencing the food-related behaviors of children participating in the NSLP, and identify low-cost strategies implemented in school meal programs to improve children’s dietary and food waste behaviors. Previous research indicates that school meal programs are well-positioned to address food insecurity and children’s diet quality, yet the wide variety of modifiable factors influencing children’s behaviors necessitate feasible strategies and community partnerships to address these societal issues. The existing body of school nutrition literature indicates that rigorous research study designs and validated and reliable implementation metrics will be instrumental in examining the efficacy of strategies in these complex, real-world settings. A mixed-methods study was implemented to evaluate the effectiveness of environmental change strategies on children’s fruit and vegetable selection and consumption behaviors in school lunch, and implementation metrics and qualitative interviews were used to understand the relationship between fidelity, acceptability, and feasibility, and the intervention’s efficacy and uptake. The multi-component intervention consisted of cafeteria decorations, creative names, taste test, and flavor station implementation. Selection and consumption of fruits and vegetables were measured at 3 schools with monthly plate waste assessments over the course of one academic year (n = 1255 lunch trays). Qualitative interviews with school nutrition services staff (n = 3) were conducted at the conclusion of the intervention to assess implementation constructs using validated feasibility and acceptability metrics. Logistic and multiple linear regressions were used to evaluate plate waste data, and indicated that trends in fruit and vegetable consumption were inconsistent over the course of the intervention. Slight, but significant, increases in fruit consumption were associated with taste test and flavor station components of the intervention when compared to baseline. The odds of children selecting a vegetable were three times higher compared to baseline during the taste test component of the intervention at one school (odds ratio (OR), 3.0; 95% confidence interval (CI), 1.3–6.5). Taste test and cafeteria decoration strategies had the highest feasibility and acceptability metrics, and thematic analyses of school nutrition services staff interviews indicated that systems factors and Cooperative Extension support served as facilitators and barriers to implementation across all schools and strategies. The literature review and study indicate that Cooperative Extension support of, and partnerships with, schools are valuable assets to implement environmental change and nudge strategies in the NSLP. Additionally, a systems approach and rigorous study designs should be used, in combination with validated implementation metrics, to holistically evaluate the uptake and efficacy of environmental change and nudge strategies in low-resource schools.

Graduation Semester

2021-05

Type of Resource

Thesis

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http://hdl.handle.net/2142/110795

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Copyright 2021 Nader Hamdi

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