- Title
- Improving the nutritional quality of Australian primary school lunchboxes
- Creator
- Brown, Alison Lyndal
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Poor dietary behaviour is one of the leading modifiable risk factors for overweight and obesity in childhood. The primary school setting provides an ideal opportunity to improve child nutrition, given it provides unparalleled access to children and their families. The nutritional quality of primary school lunchboxes are currently inadequate. Despite this, there has been limited effective and scalable interventions that have improved the nutritional adequacy of school lunchboxes. In order to achieve population wide health improvements, interventions must be both effective and amenable to scale. Therefore, the broad aim of this thesis was to investigate the effectiveness of an m-health intervention to improve the nutritional quality of school lunchboxes in primary school aged children, with scale in mind. Specifically, this thesis aimed to: • Determine the preliminary effectiveness and cost effectiveness of a pilot randomised controlled trial targeting parents to improve the nutritional quality of primary school lunchboxes (Chapters 2 and 3) • Optimise the effectiveness of messages delivered to parents via an m-Health intervention to improve the nutritional quality of primary school lunchboxes (Chapter 4) • Determine the effectiveness of a fully powered m-Health randomised controlled trial targeting parents to improve the nutritional quality of primary school lunchboxes (Chapter 5) • Assess the implementation outcome measures from the parental perspective of a primary school lunchbox m-Health intervention (Chapter 6) • Determine the effectiveness of technology enabled knowledge translation in public health (Chapter 7) • Provide recommendations for future research and practice in relation to improving the nutritional quality of primary school aged children’s lunchboxes (Chapter 8). RESULTS: A 2x2 factorial cluster randomised controlled trial (C-RCT) in 12 primary schools in the Hunter New England (HNE) region of New South Wales (NSW) was conducted to determine the preliminary efficacy, feasibility and acceptability of an m-health intervention, SWAP IT, that targeted parents of school aged children to improve the nutritional quality of school lunchboxes. The trial found a significant increase in energy from recommended ‘healthier’ alternative foods (P=0.04), in addition to being considered feasible and acceptable by both parents and schools. Additionally, an economic evaluation was retrospectively conducted on the 2x2 factorial C-RCT and found that the incremental cost per student to receive the intervention was AUD$31 per student. The economic evaluation highlighted that the SWAP IT program had the potential to be cost effective in reducing the kilojoules from discretionary goods in primary school lunchboxes. A further study provided insight into the framing and delivery of m-health lunchbox messages to parents, prior to the commencement of a fully powered type 1 hybrid effectiveness-implementation C-RCT that aimed to determine the effectiveness of the SWAP IT program in addition to measuring key implementation outcomes (acceptability, adoption, feasibility, appropriateness). The fully powered C-RCT reported significant reduction in discretionary foods packed (P=0.04) and consumed (P=0.05) in school lunchboxes. Additionally, SWAP IT was considered to be highly feasible, appropriate, acceptable and had high adoption by parents of primary school aged children. Finally, a systematic review of eight studies provided evidence on strategies for effective technology enabled knowledge translation in public health to improve the current evidence-practice gap and contribute to the population wide implementation of evidence based programs. CONCLUSION: This thesis provides a comprehensive evidence based assessment of a scalable m-Health lunchbox intervention for primary school children. This thesis, additionally provides considerable recommendations for future research and practice in relation to effective digital dissemination in improving the nutritional quality of primary school aged children’s lunchboxes, that are both sustainable and amenable to scale.
- Subject
- lunchbox; public health nutrition; public health; obesity prevention; childhood obestity prevention; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1507005
- Identifier
- uon:55945
- Rights
- Copyright 2023 Alison Lyndal Brown
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 9 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 387 KB | Adobe Acrobat PDF | View Details Download |