Pilot of an online multi-component public health nutrition intervention to improve healthy food purchases from primary school canteens – A pilot cluster randomised controlled trial

Eligible schools using an online lunch ordering service will be approached and randomised to receive an online multi-component public health nutrition intervention. The aim of the intervention is to increase the purchase of healthy food and beverage menu items from school canteens using an online lunch ordering service.The following evidence-based strategies will be employed: 1. Availability: Canteen managers will be supported to improve the relative availability of healthy items sold at their canteen. Specifically, a dietitian will classify foods and beverages sold by schools as ‘red’ (low in nutritional value), ‘amber’ (moderate nutritional value) or ‘green’ (high nutritional value) according to NSW government school canteen policy ‘Fresh Tastes @ School’ and provide a comprehensive feedback report to schools encouraging canteen managers to improve the relative availability of healthy items ('green') by increasing the availability of healthy items (green) or removing unhealthy items (red) from menus. These reports will be distributed via email to both the canteen manager and Principal at a minimum of 1 time point, immediately prior to the redesigned canteen menu being uploaded online. A brief phone call (approx.15 minutes) will be made to the canteen manager and/or Principal to discuss contents of the feedback report. 2. Labelling: a. Traffic light labels - Each online menu item will be labelled with a single traffic-light label based on the Fresh Tastes @ School classification (red, amber or green). b. Label Guide - A definition of ‘green’, ‘amber’ and ‘red’ foods will appear at the top of webpage, and when user hovers their mouse over each traffic light symbol c. Descriptions – Green menu items that require assembly of ingredients and that are commonly purchased as a main meal item (e.g. Sandwiches/Salads/ homemade hot meals) will include a hedonic description directly under the item name. 3. Placement: Healthier menu categories (i.e. fruit, sandwiches, salads) and items within categories will be will be ordered to give ‘green’ items positions of greatest prominence i.e. positioned first. Where there are multiple flavours of a ‘red’ or ‘amber’ food, users will be required to ‘click’ on the category before the full list of items are displayed. Conversely, all ‘green’ items will appear in the main website interface. 4. Prompting: Healthier menu categories (i.e. sandwiches, salads, fruit) will display images and a positive purchase prompt. When users select a red or amber hot food item they will also be provided with a suite of green add-ons (water, fruit or vegetable) called ‘meal extras’. Schools in the intervention group will be required to retain the menu design throughout the study period (for a minimum of 2 months). Intervention Fidelity: The research team will have access to a school’s online menu in its ‘build phase’, this will minimise error in the application of intervention strategies from the online provider. The online provider will also supply the research team with monthly reports describing changes made to the menu over the preceding month. These reports will enable the research team to identify the addition of new menu items. New menu items will be labelled and positioned according to the redesign strategies. The research team will contact the provider to make the required changes.