A cluster randomised controlled trial of a consumer behaviour intervention to reduce the average energy, saturated fat, sugar and sodium content of the online canteen lunch orders of primary school students: The 'Click & Crunch' Trial.

The aim of this study is to assess the effectiveness of integrating consumer behaviour strategies such as menu labelling, item positioning, feedback, incentives, prompts, and price into an online canteen ordering system to reduce the average energy, saturated fat, sugar and sodium content of student lunch orders. The study will employ a clustered randomised trial design. Sixty two NSW primary schools with an existing online canteen ordering system will be randomised to receive either a consumer behaviour intervention or control (online canteen ordering only). The effectiveness of the intervention will be determined by comparing between-group differences at follow-up in the average i) energy (kilojoules), ii) saturated fat (grams) iii) sugar (grams), and iv) sodium (milligrams) content of students' online lunch orders using purchasing data automatically collected by the online canteen system. Outcome data will be assessed at baseline and 12-month follow-up. Assessment periods will be conducted over one school term (approximately 10 weeks). All users (i.e. parents and students) of an online canteen at intervention schools will receive a consumer behaviour intervention that will be integrated into the school’s existing online canteen ordering system. Online canteen ordering systems allow users (students or a parent on behalf of a student) to login to a website to access the school’s canteen menu. Users are able to select and pay for food and drink items, which are processed by the canteen and supplied to students during their lunch break. The online canteen provider will modify the display of the online ordering system to incorporate the consumer behaviour strategies. For intervention schools, the provider will reprogram the website to automatically apply the strategies (where possible) to online menus, and then the research team will access the online menu for each intervention school to manually apply the remaining strategies. All strategies will be implemented on the mobile site of the online ordering system. The intervention will consist of the following evidence based strategies previously associated with healthy food purchases in analogous settings: 1. Labelling: Each item on the online menu will be labelled. The labelling system is based on the NSW Healthy School Canteen Strategy (e.g. ‘Everyday’, 'Occasional'). Canteen managers will also receive a hard-copy report of their labelled menu. 2. Positioning: Menus items will be ordered to give healthy items positions of greatest prominence. This will occur at the food category level (e.g. Drinks) and at the item level (e.g. Strawberry Flavoured Milk). The healthiest food categories / items will be positioned first & last, with the least healthy in the centre. Where there are multiple flavours of an ‘Occasional’ foods (e.g. multiple flavours of chips), users will be required to first ‘click’ on the item before the full list of flavours are displayed. 3. Feedback: Prior to each lunch order being confirmed within the online ordering system, the user will receive graphical feedback summarising the nutritional content of the lunch order. 4. Incentives: A healthy lunch award symbol will be printed on the lunch bag label if the order contains 100% 'Everyday' items (excluding sauces, condiments, all non-food items). Symbols will rotate every week within each term 5. Prompts: Prompts will appear on the online menu including messages, images and descriptions specifically designed to encourage healthy purchasing. Prompts will also include healthy add-ons for ‘Occasional’ hot food items. For example, if users select an 'Occasional' hot food item for lunch then they will be prompted to purchase healthy add-ons (e.g. water and/or carrot sticks). 6. Pricing: Price is a key driver of consumer choice. While the pricing of menu items will be at the discretion of each school, canteen managers will receive a report summarising the average costs of 'Everyday' and 'Occasional' items across their menu and will receive information about how to competitively price ‘Everyday’ foods whilst maintaining canteen profitability. Observations: Information collected from the online ordering system will undergo independent verification to ensure the integrity of data that is supplied by the provider. Specifically, in a random sample of 20% of participating schools, research assistants will visit the school canteen on one day and record all of the foods and drinks available for purchase, and all items ordered through the online ordering system. This information will be collected from the lunch order labels, as generated by the online system and cross-referenced with the purchasing data supplied by the provider. Schools will be asked to nominate a day that is convenient for them. Child level data including child grade will be collected from the online ordering system. School level data including size (number of enrolments) and sector (Government, Catholic or Independent), year range (e.g. K-6), and school location (metropolitan, provincial, remote and very remote) will be collected from the ‘My School’ website. After the collection of follow up purchasing data, the Canteen Managers of schools allocated to the intervention will be contacted to take part in a computer assisted telephone interview (CATI) to assess the acceptability of intervention strategies and processes. Menu composition and analytics data (e.g. frequency of use, device used to place order, time taken to place the order) from the online ordering system will also be collected for descriptive purposes.