A cluster randomised controlled trial to improve the lunchbox contents of primary school aged children.

The lunchbox program aims to improve the contents of children’s lunchboxes by supporting parents/carers to swap what is packed from discretionary (“sometimes”) foods and drinks to core (“everyday”) foods and drinks. Core foods are defined as minimally processed foods from the five food groups set out in the Australian Dietary Guidelines, and discretionary foods are those not consistent with the Dietary Guidelines and tending to be higher in fat, sugar and salt and poorer in nutritional quality. The program seeks to address the barriers faced by parents to packing a healthy lunchbox (time/convenience, cost, child preference, food safety and knowledge). Schools will be randomly allocated to either the program group or a waitlist control group. The program will run for approximately 15 weeks and includes 4 key strategies: 1. Lunchbox nutrition guidelines – an experienced public health nutritionist will work with program schools to develop lunchbox nutrition guidelines. Principal endorsement of guidelines will be promoted to the school community utilising the authority of the school principal, to communicate school expectations and normalise healthy lunchboxes. To assess implementation fidelity, principals will be asked about the guidelines and methods used to inform parents during a post-program interview. 2. Weekly support messages – Following the development of lunchbox nutrition guidelines, weekly messages (developed by Public Health Nutritionists) will be “pushed” to parents using the existing school communication application for a period of 10 school weeks. These messages address the identified barriers to packing a healthy lunchbox and act as prompts and cues to reinforce the packing of everyday foods. Content may include short word messages, relevant pictures, links to videos and project website and an email address to request further information. Implementation fidelity (ie. delivery of messages) will be ascertained through accessing app analytics. 3. Resources for parents – To coincide with the first support message, children will receive a magnetised parent resource booklet, designed by public health nutritionists for the SWAP IT program, as well as a branded ice brick and a water bottle. These resources aim to facilitate the packing of healthy lunchboxes. Hyperlinks embedded in the app messages will connect parents to additional resources, created by public health nutritionists for the SWAP IT program, accessible via the Good for Kids website. To assess implementation fidelity, parents will be asked questions relating to the resources during a telephone survey at the completion of the program and website analytics will be collected to monitor website traffic. 4. Resources for schools - Schools will be sent complimentary stage appropriate curriculum resources that align with syllabus outcomes. These resources were developed for the SWAP IT program by school teachers and public health nutritionists, for use by teachers to reinforce healthy food preferences and improve student’s nutrition knowledge. Schools will be encouraged to deliver the lessons at a time appropriate to them during the 15 week program. Schools will also be asked to display 10 pictorial posters (one per week) in school classrooms to coincide with the weekly support messages for parents. These posters show examples of healthy lunchboxes and include tips to address the known barriers. These posters were designed for the program by public health nutritionists to act as prompts for teachers to facilitate discussion of lunchbox ideas with students. To assess implementation fidelity, teachers will be asked questions relating to the delivery of curriculum resources and posters during a post-program survey.