The effectiveness of online menu labelling and audit and feedback in encouraging healthier food choices: a cluster randomised trial in NSW primary school canteens

Intervention components: i) Strategy 1- Audit and feedback report: Canteen menus were audited against the NSW Healthy School Canteen Strategy – Food and Drink criteria, and a feedback report was provided to canteen managers and school principals. The 4-6 page report contained the school canteen’s menu classified against the Food and Drink Criteria and provided tailored suggestions for suitable product alternatives. ii) Strategy 2- Online menu labels: Labels were added to online canteen menus. Each menu items was labelled as "Everyday", "Occasional", or "Caution" consistent with NSW Healthy School Canteen Strategy- Food and Drink criteria. Mode of delivery: i) Strategy 1- Audit and feedback report: Canteen menu audit and feedback reports were emailed to canteen managers and principals at intervention schools. ii) Strategy 2- Online menu labels: All users of an online canteen ordering system at participating intervention schools were exposed to the labelling intervention. The intervention was integrated into the school's existing online canteen ordering system. Online canteen ordering systems allows users to view, select and pay for food and drink menu items, which are processed by the canteen and supplied to students during the lunch break. A small symbol appeared next to each menu item; a green circle for “Everyday” foods; a grey circle for “Occasional” foods; and a red warning sign (exclamation mark in a triangle) for “Caution” foods. Intervention delivery personnel: i) Strategy 1- Audit and feedback report: Research dietitians assessed the canteen menu against the Food and Drink Criteria, generated the feedback report (using a standardised template) and then emailed the report to the school. The research team also delivered verbal feedback to canteen staff via telephone (approx 30 min duration). ii) Strategy 2- Online menu labels: Staff from the online canteen provider (Flexischools) modified the display of the online ordering system, so that each menu item was labelled as ‘Everyday’, ‘Occasional’, or ‘Caution’. At the commencement of strategy 2, a research assistant monitored the application of the online menu labels by checking the Flexischool system. Intervention delivery schedule: All intervention schools underwent a baseline data collection period of approximately 3 weeks. Immediately following the baseline period, intervention schools were emailed the menu audit and feedback report from the research team and received a phone call (approx 30 min) from a research dietitian. No additional intervention strategy or support was offered from the project team for approximately 4 weeks (strategy 1). Immediately following the 4 week period post report delivery (strategy 1), intervention schools had online canteen menu labelling switched on (strategy 2) for approximately 6 weeks. This 6 week period included an initial 2 week wash-in period, followed by a 4 week follow-up data collection period. The study duration was 13 weeks in total, including a 3 week baseline period, 4 weeks of strategy 1, and 6 weeks of strategy 2.