An evaluation into the national scale-up of an effective text message based healthy lunchbox program aimed at improving child nutrition

A parallel group randomised controlled trial design will be used to test the effectiveness of a 9-month theory-based multi-component strategy to achieve large scale adoption of an effective healthy lunchbox program (‘SWAP IT’) in primary schools located within Victoria (VIC), Queensland (QLD) and South Australia (SA). SWAP IT 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. SWAP IT messages are delivered weekly to parents and carers via usual school-parent communication channels for one school term (one message per week), followed by two messages per term on an ongoing basis. The messages provide parents and carers with useful tips and ideas for packing a healthy lunchbox, including recipe ideas and healthy alternatives for ‘sometimes’ foods. Additional resources, including classroom lessons for teachers, school nutrition guidelines and parent booklets, have been specifically developed for the SWAP IT program and are freely available to schools and parents. Schools allocated to the intervention group within the three states will receive a theoretically-based multi-component dissemination intervention to support schools to register for SWAP IT. The scale up strategy will consist of the following evidence-based components: 1. Program integration: SWAP IT will be integrated into the school communication platform (Audiri) interface routinely used by, and familiar to schools. Specifically, principals will be alerted to program availability via up to four Audiri system pop-ups, prompts and banners, accessible via the user dashboard, and adoption completed via simple click-commands, confirming guideline and message content and timing. The strategies will be delivered in a staggered format throughout the intervention. Once a school registers for the program, they will not receive any additional strategies. 2. Endorsement from state-level health and education stakeholders: State-level policy makers from Education and Health from NSW, VIC, QLD and SA will target principals, to communicate via up to two targeted email, support and endorsement of the program and its outcomes, its alignment to sector policies, recommend its adoption and will provide a link to resources and the enrolment site. 3. Local opinion leaders: Health promotion staff located within each state (SA, QLD and VIC) have developed strong and trusted local relationships with schools for over a decade and represent credible sources of local nutrition expertise. They will use up to three existing school contacts, including email, telephone and face-to-face visits, to assess interest in the program, address any barriers to adoption, and facilitate goal setting and action planning. 4. Educational materials: Targeted at principals and other school decision makers, such as the school administration manager and parent committee to address perceived barriers to adoption, the strategy will initially aim to create tension for change (e.g. via outlining parent interest and expectations); and then communicate the attractive program attributes (e.g. simplicity, no-cost). This communication will consist of up to four contacts, including a combination of email and mailed materials (information booklets, flyers, calendars, curriculum resources, classroom resources). 5. Audit and feedback: Data and feedback on adoption of SWAP IT will be automatically captured via electronic registration records and will be provided to schools via the communication strategy and help guide execution and targeting of components. For example, communication materials provided to principals, school administration managers and parent committees will include information on the number of schools that have registered for SWAP IT and provide instruction on how the school can also register for the program. The research team will control the delivery of the scale-up strategies, ensuring they are only received by schools in the intervention group. Project records maintained by the research team and collaborating health promotion staff will be used to monitor adherence to the intervention, including the delivery of each scale-up strategy.