None listed
Conditions
Brief summary
The SWAP IT program is integrated within an app-based communication platform used by schools to communicate with parents and consists of text-messages sent to parents targeting barriers to packing healthier lunchboxes. SWAP IT has proven to be effective in improving child nutrition and weight outcomes, is acceptable to parents and principals, and is cost effective. Although SWAP IT has the potential to improve child health at a population-level, little evidence exists to guide efforts to encourage school adoption of these programs at scale. This research aims to maximise the impact of the SWAP IT program through a scale-up involving 1341 primary schools across 10 NSW local health districts. A modified platform trial design will be used to test the effectiveness of a series of scale-up strategies that have been tailored to context to maximise the adoption of an effective healthy lunchbox program within NSW primary schools located within 10 Local Health Districts of NSW. Adoption of the SWAP IT program will be the primary outcome of the trial. This research will result in new knowledge to inform how school-based nutrition programs can be successfully tailored to the local context and scaled-up at a population level.
Interventions
A modified platform trial design will be used to test the effectiveness of a series of scale-up strategies that have been tailored to context to maximise the adoption of an effective healthy lunchbox program within NSW primary schools located within 10 Local Health Districts of NSW.
The effective healthy lunchbox program (‘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 co
A modified platform trial design will be used to test the effectiveness of a series of scale-up strategies that have been tailored to context to maximise the adoption of an effective healthy lunchbox program within NSW primary schools located within 10 Local Health Districts of NSW. The effective healthy lunchbox program (‘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. A number of evidence-based scale-up strategies have been developed to support schools in the 10 LHDs to register for (i.e. adopt) SWAP IT. In order to ensure the strategies are appropriate for the context of each LHD, health promotion staff within each LHD selected strategies that would be delivered to schools in their region over a 9-month period. As a result, each LHD has selected a different combination of scale up strategies to be delivered to schools in their region. Within the 9-month intervention period, schools allocated to the intervention group within each LHD will receive a combination of the following strategies: 1. Sector Support and Endorsement: Policy makers from Education and Health will target principals, to communicate via up to three targeted letters (developed by the research team, approved and endorsed by the local opinion leaders), 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. As an additional strategy, some LHDs (outlined below) will use their existing connections to obtain endorsement for the program from local educational and wellbeing liaisons within the NSW Department of Education. This endorsement will be promoted to schools for an email distributed by the liaisons. 2. Local facilitation: Health promotion staff from LHDs 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 two existing school contacts, telephone calls or face-to-face visits, to assess interest in the program, address any barriers to adoption, and facilitate goal setting and action planning. Scripts developed by the research team to guide the local facilitation will incorporate motivational interviewing techniques to be employed by health promotion staff to address school barriers to adoption. 3. Develop and distribute educational materials: Targeted at principals 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 three contacts, including a printed information pack (consisting of a flyer, SWAP IT pen and booklet) and two emails to promote the program. As an additional strategy, one LHD will provide parent booklets promoting the SWAP IT program to all parents with children commencing the following school year within their school kindergarten orientation packs. 4. Local opinion leaders: Promotional materials, including one printed information pack (consisting of a flyer and SWAP IT parent booklet) and one email, will be delivered to other school decision makers, specifically the school administration manager and parent committee to promote the SWAP IT program and encourage schools to register. 5. Audit and feedback: Data and feedback on adoption of SWAP IT will be automatically captured via electronic registration records and 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. 6. Educational meeting: Health promotion staff from LHDs have developed strong and trusted local relationships with schools for over a decade and represent credible sources of local nutrition expertise. They will conduct a webinar with schools to assess interest in the program, address any barriers to adoption. Webinar content will be developed by the research team in collaboration with health promotion staff. An outline of the strategies employed by each LHD is provided below: LHD 1: Sector support and endorsement; educational meeting; local facilitation; develop and distribute educational materials; local opinion leaders; audit and feedback. LHD 2: Sector support and endorsement; educational meeting; local facilitation; develop and distribute educational materials; audit and feedback; local opinion leaders; additional endorsement strategy. LHD 3: Sector support and endorsement; educational meeting; local facilitation; develop and distribute educational materials; local opinion leaders; audit and feedback. LHD 4: Sector support and endorsement; educational meeting; develop and distribute educational materials; local opinion leaders; audit and feedback; additional endorsement strategy. LHD 5: Sector support and endorsement; educational meeting; develop and distribute educational materials; local opinion leaders; audit and feedback. LHD 6: Sector support and endorsement; educational meeting; develop and distribute educational materials; local opinion leaders; audit and feedback. LHD 7: Sector support and endorsement; educational meeting; develop and distribute educational materials (printed information pack only, no emails); local opinion leaders; audit and feedback. LHD 8: Sector support and endorsement; educational meeting; local facilitation; audit and feedback; additional educational materials strategy. LHD 9: Sector support and endorsement (one letter only); educational meeting; local facilitation; develop and distribute educational materials; additional endorsement strategy. LHD 10: Local facilitation; audit and feedback.
Sponsors
University of Newcastle
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Department of Education (DoE), Catholic and Independent primary schools located within 10 LHDs of NSW (Murrumbidgee, Hunter New England, Sydney, Western Sydney, South Western Sydney, South Eastern Sydney, Northern Sydney, Western NSW, Nepean Blue Mountains, Illawarra Shoalhaven). Primary and combined schools who cater for primary school aged children will be invited to participate. Schools who have not implemented the lunchbox nutrition program will be eligible to participate. Schools that do not use the Audiri parent communication app will be eligible, as these schools are participating in another trial (ACTRN12623000145606).
Exclusion criteria
Schools with secondary students only, schools catering exclusively for children requiring specialist care, schools who have already implemented the lunchbox nutrition program will be ineligible to participate.
Outcome results
None listed