Implementation of a Multi-Component School Lunch Environmental Change Intervention to Improve Child Fruit and Vegetable Intake: A Mixed-Methods Study

Nader Hamdi, Brenna Ellison, Jennifer McCaffrey, Jessica Jarick Metcalfe, Ashley Hoffman, Pamela Haywood and Melissa Pflugh Prescott
Additional contact information
Nader Hamdi: Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
Brenna Ellison: Department of Agricultural and Consumer Economics, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
Jennifer McCaffrey: Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
Jessica Jarick Metcalfe: Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
Ashley Hoffman: Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
Pamela Haywood: Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
Melissa Pflugh Prescott: Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA

IJERPH, 2020, vol. 17, issue 11, 1-17

Abstract: Nudge interventions are widely used to promote health in schools, yet implementation metrics are seldom used to understand intervention outcomes. A multi-component intervention consisting of cafeteria decorations, creative names, social norming taste tests, and flavor station components was implemented in three rural elementary school cafeterias by school nutrition services (SNS) and extension staff. Selection and consumption of fruits and vegetables at lunch were measured through monthly plate waste assessments over eight months ( n = 1255 trays). Interviews were conducted with SNS staff ( n = 3) upon completion of the intervention to assess implementation outcomes using validated acceptability and feasibility metrics. Consumption findings were generally inconsistent across schools and time points, yet fruit consumption increased at School 1 ( p < 0.05) during the taste test and flavor station intervention months and School 2 ( p < 0.001) during the creative names intervention months compared to baseline. Odds of selecting a vegetable at School 3 were three times higher than baseline during the taste test intervention months (odds ratio (OR), 3.0; 95% confidence interval (CI), 1.3–6.5). Cafeteria decorations and taste tests had higher reported implementation metrics for acceptability and feasibility than other interventions. Thematic analysis underscored the facilitating role of extension support, as well as systems factors, which served as facilitators and barriers across schools and interventions. These findings suggest that nudge interventions are a promising strategy to improve vegetable selection and fruit consumption in school meal programs.

Keywords: school meals; nudge; implementation science; food waste; systems (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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