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

Author

Listed:
  • 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)

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.

Suggested Citation

  • Nader Hamdi & Brenna Ellison & Jennifer McCaffrey & Jessica Jarick Metcalfe & Ashley Hoffman & Pamela Haywood & Melissa Pflugh Prescott, 2020. "Implementation of a Multi-Component School Lunch Environmental Change Intervention to Improve Child Fruit and Vegetable Intake: A Mixed-Methods Study," IJERPH, MDPI, vol. 17(11), pages 1-17, June.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:11:p:3971-:d:366997
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    References listed on IDEAS

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    Cited by:

    1. Stephanie S. Machado & Lorrene D. Ritchie & Hannah R. Thompson & Kristine A. Madsen, 2020. "The Impact of a Multi-Pronged Intervention on Students’ Perceptions of School Lunch Quality and Convenience and Self-Reported Fruit and Vegetable Consumption," IJERPH, MDPI, vol. 17(16), pages 1-11, August.
    2. Qi, Danyi & Li, Ran & Penn, Jerrod & Houghtaling, Bailey & Prinyawiwatkul, Witoon & Roe, Brian E., 2022. "Nudging greater vegetable intake and less food waste: A field experiment," Food Policy, Elsevier, vol. 112(C).
    3. Christine Kawa & Patrizia M. Ianiro-Dahm & Jan F. H. Nijhuis & Wim H. Gijselaers, 2021. "Cafeteria Online: Nudges for Healthier Food Choices in a University Cafeteria—A Randomized Online Experiment," IJERPH, MDPI, vol. 18(24), pages 1-13, December.

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