The long-term effectiveness of a multi-strategy behavioural intervention to increase the nutritional quality of primary school students’ online lunch orders: 18-month follow-up of the ‘Click & Crunch’ cluster randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Rebecca Wyse ◽  
Tessa Delaney ◽  
Fiona Stacey ◽  
Christophe Lecathelinais ◽  
Kylie Ball ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Saturated Fat ◽  
Sodium Content ◽  
Behavioural Intervention ◽  
Primary School Students ◽  
School Students ◽  
Randomized Controlled ◽  
Cluster Randomized

BACKGROUND School food services, including cafeterias and canteens are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. OBJECTIVE To determine the long-term effectiveness of a multi-strategy behavioural intervention (‘Click & Crunch’) embedded within an existing online school lunch ordering system on the energy, saturated fat, sugar and sodium content of primary school students’ lunch orders 18 months after baseline. METHODS A cluster randomized controlled trial that involved a cohort of 2,207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multi-strategy behavioural intervention or control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (i.e. mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (i.e. the proportion of online lunch order items that were ‘Everyday’, ‘Occasional’ and ‘Caution’) were assessed over an eight week period at baseline and 18-months follow-up. RESULTS 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (-74.1kJ; 95%CI -124.7, -23.4; P=.006) and saturated fat (-0.4g; 95%CI -0.7, -0.1; P=.003), but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing ‘Everyday’ items increased significantly (OR=1.2; 95%CI 1.1, 1.4; P=.009, corresponding to a +3.8% change) and the odds of purchasing ‘Caution’ items significantly decreased among intervention schools (OR=0.7, 95%CI 0.6, 0.9; P=.002, corresponding to a -2.6% change). There was no between-group difference over time in canteen revenue. CONCLUSIONS The findings suggest that there are intervention effects up to 18-months post baseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behaviour change strategy within schools. CLINICALTRIAL The trial methods were prospectively registered (ACTRN12618000855224) and the 18-month follow-up was conducted in accordance with these registered procedures.

scholarly journals Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Rebecca Wyse ◽  
Tessa Delaney ◽  
Fiona Stacey ◽  
Rachel Zoetemeyer ◽  
Christophe Lecathelinais ◽  
...  
Keyword(s):  
Behavioral Intervention ◽  
Controlled Trial ◽  
Saturated Fat ◽  
Sodium Content ◽  
Choice Architecture ◽  
Web Based ◽  
Randomized Controlled ◽  
School Canteen ◽  
Trial Outcomes ◽  
Cluster Randomized

BACKGROUND School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. OBJECTIVE This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. METHODS The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as <i>everyday</i>, <i>occasional</i>, and <i>caution</i> (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. RESULTS From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; <i>P</i>=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; <i>P</i>&lt;.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; <i>P</i>&lt;.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; <i>P</i>=.02). Relative to control schools, intervention schools had significantly greater odds of having <i>everyday</i> items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; <i>P</i>&lt;.001), corresponding to a 9.8% increase in <i>everyday</i> items, and lower odds of having <i>occasional</i> items purchased (OR 0.7, 95% CI 0.6-0.8; <i>P</i>&lt;.001), corresponding to a 7.7% decrease in <i>occasional</i> items); however, there was no change in the odds of having <i>caution</i> (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; <i>P</i>=.05). Furthermore, there was no change in schools’ revenue between groups. CONCLUSIONS Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-030538

scholarly journals A Cluster Randomized Controlled Trial Evaluating the Impact of Tailored Feedback on the Purchase of Healthier Foods from Primary School Online Canteens

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2405
Author(s):  
Fiona Stacey ◽  
Tessa Delaney ◽  
Kylie Ball ◽  
Rachel Zoetemeyer ◽  
Christophe Lecathelinais ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Primary Schools ◽  
Controlled Trial ◽  
Saturated Fat ◽  
Sodium Content ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Cluster Randomized ◽  
The Impact

Few online food ordering systems provide tailored dietary feedback to consumers, despite suggested benefits. The study aim was to determine the effect of providing tailored feedback on the healthiness of students’ lunch orders from a school canteen online ordering system. A cluster randomized controlled trial with ten government primary schools in New South Wales, Australia was conducted. Consenting schools that used an online canteen provider (‘Flexischools’) were randomized to either: a graph and prompt showing the proportion of ‘everyday’ foods selected or a standard online ordering system. Students with an online lunch order during baseline data collection were included (n = 2200 students; n = 7604 orders). Primary outcomes were the proportion of foods classified as ‘everyday’ or ‘caution’. Secondary outcomes included: mean energy, saturated fat, sugar, and sodium content. There was no difference over time between groups on the proportion of ‘everyday’ (OR 0.99; p = 0.88) or ‘caution’ items purchased (OR 1.17; p = 0.45). There was a significant difference between groups for average energy content (mean difference 51 kJ; p−0.02), with both groups decreasing. There was no difference in the saturated fat, sugar, or sodium content. Tailored feedback did not impact the proportion of ‘everyday’ or ‘caution’ foods or the nutritional quality of online canteen orders. Future research should explore whether additional strategies and specific feedback formats can promote healthy purchasing decisions.

scholarly journals Effects of a health educational intervention on cardiovascular disease knowledge, motivation and behavioral skills: A cluster randomized controlled trial

2019 ◽  
Author(s):  
John Amoah ◽  
Salmiah Md. ◽  
Lekhraj Rampal ◽  
Rosliza A Manaf ◽  
Normala Ibrahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Education ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
School Students ◽  
Behavioral Skills ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Background Cardiovascular diseases (CVD) are the number one public health challenge of the 21st century. Globally, the disease causes more deaths than any other cause. Unfortunately, many people are not aware of CVDs and its risk factors and because of this the disease burden keeps on rising. Objective of this study was to develop, implement and evaluate the effects of a health education program to improve CVD knowledge, motivation, and behavioral skills among secondary school students in Ghana. Methods A parallel single-blind cluster randomized controlled trial was carried out for a period of six-months with baseline and post intervention evaluations. Participants (n=848) were secondary school students of ages of 14-19 years from four schools (clusters) in Brong Ahafo, Ghana. Students in the intervention group received health education intervention whereas those of the control group received no intervention. The intervention included information on cardiovascular diseases and its risk factors, motivation, and behavioral skills modules. At six months, a follow-up data using same questionnaire were collected after the intervention was completed. The generalized linear mixed model (GLMM) was used to assess the overall effects of the intervention. Results Of the 848 students, 836 completed the follow-up assessment immediately after six-month. The GLMM showed the intervention was significant in improving 6.85(p<0.001), 0.90(p<0.001), 0.94(p<0.001) higher total CVD knowledge, motivation, and behavioral skills scores respectively for the intervention group when compared to the control group. Conclusions The intervention was effective in increasing CVD knowledge, motivation, and behavioral skills of students in the intervention arm of the study. It is recommended that the health education module be implemented into secondary schools education curricula in Ghana to improve CVD knowledge, motivation, and behavioral skills. Equipping students with the IMB will reduce CVD risk factors and prevent the onset of CVDs in future.

scholarly journals Detection of Domestic Violence and Abuse by Community Mental Health Teams Using the BRAVE Intervention: A Multicenter, Cluster Randomized Controlled Trial

2021 ◽  
pp. 088626052110041
Author(s):  
Roos Ruijne ◽  
Cornelis Mulder ◽  
Milan Zarchev ◽  
Kylee Trevillion ◽  
Roel van Est ◽  
...  
Keyword(s):  
Mental Health ◽  
Domestic Violence ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Referral Rates ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
And Control ◽  
Domestic Violence And Abuse

Despite increased prevalence of domestic violence and abuse (DVA), victimization through DVA often remains undetected in mental health care. To estimate the effectiveness of a system provider level training intervention by comparing the detection and referral rates of DVA of intervention community mental health (CMH) teams with rates in control CMH teams. We also aimed to determine whether improvements in knowledge, skills and attitudes to DVA were greater in clinicians working in intervention CMH teams than those working in control teams. We conducted a cluster randomized controlled trial in two urban areas of the Netherlands. Detection and referral rates were assessed at baseline and at 6 and 12 months after the start of the intervention. DVA knowledge, skills and attitudes were assessed using a survey at baseline and at 6 and 12 months after start of the intervention. Electronic patient files were used to identify detected and referred cases of DVA. Outcomes were compared between the intervention and control teams using a generalized linear mixed model. During the 12-month follow-up, detection and referral rates did not differ between the intervention and control teams. However, improvements in knowledge, skills and attitude during that follow-up period were greater in intervention teams than in control teams: β 3.21 (95% CI 1.18-4.60). Our trial showed that a training program on DVA knowledge and skills in CMH teams can increase knowledge and attitude towards DVA. However, our intervention does not appear to increase the detection or referral rates of DVA in patients with a severe mental illness. A low detection rate of DVA remains a major problem. Interventions with more obligatory elements and a focus on improving communication between CMH teams and DVA services are recommended.

scholarly journals Endothelial Dysfunction, Atherosclerosis, and Increase of von Willebrand Factor and Factor VIII: A Randomized Controlled Trial in Swine

2021 ◽  
Author(s):  
Ferdows Atiq ◽  
Jens van de Wouw ◽  
Oana Sorop ◽  
Ilkka Heinonen ◽  
Moniek P. M. de Maat ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Randomized Controlled Trial ◽  
Endothelial Dysfunction ◽  
Controlled Trial ◽  
Short Term ◽  
Randomized Controlled ◽  
Von Willebrand ◽  
Willebrand Factor

AbstractIt is well known that high von Willebrand factor (VWF) and factor VIII (FVIII) levels are associated with an increased risk of cardiovascular disease. It is still debated whether VWF and FVIII are biomarkers of endothelial dysfunction and atherosclerosis or whether they have a direct causative role. Therefore, we aimed to unravel the pathophysiological pathways of increased VWF and FVIII levels associated with cardiovascular risk factors. First, we performed a randomized controlled trial in 34 Göttingen miniswine. Diabetes mellitus (DM) was induced with streptozotocin and hypercholesterolemia (HC) via a high-fat diet in 18 swine (DM + HC), while 16 healthy swine served as controls. After 5 months of follow-up, FVIII activity (FVIII:C) was significantly higher in DM + HC swine (5.85 IU/mL [5.00–6.81]) compared with controls (4.57 [3.76–5.40], p = 0.010), whereas VWF antigen (VWF:Ag) was similar (respectively 0.34 IU/mL [0.28–0.39] vs. 0.34 [0.31–0.38], p = 0.644). DM + HC swine had no endothelial dysfunction or atherosclerosis during this short-term follow-up. Subsequently, we performed a long-term (15 months) longitudinal cohort study in 10 Landrace–Yorkshire swine, in five of which HC and in five combined DM + HC were induced. VWF:Ag was higher at 15 months compared with 9 months in HC (0.37 [0.32–0.42] vs. 0.27 [0.23–0.40], p = 0.042) and DM + HC (0.33 [0.32–0.37] vs. 0.25 [0.24–0.33], p = 0.042). Both long-term groups had endothelial dysfunction compared with controls and atherosclerosis after 15 months. In conclusion, short-term hyperglycemia and dyslipidemia increase FVIII, independent of VWF. Long-term DM and HC increase VWF via endothelial dysfunction and atherosclerosis. Therefore, VWF seems to be a biomarker for advanced cardiovascular disease.

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