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A randomised controlled trial to evaluate the scale-up of a technology based healthy lunchbox initiative: a solution to address poor dietary intake

Hunter New England Local Health District

  • Translational Research Grants Scheme
Date Funded:
  • 1 July, 2022
Chief Investigator/s:
  • Dr. Rachel Sutherland
  • Associate Professor Luke Wolfenden

Project Summary

This research aims to generate new knowledge to inform how school-based nutrition programs can be successfully scaled-up. A randomised controlled trial will evaluate the NSW scale-up of a text-message based healthy lunchbox program ‘SWAP-IT’ to improve child nutrition.

The main researchers for this project are Dr Rachel Sutherland and Professor Luke Wolfenden.

What is the issue for NSW?

Poor nutrition is a leading cause of preventable death and disability in Australia. To reduce chronic disease risk, it is recommended that effective school-based nutrition programs are delivered at scale (i.e. to large numbers of schools). However, the majority of efforts to scale-up such programs have been unsuccessful, as little is known about the best strategies to support the scale-up and adoption of effective school-based nutrition programs. The SWAP-IT program is integrated within an app-based communication platform used by schools to communicate with parents. Text-messages are 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. Even though 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.

What does the research aim to do and how?

This research aims to maximise the impact of the SWAP-IT program through a scale-up involving 400 primary schools across 11 NSW local health districts. A randomised trial will be undertaken with schools allocated to either a group which receives a 12-month multi-component scale-up strategy or a control group, which has access to the app and one scale up strategy within the app. Schools in the control group will receive the additional scale up strategies at the completion of the intervention, if the multi-component scale up strategy is shown to be effective. The scale-up strategy is theory-based and was developed in consultation with researchers and stakeholders from health, education and industry. This research will result in new knowledge to inform how school-based nutrition programs can be successfully scaled-up at a population level.

The project will assess:

  • SWAP-IT program adoption (the number of eligible primary schools that register and deliver the program at 12-month follow-up).
  • Efficiency and affordability of the intervention (using a cost-consequence analysis and budget impact assessment).
  • Process evaluation with stakeholders to assess the acceptability of the scale-up strategy.