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Trial registered on ANZCTR

Registration number

ACTRN12621000564853

Ethics application status

Approved

Date submitted

17/03/2021

Date registered

13/05/2021

Date last updated

13/04/2023

Date data sharing statement initially provided

13/05/2021

Date results information initially provided

13/04/2023

Type of registration

Prospectively registered

Titles & IDs

Public title

VegUP: The effect of a vegetable-focused menu in primary school canteens

Scientific title

Effect of a vegetable-focus in primary school canteen menus on vegetable sales: a randomised controlled trial

Secondary ID [1]

Nil known

Universal Trial Number (UTN)

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

low vegetable intake

poor diet

Condition category

Condition code

Public Health

Health promotion/education

Diet and Nutrition

Other diet and nutrition disorders

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

The intervention consists of increased vegetable provision and online ordering changes in NSW primary school canteen menu's for an 8-week period. The menu changes consists of the following elements:

1. Novel vegetable-containing product
A new vegetable-containing product ‘Rainbow Dippers’ will be introduced. This product concept was developed based on sensory science and knowledge on children’s food acceptance. The product contains a range of vegetable dippers which include a dipper (raw vegetable sticks) and a vegetable dip, and it will contain one serve of vegetables. The product was developed using insights from a consumer sensory acceptance test with children. The product will adhere to school guidelines concerning allergies and will be produced by a commercial producer and delivered for free to schools during the intervention period.

2. Changes to online menu structure/choice architecture
Two changes will be made to the online menu structure:
- Positioning changes will be made to fit with the “primacy effect” – the tendency to pay more attention to the first items in a list. Vegetable-containing items will be positioned higher than non-vegetable-containing items in their categories in the (online) menus.
- Sandwiches with a protein component (e.g. cheese/ham/turkey/chicken) will contain one vegetable filling by default, to which parents can opt-out. Currently, parents/children need to opt-in for a vegetable filling. This strategy is based on the finding that decision makers have a tendency to choose the default among several possible actions, as a result of ‘loss aversion’.

3. Changes to hot foods
The vegetable content in popular hot foods will be increased through recipe development, undertaken in collaboration with the canteen manager. An earlier menu analysis of primary school menus in NSW showed that only 49% of hot meals/foods contained vegetables. Canteen managers will be provided with advice and support on how the vegetable content of their most popular hot meals can be increased. They are encouraged to include students in the school to take part in a ‘taste test’ to select the winning recipes that will be introduced, in order to create student engagement.

4. Brochure with other suggestions to increase vegetable content
Canteen managers will be provided with a leaflet containing other suggestions to increase the vegetable content of their menu. These suggestions are based on the results of a previous menu analysis for opportunities to increase the vegetable content of canteen menu’s. The possibilities to implement changes will be discussed individually with each canteen manager to fit around their current menu and practices.

Canteen managers will be provided with an information pack on the changes which will be individually discussed and tailored to their situation by a research staff member with nutrition qualifications. Canteen managers can choose themselves how and which of the changes they will implement to fit with their schools, students and canteens needs. From the intervention perspective there will be no other changes to the foods other than addition of vegetables and order of items on menus. If canteen managers feel they need to withdraw a food item to comply with their menu policy (e.g. if addition of a new snack would require removal of another snack) then we will allow them to implement that. This additional change would then be recorded.

Parents, students and staff will be informed about the menu changes after collection of baseline data (and before the new menu is introduced) via the school’s regular communication channels.

All physical information materials were designed specifically for this study.

Intervention adherence will be checked by recording which initial changes to the menu the canteen managers will implement, and a phone call mid-way and at the end of the intervention. In addition, weekly checks of the online menu will be conducted and delivery records of vegetables supplied by the commercial provider will be kept.

Intervention code [1]

Prevention

Intervention code [2]

Behaviour

Intervention code [3]

Lifestyle

Comparator / control treatment

Control schools will follow their usual practices. They will be instructed not to change anything in their menu during both the baseline and intervention period. They will also be requested to maintain the status quo with regard to recipes and other practices.

Control group

Active

Outcomes

Primary outcome [1]

Overall vegetable sales (g/week), derived from canteen sales data

- Menus of participating schools will be assessed by a trained dietitian experienced in reviewing school canteen menus. Vegetable content (in g) will be determined for each vegetable-containing item on the online menu. Where needed, specific information from the canteen manager will be sought
- Daily individual sales data from canteens from online ordering will be used
- Any over-the counter-sales of vegetable-containing items will be manually recorded on a check-list by canteen managers
- Vegetables sold will be calculated by multiplying the number of vegetable-containing items sold each day by the vegetable content (in g) of the items. Daily vegetable sales will be converted to weekly sales by adding daily totals.

Timepoint [1]

Baseline data collection will take place over 3 weeks in the first term of the school winter menu (term 2 of 2021). Follow-up data collection will take place over 8 weeks of the intervention in school term 1 of 2022.

Secondary outcome [1]

Vegetable sales (g/wk) in specific categories (e.g. sandwiches, snacks)

Menu items will be grouped into subcategories. Vegetable sales data in relevant subcategories will be captured and analysed in the same way as for the overall vegetable sales.

Timepoint [1]

Secondary outcome [2]

Canteen revenue sales (in AUS$/week)

To determine that the intervention does not adversely affect canteen sales, total revenue data will be collected from online ordering data and over-the-counter cash register data

Timepoint [2]

Secondary outcome [3]

Vegetable waste (g/week)

To verify if vegetable sales is a good approximation of vegetable intake, student vegetable waste will be collected from school grounds from a random sample of 4 participating intervention (n=2) and control (n=2) schools. Dedicated bins will be provided during test days. Waste will be collected by research staff, sorted for vegetable items and weighed on the same day.

Timepoint [3]

Vegetable waste will be measured over 2 representative days mid-baseline and mid-intervention period.

Secondary outcome [4]

Process evaluation data from canteen managers of intervention schools.

An online survey (closed and open questions) will be undertaken with canteen managers to evaluate the perception of student interest on specific elements of the intervention, implementation difficulties, long-term viability and potential improvements. The survey was designed specifically for this study.

Timepoint [4]

Within three weeks after completion of the intervention period

Secondary outcome [5]

Process evaluation amongst parents in intervention schools

An online quantitative survey will be undertaken with parents of students to seek information on menu perception and behavioural changes using a combination of multiple choice questions and 7-point Likert scales. All eligible parents from the participating intervention schools will be invited to take part. The survey was designed specifically for this study.

Timepoint [5]

Within three weeks after completion of the intervention period

Secondary outcome [6]

Process evaluation data from canteen managers of intervention schools.

After the online survey, a follow up phone call will be undertaken with canteen managers when needed to be able to get deeper insights and clarify answers.

Timepoint [6]

Within 1-2 weeks after completion of the online survey

Eligibility

Key inclusion criteria

Schools (through principals) and canteen managers in metropolitan Sydney (NSW) will be recruited that meet the following inclusion criteria:
- Government, independent and catholic primary schools (Kindergarten - Year 6) with a school canteen
- School canteen is operating with an online ordering system (Cashless) with more than 70% of sales done online
- School canteen is operating at least 3 days a week
- Principals are willing to let their school participate and are willing to share de-identified sales data (provided by online ordering system provider)
- Canteen managers are willing to implement changes to their vegetable provision and participate in a follow up survey

For the process evaluation, parents will be eligible for participation when:
- Child is enrolled in intervention school
- Parent regularly (at least once a week) orders food for their child from the school canteen via online ordering
- Parent does not exclusively order foods via recurring ordering

Minimum age

5 Years

Maximum age

12 Years

Sex

Both males and females

Can healthy volunteers participate?

Yes

Key exclusion criteria

Exclusion criteria for schools:
- Schools registered as a Special Needs school
- Combined schools (K-12)

Study design

Purpose of the study

Prevention

Allocation to intervention

Randomised controlled trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Allocation is not concealed

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

One-to-one ratio of allocation to treatment or control. Randomised stratified allocation by SES level of school suburb (low/medium/high) created by computer software by an independent statistician.

Masking / blinding

Open (masking not used)

Who is / are masked / blinded?

Intervention assignment

Parallel

Other design features

Phase

Not Applicable

Type of endpoint/s

Efficacy

Statistical methods / analysis

Vegetable sales data (g/week) and total sales ($/week) will be analysed using repeated measures analysis of variance using intervention arm (intervention or control) as between-subject variable and time point (week) as repeated measures. Planned contrasts (compare to baseline period) will be undertaken as post-hoc measurements.

Vegetable waste data (g) will be analysed using two-way ANOVA with intervention arm and time point as factors.

Outcomes from the process evaluation (canteen managers, parents) will not be statistically analysed, but reported as means (interval data) and frequencies (nominal data) for quantitative variables.

Recruitment

Recruitment status

Completed

Date of first participant enrolment

Anticipated

21/05/2021

Actual

27/05/2021

Date of last participant enrolment

Anticipated

Actual

10/02/2022

Date of last data collection

Anticipated

Actual

30/04/2022

Sample size

Target

500

Accrual to date

Final

4302

Recruitment in Australia

Recruitment state(s)

NSW

Funding & Sponsors

Funding source category [1]

Commercial sector/Industry

Name [1]

Horticulture Australia Innovations Limited

Address [1]

Level 7/141 Walker St, North Sydney NSW 2060

Country [1]

Australia

Primary sponsor type

Government body

Name

Commonwealth Industrial and Scientific Research Organisation

Address

11 Julius Avenue, North Ryde NSW 2113

Country

Australia

Secondary sponsor category [1]

None

Name [1]

Address [1]

Country [1]

Other collaborator category [1]

Charities/Societies/Foundations

Name [1]

Healthy Kids Association

Address [1]

Suite 1.02/38 Oxley St, St Leonards NSW 2065

Country [1]

Australia

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

CSIRO Health and Medical Research Human Research Ethics Committee

Ethics committee address [1]

41 Boggo Road Dutton Park QLD 4102

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

11/12/2020

Approval date [1]

17/12/2020

Ethics approval number [1]

2020_120_LR

Ethics committee name [2]

State Education Research Approval Process (SERAP)

Ethics committee address [2]

NSW Department of Education
Level 9, 105 Phillip Street, Parramatta, NSW 2150

Ethics committee country [2]

Australia

Date submitted for ethics approval [2]

05/02/2021

Approval date [2]

30/03/2021

Ethics approval number [2]

2021011

Summary

Brief summary

Vegetable consumption among children in Australia is below recommendations and most vegetables are currently consumed at home. This research aims to determine the effect on a multi-component intervention consisting of increased vegetable offering and menu architecture in Sydney metropolitan primary school canteens on vegetable sales, using a randomised controlled trial. The intervention is based on sensory and behavioural science and will consist of a new vegetable-based product, increasing vegetable content in hot meals and sandwiches and changes to the online ordering system. It is hypothesized that the intervention will increase vegetable sales in canteens.

Trial website

Trial related presentations / publications

Public notes

Contacts

Principal investigator

Name

Dr Astrid Poelman

Address

CSIRO, 11 Julius Avenue North Ryde NSW 2113

Country

Australia

Phone

+61 2 9490 8356

Fax

[email protected]

Contact person for public queries

Name

Dr Astrid Poelman

Address

CSIRO, 11 Julius Avenue North Ryde NSW 2113

Country

Australia

Phone

+61 2 9490 8356

Fax

[email protected]

Contact person for scientific queries

Name

Dr Astrid Poelman

Address

CSIRO, 11 Julius Avenue North Ryde NSW 2113

Country

Australia

Phone

+61 2 9490 8356

Fax

[email protected]

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

No/undecided IPD sharing reason/comment

What supporting documents are/will be available?

No Supporting Document Provided

Results publications and other study-related documents

Documents added manually

Type	Is Peer Reviewed?	DOI	Citations or Other Details	Attachment
Study results article	Yes		Poelman AAM, Djakovic S, Heffernan JE, Cochet-Broc... [More Details]
Plain language summary	No		This study aimed to determine the effectiveness of... [More Details]

Documents added automatically

Source	Title	Year of Publication	DOI
Embase	Effectiveness of a Multi-Strategy Behavioral Intervention to Increase Vegetable Sales in Primary School Canteens: A Randomized Controlled Trial.	2022	https://dx.doi.org/10.3390/nu14194218

N.B. These documents automatically identified may not have been verified by the study sponsor.

Trial Review

Documents added manually

Documents added automatically