Abstract
Background: Providing children with healthy meals at schools can benefit the health of children and can positively influence health behavior. However, most studies on this topic are cross-sectional and focus on the short-term effects. Recently, the city authorities of Antwerp invested 40 million euros in the project 'Smakelijke School'. The aim of the project is to provide children with healthy meals at school and consequently to improve the health of children. In Belgium, no studies are conducted yet to evaluate the process and impact of such interventions.
The specific aims are:
1. To describe the intervention and implementation process in detail using the 'Template for Intervention Description and Replication' checklist and guideline (TIDieR).
2. Explore the attitudes and experiences of the schools, teachers, parents and children, focusing on feasibility, acceptability and perceived impact on eating behavior.
3. Explore the impact of the intervention on knowledge, attitude and habits (regarding diet and health) and well-being of children.
4. To measure the impact of the intervention on children's cognitive performance, blood pressure, anthropometry and behavior.
Methods:
• Intervention: In total, 4 schools (participating in the Smakelijke School project) will be included: two high-intensity intervened schools (defined as schools offering a healthy meal/snack every day) and two low-intensity intervened schools (defined as schools that offer a healthy meal/snack no more than twice a week). Low-intensity schools will be compared with high-intensity schools and within the schools children not taking the meals (intervention) will be compared with children taking the meals.
• Participants and setting: We will invite schools starting in September 2023. The school management (principals), teachers, children of the 4th grade and their parents will be invited to participate.
Work package 1: quantitative assessments
• Measurements:
o Cognitive function tests: Stroop Test (selective attention), Continuous Performance Test (attention and concentration), Memory Span Test (short-term memory), Digit Symbol Test (information processing), Signal Detection Test (visual information processing).
o Anthropometrics (height, weight and fat percentage) and blood pressure measurement
o SDQ, KIDSCREEN-27 questionnaire and KAH-questionnaire (knowledge, attitude and habits) regarding food.
o Questionnaire for the parents to gather information on individual socio-economic status and child general health and physical activity.
Work package 2: qualitative assessments
In the first phase of the qualitative aspect, we will describe the intervention and the implementation process and conduct interviews with the school management, teachers, children and parents. Based on the results from the quantitative part (WP 1) of this study, we will select the participants needed to continue the qualitative part of this study. We will organize observations in the schools, focus groups and a class conversation.
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