Improving the eating behaviours of primary schoolchildren
mesheuropmc: education | digestive, oral, and skin physiology
Socio-ecological health improvement approaches, such as Health Promoting Schools, emphasise the dynamic inter-relationships between individuals and environments, such as children's experiences with food in school. Evaluating previous school-based nutritional interventions from a socio-ecological perspective suggests areas where macro policy is ineffective in influencing children's eating behaviour (e.g., some children remain unwilling to consume healthier food). On the other hand, promising results have been obtained from interventions based on the social interactions between children and school meal staff. The aim of this thesis is to explore how school-based nutritional policies might realise health improvements through understanding the policy and environmental contexts associated with school dining halls, together with the influences on children's eating behaviour of the feeding strategies employed by school meal staff. A qualitative case study was conducted in one Welsh Local Education Authority (LEA). Observations were carried out in eleven primary school dining halls, supplemented by interviews with participants at multiple socio-ecological levels. LEA and school policies reflected national objectives with respect to nutritional guidelines, but were influenced by multiple, competing interests including pupil's food preferences, and organisational objectives such as protecting school meal uptake. Some dining hall features (e.g., accommodation, negative teacher modelling) had an adverse influence on eating behaviour and many children failed to select and/or consume nutritionally balanced meals. The feeding strategies used by school meal staff were used naturally but inconsistently and were subject to contextual constraints (e.g., time pressures). Higher level policy interventions may have limited effectiveness if undermined by lack of attention to lower level factors compromising their effectiveness. Behavioural approaches based on repeated taste exposure to encourage children to taste the nutritionally balanced meals made available by school meal policies are recommended. As utilising teachers during lunchtimes may be problematic, enrichment of the feeding interactions between school meal staff and children is suggested.