Acceptability and Feasibility of Best Practice School Lunches by Elementary School-Aged Children in a Serve Setting: A Randomized Crossover Trial

Abstract

Background: National School Lunch Program (NSLP) standards have improved school lunch dietary quality (DQ), however, further improvements could be made. Acceptability and feasibility of higher DQ are potential barriers. Thus, the purpose is to compare acceptability and feasibility of best practice (BPSL, optimizing DQ) with typical school lunches (TSL, meeting minimum NSLP standards) served separately and concurrently. Methods: Forty elementary school-aged participants were recruited for a randomized crossover trial. Participants attended three meal conditions (MC) choosing one of two meal types—MC1) BPSL1/BPSL2, MC2) TSL1/TSL2, MC3) BPSL/TSL. Acceptability included taste test surveys, weighted plate waste assessments, and hunger scales. Feasibility included meal cost, time, and skill and equipment requirements. Results: There were no significant differences in total taste test score, average total plate waste, or change in hunger (ps > 0.017) before or after adjusting for covariates. TSL was selected significantly more often in MC3 (TSL = 83.3%, BPSL = 16.7%, p = 0.001). Meal cost (p = 0.783) and skill and equipment requirements were not significantly different between meal types. BPSL required significantly longer preparation time (TSL = 60 ± 25 min, BPSL = 267 ± 101 min, p = 0.026). Conclusions: Results indicate few differences in acceptability and feasibility between BPSL and TSL. This study could inform decision and policy-makers seeking to improve school lunch DQ and acceptance of higher DQ meals.

Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes

“… 19 In one randomized cross-over trial, acceptability of a dietary guideline was explored through the assessment of optics, taste fulfilment (satiation) and leftovers (plate waste weighing). 20 …”

“…Ten studies analysed appropriateness, feasibility or perceived effectiveness as implementation outcomes in addition to acceptability. 20 , 28 , 30 , 34–41 Six studies 28 , 30 , 34–37 measured appropriateness, such as the perceived importance or relevance of the policy. 3 Findings showed that target group respondents who strongly believed that obesity was a serious problem were overall more supportive of healthy nutrition policies [beta = 0.36, 95% confidence interval (CI) 0.24–0.47].…”

“…Three studies explored feasibility alongside acceptability. 20 , 29 , 41 Feasibility is defined as the extent to which a policy can be successfully used or carried out within a given setting. 3 Within each of these studies, policies were perceived equally acceptable and feasible.…”

“…This is substantiated by our findings on the relationship between acceptability and other implementation outcomes: Respondents who rated the policies to be effective, appropriate or feasible also found them to be acceptable. 20 , 28 , 30 , 34–41 …”