Scrutinize of healthy school canteen policy in Iran’s primary schools: a mixed method study

Abstract

Background Schools provide an opportunity for developing strategies to create healthy food environments for children. The present study aimed to analyze the Healthy School Canteen (HSC) policy and identify challenges of its implementation to improve the school food environment in Iran. Methods This mixed method study included two qualitative and quantitative phases. In the qualitative phase, triangulation approach was applied by using semi-structured interviews with key informants, documents review and direct observation. Data content analysis was conducted through policy analysis triangle framework. In the quantitative phase, food items available in 64 canteens of primary schools of Tehran province were gathered. The food’s nutrient data were evaluated using their nutrition facts label. The number and proportion of foods that met the criteria based on Iran’s HSC guideline and the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined. Results The main contextual factors that affected adoption of HSC policy included health (nutritional transition, high prevalence of non-communicable diseases and unhealthy food environment in and around the schools), political (upstream supportive policies and joint memorandums about health children between the Ministry of Health and Medical Education and Ministry of Education), structural (the lack of unified stewardship, inadequate human resource capacity, poor inter-sectional cooperation), economic (school financial problems, poor fiscal supportive of food policies), and socio-cultural (mothers working outside the home, the role of children’s peer group, low nutrition knowledge of school principals) factors. Assessment of the school canteens showed that a large proportion of available foods did not comply with the national guidelines (54.7 ± 2.54%) and WHO-EMR model (85.6 ± 2.34%). The main reasons identified for incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, lack of scientific criteria for food categorization, poor monitoring, high price of healthy foods, and conflict of interest among the actors. Conclusion The majority of foods and beverages available in the school canteens did not comply with national and regional standards. Iran HSC policy needs to be improved by using an evidence-based approach and active interaction between all key actors.

Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review

“…There are few countries that have conducted monitoring and evaluation activities. In Iran, food items available in primary schools’ canteens in Tehran were evaluated [ 176 ], and compliance with the guidelines was assessed by comparing nutrient content of food items (TS, AS and non-sugar sweeteners) with the WHO EMR nutrient profile model [ 226 ] and Iran Healthy School Canteen Guideline [ 175 ]. The findings showed that 9.2% of chocolates, sugar confectionery and desserts that were available in the school canteens, as well as 15.7% of beverages and 45.2% of cakes, sweet biscuits and pastries, are not permitted based on the WHO EMR model [ 176 , 226 ].…”

“…In Iran, food items available in primary schools’ canteens in Tehran were evaluated [ 176 ], and compliance with the guidelines was assessed by comparing nutrient content of food items (TS, AS and non-sugar sweeteners) with the WHO EMR nutrient profile model [ 226 ] and Iran Healthy School Canteen Guideline [ 175 ]. The findings showed that 9.2% of chocolates, sugar confectionery and desserts that were available in the school canteens, as well as 15.7% of beverages and 45.2% of cakes, sweet biscuits and pastries, are not permitted based on the WHO EMR model [ 176 , 226 ]. Similarly, 13.7% of chocolates, sugar confectionery and desserts found in the canteens, 19.7% of beverages and 28.8% of cakes, sweet biscuits and pastries are not permitted based on the national guideline [ 175 , 176 ].…”

Developing a Catering Quality Scale for University Canteens in China: From the Perspective of Food Safety

“…The school canteen is an integral aspect of the eating environment at the school. It is vital in increasing the quality of school eating to provide a healthy atmosphere for youngsters [35]. Because dangers from many sources may cause contamination throughout the food preparation and distribution phases and eventually contribute to the development of FDS [36], quality management of school catering is essential.…”

Prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran: a multi-criteria decision-making approach

“…Although several efforts in the area of nutrition have been made for the prevention and management of hypertension in developing countries such as Iran, populationbased studies have shown that control and preventive measures for high blood pressure levels are far from the optimal level [56]. Evidence indicated that the formulation of these policies faces barriers and challenges that restrict achieving the desired effects on the intended outcomes [57][58][59]. There are several possible reasons for the failure and ineffectiveness of these programs, including a focus on single criteria for priority setting (such as effectiveness, cost-effectiveness, etc.)…”

“…For example, in 2014, the Ministry of Health, Treatment and Medical Education (MoHME) formulated the national guidelines for Healthy School Canteen (HSC), based on the available evidence regarding the high consumption of unhealthy and nutrient-poor foods by children and availability of such foods in schools [62]. Based on the HSC guideline, all schools in Iran should provide healthy foods and drink choices in their canteens and limit selling unhealthy items [57,62]. Two recent studies evaluated the implementation of this bylaw and provided evidence on the failure to achieve the desired result [63,64].…”