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Table 3 Summary of adolescent and staff participant views relating to each intervention strategy, organised by intervention category

From: Acceptability and feasibility of strategies to promote healthy dietary choices in UK secondary school canteens: a qualitative study

Category

Strategy

Adolescent views (appeal)

Staff views (feasibility)

Availability

Wider choice of salads/vegetable dishes

Adolescents value choice

Report high demand for wide choice

Some cynicism about pupils purchasing salads

Concern about increased food waste

Ban on sales of unhealthy snacks and drinks within school canteen

Removes choice/autonomy (viewed negatively)

Belief that teens need sugary foods for energy boost

Pupils would purchase banned foods elsewhere

Easily implemented in canteen

However, pupils would purchase banned foods elsewhere

Position

Unhealthy snacks placed behind till, available upon request only

Viewed as likely to be effective because ‘Out of sight, is out of mind’

Viewed as likely to be effective since pupils prioritise speed

Concerns about lack of space behind tills

Potential consequence is increased desirability of hidden food items

Fridge reorganisation (healthier drinks more prominent)

Viewed as likely to be effective because ‘Out of sight, is out of mind’

Already in place to some extent so easy to implement

Functionality

Colour coded serving utensils (to indicate whether to have large or small amounts of each dish depending on calorie content)

Viewed as helpful and instructive

However, would slow service down

Low cost to implement

However, would slow service down

Express/self-service till for healthy food items only

Viewed as likely to be effective as adolescents value speed

Concerns about behavioural issues (i.e. theft)

High initial cost outlay for infrastructural changes

Expect high levels of pupil buy-in as suits their desire for speed

Concerns about behavioural issues (i.e. theft)

Concerns about high volume of customers removing the ‘express’ nature of the strategy

Requires a large amount of space

Pre-ordering of lunchtime meal

Viewed negatively as removes opportunity for spontaneity

However, adolescents believed it allows for more considered/rational choices

Resource-intensive for catering staff to implement

High start-up costs for pre-order electronic system

Volume of customers too high to be practical in secondary school setting

‘Cash for cookies’ (treat foods cannot be purchased using pre-paid cardsa)

Viewed as fundamentally unfair to specific groups of pupils e.g. children from low income families

Adolescents expect this would encourage unhealthy purchases as cash purchases are unmonitored by parents (as opposed to cashless systems)

Adolescents had concerns about carrying cash (i.e. theft)

Administrative cost in re-introducing cash-based system too high

Would lead to a loss of valuable data about purchases via the cashless system

Presentation

Pre-chopped fruits and vegetables

Viewed as visually appealing and on-trend

Viewed as an economical use of left-over produce

Salad toppings station

Viewed positively as adolescents value choice

Concerns about behavioural issues (i.e. mess)

Expect high levels of pupil buy-in

Some cynicism about pupils purchasing salads

Concerns about a high volume of pupils using it

Dining room decoration to improve ambience

Would create a more visually appealing environment for eating

Requires only an initial cost outlay, so relatively inexpensive to implement

Café style set-up (food service) to improve presentation/appeal of food purchasing environment

Appealing aesthetic, creates an inviting purchasing environment

Concerns over behavioural issues if foods were presented so openly (i.e. theft)

Viewed as appealing to young people

Viewed positively as mimics out-of-school environment

Concerns over behavioural issues if foods were presented so openly (i.e. theft)

Guided floor markings e.g. footprints to healthy food/drink items

Viewed as fun

However, dining room too crowded so wouldn’t be visible

Dining room too crowded so wouldn’t be visible

Viewed as more appropriate for primary school children

Size

Smaller plates (to make portion sizes appear larger)

Concerned about hunger due to smaller portion sizes

Viewed as too manipulative

Low cost so inexpensive to implement

Concerned about student resistance as pupils would not want smaller portion sizes

Information

Simple traffic light label scheme

Adolescents value the opportunity for more informed decision-making

However, adolescents prioritise taste

Scheme would need to be supported by education/curriculum learning

Concerns about maintaining an accurate database of nutritional information for all dishes

Promotional posters to encourage healthy eating

Adolescents value the opportunity for more informed decision-making

Adolescents expect reduced impact/visibility over time

Low cost so inexpensive to implement

Pupil taste tests of new healthy dishes

‘Try before you buy’ approach viewed as reducing risk of wasting money on disliked dishes

Provides greater autonomy to adolescents to make informed choice based on taste preference

Viewed as appealing to pupils

Easy to organise

Nutritional information available on mobile app (e.g. nutritional content of dishes at point of purchase; and/or post-purchase individualised report of nutritional intake)

Viewed as increasing autonomy through self-monitoring of purchases

However, adolescents critical of the potential additional screen time required

Adolescents reported potential for negative peer-peer competitive consumption as an unintended consequence

Would work well within existing cashless payment system (has this functionality)

Expect high levels of parent buy-in

Mixed views on expected levels of pupil buy-in

Social media promotion of healthy dishes

Disliked the potential for dishonest visual representations of dishes

Reluctance to open up food provision to pupils’ feedback over online platform (potential for abuse)

Concerns about increasing pupils’ social media use

Verbal prompt from lunch staff to add fruits/vegetables

Adolescents felt this added unnecessary pressure to select certain items, which may not be eaten/wasted

Considered easy to implement as can be built into normal conversations with pupils with no additional resources required

  1. aPre-paid cards/systems are commonly used in UK school canteens operating a ‘cashless system/school’. Parents/guardians pre-load cards with money for in-school purchases (for those receiving Free School Meals, their entitlement is also pre-loaded)