A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness–Implementation Hybrid Cluster Randomized Controlled Trial

Study answer

What this study found

Compared with control, SWAP IT reduced mean energy from discretionary lunchbox foods packed by 117.26 kJ (95% CI −195.59 to −39.83; P=.003), and reduced total lunchbox energy packed by 88.38 kJ (95% CI −172.84 to −3.92; P=.04) and consumed by 117.17 kJ (95% CI −233.72 to −0.62; P=.05). The share of lunchbox energy from discretionary foods decreased by 3.16 percentage points (95% CI −5.46 to −0.86; P=.01), while energy from everyday foods increased by 3.16 percentage points (95% CI 0.86 to 5.46; P=.01). No significant differences in student engagement, discretionary foods consumed outside of…

Study & population

Type I effectiveness-implementation hybrid cluster randomized controlled trial; 32 government primary schools across three local health districts in New South Wales, Australia; participants: 3022 students (mean age 7.8 years; 49.22% girls; 1487 girls) with 16 schools per arm; intervention duration 6 months; outcomes assessed by lunchbox observation using…

Key limitation

Participation rate was lower than expected (41.9% of parents consented); baseline imbalance with more disadvantaged schools in the intervention group; lunchbox observations raise privacy concerns and may have affected consent; multicomponent design prevents attribution to individual components; follow-up limited to 6…

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Original abstract