Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Postdoctoral Researcher Bianca Albers, University of Zürich, Switzerland,
- Second opponent: Associate Professor Charlotte Evans, University of Leeds, UK,
- Third member and chair of the evaluation committee: Professor Eivind Engebretsen, University of Oslo
Chair of the Defence
Associate Professor Hanne Cathrine Lie, University of Oslo
Principal Supervisor
Professor Nanna Lien, University of Oslo
Summary
The national guideline for food and meals in schools aims to ensure favorable eating conditions and high nutritional quality of the food and drinks on offer. The guideline is mandated by the Public Health Act, which obliges Norwegian municipalities to work systematically to promote and protect the health of their population. Awareness of the guideline has been shown to be low and implementation weak in some areas. Guideline adherence has not previously been measured. Evidence gaps remain as to what hinders and enables implementation and which strategies are effective for increasing implementation.
The aim of the project was to identify effective strategies and tools to increase the implementation of the school meal guideline for primary schools and after-school services. The research objectives were to develop valid and reliable questionnaires for measuring guideline adherence in Norwegian primary schools and after-school services, to examine determinants of meal practices in these settings, and to develop and test an implementation intervention to increase schools’ adherence to the guideline.
Through cognitive interviews with principals and after-school leaders to develop valid questionnaires, content validity improved through improved relevance, wording, and user friendliness. A subsequent test–retest reliability study among principals and after-school leaders showed that most items obtained Cohen’s kappa values for reliability rated as “substantial” or “almost perfect”; >80% of items showed a percentage agreement of ≥70%, and both of the questionnaires’ adherence index scores obtained an intraclass correlation coefficient (for absolute agreement) (ICCA) >0.80. Through qualitative interviews with school staff and children at four schools, important implementation barriers and enablers were identified. Barriers included a weak mandate from national authorities to prioritize work on school meals, weak leadership for school meals by principals, and lack of a school culture among teachers around meal practices. Whole-school discussions about meal practices enabled good practice. An implementation intervention to increase schools' adherence to the guideline was tested through a nonrandomized controlled trial. The intervention consisted of an educational meeting, training of an appointed teacher and the leader of the after-school service, as well as internal facilitation by means of the appointed teacher leading school-based workshops. Evaluation showed a significant difference of 4 percentage points in change scores between the groups (P=0.003) after adjusting for baseline adherence. The intervention effect was not associated with school-level socioeconomic status. Organizational support by the school principal was correlated with increased adherence post intervention.
The project showed that an implementation intervention based on carefully selected strategies can be effective in increasing adherence to a school meal guideline and that adherence may be measured reliably through the developed questionnaires. Implementation efforts should address context-specific determinants for meal practices and involve teachers directly. More implementation support to schools and a clearer mandate to prioritize school meals may contribute to more children receiving favorable mealtime conditions and high nutritional quality of food and drinks, regardless of local socioeconomic conditions.
Additional information
Contact the research support staff.