A Mixed-Methods Exploration of Implementation of a Healthy School Canteen Program after a Year Intervention

BACKGROUND: The previous studies have shown that adolescents prefer less healthy food and their eating habits
will affect their nutritional status in adulthood and old age. School canteen is a part of food retailing and provisioning
that influence the diet quality of the adolescents. Healthy school canteen intervention is recommended as one of the
public health strategies in supporting the development of healthy diet behavior.
AIM: The objectives of the study were to evaluate the effects of a healthy school canteen intervention program
among middle school children.
METHODS: A mixed-methods research design including focus group interviews for teachers and principal, observation
on school canteen, a survey for food handlers, and food testing for hazardous chemicals. Thematic analysis of focus
group data and descriptive analyses of survey data were conducted. Four schools were selected as intervention groups
and four schools as positive control groups. Data collection phase took place between April 22 and May 2, 2019.
RESULTS: Only one school out of eight schools that had written commitment and a food safety team. In intervention
school 50% of food handlers use personal protective equipment and 25% of food handlers received training. In the
positive control group, none of the food handlers used personal protective equipment and they had not received
any training. Food handlers in the positive control group have a higher rate of correct answers. Only 2 out of 4
schools in the intervention group had nutritious foods available in the canteen and 3 out of 4 schools in the positive
control group. None of the school canteens were found positive for metanil yellow. Higher positive findings for
Rhodamin B, Formaldehyde, and Borax (33.3%, 60.0%, and 33.3%, respectively) in the control group compared to
the control group (28.6%, 27.3%, and 28.6%, respectively).
CONCLUSIONS: Intervention groups have been slightly more successful in creating healthy school canteens, as
they had a slightly better total score in the observation sheet compared to the schools from the positive control group.
Collaboration with another stakeholder such as Primary Health Center can be thought of as a solution to train food
handlers about healthy practice while handling the food.