Evaluating the effectiveness of scale up strategies tailored to local context on the adoption of a text message based lunchbox program to address poor dietary intake in primary school aged children

INTERVENTION: A modified platform trial design will be used to test the effectiveness of a series of scale‐up strategies that have been tailored to context to maximise the adoption of an effective healthy lunchbo Xprogram within NSW primary schools located within 10 Local Health Districts of NSW. The effective healthy lunchbo Xprogram (‘SWAP IT’) aims to improve the contents of children’s lunchboxes by supporting parents/carers to swap what is packed from discretionary (“sometimes”) foods and drinks to core (“everyday”) foods and drinks. SWAP IT messages are delivered weekly to parents and carers via usual school‐parent communication channels for one school term (one message per week), followed by two messages per term on an ongoing basis. The messages provide parents and carers with useful tips and ideas for packing a healthy lunchbox, including recipe ideas and healthy alternatives for ‘sometimes’ foods. Additional resources, including classroom lessons for teachers, school nutrition guidelines and parent booklets, have been specifically developed for the SWAP IT program and are freely available to schools and parents. A number of evidence‐based scale‐up strategies have been developed to support schools in the 10 LHDs to register for (i.e. adopt) SWAP IT. In order to ensure the strategies are appropriate for the context of each LHD, health promotion staff within each LHD selected strategies that would be delivered to schools in their region over a 9‐month period. As a result, each LHD has selected a different combination of scale up strategies to be delivered to schools in their region. Within the 9‐month intervention period, schools allocated to the intervention group within each LHD will receive a combination of the following strategies: 1. S CONDITION: Diet and Nutrition ‐ Obesity Obesity; ; Obesity Public Health ‐ Health promotion/education PRIMARY OUTCOME: Adoption will be defined as the number of schools who register for the lunchbox nutrition program (SWAP IT) and will be assessed within schools allocated to the intervention and control group via electronic registration records captured automatically following school registration to SWAP IT. [Assessed at baseline and approximately 9 months after baseline data collection ] SECONDARY OUTCOME: Cost efficiency and affordability of the scale‐up intervention (composite measure) will be assessed using cost‐consequence analysis and budget impact via internal study records kept by the research team, conducted from the perspective of the government. [Assessed at approximately 9 months after baseline data collection ] Sustainability, defined as continued use of the lunchbo Xnutrition program (SWAP IT) at 18 months, will be assessed via electronic registration records captured automatically following school registration to SWAP IT.[Assessed at approximately 18 months after baseline data collection ] INCLUSION CRITERIA: Department of Education (DoE), Catholic and Independent primary schools located within 10 LHDs of NSW (Murrumbidgee, Hunter New England, Sydney, Western Sydney, South Western Sydney, South Eastern Sydney, Northern Sydney, Western NSW, Nepean Blue Mountains, Illawarra Shoalhaven). Primary and combined schools who cater for primary school aged children will be invited to participate. Schools who have not implemented the lunchbo Xnutrition program will be eligible to participate. Schools that do not use the Audiri parent communication app will be eligible, as these schools are participating in another trial (ACTRN12623000145606).