Purpose: College food insecurity (FI) has garnered attention as rates are reported to be higher than the United States national average. To help alleviate this issue, many higher education institutions have implemented campus-based FI initiatives. However, literature on these initiatives is lacking, and little is known about program operations, funding mechanisms, and evaluation. The purpose of this study was to describe campus-based initiatives and to investigate the barriers and facilitators to sustained implementation on campus. 

Methods: Twelve nutrition and dietetic professionals from the Society of Nutrition Education and Behavior’s College FI Subcommittee developed an online survey based on previous literature. A convenience sample of higher education professionals with experience regarding campus FI initiatives completed the 23-item survey via Qualtrics. The survey included questions about campus FI initiatives, including how they were funded, led, and evaluated, and if COVID-19 impacted implementation. Respondents were asked to describe what barriers they faced when implementing initiatives and what is needed for sustained implementation. Descriptive statistics were computed for quantitative data. Qualitative data were independently coded by two researchers, with any discrepancies resolved, and overarching themes were identified. 

Results/Findings: Ninety-five percent of respondents (n=108) reported having at least one campus  FI  initiative. A campus food pantry was the most common initiative (98%), and 75.3% of campuses reported changes in implementation due to COVID-19.  Respondents (69.7%) stated initiatives were evaluated for impact, but evaluation methods varied. Some institutions (38.9%)  provided an allocated budget for initiatives, but funding mechanisms varied. FI initiatives were most often managed through Student Life Offices. Barriers to implementation were funding and marketing/student awareness. Campus culture (such as institutional support), resources and operations (such as funding), and data collection (such as needs assessment) were themes derived as facilitators to sustaining initiatives. 

Conclusions: Campus-based FI initiatives are available, although the type, funding, and evaluation vary. The need for a campus culture that promotes sustainable funding and support is highlighted. Increased investment from administration and stakeholders is warranted. Awareness campaigns could be prioritized to increase student awareness of initiatives, especially as operations may continue to fluctuate due to COVID-19.

Purpose: Healthy food-store interventions (HFIs) are a promising tool to reduce the societal burden of noncommunicable diseases through the stimulation of healthier diets. The alignment of these interventions within their context is vital for their sustainable implementation and potential for up-scaling. Monitoring and adapting HFI implementation by means of a reflexive monitoring in action (RMA) approach, may help identify and address cases of misalignment. We will discuss our findings and experiences with the application of RMA to monitor HFI implementation.

Method: The HFIs were implemented in six supermarkets, for 12 months maximum. These stores were visited at regular intervals (every 2 weeks up to every 2 months), to monitor the fidelity of the HFIs. Concurrently, interviews were held with store management and/or employees, to discuss the outcomes of the latest monitoring visit for their store, and reflect on the underlying causes for high or low fidelity. When causes were clear, solutions were formulated, and disseminated to the other stores. Additional (incidental) interviews were held with relevant actors from the central organisation, to (further) explore issues between store and central organisation, and organisation-level factors. 

Results: We divided HFIs in three groups: Pricing strategies, signage, and product positioning & presentation. Another distinction was made between static (stayed the same throughout the study) or dynamic (changed at regular intervals) HFIs. Static HFI fidelity was overall higher than dynamic. This difference seemed linked to communication issues, store-staff and management attitudes, and shortage of staff/hours. Positioning & presentation fidelity suffered from commercial concerns and limitations in space. Signage fidelity suffered from damage/removal by customers and staff. Pricing strategies suffered from technological problems and communication issues. Discussion of fidelity issues between multiple stores was useful in understanding and resolving underlying causes, and enhancing implementation.

Conclusions: Our results illustrate a number of factors which can present threats to the sustainable implementation of HFIs in food-stores, and how these affect the fidelity of these interventions. We end with recommendations on HFI implementation and the implications of our findings for scaling up.

Purpose: In countries such as Australia and the UK, the majority of children bring a packed lunch to school each day. More than six million serves of discretionary foods are packed in Australian lunchboxes every year, which has impacts on health and educational outcomes. We report the development and effectiveness of a scalable m-health healthy lunchbox intervention (SWAP IT) that has been piloted, optimised and evaluated at a population level, prior to state-wide scale-up.

Methods: A five step program of work has been undertaken in the evaluation of the SWAP IT program including: 1) formative research to identify parental barriers and behaviour change techniques (BCT) that underpin the SWAP IT program to support parents to pack healthy lunchboxes; 2) a pilot randomised controlled trial (RCT) to evaluate acceptability, feasibility and potential efficacy; 3) intervention optimization prior to a fully powered trial; 4) hybrid effectiveness-implementation RCT and 5) assessment and commencement of state-wide program scale-up in New South Wales (NSW), Australia. Cultural and equity engagement was conducted at all steps of the SWAP IT program development.

Results: SWAP IT targets five common parental barriers to packing healthy lunchboxes: time, cost, convenience, child preference and knowledge. BCT’s were incorporated into the intervention, delivered via an existing school-communication app. The pilot RCT (n=1200) found an increase in mean lunchbox energy from ‘healthy’ foods (79.21 kJ,p=0.04) and was acceptable to 95% of parents. Optimized lunchbox messages were then incorporated into the hybrid effectiveness- implementation trial (n=3022) conducted in 32 schools across NSW, Australia. The trial found a significant reduction in mean energy from discretionary foods (-117.26kJ, p=0.003). SWAP IT has been assessed for suitability for scale-up. A scale-up plan has been developed using the NSW Health Scale Up Guide, with implementation to commence in 2022.

Conclusion: This scalable m-health intervention has the potential for significant population-wide effects on the nutritional quality of school lunchboxes, and consequently impacting the weight status of primary school aged children and the associated healthcare costs.

Purpose: Gamification is a promising approach to improve engagement with health apps by implementing game features. Prior evidence has shown that it can increase physical activity (PA) when the game design is appropriately tailored to users. The primary objective study was to evaluate children’s satisfaction and acceptance of a self-determination theory-based novel smartphone game to promote PA. Secondary objectives included evaluating the game’s effectiveness to increase steps, moderate-to-vigorous physical activity (MVPA), perceived autonomy, competence, and relatedness.

Methods: Children aged 8-14, not meeting the Canadian PA guidelines, were recruited to a 4-week pilot trial, and randomized to a control or intervention group. The intervention featured a smartphone game ‘Draco’ who is a virtual pet where users care for it by walking, exercising, completing challenges, and answering questions. The intervention group received access to play ‘Draco’ until trial completion. Satisfaction was measured using an adapted version of the intrinsic motivation inventory (IMI). Steps, and MVPA were collected using a Fitbit Inspire HR. Perceived autonomy, competence and relatedness were collected using the IMI. Baseline steps and MVPA were collected for 1 week. Exit interviews were completed by the intervention group to evaluate their experience and inform future design changes. Data was analysed in SPSS using a 2x2 repeated measures ANOVA and independent samples t-test. Effect sizes were expressed in partial η2.

Results: 41 children were recruited (mean age: 10.56, SD 1.48, 51% male). Children reported they enjoyed 'Draco' with a mean score of 2.83 (SD 1.29) on a scale of 1-5. Exit interviews showed that children enjoyed the game concept, but more features were necessary to support continued engagement. The intervention group produced small effects on steps (∆Mean=897, SD=1657, η2=0.04) and MVPA (∆Mean=5.3min, SD 19.29, η2=0.03). No significant effect was found for perceived autonomy, competence, relatedness.

Conclusion: Children enjoyed playing ‘Draco’ and cited the video demonstrations of exercises as the most useful feature. Initial evidence for ‘Draco’ to improve PA rates was promising. The design implications from the results include customization options and including social-like features. Further recruitment is necessary to evaluate the efficacy of ‘Draco’ relative to control.

Purpose: Mobile produce markets are a prevalent, favored and effective public health strategy for increasing access to and consumption of fresh fruits and vegetables in underserved and lower-income communities. The Veggie Van (VV), an evidence-based approach to running a mobile market, is currently being evaluated in a hybrid implementation-effectiveness study across multiple states in the United States. Understanding the implementation process will improve future dissemination and implementation of both the VV model and other community-based food access interventions and ensure that the model is effective when scaled.

Methods: We conducted a mixed methods evaluation of implementation effectiveness among VV study partners informed by the Consolidated Framework for Implementation Research (CFIR) and Proctor et al.’s taxonomy of implementation outcomes. Representatives from six study partner organizations participated in in-depth interviews to understand VV model implementation over the prior 6-9 months. A representative from each organization completed monthly process measures surveys to report on adoption and fidelity. Quantitative process measures data was used to categorize implementation effectiveness. Qualitative data was analyzed through thematic analysis using qualitative software and comprehensive memos were written to summarize each organization’s data and were subjected to a CFIR construct rating process. Implementation effectiveness categories were compared to qualitative data on CFIR constructs to identify which constructs distinguish effectiveness between higher and lower implementers.

Results: The CFIR construct “tension for change,” or the degree to which stakeholders welcome an intervention, was higher among low implementing organizations than high implementors. Constructs related to perceptions of VV model complexity l (complexity), model alignment with organizational mission (compatibility), networks with other implementers (cosmopolitanism, peer pressure), advantages of implementing the model (relative advantage), and planning and goal setting (planning, goals and feedback) were also related to the level of implementation of the VV model.

Conclusions: Identifying constructs that distinguish between high and low implementors can help determine organizational characteristics that can help or hinder program implementation and assist with selecting appropriate implementation partners.  This research will also help pinpoint concerns or knowledge gaps prior to implementation; it will also inform the refinement of the VV model and training and technical assistance for partners. 

Purpose: Web-based personalised dietary interventions could support young adults to eat healthily. The aim of the Advice, Ideas and Motivation for My Eating randomised controlled trial was to investigate the impact of three levels of personalised dietary feedback using web-based technologies on diet quality (Australian Recommended Food Score [ARFS]) in young adults. Secondary aims were to investigate participant retention, engagement, and satisfaction.

Methods: Participants (18-24 years) were recruited across Australia via web-based methods and randomised to one of three groups. Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + Aim4Me website nutrition resources), or Group 3 (30-minute dietitian consultation + Group 2 elements). ARFS, ARFS subscales and percentage energy (%E) from nutrient-rich core foods were analysed at 3, 6 and 12 months using generalised linear mixed models. A per-protocol sensitivity analyses compared Group 1 vs Groups 2&3 combined at each timepoint. Engagement was measured using study website usage statistics and satisfaction using a process evaluation administered at each timepoint.

Results/findings: One thousand five participants (85% female, mean age 21.7±2.0 years) were randomised (Group 1 n=343; Group 2 n=325, Group 3 n=337), of whom 32 (3%), 88 (9%) and 141 (14%) completed the 3, 6, and 12-month surveys respectively. Only 52 participants in Group 3 (15%) completed the dietitian consultation. No significant group-by-time interactions were observed in the main or sensitivity analyses (p>0.05). At 3 months, Group 3 had higher %E core foods (mean [95% CI] difference between groups 12.8% [1.97, 23.56], p=0.021), and Group 2&3 combined had higher ARFS (mean difference 7.17 [0.06, 14.29] points, p=0.048) and %E core foods (11.34% [0.92, 21.8], p=0.033) versus Group 1. Across 13 website landing pages, the proportion of participants who visited pages ranged from 0.6% (Articles) to 75% (Set goals). Half (53% and 52% in Groups 2 and 3, respectively) of participants who completed the process evaluation were satisfied with the Aim4Me program overall.

Conclusions: Recruiting, engaging and retaining young adults in personalised web-based dietary interventions is challenging. Future research needs to consider methods to optimise web-based dietary interventions for young adults, including use of co-design principles.