Introduction: There is minimal evidence assessing the outcomes of different Canadian school food  programs (SFP), policies, and guidelines on students physical and mental health, including their  academic achievement . With Canada being the only OECD country without a national SFP, this study aims to bridge the existing knowledge gap and empower local actors by actively involving stakeholders in the research process. 

Methods: This study applied the principles of Participatory Action Research (PAR) by actively involving SFP stakeholders as co-creators in the research process. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape  SFPs in Canada. This was done through conducting a systematic review of SFPs, compiling datasets, and a situational analysis of SFPs in Canada, followed by establishing partnerships with the nutrition coordinators within the district school system. 

Results: Engaging stakeholders in the process of formulating research aims and questions, having discussions about guiding frameworks, as well as designing and implementing data collection tools led to a nuanced approach in understanding the dimensions of SFP impacts, and it ensured the relevance, cultural appropriateness, and practical utility of our data collection tools. Given the challenges associated with diversity in Canadian education systems, restrictions on data availability and accessibility, and the evolving policy landscape, building trust for collaboration with key stakeholders was a yearlong process, but proved essential to creating interdisciplinary teams to undertake the research aims.

Conclusion: Through PAR, this study seeks to understand the multifaceted influences of SFPs on students' well-being and academic performance. It not only contributes to an evidence base but allows for the democratization of knowledge, empowering the stakeholders with a sense of ownership in the research process. The outcomes of this research are poised to inform policy development and public health interventions, providing valuable insights for the enhancement of SFPs across Canada. Ultimately, the participatory approach and systems perspective adopted in this research seek to foster a holistic understanding of the complex interplay between SFPs, student health, and academic achievement.

Purpose: Universal provision of preventive health services for families is key to optimising health and nutrition outcomes in the first 2000 days of a childs life. Despite this, parental engagement with face-to-face health services declines significantly over time following birth. Despite significant promise, there are no behavioural interventions delivered via mHealth targeting child health and nutrition outcomes spanning the first 2000 days internationally. This presentation outlines the co-design process to develop and scale up an mHealth intervention which has been embedded into routine care and delivered universally to parents/carers to support child health and nutrition outcomes across the first 2000 days. The acceptability, feasibility, appropriateness of the mHealth intervention from the perspective of clinicians and parents/carers will be presented.

Methods: Designed using the COM-B model of behaviour change, an mHealth (text-message) intervention was co-designed by a multidisciplinary team to support parents/carers to make informed health choices aligned to age and stage milestones and policy guidelines. Initially, the intervention supported sustained breastfeeding, introduction of solids, sleep behaviours, immunization reminders and maternal wellbeing. Semi-structured interviews with clinicians and telephone surveys with parents/ carers assessed acceptability, feasibility and appropriateness. 

Results: From the co-design process, seventy-one messages were developed from birth-12 months and fifty-six messages from 12 months to 2 years empowering parent/carers to autonomously make decisions related to preventative health practices for families. Commencing in 2021 as a pilot, the intervention has now been scaled up to ~3000 families, capturing 96% of parents/carers of newborn infants entering a service. Semi-structured interviews (clinicians) and cross-sectional phone surveys (parents/carers) indicate high acceptability, (85% and 96% respectively) of the mHealth service. 

Conclusion: This provides a comprehensive overview of the co-design of an m-health service that can be used as a guide for other researchers and health care practitioners interested in scaling up digital service delivery models.  The use of mHealth interventions holds significant promise and potential for further vertical and horizontal scale-up. The intervention has the ability to address multiple behavioural health and development outcomes with significant potential to tailor content and support screening and early intervention.

Purpose: Malnutrition is gendered, so eradicating malnutrition demands gender-transformative approaches. Our team is engaging with the Gender Transformative Framework for Nutrition, which applies systems thinking to critically examine the multi-sectoral drivers of malnutrition, while placing empowerment and gender equality at its core. The overarching goal of our project is to co-create a toolkit for operationalizing the GTFN.  

Methods: We are currently applying feminist principles of co-creation, reflexivity, equality, and social justice as we work towards developing a GTFN toolkit for integrating gender transformative approaches into nutrition interventions, throughout project cycles. To date, we have engaged a range of nutrition and gender stakeholders to complete a descriptive landscaping of existing multi-sectoral tools on nutrition-gender relationships [that highlighted current guidance gaps], a mixed-methods needs assessment, a case study on the application of the GTFN, and a draft advocacy tool.

Results: Our contribution to the panel discussion will aim to highlight our project’s learning journey of co-creation, bringing in the successes and challenges experienced by our team thus far. The panelist will discuss the complexity of co-creation; acknowledging the wide range of stakeholders involved, and varying end-users’ needs and priorities. Further, the panelist will outline common challenges when managing a co-creation-led project based on shared experiences and will lastly highlight key lessons learned while endeavoring to meaningfully bring co-creation and feminist research principles into practice. 

Conclusions: Nutrition programmes can be gender-transformative and address the full social complexity of malnutrition. The experiences of the project team to date highlight the complexity and challenges of co-creation with a wide range of stakeholders and intended end-users in the gender and nutrition sector. However, the team believes this consultative and engagement-oriented approach will result in a toolkit that is widely accepted and addresses the range of needs in the nutrition and gender space.