Scrutinize of healthy school canteen policy in Iran’s primary schools: a mixed method study

Abstract Background Schools provide an opportunity for developing strategies to create healthy food environments for children. The present study aimed to analyze the Healthy School Canteen (HSC) policy and identify challenges of its implementation to improve the school food environment in Iran. Methods This mixed method study included two qualitative and quantitative phases. In the qualitative phase, triangulation approach was applied by using semi-structured interviews with key informants, documents review and direct observation. Data content analysis was conducted through policy analysis triangle framework. In the quantitative phase, food items available in 64 canteens of primary schools of Tehran province were gathered. The food’s nutrient data were evaluated using their nutrition facts label. The number and proportion of foods that met the criteria based on Iran’s HSC guideline and the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined. Results The main contextual factors that affected adoption of HSC policy included health (nutritional transition, high prevalence of non-communicable diseases and unhealthy food environment in and around the schools), political (upstream supportive policies and joint memorandums about health children between the Ministry of Health and Medical Education and Ministry of Education), structural (the lack of unified stewardship, inadequate human resource capacity, poor inter-sectional cooperation), economic (school financial problems, poor fiscal supportive of food policies), and socio-cultural (mothers working outside the home, the role of children’s peer group, low nutrition knowledge of school principals) factors. Assessment of the school canteens showed that a large proportion of available foods did not comply with the national guidelines (54.7 ± 2.54%) and WHO-EMR model (85.6 ± 2.34%). The main reasons identified for incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, lack of scientific criteria for food categorization, poor monitoring, high price of healthy foods, and conflict of interest among the actors. Conclusion The majority of foods and beverages available in the school canteens did not comply with national and regional standards. Iran HSC policy needs to be improved by using an evidence-based approach and active interaction between all key actors.

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Do birds singing the same song flock together? A mixed-method study on language as a tool for changing social homophily in primary schools in Flanders (Belgium)

International Journal of Intercultural Relations ◽

10.1016/j.ijintrel.2015.10.002 ◽

2015 ◽

Vol 49 ◽

pp. 168-182 ◽

Cited By ~ 2

Author(s):

Anouk Van Der Wildt ◽

Piet Van Avermaet ◽

Mieke Van Houtte

Keyword(s):

Mixed Method ◽

Primary Schools ◽

Mixed Method Study

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Hispanic immigrant women’s perspective on healthy foods and the New York City retail food environment: A mixed-method study

Social Science & Medicine ◽

10.1016/j.socscimed.2011.04.012 ◽

2011 ◽

Vol 73 (1) ◽

pp. 13-21 ◽

Cited By ~ 50

Author(s):

Yoosun Park ◽

James Quinn ◽

Karen Florez ◽

Judith Jacobson ◽

Kathryn Neckerman ◽

...

Keyword(s):

New York ◽

New York City ◽

Mixed Method ◽

York City ◽

Food Environment ◽

Mixed Method Study ◽

Healthy Foods ◽

Retail Food Environment ◽

Retail Food

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Determinants of breastfeeding practice in Pujehun district, southern Sierra Leone: a mixed-method study

International Breastfeeding Journal ◽

10.1186/s13006-021-00390-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dorothee van Breevoort ◽

Francesca Tognon ◽

Arne Beguin ◽

Amara S. Ngegbai ◽

Giovanni Putoto ◽

...

Keyword(s):

Breast Milk ◽

Sierra Leone ◽

Exclusive Breastfeeding ◽

Mixed Method ◽

Critical Role ◽

World Health ◽

Mixed Method Study ◽

Breastfeeding Rate ◽

Breastfeeding Practice ◽

Determinants Of Breastfeeding

Abstract Background It is well established that exclusive breastfeeding can play a critical role in reducing child morbidity and mortality. Limited research has been done thus far on the practice and perceptions of breastfeeding in Sierra Leone, where more than 10 % of children die before the age of five. This study aimed to gain understanding into and explore both matters in order to develop recommendations for effective strategies to promote breastfeeding practice in Pujehun District, Southern Sierra Leone. Methods This exploratory mixed-method study included a cross-sectional survey of 194 mothers, semi-structured interviews and focus group discussions. Logistic regression analysis was used calculated odds ratios of factors associated with primarily breastfeeding practice, defined as ‘Children under six months of age who are fed with breast milk only and children older than six months of age that were exclusively breastfed up to six months’, based on recall from birth. Exclusive breastfeeding rate was based on breastfeeding practice 24 h prior to the survey. Qualitative data was analysed through a deductive approach, using a pre-determined framework on determinants of breastfeeding. Results This study revealed an exclusive breastfeeding rate of 62.8% (95% CI 53.9, 71.7); dropping from 74% in the 0–1-month age group to 33% in the 4–5 months group. Triangulation of qualitative and quantitative data revealed enabling factors for primarily breastfeeding practice included mothers receiving support during their first breastfeed, pregnant women being provided with information on the benefits of the practice, counselling by nurses, support from husbands, and women’s awareness of how their friends and family members fed their own babies. The main barriers were a lack of encouragement by husbands, women’s perception that their infants’ stools were abnormal or that they were not producing enough breast milk. Conclusions Although the exclusive breastfeeding may have risen over recent years, a gap remains compared to World Health Organization recommendations. According to the breastfeeding determinants identified in this study, promotion of counselling by a nurse, encouragement of husbands’ support, and improve knowledge of mothers on breastfeeding are recommended to be incorporated in the design of future health programs.

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Use of the World Health Organization Checklist—Swedish Health Care Professionals' Experience: A Mixed-Method Study

Journal of PeriAnesthesia Nursing ◽

10.1016/j.jopan.2019.10.002 ◽

2020 ◽

Vol 35 (3) ◽

pp. 288-293

Author(s):

Ferid Krupic ◽

Eleonor Svantesson ◽

Nail Seffo ◽

Olof Westin ◽

Eric Hamrin Senorski

Keyword(s):

Health Care ◽

World Health Organization ◽

Mixed Method ◽

Health Care Professionals ◽

World Health ◽

Mixed Method Study ◽

Swedish Health Care ◽

The World ◽

Health Organization

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Understanding health needs of men who have sex with men in Agra district of India: a community based mixed method study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20204001 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3877

Author(s):

Khan Iqbal Aqeel ◽

S. S. Chaudhary ◽

S. K. Misra ◽

Abhishek Royal

Keyword(s):

Mixed Method ◽

Peer Group ◽

Low Cost ◽

Transmitted Disease ◽

Health Needs ◽

Mixed Method Study ◽

Health Coverage ◽

Non Profit ◽

Sex With Men ◽

Health Need

Background: In India, after decriminalization of homosexuality, men who have sex with men (MSM) emerged as legal community but still one of the most stigmatized section of society. their health needs are distinct due to their distinct behaviour. To achieve ‘Universal health coverage’, this group health needs must be addressed as they had been living in shackles of exclusion.Methods: This mixed method study was conducted in men who have sex with men (MSM) population in Agra district of India. For qualitative part, Audio recorded in-depth interviews were transcribed into verbatim. Potential themes were extracted as a part of analysis as per respondents’ experiences. Data saturation was achieved after 13 IDIs. For quantitative assessment, the snowball technique for sampling was used. First participants were recruited through a non-profit peer group. Further participants were subsequently referred by the participants from their peer circles.Results: Easy /low cost availability of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing (32.69%) was foremost cited health need. 26.92% of respondents were unable to tell anything about their health need. 25% of respondents told to increase the number of MSM friendly STD clinics. 15.38% of respondents think that doctor should be taught not to discriminate with MSM and 5.76% asked for psychiatric and medical counselling for MSM. Similarly, qualitative findings highlighted need of non-judgemental and discrimination free health facilities and also suggested MSM inclusive STD centres and psychiatric counselling.Conclusions: The main implication of this study was need to recognize the existence and their diverse health needs and link them to appropriate health care.

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Can changing the position of online menu items increase selection of fruit and vegetable snacks? A cluster randomized trial within an online canteen ordering system in Australian primary schools

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy351 ◽

2019 ◽

Vol 109 (5) ◽

pp. 1422-1430 ◽

Cited By ~ 1

Author(s):

Rebecca Wyse ◽

Gnel Gabrielyan ◽

Luke Wolfenden ◽

Serene Yoong ◽

Jeffrey Swigert ◽

...

Keyword(s):

Food Environment ◽

Primary Schools ◽

Controlled Trial ◽

Cluster Randomized Trial ◽

Baseline Period ◽

Large Trial ◽

Fruit And Vegetable ◽

School Canteen ◽

Significant Difference ◽

Selection Of

ABSTRACT Background Manipulating the position of food items within the physical food environment has consistently been found to influence item selection. However, the extent to which this strategy is effective in an online food environment is unknown. Objective This study investigated whether an intervention to position fruit and vegetable snack items as the first and last menu items in an online school canteen ordering system increased the selection of those items. It was hypothesized that at follow-up, a higher proportion of online lunch orders in intervention schools would contain the target items (fruit and vegetable snacks) in comparison to control schools. Design Six primary schools in New South Wales, Australia, were recruited to a clustered randomized controlled trial conducted over an 8-wk period. Intervention schools received a redesigned menu where the target items were positioned first and last on the online menu. Control schools received no change to their online menu. Results During the baseline period 1938 students (1203 intervention, 735 control) placed at least one online lunch order and were included in the study, with 16,109 orders placed throughout the study. There was no significant difference between groups over time in the proportion of orders that contained a “Fruit and Veggie Snack” item (OR = 1.136 [95% CI: 0.791, 1.632] P = 0.490). Conclusions Evidence from this large trial with robust study design and objectively collected data suggests that positioning fruit and vegetable snack items first and last within an online canteen menu does not increase the selection of these items. Further research is warranted to confirm this finding with other target menu items (e.g., treats) and across other purchasing contexts and online food ordering platforms. This trial was registered at the Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au/ as ACTRN12616001520426.

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