Process evaluation of Project Daire: a food environment intervention that impacted food knowledge, wellbeing and dietary habits of primary school children

Abstract

Abstract Background: The Project DAIRE trial aimed to improve children’s health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions: Nourish, and Engage. Nourish was an intervention aiming to alter the school food environment, provide food-based experiences and expose pupils to locally produced foods. Engage was an age-appropriate cross-curricular food education intervention incorporating food, agriculture, nutrition science and related careers. The purpose of this study was to conduct a mixed methods process evaluation to evaluate DAIRE implementation, mechanisms of impact (MOI) and context, and inform scalable implementation of the DAIRE approach. Methods: The Medical Research Council’s (MRC) framework for process evaluation was followed. Formal and informal methods were used to collect quantitative and qualitative data during the DAIRE trial in relation to process evaluation. Quantitative data were analysed using descriptive statistics and qualitative data via thematic analysis to identify key themes. Results: Fifteen schools and 983 pupils (n=495 Key Stage 1 (KS1) and n=488 Key Stage 2 (KS2) pupils) were recruited for the 6-month DAIRE intervention; a 100% retention rate was observed at the school level and the interventions had a high level of acceptability. Nourish schools implemented a higher mean intervention dose (57.2%) than Engage (50%) schools but, overall, mixed implementation of both interventions occurred. DAIRE produced change through four key MOI: social learning, experimental learning, interactive engaging content and real-life connections. Lack of time was the main contextual barrier to DAIRE implementation and lack of financial cost to schools was indicated as a potential facilitator. Conclusions: This process evaluation helped to identify important findings related to implementation, MOI and context. The most effective elements of the interventions which should be maintained include provision of interactive and engaging intervention elements and ensure these are at no financial cost to the school. Findings also identified suggestions for improvement including provision of increased teacher training, support and planning time, content reduction to facilitate easy integration into the school curriculum, and implementation across the full academic year. A sustainable funding and resourcing mechanism is required for successful future roll-out. Trial Registration: The original trial referenced in this process evaluation is registered as follows: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312)