Reilly Kathryn, Nathan Nicole, Wolfenden Luke, Wiggers John, Sutherland Rachel, Wyse Rebecca, Yoong Sze Lin
School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
Health Promot J Austr. 2016 Feb;27(3):215-221. doi: 10.1071/HE16053.
Issue addressed In order to assess the impact of healthy school canteen policies on food availability for students, valid methods of measuring compliance are needed that can be applied at scale. The aim of this study is to assess the validity and direct cost of four methods to assess policy compliance: 1) principal and 2) canteen manager self-report via a computer-assisted telephone interview; and 3) comprehensive and 4) quick menu audits by dietitians, compared with observations. Methods A cross-sectional study took place in the Hunter region of NSW, Australia, in a sample of 38 primary schools that had previously participated in a randomised controlled trial to improve healthy canteen policy compliance. Policy compliance was assessed using the four methods specified above. Percentage agreement, kappa, sensitivity and specificity compared with observations was calculated together with the direct time taken and costs of each method. Indirect costs (including set-up costs) for all measures have not been included. Results Agreement with observations was substantial for the quick menu audit (kappa=0.68), and moderate for the comprehensive menu audit (kappa=0.42). Principal and canteen manager self-report resulted in poor agreement and low specificity with the gold standard. The self-reported measures had the lowest cost, followed by the quick menu audit and lastly the comprehensive menu audit. Conclusion The quick menu audit represents a valid and potentially low-cost method of supporting policy implementation at scale. So what? This study demonstrates that a quick menu audit represents a valid measure of undertaking assessment of school canteen policy compliance at a population level.
解决的问题 为了评估健康学校食堂政策对学生食物供应的影响，需要能够大规模应用的有效合规性测量方法。本研究的目的是评估四种评估政策合规性方法的有效性和直接成本：1）校长和2）食堂经理通过计算机辅助电话访谈进行的自我报告；以及3）营养师进行的全面和4）快速菜单审核，并与观察结果进行比较。方法 在澳大利亚新南威尔士州的亨特地区进行了一项横断面研究，样本为38所小学，这些小学之前参与了一项旨在提高健康食堂政策合规性的随机对照试验。使用上述四种方法评估政策合规性。计算与观察结果相比的百分比一致性、kappa值、敏感性和特异性，以及每种方法所需的直接时间和成本。所有措施的间接成本（包括设置成本）未包括在内。结果 快速菜单审核与观察结果的一致性较高（kappa=0.68），全面菜单审核的一致性中等（kappa=0.42）。校长和食堂经理的自我报告与金标准的一致性较差且特异性较低。自我报告措施的成本最低，其次是快速菜单审核，最后是全面菜单审核。结论 快速菜单审核是一种有效的、可能低成本的大规模支持政策实施的方法。那又怎样？本研究表明，快速菜单审核是在总体层面上对学校食堂政策合规性进行评估的有效措施。
