Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
BMC Public Health. 2023 Feb 9;23(1):300. doi: 10.1186/s12889-023-15082-3.
In the UK, one in five households with children experienced food insecurity in 2022, defined as a household-level economic and social condition of limited or uncertain access to adequate food. Free school meals are a public health intervention aimed at reducing food insecurity amongst children. The provision of universal free school meals (UFSM) to secondary school-aged children is a novel and untested intervention in the UK. This study is a process evaluation of a pilot of UFSM in two secondary schools in England. The aim was to understand the feasibility, acceptability, cost implications and lessons for the implementation of UFSM.
20 parents, 28 students and 8 school staff from two intervention schools participated in online qualitative interviews, as well as 4 staff from non-intervention schools. The Framework Method of thematic analysis was applied. These data were supplemented with student-led observations of school meal times, and school lunch uptake-data and cost information provided by the local authority delivering the pilot.
UFSM in secondary schools is a feasible and acceptable intervention, with coherent goals of increased access to a healthy meal, reduced food insecurity and better nutrition. All participants perceived these goals were met. Acceptability was further enhanced by the perception that UFSM were supporting a greater proportion of low-income families than the national, targeted Free School Meal scheme, as well as being easier to implement. Potential barriers to implementation include limited school kitchen and dining infrastructure, meal quality and choice, and increased queuing times. Participants' concerns that UFSM may benefit middle- and high- income families not in need were not as prevalent as the perception that UFSM was an effective way to support all families with secondary-aged children experiencing food insecurity.
This small-scale pilot study suggests that UFSM in secondary schools is feasible and acceptable, but more evidence is required from larger studies on the impact on long-term health, psychosocial and educational outcomes. Future, larger studies should also include detailed economic evaluations so this approach can be compared with other possible interventions.
2022 年，英国五分之一有孩子的家庭经历了粮食不安全，这是一种家庭层面的经济和社会条件，表现为获取充足食物的机会有限或不确定。免费校餐是一项旨在减少儿童粮食不安全的公共卫生干预措施。为中学年龄段的儿童提供普及性的免费校餐是英国一项新颖且未经检验的干预措施。本研究是对英格兰两所中学实施普及性免费校餐试点的过程评估。目的是了解普及性免费校餐的可行性、可接受性、成本影响以及实施方面的经验教训。
来自两所干预学校的 20 名家长、28 名学生和 8 名校方工作人员以及 4 名来自非干预学校的工作人员参与了在线定性访谈。采用框架方法进行主题分析。这些数据还辅以学生对学校用餐时间的主导观察，以及地方当局提供的试点校午餐参与数据和成本信息。
中学阶段的普及性免费校餐是一项可行且可接受的干预措施，其目标一致，即增加获得健康膳食的机会、减少粮食不安全和改善营养。所有参与者都认为这些目标得到了实现。普及性免费校餐被认为更能惠及比国家有针对性的免费校餐计划更多的低收入家庭，而且实施起来更容易，这进一步提高了其可接受性。实施的潜在障碍包括学校厨房和用餐设施有限、餐食质量和选择以及排队时间延长。参与者担心普及性免费校餐可能使不需要的中高收入家庭受益的情况并不像人们认为普及性免费校餐是支持所有有中学年龄段孩子经历粮食不安全的家庭的有效方式那样普遍。
这项小规模试点研究表明，中学阶段的普及性免费校餐是可行且可接受的，但需要更大规模的研究提供有关长期健康、心理社会和教育结果影响的更多证据。未来的更大规模研究还应包括详细的经济评估，以便将这种方法与其他可能的干预措施进行比较。
