Making healthy choices easy choices : taking Tasmanian primary school children on their own food journey

\\(Introduction\\) Most Australians, including children, are not eating a healthy diet according to the Australian Dietary Guidelines (ADG). Only two per cent of children are eating the recommended daily serves of vegetables and fruit, and nearly half of their daily intake comes from nutrient- poor and over-processed food. The prevalence and early onset of chronic disease are increasing globally. Currently in Australia, 90 per cent of deaths are attributable to chronic disease. Healthy eating habits are key protective factors for many common chronic diseases such as obesity, type 2 diabetes and heart disease. Finding new ways to establish healthy eating habits in children is imperative to promote wellness and provide protection against chronic disease later in life. Yet, it remains unclear how to increase the number of children eating according to the ADGs and how to support children to establish healthy eating habits that persist into adulthood. There is an international consensus that some aspects of a whole-of-school approach have resulted in significant yet moderate improvements to healthy food available to children and their food choices. The question is, what strategies will have a bigger impact on children's food choices during school. Researchers have underscored the importance of incorporating the views of children in planning health promotion programs within the school setting; however, research that puts the direct views of children about their intake at the centre of inquiry is limited. Incorporating the views of children not only provides children with ownership of programs targeted at them, it provides an accurate account of factors that influence children's eating behaviours. In the limited research that has worked directly with children, adult perceptions about why children make food choice is not the same as what children think. To effectively improve children's eating behaviours, it makes sense to base interventions on factors that will influence food choice as reported by children. Currently, there is a gap in knowledge about the decision-making criteria that children use to make food choices and what influences these choices. Research that asks children directly why they make the food choices they do is limited. The literature available suggests that adults are making assumptions about why children are making particular food choices. To improve the understanding of children's decision-making criteria, more research that asks children themselves about their views on food choice is required. \\(Aim\\)The aim of this study was to investigate the decision-making criteria that children use to make food choices in a primary school setting using a Participatory Action Research (PAR) method. \\(Methodology\\) A qualitative, inductive and participatory approach guided the research using PAR. This methodology has been reported as an appropriate research approach when working with children and schools because PAR can act as a conduit to make improvements with the school environment, as well as understand what is happening amongst participants. The study received a full ethics approval (number H0012935) through the University of Tasmania Social Science Human Research Ethics Committee (SS HREC). A convenience sample of students from a non-government primary school in Tasmania was used to complete five PAR cycles. Data were collected from children on five occasions using; an open class discussion (n=80), a day in the canteen (all grades), a specified meal for the day (grades two - six) and two Discovery Days with grades two - six (n=100). The Discovery Days were designed to provide a platform for children to work in groups of mixed grades to address a creative brief in an open classroom, with no input from the teachers. On each Discovery Day, children were instructed to create a menu for their canteen. As a group, they recorded the reasons why they chose particular foods. Groups of children were filmed during the day and were asked to share why they chose the foods on the menu. Answers from open-ended questions were documented on an Excel spreadsheet. Data were analysed using descriptive statistics and conventional content analysis. \\(Methods\\) Five action cycles were completed and on a conceptual level the action cycles were an interconnected matrix. Action Cycle 1 led to Action Cycle 2 and 3 simultaneously. The reflection of Action Cycle 2 and 3 led to Action Cycle 4 and 5. Data revealed that most children regularly used the canteen. Despite the availability of healthy foods on the canteen menu, the foods most often purchased were unhealthy. Children also created menus on each Discovery Day that were predominantly unhealthy foods. A conventional content analysis resulted in a series of codes and thirty-one categories across both Discovery Days. From the categories, five themes emerged on Discovery Day one and six themes emerged on Discovery Day two. The emerging themes from different action cycles were considered collectively to develop theoretical concepts. \\(Findings\\) The conceptualisation process resulted in six theoretical concepts. Five concepts that were formed from the children's perspectives appeared to influence their food choice: pleasure, popularity, eating context, versatility and texture. A sixth concept (knowledge) did not influence their food choices. To translate the complexities and integrate 'what was known' with 'what was found', the results of the study informed the development of a model that can be used by schools to plan health promotion initiatives. The model can be used to explain the theoretical research findings in a format that is easy to understand and will enable translation of this research into practice. \\(Conclusions\\) This study has found that children are key informants because they were able to articulate their decision-making criteria for food choice. Their criteria informed the development of a practical model that can be used to guide public health interventions and nutrition-related policy in the school setting. It is known that for a paradigm shift to occur for healthy eating in schools, health professionals, school communities and government need to consistently convey the same healthy food messages. The practical model developed in this research strengthens the current approach to health promotion in schools by seeking to make healthy options more desirable to children. The model developed also represents the complexities of promoting healthy eating to schoolchildren and can serve as a consistent guide for all sectors that address healthy eating in schools.