Implementation of national school food policy in special and alternative education: a mixed methods study.

OBJECTIVE

To understand how special and alternative education settings implement national school food standards and policy and identify challenges to and support for implementation.

DESIGN

Mixed methods study comprising (1) cross-sectional quantitative assessment of: (a) compliance with standards through menu review and researcher observation; (b) implementation of actions from the School Food Plan (SFP) through survey and (2) qualitative interviews with school staff.

SETTING

State-funded special and alternative education settings with pupils aged 4-18-years in England.

PARTICIPANTS

Eight settings and thirty-seven school staff with a role in school food, including catering staff, school leadership, teaching staff and school governors.

RESULTS

The median level of compliance for all standards was 66·7 % (interquartile range (IQR) = 61·3-70·0), with highest compliance for lunchtime standards (median = 73·3 %, IQR = 68·2-75·3) and standards aiming to promote dietary variety (median = 73·3 %, IQR = 66·7-73·3) and lowest for standards that apply across the whole school day (median = 50·0 %, sd = 36·4-59·1) and standards aiming to restrict foods/drinks high in fat, salt and sugar (median = 57·7 %, IQR = 50·0-71·2). Most schools carried out independent monitoring of standards (71·4 %), but none had a healthy eating award. Three qualitative themes demonstrated challenges in meeting the standards, including accommodating the complex needs of pupils and varied staff engagement and school food monitoring processes.

CONCLUSIONS

Special and alternative education settings had intensive, highly individualised approaches to school food that often conflicted with standards compliance. School food standards and policy need consider the unique challenges for these settings and the need for flexibility, adequate funding, tailored resources and staff training to improve quality of diets in this population.