Evidence map›Paper›PMID 41826957›Full record

Trial reportThe international journal of behavioral nutrition and physical activity2026

A theoretically designed scale-up intervention increases adoption of an effective school nutrition program 'SWAP IT': outcomes of a randomised trial.

Rachel Sutherland, Demi Herdegen, Jannah Jones, Courtney Barnes, Nicole Nathan, Katie Robertson, Anna Rayward, Adrian Bauman, Tameka McFadyen, Andrew Milat and 8 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The international journal of behavioral nutrition and physical activity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Rachel SutherlandSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. Rachel.Sutherland@health.nsw.gov.au.
Demi HerdegenSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Jannah JonesSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Courtney BarnesSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Nicole NathanSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Katie RobertsonHunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.
Anna RaywardSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Adrian BaumanSydney School of Public Health, University of Sydney, Camperdown, NSW, 2050, Australia.
Tameka McFadyenOffice of PVC - Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Andrew MilatNSW Ministry of Health, Agency for Clinical Innovation, Reserve Road, St Leonards, NSW, 2065, Australia.
Philip MorganSchool of Education, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Penny ReevesHunter Medical Research Institute, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
Christopher OldmeadowHunter Medical Research Institute, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
Serene YoongFaculty of Health/School of Health and Social, Development/Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
Megan CobcroftNew South Wales Ministry of Health, Centre for Population Health, Reserve Road, St Leonards, NSW, 2065, Australia.
Simon ChiuSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
John WiggersHunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.
Luke WolfendenSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.

Funding

Medical Research Futures Fund, Australia APP1150661Medical Research Futures Fund Investigator Fellowship GS2000053National Health and Medical Research Council APP11960419Wellcome Trust 106654
6 · The paper itself

Abstract

backgroundScale-up (i.e., the intentional effort to increase the reach and impact of an intervention) of effective school-based interventions is recommended to improve public health nutrition and prevent chronic disease. However, limited evidence to guide effective scale-up exists. This study aimed to assess the effectiveness of a theoretically designed multi-component scale-up intervention, designed using the Theoretical Domains Framework and Behavior Change Wheel, to increase the adoption of an evidence-based school nutrition program (SWAP IT) within primary schools in NSW Australia. We also identify any differences in the characteristics of schools adopting the program and describe the fidelity of delivering, and reach of each scale-up strategy.

methodsA parallel-group randomised controlled trial was conducted across 11 Local Health Districts (LHD) in New South Wales Australia (n = 337 schools). Primary schools which had not previously adopted the SWAP IT school nutrition program and used an existing parent communication app (Audiri) in each LHD were randomised to receive a theoretically designed multi-component scale-up intervention (n = 169 schools) or to a waitlist control, exposed to a single discrete scale up strategy (n = 168 schools). The scale-up intervention consisted of nine scale-up strategies: three ‘vertical’ strategies aiming to increase LHD Health Promotion Units capacity to scale-up and six ‘horizontal’ strategies aiming to overcome school barriers to adopting the programs. The primary outcome was school adoption of SWAP IT objectively assessed via electronic records at 6-months, assessed via logistic regression adjusting for baseline and stratification variables.

resultsFollowing the 6-month multi-component scale-up intervention, significantly more schools in the scale-up intervention group (n = 67/169, 40%) had adopted the SWAP IT program compared to schools in the control group (n = 0/168, 0%) (p < 0.001). Schools with a higher enrolment of Aboriginal and Torres Strait Islander students were more likely to adopt the program (p = 0.02), however no other school characteristics were associated with program adoption. Most scale-up strategies were delivered by LHD Health Promotion Units to schools with high fidelity (72–100%), however reach of the strategies varied widely (4-100%).

conclusionsA theoretically designed approach to scale-up, increased schools’ adoption of an evidence-based school nutrition program across a large and socio-economically and geographically diverse population. Program adoption rates were similar across socio-demographic and geographic characteristics. This approach can inform efforts of improving public health nutrition equitably through large scale adoption of school nutrition initiatives.

trial registrationThe trial was prospectively registered on 13/02/2023 with the Australian New Zealand Clinical Trials Registry (ACTRN12623000145606). https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12623000145606 .

Indexed as

Food ServicesHealth PromotionSchool Health ServicesChildFemaleHumansMaleNew South WalesProgram EvaluationSchoolsAdoptionDisseminationImplementationNutritionScale-upSchool

Identifiers

PMID41826957
PMCPMC13101112

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.