Table 3 Evidence on multi-component interventions

Bailey CJ et al., 2019 [36]

Study design: cross-sectional (n = 16), quasi- experimental (n = 13), qualitative (n = 7), mixed methods (n = 4), pre–post intervention (1), RCT (n = 1), longitudinal cohort (n = 1), observational (n = 1)

Theories: SCT, TTM, TPB, HBM

Healthy eating education components: workshops, nutri-advice kiosk, cooking classes, quiz, games, field visits

Contents: nutrition education, food safety, reading nutritional labels, healthy food purchase knowledge, farmers to visit schools to interact on healthy food cultivations

School environment change component: school gardening, workshops with kitchen staff, canteen modification

Contents: FV gardening, culinary lessons for kitchen staff and on-site chef consultations on healthy cooking, FV, milk, meat provision in canteen

Duration of interventions: 1 week to 10 years

Follow-up range: immediate to 2 years

97% of the included studies reported improved healthy eating knowledge, increased FV, decreased processed snacks intake

Promising; 8 (high quality)

Calvert S et al., 2019; [37]

Study design: RCT (n = 19), quasi-experimental (n = 7), cohort (n = 3)

Theories: Not reported

Healthy eating education components: workshops, quiz, self-evaluation diary, self-assessment homework, entertainments, media shows (radio/TV), practical culinary lessons

Contents: healthy eating education, handbooks, worksheets,, (e.g. problem solving, goal setting on healthy eating), computerised feedback, healthy cooking, media shows

School environment change components: canteen modification

Contents: increased availability of healthy foods

Family involvement components: workshops, SMS, emails, homework, coupons

Contents: information on healthy eating, heathy cooking via newsletters, feeding healthy foods to children, coupons for healthy food purchase

Duration of interventions: 2 weeks to 3 years

Follow-up range: 1 week to 4 years

83% of the included studies reported increased FV, decreased SSB, fat, and processed snack intake, improved intake of recommended calories and protein

Promising; 8 (high quality)

Champion KE et al., 2019 [44]

Study design: RCT (n = 14), quasi-experimental (n = 2)

Theories: ASE model, Principles of interactive technology, SCT, SLT, TTM, TPB, HPM (pender’s),

Healthy eating education components:, online discussion boards, online games, SMS, emails, blog by health coach

Contents: healthy eating lessons, knowledge and information via compact disc (CD), videos

School environment change component: reduced price of fruit

Family involvement component: healthy eating information handouts

Contents: healthy eating information via newsletters, CD

Duration of interventions: 1 month to 3 years

Follow-up range: Immediately after intervention to 2 years

Inadequate evidence in improving healthy eating behaviour across all studies

No conclusion; 9 (high quality)

Hackman et al., 2014 [38]

Study design: RCT (n = 8), quasi-experimental (n = 2), pre-post (n = 1)

Theories: TRA, TPB

Healthy eating education components: workshops, conference, campaign, games, quiz, SMS, entertainment, rewards

Contents: healthy eating lessons, healthy cooking lesson, healthy menu planning, healthy foods as rewards, role play, creative writing on healthy eating, poster, comic workbooks, theatre play

School environment components: school food marketing, food provision

Contents: provision of FV, taste testing, healthy food promotion in school

Family involvement components: healthy eating information handouts

Contents: nutritional needs for adolescents via newsletters

Duration of interventions: 15 min to 1 year

Follow-up range: not reported

88% of included studies reported improved healthy eating knowledge and behaviour with increased FV, decreased snacks, high fat, SSB intake, increased intention for eating lunch in school

Promising; 8 (high quality)

McHugh C et al., 2020 [39]

Study design: RCT (n = 9)

Theories: SCT, TTM, TPB, SEM, Diffusion of innovation theory, ASE model, control theory, IMBSM

Healthy eating education components: workshops for staff and students

Contents: food and nutrition lessons, drama workshops on healthy eating

School environment change components: canteen modification, social food marketing, staff training

Contents: restriction of unhealthy foods, increased FV and healthy snacks, healthy food promotion, staff training on healthy cooking

Family involvement components: events with parents (meetings, workshops, invite to school meals, including them in school nutrition council group), healthy eating information handouts, loyalty programs

Contents: adolescents’ healthy eating, healthy cooking recipes, healthy eating information via calendars, newsletters, magazines, incentives to purchase healthy foods

Duration range: 8 months to 3 years

Follow-up range: 1–3 years

Inadequate evidence in improving healthy eating behaviour across all studies

No conclusion; 8 (high quality)

Medeiros et al., 2022 [45]

Study design: RCT (n = 24)

Theory: Self-Regulation Theory, ASE Model, The action planning literature, Pedagogy of the Oppressed, by Paulo Freire, SCT, SEM, Bloom’s mastery of learning model, Bronfenbrenner’s ecological theory, TPB, TTM

Healthy eating education components: workshops

Contents: healthy eating lessons

School environment change components: canteen modification, postering, media marketing of healthy foods

Contents: provision of healthy foods including FV, healthy eating posters around school premises, campaign on healthy eating

Family involvement components: parents meeting, workshops, free healthy foods provision,

Contents: healthy eating information discussion, leaflets, offering FV

Duration range: 2 months to 3 years

Follow-up range: Not reported

70% of the included reviews reported increased intake of FV, protein, healthy snacks

Promising; 11 (high quality)

Meiklejohn et al.; 2016 [40]

Study design: RCT (n = 13)

Theories: SCT, TPB, Community-based capacity building approach

Healthy eating education components: workshops, games, entertainment

Contents: healthy eating knowledge based lessons, food preparation, taste testing, drama

School environment change components: gardening, postering, canteen modification, loyalty program

Contents: FV gardening, posters display in lunch room on healthy eating, enhanced lunch session with healthy meals, replacing processed foods and SSBs with healthy foods and juice in vending machines, subscriptions (paying for regular access) to FV

Family involvement components: parents’ meeting, loyalty program, healthy eating information handouts

Contents: discussion on FV intake, meal preparation, money rewards for healthy feeding to their children, healthy eating information via newsletter, fact sheets, brochure, CD, magazine

Duration range: 12 h to 12 weeks

Follow up range: immediately after intervention to 2 years

Inadequate evidence in improving healthy eating behaviour across all studies

No conclusion; 9 (high quality)

Nakabayashi J et al., 2020 [42]

Study design: RCT (n = 8), quasi-experimental (n = 6)

Theory: TTM

Healthy eating education components: workshops

Contents: healthy eating knowledge, behaviour, and goal setting worksheets

Family involvement components: healthy eating information handouts SMS

Contents: healthy eating behaviour, nutritional guidelines for adolescents via magazines, letters

Duration range: 1 h to 3 years

Follow up range: 1 week to 2 years

86% of the included studies reported increased FV, decreased fat intake, balanced calorie intake

Promising; 7 (moderate quality)

Pierre CS et al., 2021 [43]

Study design: Not reported

Theories: TTM, SCT, TPB, ASE model

Healthy eating education components: workshops, visits by inspiring personalities, games, SMS, healthy eating club

Contents: healthy eating and nutrition lessons, cartoon-style nutrition handbook, visits by athletes, dancers, club activities (healthy cooking, drama, role-playing, poster making, photography exhibition on unhealthy eating)

School environment changes components: school-wide food marketing

Contents: SNaX messages- promotional displays via digital media, posters on healthy snacks

Family involvement components: Parents meeting, homework

Contents: healthy eating education for adolescents, feeding healthy foods to adolescents at home

Duration range: 1 month-1 year

Follow-up range: Not reported

All included studies reported improved healthy eating knowledge and behaviour including increased FV, decreased SSB intake, willingness to try new healthy foods, increased frequency of breakfast consumption

Likely effective; 9 (high quality)

Rose K et al., 2021 [31]

Study desing: Quasi-experimental (n = 11), RCT (n = 9), Qualitative (n = 4) mixed-method (n = 2), cross-sectional (n = 1)

Theories: Not reported

Healthy eating education component: lectures, board game, instrumental SMS, nutri-active kiosks, drama, counselling via mHealth

Contents: healthy eating, nutrition information via computer-generated tailored leaflet, nutritional behavioural counselling

School environment changes components: Social food marketing, canteen modification

Contents: daily free healthy meal, food choice towards plant based foods, chef demonstration, promotion of healthy snack purchases

Family involvement components: Parents meeting

Contents: healthy eating for adolescents

Duration of interventions: Not reported

Follow-up range: 4 weeks to 18 months

All included studies reported improved nutritional knowledge, increased FV, protein, decreased SSB, red meat, fat, processed snacks intake, improved frequency of breakfast consumption

Likely effective; 10 (high quality)

Sa JD & Lock K, 2008 [32]

Study design: RCT (n = 6), non-RCT (n = 1)

Theories: Not reported

Healthy eating education contents: workshops, peer-leading activities

Contents: lectures on healthy eating and its promotion, peer-leaders to promote healthy eating knowledge

School environment change components: canteen modification, loyalty programmes, gardening

Contents: increased provision of FV- free and/or subsidised, FV gardening

Family involvement components: healthy eating information handouts

Contents: healthy eating behaviour for adolescents via newsletters

Duration of interventions: Not reported

Follow-up range: 12 months to 3 years

70% of the included studies reported increased intake of FV

Promising; 9 (high quality)

Shinde et al., 2023 [30]

Study design: RCT (n = 19), CBA (n = 8)

Theories: SCT, CBT, TPB, HBM, Pedagogy of the

Oppressed, Health action process approach, HPS, TRA

Healthy eating education components: workshop, quiz, games, healthy eating information handouts,, culinary activities, entertainments

Contents: healthy eating knowledge, role-plays, blackboard writing on healthy and unhealthy foods, food classifications, food label reading information via booklets, brochures, posters, magazines, webpage, puppet shows, movies, food tasting, healthy cooking recipe

School environment change components: canteen modification, training for school staff

Contents: daily sell of fresh fruits, nutrition training session

Family involvement components: workshops, healthy eating information handouts information provision-

Contents: healthy eating behaviour for adolescents via booklets, brochures, blackboard writings, posters, slogans, news leaflets, healthy recipe guides

Duration of interventions: 7 days to 3 years

Follow-up range: 8 weeks to 28 months

78% of the included studies reported improved healthy eating knowledge, increased FV, decreased SSB and processed food intake

Promising; 9 (high quality)

Van Cauwenberghe Evet al., 2010 [34]

Study design:

RCT (n = 5), non-RCT (n = 5), prospective cohort (n = 2), pre-post (n = 1)

Theories: TPB

Healthy eating education components: workshops

Contents: healthy eating lessons

School environment change components: canteen modification,, loyalty programs

Contents: healthy foods in canteen, FV distributions, subscription (paying for regular access) to healthy foods, and incentives for purchasing healthy foods

Family involvement components: Parents meeting

Content: discussion on promoting healthy eating behaviour among their children

Duration of interventions: 1 week to 2 years

Follow-up range: 2 weeks to 2 years

Inadequate evidence in improving healthy eating behaviour across all studies

No conclusion; 8 (high quality)

Vézina-Im LA et al., 2017 [35]

Study design:

RCT (n = 13), quasi-experimental (n = 11),

pre–post (n = 12)

Theories: SCT, TPB, DIT, ET, SDT, ELM, SRT, TIT

Curriculum components: workshops

Contents: consequences of SSB intake, healthy eating goal setting, self-monitoring of eating behaviour

School environment change components: canteen modification

Contents: replacing SSB with healthier alternatives (milk, juice, water) in vending machine

Family and community involvement component: parents’ meetings, social support groups, healthy eating information handouts

Contents: healthy eating knowledge, parents and family involvement to share experience, challenges and encourage healthy eating behaviour, information distribution via newsletter, emails, postcards

Duration range: not reported

Follow-up range: not reported

72% of the included studies reported decreased intake of SSB

Promising; 9 (high quality)