Background There is a need to address the poor dietary patterns of UK adolescents to reduce their risk of obesity and other lifestyle-related diseases. Schools provide an opportune setting to do so, as typically students consume at least one meal a day whilst at school. There is a developing research base on the use of food choice cues to promote healthy eating in school contexts. To support effective planning, it is necessary to understand the acceptability, feasibility, economic viability and potential opportunities and challenges of implementing such interventions. We aimed to explore these implementation factors from the perspectives of secondary school caterers.

Methods A qualitative study using remote interviews. We aimed to recruit catering staff from different secondary schools across the West Midlands, UK and invited representatives from national/regional catering providers. Interviews were structured around a topic guide and visual aid comprising images and brief explanations of example healthy food cues. We collected data on age group, job role and employer. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12.

Results 12 participants took part (school catering managers/supervisors n=9; regional/national catering representatives n=3; 67% employed by external catering providers). Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Level of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as it requires minimal reflective motivation on the part on the young person. Salient strategies included enhancing the positioning, visual appeal and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity/portion size. Student engagement was seen as important in designing new food offerings. Some catering decision drivers conflicted with healthy eating strategies e.g. concerns over economic viability and food allergies. Some caterers felt that their role in healthy eating was diminished by external influences upon adolescent food choice, adolescent resistance to healthy eating efforts, and for some, a perception that school food is already healthy enough. Caterers believed healthy eating to be part of their role, so appeared motivated to implement healthy food cues; and identified key opportunities to implement these e.g. with year seven students.

Conclusion This research found that interventions using healthy food cues are acceptable to secondary school caterers, who are key implementers of these strategies. The exploration of the feasibility and acceptability of specific strategies will help inform future approaches to school food intervention.