The Journal of School Nursing
© The Author(s) 2020
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DOI: 10.1177/1059840520924718
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2022, Vol. 38(3) 226–232
Interventions targeting school meals have been used to combat obesity in rural youth. Parents play a powerful role in childhood nutrition; however, we know little about parents’ perceptions of school meal programs. This study aimed to understand parents’ perceptions of school meal programs. Surveys were administered to middle school parents (n = 576) at six schools in a rural state. We conducted univariate and multivariate analyses to measure parents’ overall perceptions of the school meals program and to identify differences in perceptions by their children’s participation in the Free and Reduced Price School Meals (F&RM) program. Parents had largely negative views of school meals but agreed that they met students’ needs. Results of the multivariate analysis revealed differences in perceptions by participation in F&RM including the relative importance of meal components. Including parents in meal-related experiences and decision making could improve their perceptions and increase children’s participation in school lunch programs.
national school lunch program, nutrition, middle school, food service staff, school nurse
School staff, stakeholders, and policy makers all take a great deal of interest in the meals that schools provide to students. The role that school meals play in student health has been of particular concern as obesity rates have risen, especially among children (Ogden et al., 2015). To combat the obesity epidemic, one strategy of the past 10 years has been to change the nutrition requirements of school meals (U.S. Department of Agriculture (USDA) Food and Nutrition Service [FNS], 2018). Although some of these changes were met with criticism, the new nutrition standards have improved students’ access to healthy meals (Schwartz et al., 2015). Access does not equate to consumption, however, and understanding the influences on students’ behavior is important to increase consumption of school meals. Parents play an important role in their children’s nutritionrelated behaviors (Pearson et al., 2009), which in turn may influence a child’s participation in school meals. Yet we know little about parental perceptions of school meals outside of anecdotal accounts; thus, this study was designed to more clearly identify those perceptions.
Childhood obesity continues to be a public health concern in the United States, and the prevalence of obesity increases as children grow older (Ogden et al., 2015). Multiple levels of influence impact childhood nutrition behaviors, including individual behavior, home environment, and school environment. Schools provide students with meals that are partially federally funded by the National School Lunch Program (NSLP), and these meals ensure access to healthy foods during the school day (USDA FNS, n.d.). As obesity rates continued to rise during the 2000s, the Healthy, Hunger-Free Kids Act of 2010 was enacted, which set nutrition standards for school meals (USDA FNS, 2018). That legislation set limits on sugar, sodium, and fat along with weekly minimums for servings of fruits, vegetables, and whole grains (Caruso & Cullen, 2015). Changes to the NSLP guidelines have acted as an important intervention for improving students’ consumption of certain healthy foods (Schwartz et al., 2015). Not only does school lunch have the potential to increase consumption of healthy foods, but research has shown that the meals provided at school are usually healthier than those prepared at home (Caruso & Cullen, 2015).
Parental behavior and the home environment also impact childhood nutrition, with parents influencing childhood diet through a variety of pathways (Savage et al., 2007; Shier et al., 2016). Both parental modeling and parental intake have been shown to be positively associated with children’s fruit and vegetable intake (Draxten et al., 2014; Pearson et al., 2009). Parents can also impact their children’s habits by acting as the gatekeeper to foods consumed at home (Savage et al., 2007). Overall, parents influence children’s ability to maintain a healthy diet and body weight throughout life by controlling the foods eaten at home, shaping dietary habits, and conveying nutrition attitudes, beliefs, and behaviors to their children (Craigie et al., 2011; Scaglioni et al., 2018; Scaglioni et al., 2008; Wolnicka et al., 2015).
While parental opinions may support children’s school lunch participation, the reverse may also be true. Few studies have explored parent perceptions of school meals. One foundational study asked parents their views on the purpose of school lunch, the changes since they were in school, and the policy changes to school meals (Golembiewski et al., 2015). The majority of parents identified the purpose of school meals as providing students with healthy meals (65.3%), but also noted that after changes were enacted, less food was being served (45.8%), and the food was less appealing (34.2%). Another study found that the more healthful the parent perceived the school meals, the more likely their child was to eat school meals (Ohri-Vachaspati, 2014). While this study provided support for parental influence on school meal participation, no other study has probed for details of parents’ perceptions of the NSLP, including the importance of individual meal components, or the purpose of the NSLP (Ohri-Vachaspati, 2014). The purpose of our exploratory study is to answer two research questions: (1) What are parents’ perceptions of the NSLP? and (2) Do parent perceptions of school lunch vary by their children’s participation in the Free and Reduced Price School Meals (F&RM) program? There are no hypotheses for this study because of the exploratory nature of its assessment.
For this study, we used a quantitative exploratory design to answer our research questions. A one-time Qualtrics survey was sent to parents during the fall of the 2016–2017 school year as part of a larger evaluation of a school nutrition intervention. This study was approved by the University of Iowa Institutional Review Board.
Parents of middle school students from six schools in a rural Midwestern state were invited to participate in an online survey. Five of the schools were located in rural areas, and one was in an urban area. To participate in the study, schools followed set application procedures and were selected by project staff based on readiness to implement a nutrition intervention (with the study presented here built into the evaluation). Middle school grades for the participating schools ranged from fifth to eighth grade. The F&RM program enrollment rates for the schools ranged from 18% to 42%.
Data were collected in six intervention schools, during the preintervention phase in the 2016–2017 school year. The survey, which took 5–10 min to complete, was administered online through Qualtrics. Administrators at each school sent emails to parents at the beginning of the school year describing the project and that they would be invited to participate in an online survey. Parents were able to self-select entry into this study by choosing to enter and complete the survey. The survey began with a consent document that described the elements of informed consent. By advancing to the survey questions, parents gave their consent to participate.
The research team developed the 24-question survey with a combination of multiple-choice, Likert-type scale, and open-ended responses. Survey items were informed by a previous study assessing parental perceptions of school lunch (Askelson et al., 2013). The items have face validity, as they were reviewed and improved based on feedback from two public health professionals. We first asked parents whether their middle school child participated in the F&RM (yes/no). This sociodemographic variable acted as the outcome variable that we used to examine differences by selfreported participation status.
We used additional questions to assess school lunch participation, including why their child(ren) ate school lunch, with the option to check all that applied from a list of 10 reasons such as there is no time to pack a lunch from home, my child likes school lunch, and school lunch is a good value for my money. Responses were coded as selected or not selected for each item. Parents were also asked to identify the purpose of the school meals program, by selecting all that applied from a list of seven options. Among the options were the following: provide school children with healthy food, help families who are struggling to feed their children because they do not have enough money, and use up surplus food produced by farmers. Responses were coded as selected or not selected for each item.
We solicited parents’ level of agreement (from 1 = strongly disagree to 5 = strongly agree) with six statements about school meals, including school meals are healthy, healthy school meals will help improve my child’s performance, and the food service staff at my child’s school seems well-informed about school meal nutrition.
Finally, parents identified how important specific components of school lunches were to them (from 1 = not at all important to 7 = very important). Meal components included fresh fruits and vegetables, protein-rich foods, whole grain bread, and food prepared from scratch, along with the more general feature that children think school meals taste good.
Using Stata14, we first conducted a univariate analysis to better understand the sample of parents (n = 574) participating in this study and their perceptions of the school meals program. We estimate the response rate to be 17.3%. This is likely an underestimation because one of the schools included grades K–12th, and all parents were included in our total possible population (but only middle school student parents were recruited). Next, to account for school differences, we conducted a multivariate analysis to examine differences in perceptions of school meals depending on parent self-reported participation status in the F&RM program. It was necessary to conduct multivariate rather than bivariate analysis because of the nested structure of participants in the sample (parents recruited within each school). Including schools as a control variable accounted for the shared likeness of responses of parents from the same school (Osborne, 2008). Six middle schools were participating in the intervention, and we created a school variable with five categories, each category representing one school, to control for the shared likeness of responses within schools. Logistic regression was used to explore the relationships, as the dependent variable was dichotomous. The results are reported as odds ratios (ORs), with an OR above 1 being an increased odds of an event occurring, while an OR below 1 is a decreased odds of the event occurring.
The online survey was completed by 576 parents from six schools. All univariate results are reported in Table 1. Most parents said that their child(ren) were not enrolled in the F&RM program (86.5%). Most also reported that their child(ren) did not eat school breakfast during the previous week (84.5%), but that they did eat school lunch at least 4 out of 5 days during the previous school week (72.8%). Overall, parents thought that the cost of school meals was reasonable (60.8%).
The top three reasons children choose school lunch according to parents were the child liked it (46.2%), the child’s friends ate school lunch (34.4%), and the lack of time to pack a lunch at home (28.3%). Among the three top reasons parents selected for children bringing lunch from home were the child did not like what was being served for school lunch (47.4%), the parent knew what the child was eating if the food came from home (16.5%), and the parent knew the food sent from home was healthy (15.8%).
The purpose of the school meals program most frequently selected by parents was to provide children with food during the school day (80.7%) and, more specifically, to provide healthy food (66.5%). Parents had overall negative perceptions of school meals, as well as the changes to school lunch since they had been in school. The most frequent responses being that they would be less likely to eat school meals served now (38.4%) and that school meals look less appealing (38.2%) than when they were students. When asked about the importance of certain components of school lunch, they identified fresh fruits and vegetables (M = 6.2, SD = 1.1) and protein (M = 6.1, SD = 1.3) as important components of school lunch, more so than whole grains (M = 4.9, SD = 1.7) and meals made from scratch (M = 5.1, SD = 1.7).
Parents were ambivalent about the healthfulness of school meals (M = 3.4, SD = 1.1) and unsure about their child getting enough food to eat (M = 2.8, SD = 1.3). Finally, parents reported that their children’s health behaviors were important to them, including drinking enough water (M = 4.7, SD = 0.6), eating more fruits and vegetables (M = 4.6, SD = 0.6), and reducing the amount of sugarsweetened beverages consumed (M = 4.5, SD = 0.8).
Assessing the associations between F&RM enrollment and parent perceptions of school meals with multilevel logistic regression analysis (Table 2), we found significant differences by F&RM enrollment in the reasons food is not sent from home. Parents of children receiving F&RM were more likely to not send a lunch from home because they could not afford to (OR = 26.49, p < .001). They also considered school lunch to be better than food made at home (OR = 4.06, p < .001) compared to parents of children not receiving F&RM.
Parents of children receiving F&RM were significantly more likely to perceive the purpose of school lunch as helping to feed children due to familial barriers, specifically not enough money (OR = 1.81, p < .05) and not enough time (OR = 1.92, p < .05). Those parents of children with F&RM were also more likely to perceive that the purpose of school lunch was to use surplus foods (OR = 2.77, p < .05) and to give students a break (OR = 2.43, p < .01).
Regarding F&RM enrollment and perceptions of school lunch components, we found differences in two areas. First, as the perceived importance of whole grains in school meals increased, the likelihood of being a parent of a child receiving F&RM increased (OR = 1.20, p < .05). Second, as the perceived importance of the taste of school meals increased, the odds of being a parent of a child receiving F&RM decreased (OR = 0.83, p < .01).
Finally, parents of a child receiving F&RM were more likely to report positive views of school lunch programming. The higher the level of parents’ agreement that school lunch makes their child healthy, the higher the level of their agreement that they could tell if the meals at school were healthy (OR = 1.47, p < .01) and that food staff were well informed about nutrition (OR = 1.53, p < .01).
Univariate analysis revealed that parents believed that the purpose of school lunch was to provide food to students, with many identifying the purpose being to provide healthy foods specifically. The fact that these perceptions are consistent with the description of the NSLP (USDA FNS, 2017) indicates that parents are knowledgeable about the program and its purpose. However, parents also had negative perceptions, especially related to the changes made to school lunch since they were children. These negative views are not altogether surprising given the negative press that school lunches received following the enactment of the Healthy, Hunger-Free Kids Act. The rurality of the respondents may also be a factor because schools in rural areas were more likely to report student complaints and reduced participation in the NSLP following the changes to nutrition standards (Turner & Chaloupka, 2014). Even 8 years (at the time of this study) after the nutrition policy changes, rural parents continue to view school meals negatively, which suggests a need to improve parental perceptions of school meals.
The univariate results also showed that parents considered certain lunch components more important than others, specifically fruits, vegetables, and proteins, while whole grains and meals prepared from scratch were less important. One explanation for the lower rating of whole grains could be that parents believe they offer adequate amounts of whole grain options at home (Burgess-Champoux et al., 2006), which would make them less concerned about that component of school lunch. Parents’ ranking of meals made from scratch as less important is somewhat harder to explain. Perhaps they are less concerned because they know that school meals, however prepared, must meet nutritional guidelines, or they may simply not believe that making school meals from scratch will improve their quality.
Multivariate analysis revealed differences by enrollment in the F&RM program, with parents of enrolled children being more likely to report positive perceptions of the school meals’ program. Specifically, parents of children not receiving F&RM program were less likely to perceive the school meals program in a positive light than parents of enrolled children, who may have a better understanding of the purpose of the NSLP. These results are similar to those of Ohri-Vachaspati (2014), who found that children who ate school lunch had parents with more positive perceptions. It seems clear that participation in school lunch is influenced by parent perceptions, either their positive views of the program or their perception of its necessity (i.e., basic food access), the latter view likely impacting F&RM program enrollment as well.
Parents volunteered to participate in this survey, so participation bias could have resulted from those who are more involved or have strong opinions about school lunch selfselecting. Univariate results show that perceptions were not polarized suggest strong opinions did not bias results; however, parents of children not receiving F&RM made up much of the sample, suggesting enrollment status may impact participation. A second limitation, which is linked to the first, is that our sample did not reflect actual F&RM program participation rates. Since this was an exploratory study, we considered a convenience sample appropriate for our investigation. Nevertheless, these findings provide valuable insight about parents’ perceptions of school meals.
These findings are particularly relevant for school nurses, who are often on the frontlines of school health initiatives and are a highly motivated group to tackle issues related to childhood obesity and healthy eating. A qualitative study conducted with school nurses found that many believe one of their roles is to advocate for healthy eating within their schools and support efforts by role modeling healthy eating and educating students (Muckian et al., 2017). Therefore, this group has the potential to play an important role in the promotion of healthy eating, and their experience as educators should be drawn upon for future efforts. Moreover, school nurses are highly aware of the issues of childhood obesity but believe current efforts within schools are insufficient (Morrison-Sandberg et al., 2010). As our findings suggest that parental perceptions of school lunch are important, we have two suggestions for how nurses could best support this effort. The first focuses on parents; nurses should increase positive communication about the school lunch program to the parent population to encourage more parents to participate in the program. School nurses could also work closely with food service staff to engage parents in discussions about the importance of school meals and healthy diet. The second focuses on students; as highlighted in qualitative work (Muckian et al., 2017), nurses could role model eating school lunch for students in an effort to increase students’ school lunch consumption.
The findings of this study suggest a need for more engagement of rural middle school parents in school meal programs to improve their perceptions of school meals. In collaboration with nurses, there are many opportunities for schools to tackle this issue. Schools could offer taste tests at school events or family meals during school conferences to encourage parents to try school meals. In that way, parents would have an opportunity to form their opinions based on experience. Schools could also create advisory boards so parents could interact with food service staff, learn nutrition standards, and help with school meal planning, all of which would increase their understanding of the program. The formation of an advisory board would clearly demonstrate a school’s desire to engage parents in decisions related to food service and nutrition. Existing wellness committees could likewise invite parents to participate in their efforts, which could result in valuable parent feedback on nutrition-related policy, systems, and environmental interventions.
Cristian L. Meier, Natoshia Askelson, Patrick Brady, and Grace Ryan contributed to the acquisition, analysis, and interpretation of the data, while the manuscript was drafted by Cristian L. Meier. All authors conceptualized the manuscript, were involved in the revisions, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This study was funded by Food and Nutrition Service (Grant No. CFDA 10.574).
Cristian L. Meier, PhD, MSW, MPH https://orcid.org/0000-0001-6328-4272
Grace Ryan, MPH https://orcid.org/0000-0002-0354-2644
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Cristian L. Meier, PhD, MSW, MPH, is an assistant professor at Utah State University.
Patrick Brady, MS, is a PhD student, at University of Iowa.
Natoshia Askelson, PhD, MPH, is an assistant professor at University of Iowa.
Grace Ryan, MPH, is a PhD student at the University of Iowa.
Patti Delger, RD, is at the Iowa Department of Education.
Carrie Scheidel, MPH, is at the Iowa Department of Education.
1 Utah State University, Logan, UT, USA
2 University of Iowa, IA, USA
3 Iowa Department of Education, Des Moines, IA, USA
Corresponding Author:Cristian L. Meier PhD, MSW, MPH, Utah State University, 0730 Old Main Hill, Logan, Utah 84322, USA.Email: cris.meier@usu.edu
