Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Leah Carpenter, M.P.H

Second Committee Member

Lynette M. Smith, Ph.D.

Third Committee Member

Jennie L. Hill, Ph.D.

Fourth Committee Member

David A. Dzewaltowski, Ph.D.


Background: The most recent estimate of the prevalence of child and adolescent obesity in the United States is 17% (Ogden, Carroll, Lawman, & et, 2016). Based on evidence that the availability of healthy food at schools can significantly impact the nutrition behaviors of children, the Healthy and Hunger Free-Kids Act sets policy for the United States Department of Agriculture (USDA), which includes the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) (USDA, 2017a). School food authorities (SFAs) are responsible for administering school feeding programs (Byker, Pinard, Yaroch, & Serrano, 2013). In other words, local school authorities (school districts) design lunch menus that meet the USDA meal pattern and schools within the districts are expected to deliver the menu as intended. However, there is lack of information to determine if schools deliver the school district lunch menu as intended or if they adhere to the feeding program. Hence, the purpose of this study was to develop, and to establish content validity of an observation tool used to access and report the school district lunch menu implementation across three assessment period of the elementary school lunch time. (i.e., in the beginning, middle, and end of the lunchtime).

Methods: The development of this tool involved two phases: (1) Development phase and, (2) Content validity phase. For phase 1, the tool was developed based on existing tools from the literature and the USDA Lunch Meal Pattern. For phase 2, the content validity of the tool was established using research and practitioner raters, who were experts in nutrition and familiar with USDA policy on school meals.

Results: The results of this study were organized according to the two phases established in this study. For phase 1, there were three (3) items and four (4) sub-items generated and operationalized for the school lunch menu implementation outcome tool. These items included school menu implementation outcome, quantity, and quality of the meal. The four sub-items, (which were referred to as the four indicators of quality) included meal appearance, fresh/whole food item, transitioned food item, and highly processed food item. For phase 2, each item was rated by 5 expert raters. One of the sub-items “meal appearance’ was eliminated, and the remaining items were retained based on a minimum value of 0.99. Also, more emphasis was placed on the sub-item “meal appearance” as being subjective if measured.

Discussion/Conclusions: The school lunch menu observation tool, based on a literature review, is the first tool developed to measure the implementation outcome of school district lunch menus. Data from the second phase demonstrated content validity. The items received perfect scores based on the rating metrics. This study findings suggest that public health researchers conduct further research to validate an instrument of school lunch implementation. A observation tool of this type may be useful for public health research and practice.

Keywords: Childhood Obesity, Content validity, School lunch program, Observation tool.

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