Classification of arrangements of snacks and meals in Brazilian schools: development and content validity for assessing food healthiness

Abstract

Objective: This theoretical-methodological study aimed at developing and validating the content of a classification of arrangements of snacks and meals, designed to assess food healthiness in Brazilian schools, in a simplified manner. Methods: The study was grounded on the premise that the decision-making level of the organizational food environment may shape food healthiness within institutions. Thus, this classification does not intend to evaluate foods directly but rather the potential for food to be more (or less) healthy according to school management rules and decisions regarding the arrangement of snacks and meals. The classification was developed in three stages: construction of a proposal based on knowledge generated through university extension; appraisal by a panel of experts from the five regions of the country (Delphi method); and definition of the final classification. Results: Six arrangements of snacks are presented, ordered according to the potential exposure of students to unhealthy foods; and five arrangements of meals, ordered according to the degree of school control over food combinations and portion sizes. There was a high agreement among experts regarding the relevance and comprehensiveness of the classification, and the clarity of arrangements’ nomenclature, description, and ordering (Content Validity Index from 0.80 to 1.00). Adjustments to nomenclature and descriptions were made according to panel suggestions. Conclusion: This classification is innovative, simple, and feasible for use in large-scale research as an alternative to exhaustive food audits. Future criterion validation is expected.