Happy Healthy Homes is a randomised controlled trial (RCT) studying the efficacy of in-person and virtual interventions on family child care home (FCCH) providers’ nutrition practices, self-efficacy, and Child and Adult Care Food Program (CACFP) knowledge. FCCH were randomly assigned to the intervention (NUT) or attention control (CON). Cohort1 (in-person 2017–2018) included 45 (NUT n = 24; CON n = 21) FCCHs. Cohort2 (virtual 2020) included 36 (NUT n = 15; CON n = 21) FCCHs. Outcomes included self-reported nutrition practices, confidence, barriers, and CACFP best practice knowledge. Measures were collected at 3 and 12 months. The primary 12-month analyses accounted for intent-to-treat and used a mixed model on all providers with 3-month outcomes including those who withdrew prior to 12-month assessments. At 12 months, both cohorts demonstrated significant effects. In Cohort1, NUT improved self-reported beverages provided and feeding environment, and confidence in serving healthy foods, while CON remained unchanged. No changes were observed for CACFP best practice knowledge. In Cohort2, NUT did not demonstrate a group effect over time for self-reported nutrition practices. NUT did increase confidence in serving healthy foods and decreased barriers related to food waste, whole grain service, children’s healthy eating habits, and CACFP best practice knowledge while CON experienced minimal changes. This study demonstrated that in-person and virtual interventions can help FCCHs improve their nutrition practices, confidence, and barriers in serving optimal foods, and knowledge in CACFP best practices. The utilisation of virtual interventions may increase reach in rural areas and be appealing to FCCH providers.

Clinicaltrials.gov, NCT03560050. Retrospectively registered on 23 May 2018. First participant enrolled October 2017. Trial protocol and analyses plan can be accessed on clinicaltrials.gov.

The double burden of malnutrition (DBM) – the coexistence of undernutrition and overweight/obesity – poses a critical global health challenge, particularly for children and adolescents. School meal programmes offer an opportunity to address the DBM by providing nutritious meals that support growth, development and lifelong health. However, limited school meal quality data hinders effective programme design. This study evaluates global school meal quality through nutrient composition analyses and the Global Diet Quality Score (GDQS)-Meal and -Menu metrics.

Data were collected from the Global Child Nutrition Foundation’s 2024 Global Survey of School Meal Programs, grey literature and in-country stakeholders. Nutritional content was compared to age-specific Nutrient Reference Values, including Harmonized Average Requirements. The nutritional quality of meals and menus was assessed using GDQS metrics based on twenty-five food groups.

Twenty-nine countries across diverse geographic and socio-economic contexts.

Not applicable.

Most menus met or exceeded 30 % of recommended daily nutrient values. Lunches had the highest nutrient contributions, followed by snacks and breakfasts. GDQS-Meal and -Menu scores revealed variability across age groups, meal types and countries. Overall, 57 % of menus achieved high nutritional quality, 37 % medium and 6 % low. Few menus lost points for unhealthy components. Diverse, balanced menus with healthy food groups scored higher, though fortification also proved nutritionally valuable.

While most menus contribute significantly to daily nutrient needs, variability across countries, age groups and meal types highlights opportunities for context-specific improvements through diversification and fortification. Learning from high-performing peer programmes can help identify feasible improvements.