A national evaluation of school breakfast clubs: evidence from a cluster randomized controlled trial and an observational analysis

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Abstract
Study objective To measure the health, educational and social impacts of breakfast club provision in schools serving deprived areas across England. Design A cluster randomized controlled trial and an observational analysis. Setting England, the UK. Intervention: funding to establish a school‐based breakfast club vs. control (no funding). Main results Intention to treat analysis showed improved concentration (Trail Making Test Part A) amongst the intervention group at 3 months. Fewer pupils within the intervention group reported having skipped classes within the last month and fewer pupils within the intervention group reported having skipped 1 or more days of school within the last month at 1 year. Observational analysis at 1 year showed a higher proportion of primary‐aged breakfast club attendees reported eating fruit for breakfast in comparison to non‐attendees. A higher proportion of breakfast club attendees had borderline or abnormal conduct and total difficulties scores (primary‐aged pupils) and prosocial score (secondary‐aged pupils). Conclusions Analyses revealed a mixed picture of benefit and apparent disbenefit. This study illustrated the challenges of evaluating a complex intervention in which the evaluators had less control than is usual in randomized trials over recruitment, eligibility checking and implementation. If the impact of new policy initiatives is to be assessed using the most robust forms of evaluation, social policy needs to be organized so that evaluations can be constructed as experiments. This is likely to prove most difficult where the perceived value of implementing an intervention rapidly is high.