Fueling Bright Futures: A Case Study on Integrating Gardens, Canteens, and Nutrition Training in Philippine Public Schools

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Hoang, Patricia Isabel A. Matienzo, Diana Jean Umali, Ma. Shiela Anunciado, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7701168/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Introduction: This case study evaluates Fueling Bright Futures , an integrated approach involving enhancing school gardens, improving the menu of canteen, and providing nutrition education in three public schools in Cavite, Philippines. The intervention addresses both undernutrition and overnutrition, tackling the double burden of malnutrition among Filipino schoolchildren. Methods This mixed-methods study was conducted in three public elementary schools in Cavite, Philippines. Baseline and endline assessments (Apr 2024, Feb 2025) included canteen menu audits (per DepEd Order 13), garden inventories, and focus groups with staff and administrators. Effectiveness and scalability were evaluated using the Intervention Scalability Assessment Tool (ISAT) in participatory workshops with policymakers and stakeholders. Qualitative data from all sessions were coded and thematically analyzed via NVivo14 and mapped to ISAT domains. Results All the schools made substantial gains in garden output, dietary diversity, and the nutritional quality of canteen offerings. The number of “green” menu items increased sharply (School A: 2—11 per week), whereas the number of “red” foods decreased substantially (School B: 10—2 per week; School C: 13—4). Canteen staff adjusted recipes to use more garden produce, although some packaged snacks persisted. Barriers included limited resources, irregular garden supplies, time constraints, and outside processed food vendors. Strong leadership and community participation elevated acceptability, but infrastructure and sustainability challenges persisted. Conclusions Improving and integrating school gardens, improved canteen menus, and staff training can enhance school food environments in resource-limited schools. Success requires strong leadership, partnerships, practical planning, and sustained resources. Ongoing investment and collaboration are critical to building nutrition-friendly school environments that support students’ health and well-being. School nutrition food environment school garden school-based feeding scalability child dietary behavior participatory approaches local food systems Philippines Figures Figure 1 Figure 2 1. Introduction School-aged children in the Philippines face a dual burden of malnutrition, with persistent undernutrition coexisting with rising rates of overweight and obesity. In 2019, among the 12.7 million children assessed, 13.2% were stunted or wasted. By 2021, obesity affected 10–14% of children aged 5–10 years, up from 9% in 2013 [ 1 ]. Stunting remains a major concern, with the Philippines ranking among the highest in the Asia–Pacific region at 27% for children under 5—an indicator that mirrors challenges persisting into school age [ 1 ]. A key contributor is poor dietary diversity. Filipino children increasingly consume energy-dense, processed foods, whereas fruit and vegetable intake remains very low (approximately 5–6% of school meals) [ 1 – 3 ]. Moreover, micronutrient deficiencies, socioeconomic disparities, and easy access to unhealthy food inside and outside schools further exacerbate this problem [ 1 ]. In this context, the school food environment is both a risk and an opportunity. School-based nutrition initiatives—especially when gardens, healthy canteen offerings, and classroom-based nutrition education—have shown promise in improving children’s diet quality, nutrition knowledge, and even academic outcomes worldwide [ 4 – 6 ]. However, in the Philippines, such interventions are rarely evaluated for scalability and long-term sustainability. School canteens in the Philippines are central to shaping children’s diets and are regulated through a series of Department of Education (DepEd) policies. These include DepEd Order No. 13, s.2017 on healthy food and beverage choices [ 7 ]; DepEd Order No. 8, s.2007 on canteen management [ 8 ]; DepEd Order No. 031, s. 2021, on the School-Based Feeding Program [ 9 ]; and alongside directives on food safety and nutrition. Collectively, these policies aim to promote healthy eating habits by positioning canteens as accessible platforms for translating national nutrition standards into daily school practices. For many students, particularly in low-resource settings, the quality of canteen offerings represents a substantial portion of their daily nutrition. Studies have shown that school canteens often fail to meet recommended nutrient intakes for children [ 10 ], highlighting the critical role of the school environment in influencing dietary behaviors and establishing healthier lifelong habits [ 9 , 10 ]. For many students, particularly in low-resource settings, the quality of canteen offerings represents a substantial portion of their daily nutrition. As such, the school environment is crucial for influencing dietary behaviors and establishing healthier lifelong habits (9, 10). Despite progress in policy development, the implementation of school nutrition guidelines in the Philippines remains inconsistent due to limited resources, weak monitoring, and competition from external vendors [ 12 ]. These challenges highlight the need for integrated, context-specific interventions such as Fueling Bright Futures , a pilot intervention that combines improving school gardens, healthier canteen offerings, and hands-on nutrition education. This paper evaluates the pilot’s implementation and outcomes in public schools with three objectives: (1) assess the effects of garden improvements, canteen reforms, and staff training; (2) explore stakeholder perspectives and operational challenges to sustainability; and (3) examine scalability via the Intervention Scalability Assessment Tool (ISAT) [ 13 ]. The use of a mixed-methods case study aims to generate evidence to guide the strengthening and expansion of school nutrition programs in the Philippines and comparable contexts. 2. Materials and methods 2.1. Case Study Design A convergent mixed-methods design was employed to quantify intervention effects while capturing the complexities of real-world implementation in schools. Purposive sampling focused on institutions enrolled in the Department of Education’s Integrated School Nutrition Model (ISNM), ensuring that schools had established gardens and accountability to national nutrition priorities. This design enabled a comprehensive evaluation of the added value of formally linking school gardens with canteens—a feature not previously emphasized within the ISNM. The quantitative tools used included the ISAT, programmatic checklists, and school food environment surveys, whereas the qualitative methods involved focus group discussions (FGDs) and participatory workshops. 2.2. Setting and Participants The study was conducted in three public elementary schools in Cavite, Philippines: School A (small), School B (medium), and School C (large). These schools were purposively selected to reflect variation in size, resource availability, and community context. All the schools were part of the ISNM and had preexisting gardens and canteens. The study participants included canteen and garden staff, teachers, administrators, and school heads, capturing a comprehensive range of perspectives on the intervention’s implementation. 2.3. Sampling and Recruitment Methods A stratified purposive sampling approach was used to ensure representation across small, medium, and large ISNM schools with active gardens and nutrition programs in Cavite Province. Recruitment within each school focused on permanent teachers, canteen staff, garden coordinators, and administrators in SY 2024–2025. Standardized pre- and postintervention observations fostered consistency and data validity. For broader perspectives, participatory workshops included DepEd officials, school leaders, teachers, and technical experts from UN agencies and civil society, who discussed and scored each ISAT domain to evaluate scalability from multiple sectoral viewpoints. 2.2. Intervention Description The Fueling Bright Futures intervention consisted of four integrated components designed to enhance school nutrition holistically: 1. Garden diversification and adoption of agroecological practices : This involves diversifying school gardens through the application of agroecological approaches and the cultivation of climate-resilient, indigenous crops while strengthening linkages with school cafeteria to increase the supply of fresh, locally grown produce and promote long-term sustainability. 2. Canteen technical assistance: School canteen menus were reformed through practical, participatory training aligned with DO13, increasing the availability of healthy, policy-compliant meals. 3. Capacity strengthening and nutrition education for cooks and managers: Targeted training sessions were provided to school canteencafeteria cooks and managers to increase nutrition literacy, increase the quality of meal preparation, and ensure adherence to DO13 and nutrition standards. 4. Advocacy with school administrators: Strategic advocacy encouraged administrators to strengthen their commitment to maintaining improved food offerings and provide sustained oversight for DO13 compliance. All tools were piloted with a small sample of participants to ensure clarity and appropriateness. On the basis of pilot feedback, necessary modifications were made prior to the main study. 2.3. Assessment instruments · School Meals and Environment Assessment Tool: Evaluated compliance with DO13 in three parts: (1) planned menu review against the traffic light system (green daily, yellow 1–2 times/week, red not at all), (2) direct observation of actual offerings, and (3) assessment of the environment for prohibited marketing of red-category foods. School Garden Checklist and Policy Compliance Instruments: Objectively appraised garden productivity, menu diversity, and adherence to national nutrition guidelines via observations and a checklist. ISAT and ISAT-Aligned Guides: The ISAT was used to systematically evaluate scalability. To ensure a thorough exploration of all ISAT domains, the research team developed ISAT-aligned guides for FGD and participatory workshops. These guides and the ISAT scoring sheet were developed specifically for this study and have not been published elsewhere. English language versions are provided as follows: the ISAT scoring sheet in Supplementary Material A, the FGD guide in Supplementary Material B, and the workshop guide in Supplementary Material C. 2.4. Qualitative Data Collection Procedures Qualitative insights were collected through the following: Focus Group Discussions: Three FGDs (one per school), each with 4–6 participants (canteen staff, teachers, administrators), totaling 13 participants. Each FGD lasted approximately 50–60 minutes. Participatory Workshops and ISAT Assessment: To assess scalability systematically, two participatory workshops were convened by Helen Keller Intl and IIRR, which involved approximately 50 stakeholders—including representatives from schools, the DepEd, government agencies (such as the Department of Health, DOST-FNRI), international organizations (UNICEF, World Food Programme), the Philippine Association for Nutrition, and leaders from the three pilot schools. Each three-hour workshop provided broad multidisciplinary input for the use of the ISAT. The participatory workshops were facilitated by project staff with professional backgrounds in public health, dietetics, and agriculture to guide discussions and support an inclusive, informed assessment process. The ISAT is a structured tool designed to assess a program’s readiness for scale-up, covering ten domains: 1) the problem, 2) the intervention, 3) the strategic political context, 4) evidence of effectiveness, 5) intervention costs and benefits, 6) fidelity and adaptation, 7) reach and acceptability, 8) delivery setting and workforce, 9) implementation infrastructure, and 10) sustainability. During the workshops, the participants collaboratively discussed their implementation experiences within and across these domains. After group discussion, each organization or sector nominated a representative—typically a senior lead or focal point—to independently score each ISAT domain on a scale of 0–3. Ultimately, 21 nominated representatives submitted individual ISAT ratings. This process ensured that the results reflected balanced, consensus-based, and transparent multisectoral perspectives rather than individual opinions, yielding context-specific assessments of the intervention’s scalability. All FGDs were audio-recorded and transcribed verbatim in Filipino (Tagalog) and then translated into English. During the participatory workshop, recording was not possible because multiple small group conversations occurred at once; instead, detailed notes were taken in real time. For logistical reasons, the transcripts were not shared with the participants for review. No nonparticipants were present during the workshops or qualitative sessions, and no repeat FGDs were conducted to avoid duplication or respondent fatigue. Data collection ceased once the intended FGDs were completed, and the research team determined that the information from the participants was sufficiently rich and thematically consistent. Although no additional rounds of data collection were undertaken, the study team judged that thematic saturation had been reached, with no major new themes emerging 3. Data collection and analysis 3.1 Study timing and implementation The study was conducted over an 11-month period, from April 2024 to February 2025. Data collection procedures were carefully planned to minimize classroom disruption. Each assessment—school canteen menu audits, school food environment observations, and school garden checklists—was scheduled at specific times (e.g., morning classroom sessions, lunchtime, or after lunch) to fit within normal school routines. Strict adherence to privacy and ethical standards, as outlined by DepEd, was maintained throughout the recruitment and data handling process. 3.2. Quantitative analysis The quantitative data, including garden functionality scores and canteen menu audit results, were summarized with descriptive statistics (means, proportions, temporal trends) and analyzed via statistical software in Excel. For the scalability dimension, the ISAT was administered to a diverse panel of stakeholders representing government, education, and NGO partners. Domain scores were calculated as the means and visually depicted through radar plots to support multidimensional assessment of scalability domains. 3.3. Qualitative Analysis Qualitative data from FGDs and workshops were analyzed with reference to the ISAT framework to ensure that all key scalability domains were addressed. English transcripts and notes were imported into NVivo 14 for systematic coding. Two researchers independently coded the data and discussed the findings. Deductive analysis followed an ISAT-based coding tree (covering fidelity, reach, adaptation, delivery, infrastructure, and sustainability), supplemented by inductive coding for emergent, local insights. Triangulation of qualitative and quantitative data supported a multidimensional understanding of program implementation, barriers, enablers, and scalability prospects. 4. Results 4.1. School and Stakeholder Profile The participating schools represented a spectrum of enrollment sizes and baseline nutrition environments. They ranged from rural to peri-urban settings with active local parent groups to larger peri-urban schools with long-standing canteen operations. All three had existing gardens, but their diversity and management systems varied, mirroring the uneven institutional capacity reported in national surveys. 4.2. School Gardens Across all three pilot schools, gardens consistently demonstrated strong performance, with functionality scores ranging from 14 to 16 out of 18 (Table 2). Rather than large shifts, the results highlight sustained management practices, strategic crop diversification, and adaptation to site conditions via climate-smart practices. All gardens cultivated at least three types of vegetables and legumes plus one fruit tree (typically banana or papaya), contributing to both school menu quality and student learning. In addition to overall functionality scores, crop-level changes in fruit and vegetable diversity illustrate how school gardens were adapted to enhance menu planning and year-round food availability; these detailed shifts at each school are presented in Supplementary Material E, Table 1. Soil health was maintained through compost, manure, and mulching, with School A additionally employing cover crops, especially during the summer season (April—May). Well-fenced beds minimized soil erosion and pest and disease pressure, whereas integration into classroom instruction reinforced gardening as an educational tool. The gardens contained diverse, nutrient-dense crops, used kakawate fertilizer trees, and maintained reliable yields with minimal pest or disease issues, making them valuable resources for school food environments. Students, teachers, and parents support daily upkeep and harvesting, complemented by contributions of planting materials and seasonal assistance from parent volunteers, agricultural officers, and other community partners, including local donors and farmers. Table 2. School Garden Functionality Scores (Maximum Score: 18) School Baseline (Apr 2024) Endline (Feb 2025) Score Range Classification School A (small) 14 16 14–16 Moderate-to-high to High School B (medium) 15 16 15–16 Moderate-to-high to High School C (large) 14 14 14 Moderate-to-high *Classification system: 16–18 = high; 13–15 = moderate-to-high; ≤13 = needs improvement. Notes: Scores derived from a standardized checklist covering crop diversity, use of organic fertilizers, pest and disease management, garden maintenance, student engagement, and integration into classroom instruction. Canteen managers consistently substituted or enhanced meals with available garden produce, aligning garden planting schedules with menu planning to maximize impact. Garden contributions to canteen cafeteria dishes often include amaranth, banana, cassava, chili, eggplant, papaya, string beans, and tomato. These crops are most prevalent because of their adaptability to local conditions and nutritional value. For example, micronutrient-dense foods such as papaya, amaranth, chili, and tomato (high in vitamins A, C, iron, and antioxidants), energy-dense foods such as banana and cassava, and protective vegetables such as string bean and eggplant are rich in fiber and some minor vitamins. We also observed some changes in the diversity and types of crops cultivated over time, which were likely affected by variations due to seasons and the availability of planting material. School A (small): Maintained broad vegetable selection but reduced fruit diversity from 7--5, losing strawberry and dragon fruit but adding chayote, jute mallow, sesame, and rice bean. The continued use of herbs such as oregano has supported pest management. School B (medium): Increased fruit diversity by adding mulberry, cotton fruit, and mango at endline, and expanded vegetables to include winged bean and cowpea. New additions replaced less-adapted crops, reflecting a push for year-round food availability. School C (large): Lost dragon fruit but gained additional vegetables (pechay, squash, sponge gourd, lima bean), increasing variety, soil fertility, and resilience. Minimal pest problems were reported, and the active integration of gardening activities into Edukasyong Pantahanan at Pangkabuhayan —a compulsory primary school subject in home economics and livelihood skills—helped reinforce practical knowledge and student engagement. Parents and other community members further contributed planting materials, labor, and seasonal support, strengthening both food production and the educational value of the school gardens. Overall, despite small declines in fruit diversity at some sites, schools demonstrated greater vegetable variety and maintained robust, well-integrated gardens that enhanced canteen menus, supported experiential learning, and deepened community participation. 4.3. School Menu and Canteen Environment Shifts Progress toward compliance with national canteen policy guidelines revealed encouraging improvements alongside persistent challenges, underscoring the complexity of translating nutrition standards into school practice. None of the three schools reached full adherence to DO13 on healthy food and beverage choices, yet quantitative analysis of planned menus revealed marked gains between baseline and endline. School A expanded “green” food offerings weekly from two to eleven items, School B reduced “yellow” items from 30 to nine and “red” items from ten to two, whereas School C lowered “red” items from 13 to four (see Table 3). Table 3. Weekly Canteen Menu Items by DO13 Traffic Light Category Pre- and Postintervention School Time Point Total Items Per week Green Foods Yellow Foods Red Foods School A Pre 2 4 2 Post 11 7 3 School B Pre 25 30 10 Post 23 9 2 School C Pre 12 13 13 Post 12 12 4 Notes: · Green: <3 g saturated fat, <10 g sugar/carbs, 5 g saturated fat, >20 g sugar/carbs, >200 mg sodium (all 0 g trans fat) In addition to improving menu frequency according to traffic light category, canteens actively modified the nutritional quality of hot meals. Guided by capacity-building sessions, managers applied menu planning concepts to reframe popular dishes with healthier preparation methods and ingredients. Substitutions included replacing ultraprocessed meats with plant-based proteins; enriching meals with eggs and nutrient-dense vegetables from school gardens; and reducing salt, oil, and sugar in dishes such as pancit , champorado , and arroz caldo . These adjustments reflected a practical integration of national nutrition policy with the school garden model and reinforced the use of locally available produce (see Supplementary Material E, Table 2 for detailed recipe modifications). While these adaptations improved nutrient density in hot meals, a closer analysis revealed significant variation in nutritional quality within each traffic light category. Classification alone often concealed differences between packaged and fresh options. For example, School A’s expansion of “green” items from two to 11 was partially driven by the addition of packaged snacks, which accounted for 55% of its green offerings at endline. In contrast, Schools B and C demonstrated a shift toward fresher alternatives: School B reduced packaged green snacks from 20% to 9%, whereas School C modestly lowered them from 62% to 58% (see Table 4). Table 4: Proportion of Green Foods from Packaged Snacks Pre- and Postintervention School Pre Post Comments School A 0% 55% School A increased green hot meal offerings from two to four times weekly but also added multiple green packaged foods. School B 20% 9% School B reduced packaged nut offerings from daily to twice weekly and were replaced with fresh produce and boiled eggs. School C 62% 58% School C maintained green count; but replaced some packaged snacks with hot meals. While quantitative analysis revealed improvements in menu composition and reductions in unhealthy items, it also highlighted inconsistencies in how nutrition standards were applied—particularly the reliance on packaged foods to increase “green” offerings. To better understand the drivers of these patterns, qualitative data were used to explore the operational and contextual challenges shaping canteen decision-making. Across schools, canteen managers noted financial constraints, limited preparation time, inadequate facilities, and irregular garden harvests as barriers to full DO13 compliance. Additionally, “vendor leakage”—the sale of DO13 noncompliant foods by external vendors near campuses—further undermined implementation efforts and limited the nutritional impact of school-based reforms. 4.4. Qualitative insights from key stakeholders: ISAT-guided focus group findings This section highlights illustrative and key findings from specific ISAT domains; the results for other domains are not included here for brevity and relevance but were covered in the broader analysis. The data were systematically coded by the ISAT domain and subdomain to ensure analytic rigor and transparency (see Figure 1 and Figure 2 for the coding tree structure). Each theme below corresponds directly to an ISAT domain, illustrating how stakeholder experiences informed the assessment of the intervention’s scalability. 4.4.a. ISAT Domain A: Evidence of Effectiveness FGDs suggest that Fueling Bright Futures contributed to positive shifts in the school food environment and student nutrition behaviors, although the degree and consistency of these outcomes may vary. Several stakeholders observed that replacing processed foods with locally grown fruits and vegetables in canteens resulted in diverse available choices and made healthy food more appealing, especially where menu innovations were implemented. Notably, changes in food perceptions among students took time, with some overcoming initial skepticism. “Initially, they thought vegetables were just weeds. Now they’ve discovered that these can be cooked and eaten…They didn’t realize they were edible.”—Canteen staff, School C “The most impressive activity I’ve seen is what they offer in the canteen. They sell food…using bananas and vegetables…that could be replicated in other schools.” —Canteen staff, FGD, School C While these improvements were encouraging, the impact extended beyond just food offerings. The participants noted a shift in purchasing habits toward the school canteen and away from outside vendors, as well as the development of students’ practical skills through participation in gardening and food preparation. The extent of these changes depended on student engagement and exposure to new recipes, which seemed to increase curiosity and openness over time. “When they saw [vegetable juice] being prepared, they became curious…They weren’t interested before but gradually tried it…vegetables can be used in juice.”—Canteen staff, FGD, School B “Before, there were many [vendors], but now there’s only one…[kids] just buy here inside, which is fine.” —Canteen staff, School B 4.4.b. ISAT Domain B: Fidelity, Adaptation, Reach, Workforce, and Implementation Domain B of the ISAT framework explores how nutrition interventions such as Fueling Bright Futures maintain integrity and adaptability in diverse school settings, how they gain acceptance, and what operational factors and resource gaps affect their scalability. Fidelity and Adaptation Adaptability was essential; success depended on school leadership, garden productivity, and sustained volunteer involvement. Canteens thrived with varied menus and supportive parents. “Income doubled…because the cooked meals are now more delicious.” —Canteen staff, School A “It still depends on the principal…stakeholders and community members are involved in gardening…”—Canteen staff, School A Reach and Acceptability Resistance to new foods and pricing decreased over time through adaptation, communication, and the incorporation of vegetables into familiar dishes. “At first…complaints…food was too expensive…students wouldn’t buy it. But eventually, they understood…we started blending [vegetables]…they got used to it.” —Canteen staff, School B “Acceptance increased as students’ preferences evolved.” —Canteen staff, School A Delivery Settings and Workforce Staff and teacher training concerning food safety, labeling, and menu planning was valuable, although effective application depended on practical resource support. “Before, I didn’t know how to write and calculate for the green labeling…learned about labels…food safety…menu plan.” —Teacher, School C Implementation Infrastructure Shortages of basic tools, equipment, and operating funds frequently limited improvements and undermined what staff learned in training. “Cooking equipment like pots, pans, and knives. We truly need more cooking tools.” —Canteen manager, School C “The cost of goods has increased…and our expenses have also gone up…”—Canteen manager, School C Sustainability Long-term progress was threatened by budget uncertainty and leadership turnover, despite optimism for school gardens and policy support. “That’s what’s not sustainable? …if the canteen management changes…you won’t have the same level of support.” —Project staff, School C “If the principal is good at doing PR, it is easier to obtain support from the parents. When the principal is just always inside their office, we had difficulty…”—Canteen manager, School B ISAT Roundtable Participatory Assessment As detailed in the Methods, stakeholders from multiple sectors completed the ISAT to evaluate the scalability of Fueling Bright Futures . The following summarizes domain-level findings: Fidelity and Adaptation (2.3/3) Stakeholders highlighted the value of context-specific adaptation and volunteer involvement but emphasized the need for continuous oversight and quality monitoring. “Spreading out to different schools...bound to the integration of nutrition education into behavior.”— DoH Rep “Programs should intensify monitoring, along with improving WASH...to ensure food safety and maintain hygiene.”— DepEd central official Reach and Acceptability (2.3/3) Initial concerns regarding costs and stakeholder buy-in decreased as parental and student engagement increased; principal leadership and clear orientation were identified as critical for reach and uptake. “Children should know the value of healthy food—they need regular exposure to indigenous foods.”— DepEd division official “Menu improvements can drive further implementation.”— DepEd central official Delivery Setting and Workforce (2.3/3) The commitment of the pilot schools was evident, yet the stakeholders noted that scaling efforts necessitate additional personnel and operational resources. “DepEd tried to hire additional canteen personnel to lessen the burden on teachers…”— DOST-FNRI Representative “If canteen management is removed from teachers…the response may be to outsource to concessionaires…”— School head Implementation Infrastructure (1.7/3) Infrastructure shortcomings—tools, kitchen equipment, and stable funding—were seen as critical challenges and limits to scale. “School gardens and canteens are not that well-funded...virtual sessions…not as effective compared to face-to-face.”— DepEd regional official Sustainability (1.7/3) While high-level policy support exists, chronic challenges with resourcing and management are seen as barriers to long-term sustainability, necessitating stronger partnerships and ongoing community participation. “Improvements…were demonstrated, but scaling demands increased monitoring…as well as strengthened school feeding and canteen programs.”— DepEd Central Leader “Small steps through interventions such as school gardens and dietary guidelines can be impactful.”— DOST-FNRI representative Overall Assessment and Recommendation: On the basis of ISAT scoring, Fueling Bright Futures was considered promising and merits further scale-up, but the evaluation flagged significant opportunities for strengthening the infrastructure and sustainability domains. Stakeholders recommended a phased expansion to additional schools, with best practices, and identified barriers addressed iteratively. See Figure 3 for ISAT domain ratings and overall pilot assessment. 5. Discussion Global evidence consistently demonstrates that integrated school nutrition programs—including school feeding, local food procurement, nutrition education, and supportive policy frameworks—can improve child health and educational outcomes [ 14 – 16 ]. However, the effectiveness of these programs in reducing chronic undernutrition at various scales, such as stunting and underweight, remains unclear. Recent large-scale studies emphasize the need for more rigorous research to clarify their impact on a broader range of health and academic outcomes [ 17 ]. Experiences from Ghana and Bolivia highlight the value of connecting school meals to local food systems, engaging community stakeholders, and integrating nutrition education into curricula [ 18 , 19 ]. Initiatives such as local food procurement, school gardens, and collaboration across sectors have been linked to improved program sustainability and alignment with national objectives [ 16 ]. The World Food Programme’s latest review revealed that setting clear nutrition goals, sourcing foods locally, and fostering intersectoral partnerships strengthen program outcomes, although persistent barriers remain. These include fragmented government responsibilities and limited capacity for monitoring nutritional impacts [ 16 ]. The findings from the Fueling Bright Futures pilot echo international trends: improving and integrating school gardens, food environment improvements, and participatory nutrition education enhanced menu quality and student dietary diversity. Fresh and diverse foods from school gardens, mandated by policies such as Gulayan sa Paaralan (GPP) [ 20 ] and DO 8, were directly incorporated into meals. The active participation of canteen staff and volunteers not only improved the quality of food offered but also enabled cost savings, thereby promoting program sustainability. Limitations and generalizability Despite valuable insights, the findings are limited by the focus on only three schools within one province and a short intervention period, affecting generalizability and the assessment of long-term impact. Potential bias from self-reported data and variations in resources or engagement could also influence the results. Future studies with larger, more diverse samples and longer follow-up periods are needed to better assess the scalability and durability of these approaches. 6. Conclusions The Fueling Bright Futures pilot in Cavite offers valuable, context-specific evidence that comprehensive and multisectoral school nutrition programs can serve as effective public health interventions in the Philippines and similar global settings. By integrating climate-resilient school gardens, practical canteen policy guidance, and participatory nutrition education and skills training for staff, the pilot led to clear improvements in school food environments and dietary diversity in canteen offerings. However, the Fueling Bright Futures experience reiterates a lesson found internationally: achieving and sustaining meaningful impact in school nutrition does not rest solely on adopting innovative policies or introducing new interventions. Rather, long-term improvements hinge on continued investment in school infrastructure, systematic capacity building, consistent allocation of resources, and the sustained engagement of leadership. Participatory assessments using the ISAT not only confirmed persistent challenges—such as gaps in infrastructure and staff capacity—but also highlighted the importance of shared accountability among stakeholders in overcoming these barriers and promoting sustainability. Looking forward, a strengthened school food environment in the Philippines will require not only robust implementation of existing policy frameworks but also greater emphasis on making tools such as the DO13 traffic light system practical and accessible for everyday use. Specifically, canteen managers and school staff would benefit from hands-on job aids and simple, easy-to-understand tools that guide menu planning and food categorization, ensuring that the policy can be realistically and consistently applied in diverse school settings. To address nutritional gaps and support efficient planning, open-access tools such as the Partnership for Child Development School Meals Planner and the PLUS School Menus have been developed to help program planners design meals that are nutritionally balanced, cost to local markets, and tailored to reference nutrient intakes, especially in resource-poor settings. Institutionalizing nutrition education as a regular, classroom-based activity is essential, as research shows that building food literacy promotes healthy eating habits over the long term [ 6 ]. Fostering partnerships among community and school stakeholders will further guarantee that these gains can be sustained and scaled. Ultimately, the Cavite pilot underscores a broader lesson: system-level, policy-aligned, and multisectoral approaches—grounded in supportive school environments and classroom learning—are essential to create resilient, equitable nutrition systems that advance child health and educational outcomes [ 17 , 21 ]. Declarations 7.1. Ethics approval This study protocol received approval from the St. Luke’s Medical Center – Asian Eye Institute Ethics Review Committee (Approval No. 2024--035) under the Philippine Health Research Ethics Board (PHREB) guidelines. All study procedures involving human participants were conducted in accordance with the ethical standards of the institutional and national research committees, and with the 1964 Helsinki Declaration and its later amendments. All participants (or their legal guardians, for minors) provided voluntary, written informed consent prior to inclusion in the study. Confidentiality, voluntary participation, and data security were strictly maintained throughout the study. 7.2. Consent for publication All authors have read and approved the final version of the manuscript and consent to its publication in BMC Public Health 7.3. Availability of data and materials Data and materials supporting this study are available upon reasonable request from the Principal Investigator. Access will be granted following completion of a data sharing agreement with Helen Keller Intl. 7.4. Competing Interests MAH, PIAM, LL, ASG, TVM, RK, and DR are employees of Helen Keller Intl, which provided internal funding and resources for this case study and was involved in the design, implementation, analysis, and evaluation of the intervention. The ISNM was developed and operationalized in partnership with the International Institute of Rural Reconstruction, with which DJU, MSA, SDR, and EMO are affiliated. The authors declare that they have no competing interests beyond these disclosed affiliations. 7.5. Funding Helen Keller Intl provided internal funding and resources for this case study. 7.6. Authors' contributions Conceptualization: All authors Project administration: PIAM, DJU, MSA, SDR, DR, EMO Methodology: MAH, PIAM, DJU, MSA, LL, ASG, TVM, RK Investigation: MAH (lead), PIAM, DJU, MSA, LL, LDV Data curation: MAH, PIAM, DJU, MSA, LL, LDV Formal analysis: MAH, PIAM, DJU, LL, MSA, SDR, ASG, TVM, LDV Writing – original draft: MAH Writing – review & editing: All authors Supervision: DR, EMO, RK 7.7. Competing Interests MAH, PIAM, LL, ASG, TVM, RK, and DR are employees of Helen Keller Intl, which provided internal funding and resources for this case study and was involved in the design, implementation, analysis, and evaluation of the intervention. The ISNM was developed and operationalized in partnership with the International Institute of Rural Reconstruction, with which DJU, MSA, SDR, and EMO are affiliated. The authors declare that they have no competing interests beyond these disclosed affiliations. There were no prior relationships between the research team and study participants; participants did not know the researchers before the study, and no personal characteristics of the interviewers or facilitators were discussed with participants prior to data collection. 7.8. Acknowledgments We are deeply grateful to the students, teachers, administrators, and staff of the three Cavite elementary schools for their dedication and partnership throughout this project. We also extend our thanks to DepEd officials at both the division and central levels for their unwavering support, as well as to the parents and community partners whose active involvement enriched the school gardens and canteen programs. Special thanks go to Shawn Baker for providing the financial resources that enabled innovation at Helen Keller and made this work possible. We further appreciate the valuable insights of all stakeholder roundtable participants—including representatives from the Department of Health, FAO, World Food Programme, UNICEF, Philippine Association for Nutrition, and DOST-Food and Nutrition Research Institute—whose technical expertise and contributions to the ISAT assessment enriched this evaluation. References DOST-FNRI. Philippine Nutrition Facts and Figures: 2018 Expanded National Nutrition Survey (ENNS). 2020. Adair L, Popkin B. Are Child Eating Patterns Being Transformed Globally? Obesity research. 2005;13:1281–99. https://doi.org/10.1038/oby.2005.153 Popkin BM. The Nutrition Transition and Obesity in the Developing World. J Nutr. 2001;131. https://doi.org/10.1093/jn/131.3.871S . :871S-873S. Karpouzis F, Anastasiou K, Lindberg R, Walsh A, Shah S, Ball K. Effectiveness of School-based Nutrition Education Programs that Include Environmental Sustainability Components, on Fruit and Vegetable Consumption of 5–12YearOld Children: A Systematic Review. J Nutr Educ Behav. 2025;57:627–42. https://doi.org/10.1016/j.jneb.2025.02.008 . Chan CL, Tan PY, Gong YY. Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review. BMC Public Health. 2022;22:1251. https://doi.org/10.1186/s12889-022-13587-x . dos Santos EB, da Costa Maynard D, Zandonadi RP, Raposo A, Botelho RBA. Sustainability Recommendations and Practices in School Feeding: A Systematic Review. Foods. 2022;11. https://doi.org/10.3390/foods11020176 . Department of Education. DO 13, s. 2017 – Policy and Guidelines on Healthy Food and Beverage Choices in Schools and in DepEd Offices. 2017. Department of Education. DO 8, s. 2007 – Revised Implementing Guidelines on the Operation and Management of School Canteens in Public Elementary and Secondary Schools. Department of Education. Do 031, S, 2021–Operational Guidelines on the Implementation of the School-Based Feeding Program. Encabo F, Ventanilla ML. Nutritional Quality of School Canteen Meals Consumed by the Secondary School Children. IAMURE Int J Health Educ. 2014;5. Umali D, Joy, Itliong K, Anunciado M, Sheila. Monville-Oro, Emily. School Food Environments in the Philippines. 2023. Reeve E, Thow AM, Bell C, Engelhardt K, Gamolo-Naliponguit EC, Go JJ, et al. Implementation lessons for school food policies and marketing restrictions in the Philippines: a qualitative policy analysis. Globalization Health. 2018;14:8. https://doi.org/10.1186/s12992-017-0320-y . Milat A, Lee K, Conte K, Grunseit A, Wolfenden L, van Nassau F, et al. Intervention Scalability Assessment Tool: A decision support tool for health policy makers and implementers. Health Res Policy Syst. 2020;18:1. https://doi.org/10.1186/s12961-019-0494-2 . Global Child Nutrition Foundation (GCNF). School Meal Programs Around the World: Results from the 2024 Global Survey of School Meal Programs. 2024. Abreh M, Bedasso B, Nagesh R. Cash Versus In-Kind: Households’ Preferences in the Ghana School Feeding Programme. CGD Working Paper 708. 2024. World Food Programme. The State of School Feeding Worldwide 2022. 2022. Wang D, Shinde S, Young T, Fawzi WW. Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low- and middle-income countries: A systematic review and meta-analysis. J Global Health. 2021. https://doi.org/10.7189/jogh.11.04051 . Fernandes M, Galloway R, Gelli A, Mumuni D, Hamdani S, Kiamba J, et al. Enhancing Linkages Between Healthy Diets, Local Agriculture, and Sustainable Food Systems: The School Meals Planner Package in Ghana. Food Nutr Bull. 2016;37:571–84. https://doi.org/10.1177/0379572116659156 . FAO. Nutrition guidelines and standards for school meals: a report from 33 low and middle-income countries. 2019. Department of Education. DO 223, s. 2016–Implementation of the Gulayan sa Paaralan Program (GPP) in Public Elementary and Secondary Schools as a component of the School-Based Feeding Program (SBFP). 2016. Cohen JFW, Hecht AA, Hager ER, Turner L, Burkholder K, Schwartz MB. Strategies to Improve School Meal Consumption: A Systematic Review. Nutrients. 2021;13. https://doi.org/10.3390/nu13103520 . Additional Declarations Competing interest reported. M.A.H., P.I.A.M., L.L., A.S.G., T.V.M., R.K., and D.R. are employees of Helen Keller Intl, which provided internal funding and resources for this case study and was involved in the design, implementation, analysis, and evaluation of the intervention. The ISNM was developed and operationalized in partnership with the International Institute of Rural Reconstruction, with which D.J.U., S.A., S.D.R., and E.M. are affiliated. The authors declare that they have no competing interests beyond these disclosed affiliations. Supplementary Files SupplementaryMaterialA.docx SupplementaryMaterialB.docx SupplementaryMaterialD.docx SupplementaryMaterialC.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Nov, 2025 Reviews received at journal 09 Nov, 2025 Reviewers agreed at journal 30 Oct, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers agreed at journal 28 Oct, 2025 Reviews received at journal 19 Oct, 2025 Reviewers agreed at journal 12 Oct, 2025 Reviewers invited by journal 12 Oct, 2025 Editor assigned by journal 12 Oct, 2025 Editor invited by journal 03 Oct, 2025 Submission checks completed at journal 02 Oct, 2025 First submitted to journal 02 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7701168","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":533138126,"identity":"da218a18-fd92-4a93-b763-7ad1650854c3","order_by":0,"name":"Mai A. 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M.A.H., P.I.A.M., L.L., A.S.G., T.V.M., R.K., and D.R. are employees of Helen Keller Intl, which provided internal funding and resources for this case study and was involved in the design, implementation, analysis, and evaluation of the intervention. The ISNM was developed and operationalized in partnership with the International Institute of Rural Reconstruction, with which D.J.U., S.A., S.D.R., and E.M. are affiliated. The authors declare that they have no competing interests beyond these disclosed affiliations.","formattedTitle":"Fueling Bright Futures: A Case Study on Integrating Gardens, Canteens, and Nutrition Training in Philippine Public Schools","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSchool-aged children in the Philippines face a dual burden of malnutrition, with persistent undernutrition coexisting with rising rates of overweight and obesity. In 2019, among the 12.7\u0026nbsp;million children assessed, 13.2% were stunted or wasted. By 2021, obesity affected 10\u0026ndash;14% of children aged 5\u0026ndash;10 years, up from 9% in 2013 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Stunting remains a major concern, with the Philippines ranking among the highest in the Asia\u0026ndash;Pacific region at 27% for children under 5\u0026mdash;an indicator that mirrors challenges persisting into school age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA key contributor is poor dietary diversity. Filipino children increasingly consume energy-dense, processed foods, whereas fruit and vegetable intake remains very low (approximately 5\u0026ndash;6% of school meals) [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, micronutrient deficiencies, socioeconomic disparities, and easy access to unhealthy food inside and outside schools further exacerbate this problem [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this context, the school food environment is both a risk and an opportunity. School-based nutrition initiatives\u0026mdash;especially when gardens, healthy canteen offerings, and classroom-based nutrition education\u0026mdash;have shown promise in improving children\u0026rsquo;s diet quality, nutrition knowledge, and even academic outcomes worldwide [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, in the Philippines, such interventions are rarely evaluated for scalability and long-term sustainability.\u003c/p\u003e\u003cp\u003eSchool canteens in the Philippines are central to shaping children\u0026rsquo;s diets and are regulated through a series of Department of Education (DepEd) policies. These include DepEd Order No. 13, s.2017 on healthy food and beverage choices [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]; DepEd Order No. 8, s.2007 on canteen management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; DepEd Order No. 031, s. 2021, on the School-Based Feeding Program [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; and alongside directives on food safety and nutrition. Collectively, these policies aim to promote healthy eating habits by positioning canteens as accessible platforms for translating national nutrition standards into daily school practices. For many students, particularly in low-resource settings, the quality of canteen offerings represents a substantial portion of their daily nutrition. Studies have shown that school canteens often fail to meet recommended nutrient intakes for children [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], highlighting the critical role of the school environment in influencing dietary behaviors and establishing healthier lifelong habits [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor many students, particularly in low-resource settings, the quality of canteen offerings represents a substantial portion of their daily nutrition. As such, the school environment is crucial for influencing dietary behaviors and establishing healthier lifelong habits (9, 10).\u003c/p\u003e\u003cp\u003eDespite progress in policy development, the implementation of school nutrition guidelines in the Philippines remains inconsistent due to limited resources, weak monitoring, and competition from external vendors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These challenges highlight the need for integrated, context-specific interventions such as \u003cem\u003eFueling Bright Futures\u003c/em\u003e, a pilot intervention that combines improving school gardens, healthier canteen offerings, and hands-on nutrition education.\u003c/p\u003e\u003cp\u003eThis paper evaluates the pilot\u0026rsquo;s implementation and outcomes in public schools with three objectives: (1) assess the effects of garden improvements, canteen reforms, and staff training; (2) explore stakeholder perspectives and operational challenges to sustainability; and (3) examine scalability via the Intervention Scalability Assessment Tool (ISAT) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The use of a mixed-methods case study aims to generate evidence to guide the strengthening and expansion of school nutrition programs in the Philippines and comparable contexts.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003ch3\u003e2.1.\u0026nbsp; Case Study Design\u003c/h3\u003e\n\u003cp\u003eA convergent mixed-methods design was employed to quantify intervention effects while capturing the complexities of real-world implementation in schools. Purposive sampling focused on institutions enrolled in the Department of Education\u0026rsquo;s Integrated School Nutrition Model (ISNM), ensuring that schools had established gardens and accountability to national nutrition priorities. This design enabled a comprehensive evaluation of the added value of formally linking school gardens with canteens\u0026mdash;a feature not previously emphasized within the ISNM. The quantitative tools used included the ISAT, programmatic checklists, and school food environment surveys, whereas the qualitative methods involved focus group discussions (FGDs) and participatory workshops.\u003c/p\u003e\n\u003ch3\u003e2.2. Setting and Participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in three public elementary schools in Cavite, Philippines: School A (small), School B (medium), and School C (large). These schools were purposively selected to reflect variation in size, resource availability, and community context. All the schools were part of the ISNM and had preexisting gardens and canteens. The study participants included canteen and garden staff, teachers, administrators, and school heads, capturing a comprehensive range of perspectives on the intervention\u0026rsquo;s implementation.\u003c/p\u003e\n\u003ch3\u003e2.3. Sampling and Recruitment Methods\u003c/h3\u003e\n\u003cp\u003eA stratified purposive sampling approach was used to ensure representation across small, medium, and large ISNM schools with active gardens and nutrition programs in Cavite Province. Recruitment within each school focused on permanent teachers, canteen staff, garden coordinators, and administrators in SY 2024\u0026ndash;2025. Standardized pre- and postintervention observations fostered consistency and data validity. For broader perspectives, participatory workshops included DepEd officials, school leaders, teachers, and technical experts from UN agencies and civil society, who discussed and scored each ISAT domain to evaluate scalability from multiple sectoral viewpoints.\u003c/p\u003e\n\u003ch3\u003e2.2.\u0026nbsp;Intervention Description\u003c/h3\u003e\n\u003cp\u003eThe \u003cem\u003eFueling Bright Futures\u003c/em\u003e intervention consisted of four integrated components designed to enhance school nutrition holistically:\u003c/p\u003e\n\u003cp\u003e1. \u0026nbsp; \u003cstrong\u003eGarden diversification and adoption of agroecological practices\u003c/strong\u003e: This involves diversifying school gardens through the application of agroecological approaches and the cultivation of climate-resilient, indigenous crops while strengthening linkages with school cafeteria to increase the supply of fresh, locally grown produce and promote long-term sustainability. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eCanteen technical assistance:\u003c/strong\u003e School canteen menus were reformed through practical, participatory training aligned with DO13, increasing the availability of healthy, policy-compliant meals.\u003c/p\u003e\n\u003cp\u003e3. \u0026nbsp; \u003cstrong\u003eCapacity strengthening and nutrition education for cooks and managers:\u003c/strong\u003e Targeted training sessions were provided to school canteencafeteria cooks and managers to increase nutrition literacy, increase the quality of meal preparation, and ensure adherence to DO13 and nutrition standards.\u003c/p\u003e\n\u003cp\u003e4. \u0026nbsp; \u003cstrong\u003eAdvocacy with school administrators:\u003c/strong\u003e Strategic advocacy encouraged administrators to strengthen their commitment to maintaining improved food offerings and provide sustained oversight for DO13 compliance.\u003c/p\u003e\n\u003cp\u003eAll tools were piloted with a small sample of participants to ensure clarity and appropriateness. On the basis of pilot feedback, necessary modifications were made prior to the main study.\u003c/p\u003e\n\u003ch3\u003e2.3.\u0026nbsp;Assessment instruments\u003c/h3\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSchool Meals and Environment Assessment Tool:\u0026nbsp;\u003c/strong\u003eEvaluated compliance with DO13 in three parts: (1) planned menu review against the traffic light system (green daily, yellow 1\u0026ndash;2 times/week, red not at all), (2) direct observation of actual offerings, and (3) assessment of the environment for prohibited marketing of red-category foods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchool Garden Checklist and Policy Compliance Instruments:\u003c/strong\u003e Objectively appraised garden productivity, menu diversity, and adherence to national nutrition guidelines via observations and a checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eISAT and ISAT-Aligned Guides:\u003c/strong\u003e The ISAT was used to systematically evaluate scalability. To ensure a thorough exploration of all ISAT domains, the research team developed ISAT-aligned guides for FGD and participatory workshops. These guides and the ISAT scoring sheet were developed specifically for this study and have not been published elsewhere. English language versions are provided as follows: the ISAT scoring sheet in Supplementary Material A, the FGD guide in Supplementary Material B, and the workshop guide in Supplementary Material C.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Qualitative Data Collection Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative insights were collected through the following:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFocus Group Discussions:\u0026nbsp;\u003c/strong\u003eThree FGDs (one per school), each with 4\u0026ndash;6 participants (canteen staff, teachers, administrators), totaling 13 participants. Each FGD lasted approximately 50\u0026ndash;60 minutes.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eParticipatory Workshops and ISAT Assessment:\u003c/strong\u003e To assess scalability systematically, two participatory workshops were convened by Helen Keller Intl and IIRR, which involved approximately 50 stakeholders\u0026mdash;including representatives from schools, the DepEd, government agencies (such as the Department of Health, DOST-FNRI), international organizations (UNICEF, World Food Programme), the Philippine Association for Nutrition, and leaders from the three pilot schools. Each three-hour workshop provided broad multidisciplinary input for the use of the ISAT. The participatory workshops were facilitated by project staff with professional backgrounds in public health, dietetics, and agriculture to guide discussions and support an inclusive, informed assessment process.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe ISAT is a structured tool designed to assess a program\u0026rsquo;s readiness for scale-up, covering ten domains: 1) the problem, 2) the intervention, 3) the strategic political context, 4) evidence of effectiveness, 5) intervention costs and benefits, 6) fidelity and adaptation, 7) reach and acceptability, 8) delivery setting and workforce, 9) implementation infrastructure, and 10) sustainability. During the workshops, the participants collaboratively discussed their implementation experiences within and across these domains.\u003c/p\u003e\n\u003cp\u003eAfter group discussion, each organization or sector nominated a representative\u0026mdash;typically a senior lead or focal point\u0026mdash;to independently score each ISAT domain on a scale of 0\u0026ndash;3. Ultimately, 21 nominated representatives submitted individual ISAT ratings. This process ensured that the results reflected balanced, consensus-based, and transparent multisectoral perspectives rather than individual opinions, yielding context-specific assessments of the intervention\u0026rsquo;s scalability.\u003c/p\u003e\n\u003cp\u003eAll FGDs were audio-recorded and transcribed verbatim in Filipino (Tagalog) and then translated into English. During the participatory workshop, recording was not possible because multiple small group conversations occurred at once; instead, detailed notes were taken in real time. For logistical reasons, the transcripts were not shared with the participants for review. No nonparticipants were present during the workshops or qualitative sessions, and no repeat FGDs were conducted to avoid duplication or respondent fatigue.\u003c/p\u003e\n\u003cp\u003eData collection ceased once the intended FGDs were completed, and the research team determined that the information from the participants was sufficiently rich and thematically consistent. Although no additional rounds of data collection were undertaken, the study team judged that thematic saturation had been reached, with no major new themes emerging\u003c/p\u003e"},{"header":"3. Data collection and analysis","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Study timing and implementation\u003c/h2\u003e\u003cp\u003eThe study was conducted over an 11-month period, from April 2024 to February 2025. Data collection procedures were carefully planned to minimize classroom disruption. Each assessment\u0026mdash;school canteen menu audits, school food environment observations, and school garden checklists\u0026mdash;was scheduled at specific times (e.g., morning classroom sessions, lunchtime, or after lunch) to fit within normal school routines. Strict adherence to privacy and ethical standards, as outlined by DepEd, was maintained throughout the recruitment and data handling process.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Quantitative analysis\u003c/h2\u003e\u003cp\u003eThe quantitative data, including garden functionality scores and canteen menu audit results, were summarized with descriptive statistics (means, proportions, temporal trends) and analyzed via statistical software in Excel. For the scalability dimension, the ISAT was administered to a diverse panel of stakeholders representing government, education, and NGO partners. Domain scores were calculated as the means and visually depicted through radar plots to support multidimensional assessment of scalability domains.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Qualitative Analysis\u003c/h2\u003e\u003cp\u003eQualitative data from FGDs and workshops were analyzed with reference to the ISAT framework to ensure that all key scalability domains were addressed. English transcripts and notes were imported into NVivo 14 for systematic coding. Two researchers independently coded the data and discussed the findings. Deductive analysis followed an ISAT-based coding tree (covering fidelity, reach, adaptation, delivery, infrastructure, and sustainability), supplemented by inductive coding for emergent, local insights. Triangulation of qualitative and quantitative data supported a multidimensional understanding of program implementation, barriers, enablers, and scalability prospects.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Results","content":"\u003ch3\u003e4.1. School and Stakeholder Profile\u003c/h3\u003e\n\u003cp\u003eThe participating schools represented a spectrum of enrollment sizes and baseline nutrition environments. They ranged from rural to peri-urban settings with active local parent groups to larger peri-urban schools with long-standing canteen operations. All three had existing gardens, but their diversity and management systems varied, mirroring the uneven institutional capacity reported in national surveys.\u003c/p\u003e\n\u003ch3\u003e4.2. School Gardens\u003c/h3\u003e\n\u003cp\u003eAcross all three pilot schools, gardens consistently demonstrated strong performance, with functionality scores ranging from 14 to 16 out of 18 (Table 2). Rather than large shifts, the results highlight sustained management practices, strategic crop diversification, and adaptation to site conditions via climate-smart practices. All gardens cultivated at least three types of vegetables and legumes plus one fruit tree (typically banana or papaya), contributing to both school menu quality and student learning. In addition to overall functionality scores, crop-level changes in fruit and vegetable diversity illustrate how school gardens were adapted to enhance menu planning and year-round food availability; these detailed shifts at each school are presented in Supplementary \u0026nbsp;Material E, Table 1.\u003c/p\u003e\n\u003cp\u003eSoil health was maintained through compost, manure, and mulching, with School A additionally employing cover crops, especially during the summer season (April\u0026mdash;May). Well-fenced beds minimized soil erosion and pest and disease pressure, whereas integration into classroom instruction reinforced gardening as an educational tool. The gardens contained diverse, nutrient-dense crops, used \u003cem\u003ekakawate\u003c/em\u003e fertilizer trees, and maintained reliable yields with minimal pest or disease issues, making them valuable resources for school food environments. Students, teachers, and parents support daily upkeep and harvesting, complemented by contributions of planting materials and seasonal assistance from parent volunteers, agricultural officers, and other community partners, including local donors and farmers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. School Garden Functionality Scores (Maximum Score: 18)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline (Apr 2024)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Feb 2025)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.2828%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClassification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool A\u0026nbsp;\u003c/strong\u003e(small)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e14\u0026ndash;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.2828%;\"\u003e\n \u003cp\u003eModerate-to-high to High\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool B\u0026nbsp;\u003c/strong\u003e(medium)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e15\u0026ndash;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.2828%;\"\u003e\n \u003cp\u003eModerate-to-high to High\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool C\u0026nbsp;\u003c/strong\u003e(large)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1616%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.2828%;\"\u003e\n \u003cp\u003eModerate-to-high\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Classification system: 16\u0026ndash;18 = high; 13\u0026ndash;15 = moderate-to-high; \u0026le;13 = needs improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e Scores derived from a standardized checklist covering crop diversity, use of organic fertilizers, pest and disease management, garden maintenance, student engagement, and integration into classroom instruction.\u003c/p\u003e\n\u003cp\u003eCanteen managers consistently substituted or enhanced meals with available garden produce, aligning garden planting schedules with menu planning to maximize impact. Garden contributions to canteen cafeteria dishes often include amaranth, banana, cassava, chili, eggplant, papaya, string beans, and tomato. These crops\u0026nbsp;are most prevalent because of their adaptability to local conditions and nutritional value. For example, micronutrient-dense foods such as papaya, amaranth, chili, and tomato (high in vitamins A, C, iron, and antioxidants), energy-dense foods such as banana and cassava, and protective vegetables such as string bean and eggplant are rich in fiber and some minor vitamins. We also observed some changes in the diversity and types of crops cultivated over time, which were likely affected by variations due to seasons and the availability of planting material.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSchool A (small): Maintained broad vegetable selection but reduced fruit diversity from 7--5, losing strawberry and dragon fruit but adding chayote, jute mallow, sesame, and rice bean. The continued use of herbs such as oregano has supported pest management.\u003c/li\u003e\n \u003cli\u003eSchool B (medium): Increased fruit diversity by adding mulberry, cotton fruit, and mango at endline, and expanded vegetables to include winged bean and cowpea. New additions replaced less-adapted crops, reflecting a push for year-round food availability.\u003c/li\u003e\n \u003cli\u003eSchool C (large): Lost dragon fruit but gained additional vegetables (pechay, squash, sponge gourd, lima bean), increasing variety, soil fertility, and resilience.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMinimal pest problems were reported, and the active integration of gardening activities into \u003cem\u003eEdukasyong Pantahanan at Pangkabuhayan\u003c/em\u003e\u0026mdash;a compulsory primary school subject in home economics and livelihood skills\u0026mdash;helped reinforce practical knowledge and student engagement. Parents and other community members further contributed planting materials, labor, and seasonal support, strengthening both food production and the educational value of the school gardens.\u003c/p\u003e\n\u003cp\u003eOverall, despite small declines in fruit diversity at some sites, schools demonstrated greater vegetable variety and maintained robust, well-integrated gardens that enhanced canteen menus, supported experiential learning, and deepened community participation.\u003c/p\u003e\n\u003ch3\u003e4.3.\u0026nbsp;School Menu and Canteen Environment Shifts\u003c/h3\u003e\n\u003cp\u003eProgress toward compliance with national canteen policy guidelines revealed encouraging improvements alongside persistent challenges, underscoring the complexity of translating nutrition standards into school practice. None of the three schools reached full adherence to DO13 on healthy food and beverage choices, yet quantitative analysis of planned menus revealed marked gains between baseline and endline. School A expanded \u0026ldquo;green\u0026rdquo; food offerings weekly from two to eleven items, School B reduced \u0026ldquo;yellow\u0026rdquo; items from 30 to nine and \u0026ldquo;red\u0026rdquo; items from ten to two, whereas School C lowered \u0026ldquo;red\u0026rdquo; items from 13 to four (see Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Weekly Canteen Menu Items by DO13 Traffic Light Category Pre- and Postintervention\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime Point\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Items Per week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGreen Foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYellow Foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRed Foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 606px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026middot; Green: \u0026lt;3 g saturated fat, \u0026lt;10 g sugar/carbs, \u0026lt;120 mg sodium/serving\u003c/p\u003e\n \u003cp\u003e\u0026middot; Yellow: 3\u0026ndash;5 g saturated fat, 10\u0026ndash;20 g sugar/carbs, 120\u0026ndash;200 mg sodium\u003c/p\u003e\n \u003cp\u003e\u0026middot; Red: \u0026gt;5 g saturated fat, \u0026gt;20 g sugar/carbs, \u0026gt;200 mg sodium (all 0 g trans fat)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn addition to improving menu frequency according to traffic light category, canteens actively modified the nutritional quality of hot meals. Guided by capacity-building sessions, managers applied menu planning concepts to reframe popular dishes with healthier preparation methods and ingredients. Substitutions included replacing ultraprocessed meats with plant-based proteins; enriching meals with eggs and nutrient-dense vegetables from school gardens; and reducing salt, oil, and sugar in dishes such as \u003cem\u003epancit\u003c/em\u003e, \u003cem\u003echamporado\u003c/em\u003e, and \u003cem\u003earroz caldo\u003c/em\u003e. These adjustments reflected a practical integration of national nutrition policy with the school garden model and reinforced the use of locally available produce (see Supplementary Material E, Table 2 for detailed recipe modifications).\u003c/p\u003e\n\u003cp\u003eWhile these adaptations improved nutrient density in hot meals, a closer analysis revealed significant variation in nutritional quality within each traffic light category. Classification alone often concealed differences between packaged and fresh options. For example, School A\u0026rsquo;s expansion of \u0026ldquo;green\u0026rdquo; items from two to 11 was partially driven by the addition of packaged snacks, which accounted for 55% of its green offerings at endline. In contrast, Schools B and C demonstrated a shift toward fresher alternatives: School B reduced packaged green snacks from 20% to 9%, whereas School C modestly lowered them from 62% to 58% (see Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Proportion of Green Foods from Packaged Snacks Pre- and Postintervention\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComments\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSchool A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eSchool A increased green hot meal offerings from two to four times weekly but also added multiple green packaged foods.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSchool B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eSchool B reduced packaged nut offerings from daily to twice weekly and were replaced with fresh produce and boiled eggs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSchool C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eSchool C maintained green count; but replaced some packaged snacks with hot meals.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhile quantitative analysis revealed improvements in menu composition and reductions in unhealthy items, it also highlighted inconsistencies in how nutrition standards were applied\u0026mdash;particularly the reliance on packaged foods to increase \u0026ldquo;green\u0026rdquo; offerings. To better understand the drivers of these patterns, qualitative data were used to explore the operational and contextual challenges shaping canteen decision-making. Across schools, canteen managers noted financial constraints, limited preparation time, inadequate facilities, and irregular garden harvests as barriers to full DO13 compliance. Additionally, \u0026ldquo;vendor leakage\u0026rdquo;\u0026mdash;the sale of DO13 noncompliant foods by external vendors near campuses\u0026mdash;further undermined implementation efforts and limited the nutritional impact of school-based reforms.\u003c/p\u003e\n\u003ch3\u003e4.4. Qualitative insights\u0026nbsp;from key stakeholders: ISAT-guided focus\u0026nbsp;group findings\u003c/h3\u003e\n\u003cp\u003eThis section highlights illustrative and key findings from specific ISAT domains; the results for other domains are not included here for brevity and relevance but were covered in the broader analysis. The data were systematically coded by the ISAT domain and subdomain to ensure analytic rigor and transparency (see Figure 1 and Figure 2 for the coding tree structure). Each theme below corresponds directly to an ISAT domain, illustrating how stakeholder experiences informed the assessment of the intervention\u0026rsquo;s scalability.\u003c/p\u003e\n\u003ch4\u003e4.4.a. ISAT Domain A: Evidence of Effectiveness\u003c/h4\u003e\n\u003cp\u003eFGDs suggest that \u003cem\u003eFueling Bright Futures\u003c/em\u003e contributed to positive shifts in the school food environment and student nutrition behaviors, although the degree and consistency of these outcomes may vary. Several stakeholders observed that replacing processed foods with locally grown fruits and vegetables in canteens resulted in diverse available choices and made healthy food more appealing, especially where menu innovations were implemented. Notably, changes in food perceptions among students took time, with some overcoming initial skepticism.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;Initially, they thought vegetables were just weeds. Now they\u0026rsquo;ve discovered that these can be cooked and eaten\u0026hellip;They didn\u0026rsquo;t realize they were edible.\u0026rdquo;\u0026mdash;Canteen staff, School C\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;The most impressive activity I\u0026rsquo;ve seen is what they offer in the canteen. They sell food\u0026hellip;using bananas and vegetables\u0026hellip;that could be replicated in other schools.\u0026rdquo; \u0026mdash;Canteen staff, FGD, School C\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWhile these improvements were encouraging, the impact extended beyond just food offerings. The participants noted a shift in purchasing habits toward the school canteen and away from outside vendors, as well as the development of students\u0026rsquo; practical skills through participation in gardening and food preparation. The extent of these changes depended on student engagement and exposure to new recipes, which seemed to increase curiosity and openness over time.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;When they saw [vegetable juice] being prepared, they became curious\u0026hellip;They weren\u0026rsquo;t interested before but gradually tried it\u0026hellip;vegetables can be used in juice.\u0026rdquo;\u0026mdash;Canteen staff, FGD, School B\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u0026ldquo;Before, there were many [vendors], but now there\u0026rsquo;s only one\u0026hellip;[kids] just buy here inside, which is fine.\u0026rdquo; \u0026mdash;Canteen staff, School B\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch4\u003e4.4.b. ISAT Domain B: Fidelity, Adaptation, Reach, Workforce, and Implementation\u003c/h4\u003e\n\u003cp\u003eDomain B of the ISAT framework explores how nutrition interventions such as \u003cem\u003eFueling Bright Futures\u003c/em\u003e maintain integrity and adaptability in diverse school settings, how they gain acceptance, and what operational factors and resource gaps affect their scalability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFidelity and Adaptation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdaptability was essential; success depended on school leadership, garden productivity, and sustained volunteer involvement. Canteens thrived with varied menus and supportive parents.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;Income doubled\u0026hellip;because the cooked meals are now more delicious.\u0026rdquo; \u0026mdash;Canteen staff, School A\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;It still depends on the principal\u0026hellip;stakeholders and community members are involved in gardening\u0026hellip;\u0026rdquo;\u0026mdash;Canteen staff, School A\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eReach and Acceptability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResistance to new foods and pricing decreased over time through adaptation, communication, and the incorporation of vegetables into familiar dishes.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;At first\u0026hellip;complaints\u0026hellip;food was too expensive\u0026hellip;students wouldn\u0026rsquo;t buy it. But eventually, they understood\u0026hellip;we started blending [vegetables]\u0026hellip;they got used to it.\u0026rdquo; \u0026mdash;Canteen staff, School B\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;Acceptance increased as students\u0026rsquo; preferences evolved.\u0026rdquo; \u0026mdash;Canteen staff, School A\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eDelivery Settings and Workforce\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStaff and teacher training concerning food safety, labeling, and menu planning was valuable, although effective application depended on practical resource support.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;Before, I didn\u0026rsquo;t know how to write and calculate for the green labeling\u0026hellip;learned about labels\u0026hellip;food safety\u0026hellip;menu plan.\u0026rdquo; \u0026mdash;Teacher, School C\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation Infrastructure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShortages of basic tools, equipment, and operating funds frequently limited improvements and undermined what staff learned in training.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;Cooking equipment like pots, pans, and knives. We truly need more cooking tools.\u0026rdquo; \u0026mdash;Canteen manager, School C\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;The cost of goods has increased\u0026hellip;and our expenses have also gone up\u0026hellip;\u0026rdquo;\u0026mdash;Canteen manager, School C\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSustainability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLong-term progress was threatened by budget uncertainty and leadership turnover, despite optimism for school gardens and policy support.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;That\u0026rsquo;s what\u0026rsquo;s not sustainable? \u0026hellip;if the canteen management changes\u0026hellip;you won\u0026rsquo;t have the same level of support.\u0026rdquo; \u0026mdash;Project staff, School C\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e\u0026ldquo;If the principal is good at doing PR, it is easier to obtain support from the parents. When the principal is just always inside their office, we had difficulty\u0026hellip;\u0026rdquo;\u0026mdash;Canteen manager, School B\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eISAT Roundtable Participatory Assessment\u003c/h3\u003e\n\u003cp\u003eAs detailed in the Methods, stakeholders from multiple sectors completed the ISAT to evaluate the scalability of \u003cem\u003eFueling Bright Futures\u003c/em\u003e. The following summarizes domain-level findings:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFidelity and Adaptation (2.3/3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStakeholders highlighted the value of context-specific adaptation and volunteer involvement but emphasized the need for continuous oversight and quality monitoring.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;Spreading out to different schools...bound to the integration of nutrition education into behavior.\u0026rdquo;\u0026mdash;\u003cem\u003eDoH Rep\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Programs should intensify monitoring, along with improving WASH...to ensure food safety and maintain hygiene.\u0026rdquo;\u0026mdash;\u003cem\u003eDepEd central official\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eReach and Acceptability (2.3/3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitial concerns regarding costs and stakeholder buy-in decreased as parental and student engagement increased; principal leadership and clear orientation were identified as critical for reach and uptake.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;Children should know the value of healthy food\u0026mdash;they need regular exposure to indigenous foods.\u0026rdquo;\u0026mdash;\u003cem\u003eDepEd division official\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Menu improvements can drive further implementation.\u0026rdquo;\u0026mdash;\u003cem\u003eDepEd central official\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eDelivery Setting and Workforce (2.3/3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe commitment of the pilot schools was evident, yet the stakeholders noted that scaling efforts necessitate additional personnel and operational resources.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;DepEd tried to hire additional canteen personnel to lessen the burden on teachers\u0026hellip;\u0026rdquo;\u0026mdash;\u003cem\u003eDOST-FNRI Representative\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;If canteen management is removed from teachers\u0026hellip;the response may be to outsource to concessionaires\u0026hellip;\u0026rdquo;\u0026mdash;\u003cem\u003eSchool head\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation Infrastructure (1.7/3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInfrastructure shortcomings\u0026mdash;tools, kitchen equipment, and stable funding\u0026mdash;were seen as critical challenges and limits to scale.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;School gardens and canteens are not that well-funded...virtual sessions\u0026hellip;not as effective compared to face-to-face.\u0026rdquo;\u0026mdash;\u003cem\u003eDepEd regional official\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSustainability (1.7/3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile high-level policy support exists, chronic challenges with resourcing and management are seen as barriers to long-term sustainability, necessitating stronger partnerships and ongoing community participation.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u0026ldquo;Improvements\u0026hellip;were demonstrated, but scaling demands increased monitoring\u0026hellip;as well as strengthened school feeding and canteen programs.\u0026rdquo;\u0026mdash;\u003cem\u003eDepEd Central Leader\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Small steps through interventions such as school gardens and dietary guidelines can be impactful.\u0026rdquo;\u0026mdash;\u003cem\u003eDOST-FNRI representative\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eOverall Assessment and Recommendation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn the basis of ISAT scoring, \u003cem\u003eFueling Bright Futures\u003c/em\u003e was considered promising and merits further scale-up, but the evaluation flagged significant opportunities for strengthening the infrastructure and sustainability domains. Stakeholders recommended a phased expansion to additional schools, with best practices, and identified barriers addressed iteratively. See Figure 3 for ISAT domain ratings and overall pilot assessment.\u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eGlobal evidence consistently demonstrates that integrated school nutrition programs\u0026mdash;including school feeding, local food procurement, nutrition education, and supportive policy frameworks\u0026mdash;can improve child health and educational outcomes [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the effectiveness of these programs in reducing chronic undernutrition at various scales, such as stunting and underweight, remains unclear. Recent large-scale studies emphasize the need for more rigorous research to clarify their impact on a broader range of health and academic outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExperiences from Ghana and Bolivia highlight the value of connecting school meals to local food systems, engaging community stakeholders, and integrating nutrition education into curricula [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Initiatives such as local food procurement, school gardens, and collaboration across sectors have been linked to improved program sustainability and alignment with national objectives [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The World Food Programme\u0026rsquo;s latest review revealed that setting clear nutrition goals, sourcing foods locally, and fostering intersectoral partnerships strengthen program outcomes, although persistent barriers remain. These include fragmented government responsibilities and limited capacity for monitoring nutritional impacts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe findings from the \u003cem\u003eFueling Bright Futures\u003c/em\u003e pilot echo international trends: improving and integrating school gardens, food environment improvements, and participatory nutrition education enhanced menu quality and student dietary diversity. Fresh and diverse foods from school gardens, mandated by policies such as Gulayan sa Paaralan (GPP) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and DO 8, were directly incorporated into meals. The active participation of canteen staff and volunteers not only improved the quality of food offered but also enabled cost savings, thereby promoting program sustainability.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations and generalizability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite valuable insights, the findings are limited by the focus on only three schools within one province and a short intervention period, affecting generalizability and the assessment of long-term impact. Potential bias from self-reported data and variations in resources or engagement could also influence the results. Future studies with larger, more diverse samples and longer follow-up periods are needed to better assess the scalability and durability of these approaches.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eThe \u003cem\u003eFueling Bright Futures\u003c/em\u003e pilot in Cavite offers valuable, context-specific evidence that comprehensive and multisectoral school nutrition programs can serve as effective public health interventions in the Philippines and similar global settings. By integrating climate-resilient school gardens, practical canteen policy guidance, and participatory nutrition education and skills training for staff, the pilot led to clear improvements in school food environments and dietary diversity in canteen offerings.\u003c/p\u003e\u003cp\u003eHowever, the \u003cem\u003eFueling Bright Futures\u003c/em\u003e experience reiterates a lesson found internationally: achieving and sustaining meaningful impact in school nutrition does not rest solely on adopting innovative policies or introducing new interventions. Rather, long-term improvements hinge on continued investment in school infrastructure, systematic capacity building, consistent allocation of resources, and the sustained engagement of leadership. Participatory assessments using the ISAT not only confirmed persistent challenges\u0026mdash;such as gaps in infrastructure and staff capacity\u0026mdash;but also highlighted the importance of shared accountability among stakeholders in overcoming these barriers and promoting sustainability.\u003c/p\u003e\u003cp\u003eLooking forward, a strengthened school food environment in the Philippines will require not only robust implementation of existing policy frameworks but also greater emphasis on making tools such as the DO13 traffic light system practical and accessible for everyday use. Specifically, canteen managers and school staff would benefit from hands-on job aids and simple, easy-to-understand tools that guide menu planning and food categorization, ensuring that the policy can be realistically and consistently applied in diverse school settings. To address nutritional gaps and support efficient planning, open-access tools such as the Partnership for Child Development School Meals Planner and the PLUS School Menus have been developed to help program planners design meals that are nutritionally balanced, cost to local markets, and tailored to reference nutrient intakes, especially in resource-poor settings.\u003c/p\u003e\u003cp\u003eInstitutionalizing nutrition education as a regular, classroom-based activity is essential, as research shows that building food literacy promotes healthy eating habits over the long term [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Fostering partnerships among community and school stakeholders will further guarantee that these gains can be sustained and scaled. Ultimately, the Cavite pilot underscores a broader lesson: system-level, policy-aligned, and multisectoral approaches\u0026mdash;grounded in supportive school environments and classroom learning\u0026mdash;are essential to create resilient, equitable nutrition systems that advance child health and educational outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003e7.1. Ethics approval\u003c/h3\u003e\n\u003cp\u003eThis study protocol received approval from the St. Luke\u0026rsquo;s Medical Center \u0026ndash; Asian Eye Institute Ethics Review Committee (Approval No. 2024--035) under the Philippine Health Research Ethics Board (PHREB) guidelines. All study procedures involving human participants were conducted in accordance with the ethical standards of the institutional and national research committees, and with the 1964 Helsinki Declaration and its later amendments. All participants (or their legal guardians, for minors) provided voluntary, written informed consent prior to inclusion in the study. Confidentiality, voluntary participation, and data security were strictly maintained throughout the study.\u003c/p\u003e\n\u003ch3\u003e7.2. Consent for publication\u003c/h3\u003e\n\u003cp\u003eAll authors have read and approved the final version of the manuscript and consent to its publication in BMC Public Health\u003c/p\u003e\n\u003ch3\u003e7.3. Availability of data and materials\u003c/h3\u003e\n\u003cp\u003eData and materials supporting this study are available upon reasonable request from the Principal Investigator. Access will be granted following completion of a data sharing agreement with Helen Keller Intl.\u003c/p\u003e\n\u003ch3\u003e7.4. Competing Interests\u003c/h3\u003e\n\u003cp\u003eMAH, PIAM, LL, ASG, TVM, RK, and DR are employees of Helen Keller Intl, which provided internal funding and resources for this case study and was involved in the design, implementation, analysis, and evaluation of the intervention. The ISNM was developed and operationalized in partnership with the International Institute of Rural Reconstruction, with which DJU, MSA, SDR, and EMO are affiliated. The authors declare that they have no competing interests beyond these disclosed affiliations.\u003c/p\u003e\n\u003cp\u003e7.5. Funding\u003c/p\u003e\n\u003cp\u003eHelen Keller Intl provided internal funding and resources for this case study.\u003c/p\u003e\n\u003cp\u003e7.6. Authors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eConceptualization: All authors\u003cbr\u003e\u0026nbsp;Project administration: PIAM, DJU, MSA, SDR, DR, EMO\u003cbr\u003e\u0026nbsp;Methodology: MAH, PIAM, DJU, MSA, LL, ASG, TVM, RK\u003cbr\u003e\u0026nbsp;Investigation: MAH (lead), PIAM, DJU, MSA, LL, LDV\u003cbr\u003e\u0026nbsp;Data curation: MAH, PIAM, DJU, MSA, LL, LDV\u003cbr\u003e\u0026nbsp;Formal analysis: MAH, PIAM, DJU, LL, MSA, SDR, ASG, TVM, LDV\u003cbr\u003e\u0026nbsp;Writing \u0026ndash; original draft: MAH\u003cbr\u003e\u0026nbsp;Writing \u0026ndash; review \u0026amp; editing: All authors\u003cbr\u003e\u0026nbsp;Supervision: DR, EMO, RK\u003c/p\u003e\n\u003ch3\u003e7.7. Competing Interests\u003c/h3\u003e\n\u003cp\u003eMAH, PIAM, LL, ASG, TVM, RK, and DR are employees of Helen Keller Intl, which provided internal funding and resources for this case study and was involved in the design, implementation, analysis, and evaluation of the intervention. The ISNM was developed and operationalized in partnership with the International Institute of Rural Reconstruction, with which DJU, MSA, SDR, and EMO are affiliated. The authors declare that they have no competing interests beyond these disclosed affiliations.\u003c/p\u003e\n\u003cp\u003eThere were no prior relationships between the research team and study participants; participants did not know the researchers before the study, and no personal characteristics of the interviewers or facilitators were discussed with participants prior to data collection.\u003c/p\u003e\n\u003ch3\u003e7.8. Acknowledgments\u003c/h3\u003e\n\u003cp\u003eWe are deeply grateful to the students, teachers, administrators, and staff of the three Cavite elementary schools for their dedication and partnership throughout this project. We also extend our thanks to DepEd officials at both the division and central levels for their unwavering support, as well as to the parents and community partners whose active involvement enriched the school gardens and canteen programs. Special thanks go to Shawn Baker for providing the financial resources that enabled innovation at Helen Keller and made this work possible.\u003c/p\u003e\n\u003cp\u003eWe further appreciate the valuable insights of all stakeholder roundtable participants\u0026mdash;including representatives from the Department of Health, FAO, World Food Programme, UNICEF, Philippine Association for Nutrition, and DOST-Food and Nutrition Research Institute\u0026mdash;whose technical expertise and contributions to the ISAT assessment enriched this evaluation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDOST-FNRI. 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Nutrition guidelines and standards for school meals: a report from 33 low and middle-income countries. 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepartment of Education. DO 223, s. 2016\u0026ndash;Implementation of the Gulayan sa Paaralan Program (GPP) in Public Elementary and Secondary Schools as a component of the School-Based Feeding Program (SBFP). 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen JFW, Hecht AA, Hager ER, Turner L, Burkholder K, Schwartz MB. Strategies to Improve School Meal Consumption: A Systematic Review. Nutrients. 2021;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu13103520\u003c/span\u003e\u003cspan address=\"10.3390/nu13103520\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"School nutrition, food environment, school garden, school-based feeding, scalability, child dietary behavior, participatory approaches, local food systems, Philippines","lastPublishedDoi":"10.21203/rs.3.rs-7701168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7701168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e\u003cp\u003eThis case study evaluates \u003cem\u003eFueling Bright Futures\u003c/em\u003e, an integrated approach involving enhancing school gardens, improving the menu of canteen, and providing nutrition education in three public schools in Cavite, Philippines. The intervention addresses both undernutrition and overnutrition, tackling the double burden of malnutrition among Filipino schoolchildren.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis mixed-methods study was conducted in three public elementary schools in Cavite, Philippines. Baseline and endline assessments (Apr 2024, Feb 2025) included canteen menu audits (per DepEd Order 13), garden inventories, and focus groups with staff and administrators. Effectiveness and scalability were evaluated using the Intervention Scalability Assessment Tool (ISAT) in participatory workshops with policymakers and stakeholders. Qualitative data from all sessions were coded and thematically analyzed via NVivo14 and mapped to ISAT domains.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll the schools made substantial gains in garden output, dietary diversity, and the nutritional quality of canteen offerings. The number of \u0026ldquo;green\u0026rdquo; menu items increased sharply (School A: 2\u0026mdash;11 per week), whereas the number of \u0026ldquo;red\u0026rdquo; foods decreased substantially (School B: 10\u0026mdash;2 per week; School C: 13\u0026mdash;4). Canteen staff adjusted recipes to use more garden produce, although some packaged snacks persisted. Barriers included limited resources, irregular garden supplies, time constraints, and outside processed food vendors. Strong leadership and community participation elevated acceptability, but infrastructure and sustainability challenges persisted.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eImproving and integrating school gardens, improved canteen menus, and staff training can enhance school food environments in resource-limited schools. Success requires strong leadership, partnerships, practical planning, and sustained resources. Ongoing investment and collaboration are critical to building nutrition-friendly school environments that support students\u0026rsquo; health and well-being.\u003c/p\u003e","manuscriptTitle":"Fueling Bright Futures: A Case Study on Integrating Gardens, Canteens, and Nutrition Training in Philippine Public Schools","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-26 01:01:48","doi":"10.21203/rs.3.rs-7701168/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-26T03:59:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-09T17:00:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180660651553586558242169516885832343248","date":"2025-10-30T10:18:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48705357478987320071640103898235945137","date":"2025-10-29T17:27:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290675759435414535703226377989552556488","date":"2025-10-28T14:23:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T04:36:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242486155025963179895774340808443467346","date":"2025-10-12T11:31:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-12T05:03:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-12T04:59:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-03T05:01:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-02T13:47:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-10-02T09:37:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3b1afb0-615d-49a4-a68d-adc2fb71d894","owner":[],"postedDate":"October 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-05T08:53:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-26 01:01:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7701168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7701168","identity":"rs-7701168","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}