Evaluating government milk schemes for promoting children's milk consumption in Early Years Settings and primary schools in Ireland using mixed methods

Background: Milk and dairy products are important sources of calcium and iodine in children’s diets, which are important for bone health and cognitive development. Therefore, a decline in milk consumption among children globally, including in Ireland, is of public health concern. Research investigating the determinants of milk consumption is lacking, which is required to develop effective intervention strategies. Aims: To examine the determinants of milk consumption among preschool and primary school children in Ireland. To evaluate the effectiveness and implementation of a government-supported pilot School Milk Scheme (SMS) in Irish Early Years Services (EYS). To evaluate the effectiveness and implementation of the established EU SMS in Irish primary schools. Methods: Mixed methods were used to examine the determinants of milk consumption among 2- to 5-year-old children and 6- to 12-year-old children respectively, with application of theoretical frameworks. Mixed methods outcome and process evaluations were conducted to investigate the effectiveness and feasibility of 1. a two-week pilot SMS in EYS and 2. the EU SMS in primary schools. Results: Children’s liking of milk and parental milk consumption are positively associated with children’s milk consumption at preschool and school age. The SMS pilot was effective in increasing preschool children’s milk consumption and was feasible in EYS. Primary school children’s participation in the SMS was associated with higher milk consumption, however, low participation rates and low adherence to the accompanying educational measures are barriers to the scheme’s success. Implementation of both interventions was influenced by logistical challenges and factors relating to the social and educational context. Conclusion: Individual and environmental factors influence children’s milk consumption, but parental influence is a strong determinant throughout childhood. School- and preschool-based milk provision interventions, accompanied by engaging educational measures, are promising strategies to increase children’s milk consumption, but implementation supports are necessary to sustain participation and intervention fidelity.