Beyond the food tray: linking school nutrition and feeding programmes to student health and academic outcomes through health literacy and mental health

School nutrition and feeding programmes are pivotal in addressing both public health and educational challenges, yet their multidimensional impacts remain underexplored in resource-constrained settings. Guided by the Health-Promoting Schools (HPS) framework, this study examined the relationships between s°chool nutrition and feeding programmes, students’ self-reported physical health, and academic performance, with health literacy and mental health as potential mediators. A cross-sectional survey was conducted among pupils in basic schools, comprising primary and junior high levels, using standardised questionnaires.

Data were analysed with structural equation modelling (SEM). The findings indicate that feeding programmes are positively associated with students’ self-reported academic performance, with health literacy and mental health acting as indirect pathways. Health literacy was also found to mediate the relationship between feeding programmes and students’ perceived physical health.

Effect size analysis suggested that these associations were stronger in disadvantaged communities. In conclusion, school feeding initiatives may function as dual-impact strategies linked to both health (SDG 3) and education (SDG 4). Policymakers are encouraged to integrate meal provision with health education to improve students’ well-being and learning experiences in resource-constrained contexts.

This work was supported by the Zhejiang Provincial Philosophy and Social Sciences Planning Project (Grant No.: 25NDJC001ZD). Jesse Nii Okai Amu-Darko (Jiangsu University) and Mr. Kwabena Owusu (Municipal Director of Education, Ejisu) for their substantive contributions, enriching the depth and breadth of this research endeavor.

Zhejiang Normal University, Jinhua, China Correspondence to Priscilla Adomako Gyasi or Binghai Sun. The authors declare no competing interests. This study was conducted in accordance with the ethical principles of the 1964 Declaration of Helsinki and its subsequent revisions, as well as applicable institutional and national guidelines and regulations.

Ethical clearance was obtained from the Institutional Review Board (IRB) of Jiangsu University, China (Approval ID: JSDX20230425001), on 25 April 2023. No separate Ghanaian ethics approval was required for this study, as ethical clearance had been obtained from the Jiangsu University IRB, and authorization to conduct the research in Ghana was granted by the Ghana Education Service (GES), Ejisu Municipal Directorate (Reference: GES/ASH/EM/MOE/PGI/VOL121022), before data collection. Written informed consent was obtained from all participants.