Co-creation of nutrition interventions in higher education settings: proposals from a student citizens’ assembly

Background: Improving students’ diet is a public health priority, yet interventions often fail to address the structural barriers students face, particularly in socioeconomically disadvantaged settings. This study aimed to assess how students involved in a co-creation process (i.e. a student citizens’ assembly) conceptualise and prioritise solutions to improve students’ access to healthier, more climate-friendly diets. Methods: This participatory research took place at a French university (Sorbonne Paris Nord) located in socioeconomically disadvantaged suburbs of Paris. A student citizens’ assembly was conducted with the aim to co-create concrete proposals that would enhance students’ access to sustainable diets and physical activity. The assembly involved 27 students randomly selected among a pool of volunteers. Over three days in November 2024, students received awareness-raising and training, deliberated among themselves then with institutional and local stakeholders, and formulated proposals. For each proposal, students were asked to rate anonymously their approval on a 10-point scale. Proposals related to diet (i.e. not physical activity) were analysed a posteriori using two complementary frameworks: the DONE framework classifying determinants of diet (individual, interpersonal, environmental /policy) and the FAO dimensions of sustainable diets (health, ecological, socioeconomic, cultural). Results: Overall, 31 proposals were formulated, of which 77% targeted environmental and policy determinants of diet (e.g. institutional regulations, university policies, food assistance solutions, improved food affordability and availability, food labelling). Other proposals referred to individual (19%) and interpersonal determinants (3%). In addition, 39%, 29%, 23% and 10% proposals addressed the health, socio-economic, ecological and cultural dimensions, respectively. Mean approval ratings (SD) for each proposal ranged from 6.7 (4.0) to 9.7 (0.9), with a mean (SD) value for all proposals of 8.6 (0.7). Proposals addressing the socio-economic dimension received the highest approval ratings (mean [SD] 9.0 [0.6], vs 8.4 [0.6], 8.4 [0.8] and 7.9 [0.4] for the health, ecological and cultural dimensions, respectively).Conclusion: The predominance of environmental and policy measures targeting economic access to food highlights the importance of co-creation and its value to align interventions with participants’ needs and expectations. One major challenge that warrants further investigation is the capacity of stakeholders to implement such proposals, and to evaluate their effectiveness.