# A participatory research to assess how a student citizens' assembly can facilitate the co-creation of nutrition interventions in higher education settings

Alice Bellicha, Benjamin Allès, Julia Baudry, Lucile Bouré, Henri Dehove, El Karmouni Hajar, Emilie Frenkiel, Emmanuelle Kesse-Guyot, Sandrine Péneau, Malo Mofakhami

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## ► To cite this version:

Alice Bellicha, Benjamin Allès, Julia Baudry, Lucile Bouré, Henri Dehove, et al. A participatory research to assess how a student citizens' assembly can facilitate the co-creation of nutrition interventions in higher education settings. BMC Public Health, 2024, 24 (1), pp.2772. 10.1186/s12889-024-20277-3. [https://hal.science/hal-04734439v1](https://hal.science/hal-04734439v1)

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# A participatory research to assess how a student citizens' assembly can facilitate the co-creation of nutrition interventions in higher education settings

Alice Bellicha¹*, Benjamin Allès¹, Julia Baudry¹, Lucile Bouré², Henri Dehove¹, Hajar El Karmouni³, Emilie Frenkiel², Emmanuelle Kesse-Guyot¹, Sandrine Péneau¹, Malo Mofakhami⁴ and the USPN Student Citizens' Assembly Group

**Abstract**

**Background** The transition period from adolescence to early adulthood is critical for developing new nutritional behaviors, making higher education students an important target group for public health nutrition interventions. Given the complexity of nutrition-related behaviors and their various determinants, involving the student population (the future beneficiaries of interventions) and the partners engaged in their implementation when designing campus nutrition interventions is essential. Citizens' assemblies are deliberative processes which are more and more frequently organized to co-create solutions to complex problems. This study aims 1) to design and implement a student citizens' assembly using participatory research methods, 2) to describe its process and evaluate its transferability, 3) to evaluate changes in dietary habits, knowledge and citizen practices among students participating in this assembly.

**Methods** This study will take place at a French university (University Sorbonne Paris Nord, USPN) located in socio-economically disadvantaged suburbs of Paris. The student citizens' assembly will gather a mini-public of 30 students enrolled at the time of the study and a co-creation team of academic and non-academic partners involved in student life, nutrition, physical activity, or public policies. The aim of the assembly is to co-create a set of concrete proposals that would enhance USPN students' access to sustainable diets and physical activity. The protocol is based on a continuous process evaluation and a pre-post design among the mini-public. A mixed-method framework combining quantitative and qualitative approaches will be developed. This study will make use of (i) field observations of the intervention process and transferability, (ii) data collected by questionnaires on pre- and post- dietary habits, knowledge and citizen practices of the mini-public, and (iii) pre-post interviews with a subsample of the same mini-public.

**Discussion** Relying on participatory research methods, this study will provide new insights into involving higher education students and diverse partners in co-creating campus nutrition interventions. Through the collaborative work of researchers, higher education students, university representatives, public institutions, and local and community actors, this study will provide evidence-based guidance for designing innovative and contextually-relevant nutrition interventions in the higher education setting.

<footnote>*Correspondence:
Alice Bellicha
a.bellicha@eren.smbh.univ-paris13.fr
Full list of author information is available at the end of the article</footnote>
**Trial registration** This research was registered at the ClinicalTrials.gov (NCT06580795; registration date: 2024-08-30; https://www.clinicaltrials.gov/study/NCT06580795).

**Keywords** Higher education, Students, Nutrition, Public health, Deliberative mini-public, Student citizens' assembly, Co-creation, Participatory research

**Background**

The transition from adolescence to young adulthood is seen as a critical period for developing new lifestyle habits [1, 2]. In terms of nutritional behaviors, the transition from high school to higher education is characterized by a shift towards less healthy and sustainable habits compared to adolescence: decreased diet quality [1, 2], disruption of eating patterns [3], decreased physical activity [4], significant weight gain [5] and low levels of sustainable dietary patterns and practices [6]. Higher education students are also particularly likely to experience food insecurity, defined as a lack of consistent access to sufficient food for an active and healthy life [7]. According to a recent review, 41% of higher education students in the US report food insecurity, a proportion higher than the national average of 10% [8, 9]. In France, where this study will occur, rates of food insecurity varying from 7% [10] to 43% [11] have been reported among students. Given its prevalence and detrimental consequences on diet quality, physical and emotional health, or academic achievement, food insecurity is a major cause of concern in the higher education setting [12–15].

In this specific setting, several determinants of nutritional behaviors have been identified. Individual characteristics such as younger age, a lack of cooking ability, low nutrition knowledge and financial difficulties, as well as interpersonal factors, such as having parents with a lower socioeconomic position and living away from the family home, have been associated with less healthy eating behaviors and food insecurity [16–22]. The campus food and built environment and university policies also influence students’ nutritional habits. For example, housing with on-site dining or unlimited access to on-campus dining have been associated with less healthy habits, and lower walkability or bikeability around campus with lower physical activity [18, 19]. As in the general population, multi-level interventions tackling individual, interpersonal, environmental, and policy determinants of students nutritional behaviors may therefore be needed to significantly impact their nutritional habits [23, 24].

According to a recent review, co-creating interventions with higher education students and campus food services staff may increase their effectiveness in improving students’ diet, compared to intervention designed solely by researchers [25]. Involving those who are intended to be the beneficiaries and partners of public

health interventions is indeed increasingly seen as essential to designing tailor-made, context-specific interventions [26, 27]. Involving non-academic partners such as citizens, patients, community members, professionals or institutional representatives in the research process with the aim of producing solution- and public-oriented knowledge is the fundamental principle of participatory research [26]. Their participation can take various forms. In the deepest forms of participation, non-academic partners are involved from problem definition to intervention design, implementation and evaluation [28]. This form of participation is characterized by active collaboration and shared decision-making between academic and non-academic actors at every stage of the research process [28]. When it comes to published campus nutrition interventions, students have usually been involved at the stage of intervention implementation, and not at the earliest phases of problem definition and intervention design [25]. It is, therefore, essential to organize and evaluate innovative strategies for involving non-academic partners (i.e. students) in designing and implementing campus nutrition interventions.

Deliberative mini-publics are increasingly popular for co-creating solutions to complex problems that have proved difficult to solve using traditional approaches [29, 30]. Mini-publics involve small groups of randomly chosen lay citizens who are invited to deliberate and produce policy recommendations to government executives or elected authorities. Mini-publics have been used at national levels (e.g. Ireland's [31] and France's [29] citizen's assemblies on climate change) but also at regional levels (e.g. Budapest's public consultation on climate strategy [32]) local levels, for example, within universities [33, 34]. Conducting citizen's assemblies in higher education settings appears feasible, as illustrated by the first student citizen's assembly conducted in a French university (i.e. University Paris-Est Creteil in the Paris region), which focused on sustainable diet, with the mandate to produce a series of measures that would allow an alternative food system to be set on campus [33]. More research is needed, however, to better assess student citizen's assemblies' ability to produce measures addressing the multiple determinants of students' diet, and thus to better estimate their potential impact on public health.

In this context, the main objective of this project is to provide insights into involving higher education students
and diverse partners in co-creating nutrition interventions in a higher education setting through a deliberative mini-public. The specific aims are 1) to design and implement a student citizens' assembly using participatory research methods, 2) to describe its process and evaluate its transferability, 3) to evaluate changes in dietary habits, knowledge and citizen practices among the mini-public (i.e. students participating in the student citizen's assembly), using quantitative and qualitative methods.

## Methods

### Study setting

This study will take place at the University Sorbonne Paris Nord (USPN), located in the Seine Saint Denis department, in the Northern area of the Paris region (France). USPN has a population of approximately 25,000 students across three main campuses located in the cities of Villetaneuse, Bobigny and Saint-Denis. The Seine Saint Denis department exhibits specific characteristics compared to the broader Parisian region, including a higher proportion of young people under the age of 25 y [35] but also a higher rate of unemployment [36] and households living in poverty [37]. The participants evaluated in this study are students taking part in the intervention, i.e. the student citizens' assembly.

### Overall study procedures

The intervention will consist in a deliberative mini-public, a student citizen's assembly on diet and physical activity. As presented in Fig. 1, after an initial phase of co-design in the early months of 2024, the assembly will take place between September 2024 and January 2025 (study aim #1). The other study aims will be addressed through a continuous process evaluation (study aim #2) and a pre-post quantitative and qualitative evaluation (study

aim #3). This research is conducted in accordance with the guidelines laid down in the Declaration of Helsinki, and all procedures have been approved by the University Sorbonne Paris Nord Research Ethics Committee (no. 2024–055) and registered with the Commission Nationale de l'Informatique et des Libertés (no. 2228413 v0). All participants will provide an electronic informed consent prior to their enrollment in the study. This research was registered at the ClinicalTrials.gov (NCT06580795).

## Intervention description

### Mandate of the student citizen's assembly

The mandate of this student citizen's assembly will be to co-create a set of concrete proposals that would enhance USPN students' access to sustainable diets and physical activity. These proposals will then be submitted to the President of USPN, who has committed to making them public and evaluating them through ad hoc academic committees that will provide a detailed response to each proposal. The FAO's broad definition of sustainable diets, which encompasses environmental, health, economic and sociocultural dimensions, will be used as a reference to guide the work of the student citizens' assembly: "dietary patterns that promote all dimensions of individuals' health and wellbeing; have low environmental pressure and impact; are accessible, affordable, safe and equitable; and are culturally acceptable" [38]. Similarly, the following consensual definition of physical activity will be used: "any bodily movement produced by skeletal muscles that results in energy expenditure" [39].

### Members of the student citizen's assembly

The mini-public will involve 30 students enrolled at USPN at the time of the study. This convenience sample of 30 students will allow for the creation of a group

<figure><img src="image_4.png" /><figcaption>**Fig. 1** Study procedures</figcaption></figure>
of six students for each of the five defined work themes, as detailed below. The criteria for inclusion will comprise: being an adult (18 years of age or older), being enrolled at USPN at the time of the study, being enrolled in initial training with in-person classes. Students enrolled in continuing education or work-study programs will not be included due to their limited time on university campuses and schedules constrained by mandatory presence at their host organization.

During the student citizens' assembly, in order to formulate informed and relevant proposals, the mini-public will interact with a co-creation team of academic and non-academic partners involved in student life, nutrition, physical activity, or public policies (university administrative, teaching and research staff, and actors from the civic society) (Table 1).

### Procedures and timeline of the student citizens' assembly

The USPN student citizens' assembly is organized in five steps and will be based on collective deliberation and co-creation. Collective deliberation involves the process of confronting arguments and collectively evaluating their strengths in order to make a choice or solve a problem (Manin B: Deliberation: why we should focus on debate rather than discussion, unpublished). In citizens' assemblies, the opinion of citizens prevails. Therefore, the external input is usually limited to what is strictly

necessary to provide lay citizens with the tools they need to understand the subject and the issues at stake, such as training sessions and expert hearings [29]. Co-creation refers to the engagement of beneficiaries (i.e. students) and partners of public health interventions (e.g. university staff, food services, political representatives) in the design, implementation and evaluation of interventions [28]. Thus, co-creation differs from deliberation between lay citizens in that it involves citizens alongside decision-makers, who all share responsibility for the proposals [29].

**Step 1- Recruitment of the mini-public.** Students will be randomly selected out of a pool of volunteers. In September 2024, a communication campaign targeting all university students (of all ages and fields of study) will be conducted through emails, social media, and events on campus. Voluntary students will answer an online questionnaire to confirm their willingness to participate in the random draw. The random selection will then be conducted among them, in an effort to fill quotas based on gender (60% women), campus (56%, 37% and 7% at the Villetaneuse, Bobigny and Saint-Denis campuses, respectively), field of study (33% enrolled in Health Medicine and Human Biology, 36% in Humanities, Languages and Social Sciences or Communication, Economic and Management sciences, 12% in Engineering sciences, 19% in Technical studies) and study level (74%, 24% and 2% undergraduate, post-graduate, PhD students, respectively). Assuming that some students will stop participating during the student citizens' assembly, we plan to initially select 45 students to ensure the participation of 30 students until the end of the assembly. Students will not receive financial compensation for their participation in the study. However, they will receive ECTS credits and a certificate from the University confirming their participation in the student citizens' assembly.

**Step 2 – Assembly sessions.** The student citizens' assembly will take place during three days in November 2024 (see Fig. 2 for program details). On day 1, introductions and presentations, conferences, round tables and interactive training will be organized. On day 2, the student mini-public will be separated into five thematic groups defined by the Governance Committee: 1) reducing the burden of food insecurity among students, 2) improving students' nutritional quality of the diet, 3) reducing the environmental impact of students' diet, 4) improving students' relationships with their body, weight, and eating behavior, 5) increasing their physical activity and active mobility. These themes are broad enough to allow students the freedom to approach them according to their needs, knowledge, and aspirations. On the morning of day 2, students will deliberate to define a list of preliminary proposals for each theme. Then, they will reconvene

<table><caption>**Table 1** Description of the student citizens' assembly members</caption><tr><td><strong>Mini-public</strong></td><td>- 30 students enrolled at University Sorbonne Paris Nord</td></tr><tr><td><strong>Co-creation partners</strong></td><td><em>University administrative, teaching and research staff</em></td></tr><tr><td></td><td>- Researchers in public health nutrition, physical activity and health, economic sciences</td></tr><tr><td></td><td>- Director of Student Life Department</td></tr><tr><td></td><td>- Medical director of Student Health Service</td></tr><tr><td></td><td>- Registered dietician of the Student Health Service</td></tr><tr><td></td><td>- Director of the Physical Activity and Sports Department</td></tr><tr><td></td><td>- Sustainable development project manager</td></tr><tr><td></td><td>- Elected students</td></tr><tr><td><em>Civic society</em></td><td></td></tr><tr><td><em>Public institutions</em></td><td>- University catering services</td></tr><tr><td><em>Territorial partners</em></td><td>- Elected member of the Departmental Council</td></tr><tr><td></td><td>- Elected members of municipalities and groups of municipalities</td></tr><tr><td><em>Associations</em></td><td>- Student solidarity grocery store</td></tr><tr><td></td><td>- Student Network</td></tr><tr><td></td><td>- Nutritional education sector</td></tr></table>
<figure><img src="image_5.png" /><figcaption>**Fig. 2** Timeline of the student citizens' assembly</figcaption></figure>

in plenary sessions in the afternoon to discuss and refine their proposals. On day 3, students will present their proposals and debate with the co-creation team. This will result in a list of co-created proposals. The sessions will be facilitated by a certified health education educator, with the assistance of master's students in nutrition who were previously trained in facilitation. An independent guarantor will ensure that the necessary conditions are met to guarantee the autonomy of assembly members and compliance with best practices in participatory research and collective deliberation [40, 41].

**Step 3 – Vote.** Shortly after day 3, the guarantor will supervise an online anonymous among all assembly members, asking them how much they approve the proposals on a 10-point Likert scale. Proposals receiving an average appreciation below 5 on the 10-point scale will be withdrawn from the list of proposals. Thus, after this step, a list of definitive proposals will be defined.

**Step 4 – Writing of the final report.** The coordination team, in collaboration with one student from each thematic group, will draft the final report presenting the definitive proposals. The draft will then be amended, approved and signed by all assembly members. To inform the “maxi-public” of USPN (i.e. all the students and staff of the university) and to ensure transparency on process and outcomes of the assembly, the finalized proposals will also be published on the university website.

**Step 5 – Closure.** Members of the governance committee and voluntary assembly members will formally present proposals, which will be discussed with the maxi-public.

## Participatory research and co-creation procedures

According to the typology of Biggs, this study is based on a collegiate (and deepest) mode of participation, where academic and non-academic partners collaborate in a process of mutual learning, sharing control over the

research process [42]. Indeed, the beneficiaries of the intervention (i.e. university students) and non-academic partners likely to implement the proposals are involved in the research from the start, in different ways, as summarized in Table 2. Non-academic partners participate in all steps of the process from problem definition to solution design, implementation, and evaluation.

## Data collection and planned statistical analyses

### Transferability of the student citizens' assembly (aim #2)

A continuous process evaluation will be conducted to estimate the transferability of the student citizen's assembly (Fig. 1), defined as the ability of a program to be successfully disseminated and maintained under real-life conditions [43]. Indicators of transferability will be assessed throughout the student citizen's assembly and after its completion using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework [44, 45]. The following indicators will be computed.

Reach measures participation at the individual level. To assess the proportion and representativeness of the student mini-public, their data on individual characteristics (gender, level of study, discipline, campus) will be collected and compared with the statistics of the overall USPN student population. Their participation (i.e. presence) to assembly sessions will also be recorded.

Effectiveness refers to the impact on selected outcomes, participant satisfaction and any adverse effects. Because the proposals of the student citizens' assembly will not be implemented during the time frame of this study, assessing their effectiveness on the diet of the overall student population will not be possible. Therefore, effectiveness evaluation will consist of presenting the proposals of the student citizens' assembly and assessing whether they target the main determinants of the population's diet. Relevant frameworks, such as the (Determinants of Nutrition and Eating) DONE framework synthesizing
<table><caption>**Table 2** Involvement of partners in the research process</caption><thead><tr><td>Research stage</td><td>Partners involved</td><td>Role</td></tr></thead><tbody><tr><td>Drafting the protocol for grant applications</td><td>Investigators:<br/>- Researchers in public health nutrition, political science, educational science, sports science, economic science<br/>- USPN representatives (vice-presidents for student life, for research, for science with and for society)<br/>- Vice-president representative of students<br/>- Representative of the Department council<br/>- Public institution (university catering services)<br/>- Student association (USPN solidarity grocery store)<br/>- Association (health education sector)<br/>- Association (urban agriculture and sustainable diet sector)</td><td>➤ To identify the main diet-related difficulties encountered by USPN students<br/>➤ To define the research objectives<br/>➤ To discuss the feasibility of the research plan<br/>➤ To identify potential barriers to implementing the research and to define solutions</td></tr><tr><td>Conducting an initial assessment of USPN students' diet and food environment</td><td>- Researchers in public health nutrition<br/>- PhD student in public health nutrition<br/>- Master students in nutrition and public health (USPN)<br/>- USPN representatives and administrative staff</td><td>➤ To participate in the development of an online questionnaire on students' nutrition and living conditions<br/>➤ To communicate about the survey<br/>➤ To conduct statistical analyses<br/>➤ To present the main results of the survey (day 1 of the student citizens' assembly)<br/>➤ To evaluate the food environment on and around USPN campuses</td></tr><tr><td>Co-designing the student citizens' assembly</td><td>Governance committee:<br/>- Researchers in public health nutrition, political science, educational science, sports science, economic science<br/>- USPN representatives (vice-presidents for student life, for research, for science with and for society)<br/>- Vice-president representative of students<br/>- USPN administrative staff (director of Communication, Director of the Cultural Department)<br/>- Certified educator (health education association)<br/>- Project manager trained in political science<br/>- PhD student in public health nutrition<br/>- Masters student (intern)</td><td>➤ To define the mandate of the student citizens' assembly<br/>➤ To draft the guiding principles of the student citizens' assembly<br/>➤ To define how the mini-public and the co-creation team will be selected<br/>➤ To organize the student citizens' assembly, especially the deliberation and co-creation sessions<br/>➤ To design the training sessions (day 1 of the assembly)<br/>➤ To define rules regarding data privacy, reproduction, dissemination and use of data and knowledge; and to obtain legal permits<br/>➤ To propose solutions to fairly crediting and recognizing the contribution of each partner<br/>➤ To design the communication plan (mailing, social network, website, posters to recruit students and disseminate the proposals)</td></tr><tr><td>Designing and animating an interactive training</td><td>- Researchers in public health nutrition, sociology and health geography<br/>- PhD student in public health nutrition<br/>- Master students in nutrition and public health (USPN)<br/>- Certified educator (health education association)</td><td>➤ To synthesize the literature on the individual, interpersonal, environmental and policy determinants of the diet of higher education students<br/>➤ To develop an interactive educational tool for university students aimed at raising awareness about issues related to students' diet, understanding the determinants of their diet, identifying actors involved, and exploring potential solutions<br/>➤ To use this tool the training sessions of the student citizens' assembly (day 1, training animated by the Masters students who designed the tool)</td></tr><tr><td>Defining proposals for future nutrition interventions</td><td>Student citizens' assembly (see Table 1 for details)</td><td>➤ To co-create of list of concrete proposals that would improve the access of USPN students to sustainable diets and physical activity<br/>➤ To draft the final report (with the help of the study coordinator and project manager)</td></tr><tr><td>Facilitating the assembly sessions</td><td>- Project manager trained in political science<br/>- Certified educator (health education association)<br/>- Master students</td><td>➤ To precisely organize the sessions<br/>➤ To facilitate discussions, ensure fair distribution of speaking time, and equal exchange of ideas</td></tr></tbody></table>
<table><caption>**Table 2** (continued)</caption><thead><tr><td>Research stage</td><td>Partners involved</td><td>Role</td></tr></thead><tbody><tr><td>Reviewing the communication strategy and the proposals</td><td>Student organizing committee: - Voluntary students from USPN</td><td>➤ To discuss the overall communication strategy and adapt it to student habits and needs<br>➤ To participate in campus events and promote awareness of the program among students<br>➤ To review the proposals and help improve understanding of the proposals and the final report</td></tr><tr><td>Disseminating the proposals to the maxi-public</td><td>Governance committee<br>Student organizing committee</td><td>➤ To discuss the most appropriate strategy to communicate the proposals to the maxi-public<br>➤ To implement the communication strategy</td></tr><tr><td>Interpreting research findings</td><td>Investigators<br>Governance committee<br>Student organizing committee</td><td>➤ To discuss and interpret research findings</td></tr><tr><td>Disseminating research findings to the scientific community</td><td>Investigators<br>Governance committee</td><td>➤ To draft research articles and to present at national and international conferences</td></tr></tbody></table>

the individual, interpersonal, environmental and policy determinants of diet [46], will be used to conduct this comparison.

Adoption measures the proportion and representativeness of settings and staff members adopting a given program. To describe the co-creation team, data on their individual characteristics (gender, age, employer and job description) will be collected.

Implementation is the extent to which a program is delivered as intended. It will consist of describing the assembly members' expertise, calculating the monetary cost of implementing the citizens' assembly, and comparing its actual to its planned implementation.

Maintenance refers to long-term changes at both the individual and setting levels. This will be assessed by tracking the evolution of proposals (e.g. whether they have been accepted and implemented) and the willingness of USPN representatives to replicate the student citizens' assembly in another location or on another topic will be assessed through interviews conducted with USPN representatives one year after completion of the assembly.

A narrative approach and/or standard descriptive statistics will be used to summarize data collected for process evaluation. Comparisons between characteristics of the student mini- and maxi-public will be conducted using the $\chi^2$ test for categorical variables and Wilcoxon or Kruskal Wallis tests for continuous variables.

### Changes in dietary habits, knowledge and citizen practices (aim #3)

A combination of quantitative and qualitative approaches will be used to assess and understand changes in dietary habits, as well as knowledge of the environmental

impact of diet and citizen practices among the student mini-public.

Quantitative data collection An online survey will be conducted before and after the student citizens' assembly among the student mini-public to assess changes in their dietary habits, knowledge on the environmental impact of diet and citizen practices. Questionnaires will be completed online using a dedicated secure website (https://etude-daccord.fr/). At inclusion in the study and one month after the citizen's assembly, the mini-public will be invited to complete a set of self-administered questionnaires (Additional file 1). Questionnaire 1 (pre-assembly) will assess socioeconomic and demographic characteristics (level of study and discipline, housing conditions, perceived economic difficulties...). Questionnaire 2 (pre- and post-assembly) is a short food frequency questionnaire assessing food group consumption, adapted from French national studies [47, 48]. Questionnaire 3 (pre- and post-assembly) is a French version of the SHED index assessing sustainable dietary practices [49]. Questionnaire 4 (pre- and post-assembly) is a French version of a short questionnaire assessing knowledge of diet's environmental impact [50]. Questionnaire 5 (post-assembly) will assess the perception of the student citizen's assembly and citizen practices.

Qualitative data collection Semi-structured interviews will be conducted among the mini-public before and one month after the student citizens' assembly. Before the student citizen's assembly, the interviews will explore each person's interpretation of the term 'eating well,' their understanding of the food system and its environmental impact, their dietary habits and eating practices, as well as the barriers they face in achieving a sustainable diet.
Following the student citizen's assembly, the interviews will focus on any changes observed in these areas since participating in the assembly.

*Analyses* Pre- and post- quantitative data on dietary habits, knowledge, and citizen practices will be described using standard descriptive statistics. Changes over time will be assessed using McNemar or Wilcoxon signed rank test, wherever appropriate.

The qualitative analysis is based on the transcription of interviews conducted with students. The interviews will be analyzed using thematic content analysis to highlight the similarities and differences in the respondents' statements [51]. This approach allows us to identify and code the main emerging themes. After a thorough reading and an initial open coding phase, axial coding to group the initial codes into larger and more meaningful categories will be performed. This step is followed by a selective coding phase, where the main categories are refined and interconnected to reveal recurring patterns and relationships between concepts.

Integrative analyses will also be performed to investigate how quantitative and qualitative data correspond and complement each other.

# Discussion

## A participatory research project

This study aims to provide insights into involving higher education students and diverse partners in co-creating nutrition interventions in a higher education setting through a deliberative mini-public. This project is based on participatory research, which has emerged as an appropriate approach for designing and implementing public health interventions [26]. In participatory research, academic and non-academic partners collaborate to produce solution- and public-oriented knowledge [26]. Potential benefits of participatory research include the definition of more relevant research questions, greater community engagement and better responses to the needs and expectations of target populations [52–54]. In this study, we pay particular attention to involve a diversity of partners from the start of the research. Academic partners have diverse profiles (administrative, teaching and research staff, and elected students), and non-academic partners come from public institutions (university catering services), local authorities (municipalities, groups of municipalities, departmental council), student associations, or associations established locally or nationally. Their involvement in the different research steps, from problem definition to solution design, implementation, and evaluation, is a strength of this study.

## Co-creation of nutritional interventions

This study will help understand whether using such participatory research methods and co-creation approaches can lead to the design of relevant interventions targeting the main determinants of students' diets. Among the numerous studies reporting the effectiveness of nutrition interventions in the higher education setting, the majority of interventions were designed solely by researchers and were based on one single strategy, such as implementing a nutritional education program or changing the campus food environment [25, 55]. The first student citizens' assembly conducted on a global scale, at Paris Est Créteil University in 2021, France, gathered 150 students who were asked to produce measures that would allow an alternative food system on campus [33]. Their proposals included both individual- and organizational-level interventions, indicating that students recognized the need for multi-level interventions [33]. The training sessions at the outset of citizens' assemblies are critical, as they equip participants with a common foundation of knowledge on the key issues at stake, fostering informed and productive debates. In our study, these training sessions are co-designed with master's students in public health nutrition and focus on the multi-level determinants of students' diets. This approach aims to guide discussions and proposals across these different intervention levels. Beyond analyzing the proposals, it will be critical to assess their acceptability by the university community and their effective implementation. Although the USPN President committed to making the proposals public and having them evaluated by ad hoc academic committees, it is important to clarify that, in France, universities are not solely responsible for the food environment and policy on and off campus. However, they can play a role in negotiation and coordination. This is why we believe that the involvement of other key actors during the student citizens' assembly will increase the chances of effectively implementing the proposals.

## Mixed-methods exploration

This study aims to evaluate the transferability of the student citizens' assembly, and to assess and understand changes in the participating students' dietary habits, knowledge, and citizen practices. To that end, quantitative and qualitative approaches will be combined to gain insights that neither approach alone would provide [56]. The process of the student citizens' assembly will be described in detail using the RE-AIM framework presented above, which has been used extensively in public health research [44, 57]. Describing the intervention process is critical for transferability purposes, especially for interventions using participatory and co-creation
approaches, involving numerous partners. So far, stud-
ies that have conducted participatory and co-created
campus-based nutrition interventions did not sufficiently
report the process of intervention, which limits their
potential for transferability [25].

Limitations and feasibility risks

This participatory research project involves several risks. The first risk pertains to the participation of students in the student citizens' assembly and the research protocol, and the diversity of their profiles. We are aware that the project depends on the willingness of students representing the diversity of students' profiles to invest time in this project and that disadvantaged groups are a hard-to-reach segment of the population [58]. However, this risk is reduced by the early involvement of university students and university representatives as full research partners in our consortium, thereby ensuring the adaptation of the communication strategy to student population's habits, needs and aspirations. Second, all measures of changes in dietary habits, knowledge and citizen practices are self-reported, representing a limitation due to the known social desirability bias in such sensitive topics [59]. However, the use of online questionnaires will reduce this risk, compared to a more traditional face-to-face interview [60]. Changes are also assessed in the short term, although it would be of interest to assess them at longer term. Finally, in the timeline of this study, the proposals put forward by the student citizens' assembly will not be implemented and their effectiveness on students' diets will not be assessed. Other outcomes will be assessed, such as the assembly transferability and the changes occurring within students involved in the assembly. This study will provide the foundation for designing a future research protocol to evaluate the implementation and effectiveness of the proposals.

Abbreviations

DONE Determinants of Nutrition and Eating

RE-AIM Reach, Effectiveness, Adoption, Implementation, Maintenance

USPN University Sorbonne Paris Nord

Supplementary Information

The online version contains supplementary material available at https://doi.
org/10.1186/s12889-024-20277-3.

Additional file 1.

Acknowledgements

The authors warmly thank all (future) volunteer members of the student citizens' assembly for their participation in the study. We would also like to thank the academic, institutional, territorial and associative partners for their support of the study.

Members of the "USPN Student Citizens' Assembly Group" collaboration Group should be searchable through their individual PubMed records: Alice BEL-LICHA, Carole BAEZA, Laurent BAUER, Yann CHAPIN, Henri DEHOVE, Vanessa

DEWALLERS, Jean-Luc DUMAS, Aude-Marie FOUCAUT, Emilie FRENKIEL, Olivia GROSS, Céline GUERRAND, Inaara HAIDARALY, Goran KAYMAK, Nathalie LIDGI-GUIGUI, Malo MOFAKHAMI, Pascale MOLINIER, Leslie NOUNDOU, Olivier OUDAR, Raphaëlle PISTORESI, Rouguy THIAM-SY, Lucile VIGOUROUX.

Authors' contributions

AB, HEK, EF, and MM contributed to the conceptualization of the study. All authors participated in study design and were involved in writing the study protocol. All authors contributed to the manuscript preparation and have read and approved the final manuscript. The USPN Student Citizens' Assembly Group is a consortium of researchers, university representatives, students, and associative partners who are members of the student citizens assembly governance committee.

Funding

This research has undergone independent peer-review and has received funding from the French National Research Agency (Agence Nationale de la Recherche, DACCORD study, no. ANR-23-SSAI-0020-01) and the Institute for Public Health Research (Institut pour la Recherche en Santé Publique, CoCo-Nut study, AAP-2022-SIP-312743).

Availability of data and materials

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This research is conducted in accordance with the guidelines laid down in the Declaration of Helsinki, and all procedures have been approved by the Uni- versity Sorbonne Paris Nord Research Ethics Committee (no. 2024-055) and registered with the Commission Nationale de l'Informatique et des Libertés (no. 2228413 v0). All participants will provide an electronic informed consent prior to their enrollment in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Author details

¹Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, France. ²Laboratoire Interdisciplinaire d'Etude du Politique Hannah Arendt (LIPHA), Université Paris Est-Créteil, Fontainebleau, France. ³Institut de Recherche en Gestion, Université Paris Est-Créteil, Créteil, France. ⁴Institute for Interdisciplinary Research On Social Issues (IRIS), Université Sorbonne Paris Nord, Aubervilliers, Bobigny, France.

Received: 2 September 2024 Accepted: 3 October 2024

Published: 10 October 2024

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