Appreciation and implementation of a school-based intervention are associated with changes in fruit and vegetable intake in 10- to 13-year old schoolchildren--the Pro Children study

151

140

Objective: To evaluate implementation and effectiveness of nutrition promotion programmes using the health-promoting schools (HPS) approach, to indicate areas where further research is needed and to make recommendations for practice in this field. Design: The searched electronic databases included: CINAHL, Cochrane Library, Health Reference Center, Informit Search, MEDLINE, ProQuest, PsycINFO, PubMed, ScienceDirect, Scopus, Social Services Abstracts and Web of Science. Inclusion criteria were: (i) controlled or before-and-after studies evaluating a nutrition intervention and involving the HPS approach, either fully or in part; (ii) provision of information about components and delivery of the intervention; and (iii) report on all evaluated outcomes. Setting: Schools. Subjects: Students, parents and school staff. Results: All included studies described intervention delivery and six reported on process evaluation. In intervention schools school environment and ethos were more supportive, appropriate curriculum was delivered and parents and/or the community were more engaged and involved. Students participated in interventions at differing levels, but the majority was satisfied with the intervention. The evidence indicates that nutrition promotion programmes using the HPS approach can increase participants' consumption of high-fibre foods, healthier snacks, water, milk, fruit and vegetables. It can also reduce participants' 'breakfast skipping', as well as reduce intakes of red food, low-nutrient dense foods, fatty and cream foods, sweet drinks consumption and eating disorders. It can help to develop hygienic habits and improved food safety behaviours. Conclusions: More professional training for teachers in the HPS approach, further qualitative studies, longer intervention periods, improved follow-up evaluations and adequate funding are required for future school-based nutrition promotion programmes.

Section: Curriculummentioning

confidence: 99%

Section: Curriculummentioning

confidence: 99%

Section: Before and Aftermentioning

confidence: 99%

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The implementation and effectiveness of school-based nutrition promotion programmes using a health-promoting schools approach: a systematic review

Wang

Stewart

2012

151

140

“…SEM for health have been adopted in dealing with many health behaviours (17)(18)(19)(20)(21)(22) , including healthy eating and childhood obesity (23) , as they provide useful frameworks for achieving a better understanding of the multiple factors and barriers that impact on dietary behaviours. Although past studies have used SEM in developing conceptual models to investigate the impact of interventions on healthy eating (19,20,22,24,25) , as far as the authors are aware none have investigated the relative association of the different levels found in these models through multilevel analysis.…”

mentioning

confidence: 99%

Developing and applying a socio-ecological model to the promotion of healthy eating in the school

Townsend¹,

Foster²

2011

130

Objective: To develop and apply a socio-ecological model (SEM) for healthy eating in school students, to better understand the association between factors at different levels of the SEM and pupils' dietary choices. Design: Student-level data, collected through anonymised questionnaires, included reported dietary choices and correlates to these; data on school approaches to food were collected through postal surveys. We used multilevel analysis to study the association of each level of the SEM on student dietary choice while controlling for factors found at other levels. Setting: Data were collected from secondary schools in Wales that were a part of the 2005/2006 Health Behaviour in School-aged Children (HBSC) study. Subjects: The final sample for analysis included data from 6693 students aged 11-16 years and 289 teachers from sixty-four secondary schools in Wales. Results: Student interpersonal factors, an individual's social environment, had a greater association with the dietary choices students made for lunch than student intrapersonal characteristics, those that reside within the person, which were found to have a greater association with the dietary choices made outside school. School organisational factors, such as rules and policies, had a greater association with whether students ate unhealthy foods, whereas the community nature of the school had a greater association with the choosing of healthy foods. Conclusions: Using the SEM and multilevel analysis allowed us to study how factors were associated with the choice of different foods at different times of the day by students. Interventions can use an SEM to target specific correlates and change health outcomes in the school.

“…However, the home environment and mealtime structure are vital components of a child's eating pattern (4) . To tackle this issue, the Project Tomato intervention incorporated fun activities for parents and children to do together at home, because parents play a direct role in their child's eating behaviours and attitudes towards food (4,5) . Several systematic reviews have summarised existing research on school interventions to increase children's fruit and vegetable intake (6)(7)(8) and these reviews suggest multi-component interventions are the most successful in terms of improving fruit and vegetable consumption (9)(10)(11)(12)(13)(14)(15)(16)(17) , supporting the design methodology used to create the Project Tomato intervention.…”

mentioning

confidence: 99%

Process evaluation of a cluster randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato

Mestres

Evans

Ransley

et al. 2011

Objective: The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8-9 years. Design: A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms. Setting: Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group. Subjects: A total of 311 children received the intervention. Results: Implementation of the intervention was low, 21?3 % of school items and 56?0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3-7 nights/week on average consumed 37?6 (95 % CI 9?8, 65?4) g more fruit and vegetables than children who ate with their parents 0-2 times/week. Conclusions: Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on children's fruit and vegetable intake.