- Title
- A healthy start is half the battle: towards effective nutrition education programs for primary school children
- Creator
- Verdonschot, Angeliek
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Healthy eating in early life, with sufficient fruits and vegetables (FV), protects against the development of obesity and chronic diseases, and supports academic performances and mental wellbeing. However, up to present, most children do not meet the FV guidelines. The school is an ideal environment for children to learn about the importance of healthy eating. Therefore, in the last two decades multiple nutrition education programs have been developed, implemented, and evaluated to encourage healthy eating in children. While many programs show positive effects on children’s FV intake, still multiple programs do not lead to any positive change in healthy eating behaviour. Since each program differs in content, delivery, and context, evaluating such programs is complex but essential to enhance program effectiveness and encourage healthy eating in children. The current thesis examined the effectiveness of nutrition education programs by identifying and evaluating the different components of nutrition education programs and the role of the context. Three studies were conducted: 1) a literature study to identify and explore the effectiveness of individual components.; 2) an observational study to evaluate teaching quality of two nutrition education programs, one in the Netherlands (Taste Lessons) and one in Australia (CUPS).; 3) an evaluation study to assess the effect of two Dutch programs (EU-Schoolfruit and Taste Lessons) on the FV intake and nutrition knowledge in children aged 7-12 years old. The umbrella review (i.e., a review of reviews) included eight systematic reviews, including 33 relevant primary studies. Seven individual components were identified: FV provision, gaming/computer-delivered, curriculum, experiential learning, rewards/incentives, nudging, and caregiver involvement. The first three components were found to be most frequently listed in literature and most effective in increasing children’s FV intake and nutrition knowledge. However, it was found that primary evaluation studies are highly variable when it comes to reporting program effectiveness, program content description or data integrity and are therefore difficult to compare in review studies. Future evaluation studies are therefore highly recommended to use standardized measurement methods, report effect sizes and the used units (e.g., a serving size of 80g). Results of the observational study among 31 individual lessons (Dutch n = 15, Australian n = 16) showed that the lesson delivery of both programs were of high quality. The Australian Quality Teaching Model, which includes a framework designed to guide evaluation of classroom practices, was used for this study showed to be a useful tool. Both programs could improve teaching quality by 1) identify language or symbols that help children understanding the lesson content, 2) incorporate choices within the lesson activities to exercise children’s control, 3) provide opportunities that children can learn about different social groups and 4) include stories written, told, read, viewed, or listen to, to help children understanding the lesson content. In school year 2018-2019 (October 2018) researchers visited schools (n = 37) throughout the Netherlands and collected baseline data using a questionnaire to measure children’s FV intake and nutrition knowledge (children n = 1460). The study with a quasi-experimental design included three different study groups: (1) schools that implemented both EU-Schoolfruit and Taste Lessons (n = 15), (2) schools that implemented EU-Schoolfruit only (n = 12) and schools that did not implement any nutrition education program (control group) (n = 10). Outcomes were assessed pre-, during- and 6-months after program. The results of the evaluation study showed that both programs do not directly increase children’s FV intake. This might be explained by the fact that participating schools possibly encouraged healthy eating already before the start of the study, shifting the responsibility of FV provision from caregivers to the school, or not fully delivered the provided lessons (on average 2.9 out of total 5 lessons). Taste Lessons did result in a significant increase in children’s nutrition knowledge, after participation in the program (p < 0.01), which is in line with earlier research. Secondary analyses showed that EU-Schoolfruit contributes to children’s FV intake in children from schools without school food policy (e.g., the rule of taking FV to school for the morning break only) (p < 0.05). In addition, both programs showed stronger effects on FV intake in children who receive less support to eat healthily at home, compared to children who get more encouragement to eat healthily at home. Future program implementers are therefore recommended to especially target children from schools without school food policies and/or children who receive less support to eat healthily at home, as they benefit the most from school-based nutrition education programs. In conclusion, some evidence of individual component effectiveness on children’s FV intake and nutrition knowledge exists. Programs using FV provision, gaming/computer-delivered and/or the curriculum-based approach are found to be most successful in encouraging healthy eating in children. Lesson delivery of Taste Lessons and CUPS are found to be of high quality with a few points for improvement, based on the useful Quality Teaching Framework on classroom practices. Participation in both EU-Schoolfruit and Taste Lessons have shown to be effective in increasing children’s nutrition knowledge and increasing FV intake in subgroups of children from a home/school environment where healthy eating is less promoted. Children’s healthy eating behaviour can be encouraged through school-based nutrition education, with considering all FV intake determinants as being essential given the complexity of developing, implementing, and evaluating effective nutrition education and the desired behavioural change.
- Subject
- nutrition education programs; healthy eating in children; dietary intake; nutrition knowledge; intervention components; primary schools; teaching quality; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1507450
- Identifier
- uon:56023
- Rights
- Copyright 2022 Angeliek Verdonschot
- Language
- eng
- Full Text
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