'Kids in the Kitchen' impact evaluation: engaging primary school students in preparing fruit and vegetables for their own consumption

A critical review of children's culinary nutrition interventions, the methodologies used and their impact on dietary, psychosocial and wellbeing outcomes

Diet quality has been associated with numerous health outcomes, resulting in nutrition education to improve children's diet quality. Culinary nutrition interventions have been emphasised as a promising approach for enhancing children's food preferences and behaviours. Recently, there has been an increase in such interventions, and it is essential to understand their effectiveness and the specific methods used. Therefore, this review aimed to critically investigate methodological approaches in a range of children's culinary nutrition interventions and experiments. A secondary aim was to investigate the impact of these interventions on dietary, psychosocial and wellbeing outcomes. A systematic and pragmatic search strategy was developed and implemented using two electronic databases. Data extraction of the relevant content of eligible studies and a narrative synthesis were conducted. A total of 12 312 articles were identified from the search and 38 studies on children's culinary nutrition interventions or experiments were included. Most studies (n = 25) were conducted in North America. Only two studies had an RCT design. Less than half the studies (n = 16) used an underpinning theory, model or framework. Only four studies conducted sample size calculations. Some validated measurement tools were used. Despite the methodological concerns, most studies found some positive changes in dietary and/or psychosocial outcomes, while only two studies assessed wellbeing. Therefore, the area warrants further in-depth research anchored in methodological rigor to strengthen the validity of the research. The strengthening of the evidence in children's culinary nutrition could have a significant beneficial impact on public health if it resulted in widespread interventions and, in the long-term, reduce the impact on health systems.

The Effects of a Multi-Component School-Based Nutrition Education Intervention on Children's Determinants of Fruit and Vegetable Intake

Evidence suggests that multi-component school-based health-promoting interventions have great potential to improve children's fruit and vegetable intake. However, interventions that combine classroom-based curricula with experiential learning strategies (e.g., cooking) are relatively seldom described. This study investigates the short-term and longer-term effects of a multi-component school-based nutrition education intervention combining classroom-based and experiential learning strategies on children's determinants of their fruit and vegetable intake (knowledge, taste preferences, attitudes, and intention). Using a comparative quasi-experimental study design, data were collected, via child-reported questionnaires, at the baseline, directly after the intervention, and three months after the intervention from 4 control and 15 intervention classes from Dutch primary schools. A total of 192 children in grades three and four (aged 8-10 years) constituted the participants. After correction for the baseline, sex, age, and the fruit or vegetable product assessed in the questionnaire; the intervention group showed a significant increase in knowledge (p = 0.001; standardized effect size (ES = 0.60), taste preference (p = 0.002; ES = 0.52), attitude towards the assessed fruit or vegetable product (p = 0.004; ES = 0.48), and general attitude towards healthy products (p = 0.01; ES = 0.39) over the short term, when compared to the control group. The effects of the intervention did not continue to be significant over the longer term. The findings implicate short-term intervention success, although more research and intervention adaptations are recommended to increase the impact of such programs, especially over the long term.

Evaluation of Social Impact Within Primary School Health Promotion: A Systematic Review

BACKGROUND

Health promotion programs and interventions are designed to encourage behavioral changes in children, encouraging them to make safe and healthy life choices. This systematic review seeks to examine how social impact is measured in primary school health promotion interventions.

METHOD

A systematic search and review process was used to identify and examine primary school health promotion interventions. The PRISMA guidelines were followed to source articles from 6 electronic databases reporting school health promotion programs or interventions in Australia, Canada, New Zealand, or the United Kingdom.

RESULTS

A total of 77 studies were located, representing 55 health promotion interventions delivered in primary school settings. Of these interventions, only 8 (15%) measured or attempted to measure social impact, whereas another 8 (15%) alluded to social impact. The predominant theories reported were social based theories (theories which examine the social influences on people, environments, and behaviors) (n = 17, 59%), with almost a third not informed by an overt health promotion framework or model (n = 34, 59%). A systematic rating system identified some level of stakeholder engagement (n = 30, 53%).

CONCLUSIONS

This systematic review highlights the need for social impact measurement within health promotion to illuminate the role of school programs in delivering lasting change.

Involvement of children in hands-on meal preparation and the associated nutrition outcomes: A scoping review

BACKGROUND

Emerging research has explored hands-on meal preparation as a strategy to improve children's nutrition-related outcomes. This scoping review was conducted to describe the extent of studies on children's involvement in hands-on meal preparation and the related psychosocial outcomes, actual nutrition behaviour/food consumption and weight status.

METHODS

Scoping review methodology was used to select relevant studies, as well as extract and collate the data. Four databases (PubMed, Google Scholar, Science Direct and Cochrane Database of Systematic Reviews) were searched from the earliest available time up to December 2020. Observational studies, experimental studies and reviews that were conducted among children aged 5-12 years old and published from 2010 to 2020 were retrieved. Studies extracted involved children in hands-on healthy meal preparation activities and explored the associated nutrition outcomes.

RESULTS

In total, 28 studies (5 observational studies, 21 experimental studies, 2 reviews) were included in the final review. Studies conducted demonstrated improvement in children's psychosocial outcomes and actual nutrition behaviour/food consumption after participating in hands-on meal preparation activities, despite differences in methodology, programme content and settings (countries/cultural origins). Limited studies assessed children's nutrients intake and weight status.

CONCLUSIONS

The current review suggests that hands-on meal preparation comprises approach for instilling positive perceptions towards nutrition/healthy foods, potentially improving children's diet. Future studies should include the assessment of nutrient intake and weight status. The long-term sustainability of these nutrition outcomes should be explored.

Influence of Cooking Workshops on Cooking Skills and Knowledge among Children Attending Summer Day Camps

This study aimed to measure the influence of the Chefs in Action program (3 cooking workshops) on cooking skills, nutrition knowledge, and attitudes towards healthy eating in children attending summer day camps and compare it with a single cooking workshop. Groups of children (8–12 years) were randomly assigned to the intervention group (n = 25) or to 1 of 3 comparison groups performing a single workshop (group 1, n = 16; group 2, n = 36; group 3, n = 24). Two dietitians evaluated cooking skills during the workshops. Nutrition knowledge and attitudes towards healthy eating were assessed before and after the intervention. No improvement in cooking skills was observed in the intervention group (P = 0.25). The intervention group’s cooking skills score was significantly higher than comparison group 1 (P < 0.001). Nutrition knowledge was significantly improved in the intervention group and the comparison group 3 (P < 0.0001) but no effect on attitudes towards healthy eating was observed (Pgroup × time = 0.36). In conclusion, the Chefs in Action program positively impacted nutrition knowledge in children. The results also suggest that the type of recipe may influence nutrition knowledge and cooking skills. Further studies are needed to better assess the degree of difficulty required in cooking workshop recipes to improve cooking skills in children.

Association of Dietary Patterns with Excess Weight and Body Adiposity in Brazilian Children: The Pase-Brasil Study

BACKGROUND

Obesity is a multifactorial disease and a serious public health problem. Some of the associated factors are modifiable and, among them, the diet is highlighted.

OBJECTIVE

To evaluate the association of dietary patterns of schoolchildren with obesity and body adiposity.

METHODS

A cross-sectional study was carried out with 378 children aged 8 and 9 years, enrolled in urban schools in the city of Viçosa, Minas Gerais, Brazil. A semi-structured questionnaire was applied to the children and their caregivers on sociodemographic characteristics and life habits. Three 24-hour food recalls were used to identify dietary patterns; the Principal Component Analysis was employed. Weight and height were measured for the calculation of the body mass index (BMI) of the children and their mothers, waist circumference and neck circumference. Body composition was also evaluated through dual-energy X-ray absorptiometry (DXA). For all performed tests, the level of significance was set at 5%.

RESULTS

Five dietary patterns (DP) were identified: "unhealthy", "snacks", "traditional", "industrialized" and "healthy". There was an association between excess weight (prevalence ratio [PR]: 1.38, 95% confidence interval [95%CI]: 1.02 to 1.87) and body fat (PR: 1.32, 95%CI : 1.07 to 1.64) with industrialized DP. There was an association between excess body fat (PR: 1.31, 95%CI: 1.01 to 1.74) and lower adherence to traditional DP. The other patterns were not associated with obesity and body adiposity.

CONCLUSION

Children with excess weight and body adiposity showed greater adherence to the industrialized DP and lower adherence to the traditional DP. We suggest that early assessments of dietary habits should be undertaken for monitoring and modifying these habits when necessary.

Utility of eButton images for identifying food preparation behaviors and meal-related tasks in adolescents

BACKGROUND

Food preparation skills may encourage healthy eating. Traditional assessment of child food preparation employs self- or parent proxy-reporting methods, which are prone to error. The eButton is a wearable all-day camera that has promise as an objective, passive method for measuring child food preparation practices.

PURPOSE

This paper explores the feasibility of the eButton to reliably capture home food preparation behaviors and practices in a sample of pre- and early adolescents (ages 9 to 13).

METHODS

This is a secondary analysis of two eButton pilot projects evaluating the dietary intake of pre- and early adolescents in or around Houston, Texas. Food preparation behaviors were coded into seven major categories including: browsing, altering food/adding seasoning, food media, meal related tasks, prep work, cooking and observing. Inter-coder reliability was measured using Cohen's kappa and percent agreement.

RESULTS

Analysis was completed on data for 31 participants. The most common activity was browsing in the pantry or fridge. Few participants demonstrated any food preparation work beyond unwrapping of food packages and combining two or more ingredients; actual cutting or measuring of foods were rare.

CONCLUSIONS

Although previous research suggests children who "help" prepare meals may obtain some dietary benefit, accurate assessment tools of food preparation behavior are lacking. The eButton offers a feasible approach to food preparation behavior measurement among pre- and early adolescents. Follow up research exploring the validity of this method in a larger sample, and comparisons between cooking behavior and dietary intake are needed.

What Should Be Taught in Secondary Schools' Nutrition and Food Systems Education? Views from Prominent Food-Related Professionals in Australia

Education can help young people to attain the knowledge and the skills that they need to make proper food choices and develop lifelong healthy eating patterns. This study explored the perspectives of prominent food-related professionals in Australia regarding essential nutrition and food systems (N&FS) education programs for adolescents during formal education. Semi-structured interviews were conducted with 21 prominent food-related professionals in Australia. Interview transcripts were analysed thematically. Four essential areas for N&FS education programs were identified. (1) Key nutrition messages to a healthy lifestyle; (2) Skill development programs to enhance health and wellbeing; (3) Ethical food-related lessons to support environmental sustainability, farm animal welfare, local producers, and food security; and, (4) Introductory lessons about foods from farm to plate to facilitate more informed food choices. Findings of this study may provide new insights for curriculum developers in Australia for further assessment of the current gaps in N&FS components of secondary school curriculum. Integration of these four areas into secondary school curricula has the potential to enhance adolescents’ knowledge of important scientific and ethical issues in a range of N&FS fields, and enable them to develop fundamental food-related life skills that are supportive of health and wellbeing.

Professionals' Recommended Strategies to Improve Australian Adolescents' Knowledge of Nutrition and Food Systems

Background: Education and policy measures within schools are valuable strategies to promote health. This study explored views of experienced food-related educators, researchers and policy-makers regarding their recommended strategies to improve Australian adolescents’ knowledge of nutrition and food systems (N&FS). Methods: Semi-structured interviews were conducted with twenty-one experienced food-related experts from across Australia. Interviews were conducted either by telephone or face-to-face. Recorded interviews were transcribed verbatim and analyzed thematically. Results: Five central themes and five sub-themes were identified from food professionals’ suggestions for best strategies to improve adolescents’ knowledge of N&FS. The central themes included: (1) specific improvements in schools’ core curricula; (2) pre-service and in-service training of school teachers about N&FS; (3) training students to develop a critical mind about N&FS issues; (4) multidisciplinary collaborations to improve school-based N&FS education; and (5) a supportive N&FS education environment for students. Conclusion and implication: These findings provide a guide for curriculum developers, educational policy developers, and food educators to incorporate the suggested N&FS strategies into Australian education programs in order to improve Australian adolescents’ knowledge and skills of N&FS issues. The results of this investigation also may assist the development of international N&FS curricula guides.

Experts' views regarding Australian school-leavers' knowledge of nutrition and food systems

OBJECTIVE

To explore Australian experts' views regarding strengths and gaps in school-leavers' knowledge of nutrition and food systems ( N&FS) and factors that influence that knowledge.

METHOD

Semi-structured interviews were conducted with 21 highly experienced food-related experts in Australia. Qualitative data were analysed thematically using Attride-Stirling's thematic network framework.

RESULTS

Two global themes and several organising themes were identified. The first global theme, 'structural curriculum-based problems', emerged from three organising themes of: inconsistencies in provided food education programs at schools in Australia; insufficient coverage of food-related skills and food systems topics in school curricula; and the lack of trained school teachers. The second global theme, 'insufficient levels of school-leavers knowledge of N&FS ', was generated from four organising themes, which together described Australian school-leavers' poor knowledge of N&FS more broadly and knowledge translation problem for everyday practices.

CONCLUSION

Study findings identified key problems relating to current school-based N&FS education programs in Australia and reported knowledge gaps in relation to N&FS among Australian school-leavers.

IMPLICATIONS

These findings provide important guidance for N&FS curriculum development, to clearly articulate broadly-based N&FS knowledge acquisition in curriculum policy and education documents for Australian schools.