5-a-Day Power Plus: Process Evaluation of a Multicomponent Elementary School Program to Increase Fruit and Vegetable Consumption

Abstract

The 5-a-Day Power Plus program targeted multiethnic fourth- and fifth-grade students in 10 intervention and 10 control urban elementary schools in St. Paul, Minnesota, to increase fruit and vegetable consumption. The intervention included behavioral curricula in classrooms, parental involvement, school food service changes, and food industry support. Process evaluation was conducted by using surveys and classroom and lunchroom observations to assess the characteristics of teachers and food service staff, the degree the intervention was implemented as intended, and exteral factors that may have affected the program results. Results showed high levels of participation, dose, and fidelity for all of the intervention components, with the exception of parental involvement. The process evaluation findings help explain why the increase in fruit and vegetable consumption occurred mostly at school lunch and not at home. Future intervention research should focus on creating new and potent strategies for parental involvement and for increasing the appeal and availability of vegetables.

The Tooty Fruity Vegie project: Changing knowledge and attitudes about fruits and vegetables

“…25 Confidence in our results (see project report for the full range 20 ) is enhanced by their concordance with similar overseas studies indicating: the importance of quality teacher training, curriculum and canteen components; 12,25,26 the importance and difficulties of achieving high parental involvement; 11,12,[24][25][26] improved parental involvement by using incentives and scheduling activities to coincide with other school events; 11,25,26 higher recall among children having done fruit and vegetable activities at school; 24 higher awareness among parents of their children having done the fruit and vegetable activities; 26 and higher recall and enjoyment of hands-on and tasting activities. 12,24,26 Confidence in TFV's acceptability and sustainability is also enhanced by the fact that all 10 original intervention schools continue implementing TFV strategies, now over three years since the supported intervention ended. Two additional implementation phases of the project within the Northern Rivers region have been over-subscribed with enthusiastic schools and the project is now being implemented in other regions, via 23 health professionals from three States, who attended a training workshop in 2003.…”

“…[1][2][3] While intake levels appear adequate among pre-schoolers, they become increasingly inadequate as children get older, [4][5][6] with most Australian adults' diets also falling well below recommended daily intakes. 4,7,8 Therefore, we developed a fruit and vegetable-promoting intervention for primary schools, drawing on the successes and lessons learned from similar Australian and overseas projects [9][10][11][12][13][14][15] as well as broader health promotion and behaviour change theories. 16,17 The Tooty Fruity Vegie (TFV) project was a two-year, multi-strategy program that ran in 10 primary schools during the 1999 and 2000 school years.…”

A mixed-methods exploration of implementation of a comprehensive school healthy eating model one year after scale-up

“…Facilitators were support from a technical unit (including training) and access to resources (materials and funding: all resources were provided free for the school through provincial funding). These operational factors have been identified consistently in the school health literature (31,34,35,(51)(52)(53)(54)(55)(56) . Durlak and DuPre characterized leadership, access to resources (funding), time and loss of momentum due to competing demands in their broader implementation framework as delivery system factors (21) .…”

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

“…Some of the interesting associations with fruit and vegetable intake that have been identified are verbal encouragement by food staff and number of different types of fruit and vegetables available at lunch (10) . While an intervention reported by Story et al (23) achieved a high implementation of school items, there were no differences in fruit and vegetable intake from children at schools with low implementation compared with high implementation. They did report that items which were less likely to be implemented were 'preparation intense' items such as the tasting activities.…”