Do health-promoting schools improve nutrition in China?

Abstract

To demonstrate the effectiveness of health-promoting school framework to promoting healthy eating behaviours and nutrition knowledge among Chinese middle school students, their parents and school staff. Three schools were randomly selected from 15 rural middle schools, then were randomly assigned to either (i) school using HPS framework (HPS school), (ii) school with improved health education only (HE school) or (iii) school received no intervention (control school). Nutrition knowledge and eating behaviours were measured at baseline and 3-month after interventions, using the same instrument. Students and parents in the HPS school had the largest improvement in nutrition knowledge, from 4.92 to 8.23 and 4.84 to 7.74, followed by those in the HE school, from 4.98 to 8.09 and 4.78 to 5.80. School staff in the HE school had the largest improvement in nutrition knowledge (from 4.40 to 8.45), followed by those in the HPS school (from 5.20 to 9.15). Students in the HPS school had the largest improvement in eating behaviours (from 3.16 to 4.13), followed by those in the HE school (from 2.78 to 3.54). There was a statistical difference in the improvement of nutrition knowledge of all target population and of eating behaviours of students after interventions across three schools (p < 0.05). Both HPS framework and health education can increase nutrition knowledge among Chinese middle school students, their parents and school staff. However, HPS framework was more effective than health education only. Noticeably, HPS framework had a positive impact on students' eating behaviours, which should be in the subject of further research.

Effect of a school-based nutrition education program on adolescents’ nutrition-related knowledge, attitudes and behaviour in rural areas of China

“…The results showed that some of adolescents' knowledge, attitudes and behaviour in relation to nutrition improved significantly after this 6-month nutrition education, which demonstrates that this nutrition education program is effective to promote adolescents' nutrition in rural areas of China. These findings are consistent with the results of previous studies, which showed that school-based nutrition interventions can play a major role in dietary change among adolescents because the amount of time young people spend at school and the large percentage of food they consume there, parental influence on diet decreases and the food provided in schools and the influence of peers become more important [16][17][18]. Also, nutrition education has been widely integrated into the formal curriculum for many years.…”

Delivering in‐school interventions to improve dietary behaviours amongst 11‐ to 16‐year‐olds: A systematic review

“…The target behaviours in the reviewed studies included increasing fruit and/or vegetable consumption (n = 19); improving snacking behaviours (n = 8) (this included both decreasing the intake of energy‐dense nutrient‐poor snacks) and increasing healthy snacks like fruits and vegetables; decreasing sugar‐sweetened beverage (SSB) intake (n = 8); encouragement to eat meals on a regular basis (n = 4); improving general eating behaviours (eg, increase daily nutritional recommended intake of carbohydrates, fibre minerals, protein, and vitamins, n = 5), and reducing daily fat and sugar intake (n = 3) . A number of studies (n = 13) targeted more than one dietary behaviour in their intervention (eg, increasing fruit and vegetable consumption, decreasing SSB and unhealthy snacks consumption) …”

“…In terms of eating behaviour assessments, behavioural measures included food frequency questionnaires (FFQ) (n = 24), food diaries over periods of time ranging from 24 hours to 7 days (n = 3; including one online), dietary interviews including general structured interviews on daily dietary consumption (n = 2), a paired food questionnaire (one healthy and one unhealthy option; n = 2), and a “true or false” food statement questionnaire (would you eat a foodstuff, “true or false”; n = 1). All of the reviewed studies had a “before and after” measurement of dietary behaviour, and 14 studies included a longer‐term follow‐up assessment (ranging from 6 weeks to 4 years), whilst two studies also included a measure mid‐intervention …”

“…The main intervention components of the 29 studies are outlined in Supplementary Table 2. The majority of studies included a healthy eating lesson component (n = 20), healthy eating activities (eg, practical activities—role‐playing; n = 13), a worksheet (eg, problem solving; n = 16), and/or a practical lesson (n = 11) . Ten studies included a combination of healthy eating lesson, activities, and a worksheet .…”

“…An additional seven studies were judged to be at high risk of bias primarily because the individual study designs were identified as not being randomised controlled trials (RCTs). Most of the studies were judged to have at least one domain of unclear risk of bias; this was mainly owing to the selective reporting of features of these studies. The main feature that was not reported was the blinding of participants and/or researchers to group allocation.…”