In Defense of Food Curriculum: A Mixed Methods Outcome Evaluation in Afterschool

Abstract

Background. Highly processed foods are inexpensive and abundant in our food supply, nutritionally poor, and disproportionately marketed to minority youth. This study is part of a curriculum development project to develop, implement, and evaluate the In Defense of Food (IDOF) curriculum designed to increase intake of whole/minimally processed foods and decrease intake of highly processed foods in youth. Aims. This pilot outcome evaluation was undertaken to assess initial effectiveness and to provide an in-depth understanding of changes in behavioral outcomes and psychosocial mediators. Methods. We used an explanatory mixed method approach, including a single-arm pretest–posttest of intervention effect, followed by a food rules assessment and in-depth interviews to describe participant responses to the intervention in more detail. The study was conducted in three afterschool classrooms in urban low-income neighborhoods with 32 multiethnic middle-school youth, receiving 10 weekly 2-hour sessions. Results. Two weeks postintervention, there was a large positive significant increase in whole/minimally processed food intake ( p < .01; d = 0.59) and a small decrease in consumption of highly-processed foods ( p = ns; d = 0.06), compared with baseline. Significant increases in psychosocial mediators: Self-efficacy and positive outcomes expectations were seen; others were not significant but changed in the desired direction. Qualitative assessments suggest that the intervention promoted skill building, but environmental barriers made these difficult to use. Discussion. The IDOF curriculum may be most effective for promoting consumption of fruits and vegetables, rather than decreasing intake of highly processed foods. In addition, in this young age-group, short actionable food rules may support self-regulation and behavior change. Conclusion. Among adolescent students in low-income urban neighborhoods, the IDOF afterschool curriculum may help promote self-efficacy and positive outcome expectancies and increase fruit and vegetable intake. Focusing on food processing and using “Food Rules” may be promising to elicit behavior change in youth; however, greater supports are needed to overcome social and environmental barriers.

Health Literacy in Schools? A Systematic Review of Health-Related Interventions Aimed at Disadvantaged Adolescents

“…Three programs targeted dietary behaviours specifically. One intervention reported a significant increase in the intake of fruit and vegetables and a statistically insignificant decrease in highly processed foods, compared with baseline [54]. Significant increases, however, were seen in psychosocial mediators, and qualitative assessments suggest that the intervention promoted skill building, but environmental barriers made these difficult to use.…”

“…The year of publication ranged from 1996 [59] to 2020 [76], with the majority published in the last decade (n = 35). A total of 22 studies were randomised controlled trials (RCTs) [47,48,51,52,55,58,59,63,67,68,[70][71][72][73][74][75][76][77][78]82,85,86], ten employed pre-test-post-test quasi-experimental designs [49,53,62,[64][65][66]69,79,80,84], four employed a single group pretest-post-test designs [54,56,61,83], three were post-test qualitative evaluations [57,81,87], and the remaining two adopted cross-sectional designs [50,60]. All studies assessed the interventions using quantitative techniques, with the exception of five which employed mixed methods [49,54,69,…”

“…The largest group of interventions focused on PA and diet (n = 13) [49,55,[64][65][66][67][69][70][71]77,81,84,86], followed by PA (n = 8) [47,48,58,61,[73][74][75][76]80] and mental health (n = 7) [51,53,56,72,82,83,85]. The remainder targeted diet (n = 4) [54,60,62,78]; substance abuse (n = 2) [50,68]; PA, diet, substance abuse and mental health [59]; mental health and sleep [64]; PA, diet and substance abuse [52]; Sleep [57]; mental health and PA [87] and PA, diet and mental health [79]. Interventions were delivered by a wide range of people.…”

“…The duration of the interventions ranged from a single session [55] to a three-year program [72]. Twenty of the interventions incorporated a behavioural theory into the design [47,48,52,54,55,58,61,[64][65][66][67]70,71,[73][74][75][76]85,87], with 12 of these underpinning their intervention strategies with multiple theories [47,48,54,55,[64][65][66][67][73][74][75][76][77][78]. Twenty-three of the 41 interventions did not measure implementation fidelity.…”

“…The majority of outcomes associated with the included interventions were concerned with health-related behaviours [50,52,[54][55][56]59,[61][62][63][64][65][66]68,69,73,74,76,78,80,84,86]. Other outcomes included psychosocial function [51,[53][54][55][56]63,68,72,74,78,[83][84][85], health-related knowledge [49,52,59,68,69], physical measures (body composition, physical fitness and biochemical measures) [47,59,63,67,70,71,73,77,78] and the cohort's evaluation of the intervention [57,…”