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Ontario’s Action Plan for Healthy Eating & Active Living E VALUATION OF THE N ORTHERN F RUIT & V...
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Transcript of Ontario’s Action Plan for Healthy Eating & Active Living E VALUATION OF THE N ORTHERN F RUIT & V...
Ontario’s Action Plan for Healthy Eating & Active LivingOntario’s Action Plan for Healthy Eating & Active Living
EEVALUATIONVALUATION OF THEOF THE N NORTHERNORTHERN
FFRUITRUIT & V & VEGETABLEEGETABLE P PILOTILOT P PROGRAMROGRAM – – A RA RANDOMIZEDANDOMIZED C CONTROLLEDONTROLLED T TRIALRIAL
Meizi HeMeizi He
Charlene BeynonCharlene Beynon
Michelle Sangster BouckMichelle Sangster Bouck
Team MembersTeam Members
PHRED Evaluation Team Members:Meizi He, Middlesex-London Health Unit
Charlene Beynon, Middlesex-London Health Unit
Linda Khoshaba, Middlesex- London Health Unit
Michelle Sangster Bouck, Middlesex-London Health Unit
Renée St Onge, Sudbury & District Health Unit
Susan Stewart, Kingston, Frontenac and Lennox & Addington Public Health
Elaine Murkin, Ottawa Public Health
Suzanne Lemieux, Middlesex-London Health Unit
Porcupine Health Unit:Betty Ann Horbul
Bill Chircoski
The Northern Fruit and Vegetable The Northern Fruit and Vegetable Pilot Program (NFVPP)Pilot Program (NFVPP)
• School-based free fruit and vegetable snack (FFVS) intervention targeting elementary school-age children in Northern Ontario
• FFVS 3 times/week with or without enhanced nutrition education (ENE) for 24 weeks
• Funded by the Ontario Ministry of Health Promotion and implemented by Porcupine Health Unit in partnership with the Ontario Fruit and Vegetable Growers’ Association
Evaluation ObjectivesEvaluation Objectives
• Process Evaluation– identify facilitators and challenges to implementation
• Impact Evaluation– impact of NFVPP on students’ fruit and vegetable
consumption patterns– impact of NFVPP on students’ awareness, knowledge,
preference and willingness to try fruit and vegetables
Study DesignStudy Design
32 schools6 schools (JK-G4)
26 schools (JK-G8)
Intervention IFFVS+ENE
Intervention IIFFVS
Control
Process Evaluation24 schools
FV waste trackingIn-depth interviews
Impact EvaluationPrimary Outcomes – FV consumptionSecondary Outcomes – cognitive and behavioural scoresModerators – age, gender, language spoken at home
Grade 5-8 studentsin 9 schools
Grade 5-8 studentsin 9 schools
Grade 5-8 studentsin 8 schools
6 schools (JK-G4)9 schools (JK-G8)
9 schools (JK-G8) 8 schools (JK-G8)
Process Evaluation - MethodsProcess Evaluation - Methods
• 28 in-depth telephone interviews with principals, teachers and food preparers
• Weekly fruit and vegetable waste tracking throughout the program.
Impact Evaluation - MethodsImpact Evaluation - Methods
• Cluster-randomized controlled design– Intervention I:
FFVS + ENE– Intervention II:
FFVS and routine nutrition education
– Control: routine nutrition education
• Students in Grades 5-8• Baseline and Endpoint (Dec. 2006-June 2007)
Process Evaluation - FindingsProcess Evaluation - Findings
• Valuable Program
“Being able to offer this at school level, it’s a great thing and often students don’t have this exposure at home . . . . it’s a great program and we really enjoyed it and thought it was very beneficial to our students.” (principal)
“The impact is positive and I think the kids are starting to understand healthy eating.” (principal)
Facilitators Facilitators
• Funding
“I think with the funding and being able to hire someone to do all this, made it run very smoothly. If we were to do it on a volunteer basis, not have that funding, it would have been a lot more difficult.” (principal)
• Participation of the School Community
“What made it? It’s everyone’s participation. The teachers were very eager and the children were always happy to see what was coming into the classrooms.” (food preparer)
ChallengesChallenges
• Product Delivery
“One of the challenges that we’ve had here, was the delivery of it. We had a lot of problems with the delivery and it’s being delivered without the school’s knowledge.” (food preparer)
“Most of the time I had to cut off much of them [the vegetables] . . . . I was just trying to make these very old vegetables servable.” (food preparer)
• Quality - especially vegetables
• Variety - especially fruit• Waste
Estimated Fruit & Vegetable Estimated Fruit & Vegetable WastingWasting
21
35
1820
6
23
32
1817
9
0
5
10
15
20
25
30
35
40
No waste A little bit A half Most All
Ave
rag
e p
erc
en
tag
e o
f th
e o
cca
sio
ns
rep
ort
ed
(%
) JK- Grade 4 classes Grades 5-8 classes (n=621) (n=621)
RRESULTSESULTS F FROMROM
IIMPACTMPACT E EVALUATIONVALUATION … …
Sample Scheme Sample Scheme
Intervention IIFFVS
9 schoolsJK-Grade 8
Total n=1625
Intervention IFFVS+ENE
9 + 6 = 15 schoolsJK-Grade 8
Total n=3104
Control
8 schoolsJK-Grade 8
n=1659
9 schools Grades 5-8 n=603 / 836
9 schools Grades 5-8n=492 / 652
8 schoolsGrades 5-8n=491 / 766
n=400 / 492
n=470 / 603n=407 / 491
Intervention
Evaluation: Baseline
Evaluation: Endpoint
Intervention EffectIntervention EffectFruit and Vegetable Intake at EndpointFruit and Vegetable Intake at Endpoint
0.07
0.420.49
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Intervention I vs.Control Intervention II vs. Control Intervention I vs. II
Ad
jus
ted
me
an
dif
fere
nc
e (
Se
rvin
gs
/da
y)
*
*p< 0.05 by Post Hoc multiple comparison using the LSD pairwise comparison
Intervention EffectIntervention EffectChanges in preferences Changes in preferences Intervention IIntervention I
15
12
70
57
22
17
75
70
65
58
68
71
6
17
60
65
4
8
7
9
18
17
24
26
18
18
20
22
28
33
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
Rut
abag
aC
aulif
low
erLe
eks
Pea
ch c
upA
pple
sauc
e
Internvention I (n=391)
Like Never tried Dislike
**
**p<0.01 by Chi-Square Test
Intervention EffectIntervention EffectChanges in preferencesChanges in preferences
Intervention IIIntervention II
21
15
63
54
28
21
78
71
67
60
55
62
7
17
51
58
3
6
5
10
23
24
29
29
21
21
19
23
28
30
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
Rut
abag
aC
aulif
low
erLe
eks
Pea
ch c
upA
pple
sauc
e
Intervention II (n=391)
Like Never tried Dislike
*
**
*
**
**
*p<0.05; **p<0.01 by Chi-Square Test
Intervention EffectIntervention EffectChanges in preferences Changes in preferences ControlControl
**p<0.01 by Chi-Square Test
Intervention EffectIntervention EffectChanges in intention, self-efficacy & peer influenceChanges in intention, self-efficacy & peer influence
Intervention II Intervention II Intervention II (n=439)
46
55
76
83
70
74
39
30
15
8
18
12
15
15
9
9
15
14
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Endpoint
Baseline
Endpoint
Baseline
Endpoint
Baseline
My
best
fri
ends
eat
veg
etab
les
If I
dec
ide
to e
at v
eget
able
s, I
can
do it
I w
ant
to e
atve
geta
bles
Agree Neutral Disagree
*
*
*
*p<0.05 by Chi-Square Test
Impact Evaluation - SummaryImpact Evaluation - Summary
• The combined intervention strategy increased F&V intake by 0.5 serving/day at school
• Interventions resulted in favourable preference changes on certain fruit and vegetables
• There appears to be a tendency towards unfavourable changes in intention, self-efficacy, and peer influence pertaining to vegetable consumption in the Intervention II group (FFVS only)
Policy and Practice ImplicationsPolicy and Practice Implications
• The NFVP program appears to be a valuable and effective program
• Future intervention programs should consider:
– using a combined intervention strategy (FFVS + ENE)
– offering fruit & vegetables with adequate quality, quantity and variety
– ensuring appropriate delivery of produce
• Sufficient funding and good coordination are essential
For a copy of the Final Report go to: For a copy of the Final Report go to: www.mhp.gov.on.ca/english/health/HEAL/default.aspwww.mhp.gov.on.ca/english/health/HEAL/default.asp
For further information...For further information...
Charlene BeynonDirector
Dr. Meizi HeNutrition Researcher/Educator
Middlesex-London PHRED Program50 King Street
London, ON N6A 5L7