The rationale behind the intervention conducted by Bere, Veierod, Bjelland, and Klepp (2006) was that in Norway, schoolchildren consumed less fruit and vegetables than recommended by health organizations. Two main reasons were recognized: a lower preference for fruit and vegetables among children and less availability compared to other popular products. Therefore, educators and education authorities supported an initiative to promote the consumption of fruit and vegetables among children in schools as places where children spend a lot of time and may have more than one meal a day. To understand how this consumption could be increased, an academic effort was needed, and several studies were conducted to test various approaches for ensuring that schoolchildren would eat more fruit and vegetables. Thus, the purpose of the intervention was to establish whether the designed method of encouraging schoolchildren to alter their diet through classroom sessions, parental involvement, and a school fruit program would be effective. An additional purpose was to collect feedback about the intervention and to assess how the target population perceived the program, along with assessing how effective it was.
Nineteen randomly chosen schools in one county in Norway agreed to participate in the Fruits and Vegetables Make the Marks (FVMM) program; a division into two groups—intervention and control—was made by schools, not by classes within schools. The intervention involved sixth graders and lasted for six months. For assessment, three surveys were conducted: one before the intervention, one shortly after its completion, and one more that took place a year after the intervention. Participants were asked to fill in questionnaires with the assistance of trained project workers. Also, since part of the intervention was associated with classroom sessions during home economics classes, participating teachers were also asked to provide feedback. Out of the 538 schoolchildren asked to participate, only 369 took part in the interventions and were able to complete all three surveys. These constituted the sample of the study, of which boys and girls comprised 46% and 54%, respectively; 51% were in the intervention group, and 49% were in the control group.
The intervention included three components. First, classroom sessions, part of the home economics curriculum, were led by the regular teacher who had completed a one-day training workshop. Each session was divided into three regular lessons. During the sessions, schoolchildren received information on the positive health outcomes of eating fruit and vegetables as well as the quantities recommended by health organizations. In addition, during the sessions, the participants were asked to eat fruit and vegetables as snacks and were taught to prepare various dishes with those products. The second component was parental involvement. Parents received six newsletters over the span of the program that informed them about specific fruits and vegetables, how to cook with them at home, and what health benefits were associated with each type. It was expected that receiving this information would encourage parents to buy more fruit and vegetables, thus increasing the availability of those products for children at home. Finally, the school fruit program component in all the participating schools provided either pieces of fruit or carrots to be distributed among sixth graders every day at lunch.
Three of the main principles of health promotion programs are empowering, participatory, and holistic (Rootman et al., 2001). Evaluation in such programs can be based on these principles, and all three are relevant to the given intervention. The researchers planned to evaluate the outcomes in two major areas: first, the intake of fruit and vegetables among participating schoolchildren in the intervention group in comparison with the control group; and second, feedback from participating schoolchildren, parents, and teachers. The evaluation sought to establish whether participants became more aware of the health benefits of consuming more fruit and vegetables (empowering), whether they engaged actively in the fruit program and intervention-related class sessions (participatory), and whether they became more willing to eat more fruit and vegetables (holistic). Also, feedback was collected in order to see whether the participants enjoyed the intervention, thought it was effective, and had recommendations to offer for future programs.
The intervention was not successful. At all three stages of evaluation, it was established that participating schoolchildren did not start eating more fruit and vegetables. The main reasons given included failure to change the participants’ behavior (shift toward preferring fruit and vegetables) and failure to increase availability of these products for participating schoolchildren; the same factors were also noted in a study by Evans, Christian, Cleghorn, Greenwood, and Cade (2012). Further, it is necessary to theoretically address the issue of behavior change in this context and develop better instruments. For example, Kothe, Mullan, and Butow (2012) applied the theory of planned behavior to a case promoting fruit and vegetable consumption. Their intervention was more successful, but they also revealed certain weaknesses of the theoretical framework. The intervention by De Bock, Breitenstein, and Fischer (2012) was also successful as they managed to change behaviors regarding consumption of fruit and vegetables among children through an intervention involving joint meal preparation activities with children and their parents. One successful result of the intervention by Bere et al. (2006), however, was that, according to participants’ feedback, they enjoyed the intervention even though their behavior was not changed by it.
References
Bere, E., Veierod, M. B., Bjelland, M., & Klepp, K. I. (2006).Outcome and process evaluation of a Norwegian school-randomized fruit and vegetable intervention: Fruits and vegetables make the marks (FVMM). Health Education Research, 21(2), 258-267.
De Bock, F., Breitenstein, L., & Fischer, J. E. (2012). Positive impact of a pre-school-based nutritional intervention on children’s fruit and vegetable intake: Results of a cluster-randomized trial. Public Health Nutrition, 15(3), 466-475.
Evans, C. E., Christian, M. S., Cleghorn, C. L., Greenwood, D. C., & Cade, J. E. (2012). Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y. The American Journal of Clinical Nutrition, 96(4), 889-901.
Kothe, E. J., Mullan, B. A., & Butow, P. (2012). Promoting fruit and vegetable consumption: Testing an intervention based on the theory of planned behaviour. Appetite, 58(3), 997-1004.
Rootman, I., Goodstadt, M., Hyndman, B., McQueen, D. V., Potvin, L., Springett, J., & Ziglio, E. (Eds.). (2001). Evaluation in health promotion: Principles and perspectives. Copenhagen, Denmark: WHO Regional Publications.