A healthy start is half the battle: towards effective nutrition education programs for primary school children

A healthy diet is important for optimal child growth and development. However, up to present, most children do not meet the FV guidelines. Therefore, opportunities to encourage and supporting children to adopt healthy eating behaviour should be explored. Since the school is an ideal environment for children to learn about the importance of healthy eating, multiple nutrition education programs have been developed, implemented, and evaluated. While many programs show positive effects on children’s FV intake, still multiple programs do not lead to any positive change in healthy eating behaviour. Since each program differs in content, delivery, and context, evaluating such programs is complex but essential to enhance program effectiveness and encourage healthy eating in children.This thesis examined the effectiveness of nutrition education programs by identifying and evaluating the different components of nutrition education programs and the role of the context. Three studies were conducted: 1) a literature study to identify and explore the effectiveness of individual components, 2) an observational study to evaluate teaching quality of two nutrition education programs, and 3) an evaluation study to assess the effect of two programs (EU-Schoolfruit and Taste Lessons) on the FV intake and nutrition knowledge in children.The literature study identified seven individual components: 1) FV provision, 2) gaming/computer-delivered, 3) curriculum, 4) experiential learning, 5) rewards/incentives, 6) nudging, and 7) caregiver involvement. The first three components were found to be most frequently listed in literature and most effective in increasing children’s FV intake and nutrition knowledge. Results of the observational study showed that the lesson delivery of both programs were of high quality. The Australian Quality Teaching Model, which includes a framework designed to guide evaluation of classroom practices, was used for this study showed to be a useful tool. The evaluation study showed that participation in EU-Schoolfruit with and without Taste Lessons did not directly contribute to children’s FV intake. However, Taste Lessons did result in a significant increase in children’s nutrition knowledge, after participation in the program (p < 0.01), which is in line with earlier research. Furthermore, secondary analyses showed that EU-Schoolfruit contributes to children’s FV intake in children from schools without school food policy (p < 0.05). In addition, both programs showed stronger effects on FV intake in children who receive less support to eat healthily at home, compared to children who get more encouragement to eat healthily at home.In conclusion, some evidence of individual component effectiveness on children’s FV intake and nutrition knowledge exists. Programs using FV provision, gaming/computer-delivered and/or the curriculum-based approach are found to be most successful in encouraging healthy eating in children. Lesson delivery of two different programs is found to be of high quality, based on the useful Quality Teaching Framework. Participation in both EU-Schoolfruit and Taste Lessons have shown to be effective in increasing children’s nutrition knowledge and increasing FV intake in subgroups of children from a home/school environment where healthy eating is less promoted. Children’s healthy eating behaviour can be encouraged through school-based nutrition education, with considering all FV intake determinants as being essential given the complexity of developing, implementing, and evaluating effective nutrition education and the desired behavioural change.