SR_15130_220115
January 2015
“Department SH O R T REP Ohere” RT
TEACHING HEALTHY EATING TO PRIMARY SCHOOL STUDENTS A RE V IE W OF E V I DENCE AN D BEST PR ACT ICE
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
This report was prepared for the NSW Department of Education and Communities with funding provided by the NSW Ministry of Health as part of the Healthy Children’s Initiative. The Department would like to acknowledge the SAX Institute for commissioning and coordinating the review and the following researchers from Sydney University and Macquarie University for conducting the review: Dr Dean Dudley – Macquarie University Dr Louisa Peralta – University of Sydney Dr Wayne Cotton – University of Sydney Dr David Baxter – Editorial Consultant
For further information please contact Student Engagement and Interagency Partnerships Unit NSW Department of Education and Communities 1 Oxford Street, Darlinghurst 2010 Tel: 9266 8258
This review includes the Teaching healthy eating to primary school students: A review of evidence and best practice: Short report, which highlights the findings of studies published between 2004 and 2014 within this review and summarises the key finding and messages.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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Introduction ■■
This review of evidence was undertaken to address four questions:
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1. What strategies does the evidence indicate are most effective in teaching healthy eating with K-6 students? 2. For the strategies identified in Question 1, what level of support is required for teachers to deliver them? 3. For the strategies identified in Question 1, what is the extent to which each has teaching resources that can be made available? 4. What are the recognised limitations or gaps in healthy eating resources currently available?
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This short report highlights the findings of studies published between 2004 and 2014. Studies were included if they examined interventions delivered by teachers that sought to bring about positive nutritional behaviour or knowledge change in primary school children. Definitions of the outcomes are provided in the evidence synthesis. Intervention locations included the classrooms and school gardens in primary schools. The Teaching healthy eating to primary school students: A review of evidence and best practice: Full report includes studies published earlier than 2004 (and up to 2014) if they used a well-designed intervention methodology and were considered relevant to the review. It also includes the full methodology, analysis and tables of all the studies investigated, and their associated teaching resources.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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Question 1: What strategies does the evidence indicate are most effective in teaching healthy eating with K-6 students? Overall, the evidence most strongly supports strategies that are cross-curricular and that provide students with opportunities to participate in experiential learning, as the most effective for teaching healthy eating with primary school students. Contingent reinforcement approaches have also shown some benefit, however this needs to be further explored.
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The review highlighted the following teaching strategies as most effective for teaching healthy eating: 1. Curriculum approaches (defined as nutrition education programs delivered by teachers or specialists) 2. Cross-curricular approaches (defined as learning experiences taught across two or more learning areas) 3. Parental involvement (defined as parents playing a role in the delivery of messages in the classroom and/or reinforcement of messages at home) 4. Experiential learning approaches (defined as school/ community gardens, food preparation [i.e., hygiene practices, peeling and cutting food], and cooking lessons)
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5. Contingent reinforcement approaches (defined as reward for behaviour) 6. Literary abstraction approaches (defined as approaches that use characters/stories to exemplify a message a teacher wants to communicate to students) 7. Games-based approaches (defined as board games, crosswords, find-a-words and recall activities) 8. Web-based approaches (defined as students interacting with a website(s) via the internet to enhance their knowledge of healthy eating).
Evidence synthesis ■■
A teaching strategy was determined as being effective if it demonstrated one or more of the following: reduced food consumption and energy intake; a change in fruit and vegetable consumption or preference; reduced sugar consumption or preference (not from whole fruit) or improved nutritional knowledge (defined as improving students’ understanding of what constitutes healthy eating and the importance of eating healthy and nutritious foods).
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The studies included in this review were intervention studies conducted in the following countries: Australia (n=1), New Zealand (n=2), UK (n=5), Canada (n=1), USA (n=10), Trinidad and Tobago (n=1), Italy (n=4), Norway (n=1), Iceland (n=1), Netherlands (n=1), Greece (n=1), Europe -multinational (n=1). Seventeen studies examined curriculum-based approaches. Only two studies demonstrated that curriculum-based approaches significantly reduced food consumption and energy intake. However, the studies showed a small impact only. None of the studies demonstrated that curriculum-based approaches significantly reduced sugar consumption or preference (not from whole fruit). Five studies demonstrated that curriculum-based approaches significantly improved nutritional knowledge but only one of these studies showed a large impact when coupled with an experiential learning strategy. Eight studies significantly increased the consumption of fruit and vegetables with moderate and large impacts when coupled with an experiential learning approach. Six studies examined experiential learning approaches but none of these studies demonstrated that experiential learning approaches significantly reduced food consumption and energy intake. Three studies demonstrated that experiential learning approaches significantly improved nutritional knowledge with one of these studies showing it has a large impact. Three studies significantly increased the consumption of fruit and vegetables and two of these studies had large impacts when coupled with a curriculum-based approach. Four studies examined cross-curricular approaches. None of these studies demonstrated that crosscurricular approaches significantly reduced food consumption and energy intake. One study demonstrated that cross-curricular approaches reduced sugar consumption or preference (not from whole fruit) but only showed a minimal impact. Two studies showed a significant increase in the consumption of fruit and vegetables with a moderate and large impact.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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Question 1 (continued) ■■
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Five studies examined parental involvement. None of these studies demonstrated that parental involvement reduced food consumption and energy intake. One study demonstrated that parental involvement significantly reduced sugar consumption or preference (not from whole fruit) but there was only a small impact. Four studies demonstrated that parental involvement significantly improved fruit and vegetable consumption, two of these studies showing a moderate and large impact.
Applicability of the evidence
Three studies examined contingent reinforcement approaches. All three studies demonstrated that contingent reinforcement approaches increased fruit and vegetable consumption, with one study showing that this approach had a large impact.
Two New Zealand studies were included. One study examined the effectiveness of a 2-year controlled community-based intervention to prevent excessive weight gain in 5–12-year old children by enhancing opportunities for healthy eating. The researchers found that children in the intervention consumed fewer carbonated beverages and fruit juice, and they consumed more fruit. The other New Zealand study examined the efficacy of a compulsory homework programme for increasing healthy eating in children aged 9-11 years old. The researchers in this study found that this study of compulsory health-related homework appeared to be an effective approach for improving vegetable and unhealthy food consumption in this instance.
Four studies examined literary abstraction approaches. One study demonstrated that literary abstraction approaches significantly reduced food consumption and energy intake however it only had a small impact. None of these studies demonstrated that literary abstraction approaches significantly reduced sugar consumption or preference (not from whole fruit). One study demonstrated that literary abstraction approaches significantly improved nutritional but the studies only had a small impact. One study using a literary abstraction approach coupled with contingent reinforcement significantly increased fruit consumption and demonstrated a large impact.
Only one Australian study based in NSW was included. This study examined the impact of a school gardenenhanced nutrition education program on children’s fruit and vegetable consumption, vegetable preferences, fruit and vegetable knowledge and quality of school life. The researchers found that school gardens can impact positively on primary-school students’ fruit and vegetable knowledge, their willingness to taste vegetables and their vegetable taste ratings.
Gaps in the research There is a lack of evidence about the following: ■■
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Three studies examined games-based approaches. One study demonstrated that games-based approaches significantly reduced sugar consumption or preference (not from whole fruit) when coupled with cross-curricular approaches but it had a small impact only. Two studies demonstrated that gamesbased approaches significantly improved nutritional knowledge (with one study showing this to have a moderate to large impact. One study showed that games-based approaches when coupled with crosscurricular approaches can increase fruit consumption but it had a small impact only. Two studies examined web-based approaches and one of these studies showed an increase in fruit and vegetable consumption. The overall impact however was small.
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The effectiveness of strategies for teaching healthy eating to primary school children from CALD, socially disadvantaged, rural/remote and/or Aboriginal K-6 students The effectiveness of strategies to improve primary school children’s understanding of the importance of healthy eating and the relationship of healthy eating with physical activity and healthy lifestyles The effectiveness of strategies to increase primary school children’s skills in terms of communicating, decision making, and problem solving relating to personal healthy eating choices The effectiveness of strategies to improve knowledge, understanding, attitudes and skills for primary school teachers.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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Question 2: What level of support is required for teachers to deliver these strategies? The evidence describes the type of support required by primary school teachers to deliver successful healthy eating programs but was unable to draw conclusions about the level of each type of support that is required.
Gaps in the research Research is available about the support required, however, there is a lack of research about the following: ■■
Evidence synthesis The type of support required by primary school teachers to deliver successful healthy eating programs for their students are as follows: ■■
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An environment conducive to change with interested and supportive teachers A whole school approach where students are surrounded by the intervention across numerous settings in multiple key learning areas (KLAs) and through newsletters and posters
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Applicability of findings to the Australian context The financial resources needed to develop materials, train teachers, implement programs and evaluate them Ways to create a school environment conducive to change The amount and type of teacher training required Ways of engaging and educating parents and caregivers to promote health behaviours The type, style and size of the school garden and gardening activities required to promote change.
An initial teacher training component Access to concrete experiences with food, from growing the food in a school garden, harvesting and preparing the food, through to cooking and eating the food Educational material that is developed collaboratively with teachers to produce culturally appropriate, engaging, teacher-friendly resources that enhanced student knowledge sustained parental involvement Strategies that focus on intermittent reinforcement implemented at the time of eating healthy foods.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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Question 3: For the strategies identified what is the extent to which each has teaching resources? Overall, the evidence indicates that there is no shortage of curriculum-based healthy eating resources available for primary schools. The resources that have been included in the review show a positive effect on the knowledge and understanding that primary school children have about healthy eating. The Teaching healthy eating to primary school students: A review of evidence and best practice: Full report, (Table 3) provides detailed information about the resources that have been included in the review and the teaching strategies that were used to implement them. While the evidence in this review most strongly supports experiential learning and cross-curricular teaching strategies, the review found that healthy eating resources were less likely to use these strategies.
Evidence synthesis Thirty-two resources were included in the review from four countries (United States, Australia, United Kingdom and New Zealand). Of the thirty two resources, sixteen resources were developed and used in the United States during the 2004-2014 period, with seven resources in Australia, and one resource each in the United Kingdom and New Zealand. The resources were categorised according to their teaching strategy as listed above with some resources utilising more than one teaching strategy: 1) curriculum approaches (n=32); 2) cross-curricular approaches (n=13); 3) parental involvement (n=15); 4) experiential learning approaches (n=7); 5) contingent reinforcement approaches (n=2); 6) literary abstraction approaches (n=22); 7) games-based approaches (n=13); and 8) webbased approaches (n=10).
The Australian resources (n=7) utilised the following teaching strategies: 1) curriculum approaches (n=6); 2) cross-curricular approaches (n=4); 3) parental involvement, for example, these resources may have invited parents to be helpers in the classroom, provide food for lessons and/or teachers sent information home through newsletters (n=3); 4) experiential learning approaches, for example, these resources may have garden to plate strategies where students were involved in the process from collecting food from the garden and cooking it to eat (n=3); 5) contingent reinforcement approaches (n=1); 6) literary abstraction approaches, for example, particular fruits were given character names and these characters were used to navigate through the resource (n=5); 7) games-based approaches (n=4); and 8) web-based approaches, for example, the resources were housed in a site only that was interactive, provided information and feedback (n=1).
Applicability of the evidence Nine Australian and one New Zealand resource were included in the review. Of the nine Australian resources, 5 resources were developed in NSW, 1 with the other resources developed by the commonwealth government for use across the Australian states. In addition, 23 international resources were included in the review. The 23 international resources came from three countries, all of which are members of the Organization for Economic Co-operation and Development (OECD) and are similar to the Australian context. Therefore these resources are highly applicable to the Australian settings.
Question 4: What are the recognised limitations or gaps in current healthy eating resources? Limitations/gaps of the resources There is a lack of Australian resources available that use cross-curricular approaches, experiential learning approaches or contingent reinforcement approaches. This is despite the evidence presented showing that the most effective evidence based strategies for improving healthy
eating in primary school students include cross-curriculum and experience learning approaches. Contingent reinforcement approaches have also shown some level of effect, however this needs to be further explored.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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Summary of the key messages from the review ■■
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Overall, the evidence most strongly supports strategies that are cross-curricular and that provide students with opportunities to participate in experiential learning, as the most effective for teaching healthy eating with primary school students. Contingent reinforcement approaches have also shown some benefit, however this needs to be further explored. Overall, the evidence indicates that there is no shortage of curriculum-based healthy eating resources available for primary schools. The resources that have been included in the review show a positive effect on the knowledge and understanding that primary school children have about healthy eating. While the evidence in this review most strongly supports experiential learning and cross-curricular teaching strategies, the review found that healthy eating resources were less likely to use these strategies There is a lack of Australian resources available that use experiential learning and crosscurricular teaching strategies. There is some evidence that resources should be developed in collaboration with teachers to produce culturally appropriate, engaging, teacher friendly resources and that this contributes to improving s tudent knowledge about nutrition.
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There is some evidence that the following types of support will help teachers deliver more effective healthy eating programs: –– an initial teacher training component –– an environment conducive to change with interested and supportive teachers –– a whole school approach where students are surrounded by the intervention across numerous settings in multiple key learning areas (KLAs) and through newsletters and posters –– access to concrete experiences with food, from growing the food in a school garden, harvesting and preparing the food, through to cooking and eating the food.
For more information about the healthy eating strategies and resources (including barriers and enablers) see: The Teaching healthy eating to primary school students: A review of evidence and best practice: Full report. The full report also includes evidence that precedes 2004.
NSW Department of Education and Communities | Teaching Healthy Eating to Primary School Students
www.dec.nsw.gov.au
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