Fruit and Vegetable Consumption in Children
Conditions
Keywords
Nutrition, Fruit and vegetables, School, Children, Prevention
Brief summary
In 2012, the Kids University for Cooking Foundation BV has developed a nutrition education programme called 'Kokkerelli Learning Street'. This innovative programme aims to teach primary school students from study years 5-8 where food comes from, how it is processed, and how it can be used for the preparation of a healthy meal. The Kokkerelli Learning Street is offered to primary school children in the region of Venlo, the Netherlands. The present study will investigate the effects of the Kokkerelli Learning Street on several determinants of children's fruit and vegetable intake. Based on the literature and the aims of the Learning Street, five relevant determinants are selected: (i) knowledge; (ii) taste preferences; (iii) intention; (iv) skills; and (v) attitude. Using child-reported questionnaires, the present study aims to answer the following key questions: What are the short-term and longer-term effects of the Kokkerelli Learning Street on children's: * Knowledge regarding fruit and vegetable consumption? * Intentions regarding fruit and vegetable consumption? * Attitude regarding fruit and vegetable consumption? * Liking of fruit and vegetables? * Skills regarding fruit and vegetable preparation? * Fruit and vegetable intake?
Detailed description
In 2012, the Kids University for Cooking Foundation BV has developed a nutrition education programme called 'Kokkerelli Learning Street'. This innovative programme aims to teach primary school students aged 8-12 years (study years 5-8) where food comes from, how it is processed, and how it can be used for the preparation of a healthy meal. The theoretical foundation of the Learning Street is based on the EnRG framework, which states that behaviour is influenced both by conscious and unconscious processes. These processes can (in)directly be influenced by environmental factors. In addition, several behavioural and personal factors are thought to moderate the causal path. The Kokkerelli Learning Street is offered to primary school children in the region of Venlo, the Netherlands. It involves education based on concepts of the Self-Determination Theory, active learning, and imagineering (e.g., self-experience in an interactive environment, rather than conventional education). The present study will investigate the effects of the Kokkerelli Learning Street on several determinants of children's fruit and vegetable intake. Based on the EnRG framework, other literature and the aims of the Learning Street, five relevant determinants are selected: (i) knowledge; (ii) taste preferences; (iii) intention; (iv) skills; and (v) attitude. Using child-reported questionnaires, the present study aims to answer the following key questions: What are the short-term and longer-term effects of the Kokkerelli Learning Street on children's: * Knowledge regarding fruit and vegetable consumption? * Intentions regarding fruit and vegetable consumption? * Attitude regarding fruit and vegetable consumption? * Liking of fruit and vegetables? * Skills regarding fruit and vegetable preparation? * Fruit and vegetable intake?
Interventions
BEHAVIORALKokkerelli Learning Street
The Kokkerelli Learning Street focusses on one specific food product (kale, tomato, asparagus, pepper, strawberry, blue berry, mushroom, carrot, or leek) and consists of multiple components: 1. An introduction lesson at school. Children are introduced to the product and familiarised with growing and harvesting processes and the importance of the product regarding health. 2. A visit to a grower's farm during which children are introduced to the precise planting, growing and harvesting procedures of the product. Children are allowed to enter the facilities (e.g., the greenhouse) and observe and experience the farming of the product. 3. A cooking workshop at the facilities of Kids University for Cooking BV. Children prepare a meal with help of volunteers. After preparing the meal, children help to set the table and consume their self-prepared meal. 4. An evaluation lesson at school. Children evaluate the Learning Street together with their peers and teacher.
Sponsors
Maastricht University Medical Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
The study will consist of one intervention group (several primary school classes that participate in the Kokkerelli Learning Street) and one control group (several primary school classes that don't participate in the Kokkerelli Learning Street and continue with their regular curriculum).
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Student of study years five to eight of one of the predetermined primary schools
Exclusion criteria
* School classes who already participated in the Kokkerelli Learning Street during previous school years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline Fruit and Vegetable Knowledge at 3 Months After the Evaluation Lesson | Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson | Knowledge will be assessed by six knowledge questions in the child questionnaire. A total knowledge score based on the number of correct answers will be calculated. The minimum score that can be obtained is 0, indicating low knowledge. The maximum score that can be obtained is 6, indicating high knowledge. |
| Change From Baseline Intention to Consume Fruit and Vegetables at Three Months After the Evaluation Lesson | Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson | Questions assessing intention will concern participants' plans to consume or cook a meal containing the specific food product in the future and will be assessed on a scale from 1='I don't know' to 6='yes I will'. A mean score will be calculated to assess intention. The minimum score that can be obtained is 0, indicating low intention. The maximum score that can be obtained is 6, indicating high intention. |
| Change From Baseline Attitude Towards Fruit and Vegetable (Consumption) at 3 Months After the Evaluation Lesson | Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson | Questions for attitude ('How much do you think the target behaviours are clever/interesting and nice/cool/tasty?') will be used as described by Ajzen and Fishbein and as previously used in comparable research. They will have response options ranging from 1='no, not at all' to 5='yes, totally'. A mean score will be calculated to assess attitude. |
| Change From Baseline Taste Preferences for Fruit and Vegetables at 3 Months After the Evaluation Lesson | Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson | Three questions will be used for taste preferences (e.g., 'What do you think about the taste of the food product?') (scale from 1='never tried' to 6='I like it very much'). A mean score will be calculated to assess taste preferences. |
| Change From Baseline Attitude Towards Healthy Food Products at 3 Months After the Evaluation Lesson | Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson | Questions for attitude ('How much do you think the target behaviours are clever, interesting, nice, cool, and tasty?') will be used as described by Ajzen and Fishbein and as previously used in comparable research. They will have response options ranging from 1='no, not at all' to 5='yes, totally'. A mean score will be calculated to assess attitude. |
Countries
Netherlands
Participant flow
Recruitment details
Participants were children in study years five and six (internationally comparable to grades three and four; aged 8-10 years) from primary schools in Northern Limburg, the Netherlands. Researchers and employees of Kids University for Cooking informed the children and parents about the study both orally and via information brochures (containing information about the study's purpose, procedures, and data handling). Informed consent was obtained from all parents of the participating children.
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group The classes included in this group participate in the Kokkerelli Learning Street; a school-based nutrition education programme included classroom-based lessons, a visit to a grower's farm and a cooking workshop.
Kokkerelli Learning Street: The Kokkerelli Learning Street focusses on one specific food product (kale, tomato, asparagus, pepper, strawberry, blue berry, mushroom, carrot, or leek) and consists of multiple components:
1. An introduction lesson at school. Children are introduced to the product and familiarised with growing and harvesting processes and the importance of the product regarding health.
2. A visit to a grower's farm during which children are introduced to the precise planting, growing and harvesting procedures of the product. Children are allowed to enter the facilities (e.g., the greenhouse) and observe and experience the farming of the product.
3. A cooking workshop at the facilities of Kids University for Cooking BV. Children prepare a meal with help of volunteers. After preparing the meal, children help to set the table and consume their self-prepared meal.
4. An evaluation lesson at school. Children evaluate the Learning Street together with their peers and teacher. | 60 |
| Control Group The school classes included in the control group were chosen from a pool of primary schools already participating in another research project on the effects of school-based health-promoting initiatives on children's health and well-being (no publications on this study are available as the study is still ongoing). From this pool, classes from schools that were not (planning on) implementing nutrition-related and/or physical activity (PA)-related health-promoting initiatives in the context of this project were eligible to be included in the control group of the present study. | 132 |
| Total | 192 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative error | 0 | 18 |
| Overall Study | Not meeting criteria for data analysis | 1 | 15 |
Baseline characteristics
| Characteristic | Control Group | Total | Intervention Group |
|---|---|---|---|
| Age, Continuous | 8.6 years STANDARD_DEVIATION 0.7 | 8.5 years STANDARD_DEVIATION 0.7 | 8.3 years STANDARD_DEVIATION 0.5 |
| Attitude towards addressed FV product (mean score) | 2.6 score on a scale STANDARD_DEVIATION 0.9 | 2.6 score on a scale STANDARD_DEVIATION 0.9 | 2.7 score on a scale STANDARD_DEVIATION 0.9 |
| General attitude towards healthy food (mean score) | 3.1 score on a scale STANDARD_DEVIATION 0.9 | 3.1 score on a scale STANDARD_DEVIATION 0.9 | 3.0 score on a scale STANDARD_DEVIATION 0.9 |
| Intention (mean score) | 3.1 score on a scale STANDARD_DEVIATION 1.3 | 3.4 score on a scale STANDARD_DEVIATION 1.3 | 3.9 score on a scale STANDARD_DEVIATION 1.1 |
| Knowledge (mean correct) | 3.2 score on a scale STANDARD_DEVIATION 1.2 | 3.2 score on a scale STANDARD_DEVIATION 1.3 | 3.0 score on a scale STANDARD_DEVIATION 1.6 |
| Race/Ethnicity, Customized Non-Western background | 5 Participants | 13 Participants | 8 Participants |
| Race/Ethnicity, Customized Western background (European countries (excluding Turkey), North America, Japan, Indonesia,Oceania) | 127 Participants | 179 Participants | 52 Participants |
| Sex: Female, Male Female | 77 Participants | 113 Participants | 36 Participants |
| Sex: Female, Male Male | 55 Participants | 79 Participants | 24 Participants |
| Taste preferences (mean score) | 3.5 score on a scale STANDARD_DEVIATION 1.2 | 3.5 score on a scale STANDARD_DEVIATION 1.2 | 3.6 score on a scale STANDARD_DEVIATION 1.1 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 61 | 0 / 165 |
| other Total, other adverse events | 0 / 61 | 0 / 165 |
| serious Total, serious adverse events | 0 / 61 | 0 / 165 |
Outcome results
Primary
Change From Baseline Attitude Towards Fruit and Vegetable (Consumption) at 3 Months After the Evaluation Lesson
Questions for attitude ('How much do you think the target behaviours are clever/interesting and nice/cool/tasty?') will be used as described by Ajzen and Fishbein and as previously used in comparable research. They will have response options ranging from 1='no, not at all' to 5='yes, totally'. A mean score will be calculated to assess attitude.
Time frame: Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Change From Baseline Attitude Towards Fruit and Vegetable (Consumption) at 3 Months After the Evaluation Lesson | T1 (directly after the intervention, approximately three weeks after baseline) | 2.8 score on a scale | Standard Deviation 0.97 |
| Intervention Group | Change From Baseline Attitude Towards Fruit and Vegetable (Consumption) at 3 Months After the Evaluation Lesson | T2 (three months after the intervention) | 2.6 score on a scale | Standard Deviation 0.96 |
| Control group | Change From Baseline Attitude Towards Fruit and Vegetable (Consumption) at 3 Months After the Evaluation Lesson | T1 (directly after the intervention, approximately three weeks after baseline) | 2.3 score on a scale | Standard Deviation 0.89 |
| Control group | Change From Baseline Attitude Towards Fruit and Vegetable (Consumption) at 3 Months After the Evaluation Lesson | T2 (three months after the intervention) | 2.4 score on a scale | Standard Deviation 0.93 |
Comparison: Statistical analysis at T1 (directly after evaluation lesson).p-value: 0.004Regression, Linear
Comparison: Statistical analysis at T2 (three months after evaluation lesson).p-value: 0.84Regression, Linear
Primary
Change From Baseline Attitude Towards Healthy Food Products at 3 Months After the Evaluation Lesson
Questions for attitude ('How much do you think the target behaviours are clever, interesting, nice, cool, and tasty?') will be used as described by Ajzen and Fishbein and as previously used in comparable research. They will have response options ranging from 1='no, not at all' to 5='yes, totally'. A mean score will be calculated to assess attitude.
Time frame: Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Change From Baseline Attitude Towards Healthy Food Products at 3 Months After the Evaluation Lesson | T1 (directly after the intervention, approximately three weeks after baseline) | 3.0 score on a scale | Standard Deviation 0.93 |
| Intervention Group | Change From Baseline Attitude Towards Healthy Food Products at 3 Months After the Evaluation Lesson | T2 (three months after the intervention) | 2.9 score on a scale | Standard Deviation 1.05 |
| Control group | Change From Baseline Attitude Towards Healthy Food Products at 3 Months After the Evaluation Lesson | T1 (directly after the intervention, approximately three weeks after baseline) | 2.8 score on a scale | Standard Deviation 0.97 |
| Control group | Change From Baseline Attitude Towards Healthy Food Products at 3 Months After the Evaluation Lesson | T2 (three months after the intervention) | 2.8 score on a scale | Standard Deviation 0.89 |
Comparison: Statistical analysis at T1 (directly after evaluation lesson).p-value: 0.01Regression, Linear
Comparison: Statistical analysis at T2 (three months after evaluation lesson).p-value: 0.19Regression, Linear
Primary
Change From Baseline Fruit and Vegetable Knowledge at 3 Months After the Evaluation Lesson
Knowledge will be assessed by six knowledge questions in the child questionnaire. A total knowledge score based on the number of correct answers will be calculated. The minimum score that can be obtained is 0, indicating low knowledge. The maximum score that can be obtained is 6, indicating high knowledge.
Time frame: Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Change From Baseline Fruit and Vegetable Knowledge at 3 Months After the Evaluation Lesson | T1 (directly after intervention, approximately three weeks after baseline) | 4.1 score on a scale | Standard Deviation 1.09 |
| Intervention Group | Change From Baseline Fruit and Vegetable Knowledge at 3 Months After the Evaluation Lesson | T2 (three months after intervention) | 3.7 score on a scale | Standard Deviation 1.31 |
| Control group | Change From Baseline Fruit and Vegetable Knowledge at 3 Months After the Evaluation Lesson | T1 (directly after intervention, approximately three weeks after baseline) | 3.5 score on a scale | Standard Deviation 1.33 |
| Control group | Change From Baseline Fruit and Vegetable Knowledge at 3 Months After the Evaluation Lesson | T2 (three months after intervention) | 3.6 score on a scale | Standard Deviation 1.24 |
Comparison: Statistical analysis at T1 (directly after the evaluation lesson).p-value: 0.001Regression, Linear
Comparison: Statistical analysis at T2 (three months after the evaluation lesson).p-value: 0.31Regression, Linear
Primary
Change From Baseline Intention to Consume Fruit and Vegetables at Three Months After the Evaluation Lesson
Questions assessing intention will concern participants' plans to consume or cook a meal containing the specific food product in the future and will be assessed on a scale from 1='I don't know' to 6='yes I will'. A mean score will be calculated to assess intention. The minimum score that can be obtained is 0, indicating low intention. The maximum score that can be obtained is 6, indicating high intention.
Time frame: Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Change From Baseline Intention to Consume Fruit and Vegetables at Three Months After the Evaluation Lesson | T1 (directly after intervention, approximately three weeks after baseline) | 4.1 score on a scale | Standard Deviation 0.91 |
| Intervention Group | Change From Baseline Intention to Consume Fruit and Vegetables at Three Months After the Evaluation Lesson | T2 (three months after intervention) | 3.8 score on a scale | Standard Deviation 1.28 |
| Control group | Change From Baseline Intention to Consume Fruit and Vegetables at Three Months After the Evaluation Lesson | T1 (directly after intervention, approximately three weeks after baseline) | 3.2 score on a scale | Standard Deviation 1.25 |
| Control group | Change From Baseline Intention to Consume Fruit and Vegetables at Three Months After the Evaluation Lesson | T2 (three months after intervention) | 3.3 score on a scale | Standard Deviation 1.44 |
Comparison: Statistical analysis at T1 (directly after evaluation lesson).p-value: 0.55Regression, Linear
Comparison: Statistical analysis at T2 (three months after evaluation lesson).p-value: 0.33Regression, Linear
Primary
Change From Baseline Taste Preferences for Fruit and Vegetables at 3 Months After the Evaluation Lesson
Three questions will be used for taste preferences (e.g., 'What do you think about the taste of the food product?') (scale from 1='never tried' to 6='I like it very much'). A mean score will be calculated to assess taste preferences.
Time frame: Baseline, directly after the evaluation lesson (approximately three weeks after baseline), three months after the evaluation lesson
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Change From Baseline Taste Preferences for Fruit and Vegetables at 3 Months After the Evaluation Lesson | T1 (directly after the intervention, approximately three weeks after baseline) | 3.8 score on a scale | Standard Deviation 1.08 |
| Intervention Group | Change From Baseline Taste Preferences for Fruit and Vegetables at 3 Months After the Evaluation Lesson | T2 (three months after the intervention) | 3.7 score on a scale | Standard Deviation 1.06 |
| Control group | Change From Baseline Taste Preferences for Fruit and Vegetables at 3 Months After the Evaluation Lesson | T1 (directly after the intervention, approximately three weeks after baseline) | 3.4 score on a scale | Standard Deviation 1.18 |
| Control group | Change From Baseline Taste Preferences for Fruit and Vegetables at 3 Months After the Evaluation Lesson | T2 (three months after the intervention) | 3.4 score on a scale | Standard Deviation 1.21 |
Comparison: Statistical analysis at T1 (directly after evaluation lesson).p-value: 0.002Regression, Linear
Comparison: Statistical analysis at T2 (three months after evaluation lesson).p-value: 0.16Regression, Linear