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

cbeynon@uwo.ca

Dr. Meizi HeNutrition Researcher/Educator

meizi.he@mlhu.on.ca

Middlesex-London PHRED Program50 King Street

London, ON N6A 5L7