To assess the implementation of the Healthy Schools, Healthy Students (HSHS) intervention and evaluate its impact on knowledge, fruit and vegetable (FV) attitudes, FV preferences, and MyPlate awareness.
Use of Theory or Research
Prior school based nutrition-education interventions have been shown to positively impact knowledge, FV attitudes, and FV preferences, which are important determinants of dietary intake.
The HSHS intervention targeted 4th grade students (n intervention = 567 and n control = 490) in a rural, Midwestern state during the 2017-2018 school year.
HSHS was a multi-component intervention featuring classroom-based nutrition education using a modified version of the USDA's Serving Up MyPlate curriculum, cafeteria coaching with older students, and FV taste tests.
We used a mixed methods evaluation featuring a cluster randomized controlled trial. We matched 20 schools on demographic characteristics and randomized them to intervention or control conditions. We used matched pre- and post-intervention surveys to evaluate quantitative impact, measuring knowledge, FV attitudes, FV preferences, and MyPlate awareness. We used student fixed effects regression models to estimate the intervention effect on post-intervention outcomes. To better understand implementation, we conducted in-depth interviews with project stakeholders and nutrition educators and focus groups with cafeteria coaches.
For the quantitative evaluation, we observed a significant intervention effect for knowledge (β = 0.27, SE = 0.13, P = .04), taste test vegetable preferences (β = 0.25, SE = 0.09, P = .01), and MyPlate awareness (β = 0.21, SE = 0.05, P < .001). For the qualitative evaluation, all participants described HSHS as successful and easy to implement. Both project stakeholders and cafeteria coaches requested more communication, technical assistance, and training. Nutrition educators approved of the lessons, but noted that there was not enough time to complete all the activities and wanted to cover broader topics.
The HSHS intervention was well received by the schools implementing it and had a modest impact on knowledge and vegetable preferences. Wider implementation of interventions like HSHS could positively impact students without overburdening schools.