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Emma-Lee Finch (Example iPortfolio)

Health Promotion Planning

Health Promotion Planning

This unit was great. It combined the key aspects of health promotion into one unit and provided me with a big picture view. It combined aspects of health promotion and how they are essential in developing an intervention. This unit allowed myself to develop key skills associated with health promotion.

The major assignment for this unit is shown below:

veggies

1.0  Synopsis

Adequate nutrition is an essential component of health and is necessary for good quality of life. Evidence indicates that in childhood, specifically between 8-12 years, is the best time to develop healthy eating behaviours (Eboh and Boye 2006). Furthermore, acknowledging the importance of peer and parental influence is essential to developing the most effective program possible.

“Nutritious is Delicious!” is a health promotion program aimed at improving the nutritional levels of children aged between 8-11 years attending Ballajura Primary School in Western Australia. This is a one year pilot program with the potential to continue and expand after the completion of the trial. The program will use a variety of strategies including cooking and educational sessions, construction of a vegetable garden and taste testing activities to enhance the knowledge and skills of the target groups, regarding healthy food options. The strategies have been developed through a needs assessment with parents, a focus group with students and discussions with teaching staff in combination with psychosocial models, theories and previous programs. Issues of cost, convenience and taste will be addressed with the goal to improve nutritional status in the community.

Evaluation is an important tool to measure the effectiveness of the program and its individual components. “Nutritious is Delicious!” will measure the success through formative, process, impact and outcome evaluation. The results of this analysis will aim to achieve improved nutrition amongst young children aged 8-11 years attending Ballajura Primary School.


2.0 Rationale

Sustaining a healthy diet is essential for everyone, especially children at school (Jukes 2007). In order to reach optimal nutrition, children must consume a range of foods that provide sufficient nutrients (Jukes 2007). Adequate nutrition for children is crucial as it affects their learning abilities and quality of life (Jukes 2007). Nutrition education is regarded as an important component in promoting lifetime healthy eating behaviours (Perez-Rodrigo and Aranceta 2001). This process should begin during the early stages of growth (Perez-Rodrigo and Aranceta 2001).

Nutrition messages must be developmentally appropriate for children (Eboh and Boye 2006). According to Eboh and Boye (2006) the most effective time for nutrition education to occur successfully is between the ages of 8-12 years. After this age the child’s behaviours become increasingly harder to change (Eboh and Boye 2006). Effective nutrition education requires a combination of structured learning methods; lectures and reading, and unstructured learning methods; cooking sessions, in-class activities and videos (Eboh and Boye 2006). The foods children consume during childhood sets the basis for adulthood, thus, parents and guardians must ensure they adopt healthy eating habits early in life (Noble et al. 2000). If healthy eating practices are not adopted early then diabetes, high blood pressure, high cholesterol, coronary plaque formation and psychosocial problems may occur (Hendy, Williams and Camise 2005, Molnar et al. 2008). Behavioural consequences such as low levels of concentration and decreased activity levels are the main short term outcomes of poor nutrition (Jukes 2007).

Based on outcomes from other nutrition-based school programs parental involvement is essential for success, as the family creates a supportive environment for children to establish healthy eating habits (Manios et al. 1999). This health issue is a concern to parents as many are worried about their child’s eating patterns (Noble et al. 2000). In addition, studies have shown that parents from an educated background are more concerned with their child’s food choices than parents from lower socio-economic areas, thus, indicating lower socio-economic areas require significant intervention (Walingo et al. 2008).

During implementation the program should aim to use existing structures and curricula within the school (Gortmaker et al. 1999). As discussed by Sherman and Muehlhoff (2007) there has been a shift away from knowledge based education programs to a behavioural orientation.

Evidence indicates that the school community is an effective setting to positively influence young children as they are easily persuaded by their peers and learn quickly (French and Stables 2003). Studies show that children are unable to recognise the influential intent of their peer relationships, in turn increasing their susceptibility (Molnar et al. 2008). In schools, this often includes eating and wanting the ‘fad trend’ (French and Stables 2003). Research indicates that children’s food choices are greatly influenced by their parents and peers (Gray et al. 2007). Many parents act as role models for their children in turn greatly influencing their child’s food consumption, food choices and preferences (Gray et al. 2007). According to Gray et al. (2007), parents who encourage conversation, nutrition education and food tasting during mealtimes are creating positive environments for their children, and will positively influence the child to adopt healthy eating practices. Tuuri et al. (2009) states that it is important for children to acquire a personal preference for fruit and vegetables early in life as this effects successive food selection.

Children instinctively prefer salty, sweet and energy dense food, hence, when foods conflicting with these characteristics are present rejection is likely to occur (Turri et al. 2009). Therefore as a result of this, nutritious foods need to be introduced at a young age (Tuuri et al. 2009). Watching others eat healthy food and being encouraged to consume unfamiliar foods by a role model influences a child’s food preferences (Tuuri et al. 2009).

Most children are supplied food for school by their parents/guardians. Decisions regarding what foods to be placed in the lunchbox are factored around; peer pressure, taste preferences of the child, food safety and convenience (Perez-Rodrigo and Aranceta 2001).

Furthermore, studies indicate that work commitments, cost, time and preparation of meals are barriers towards achieving a nutritious lifestyle (Gray et al. 2007).

Low income is one barrier towards healthy eating but it must be noted that there are several socio-environmental factors that contribute to this issue. These include culture, lack of literacy and abridged education (Sorhaindo and Feinstein 2006).

According to the Dieticians Association of Australia (2007) there are “9 healthy habits to get your family eating better”. Some of these include planning healthy foods to purchase at the supermarket, cooking and eating together, praising the child for consuming healthy food and parents acting as role models. This list correlates with evidence based on various sources indicating that these are priority areas when attempting to improve child nutrition.

2.1 Environmental Risk factors

Environmental contributing factors influence the individual through their wider surroundings, such as social and cultural factors.

2.1.1. Degree of access to unhealthy food at school

Students spend approximately 32 hours a week at school and approximately a third of their energy intake is consumed there (Sanigorski 2005). According to an article by Kubik (2003) the school environment is believed to have a powerful effect on students eating behaviours. In consideration with school lunches the majority of children take their lunch to school with 14% purchasing food from the canteen. (Sanigorski 2005).

2.1.2 Perceived cost of healthy food

Healthy food in society is perceived as being more expensive than cheaper, less nutritious options (Darmon, Ferguson and Briend 2006). Therefore people who have a lower income may be more likely to avoid healthy foods in order to save money and poor nutrition occurs as a result (Darmon, Ferguson and Briend 2006). Studies have shown that healthy and more nutritious options are often more cost effective (Sanigorski 2005).

2.1.3 Inconvenience of healthy food

A common perception that can act as a barrier to healthy eating is that healthy food is inconvenient (Andajani-Sutjahjo 2004). A study by O’Neill, Rebane and Lester (2004) revealed that people purchase convenience food because it’s an easier option than buying fresh food and creating a meal.  Short term benefits of convenience food are seen as more important, by the population, than the long term effects of maintained health and a prolonged life (O’Neill, Rebane and Lester 2004).

2.1.4 Peer influence on food choices

Acceptance by peers is an important factor that influences children in their school environment (McLellen). According to an article written by Trogdon (2008) peers have a strong ability to affect a wide range of choices including the selection of either healthy or unhealthy eating habits.

2.1.5 Parental influence on food choices

Ball, Crawford and Mishra (2005) report that family support is a key influence on food choice and families in lower socio-economic areas report lower levels of support. The support that is given from the parents is a key factor in determining what foods the child is provided with on a daily basis (Ball, Crawford and Mishra 2005).

2.2 Behavioural risk factors

Behavioural factors relate to the behaviour of the individual, and these factors increase their risk of developing a specific health problem.

2.2.1 Unaware of the effects of poor nutrition


Lack of knowledge regarding the effects of nutrition has an impact on the decision of an individual to choose certain foods, if they are unaware of the consequences of that choice (Brug et al. 2008).  

2.2.2 Lack of knowledge regarding healthy food choices

Children in primary schools have limited levels of nutritional education and therefore may not have the knowledge or skills to identify a healthier food option (Peng 2009). If children are given the skills and knowledge to identify what is a healthier option they are more likely to choose it over an unhealthier option (Peng 2009).

2.2.3 Dislike of healthy food options

According to by Brug et al. (2008) children are more likely to consume foods when they like the taste, however taste preferences can be trained and changed. Currently the intake of fruit and vegetables are below the required level according to the Australian Dietary Guidelines for healthy eating and therefore there is a need to increase the taste preference for fruit and vegetables to increase consumption (Brug et al. 2008).

2.3 Theoretical models that relate to Risk and Contributing factors

Theoretical models are used in program construction as an aid to developing and understanding contributing factors that are associated with the health issue. In particular the social cognitive theory, health belief model and trans-theoretical model are the foundation for the “Nutritious is Delicious!” program. Table 1 indicates the association between the contributing factors and each model.

Table 1: Contributing factors with associated models

  Contributing Factor
 Model Explanation
Environmental:
 Peer influence on food choice
Social Cognitive Theory
 The children are influenced by their social environment and are more likely to consume foods if they are exposed to peers who eat that particular food (Hendy et al. 2005; Tuuri et al. 2009).
 Environmental:  Parental influence on food choice
Health Belief Model
 If the parents do not perceive that they are at a risk of poor nutrition they are not likely to offer support to change their health behaviour to benefit their family (Savage, Fisher and Birch 2007).
 Behavioural:  Primary target group are not aware of the effects of poor nutrition
 Trans-Theoretical Model
 This applies to the stages of change model where the primary target group are in the phase of pre-contemplation, meaning that they are not aware of the long and short term effects of poor nutrition (Pérez-Rodrigo and Aranceta 2001)

2.4 Conclusion

Nutrition among young children is an important health issue and must be dealt with at a young age in order to prevent detrimental health effects later in life. Parental support and role modelling are important factors that must be considered because of the influence they have upon young children. Furthermore, parents and children must be educated on this issue in order to understand the concept and form personal ideals, beliefs and behaviours towards healthy eating.

Research provides supporting evidence that this health issue needs to be addressed and includes effective ways to manage the problem. These must be taken into consideration when developing the intervention program.

3.0 Needs Assessment

This target group is selected based on the results of the needs assessment conducted by the “Nutritious is Delicious!” team. Also decided through the findings of the literature review that the team carried out, it was determined that the school community would be the most effective setting to conduct a nutrition program for young children. Members of the community who had a vested interest in this setting were asked to become part of the programs focus group. This included parents of the children at Ballajura Primary School. The team also conducted various discussions with teachers and the principal, and focus tested a small group of children within the school. On completion of these discussions information regarding their thoughts, concerns and suggestions were generated and incorporated into this program.

4.0 Target Group

There are two target groups in this intervention program.

Primary target group: Children aged 8-11 years attending Ballajura Primary School, in the northern suburbs of the Perth metropolitan area.

Secondary target group: Parents, guardians and teachers of the primary target group.

There are 278 students in years 3-6, in the primary target group, who attend full time study at Ballajura Primary School (Department of Education and Training 2009).

It is necessary to have two target groups for this intervention as the parents, guardians and teachers are role models for the children and greatly influence their choices and behaviours.

The age group for the primary target group was chosen as students will have developed sufficient skills to learn, understand and participate in the activities of the program. They are also at a suitable age to begin learning the effects of nutrition and develop their personal attitudes and beliefs accordingly. Furthermore, if they are educated on this issue at a young age it should help to prevent nutrition-related diseases later in life.

This program is targeting the school-community as it has the potential to access a wide range of children, and their cultures. There is evidence that school-based health and nutrition programs have had a positive preventive effect. The “Nutritious is Delicious!” program will commence implementation in Ballajura Primary School. This school was chosen as a high proportion of residents in the area experience socio-economic difficulty and studies have shown these areas consume less fruit and vegetables (Ball, Crawford, and Mishra 2005; Laurence, Peterken, and Burns 2007)

Furthermore, this school has two surrounding primary schools and on the completion of grade 6 the majority of students from these schools attend middle and high school at Ballajura Community College. Pending the success of the program at Ballajura Primary it should expand to these neighbouring schools. This allows for further development of the “Nutritious is Delicious!” program to create supportive environments for healthy eating and the opportunity for reinforcement to take place, where positive attitudes and behaviours towards healthy eating have been introduced.

Illawarra primary school will be used as the control school for the duration of the program while it is being conducted only at Ballajura Primary.

“Nutritious is Delicious!” is a pilot program in “phase one” of a broader approach to improve childhood nutrition. The program plan outlined in this report indicates the first year of the “Nutritious is Delicious!” program and will commence in January 2010. Based on the program’s effectiveness it will continue to run in Ballajura Primary School and be introduced into the two surrounding primary schools in coming years. Furthermore, it may be adapted, in the future, to suit a middle school target group.

5.0 Other related programs

The “Nutritious is Delicious!” team used current programs to support ideas and gain an insight to what would be suitable for the intervention. The strategies in the “Nutritious is Delicious!” program were developed in a one week intensive course and further critiqued based on these programs.

The “Food Dudes” program was a significant source in the development of the “Nutritious is Delicious!” program (Food Dudes 2009). The “Food Dudes” program was a school-based program, indicating the effectiveness of this setting. The use of positive rewards, role models and taste testing healthier foods were strategies that the team adapted for the ““Nutritious is Delicious!”!” program (Food Dudes 2009). This program is not present in Australia, thus the development of the “Nutritious is Delicious!” program, which highlights similar ideals, is necessary.

The “Gimme 5” program focuses on improving knowledge on the importance of fruit and vegetable consumption through incorporating education sessions into the school curriculum (Davis et al. 2000).  

The “Know Your Body” intervention program used environmental adjustments to aid the change of health behaviours, in particular, working in conjunction with school canteen staff to modify the foods served to make them more nutritious (Resnicow et al. 1992).. This strategy in conjunction with the “Traffic Light System” that is promoted by the Western Australian School Canteen Association will be used in the “Nutritious is Delicious!” program (Resnicow et al. 1992).

Through analysis of these programs the “Nutritious is Delicious!” team recognised the importance of a multifaceted approach which incorporated aspects of previous programs combined with original ideas in order to develop an effective intervention program.

6.0 Models and theories:

6.1 Diffusion of Innovation

The Diffusion of Innovation theory is used to support the strategies in the “Nutritious is Delicious!” program. It is appropriate for a broad range of adopting levels and fits with the strategies in this program on a community based level. The innovators are the students that are already demonstrating healthy eating behaviours; therefore implementation of the education strategy will encourage a proportion of the students to become early adopters. Removing unhealthy foods from canteen will spread the message across the school community assisting the early adopters to an early majority. Cooking classes and the computer game strategy will further assist the community to become an early majority and build momentum.  Implementing the vegetable garden strategy in conjunction with the help and support from family, peers and school members will assist in the involvement of the late adopters and late majority.

6.2 Stages of Change

The Stages of Change model applies to our program working more on the individual basis. The strategies in the “Nutritious is Delicious!” program work across the six steps in the model to assist a change in the health behaviour. Pre- contemplation is the stage when the individual is content with the current behaviour and is unaware that there is a problem (Ma et al. 2003). Using the strategy of removing unhealthy food from the school canteen and educating the parents on the effects of poor eating is the best way to minimize unhealthy eating habits. Contemplators are the individuals who are aware of the problem, open to information and education on the health issue, but are not ready to make a change (Ma et al. 2003). Implementing education classes on nutritional benefits and taste testing are the strategies that this program uses to prepare the contemplators for action. Ready for action is the stage where the individual has gained the motivation and wants to change (Ma et al. 2003). Cooking classes and planting the vegetables will motivate the individuals into action. Removing unhealthy foods from the canteen, harvesting the vegetables from the garden and cooking classes are strategies used in the action phase. Fortnightly newsletters sent to the student’s homes with cooking ideas and recipes along with cooking session times as well as in class quiz activities and educational computer games will all assist in the maintenance of the healthy eating habits.

6.3 Ottawa Charter

Different components of the Ottawa Charter were used in consideration when developing our strategies. The three main aspects that were used when developing strategies for the “Nutritious is Delicious!” program was: creating supportive environments, developing personal skills and building healthy public policy.

6.3.1 Creating Supportive Environments

Creating a supportive environment for healthy eating behaviours within a school community was an important consideration when developing strategies for the “Nutritious is Delicious!” program. This included removal of unhealthy food from school canteens and not using unhealthy foods as rewards as well as building a vegetable garden within the school grounds.

6.3.2 Developing Personal Skills

Developing personal skills is an important method to increase the levels of healthy eating within the school community. Using combined educational and cooking sessions will enhance the parents and children’s knowledge and abilities on healthy eating as well as building their skills. Cooking classes will be used to educate the parents, as well as the children, on how to cook nutritious, tasty and convenient foods, while teaching skills enables them to maintain healthy eating practises.

6.3.3 Building Healthy Public Policy

Building healthy public policy in the school environment can be used to support healthy eating behaviour. Creating a policy that aims to minimize unhealthy foods in the school setting, discourages the consumption of poor nutritional foods. This includes removal from the canteen and not using them as rewards for good behaviour or academic achievement.

7.0 Goal

By the end of the program, there will be a 10% increase in nutrition levels, according to the Australian Dietary Guidelines, for 8-11 year old primary school students attending Ballajura Primary school.

Note: below are the Australian Dietary Guidelines for children aged 8-11 years as published by the Australian Government. This indicates that 8-11 year olds require:

  • 6-9 serves of cereals
  • 3 serves of vegetable and legumes
  • 1 serve of fruit
  • 2 serves of milk, yoghurt and cheese
  • 1 serve of lean meat, fish, poultry, nuts and legumes
  • 1-2 serves of ‘extra’ foods each day

8.0 Objectives

The “Nutritious is Delicious!” intervention program uses a large number of objectives as the health issue is the main risk factor, therefore, eliminating the need for sub-objectives.

8.1 Behavioural objectives

OBJECTIVE 1: Increase, by 20%, the proportion of the primary target group who can identify healthy foods and their importance.

OBJECTIVE 2: Increase, by 15%, the proportion of the primary target group who have tried and liked healthy food.

OBJECTIVE 3: Increase, by 10%, the proportion of the primary target group who can identify the effects of poor nutrition.

OBJECTIVE 4: Decrease by 10% the proportion of the primary target group who consume unnaturally sweetened drinks at school.

Note: Unnaturally sweetened drinks include: soft drinks, cordial and flavoured mineral water. 

8.2 Environmental objectives

OBJECTIVE 5: Decrease by 40% unhealthy food options from the primary target school.


OBJECTIVE 6:
Increasing the degree of parental support, by 10%, through the primary target group reporting what foods they are provided with for lunch.

OBJECTIVE 7: Increase, by 15%, the proportion of the primary target group who believe their peers support healthy eating.

OBJECTIVE 8: Increase, by 5%, the proportion of parents of the primary target group who can identify ways to conveniently incorporate healthy food into their family lifestyle.

OBJECTIVE 9: Increase, by 15%, the proportion of parents of the primary target group who believe healthy food is cost effective.

Definition of “unhealthy food” – high sugar, high fat, processed, high sodium, energy dense, low nutrient

9.0 Strategies

Table 2: Objectives and associated strategies

Objectives  Strategies
OBJECTIVE 1: Increase, by 20%, the proportion of the primary target group who can identify healthy foods and their importance
Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Taste testing of healthy food options.

Development of a vegetable garden within the school.

Educational computer game.
OBJECTIVE 2: Increase, by 15%, the proportion of the primary target group who have tried and liked healthy food  Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Taste testing of healthy food options.

Development of a vegetable garden within the school.
OBJECTIVE 3: Increase, by 10%, the proportion of the primary target group who can identify the effects of poor nutrition Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Quiz testing student’s knowledge of the health effects of nutrition.

Educational computer game.
OBJECTIVE 4: Decrease by 10% the proportion of the primary target group who consume unnaturally sweetened drinks at school. Removal of unhealthy food from school canteen through implementing the Traffic Light system
OBJECTIVE 5: Decrease by 40% unhealthy food options from the primary target groups school Removal of unhealthy food from school canteen through implementing the Traffic Light system.

Not using food as rewards/bribery tools.

Fortnightly school newsletters to inform parents/guardian of cooking session times, simple recipes for the home and lunch box.
OBJECTIVE 6: Increasing the degree of parental support, by 10%, through the primary target group reporting what foods they are provided with for lunch

Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Fortnightly school newsletters to inform parents/guardian of cooking session times, simple recipes for the home and lunch box.
OBJECTIVE 7: Increase, by 15%, the proportion of the primary target group who believe their peers support healthy eatin Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Compulsory sit down time to eat lunch
OBJECTIVE 8: Increase, by 5%, the proportion of parents of the primary target group who can identify ways to conveniently incorporate healthy food into their family lifestyle

 
Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Fortnightly school newsletters to inform parents/guardian of cooking session times, simple recipes for the home and lunch box.
OBJECTIVE 9: Increase, by 15%, the proportion of parents of the primary target group who believe healthy food is cost effective Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

Fortnightly school newsletters to inform parents/guardian of cooking session times, simple recipes for the home and lunch box.

9.1 Removal of unhealthy food from school canteen through implementing the Traffic Light system


This strategy is complex and will involve participation and partnerships. It is directly associated with OBJECTIVE 5.

This strategy requires sufficient organisation before implementation can occur. Discussion is required with canteen staff regarding current food options and the costs of introducing the traffic light system. This will occur at the beginning of the program.

The project manager will carry out discussions with the school principal, canteen staff, teachers and the P+F association to assess the benefits and limitations of introducing this strategy and to gain an understanding of the best way to introduce it. This is an important process as the program staff need to understand the actual benefits/limitations involved and not what is believed to be the issue, and so the school community feel included in the decision making process, thus creating community participation and partnerships.

Once these steps have been completed the program staff will co-ordinate with the canteen members suitable times to develop menu plans and implementation.

The next stage of implementing this strategy is to incorporate the Traffic Light system into the canteen menu, a month after the program has begun. This will allow time for the school to purchase appropriate food for the new system and consume current stock so wastage is kept to a minimum. A one week transition period will enable an effective change-over for canteen staff, teachers, parents and the students.

See appendix 1 for the Traffic Light system registration form, or program staff and appropriate members of the school community can participate in an online training session for $10.00. See link: http://www.waschoolcanteens.org.au/training/

Table 2 below indicates the foods included in the Traffic Light system

Table 2: Traffic Light system

GREEN – FILL THE MENU – Encourage and promote
These are EVERYDAY choices

AMBER – Select carefully. Do not let these foods dominate the menu and choose small serves.
These are LIMITED

RED – OFF THE MENU
NOT AVAILABLE

  • Fruit, preferably fresh but may include frozen, canned (in natural juice)
  • Vegetables and legumes, fresh, e.g. stuffed potatoes, corn-on-cob, or canned varieties e.g. baked beans, 3 bean mix. Salads (using reduced fat dressings only), all salad mixes
  • Cereal foods – wholegrain cereals, pasta, noodles, rice, sushi
  • A variety of bread types including wholegrain and/or wholemeal
  • A variety of sandwich/roll fillings that are all available with salad, e.g. egg, reduced fat cheese, skin-free chicken, tuna, lean meats, yeast spreads, hommus
  • Reduced fat dairy products including plain and flavoured milk and cheese
  • Lean meats, fish, poultry and alternatives e.g. skin-free chicken meat, lean meats, fish (tuna, salmon, sardines)
  • Plain water, plain mineral water
  • Fruit juices – small sizes (250ml or less) and no added sugar
  • Full fat dairy foods, e.g. milk, yoghurt, low fat dairy desserts, cheese
  • Registered cereals with added sugars*
  • Registered reduced fat pastry items*
  • Hot dogs made using registered frankfurts*
  • Registered sausages for sausage sizzles or special events organised by the canteen*
  • Registered savoury commercial products, e.g. fish, chicken, potato portions, pizza*
  • Registered hamburger patties*
  • Registered assorted cakes/biscuits or muffins*
  • Registered sweet and savoury snack foods*
  • Registered ice-creams/icy poles*
  • Registered mineral waters flavoured with fruit juice (no added sugar)*

NOTE: Full fat dairy products cannot be registered. Reduced fat dairy products are recommended for children over the age of 2 years. Only choose the full fat varieties if reduced fat is not available.

  • Full-fat pastry items of any description
  • Deep fried food of any description
  • Sweet sandwich fillings including jam, nut spreads, honey, or confectionery sprinkles
  • High fat sandwich meats including polony and salami
  • Confectionery (including liquorice, cough lollies, and fruit juice based jellies) and/or sweet or savoury snack items not registered by WASCA or FOCiS
  • Chocolate confectionery
  • Soft drinks, cordial, sports drinks
  • High caffeine drinks (eg drinks containing Guarana)
  • Chocolate coated and premium style ice-creams
  • Croissants, doughnuts, cream filled or iced buns/cakes, sweet pastries, slices

Source: Western Australian Schools Canteen Association Inc. n.db.

This strategy will be evaluated through a questionnaire given to all students in the primary target group pre and post implementation. The questionnaire will include questions regarding how often they purchase their lunch, the types of foods they order and the level of satisfaction with the foods provided.

A second evaluation method will be an in-depth interview with the canteen staff regarding the effectiveness of the strategy, profit levels before and after implementation and general feedback received from the primary target group and their parents/guardians. This is a form of record keeping, and will be conducted on a monthly basis.

9.2 Not using food as rewards/bribery tools

This strategy involves reducing the amount of food given to the primary target group as a reward or bribery. This relates directly to OBJECTIVE 5, and requires teacher involvement and support.

This strategy aims to limit the amount of food used as rewards so the children do not associate a positive behaviour with an unhealthy food reward.

This strategy will be implemented by the teacher on a daily basis, and continued for the duration of the program. The strategy will be used in place of usual rewards given by the teacher. For example, achieving high marks in an assignment and good behaviour.

The teachers of the students in the primary target group will attend a compulsory half hour session one morning before school commences. This session will briefly inform them of the issues associated with food rewards and simple ways to correct this. It will be conducted by the project manager.

The participating school will be given various tools that should be used instead of food rewards. Reward types will be discussed with staff and the principal, and given consent will include stickers, coloured pencils, crayons, erasers, rulers and notepads. These will be wrapped and drawn as a lucky dip.

Furthermore, another reward incentive that will be discussed with teachers are certificates. When students accumulate a certain number of rewards they will receive a certificate congratulating them on their good efforts. This is another way to engage students without using food as a tool.

This strategy will be evaluated through an interview with the primary target groups’ teachers, to see if they were successfully able to replace all food rewards with alternative options. This will take place at the end of each school term.

9.3 Compulsory sit down time to eat lunch

This strategy is simple, effective will be implemented immediately. It relates to OBJECTIVE 7 as children are more likely to eat their lunch if their peers do.

 Students will be required to sit in an allocated area of the school for the first 10 minutes at the beginning of each lunch time session, and teachers on duty must supervise and encourage that a substantial proportion of packed/bought lunches are consumed by the children. This strategy will be implemented at the beginning of the program and run for its entirety.

Teachers of the primary target group and the remaining school staff will be asked to participate in this strategy as a component of the school curricula. This will be confirmed by the principal.

To ensure all teachers are aware of this strategy a short information session will be held before school on a morning suitable to all parties.

This strategy will be evaluated through observation of the students compliance by the project manager on a fortnightly basis.

9.4 Development of a vegetable garden within the school

This strategy relates to OBJECTIVE 1 and 2.

Implementation of a vegetable garden will require the cooperation from the principal of the school to allocate time and space for the garden to be constructed.

Students from the primary target group will be divided into 5 different groups and each group will work in the garden one day per week. This will occur after the compulsory sit-down time at the beginning of lunch.

The “Nutritious is Delicious!” team has adopted this strategy from an intervention program by Somerset and Markwell (2008) where a garden based teacher/coordinator will be hired to run the strategy. This person will be required to mediate with teachers of the primary target group, maintain the garden and supervise the students during their allocated ‘work time’.

Students will feel ownership towards the garden as they are given the responsibility of planting, watering and harvesting the vegetables. All of the necessary tools will be provided by the “Nutritious is Delicious!” team including seedlings, fertiliser and gardening tools.

This strategy will be implemented at the beginning of term two and will run for the length of the program.

This strategy will be evaluated through discussion with the garden-based teacher/coordinator on how well the garden is received by students and its effectiveness. This will occur on a weekly basis for the first month of implementation and monthly thereon.

Students will be required to complete a survey, where questions will be answered on a 1-5 point scale. Questions will be based on:

  • Degree of like for the vegetable garden
  • Increased identification of vegetables
  • Increased consumption of vegetables

9.5 Combined parent/guardian, teacher and student cooking and educational sessions regarding benefits of healthy food, convenience and cost-effectiveness.

This strategy relates to OBJECTIVE 1, 2, 3, 6, 7, 8, and 9.

Implementation of this strategy will require support from the parents/guardians and teachers of the primary target group. It is a difficult strategy to implement so all stages must be completed before it takes place. These include discussions with:

  • The principal regarding the benefits of this strategy and permission to conduct it in the school
  • Teachers as to a suitable time, day and location for the activity to be held
  • Parents of the focus group regarding parental attendance and involvement
  • Focus group regarding culturally appropriate recipes
  • Focus group regarding availability of a nutritionist parent-figure that can help run the program, so parents can identify with them

Once these stages have been completed program staff will devise basic lesson plans including recipes and information regarding health, convenience and cost-effectiveness. The cooking sessions will be held once a fortnight, with a complementary education session every alternate week. Both sessions will highlight the three main topics of health, convenience and cost-effectiveness.

Each student will be required to complete a small assignment on the nutritional benefits of a selected food group, for terms 2, 3 and 4.

The strategy will commence a month into the programs duration and run for its entirety.

Evaluation of this strategy will involve 3 stages. Firstly, an in-depth discussion with the parents of the focus group who participated in the strategy regarding its effectiveness and help with convenience, cost effectiveness and increasing healthy food intake. Secondly, a survey will be given to all teachers and staff involved in the implementation of the strategy. This will include questions around their belief if the classes achieved the aim of the strategy. Thirdly, all participating students will be required to complete a questionnaire based on their perceived benefits and limitations of the strategy.

9.6 Fortnightly school newsletters to inform parents/guardian of cooking session times, simple recipes for the home and lunch box.

This strategy relates to OBJECTIVE 5, 6, 8 and 9.

Implementation will involve using a small section in the fortnightly newsletter dedicated to quick, easy and healthy meals and lunch box ideas.

This strategy will be implemented by the project manager with permission from the school P+F association. The development of the section will require involvement from the P+F association and voluntary teachers and parents who can provide simple, cost-effective and healthy recipes they use.

This strategy will be executed one week after the commencement of the program once approval has been finalised, and will appear in every newsletter released throughout the program.

Evaluation will include analysing the number of newsletters that reached the family home and satisfaction with newsletters. The most effective way to complete this will be to ask the parents personally. This will occur at parent-teacher meetings held throughout the year. Frequency will be discussed with the teachers.

 

9.7 Quiz testing student’s knowledge of the health effects of nutrition

This strategy is related to OBJECTIVE 3.

This strategy will be implemented six months into the program, and run once a fortnight until the “Nutritious is Delicious!” program is finished. Discussions with teachers of the primary target group will be held at the beginning of the program to devise the most appropriate time for testing the student’s knowledge. The “Nutritious is Delicious!” project manager will create a combination of quiz, true/false, multiple choice and energizer activities that will be given to the staff to carry out. The project manager will mark the activities.

This strategy will begin six months into the program based on the assumption that students knowledge on this issue will increase through implementation of other strategies, such as the education and cooking sessions and the computer game.

This strategy will be evaluated through observation and analysis of results.

 

9.8 Educational computer game

This strategy relates to OBJECTIVE 1 and 3.

Computers are a popular and engaging tool which is considered an effective means of interactive learning for children (Roschelle et al. 2000). The project manager would recommend that computer programs are utilised to assist in nutrition education.

A pre-developed software program will be used to implement this strategy.

 Program staff will need to work in conjunction with teachers to develop a roster for the times when the computer sessions will take place. Students will work in pairs and participate in the game on a rotational roster. This strategy will be implemented two weeks after the commencement of the program and once the roster is established. It will continue for the entire length of the program.

This strategy will be evaluated, by program staff, through observation of the children participating in the computer game and final results.

 

9.9 Taste testing of healthy food options

This strategy relates to OBJECTIVE 1 and 2.

Implementation will require the involvement of teaching staff and parents/guardians, in regards to ideas, preparation, set up and running the activity.

This strategy is ideally carried out during morning recess, as this will not interrupt the school learning time, and introduces healthy snack options free to the primary target group.

The project manager will prepare the food the morning prior to the workshop. Samples of fresh fruit, vegetables, low-fat dip, small yoghurt tubs and wholegrain crackers with low-fat cheese will be available as examples of healthy yet tasty options.

The samples will be placed on 4 tables and divide into fruit, veg, diary and wholegrain. A fact sheet with simple information regarding the benefits of the food and how they influence good health will be provided on each table.

Students will be divided into 4 groups and assisted at each table by a teacher or parent/guardian who will explain the benefits of the food, and different ways to eat them.

This strategy will be implemented once a fortnight throughout the program.

This strategy will be evaluated through observation of food consumption and by conducting a class discussion of what foods the children tried, liked and will request in the future.

10.0 Evaluation

The intervention and control schools will be evaluated by the methods outlined below in Table 3. This is necessary to compare environmental and behavioural changes that may have occurred. It will also analyse the effectiveness of each strategy and determine if change is needed.

It should be noted that the control school will not need to complete all methods of evaluation.

Table 3: Evaluation methods

 

Methods of Evaluation

Formative Evaluation

-how to improve the program

-evaluates proposed strategies

-Reference group of parents who are able to help in developing appropriate strategies

-Parent participants from the reference group who can help in carrying out some of the strategies

-Focus testing a group of students for the effectiveness/appropriateness of the computer game

-Discuss with teachers the best reward systems for students

-Discuss with teachers the best time of day for strategies to take place

-Small focus group of students to help develop appropriate strategies

-Discuss with canteen staff regarding budget

-Literature reviews

-In-depth interviews with parent focus group, and staff

Process Evaluation

-evaluates strategies

-to ensure the program is running effectively and reaching the target groups

-Number of newsletters that reached the family home

-Satisfaction with newsletters

-Benefits/limitations of cooking sessions

-Effectiveness of lunchbox ideas

-Student satisfaction with activities

-Observation

Impact Evaluation

-evaluates objectives

-analyses behavioural change

-Pre implementation questionnaire

-Post implementation questionnaire

-Focus groups

-In-depth interviews with focus group

Outcome Evaluation

-evaluates the goal

-concerned with long term changes

-In depth interviews with parents of focus group and teachers

-Observation

-Surveys

 

11.0 Timeline

The timeline outlined below in Table 4 indicates when each step of the program will be implemented and its duration.

Table 4: Timeline for “Nutritious is Delicious!” project

“Nutritious is Delicious!” Gantt Chart

Month of Project

1

2

3

4

5

6

7

8

9

10

11

12

Gather necessary resources

 

 

 

 

 

 

 

 

 

 

 

 

Appointment of Project Manager

 

 

 

 

 

 

 

 

 

 

 

 

Formative research

 

 

 

 

 

 

 

 

 

 

 

 

Process evaluation

 

 

 

 

 

 

 

 

 

 

 

 

Participant recruitment

 

 

 

 

 

 

 

 

 

 

 

 

Impact evaluation

 

 

 

 

 

 

 

 

 

 

 

 

Outcome evaluation

 

 

 

 

 

 

 

 

 

 

 

 

Removal of unhealthy food from school canteen

 

 

 

 

 

 

 

 

 

 

 

 

Not using food as rewards/bribery tools

 

 

 

 

 

 

 

 

 

 

 

 

Compulsory sit-down time to eat lunch

 

 

 

 

 

 

 

 

 

 

 

 

Preparation for development of vegetable garden

 

 

 

 

 

 

 

 

 

 

 

 

Development of vegetable garden in the school

 

 

 

 

 

 

 

 

 

 

 

 

Preparation for cooking/education sessions

 

 

 

 

 

 

 

 

 

 

 

 

Combined cooking and education sessions

 

 

 

 

 

 

 

 

 

 

 

 

Fortnightly school newsletters

 

 

 

 

 

 

 

 

 

 

 

 

Quiz testing

 

 

 

 

 

 

 

 

 

 

 

 

Educational computer game

 

 

 

 

 

 

 

 

 

 

 

 

Taste testing

 

 

 

 

 

 

 

 

 

 

 

 

 

12.0 Capacity building and sustainability

The “Nutritious is Delicious!” program aims to work with a variety of people and develop working partnerships, in order to increase sustainability of the intervention program.

Initially this will commence by incorporating community members in the decision making process and integrating their ideas and suggestions into the programs outline. This will give the community a sense of ownership of the program and motivate participation.

Social capital is an essential component of a successful intervention program. Areas where social capital is low are associated with a higher risk of poor health issues and negatively influences the sustainability of the program.

Social capital will be enhanced within the school community through participation in the “Nutritious is Delicious!” program. Parental involvement will help to increase capacity building within the school community. By increasing the parents/guardians knowledge they will have greater capability to undertake healthy eating habits and pass these on to their family and friends.

Capacity building reinforces the flexibility of the strategies. This is achieved through organisational support, workforce development, resource allocation and the formation of leaderships and partnerships. Such strategies that achieve this capacity building are the resources available from phase one of the “Nutritious is Delicious!” program.

Leadership is achieved by connecting the parents with the community, as well as enhancing team work skills. Partnerships are important to ensure those involved in “Nutritious is Delicious!” work together to achieve the health goal. The partnerships formed are with:

-         Health professionals

-         The target school

-         Parents of the primary target group

The below Table 4 effectively highlights how all these aspects work together to achieve capacity building which then creates a sustainable environment once the program has ended.

Table 4: Achieving capacity building

Strategy

Approach

Examples

Organisational

Policy changes

Introducing the Traffic Light system into school canteen

Workforce

On the job training for teachers

 

 

Professional development

 

Education on how to carry out the strategies

Staff encouraged to participate in discussions

Training for the project manager

Training for the vegetable garden supervisor

Resource

Human resources

 

 

Financial resources

 

 

 

 

 

Tools

 

 

 

 

Access to information

Encourage teachers to promote healthy eating habits into children’s daily behaviours

 

Providing funding for activities carried out in the intervention school

Obtained through a Healthway grant

 

Computer game

Vegetable garden

Stationary rewards provided to teachers

 

 

Provided from community members during focus groups and discussions

Information gathering from the community during needs assessment

Leadership

Identify leaders and role models

Promote an environment that encourages leadership

Employment of project manager

Employment of vegetable garden supervisor

Train teachers and parents/guardians of the primary target group as peer educators

 

Partnership

Building relationships with the local community

 

Developing partnerships with organisations

Parents/guardians and teachers of the primary target group

WA Schools Canteen Association,

Healthway

Diabetes WA

Heart Foundation

Cancer Council

Education Department

Kidsafe WA

 

13.0 Budget:

Table 5: Budget breakdown for “Nutritious is Delicious!” program for a 1 year period

Components

Costs ($)

Personnel

Project Manager

Garden based teacher/co-ordinator

 

60 000

10 000

Sub total

70 000

Equipment

Laptop for Project Manager

Food for strategies

Cooking equipment

Stationary

Computer game

Garden equipment and products

 

1 500

41 700

500

500

160

550

Sub total

44 910

Maintenance

Printing

1 x 12 month $69 cap mobile phone contract including phone with Vodafone with 1GB email/internet

Travel

Final Report

 

222.40

828

 

 

250

500

Sub Total

1 800.40

Other

Refreshments for parent focus group meetings

Refreshments for teacher group meetings

Refreshments for child focus group meetings

 

200

150

100

Sub Total

450

TOTAL

117,160.40

 

13.1 Project manager

The project manager is involved in co-ordinating and over-seeing all aspects of the “Nutritious is Delicious!” program. The main duties include: collecting supplies for the strategies, liaising with school staff and handling any difficulties that may occur.

Another “Nutritious is Delicious!” team member will be well equipped to carry out the necessary duties in case of unforseen events preventing the project manager from completing the program.

13.2 Laptop for project manager

The laptop is required by the project manager for communication purposes such as liaising with stakeholders, parents and school staff. It will also be used for data entry and analysis to effectively evaluate the program strategies.

13.3 Food

Food is required for the cooking sessions and taste testing. Approximately $7.50 is allocated for each of the 278 students involved in the program across the 41 weeks in the school year.

13.4 Cooking equipment

Cooking equipment will be required for the cooking education session and taste testing. Utensils such as bowls, cutlery, pots and pans will be purchased for the amount of $500, to service a class of approximately 30 students at one time. This equipment can be used repeatedly throughout the year.

13.5 Stationary

Stationary will be required for the rewards component, quizzes and questionnaires. Such things will include pens, notepads and erasers for rewards, general office stationary and evaluation.

13.6 Computer game

This is to cover costs for each class to have a computer game.

13.7 Garden equipment and products

In order to start and maintain the vegetable garden tools are needed such as gardening forks, wheel barrow, stakes, watering can, shovels and weeding equipment. Also, seedlings and fertilisers need to be purchased.

13.8 Printing

We have allocated 20c per sheet printed. Printing will be required for questionnaires, evaluation and general handouts during implementation of the strategies.

13.9 1 x 12 month $69 cap mobile phone contract including phone with Vodafone with 1GB email/internet

The project manager will be given a mobile phone on a $69 cap from Vodafone to use throughout the duration of the program. Furthermore, this cap comes with a 1GB internet allowance that the project manager will be able to use to send emails. This allows effective communication between the project manager and those involved in the program.

13.10 Travel

We have allocated $250 to the project manager to use for travel purposes.

13.11 Final report

A final report is required so that this program can be effectively documented and evaluated for future reference purposes.

13.12 Refreshments

 A portion of the budget has been allocated to refreshments that will be given during the focus group sessions and discussions with the teaching staff. This is offered as a gesture to make the experience more pleasurable.

 

Created 26/10/2010 at 15:35:52

Modified 26/10/2010 at 16:25:59