David Teeman, Emma Scott, Sandie Schagen, Sarah Blenkinsop, Janet Cade, Darren Greenwood, Joan Ransley, Ian Schagen, Gabrielle White
01 June 2005
The School Fruit and Vegetable Scheme (SFVS), is one aspect of the ‘5 A DAY’ programme and provides a free piece of fruit or a vegetable to children aged four to six years, each school day. The scheme was originally piloted in more than 500 schools throughout England in 2000 and 2001, to examine the practicalities of the scheme before rolling it out nationally.It was expanded region by region with funding from the Big Lottery Fund; since April 2004 the Department of Health has been funding the SFVS, which is now operating throughout England.
NFER, in partnership with nutritionists from the University of Leeds, was commissioned by the Big Lottery Fund to carry out an evaluation of the impact of the SFVS by monitoring changes in consumption, nutrient intake and attitudes to healthy eating in children from one region before and after they became involved in the scheme.
Two research instruments were used: a food diary, the Child and Diet Evaluation Tool (CADET) to measure food intake over one day, and a pictorial pupil questionnaire to explore children’s attitudes, knowledge and awareness. Data was collected on three occasions from schools in the North East where pupils began to receive fruit just after the first (baseline) survey, and from a matched group of schools in Yorks and Humber, where the SFVS was not introduced until after the final survey.
The SFVS increased children’s awareness of fruit by enabling them to try previously unfamiliar items. The scheme also significantly improved children’s consumption of fruit, but appeared not to have any wider impact on diet.Increased consumption of fruit was not sustained when children’s participation in the scheme came to an end.However, there was some evidence of increased knowledge of healthy eating, particularly in children from deprived areas.
It may be that the SFVS will have a longer-term impact on children who are exposed to the scheme for a greater period of time. Further, the potential of the SFVS to positively impact on children’s overall diet might well be enhanced, if implemented in the context of a whole-school policy designed to promote healthy eating.
About the study
The evaluation adopted a quasi-experimental approach, selecting a stratified random sample of 55 schools in the North East, and a comparison group of 45 schools in Yorks and Humber, with the same distribution in terms of school type, performance and percentage of children eligible for FSM.
Two quantitative instruments were used on three occasions:
- CADET was used to record the total dietary intake of the sampled pupils in Reception, Year 1 and Year 2 over 24 hours
- A simple questionnaire (based mainly on pictures) was administered to Year 2 pupils (in the classes selected for CADET) on the three ‘CADET days’.
The first data collection took place in March 2004, immediately prior to the introduction of the SFVS in the North East. Findings from the two later surveys (in June and November 2004) thus made it possible to measure change over time, within and between intervention and comparisons groups, and thereby assess possible NFSVS-related impacts. Analysis was undertaken by multilevel modelling, based on about 3,000 CADET responses and about 2,000 pupil questionnaire responses.
In addition, case-study visits were made to ten schools involved in the SFVS, where interviews with staff and pupils were conducted in order to explore and interpret the survey findings. These visits included 29 group interviews involving 98 pupils (usually in groups of three), and interviews with 42 members of staff.
At baseline findings showed that:
- overall, pupils consumed an average of 3.36 portions of fruit and vegetables a day, with only 27 per cent achieving the recommended intake of 5 A DAY
- girls ate more fruit than boys, and were more likely to achieve the 5 A DAY target
- girls also ate fewer snacks and desserts (a classification referring to food items such as cakes, crisps, sweets and puddings, not to the time of day at which they were consumed)
- pupils in schools with high proportions of pupils eligible for free school meals (FSM) ate less fruit and vegetables, more snacks and desserts; they were less likely to achieve the 5 A DAY target
- pupils in schools with high proportions of pupils with English as an additional language (EAL) ate more fruit and fewer snacks and desserts
- generally, fruit consumption decreased between Reception and Year 2, and older pupils were less likely to achieve the 5 A DAY target.
Three months after the SFVS had been introduced, pupils in the intervention group were eating significantly more fruit (0.37 portions) than at baseline, in the context of a general decline in fruit-eating, probably linked with age(pupils from the comparison group were eating 0.11 portions less than at baseline). The final survey (seven months after introduction of the scheme) indicated a further general decrease in consumption of fruit, and a decline in the consumption of snacks and desserts.
In order to assess the impact of the SFVS, it was necessary at that stage to distinguish between the oldest children (who were now in Year 3 and no longer receiving free fruit) and the two younger cohorts who were still involved in the scheme. Among the oldest children, consumption of fruit and vegetables had dropped to below baseline levels, i.e. they were eating less fruit and vegetables than before the SFVS was introduced in their schools. For the younger children in the intervention group, there was a reduction in fruit consumption between Phases 2 and 3, but it remained significantly higher than at baseline and significantly higher than in the comparison group; they were now one and a third times as likely to achieve the 5 A DAY target.
Analysis of the complete survey data also indicated that:
- the combined fruit and vegetable consumption of children eating school dinners was greater than those who had packed lunches
- consumption of snacks and desserts amongst pupils who had packed lunches was much higher than those who had school dinners
- living in areas of high deprivation was associated with lower fruit and vegetable intake and higher consumption of snacks and desserts
- girls (but not boys) in the intervention group ate slightly more vegetables after the introduction of the SFVS
- over the lifespan of the evaluation, fruit and vegetable consumption of children in the intervention group declined at home and increased in school.
There was some evidence to suggest that children from minority ethnic groups ate more fruit than white UK pupils, but this was not confirmed by further analysis, possibly due to the small number of minority ethnic children included in the survey.
At baseline, pupils were eating a nutritionally adequate diet which met their requirements for growth and health, but with high levels of salt. Seven months after the introduction of the SFVS, the findings showed that:
- for the oldest cohort only, the intervention was associated with a significant decrease in energy intake, probably related to a reduction in sugar intake; this decrease coupled with a slight increase in fat intake increased the percentage of energy derived from fat in their diet.
- while younger pupils in the intervention group were eating more fruit and vegetables, their intake of dietary fibre appeared to have been unaffected a small increase in carotene intake was recorded for the two younger cohorts, and a decrease was observed in those now in Year 3
- salt intakes remained universally high following the intervention.
The nutritional intake of children still participating in the SFVS showed some changes that might be associated with increased intake of fruit and vegetables, e.g. small changes in carotene, folates and Vitamin C.
Attitudes, awareness and knowledge
Pupils’ attitudes, awareness and knowledge were explored and tested by the pupil questionnaire, supplemented by interviews with pupils and school staff.
Baseline results from the pupil questionnaire showed that:
- girls reported trying more fruits and vegetables and liking more fruits than boys; they achieved higher scores on three of the six questions designed to test knowledge of healthy eating
- children in the comparison group reported liking more vegetables than children in the intervention group
- pupils from schools with high proportions of children with special educational needs (SEN) or eligible for FSM achieved lower test scores, while pupils from high-achieving schools obtained higher scores
- pupils from schools with high proportions of children with EAL reported liking more items of fruit and were more likely to know the 5 A DAY message
- overall, only a third of children were aware of the 5 A DAY recommendation, although another third thought they should eat more than 5 A DAY
- children in the intervention group were much more aware of the 5 A DAY message (even before involvement in the scheme).
In the later surveys, test scores increased, as would be expected due to maturation and possibly also to familiarity with the questionnaire. Children generally reported trying and liking more items of fruit and vegetables. In addition, however, there was some evidence of a positive SFVS-related impact on the attitudes, knowledge and awareness of pupils in the intervention area. For instance:
- There were positive trends for the test questions; pupils in the intervention group were more likely to identify the healthiest options from a choice of snacks, and had increased their score on this question more over time than comparison group pupils.
- The increase in the number of fruits tried and liked was greater for the intervention group than for the comparison group at Phase 2, though there was no such difference at Phase 3. (This may be because the children had already sampled all of the SFVS-provided fruits in the first three months of the scheme.)
- Intervention group children living in areas of high deprivation increased their scores on two of the pupil questionnaire items more than expected, suggesting that the impact of the SFVS on these children was higher than for others.
Interviews with pupils and staff confirmed that the SFVS had encouraged children to try fruit and vegetables previously unfamiliar to them. Analysis of the pupil questionnaire data also showed an overall increase in the number of vegetables tried, but comparison pupils continued to report trying a larger number of vegetables than the intervention group.
The interviews showed that the SFVS was enthusiastically received by pupils and welcomed by staff, with very few of the staff’s concerns about possible burdens and school disruption realised. This was mainly because staff felt they could implement the scheme flexibly, meeting their school’s needs in their own particular context. However, while school staff said that the SFVS would ‘reinforce’ their efforts to teach children about healthy eating, they did not feel that the scheme brought anything new in this regard, as most felt that they were already addressing the matter satisfactorily.