Authors' objectives:

This Technical Brief aimed to review evidence for the effectiveness of interventions to promote fruit and vegetable intake in school aged children (i.e., aged between 5 and 18 years at commencement of the intervention).

Authors' results and conclusions: From the search strategy, 732 potentially relevant articles/abstracts were identified, of which 59 were retrieved. Of these, seven systematic reviews (reported in eight secondary research articles/reports) were identified as eligible for appraisal and were included in the review. The following conclusions are based on the current evidence available from this report's critical appraisal of secondary literature published on the effectiveness of interventions to promote fruit and vegetable intake in school-aged children: - many interventions have resulted in statistically significant increases in fruit and vegetable intake, at least in the short term - increases in fruit and vegetable intake have been modest, averaging around half a serving per day; and of questionable clinical significance - multifaceted interventions extending over at least two months have tended to be most successful in altering food intake - some reviewers have suggested that more successful interventions appeared to have had a theoretical basis, included small groups, included goal setting, and targeted specific behaviour change (e.g., increase fruit intake).

Authors' recommendations: Implications for practice Whilst the current evidence base is limited, several implications for practice have been suggested by the appraised systematic reviews. These include: - develop interventions from a theoretical base - promote specific behaviour changes (e.g., increase fruit and vegetable intake) rather than nutritional knowledge - encourage individual goal setting - employ multifaceted interventions (school curricula, mass media, parent mailings) - extend interventions over at least 8-10 weeks. It has also been suggested that to make substantive changes to nutritional outcomes, interventions need to be developed beyond the individual-level to include the population-level, macro-level public policy and environmental interventions (Ammerman et al. 2002). Programme providers in New Zealand considering transferring programmes already implemented elsewhere need to bear in mind how these can be best adapted to suit features of their target community, resources and outcome priorities. Pilot testing, process evaluation and ongoing monitoring and followup are also crucial to determine programme fidelity and efficacy. Further research required Future research needs to address specific methodological limitations including the need for more detailed reporting of sample characteristics, response and retention rates, randomization methods, theoretical basis of intervention, program delivery and integrity, and cost. Other priorities include the need for sample size calculations; evaluation of maintenance interventions; blind outcome assessment; analysis at level of allocation, cluster analysis and intention to treat analysis; and longer follow-up (beyond one year). Key gaps in the literature were identified, including the need for investigation of the reasons for subgroup differences; studies comparing specific strategies and different levels of intensity within the same population; and efficacy studies of successful interventions in the "real world", including cost effectiveness data. Crucially, there needs to be consensus from experts about what constitutes clinically important differences in outcomes in terms of risk for chronic disease, morbidity and mortality.

Authors' methods: Review

Project Status: Completed

URL for project: http://nzhta.chmeds.ac.nz/publications.htm

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: New Zealand Health Technology Assessment

Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;

Contact Name: nzhta@chmeds.ac.nz

Contact Email: nzhta@chmeds.ac.nz

Copyright: New Zealand Health Technology Assessment (NZHTA)