Research Evidence
The feasibility and acceptability of a primary school-based programme targeting diet and physical activity: the PhunkyFoods Programme
Pilot and Feasibility Studies 2019 [Open Access]
Pinki Sahota¹, Meaghan Christian¹, Rhiannon Day¹ and Kim Cocks²
¹ School of Clinical and Applied Sciences, Leeds Beckett University, Calverley Street, Leeds, LS1 3HE
² KCStats Consultancy, Leeds, UK
Increasing intake of an unfamiliar vegetable in preschool children through learning using storybooks and sensory play: A cluster randomized trial
Journal of the Academy of Nutrition and Dietetics 2019 [Open Access]
Chandani Nekitsing¹, Pam Bllundell-Birtill¹, Jennie E Cockroft², Marion M. Hetherington¹
¹School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
²Purely Nutrition Ltd, Harrogate, HG1 1DL, UK
Taste exposure increases intake and nutrition education increases willingness to try an unfamiliar vegetable in preschool children: a cluster randomized trial.
Journal of the Academy of Nutrition and Dietetics 2019 [Open Access]
Chandani Nekitsing¹, Pam Bllundell-Birtill¹, Jennie E Cockroft², Marion M. Hetherington¹
¹School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
²Purely Nutrition Ltd, Harrogate, HG1 1DL, UK
PhunkyFoods Early Years Programme in East Sussex
Since 2015, almost 190 early years settings across East Sussex have participated in the Early Years PhunkyFoods programme, with approximately 260 early years practitioners having participated in a PhunkyFoods training course. The programme has been funded by East Sussex Public Health (and by NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group (CCG) and NHS Hastings and Rother CCG as part of the 2016/17 Nursery Grants Programme).
- Post the training, an incredible 97% of practitioners have reported an increase in their confidence to deliver key healthy lifestyle messages for early years children.
- As part of an annual evaluation survey, 94% of active settings who responded reported an increase in delivery of key healthy lifestyle messages in their setting as a result of participating in the PhunkyFoods Programme.
- 88% of settings responding to the survey also stated that they believed that the implementation of the PhunkyFoods Programme had had a positive impact on improving healthy eating behaviours in their children, and have provided a range of observational and anecdotal reports to evidence this change.
- 71% of settings responding to the annual survey agreed that the PhunkyFoods Programme had made it easier for them to engage with parents and extended families around the healthy lifestyles agenda
- Parental reports of their child’s typical food and drink consumption were also collected at baseline and follow up, with small but positive improvements in key dietary behaviours observed as part of the evaluation follow up. The largest change seen was in parental reports of their child’s fruit and vegetable consumption, with parents reporting an overall increase of 1.5 extra eating occasions of fruit and vegetables per day.
Annual Schools Survey 2018
Each year the PhunkyFoods research and development team conduct an annual school survey and the data is published on our website. Our headline findings from the 2017/18 survey are shown below.
97.5% of respondents using the programme rated the PhunkyFoods package as either 'good' or 'excellent'.
95% of schools responding to the survey stated that they believed that the implementation of the PFP and/or use of its resources in school had had a positive impact on awareness and knowledge of healthy eating issues for their pupils. Some schools were able to offer evidence for this through pupil surveys, workbooks and homework. Others reported evidence around children being able to 'discuss' healthy lifestyle issues more fully and more knowledgeably. Evidence given included statements such as;
“Through questioning; children have a better understanding of what is healthy and how much they should be eating."
"Through pupil feedback, they are aware of choices of healthy meals at lunchtime."
"Children are aware of the eatwell plate and what a balanced diet should include."
"The children understand the 'eatwell' plate having put together their own example. They discuss their meals at lunch time in relation to a balanced diet."
"Teachers are questioning to the pupils so we are aware of what they have understood in lessons."
"Children can talk about healthy lifestyle, particularly the eat well plate."
"Children are more knowledgable"
"lots more open discussion and children more confident about talking about their lifestyles and choices."
"Children are able to talk about food with more confidence."
"When asked by an Ofsted inspector about assemblies one of the first things the children mentioned was about the phunky foods assemblies and healthy eating."
88% of schools responding to the survey stated that they believed that the implementation of the PFP and/or use of its resources in school had had a positive impact on improving healthy eating behaviour of their pupils. Most of this improvement was reported in terms of improved snack and school lunch choices, and observing healthier lunchboxes. A number of respondents also reported an increased willingness of their children to try new foods. Evidence given included statements such as;
“Children with narrow fast foody diets have noticeably widened what they will eat.”
"Children have chosen fruit in packed lunches rather than biscuits etc."
“At lunch time. Children are going for healthier foods.”
"Children are now trying a much larger variety of fresh fruit and vegetables at lunchtime."
"Yes. Children trying new foods and fruit etc which they may not have tried before for example Chinese New Year."
"Children are making informed choices for themselves."
"Children who attend my club are choosing healthier snacks at playtime and say they are eating more fruit and vegetables at home, as well as drinking more water and being more aware of sugar in different foods."
"Some children have given up or cut back on their intake of certain fizzy drinks and treats."
"It has complemented my Healthy Schools Plus work greatly, supplementing the input we are making within the classrooms and outside of the classrooms and packed lunches have improved in quality and more children are using the salad bar."
"Children make healthier choices for lunch boxes and more willing to try new foods."
Schools were asked what the best thing about the PhunkyFoods Programme is and the following cloud was observed;
Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years (2018)
Appetite. 2018 Aug 1;127:138-154.
Chandani Nekitsing¹, Pam Bllundell-Birtill¹, Jennie E Cockroft², Marion M. Hetherington¹
¹School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
²Purely Nutrition Ltd, Harrogate, HG1 1DL, UK
Abstract
BACKGROUND: Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important.
OBJECTIVE: To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years.
DESIGN: The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included.
RESULTS: 30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked.
CONCLUSIONS: Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).
Feasibility Study - The Evaluation of the PhunkyFoods Programme (2014)
Meaghan Christian1, Pinki Sahota1, Rhiannon Day1, Kim Cocks2
1The Institute for Health and Wellbeing, Faculty of Health and Social Sciences Leeds Beckett University (formerly Leeds Metropolitan University) Calverley Street, Leeds LS1 3HE
2York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD, UK
Abstract
Purpose
Within schools there is a need for easily implemented interventions designed to promote healthy lifestyles through encouraging a healthier balanced diet and to increase children’s physical activity. The PhunkyFoods programme (PFP), underpinned by the whole school approach is a nutrition and physical activity education intervention aimed at improving health related knowledge and behaviours in children. This study aimed to assess: the feasibility, acceptability and delivery of the PFP intervention; appropriateness of outcomes and outcome measures; recruitment, and retention.
Methods
A cluster randomised feasibility trial consisting of eight primary schools (4 Intervention and 4 Control) in the North of England with a total of 311 pupils (175 boys; 183 girls’ aged 6-9 years old). The following validated tools used at baseline, 6 months and 18 months were; anthropometric measurement, a Healthy Lifestyle Knowledge Questionnaire (HLKQ), dietary intake and physical activity using the Synchronised Nutrition and Activity Program (SNAPTM), and psychological well-being to assess intervention effect of dieting behaviours; body image; self-perceptions.
Results/findings
At 6 months a total of 337 (94.1%) of the original pupils remained in the trial, and this decreased to 325 (90.8%) at 18 months. There was no difference between the two groups for total knowledge score, however, for Year 4 pupils there was a statistically significant, higher mean healthy balance score from the HLKQ (mean difference 5.1, 95%CI 0.1-10.1, p=0.05). The SNAP tool identified a possible trend towards Year 2 Intervention pupils consuming fewer fizzy drinks, chocolates, sweets, biscuits and cakes compared to Control group pupils. Year 4 Intervention pupils reported higher fruit consumption at 18 months compared to the Control pupils. However, a fully powered randomised controlled trial is needed to determine if these differences are statistically significant. There was no evidence that the intervention had any detrimental effect on the psychological well-being of the Intervention school pupils.
Conclusion
The results support the future implementation of a randomised controlled trial to evaluate the effectiveness of the PFP. Overall teachers found PFP to be a highly acceptable programme for teaching children about nutrition and physical activity which could possibly help tackle poor nutrition and sedentary behaviour in children.
Presented as an oral presentation at the ASO UK Congress on Obesity, Sept 2015, Glasgow. Published in the conference proceedings.
Evaluation of the PhunkyFoods Programme (2008)
Independent research conducted by the National Foundation for Education Research (NFER) found that;
- Evidence from pupils, staff and parents/carers was clear; there were large and positive changes in attitudes, awareness and behaviouraround healthy eating and physical activity.
- Teachers and parents reported increased awareness and knowledge of healthy eating and physical activity.
- There was evidence that where the PFP was delivered regularly, whether through the curriculum, in PPA time or in after-schools clubs, there was more likely to be a positive impact on pupils’ knowledge and awareness of health messages.
- Most pupils reported eating more healthily and doing more physical activity after taking part in the PFP.
- Staff, parents and pupils all reported that children ‘LOVED’ the PFP.
The study concluded:
"Popular with the whole school community, PFP clearly helps expand, embed and enhance health-related teaching, through increasing school staff competence and confidence, complementing other initiatives and positively impacting on pupils knowledge, attitudes and behaviour."
Assessment of shared characteristics of PhunkyFoods schools that run extra-curricular outreach programmes in the UK
This qualitative study was carried out by Daniel McAlpine (Advanced Nutrition MSc, Leeds Metropolitan University). The study aimed to identify the characteristics of schools that chose to implement community healthy lifestyles outreach programmes, and to determine barriers to successful implementation. Five core themes emerged from the data when looking at the characteristics of schools implementing surccesful community programmes. These are detailed below;
- Parental Involvement - 63% of schools found that increased parental involvement was key to running a successful programme, increased parental involvement eased staffing issues and reinforced messages at home
- Community Links - Increased community links can help overcome staffing, resources, financial barriers, and is a major facilitator found in successful schools
- Key Drivers - Schools champions and effort were seen as key drivers to success. As a dedicated, passionate teacher can link all four of the other themes together
- Staff to Children Ratio - 36% respondents reported this as the main barrier to success. It can be overcome through community links and parental involvement
- Design Feedback - 40% described a good feedback loop from design through to evaluation as beneficial when tailoring sessions to vulnerable communities. Involving parents and children in the design phase instilled the relevance and importance of the project.
The study concluded that these themes should not be seen as separate isolated characteristics, but rather an interlinking process, that do not in themselves cause success, but rather facilitate the easy implementation of successful programmes.
