icahe JC Critical Appraisal Summary

Transcription

1 icahe JC Critical Appraisal Summary Journal Club Details Date of submission May 2011 Journal Club location JC Facilitator JC Discipline Victor Harbour Mel Tripptree Multi-D Clinical Scenario In children, are interventions focused solely on parents more effective in improving children's vegetable consumption compared to child-only, settings-based (i.e primary school, preschool/child care) interventions Article/Paper Knai C, Pomerleau J, Lock K, & McKee M (2006) Getting children to eat more fruit and vegetables: A systemic review. Prev Med 42: Please note: due to copyright regulations icahe is unable to supply a copy of the critically appraised paper/article. If you are an employee of the South Australian government you can obtain a copy of articles from the DOHSA librarian. Article Methodology: Systematic Review Returned JC on: April 2011 By icahe staff member: Lexi Young

2 Ques No. Yes Can t Tell No Comments Did the review ask a clearly-focused question? The review has a clearly focused question. 1 Population: Studies that involved promotion/increase of children s intake of vegetables and fruit. The children were not acutely ill or institutionalized individuals Intervention: Studies that reported an intervention that promoted a diet high in fruit and vegetables. Outcomes: fruit and vegetable consumption in children. 2 Did the review include the right type of study? The review included only studies (non- & randomized controlled trials) where an intervention to increase the fruit and vegetable intake of children was investigated Is it worth continuing? YES 3 Did the reviewers try to identify all relevant studies? The electronic search included a considerable range of bibliographic databases. The reviewers also screened for additional articles in the reference lists of the included studies. Experts in the field were also consulted. Did the reviewers assess the quality of the included studies? 4 Two independent reviewers appraised the validity of the included studies. Consensus was used to resolve any disagreement. 5 If the results of the studies have been combined, was it reasonable to do so? Due to small number of studies and heterogeneity in the study populations, types of interventions, and outcome assessment measures, meta-analysis was not attempted. Findings were compared by age group: 5-12yo & yo.

3 6 7 How are the results presented and what is the main result? The results were presented using a consort diagram, table of results and in the text. Summaries of the studies were given in tables in the results sections. Findings were compared by age group: 5-12yo & y/o and given an estimation of effect size by comparing the difference between groups at intake and after follow up. Bottom line result: None of the studies reviewed had a detrimental effect on fruit and vegetable consumption. Ten studies had a significant effect, ranging from +0.3 to servings/day. How precise are these results? Precision of results could not be determined based on the analysis done in this systematic review.

4 Journal Club Can the results be applied to the local population? The population sample covered by the review was reasonably similar to the local population, although with some key differences: - Only 1 of the studies reviewed was with a rural population - our local populations are all classified as rural and/or remote, which often adds additional complexities/challenges. - Most of the schools in the studies reviewed were very large, with large student populations and possibly greater resources than the majority of our local schools, which are considerably smaller (some only have 30 students). 8 The majority of interventions described in the review could be replicated locally, with some modifications, but with a few notable exceptions: - A number of the schools in the studies reviewed had a 'food service' component to their intervention, where students participated in a 'school meals' program. This does not exist in our local schools, many of which don't any have canteens or operate only limited canteens on a part-time basis. - We do not have the human or financial resources to organise regular free fruit and vegetable provision programs in schools, such as those described in some of the studies reviewed. However, we can influence development of school vegetable gardens and programs, try to link schools in with local fruit and vegetable shops/suppliers for discounted produce, and encourage/support development of Fruit/Vegetable breaks like Crunch & Sip program in schools, which may produce similar outcomes. Our PICO question specifically focussed on vegetable consumption and unfortunately the studies in this review all targeted fruit and vegetable consumption and did not delineate in their results regarding changes in consumption whether it was fruit consumption or vegetable consumption that increased or both. We agree that the differences described above may produce different results or result in smaller, less significant effects on school populations within our local areas. However, particularly given our schools are smaller (and some are tiny), we agree there is greater opportunity to influence the whole school population, so our interventions may actually result in effects of greater significance. Either way, we agreed that the results from this review could be applied (in the most part) to our local populations with some modifications to interventions described.

5 Journal Club Were all important outcomes considered? The review considered outcomes from the point of view of professionals and policy makers, rather than individuals, family/carers or the wider community, so was of most benefit to us in terms of the potential application of the results within our practice.the nature of this review was to look at population level interventions and outcomes within schools, so this was appropriately pitched at a professional/policy maker, rather than an individual, family or community level. Journal Club Should policy or practice change as a result of the evidence contained in this review? The review clearly stated that there were no detrimental effects on children's fruit and vegetable consumption and no other negative outcomes or harm were reported. There were no costs or cost effectiveness outlined for any of the interventions, which would have been useful in terms of considering local applicability of interventions. However, despite the lack of information re: intervention costs/cost effectiveness, we believe that our practice should change as a result of this review. In reference back to our PICO question, this review clearly highlights that: -we need to include parents as a key target in our interventions, along with children and staff in education settings to increase intervention success and ensure sustained behavioural change in children's consumption patterns; -we need to ensure 'active involvement' of parents within our interventions (not just involve them in paper-based intervention).