EVALUATION OF THE BIG LOTTERY FUND S NATIONAL SCHOOL FRUIT AND VEGETABLE SCHEME

Transcription

1 National Foundation for Educational Research EVALUATION OF THE BIG LOTTERY FUND S NATIONAL SCHOOL FRUIT AND VEGETABLE SCHEME Second Interim Report David Teeman Sarah Blenkinsop Joan Ransley Ian Schagen Sandie Schagen Emma Scott Gabrielle White NFS December 2004

2 Copyright: Big Lottery Fund 2004 Big Lottery Fund is the joint operating name of the New Opportunities Fund and the National Lottery Charities Board (which made grants under the name of the Community Fund). The Big Lottery Fund, launched on 1 June 2004, is distributing half of all National Lottery good cause funding across the UK. Published by: Evaluation and Research Team Big Lottery Fund 1 Plough Place London EC4A 1DE Tel: Fax: e&r@biglotteryfund.org.uk Use of material in this report must be appropriately acknowledged.

3 CONTENTS page 1. Introduction Background to the evaluation Overall research aims and objectives Phase 2 of the evaluation 3 2. CADET Analysis of data Findings Nutritional analysis Pupil questionnaire Analysis of data Change at Phase Multilevel modelling Summary How schools implemented the NSFVS School context Setting up the NSFVS Operating the NSFVS Summary Pupil interviews Introduction Lunch and snacks Knowledge and awareness Summary Impact of the NSFVS Impact on pupils Impact on staff Impact on schools Summary Conclusions Summary of findings The next stage of the evaluation 93 References 95 Appendix A. Interview Question Schedules 96 Appendix B. Pupil Interview Exercise Appendix C. Pupil Interview Exercise 2 124

4

5 1. Introduction 1.1 Background to the evaluation The Government s national 5 A DAY programme forms part of the strategy to raise awareness of the health benefits of fruit and vegetable consumption, and to improve access to fruit and vegetables. One aspect of the 5 A DAY programme is the National School Fruit Scheme (NSFS), recently re-branded as the National School Fruit and Vegetable Scheme (NSFVS). Following successful piloting, the NSFVS provides a free piece of fruit or a vegetable to children aged four to six years in selected regions each school day. The aim is to roll out the scheme nationally by the end of 2004, which will involve distributing around 440 million pieces of fruit and vegetables each year to over two million children in 18,000 schools across England. The NSFVS is now being extended throughout England region by region, funded by the New Opportunities Fund, now renamed the Big Lottery Fund (The Fund). Sponsored by The Fund, the National Foundation for Educational Research (NFER), in partnership with nutritionists from the University of Leeds, is undertaking an evaluation of the impact of the NSFVS by monitoring changes, if any, in consumption and in attitudes to healthy eating in children before and after they receive the free fruit or vegetables. The data reported here derives from the second phase of the NSFVS evaluation and constitutes a second interim report, which is divided into seven chapters: Chapter 1 (this chapter) summarises the background to the evaluation, and discusses the implementation of the second phase of the evaluation, the administration of research instruments, response rates by research instrument and the case-study element of the evaluation. Chapter 2 describes how CADET data was analysed and presents findings from the analysis of data gathered during Phase 2. Chapter 3 describes how pupil questionnaire data was analysed and presents findings from the analysis of data gathered during Phase 2. Chapters 4 to 6 describe how case studies were conducted and present the analysis of data gathered during the case studies. Chapter 4 reports on the implementation of the NSFVS in the ten schools visited, Chapter 5 presents the data resulting from group interviews with children and 1

6 Chapter 6 addresses the impacts of the NSFVS from the perspectives of schools staff and pupils. Chapter 7 summarises findings from the second phase of the NSFVS evaluation and provides an outline of future evaluation activity. External influences It is worth noting that, as mentioned in our first interim report (Teeman et al., July 2004) since this evaluation began in July 2003, there have been (and continue to be) a large number of school-orientated nutrition and diet stories in the printed and broadcast media. It is likely that such widespread and consistent inputs about health and diet will have an impact across children s and parents awareness of this area and therefore, potentially on the data collected during this research project. Having said this, the experimental design of this evaluation (and the approach taken to sampling) will provide consistent data, from baseline to completion, so that any potential NSFVSrelated impacts can be measured, over and above the external influences exerted on both groups. 1.2 Overall research aims and objectives The overall aim of the research remains to: evaluate the impact of the Big Lottery Fund s pilot of the NSFVS on children and schools. The scheme is being evaluated from two perspectives; the impact on children and the impact on schools Impact on children The research seeks to identify changes, resulting from the introduction of the NSFVS, relating to: children s consumption of fruit and vegetables for instance, has the daily free fruit and vegetables encouraged them to eat more fruit and vegetables? Or have the free fruit and vegetables functioned as a substitute for what they would eat anyway? 2

7 children s overall dietary patterns if they are eating more fruit and vegetables, is this in addition to their normal diet, or are they (for example) eating fruit and vegetables instead of less healthy food? children s nutrient intake do any changes in eating patterns have an effect on e.g. intake of calcium, percentage energy derived from fat in the diet? children s knowledge, awareness and attitudes relating to the benefits of increased fruit and vegetable consumption do they know which foods are good for them? Are they willing to try eating unfamiliar fruits and vegetables? With reference to all of these objectives, we are investigating the impact of the NSFVS on different subgroups of children, to see whether the impact differs according to age, sex or certain school-level characteristics Impact on schools In identifying the impact on schools, the research is exploring: any changes in school practice introduced in connection with the NSFVS: for example, changes in catering arrangements or in the provision of breaktime drinks and snacks whether the introduction of the NSFVS inspires more classroom teaching on healthy eating any difficulties encountered in implementing the NSFVS. 1.3 Phase 2 of the evaluation The research has continued to employ two quantitative instruments, the CADET food diary and a pictorial pupil questionnaire. This second report presents comparative analysis of data gathered from the second sweep of these instruments; we refer to this sweep and associated activity as Phase 2. In Phase 2 we have: retained all but three of the schools who agreed to participate in Phase 1 produced amended guidance documents for school staff and NFER administrators administered the second sweep of CADET and the Pupil Questionnaire (CADET days) 3

8 used multilevel modelling to provide further analysis of data used baseline data and data from the second sweep to measure change in and between the intervention and comparison groups selected, recruited and visited ten schools for qualitative study collated and analysed all interview data CADET and Pupil questionnaire Schools which had participated in Phase 1 of the evaluation were contacted at the beginning of the summer term to confirm their agreement to take part in the second phase and to provide them with details about the organisation and timetabling of the second sweep, which occurred in June Between the two phases of the project, one school in the main sample and two in the comparison sample expressed concerns about the amount of work that completion of the CADETs caused their staff at lunch time and they decided to withdraw. One was a very small school and neither of the other two could be persuaded to undertake a more limited exercise with smaller numbers of pupils. Overall, this left 95 schools to participate in Phase 2. CADET day On CADET day, NFER administrators were again responsible for organising and delivering the Year 2 pupil questionnaire and for coordinating the completion of CADET diaries, from morning break until the end of the school day. An NFER telephone helpline number (manned from 9.00 am to 6.00 pm) was provided for any teacher, administrator or parent who had any queries about completing the CADET. The database of pupil information from Phase 1 was used to compile lists of children by school and by class for whom CADETs and questionnaires would be allocated for Phase 2. These lists were used to compile the school packs for despatch, and were also sent in advance to both schools and administrators so that they would be clear about who was expected to participate. For Phase 2, all children whose parents had given consent in Phase 1 were provided with a named CADET, whether or not they had completed one in the first phase. 4

9 Named questionnaires were provided for all Year 2 pupils for whom we had details. In addition, administrators were provided with spare questionnaires which could be given to any new Year 2 pupils. Administration in schools To build on relationships initiated during the first phase of the evaluation, wherever possible, administrators were allocated to the same schools for Phase 2. Letters were sent to schools prior to Phase 2 to remind them of the dates and key features of the project. Administrator feedback Generally, the feedback received from administrators indicated that Phase 2 had run more smoothly than Phase 1, because staff now knew what was expected. Most administrators reported that, together with their schools, they had devised charts and checklists to simplify the task of completing the CADETs over the lunch period. A number of administrators commented that all of the expected pupils, apart from those who were absent from school, participated in Phase 2. Unfortunately a chicken pox outbreak in two schools resulted in a large number of absences. A number of families were also understood to be on holidays. CADET and pupil questionnaire response rates Here we summarise the response rates for Phase 2 of the evaluation for the CADET and pupil questionnaire. Table 1.1 shows the total number of CADETs despatched and the proportion returned completed, in both the intervention and comparison group. 5

10 Table 1.1 Response rates for CADET phase 2 Total CADETs Intervention Comparison Total Number despatched % of total despatched CADETs returned used Average number of returned CADETs per school Since the first round of CADET days (see Teeman et al., 2004) there has been some drop off in the average number of CADETs returned per school. However, in spite of the withdrawal of three schools, at the end of Phase 2, 55 per cent of the CADETs despatched were returned used. This was slightly higher than the 50 per cent return achieved in Leeds University trials over just one phase. The number of participating pupils averaged per class. Table 1.2 Response rates for the pupil questionnaire Year 2 pupil questionnaires Intervention Comparison Total Number despatched % of despatched questionnaires returned used Average number of returned questionnaires per class Since consent was not required, pupil questionnaires were completed by all pupils except those who were absent on the day when they were administered Case studies The pre- and post-test CADET diaries and the pupil questionnaire measure the impact of the NSFVS in terms of children s eating habits, knowledge and awareness of healthy eating; qualitative research is intended to help to interpret and complement findings from CADET and the pupil questionnaire, and to help investigate the reasons for observed patterns of changes. The qualitative research was timed to occur after the second sweep of CADET and the pupil questionnaire. This timetabling was intended to allow the 6

11 research team to take the findings from the pre- and post-tests into account when considering the main issues that would be explored during our qualitative investigation and to help inform school selection. Sampling schools We selected ten intervention schools to be included in the qualitative research. It was not appropriate to include comparison schools in the qualitative study, as the aim of our qualitative research was to explore the experiences and perceptions of those directly involved in the NSFVS. It had been intended to use comparative analysis of data from Phase 1 and 2 to help inform school selection; however, analysis indicated that patterns of results were much more complicated than anticipated and therefore such an approach was not considered appropriate. Schools were selected to include a full range of background factors, such as: Type of school Type of authority Size of school/school roll KS1 attainment proportion of children eligible for free school meals (FSM) proportion of children with English as an additional language (EAL). Table 1.3 provides an overview of the background factors of the schools actually visited. 7

12 Table 1.3 A profile of case-study schools by background factors LEA Type School Type FSM EAL KS1 Metropolitan Metropolitan Metropolitan English Unitary English Unitary County County County County Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) Infant & Junior (Primary) nd highest 37 8 Highest band 40 1 Lowest band 40 0 Middle band nd lowest nd Highest 29 0 Middle band 27 2 Lowest band No data available County Infants 15 1 Highest band Interviews In each school selected for qualitative study we aimed to interview: Pupils (in groups of three) in Years 1, 2 and 3 who had been in Reception, Year 1 and Year 2 at the time of the second sweep of CADET and the pupil questionnaire The NSFVS coordinator who in most cases is responsible for the implementation and daily running of the NSFVS in schools The Personal Social and Health Education (PSHE) coordinator Class teachers who had been responsible for Reception, Year 1 and Year 2 at the time of the second sweep of CADET and the pupil questionnaire Catering managers. 8

13 Interviews were largely completed over the first three weeks of October 2004, with one case-study visit being undertaken in the first week of November. Further details about who was interviewed and the number of interviews conducted can be found in the introductions to Chapters 4 and 5. Question schedules were designed for each category of interviewee and while staff schedules included many common questions, they were also tailored to suit a particular interviewee s role. These role-specific interview schedules are included in Appendix A. Analysis Interview notes were written up electronically and transferred into MaxQDA, a qualitative analytical software package. The research team developed a coding framework designed to meet the aims of the qualitative aspect of the evaluation and then coded and analysed all interview data using the MaxQDA package. 9

14 2. CADET CADET diaries were completed in June on behalf of those children who had participated in the first round of CADET data collection in March. The instrument used in Yorks and Humber was exactly the same as that used on the previous occasion. The diary employed in the North East had an additional column used to record the NSFVS fruit or vegetables eaten. It was decided that it would be helpful to distinguish this from any other fruit or vegetables that the children might eat. 2.1 Analysis of data Following the Phase 2 data collection, 3,842 completed CADET diaries were received by NFER. The same exclusion rules were applied as in Phase 1, and this reduced the total to 3,600 diaries which were included in the basic analysis. As in Phase 1, this included basic frequencies, cross-tabulations and analysis of variance. Further analysis was restricted to those pupils (a total of 3,262) for whom CADET diaries had been completed at both timepoints (March and June). An analysis of change over time was undertaken, to identify the changes which had taken place between March and June, and see whether the extent of change was different for different groups (most importantly, between the intervention and the comparison group). Finally, multilevel modelling of the data was undertaken. 1 Multilevel modelling can be used to analyse longitudinal data which has been collected from pupils at more than one timepoint, by including timepoint as a level in the model. Irrespective of the impact on an intervention, there is likely to be a 1 Multilevel modelling is a development of regression analysis which takes account of data which is grouped into similar clusters at different levels (see Goldstein, 2003). For example, individual pupils are grouped into year groups or cohorts, and those cohorts are grouped within schools. There may be more in common between pupils within the same cohort than with other cohorts, and there may be elements of similarity between different cohorts in the same school. Multilevel modelling allows us to take account of this hierarchical structure of the data and produce more accurate predictions, as well as estimates of the differences between pupils, between cohorts, and between schools. 10

15 certain amount of random fluctuation between timepoints in this case, children may not eat exactly the same on two separate occasions. A repeated measures model takes into account this kind of variation, and is therefore a powerful way of analysing the kind of data collected as part of this evaluation. Details of modelling A five-level repeated measures multilevel model was set up, with the following levels: LEA School Year group (= class) Pupil Timepoint. The bottom level, labelled timepoint allowed us to model repeated measures for the same pupils, with two values per pupil in the present model (and three in the final analysis). Random variances at this level model measurement error in the instruments, reflecting the fact that each use will yield a different estimate of children s dietary intake. The background variables, defined at both timepoints, included: Pupil-level gender (boy or girl) year group (reception, Year 1 or Year 2) time (Phase 1 or Phase 2) School-level school type (infant or primary) percentage of pupils eligible for free school meals percentage of pupils with special educational needs (SEN) percentage of pupils with EAL key stage 1 average attainment (banded) comparison or intervention group. 11

16 Also included in the model were certain interaction terms, which allow us to measure whether the change between time 1 and time 2 is different for different groups (e.g. Year 1 rather than reception; intervention rather than comparison group). The model was designed to allow for the fact that the impact of the NSFVS could vary from class to class and from school to school. 2.2 Findings In our first interim report (Teeman et al., 2004) we reported in detail on the consumption of fruit, fruit juice, vegetables and snacks among children participating in the CADET data collection. In the analysis of Phase 2 data, the same five outcomes were explored, and the results compared with the Phase 1 data. Below we provide a brief summary of the Phase 2 findings, highlighting any significant differences between March and June. It is important to note that the figures quoted for fruit include (for the intervention group) fruit provided under the NSFVS. For the preliminary analysis which was undertaken and reported in August, NSFVS fruit was treated separately, as we wished to ascertain whether there was any impact on children s normal eating patterns (i.e. whether their participation in the NSFVS had resulted in an increase in consumption of fruit and vegetables eaten outside the scheme). However, only just over half (54 per cent) of the children in the intervention group were reported to have eaten NSFVS fruit. Further investigation (via the NFER administrators) suggested a number of reasons for this. There were several reports of fruit being distributed to the children, but not eaten (it seems that tomatoes were particularly unpopular, and many children refused to eat them). There were also cases where the administrator had not been able to witness completion of the CADET forms, which could mean that the school staff concerned either omitted to record the NSFVS fruit, or they did so incorrectly (for example, entering it in the morning break column rather then the NSFVS fruit column). The latter possibility means that we cannot distinguish with certainty between NSFVS and other fruit; it was decided therefore that NSFVS fruit and vegetables would be included in the main analysis. Finally, findings reported in Chapter 12

17 4, Section 4.1 suggest that accurate observation of consumption, (for instance, by teachers on duty in a playground) is likely to have been relatively difficult. It should also be noted that Phase 2 means quoted refer to the average for all children participating in the Phase 2 data collection (3,600 pupils). Where differences between the two timepoints are quoted, these refer to the group of children for whom data was available at both timepoints (3,262 pupils) Consumption of fruit In March, the overall average consumption of fruit was 1.49 portions per day. In June, following the distribution of NSFVS fruit in the North East, the overall average had increased to 1.7. It was still the case that girls ate more (1.74) than boys (1.66); this difference was significant at the ten per cent but not the five per cent level. As before, the amount of fruit eaten decreased with age (Reception 1.84; Year 1, 1.76; Year 2, 1.52 portions). Children in the intervention group ate considerably more fruit (average 1.95 portions) than those in the comparison group (1.38 portions). In March, the intervention group ate more fruit than the comparison group, but the difference was quite small and not statistically significant. When findings from the children involved in both surveys were compared, it appeared that the average consumption of children in the comparison group had gone down by 0.11 portions, while that of the intervention group had increased by only 0.37 portions, despite being given a free fruit or vegetable (usually the former) every day Consumption of fruit juice Mean consumption of fruit juice in June was 0.53 portions (compared with 0.50 in March). Girls drank more (0.55) than boys (0.51), a difference which was just significant at the ten per cent level. There was no difference in consumption between year groups. The intervention group drank significantly more (0.59) than the comparison group (0.45). 13

18 Comparing the findings for children involved in both surveys, consumption in the intervention group had increased by 0.07 portions, while in the comparison group consumption had decreased by 0.03 portions. This difference was statistically significant, but we cannot know whether the more positive change in the North East was associated with the introduction of the NSFVS Consumption of vegetables In June, average overall consumption of vegetables was 1.59 portions (compared with 1.54 in March). Girls ate more vegetables (1.65 portions) than boys (1.53 portions), but there was no significant difference between year groups, and no difference at all between the intervention and the comparison groups. In March, children in the comparison group were reported to eat more vegetables than those in the intervention group, although the difference was not significant. Comparison of data for 3,262 children at both timepoints showed that the average consumption in the North East had increased slightly (0.06 portions) while that in Yorks and Humber had declined slightly (0.03 portions). However, the difference in change between the two groups was not significant Total consumption of fruit and vegetables As in the analysis following the first survey, total consumption of fruit and vegetables was calculated in accordance with the 5 A DAY guidance (Department of Health, 2003a): fruit juice was included, but counted only once (even if the child had drunk more than one portion); beans, lentils and pulses were also included but only counted once. Average total consumption of fruit, fruit juice and vegetables was 3.66 portions in June, compared with 3.36 in March. This reflects the individual increases reported above. Girls ate significantly more (3.76) than boys (3.55), and consumption decreased with age (3.80 in Reception, 3.72 in Year 1, 3.47 in Year 2). 14

19 In June (but not in March) there was a significant difference between the intervention group (3.95) and the comparison group (3.28), which reflects the impact of the NSFVS on fruit and vegetable (particularly fruit) consumption. Analysis of change over time (for pupils included in both surveys) revealed that total consumption of fruit and vegetables had decreased by 0.16 in the comparison group, against an increase of 0.5 in the intervention group. No other differences were significant Achieving 5 A DAY Overall, 31 per cent of Round 2 pupils consumed at least five portions of fruit and vegetables a day, compared with 27 per cent in Round 1. Again, there was a significant difference between girls (34 per cent) and boys (29 per cent). There was also a difference between year groups, but this time it was Year 1 (34 per cent) who were most likely to achieve 5 A DAY, compared with Reception (32 per cent) and Year 2 (28 per cent). Findings were however consistent with Phase 1 insofar as the difference between Reception and Year 1 was relatively small, but Year 2 ate significantly less fruit. On this occasion, there was a highly significant difference between the intervention group (35 per cent) and the comparison group (27 per cent). It would appear that the introduction of the NSFVS had increased pupils chances of reaching the 5 A DAY goal. This was confirmed when findings from children involved in both surveys were analysed. The percentage of 5 A DAY children in the intervention group had increased by 6.1 percentage points (from 29.1 to 35.2), while the proportion in the comparison group dropped by 1.2 (from 28.3 to 27.1). It is worth noting that, even with the addition of a free piece of fruit each day, only just over a third of children in the North East were reaching the 5 A DAY target Consumption of snacks and desserts Because an increase in consumption of fruit and vegetables might lead to a corresponding decrease in the amount of other foods consumed, a baseline measure of snacks and desserts was undertaken following the Phase 1 survey, and repeated after Phase 2. Overall, the number of snacks eaten had remained the same, at 3.36 portions in 24 hours. As in March, boys ate more snacks 15

20 than girls, but in June the difference was smaller and not statistically significant. However, the difference between intervention (3.29) and comparison group (3.46) had increased. Analysis of change over time indicated that, for children involved in both surveys, overall snack consumption had remained essentially constant. There was no significant difference in change between intervention and comparison group Multilevel modelling Multilevel modelling enables us to consider the impact of a wider range of variables, and to consider them all simultaneously (this is important, as relevant factors often tend to overlap). Models were created in order to further explore five outcomes: consumption of fruit consumption of vegetables total consumption of fruit, fruit juice and vegetables (calculated according to the 5 A DAY rules) consumption of snacks achievement of 5 A DAY goal. The first four outcomes were measured in terms of portions, and Table 2.1 summarises the results. The coefficients in each row indicate the impact of the factor named on the relevant outcome(s). They needed to be considered in relation to the base case, i.e. a boy in the comparison group at baseline (the March survey). It should also be noted that the differences shown in the table are after controlling for all other factors, i.e. when all other factors are taken into account, the differences between boys and girls are shown in the first row. It shows that in accordance with findings reported above, and also in the first interim report girls are likely to eat more fruit and vegetables, and fewer snacks. 16

21 Table 2.1 Significant coefficients for background variables relative to food intakes expressed as portions Variable Total fruit Total vegetables Total fruit & vegetables Total snacks Variables at both time points Sex (girl = 2, boy = 1) Intervention group Year 1 pupils -0.2 Year 2 pupils -0.3 Intervention group Year 1 pupils Intervention group Year 2 pupils Infant school % eligible for free school meals* % with SEN* % with EAL* -0.1 Key stage 1 overall performance 2002 Variables relating to change from Baseline to Round 2 Timepoint (Round 2 v. baseline) Intervention group at time Year 1 pupils at time Year 2 pupils at time Intervention group Year 1 pupils at time Intervention group Year 2 pupils at time *Value given is actually expected change for 10 percentage points change in the background variable. The first set of variables relates to overall differences, not to change over time. Overall, there were no significant difference between intervention and comparison groups. Year 1 pupils ate on average 0.2 portions of fruit less than Reception children, and Year 2 pupils ate 0.3 portions less. Two school-level variables were shown to be significantly associated with food intake. Children in schools with high proportions of pupils eligible for 17

22 FSM tended to eat considerably less fruit and vegetables and more snacks, while in schools with high proportions of EAL pupils, pupils ate fewer snacks. Similar findings were observed in Phase 1; they suggest that dietary habits are linked to deprivation 2 and possibly also to ethnicity. There were no links with attainment, or special educational needs. Variables relating to change over time indicated no general change in consumption of fruit, vegetables or snacks. Indeed, Year 1 pupils generally ate less fruit, and Year 2 pupils less fruit, fruit juice and vegetables combined. For the intervention group, however, there were more positive findings. There was a general increase of 0.3 portions of fruit, but this was higher for pupils in Year 1 (0.7 portions) 3 and Year 2 (0.6 portions). It appears that, within the intervention group, the NSFVS was helping to compensate for the decline in fruit eating which seems to happen as children grow older. It may be that, in some schools, children in nursery classes were already being given fruit, while in Year 1 and Year 2 the NSFVS fruit was more likely to be an addition to their normal diet. In terms of fruit, fruit juice and vegetables combined, there was an increase for the intervention group of 0.6 portions in June, but for Year 2 pupils the increase was reduced to 0.4. The final outcome to be explored by multilevel modelling was 5 A DAY : did children achieve this goal or not? As this is a binary (yes/no) outcome, it requires a logistic multilevel model, which produces odds ratios indicating the likelihood of various groups achieving the desired outcome. The results of this analysis are shown in Table 2.2 below. 2 3 Interviews with school staff in case-study schools show that some staff also draw a link to deprivation and their perceived impact of deprivation on children s consumption, especially in relation to fruit and vegetables (see Chapters 4, 5 and 6). Intervention group Year 1 pupils were eating 0.6 portions of fruit more at Time 2, while Year 1 generally were eating 0.1 portions less. 18

23 Table 2.2 Variable Significant odds ratios for background variables relative to reaching 5 A DAY standard Odds ratio Variables at both time points Sex (girl = 2, boy = 1) Intervention group Year 1 pupils Year 2 pupils Intervention group Year 1 pupils Intervention group Year 2 pupils Infant school % eligible for free school meals* % with SEN* % with EAL* Key stage 1 overall performance 2002 Variables relating to change from Baseline to Round 2 Timepoint (Round 2 v. baseline) Intervention group at time Year 1 pupils at time 2 Year 2 pupils at time 2 Intervention group Year 1 pupils at time 2 Intervention group Year 2 pupils at time 2 * Value given is actually expected odds ratio for 10 percentage points change in the background variable. The table shows that, overall, three groups of pupils were more likely to be eating 5 A DAY : girls, pupils in infant schools, and pupils in schools with high proportions of EAL children. All the research we have conducted to date has shown consistently that girls eat more fruit and vegetables than boys. The added benefit of being in an infant school, or a school with high EAL numbers, is consistent with the findings from Phase 1 reported in the first interim report (Teeman et al., 2004). These factors were not significant in the multilevel analysis of fruit and vegetables consumed, reported earlier in this section: this suggests a different pattern of distribution, i.e. within those categories there were more children eating five or more portions, but also more children eating low quantities of fruit and vegetables, so that overall, the difference in mean consumption was not significant. 19

24 The table also shows that two groups of children were much less likely to eat 5 A DAY : pupils in Year 2, and pupils in schools with a high proportion eligible for FSM. For example, the chances of a Year 2 pupil eating 5 A DAY were only 80 per cent that of a reception pupil. Again, these findings are consistent with the analysis undertaken to date. The only significant change over time variable was belonging to the intervention group at Timepoint 2. These children were now one and a third times as likely to achieve the 5 A DAY target, due to the additional fruit that they were eating Summary of Sections 2.1 and 2.2 In the second (June) survey, consumption of fruit had increased for the intervention group, as would be expected, given that they were now participating in the NSFVS. The increase was less than half a portion, but this needs to be seen in the context of a small decrease in fruit consumption in the comparison group. This suggests that children in the North East were eating about half a portion of fruit more each day than they would have done if not involved in the scheme. The analysis provided some very tentative indications of a very slight impact on consumption of vegetables and fruit juice, but the evidence was inconclusive. On average, children in the North East were eating nearly four portions of fruit, fruit juice and vegetables, and more than a third were achieving the 5 A DAY goal. It is clear that the scheme is having an impact on children s fruit consumption. However, since the increase in daily consumption is less than one portion, there is no evidence that the free piece of fruit provided at school is encouraging children to choose to eat more fruit in other contexts. On the contrary, the data may suggest a limited degree of displacement, i.e. the NSFVS fruit may be regarded by some children (or parents) as a substitute for fruit which they would have eaten anyway. The impact of the scheme was greater for Year 1 and Year 2, suggesting that their fruit was more likely to be an addition to their normal diet. It may be that some reception children were already being given fruit at school, and the NSFVS fruit has replaced this. 20

25 There was no change in consumption of snacks, so no evidence yet that children are switching from sweet or savoury snacks to fruit. However, it must be borne in mind that, at the time of the second survey, children had been receiving school fruit for less than three months. A longer period of time may be needed to bring about such a change in children s eating habits. 2.3 Nutritional analysis The purpose of this analysis is to present changes in energy and nutrient intake of children three months after the introduction of the NSFVS. The results have been expressed in original units so any changes in intake may be related to the amount of energy and nutrients required for growth and health. Below we discuss the outcomes of the basic analysis of Phase 2 data, and then the results of the multilevel modelling which compares Phase 1 and Phase Findings from analysis of Phase 2 data Table 2.3 shows the mean intake of a selection of key nutrients three months after the introduction of the NSFVS. Figures presented in this table do not take into account background variables and simply indicate whether the figures obtained fall close to the expected range for the age group of children included in the survey. It is interesting to note the energy intake of the comparison and intervention groups is more closely matched than at baseline (Teeman et al., 2004) and is similar to that reported for this age group in the National Diet and Nutrition Survey of children (NDNS) (Gregory et al., 2001). Energy intake is lower than the Reference Nutrient Intake (RNI) (Department of Health, 1991) 4 for this age group and probably reflects a degree of underreporting in the CADET. Intake of fat falls within the range expected for this age group, of children living in the UK. Salt intake appears universally high across the intervention and comparison groups and is approximately twice the reference nutrient intake (RNI) for the age group. Intake of carotene is similar to the values obtained at baseline and compares closely with figures presented in the NDNS survey. Vitamin C intake is also universally high and exceeds the RNI of 30 mg per day for the children included in this study. This poses no threat to health at this level of intake as vitamin C is water soluble and is easily excreted in urine. Intake of sugar is high and accounts for approximately 30 percent of energy intake across the groups. This intake of 4 Also see glossary of terms in first interim report (Teeman et al., 2004). 21

26 sugar is three times the Dietary Reference Value (DRV) which has been set at ten per cent of energy intake. Table 2.3. Mean intake of selected nutrients three months after the introduction of the NSFVS (Phase 2) Reception Mean intake Year 1 Mean intake Year 2 Mean intake Comparison Intervention Comparison Intervention Comparison Intervention Energy kcal Energy MJ Fat g Salt g Carotene µg Vitamin C mg Sugars g N= Findings from multilevel modelling Table 2.4 is based on the multilevel modelling which takes relevant background variables into account (see Section 2.1 for details). The coefficients in the column headed Estimate (MLM) indicate the change over time for intervention group pupils only between the Phase 1 and Phase 2 surveys, in units appropriate to the energy and selected nutrients. The confidence intervals indicate how sure we can be of any changes in energy and nutrient intake which have occurred following the introduction of the NSFVS. For example, we can be 95 per cent sure the observed decrease in fat intake lies between one tenth and three grams in each year group. Table 2.4 shows a very small non-significant decrease in energy intake in Reception and Year 1 pupils in the intervention group. For Year 2 children the decrease is larger and significant. 5 The confidence intervals indicate that the decrease in energy intake could be in the region of to MJ (141 5 It should be noted that this decrease is relative to Year 2 pupils in the comparison group. At baseline those pupils recorded particularly low intakes of certain nutrients, and at Phase 2 these came back into line meaning that the intervention group pupils had decreased by comparison. 22

27 to 274 kcals), approximately 9-17 per cent of energy for this age group. Energy intake at baseline was low for the three year groups included in the study and they remain low at Phase 2. It is unlikely that the decrease in the intervention group is wholly due to the NSFVS scheme; it may be related to under-reporting in CADET or some other difference between the two groups that has not been taken into account in the multilevel modelling. There is a small decrease in fat intake of 1.6 grams across each of the year groups. The confidence intervals for this reduction are narrow (between 0.1g and 3g) and suggest the reduction is unlikely to have much impact on the overall balance of nutrients in the diet of the children surveyed. The decrease in fat intake is less than the amount of fat contained in one fifth of a standard packet of crisps. Table 2.4. Estimated apparent impact coefficients associated with the intervention, by year group nutrient intake Reception Year 1 Year 2 Estimate (MLM)* 95% CI for estimate (MLM)* Energy kcal to 34.3 Energy MJ to Fat g to -0.1 Salt g to Carotene µg to Vitamin C mg to 21.0 Sugars g to 6.4 Estimate (MLM)* 95% CI for estimate (MLM)* to to to to to to to 6.4 Estimate (MLM)* 95% CI for estimate (MLM)* to to to to to to to *The results from the MLM show the putative effect associated with (but not necessarily caused by) the intervention and take into account factors that may affect the results of the intervention Salt intake has decreased by approximately one tenth of a gram since the Phase 1 survey. However the magnitude of the decrease is very small less than a small pinch of salt. The salt intake of each year group is approximately twice as high as the intake advised by the Food Standards Agency ( and the Department of Health (Department of Health 23

28 1991) and so this very small reduction will make very little difference the high intake of this group. Intake of carotene has decreased in each year group which is a surprising result given that fruit is a major source of this nutrient. However the confidence intervals for the decrease in carotene intake are fairly wide so we can be less certain about the true magnitude of any decrease likely to occur following the intervention. Vitamin C intake, also associated with fruit consumption, has increased considerably in the Reception children and Year 1 and may reflect the increased consumption of fruit seen in the intervention group. In Year 2, however, the intake of vitamin C has decreased despite a reported increase in fruit intake in this group in Table 2.1 in Section Sugar intake has increased very slightly in Years 1 and 2 which is not a particularly desirable outcome given the already high sugar intake of this group of children. The increase is however only in the region of half to a full teaspoon full of sugar per day. In contrast Year 2 children have experienced a large decrease in sugar intake of 30-50g per day which is a beneficial change in children with such a high intake. This is a marked reduction in sugar intake and it will be important to investigate whether this reduction is sustained in the Phase 3 survey Findings when controlling for energy intake To ensure the changes in nutrient intake are not due to any differences in energy intake between the two groups (i.e. one groups just eats more) the comparison of nutrient intake has controlled for energy intake (Table 2.5). When controlling for energy intake a small decrease in fat intake was observed in Reception and Year 1; however this was offset by an increase in Year 2 pupils. Decreases in salt intake across the year groups are extremely small and statistically insignificant. The decrease in carotene intake is uniform across the three groups and probably reflects the difference in the amount of food reported in CADET, rather than any difference in the overall quality of the diet of Year 2 pupils. The increase in vitamin C intake remains virtually the same; however, the magnitude of the decreased intake in Year 2 has been reduced by approximately half. It appears that the diet of Reception and Year 1 children has become slightly higher in sugar, although the large decrease in sugar intake observed in Year 2 pupils remains. 24

29 Table 2.5. Estimated apparent impact coefficients associated with the intervention, by year group nutrient intake controlling for energy intake. Reception Year 1 Year 2 Estimate (MLM)* 95% CI for estimate (MLM)* Estimate (MLM)* 95% CI for estimate (MLM)* Estimate (MLM)* 95% CI for estimate (MLM)* Fat g to -1.5 Salt g to 0.09 Carotene µg to Vitamin C mg to to to to to to to to to -0.2 Sugars g to to to *The results from the MLM show the putative effect associated with (but not necessarily caused by) the intervention and take into account factors that may affect the results of the intervention Summary of Section 2.3 Overall changes in energy and nutrient intake following the introduction of the NSFVS scheme were very small. There were no significant differences between the intervention and comparison groups with regard to energy. There was a small decrease in fat intake following the intervention in each year group; however, when controlling for energy intake, Year 2 pupils reported a slight increase in fat intake equivalent to the amount contained in approximately one third of a standard packet of crisps. Salt intake changed little following the intervention in each of the year groups. This group of children has a high intake of salt in common with other children in the UK and this did not appear to change following the intervention. The decrease in carotene intake was unexpected and may be due to factors that were not controlled for in the multilevel model, for example seasonality of fruit and vegetable intake. The increase in vitamin C intake in Reception and Year 1 may reflect the increase in fruit consumption; however, the decrease in 25

30 Year 2 is unexpected given fruit intake increased relative to the comparison group by 0.6 portion, although the 95 per cent confidence intervals are wide for this effect (0.2 to 0.9 of a portion). This finding may be due to the type of fruit consumed. Certain fruits are lower in vitamin C than others e.g. apples are low in vitamin C compared to satsumas and fruit juice. It is important to note however that this group of children had adequate vitamin C intakes at baseline. Sugar intake increased slightly in Reception and Year 1 children, but decreased markedly in Year 2 children. This result may be due to displacement of sweets by fruit, although consumption of desserts (including sweets) remained constant between Phase 1 and 2 (see Section ). All of these effects must be interpreted in the light of the short-term follow-up period at this stage. We must wait for the longer-term results before drawing conclusions, because long-term effects may be less impressive and may show modification in other aspects of a child s diet. At this stage we cannot predict whether there will be any long-term benefits from the NSFVS initiative. 26

31 3. Pupil questionnaire The pupil questionnaire was administered again in June to one whole Year 2 class in all of the intervention (52) and comparison (43) schools. In all, 2,227 questionnaires were returned to NFER, but eight were excluded from the analysis because the pupils date of birth indicated that they were not old enough to be in Year Analysis of data The aim of the analysis was to explore change over time, by comparing June (Phase 2) responses with those given in March (Phase 1). Specifically, we wished to discover: whether children reported a greater awareness of, and liking for, different fruit and vegetables (Qs 1-3 on the questionnaire) whether their knowledge of healthy eating had increased (Qs 4-9). Since change over time could be due to maturation and other factors unconnected with the NSFVS, it was important to see how any identified change over time differed between the intervention and the comparison group. Phase 2 data was first analysed in the same way as Phase 1, to provide a summary of the responses and to identify significant differences between boys and girls, or between intervention and comparison group. Individual responses at Phase 1 and Phase 2 were matched, and the next stage of the analysis was restricted to those pupils who had responses at both timepoints (a total of 2,071). For each question, the mean difference in response was calculated, and the mean differences for intervention and comparison groups compared. Finally, multilevel modelling of the data was undertaken, as described in Section 2.1 for the CADET data. The same variables were included, except for those relating to differences between year groups (as the pupil questionnaire is administered only to Year 2 pupils). School size (i.e. the 27

32 number of pupils on roll) was also included. Six different outcomes were investigated, including the total score for Qs 4-9 as an overall measure of pupils knowledge of healthy eating. As explained in Section 2.1, multilevel modelling is a more sophisticated technique and produces more accurate estimates than simple linear regression (used in the Phase 1 analysis) as it takes into account the hierarchical structure of the data. Further, timepoint can be used as an additional level, so that two (or more) results for individual pupils can be included. The analysis can thus take account of all the data collected, and identify the relative significance of all the factors involved. In the sections which follow, we report on any changes between the Phase 1 and Phase 2 results, and then on the findings from the multilevel modelling. 3.2 Change at Phase 2 In our first interim report (Teeman et al., 2004) we reported the results of the analysis of every individual question on the pupil questionnaire (Section ). It is not our intention to provide an equivalent report of the Phase 2 findings, since most are very similar to the earlier findings. Instead, we discuss in this section any interesting differences between the two sets of results. It should be noted that Phase 2 findings are based on all the children (a total of 2,219) who completed a valid pupil questionnaire. Analysis of change over time, and the multilevel modelling, was confined to pupils who completed questionnaires at both timepoints (a total of 2,071) Fruit tried and liked (Question 1) The mean number of fruits which pupils reported having tried (of the 12 pictured in the pupil questionnaire) had risen slightly, from 9.9 to There was a statistically significant difference between the mean for the intervention group (10.22) and the comparison group (10.02). Looking at individual fruits, the percentage reporting haven t tried had in most cases remained stable or had decreased slightly. For satsumas, however, the proportion reporting haven t tried had dropped dramatically, from 33 per cent in March to 17 per cent in June. Since satsumas, or easy-peel citrus are distributed under the 28

33 NSFVS, the implication was that children had encountered these fruits for the first time through their participation in the scheme. This hypothesis was tested by examining the responses of children in the intervention and comparison groups. In the comparison group, 31 per cent of children reported in March that they had not tried satsumas, and this figure fell to 23 per cent in June. In the intervention group, however, the drop was much greater from 35 per cent in March to 11 per cent in June, and this would appear to confirm that the NSFVS had raised children s awareness of satsumas. There was no similar change for any other fruit, but it should be noted that the other main NSFVS fruits (apples, pears and bananas) were known to all but a small minority of pupils before the scheme began. Overall, the number of fruits tried by the intervention group had risen by 0.26, compared with an increase of 0.1 for the comparison group. This difference fell just short of statistical significance at the five per cent level. In terms of liking fruit, there was again a positive trend: the mean number of fruits liked increased from 6.85 in March to 7.2 in June. Fruit was still more popular with girls (mean 7.47) than boys (mean 6.91). But at Phase 2 there was also a significant difference between the intervention group (7.38) and the comparison group (6.98). Over time, the mean number of fruits liked by the intervention group had risen by 0.47, significantly more than the comparison group (0.18) Vegetables tried and liked (Question 2) For almost every vegetable listed, there was a slight decrease in the proportion of children saying not tried. There was a corresponding small increase in the mean number of vegetables tried (from 9.76 to 10.02). There was a statistically significant difference between the intervention and comparison groups, but in this case the comparison group had tried more vegetables (mean 10.15) than the intervention group (9.9). Further, the comparison group had increased significantly more over time (0.38) than the intervention group (0.13). There is thus no evidence to suggest that the NSFVS is having an impact on children s awareness of vegetables. It should be noted that the only vegetables 29

34 commonly distributed within the NSFVS are carrots and tomatoes. 6 Very few children, even at baseline, had not tried carrots, so there was little scope for change. The percentage who had not tried tomatoes decreased from 16 per cent in March to 13 per cent in June, although they remained one of the least popular vegetables with children. Already, at Phase 1, children in the comparison group liked more vegetables than those in the intervention group. There was a similar increase for both groups, so at Phase 2 the comparison group still liked more vegetables (5.91, compared with 5.5). It would appear that children in Yorks and Humber experience a greater range of vegetables than those in the North East, and like more as a result Fruit and preferences for snack foods (Question 3) In this question, children were asked to select their preferred snack from a choice of food items, grouped in five pairs, each pair consisting of one fruit and one other option. In each case, the proportion of children selecting the fruit item had increased between Phase 1 and Phase 2. The greatest increase was in the proportion of children selecting the satsuma in preference to yoghurt: from 32 per cent in Phase 1 to 43 per cent in Phase 2. This is consistent with the increased awareness of satsumas discussed above. Overall, the mean number of fruit options selected was 2.8, an increase of 0.44 compared with Phase 1. This could suggest that fruit had become more popular in the intervening period, due to the NSFVS, but it could also be that children have realised that fruit is the right answer (even though the question specifically asks about preferences). These explanations are not of course mutually exclusive, and indeed the data suggests that there may be some truth in both: the number of fruit choices increased for both intervention and comparison groups, but the increase was greater for the intervention group (0.51) than the comparison group (0.35). Hence the total number of fruit selections made by children in the North East (mean 2.89) was significantly higher than Yorks and Humber (2.69). 6 Although tomatoes are a fruit, they tend to be used as a salad vegetable, and were therefore included in Question 2 rather than Question 1. 30

35 3.2.4 Choosing a healthy snack (Question 4) Question 4 is the first of the test questions. Again, there are five items, and in each pupils are asked to choose between (three) different snacks, but in this case they are asked to select the healthiest option, rather than the one that they prefer. Even at Phase 1, a majority selected the healthiest option in each case, but at Phase 2 the proportions giving the correct answer had increased. Overall, pupils selected an average of 4.05 healthy options at Phase 2, compared with 3.68 at Phase 1. There was a significant difference between the intervention group (4.18) and the comparison group (3.89). Scores for the intervention group had increased more (0.44) than those for the comparison group (0.34) although this difference was significant only at the ten per cent level A balanced and healthy diet (Question 5) Question 5 is based on The Balance of Good Health (BNF, 2004). Children are asked to indicate whether they should eat lots, some or a small amount of ten different foods. Responses to the fruit item had hardly changed, but this is not surprising, because even at baseline 89 per cent of children knew that they should eat lots of fruit. The NSFVS would not directly impact on other answers, but it was thought that it might do so indirectly by inspiring more classwork on healthy eating. For most of the other items, the proportion of children giving the correct answer had increased at Phase 2. However, for bread and butter there was a decrease, and for butter there was a dramatic change: at Phase 1 81 per cent said correctly that they should eat only a small amount of butter, but at Phase 2 only 36 per cent gave this response, with 51 per cent saying that they should eat some butter. It is difficult to understand the reason for such a change. It was evident for both boys and girls, in both intervention and comparison groups. Due mainly to the incorrect classification of butter, the average score on Q5 (at one point per correct answer) dropped from 5.62 at baseline to 5.39 at Phase 2. This was the only question for which scores went down rather than up at Phase 2 compared with baseline. The intervention group scored higher (mean 5.49) than the comparison group (5.26), but there was no significant difference in the extent of change over time between the two groups. 31

36 3.2.6 Selecting a healthy balanced lunchbox (Question 6) Pupils were given a score in the range 0-3, depending on their selection of items for the healthy balanced lunchbox. The mean score at Phase 2 was 1.81, compared with 1.7 at baseline. As before, girls (1.86) scored significantly higher than boys (1.76). There was no significant difference between intervention and comparison groups Selecting a healthy balanced lunch (Question 7) As with Q6, the range of scores was 0-3. Mean scores rose from 1.64 (baseline) to 1.7 at Phase 2, but in this case there was no significant difference between girls and boys, nor between the intervention and the comparison group What counts as a portion of fruit? (Question 8) In this question children are given pictures of nine food items, and asked to say which would count as a portion of fruit. Correct answers to seven of the nine items were given by a higher proportion of children at Phase 2, compared with baseline; for one item the proportion remained the same and for one item there was a drop (28 per cent said that fruit cake did not count as a portion of fruit, compared with 31 per cent at baseline). The average score rose from 4.67 to There was no statistically significant difference between the intervention and the comparison group Awareness of 5 A DAY (Question 9) At baseline, one third of the children knew that they should eat five portions of fruit and/or vegetables per day, but there was a major difference between the intervention group (40 per cent) and the comparison group (26 per cent) leading us to hypothesise that pupils in the North East had been exposed to the 5 A DAY message when NSFVS letters and materials were sent to parents. At Phase 2, the proportion of children giving the correct answer had increased to 39 per cent. However, it is difficult to attribute this increase to the NSFVS, as the increase was greater in Yorks and Humber (up from 26 per cent to 34 per cent) than in the North East (up from 40 per cent to 45 per cent). 32

37 For inclusion in the total score, children were given two points for the correct answer, and one point if they thought they should eat more than five portions a day. Children in the intervention group had a higher mean score (1.19) than those in the comparison group (1.02), but as suggested by the figures quoted above, the change over time was greater for the comparison group, although that difference was not statistically significant Aggregated scores Scores for Qs 4-9 were summed, to give an overall total out of a possible 32 points. The overall mean score was 18.91, an increase of 0.67 on the baseline score. As before, girls (mean 19.25) scored higher than boys (18.57), and the intervention group (19.25) scored higher than the comparison group (18.51). At baseline, the latter difference was due entirely to Question 9, but at Phase 2 children in the North East also gave significantly better responses to Qs 4 and Multilevel modelling Responses from children who had completed the pupil questionnaire at both timepoints were included in a multilevel model, together with pupil-level and school-level variables. One advantage of multilevel modelling is that it can take into account all relevant factors simultaneously, and indicate the relevant strength of the impact of each. The following outcomes were explored: number of fruits tried number of fruits liked number of vegetables tried number of vegetables liked number of healthy snacks preferred (Question 3) aggregate test score (Questions 4-9). The results are summarised in Table 3.1. The coefficients in each row indicate the impact of the factor named on the relevant outcome(s). They need to be considered in relation to the base case, i.e. a boy in the comparison group at 33

38 baseline. It should also be noted that the differences in the table are after controlling for all other factors, e.g. when all other factors are taken into account, the differences between boys and girls are as shown in the first row. As already reported (Teeman et al., 2004) girls were more positive: they had tried, and liked, an extra 0.5 portions of fruit; they had tried (but did not like) more vegetables; they chose more healthy options, and they scored an extra 0.8 points (in total) on the test questions. Table 3.1 Significant coefficients for background variables relative to pupil questionnaire outcomes Variable Total Fruits liked Total Fruits tried Total Vegetables liked Total Vegetables tried Q3 - Prefer healthy options Total score (Q4-9) Variables at both time points Sex Intervention group -0.5 Infant school -0.4 % eligible for free school meals* -0.5 % with SEN* -1.9 % with EAL* 0.2 Key stage 1 overall performance 2002** 0.3 Total No. of pupils*** Variables relating to change from Baseline to Round 2 Timepoint (Round 2 v baseline) Intervention group at time * Value given is actually expected change for 10 percentage points change in the background variable ** Value given is actually expected change for a shift of 1 position on the 5-point scale for school performance at key stage 1 *** Value given is actually expected change for an increase of 100 pupils in school size Overall, the only difference between intervention and comparison group is that the former liked 0.5 vegetables less than the latter. Type of school also had an apparent influence on some outcomes. Children in infant schools had tried fewer fruits than those in primary schools; those in larger schools had tried fewer fruits and vegetables, and liked fewer vegetables. The reason for these differences is unclear. 34

39 There was an association between the number of fruits liked and the proportion of pupils with English as an additional language: in the first interim report, we suggested that this could be linked with ethnicity, which we shall explore further in the final round of analysis and reporting. Children from high-achieving schools obtained higher test results, while those from schools with high proportions of FSME or high proportions of pupils with SEN did not do so well; this is as would be expected. The key factor in this analysis is Timepoint, since it quantifies the difference between the March and June results, after controlling for all other relevant factors. At Timepoint 2 (June) there was a positive change in relation to all of the outcomes except the number of fruits tried. Pupils generally liked an extra 0.2 fruits and 0.2 vegetables; they had tried 0.4 extra vegetables and chose 0.3 more healthy snacks; their test score rose by 0.6 points. These are very positive findings, but they apply to pupils overall, and could therefore be the due to maturation or other factors, rather than the NSFVS. By contrast, the row labelled Intervention group at time 2 refers to the differential impact of the scheme on the intervention group, i.e. it shows where there was an additional change at Timepoint 2 for children in the North East. They liked an extra 0.3 fruits, and chose 0.2 additional healthy options in Question 3. It must be emphasised that these changes are over and above any other changes reported. Thus, in June (compared with March), children in the comparison group liked an extra 0.2 fruits, but children in the intervention group liked an extra 0.5 fruits (the general increase of 0.2, plus an additional increase of 0.3). However, at Timepoint 2 there was a negative association between the intervention group and the number of vegetables tried. While the comparison group had tried 0.4 extra vegetables in June (compared with March), the intervention group had tried only an extra 0.1 ( ). 3.4 Summary The findings suggest that the NSFVS is having some impact on children s awareness of fruit and knowledge of healthy eating. There were positive trends in the numbers of pupils reporting that they had tried and liked fruit and vegetables, and in the scores obtained on the test questions. It is possible of course, that the improvement was due to maturation, to the practice effect of repeating the test, and to the children s desire to give the right answer, even 35

40 when asked to give their preferences. The fact that a positive trend was observed among the comparison group as well as the intervention group confirms that these factors probably account for some of the positive change over time. However, on a number of items the increase was greater for children in the intervention group, suggesting that part of the improvement was attributable to the NSFVS. In contrast with the baseline survey, children in the North East reported having tried and liking more fruit than those in Yorks and Humber (the increase in those having tried satsumas was particularly marked). They were also more likely to state a preference for a healthy snack, and gained higher scores on the test: at baseline, this was due entirely to one question, but in the second survey the intervention group obtained significantly better scores on three of the questions. Multilevel modelling, taking all relevant factors into consideration, confirmed that over and above the general improvement in June children in the North East were significantly ahead in terms of fruit liked and preferring healthy options, although they had tried fewer vegetables than those in Yorks and Humber. 36

41 4. How schools implemented the NSFVS This chapter focuses on the different ways the NSFVS was implemented and operated in each of the ten case-study schools. The chapter will detail and explore: contextual information about each of the schools the ways the schools set up and operated the NSFVS any difficulties schools reported related to implementing the scheme any changes to the scheme that were suggested by interviewees. The data for this chapter is based largely on a total of 42 face-to-face semistructured interviews. However, in most of the schools we visited certain staff had more than one role, as indicated in our staff category breakdown below. By staff category, interviews were conducted with: Ten NSFVS coordinators (six of whom were also the class teachers for classes involved in the NSFVS during the summer term of 2004, one was a headteacher and another a school secretary) Nine Personal Social and Health Education (PSHE) coordinators (five of whom were also the NSFVS coordinator in their school; one PSHE coordinator was unavailable at the time of our visit) Eight catering managers (two catering managers were unavailable at the time of our visits) Twenty-seven class teachers whose children had been participating in the scheme during the summer term of 2004 (six of whom were also the NSFVS and/or PSHE coordinator in their schools, two class teaches were unavailable at the time of our visits). 4.1 School context Promoting healthy eating Interview data shows that all ten case-study schools had promoted healthy eating in school prior to participating in the NSFVS, either in the classroom as part of the science/pshe curriculum or through wider whole-school activities. 37

42 The majority of the schools had been involved in other health education initiatives before deciding to take part in the NSFVS. 7 These other initiatives were: working towards the Healthy Schools Award (four schools) having a fruit tuck shop in school (four schools) encouraging the children to bring fruit as a snack (three schools) providing milk that could be purchased for children to have in school (two schools) having a healthy choices week in school (an activity week aimed at promoting a healthy lifestyle) (one school) School food policies Staff in seven schools reported that they had school policies in place to address the types of snacks eaten in school, and many also had wider school food policies aimed at reducing the amount of high-sugar items (e.g. fizzy drinks and sweets) that children brought into school in their packed lunches. For example, one PSHE coordinator commented: We do ask that with the packed lunches that they [the parents] try and provide a healthy meal and we ask them not to send in fizzy drinks, chocolate bars or sweets School catering and food provision The catering arrangements for providing school meals were similar across the sample of schools. The majority of schools contracted out their catering arrangements to specialist food services that were geared to providing meals for the education sector. The meals were prepared on the school premises but the staff who prepared the food were not employed directly by the school. The catering staff interviewed said that they were sent nutritionally-balanced menus to follow. One interviewee explained: All that is done by the company that I work for, they do all that and then we have menus sent to us. In light of this, most of the catering staff interviewed indicated that there was little flexibility for them in the types of food and meals they could provide. 7 The impact on children of healthy eating initiatives (other than the NSFVS) is discussed in Section

43 However, interviews with two catering managers suggested that they were able to approach the provision of food in their schools in a more flexible way. For instance, one catering manager explained that although they had a set menu with a four-week turn round they did sometimes change things if they were not popular with the children but, any changes had to be like for like. In the other school the catering manager s role had become a key part of that schools drive towards persuading children to eat healthily. In this school the catering manger (in cooperation with the NSFVS/PSHE coordinator) had been involved prior to the NSFVS in preparing cartons of mixed fruit, for children to sample. Furthermore this catering manager was personally very keen to play a role in encouraging healthy eating said that they would always actively encourage the children to select fruit and vegetables. Also, in partnership with the NSFVS/PSHE coordinator, the catering manager constantly reviewed ways the school could help encourage healthy eating and food selection. 8 The catering managers reported that the children had quite a lot of choice within the meals that were provided in school. Most schools provided at least two or three different main meals and desserts every day for the children to choose from. Comments included: We have three main choices, we have fruit on every day, bread every day, salad and we do a vegetarian choice every day. They get two or three choices for main and sweet. We have the hot side which is normally four hot choices, three sweets, yoghurts, cheese and biscuits and we have the salad bar where the children help themselves from the different salad bowls. Most of the catering staff reported that both fresh fruit and vegetables were provided each day and the majority felt that the food they provided related to the 5 A DAY message. However, three members of catering staff observed that even though the children were provided with fruit and vegetables, they did not necessarily choose to eat them, despite their efforts to encourage consumption. 9 For example, one interviewee commented: 8 9 The possible impact of such a coordinated approach on children s consumption is highlighted in Section The impact of NSFVS on food provision in school is discussed in Section

44 I think it does relate to the 5 A DAY message. But you can t make children eat what you put out in front of them. I have a special vegetable day where we have raw veg and try to get them to eat things like that we do try and we are providing it but it is up to them Setting up the NSFVS Staff views about the aim/s of the NSFVS All of the staff that were interviewed were asked what they saw as the main aims and objectives of the NSFVS. The majority reported that the aims were to improve children s access to fruit and vegetables and to promote healthy eating. Many interviewees linked their views about the aims of the NSFVS to an overall perception that some of the children in their school might not have access to fresh fruit and vegetables at home. For example, one teacher commented: Some of the children at this school may not have fruit at home and it is important for them to get the nutrients and the vitamins in their diet. Others saw the fruit scheme as providing an opportunity for children to have more of a variety of fruit and vegetables, giving children a selection of fruit that they wouldn t have at home. For example, one teacher explained: Lots of children don t have the chance of the variety of fruit if left to their own devices at home Reasons for taking part in the NSFVS In most schools the decision to take part in the NSFVS had been a team one and staff had been consulted prior to participation. However, in one school the headteacher (who was also the PSHE coordinator) took the decision to participate without consulting staff: It was my decision as head and I didn t consult staff at that point as I felt that it was a good initiative obviously once that decision was made then I discussed it with the staff on more of a consultation basis about how we would run the scheme and the benefits it would have for the children The choices children make in relation to food provided in school is further discussed in Section For discussion about the impacts of NSFVS in relation to children trying, liking and eating more fruit see Sections 2.2.1, and section

45 The majority of schools had decided to take part in the NSFVS as it fitted in well and reinforced the healthy eating message that they were already trying to promote in school. Some of the staff in schools that were involved with the Healthy Schools Award felt that the NSFVS would fit in well with what they were trying to achieve in school. Other reasons for deciding to join the scheme included: children being hungry in school as they had not been given breakfast at home (staff in two schools) wanting to promote children s social skills by distributing and consuming the fruit in a circle time (staff in three schools). In relation to joining the scheme one PSHE coordinator also commented: Well, I mean if you re being given something free, you want it! If we had to pay for it, it would be a different matter NSFVS coordinators In six case-study schools a member of staff was asked to take on the role of NSFVS coordinator, in the other four a member of staff volunteered to take on the role. In five schools the role was taken on by the PSHE coordinator. In one of these schools the PSHE coordinator was the headteacher so the NSFVS role was shared with the caretaker who dealt with most of the day-to-day running of the scheme. In two schools the role was taken on by a key stage 1 teacher whose class would be involved in the scheme. In the remaining two schools the role was taken on by a nursery nurse and the school secretary. In preparation for the implementation of the scheme, the majority of NSFVS coordinators said they had attended a seminar run by their local NSFVS area coordinator; that they had received guidance and, in some cases, a video to help them implement the scheme effectively in their school. However, some coordinators mentioned that they had not found the seminar particularly useful and felt that a lot of what they had been told was just common sense. When asked if there was any other information that they would have liked, one coordinator commented that information posters and resources could help them to link the NSFVS to the curriculum, and raise its profile in the school. Most schools had remained in contact with their local area coordinator via 41

46 and schools were sent regular letters informing them of changes when necessary. None of the coordinators reported requiring any additional support from their area coordinator Staff reactions to involvement in the NSFVS The reaction from most staff to participation in the scheme was positive and they were enthusiastic about being involved. For example one class teacher explained: My reaction to the scheme was positive everyone was keen to take part. Another teacher had spoken with colleagues from a school involved with piloting the NSFVS and this had left them excited at the prospect of involvement. A minority of teachers had a more of a mixed response as they were concerned about the extra work that the scheme might introduce and the practicalities of operation: Initially I was concerned about the logistics of it, having 35 children all eating fruit. But I have to say it hasn t posed any problems. In all but one instance these concerns had not been realised and the teachers were happy with how the scheme was now being operated in their schools. However, in one school the NSFVS coordinator had expected the scheme to cause work burdens and (while they noted that these burdens were not as bad as they had expected) they did say that the extra pressure on their time had been unwelcome to say the least Informing parents and children about the NSFVS All of the schools sent out information packs with letters (many seeking parental consent for their child s participation). In one school, staff held meetings for parents each school term and parents that attended the meeting in the term before the NSFVS started were given an opportunity to discuss the scheme and ask any questions: We asked them how they felt about us taking part and they were very keen as well. Parents in another school did ask for their children to be excluded from the scheme: Some parents said no on dietary grounds. In all other case-study schools all the children took part in the scheme and there were no exclusions. 12 The impact of the NSFVS on staff workload is discussed in Section

47 The majority of the schools informed the children about the scheme, five during a school assembly and four in class within the context of a discussion about healthy eating. For example, one NSFVS coordinator remarked: It was through PSHE in their classes, I did also talk to them [the children] in assembly as well, but a lot of work was done in class. One coordinator reported that the children were not told about the scheme until the fruit had arrived and was being given out, although there was no real explanation as to why the children had not been informed sooner. 4.3 Operating the NSFVS Deliveries to the schools of NSFVS produce In the majority of schools the deliveries of fruit/vegetables were received and signed for by the catering staff. In two schools the deliveries were received by the school secretary (in one of these schools the secretary had taken on the role of NSFVS coordinator). In one school deliveries were received by the school caretaker. All of the ten schools reported that the deliveries were generally reliable and only one member of staff said they had experienced problems with the delivery of the fruit and vegetables: Normally the deliveries are made early, sometimes before school so I m not always there when that happens and the school gates aren t open the fruit tends to get dumped over the gate which can bruise the fruit. It is unclear whether these problems had been reported to the area coordinator or if any action had been taken Storage of NSFVS produce The majority of schools stored the fruit and vegetables in the school kitchen and refrigerators were usually used to store perishable produce. In these schools the storage was usually organised by the catering staff and no problems related to storing the fruit/vegetables were reported. In two schools the fruit/vegetables were stored in rooms (an office and a parents room) that did not have refrigeration facilities. In one of these schools the NSFVS coordinator reported that they were not able to store the 43

48 produce in the kitchen fridge, as any items stored there must be prepared by the authority. In the other school no reasons were given to explain why the produce was not stored in perhaps a more suitable area The quality of NSFVS produce The majority of NSFVS coordinators reported that quality of the fruit/vegetables delivered to the school was somewhat variable. Overall the produce had been reasonable, but some schools had experienced usually isolated or one-off problems with mushy or bruised fruit/vegetables. One coordinator explained: It is mainly the apples that have been a problem, with a large number of them being marked. When there had been problems with the quality of the produce the NSFVS coordinators had reported the problems to the area coordinator and on occasions the produce had been replaced by the suppliers The preparation of NSFVS produce The ten case-study schools managed any preparation of the fruit/vegetables that was required in several different ways. In the majority of schools any preparation (e.g. washing, peeling or chopping) was done by the teaching staff and/or assistants. The staff that were interviewed in these schools did not report any major problems related to preparation. 13 The preparation had obviously increased their workload as it was another task that needed doing each day but staff said that this was not really a problem. One teacher acknowledged that the preparation had not really been an issue in her school because of the classroom support that the teachers had access to, but she recognised that this was not the case for all teachers: I have a classroom assistant who prepares the fruit. She washes it every day but we tend not to peel it and let the children be independent with it. There are no problems and it works very well but if you didn t have a classroom assistant then there would be a lot more work for the teachers. In another school the NSFVS coordinator reported that preparation did not cause any problems in the lower half of the school as they had classroom 13 The impact of the NSFVS on staff workload is discussed in Section

49 support which enabled some flexibility. However, it was more difficult to prepare the fruit for the children in Year 2 as there was less classroom support available for the Year 2 class. In one of the case-study schools the catering staff washed all of the fruit before it was delivered to the classes, which meant teaching staff had only minimal preparation to do (in the reception class the staff reported that they did sometimes peel the fruit for the children). In one of the schools the school secretary had taken on any preparation that was required and in another school the caretaker had taken on this responsibility The distribution and consumption of NSFVS produce The case-study schools were all operating the NSFVS in different ways and staff had different arrangements in place for distributing and consuming the fruit/vegetables. A number of schools operated the scheme differently across the year groups and had different arrangements in place for the youngest children (reception class). The table below details the different timepoints during the day when the children consumed the NSFVS produce and the total numbers of year groups across the ten schools for each timepoint. Table 4.1 Distribution and consumption of the fruit/vegetables Foundation Stage (reception class) Key Stage 1 (Year 1 and Year 2 classes) No of schools giving fruit/vegetables in classroom No of schools giving fruit/vegetables at playtime AM No of schools giving fruit/vegetables at playtime PM Two of the schools gave the fruit to the children when they arrived at school in the morning and they ate the fruit/vegetables during registration. However, one of these schools operated the scheme slightly differently for the children in reception (these children had their fruit in class but they had it mid-morning and in small groups). The children in these two schools came into the classroom and could help themselves to the fruit/vegetables which were placed in a bowl. They sat on the carpet and ate their fruit/vegetables as a group and were supervised by the class teacher and the classroom assistant. One NSFVS 45

50 coordinator explained the process: They [the children] sit down for registration and have the fruit, the children sit and eat the fruit together and they encourage each other. Every class does it in the same way; we discussed it at the start as a staff. The NSFVS coordinators in both of these schools gave the same reasons for operating the scheme in this way. Both coordinators explained that they were concerned that some children were coming to school hungry as they had not had any breakfast at home. For example, one coordinator reported: Some of the children we know don t have much breakfast, if any at all, so we felt it [the NSFVS fruit/vegetables] would give them a good start. Another reason given for wanting to operate the scheme like this was so that consumption could be monitored more closely and staff felt that children were more likely to eat the fruit if they were in the classroom rather than in the playground. Comments included: We didn t want children running around the yard with a piece of fruit in their hand and: We also felt we could control it better and make sure they weren t just taking a bit and throwing it away in the playground. We know that some of them would be more interested in playing than eating their fruit. One of the NSFVS coordinators explained that they had also chosen to operate the scheme in this way partly for convenience it got it over with and out of the way. The other coordinator commented that operating it this way works really well and doesn t infringe on the rest of the day. In three of the schools the children in the reception classes were given the fruit in class in the morning and consumed it during a social circle time, but this was not the case further up the school. One coordinator explained: In the Foundation Stage [reception class and nursery] we make it a social occasion where we sit on the carpet, share the food and consume together but with the pressures of literacy and numeracy the Year 2 teacher finds it difficult to make it a social occasion. The children further up the school (in Year 1 and Year 2) took their fruit out to play and ate it in the playground. The reasons given by staff for operating the scheme in this way was that the older children needed less help and were independent and therefore able to eat the fruit outside on their own. In one school the coordinator explained that the 46

51 younger children had always had a drink and a biscuit in class during the morning anyway, so the introduction of the NSFVS had simply meant that the biscuit was replaced by a piece of fruit. However, the older children at the school did not have this opportunity within the morning session so they took the fruit outside to eat instead. In the remaining schools all of the children (in all year groups) were given the fruit/vegetables to take outside to have at playtime. In one of these schools teachers reported that on occasion the children had been given the fruit to take home: Sometimes I used to give it out at the end of the day with the oranges they d say can we have it at the end of the day so my mum can peel it!. In the schools that distributed the fruit/vegetables at playtime the children were supervised as they consumed the fruit/vegetables by the staff who were on duty in the playground. Staff reported that they had decided to operate the scheme in this way because they were concerned about the mess it would create in the classroom if the children were eating the fruit/vegetables inside: We felt that the children should take them [the fruit/vegetables] out to play because of the sheer mess of eating indoors. Two of the schools that were giving the fruit out at playtime reported that they had experienced some difficulties initially with the scheme and as a result had changed the way in which it was operated. Both schools had started off giving out the fruit in the classroom but had found it difficult to manage. One school reported that having the children eat the fruit in class was taking up too much time: At first I d given them fruit with the milk when they come back in [after break], but it took up too much time you wouldn t believe how long it takes a five year old to eat an apple!. The other school had experienced problems related to time and mess in the classroom that then needed to be cleared up: We tried giving them the fruit in the classroom but changed that very quickly. We d find bits of peel or apples cores on the floor and it would take up 15 minutes of class time. So that changed pretty quickly. We thought is it the fruit that is the disaster or is it the time we re having it, so we changed when they were having it and eating it outside works better. It is worth noting that there were no problems in terms of mess or time reported by the other schools that were giving the children the fruit in the classroom. 47

52 Waste and leftovers All of the staff that were interviewed reported that there was very little waste and/or leftovers. Most teachers reported that they encouraged the children to try the fruit and vegetables and to eat as much as they could. Teachers reported that some children ate more of the fruit/vegetables than others but that generally the produce was consumed during the week: There is hardly any waste some children have a few bites of an apple and say they have had enough on the other hand we have children that would eat double given the opportunity. Any fruit/vegetables that were left over were usually re-distributed among the children in the infant classes or passed on and shared out in the juniors (key stage 2). 14 One teacher commented: Sometimes they [the children in key stage 2] are disappointed if I haven t got any left over. One school had a composter in the playground and all inedible waste was recycled. Another school that was in a rural area let some of the children who owned horses take the leftover carrots and apples home to give to their horses. As would be expected, some fruits/vegetables were more popular than others (this did differ from school to school) and staff reported that the amount of waste tended to vary depending on what was on offer. When asked if the NSFVS had placed any additional burdens on school resources, staff in two schools reported that they had bought some equipment and cleaning materials (e.g. sieves, plastic bags for the waste, steel bowls, paper towels, and baby wipes). The extra costs involved in purchasing these resources had not caused the schools any problems. In terms of the burden on staff time, interviewees did report that the NSFVS had had an effect on individual workloads, particularly for those members of staff who were responsible for distributing and/or preparing the fruit/vegetables. However, this was not thought to pose too much of a problem and the extra work was considered to be manageable. 4.4 Summary Unsurprisingly, our findings show that staff had implemented and organised the NSFVS in ways that were appropriate for their schools. Importantly, staff commented that it had been important to have a routine in place to manage the 14 The impact of NSFVS produce on older children is discussed in Section

53 operation of the scheme, but that once the staff and children had got used to the routine the scheme had run smoothly. 49

54 5. Pupil interviews 5.1 Introduction In this chapter we present findings from group interviews carried out with children in our case-study schools. These findings are reported in the two following sections: Lunches and snacks. Section 5.2 explores what children have for lunch and snacks, their preferences and how much choice or influence they have over what they eat for lunch or as a snack. Knowledge and awareness. Section 5.3 explores the children s knowledge about how much they should eat of certain food types and presents data about what children recall learning about healthy eating and about where they have learnt about healthy eating (school and or home) Group and interviewee profiles In nine of the ten schools group discussions were conducted with three groups of children (one each from Years 1, 2 and 3) 15, with three children in each group, apart from one Year 1 group which had four children. Because one school was an Infant school, only two groups of children were interviewed as there was no Year 3. The size of the groups was particularly important: in our experience, research activities with young children are most effective when they involve small groups or are conducted on a one-to-one basis. In total, 29 group discussions were completed involving 88 children. Data in Table 5.1 shows that we interviewed slightly more girls than boys. Group interviews were facilitated by one or two researchers and were recorded with the permission of the children participating. 15 The NSFVS provides free fruit/vegetables to pupils in Reception, Year 1 and Year 2. We interviewed pupils from the cohorts involved in the first two CADET days, but they had since moved up after the summer holiday. 50

55 Table 5.1 Number of children interviewed by year group and gender Year group Boys Girls Year Year Year N= Interview methods When involving very young children in research, it is crucial to adopt methodologies suitable for that age group. Therefore, the research team developed an approach, which employed two exercises involving visual prompts (see Appendix B and C); the question schedules (see Appendix A) were built on and around these visual prompts. The first visual prompt exercise (see also Section 5.2) involved pictures of two lunchboxes: a less balanced (unhealthy) lunchbox containing a fizzy drink, a packet of crisps, a packet of cheesy nibbles, a bar of chocolate and a cake (see Appendix B, lunchbox A) a balanced (healthy) lunchbox containing a carton of fruit juice, fresh carrots, a yogurt, an apple and a sandwich (see Appendix B, lunchbox B). The contents of each lunchbox were deliberately selected to maximise the context and present children with a clear choice. This exercise enabled researchers to explore children s dietary preferences and helped stimulate and prompt the children during subsequent questions about: what they actually had for lunch what they preferred for lunch and as a snack whether this had changed since the previous term how much input and choice they had into what they actually consumed. The second exercise (see Section 5.3) involved the use of 12 flash cards, which showed various food items or food groups (see Appendix C) and was based on The Balance of Good Health (BNF, 2003). Children were asked to sort the pictures into foods that they should eat a lot of and foods they 51

56 thought they should eat a little of. The cards were sorted into two piles by the interviewer and later used to help explore interviewees knowledge about and views of healthy eating and balanced diets. Questions here also explored: the children s reaction to the NSFVS produce and the NSFVS scheme (foods that they had tried for the first time and their likes and dislikes) where information about healthy eating had come from (home or school) whether foods they had tried for the first time at school were now being eaten at home. Overall, our approach worked as intended, the children responded often enthusiastically to the visual prompt exercises A note about focus group responses Occasionally interviewers made a note of their concern that children might have been trying to provide the right answer or that children might have been briefed by someone in preparation for our visit. There were two instances where specific comments by children indicated evidence of such briefing; one from one boy who mentioned the 5 A DAY message, when asked where this knowledge originated he responded by saying at home this morning and another from a boy who had been told about healthy eating this morning, meaning the day of our visit. While it is possible (even likely) that coaching did take place in preparation for our visit, we think that any impacts on the research were minimised because of the approach taken to managing the interviews, question delivery and a systematic approach to data analysis, which helped ensure that the data collected accurately reflected the interviewees knowledge and behaviour. Interpreting data The children (who participated in our focus groups) were not scientifically selected (in fact they were ultimately selected by teachers), therefore the resulting data cannot be seen as representative of either the likely response of children in the schools visited or more generally of children in the North East. Rather, data has been analysed and reported as being representative of only those pupils who were interviewed. Hence, in this and the following chapter findings reported (in text or as tables) should only be associated with or be 52

57 interpreted as indicative of the responses of those children who were interviewed. 5.2 Lunch and snacks Which lunchbox selected Children were asked to look at two laminated colour pictures depicting the contents of two lunchboxes and select the one they would prefer to have for lunch. The children s responses to this exercise are summarised by gender and year group in table 5.2 below. Table 5.2 Lunchbox selection by year group and gender Which box selected? Year 1 Year 2 Year 3 Boys Girls Boys Girls Boys Girls Lunchbox A Lunchbox B* No response N= * Lunchbox B was the healthier, more balanced option Looking at the responses in Table 5.2, several contrasts are apparent. Nearly two thirds of boys in Year 1 indicated that they would select the healthier Option B, a similar proportion of the girls who selected the less balanced option. In Year 2 over half the boys and girls selected the healthy option, while a large majority of boys and girls in Year 3 selected Option B. At first glance these findings might suggest that generally the older children are more likely to select a healthier lunchbox, however the data could also be interpreted as suggesting that the older children (in Year 3) may have seen this exercise as a test, despite researchers carefully explaining to the children that it was not. Having pointed out these possible anomalies, it is surely a positive sign that so many of the children selected the healthy option, at the very least indicating their levels of awareness in terms of what they should be selecting. This 53

58 observation is further supported by many of the children s comments explaining why they had selected their preferred option, which are explored in the next section Reasons for lunchbox selections Reasons for selecting Option B Of the 51 children who selected Option B, 31 said that they had made this choice because it was the healthier option. By contrast (among those children interviewed) Year 1 children were more likely (than those in Years 2 and 3) to say they picked B because they preferred certain food items, only three of these children said they selected Option B because it was healthier option. That said, Year 1 children s prima facia preference for food items such as apples, carrots, yogurt and orange juice could be interpreted as no less encouraging than children who said they selected Option B because it was healthier. Four children provided more in-depth explanations for their lunchbox selections. One Year 2 child who selected Option B explained his selection thus: I chose it so that I could tell you something about it I wanted to tell you that it is mostly high fat like the cake and the crisps. The orange juice is ok, but the other things have about 100 per cent fat in. The crisps are very high in fat and so is the chocolate. I would rather eat the other one [Option B] but the sandwiches in that one are high fat too but you have got to have some fat. Encouragingly the latter part of this explanation hints at a developed notion of the need for a balanced diet. This observation can also be made in relation to comments from other Year 3 children who were reluctant to pick either of the two lunchboxes, preferring to mix and match box contents for reasons of health (balance) and personal preference. One boy explained his dilemma by telling the researcher: I don t know which one I would pick because I would put the apple and the orange juice in the other lunchbox and swap it around. You like to treat yourself with something sweet but you like apples as well and they are good for you so it is better to have some of each. 54

59 A girl in the same group agreed, adding: Some of the things taste nice but others are healthy so you need a bit of each. The meaning of healthy The research team anticipated that many of children would say they had selected Option B because it was healthy or make some similar response, without the elaboration recounted above. Therefore, to further explore such responses children were also asked if they had heard the term healthy eating and (if they had) what they thought it meant. Seventy-six children (including all those in Year 3) indicated that they had heard the term or at least offered an opinion about what they thought it meant. Of those children who were interviewed and had heard the term healthy eating, responses varied in terms of sophistication and emphasis about its meaning. For example, about half of the children explained the meaning of healthy eating in terms of their physical wellbeing and in relation to the resulting dangers of not eating healthily; getting fat, ill or having bad teeth. Some of these children also mentioned the importance of consuming the right vitamins and the implications of eating too much salt and sugar. The following replies illustrate these types of response: keeping you body healthy, it s what they say to make you nice and healthy. it s about looking after your body, healthy eating is better for you and bad eating is not good for you. Every time you eat a bad thing you get holes in your teeth and your teeth fall out and you get fat. you should eat healthy foods because it helps you grow. Other children (usually the older ones) linked types of food (and what the effect of eating these foods would be) with what they thought healthy eating meant: But what if you did lots of exercise? Wouldn t that burn off sweets? My Dad usually packs sweets when he goes on mountain bike rides as they give him lots of energy. 55

60 You have to have a balanced diet eating healthy food and different types of food like protein and dairy. Many children simply linked their understanding of the term healthy eating with the types of food they thought of as healthy: It s got healthy stuff in. Like the carrots were healthy It means you eat all kinds of vegetables. Overall, of those interviewed, the older children were more likely to link healthy eating with physical effects of consuming certain types of food, while the younger children were more likely to link healthy eating simply to a type of food, but were generally less sure about why the food was healthy for them. Selecting Option B but liking items in Option A Among those children interviewed, the popularity of items like crisps, chocolate and pop amongst some children who had selected Option B was also demonstrated by children s responses when they were asked about what items they liked from the box they had not selected. About half of those selecting B said they liked crisps, cakes and or chocolate. Fifteen children said they did not like anything in A at all, but (later in the interview) a third of these children mentioned actually having items in Option A either in their packed lunches or as snacks. This further suggests that in some instances children were trying to provide what they thought was the right answer. Reasons for selecting Option A All of the children who selected A said they had done so on the basis of preference for certain food items, most noticeably chocolate, crisps, pop and cake, this contrasts with the reasons given by children who selected Option B. One child said he did not select Option B because it was boring. 56

61 Selecting Option A but liking items in Option B Of the children selecting Option A, 23 said they also liked items in Option B. Ten said they liked the orange juice, nine the apples and four said they would like the carrots What children have for lunch Packed lunch or school lunch As part of exploring what children were actually having for lunch they were asked if they had packed lunch or school lunch. Just over half of the children interviewed had packed lunch and school lunch. Furthermore, interview data from children and staff suggest that one of the factors behind having a packed lunch is a seasonal one; in summer more children tend to have packed lunch, compared to an upturn in school lunches during the colder months of the year. Such seasonal variation may (if it exists generally) provide an opportunity to more effectively target campaigns encouraging healthy eating, for instance at parents in relation to packed lunch content during (or in preparation for) the summer months. Choice and packed lunches To help explore who influences the content of lunchboxes, children were asked who (usually) packed their lunchbox. Unsurprisingly, the majority answered that one or both of their parents packed their box, most mentioning their mother. Five Year 3 children said they packed their own box as did two Year 2 children. In addition three children said that an older sibling helped pack their lunch. Children were also asked to what extent (usually and always) they could choose what they wanted to eat. This was asked of children who had packed lunch or school lunch. Most of the children who were interviewed across all year groups said they chose all (or some) of what went into their lunchboxes. A small minority (five in Year 1, five in Year 2 and three in Year 3) said that they did not get to choose what went into their lunchbox. However, when asked what they would choose if they had the opportunity, four children mentioned various items of fruit and one mentioned yogurt. 57

62 Our findings suggest that, while a parent is likely to be packing their child s lunchbox, the child has a large amount of say in its actual content. Having said this, the autonomy of choice a child may have is likely to be limited by what the parent has purchased, although this in turn is likely to be heavily influenced by the preferences of their child. As one child pointed out (when asked if there was anything they did not get that they would really like) No, my Mum knows what I like. The importance of parental input into child s diet has obvious implications for the potential of the NSFVS to make a difference to what children are eating. Unsurprisingly, this was mentioned by staff during our visits. For example, teachers expressed concern about the consistency between the aims of the NSFVS and parental influence. For instance, one teacher drew attention to what children were being given to eat in terms of packed lunches: Parental support is important it s good that the children are having a piece of fruit each day, which is a step in the right direction, but it would be wonderful if the parents could take that on board and support it at home as well. They might have increased their fruit and vegetable intake at home, I don t know, but it s just what I see sometimes in their packed lunches i.e. junk food. The content of packed lunches Children were asked what they had for lunch (usually and always). In relation to the content of packed lunches, responses showed little difference across year groups or by gender. The most mentioned items, which were usually or always included were sandwiches, fruit, yogurt, crisps, chocolate, fizzy drink, biscuits and cake. Nearly all of children (47 of 49) who had packed lunches mentioned that they (usually or always) had sandwiches, and 33 mentioned crisps. Roughly similar numbers of children mentioned chocolate (13) and fizzy drinks (18), while only two children mentioned cake and six biscuits. Fifteen children said they had a piece of fruit and 23 mentioned fruit juice and yogurt. In very few cases did the combined selection mirror the content of Option B, selected by the majority of children during Exercise 1. This suggests that while the awareness of what constituted the healthier option was 58

63 relatively high, this was not necessarily reflected in the children s actual lunchbox content. Choice and content of school lunches Responses showed that children who had school lunch were always able to choose from a range of food provided by their school, although one child from Year 1 said that I can choose the first thing then the lady chooses the second thing, suggesting that at his school there was some effort to ensure the children selected at least one healthy item. The availability of choice in school lunches (and evidence of staff attempts to encourage children to make a healthy selection) is supported by findings from our interviews with catering managers (see Section 4.1.3). Overall, 15 children who had said they had school lunch mentioned selecting an item of fruit (or salad) usually or always, as part of their lunch. One child, despite the evidence from catering managers (see Section 4.1.3), suggested that healthy options at his school were limited: I see quite a lot of high-fat things. There are a few good things like ravioli and stuff but there are mainly things like fish cakes, chicken nuggets and hot dogs. Items more commonly selected for school lunch were chips (or other types of fried potato), pizza, crisps, fish fingers and fizzy drinks. However, interviews with catering managers did suggest (see Section 4.1.3) that all of the schools visited provided at the very least the opportunity for pupils to select a healthy and balanced lunch, suggesting (at least for those children interviewed) that many do not select healthy items even when they are made available. One catering manager explained their dilemma, pointing out that while she always provided salads, vegetables and fruit You can t make them eat it, although I do try and encourage them. Responses from staff and children who were interviewed (see also Section 4.1) show that there are differences, not only in the food provided but also in the way catering managers were involved in the NSFVS in different schools, and more generally in the contribution catering staff make to their schools efforts to encourage their pupils to eat healthily. Interestingly, five of the pupils mentioning they selected fruit and or vegetables for their school lunch came 59

64 from a school where the catering manager was a key and integral element in the school s efforts to encourage children to eat more healthily (see Section 4.1.3). In a limited way our case-study findings suggest that it is possible that such contextual factors could have implications for the overall outcome or impact of the eat healthily message, at the individual school level What children have for snacks Children were asked what they would have as a snack when they were at home and if they could choose what to have. While the majority of children interviewed across the three year groups said they could choose what they had as a snack, most also said they were supposed to ask a parent (or in some cases an older sibling) before taking something to eat. A small number of children admitted just taking what they wanted, one boy saying I asked Mum for an apple and she said no. I took one from the bowl, I had to sneak into the bathroom The snacks children mentioned selecting most often (in order of popularity) were fruit, crisps and sandwiches. Twenty-nine children said they would have a piece of fruit as a snack, while 18 said they would select crisps and 16 sandwiches. Snacks mentioned less frequently included biscuits, chocolate, milk and fizzy drinks. Five children in total (from Years 2 and 3) said they would have milk, but no children in Year 1 mentioned milk. One child said she would have a pizza as a snack, another rice and curry and another a burger. It is encouraging that a third of the children interviewed said they would chose fruit as a snack, though many also mentioned other foods and it is not clear whether their choice of an item of fruit would be in preference to for instance a bar of chocolate. Generally (see also Section 4.1) responses from school staff suggest an effort on their (or their schools ) part to encourage children to consume healthy snacks, efforts that are often reinforced by attempts to encourage parents not to give their children less healthy snacks to bring into school. On the other hand such efforts were sometimes frustrated by parents, and sometimes schools themselves provided items like sweets as a reward to pupils. Such a contradiction was mentioned by one teacher who said: 60

65 We don t encourage children to bring chocolate or sweets but we do give them a sweet as a treat/reward in an assembly still. I was hoping to phase it out but haven t been able to yet. Whatever the encouragement, at home or at school, to persuade children to eat healthy snacks, some staff expressed concerns about what children will select as a snack, when presented with a choice. For instance one teacher told us: We put out some salty crisps, biscuits, sweets and some oranges, but nobody touched the oranges, even though they used to get satsumas. In the end they did when I said there were still oranges there and they wanted to finish them off, but they weren t the first choices the children went for. When they could choose, they all went for the biscuits and crisps before the fruit. It should be noted that this point was made by one teacher referring to their observation of one incident. However, our findings tend to support this teacher s observation in so far that they show that a child s knowledge about (or awareness of) healthy eating does not necessarily or consistently lead towards children selecting the healthy option when provided with opportunity. Overall, the findings, in relation to packed and school lunches and snacks, reported above suggest that comparatively young children have considerable input to (and large amounts of autonomy over) what they actually eat during the school day. However, findings suggest that this autonomy is set against a developing background of school food policy and provision focused on developing and encouraging healthy eating, and in an information-led environment where many children are aware of and to varying degrees have taken onboard the eat healthily message. 5.3 Knowledge and awareness Pupils were shown 12 flash cards (see Appendix C) with pictures of food items, which are listed in Table 5.4. Children taking part in the focus groups were asked to sort the flash cards into two groups, those you should eat a lot of and those they thought you should eat a little of. This exercise was designed to test the respondents knowledge about balance but also to help stimulate the children s consideration about why they thought they should eat a lot of or a little of certain foods. 61

66 Explaining responses to Exercise 2 Table 5.4 summarises the interviewees response to this exercise. Responses from interviewees show that overall the majority of these children were consistently able to select the correct options. However, this finding should be treated with a little caution as in many groups there was some discussion amongst interviewees about what response to provide. This sometimes left one child on their own and often they changed their mind and selected the majority option, although not necessarily the correct option. However, the impact of this type of response was relatively limited as researchers did make clear to interviewees that they could disagree with peers if they so chose. Cereal and pasta seem to have provided a comparative quandary to a larger number of children than other items. Dried fruit provided Year 1 and 2 children with their toughest choice; responses to the pupil questionnaire in Phase 1 suggested that many children do not recognise raisins as fruit (see Teeman et al 2004) Researchers divided the flash cards into two piles, using the cards as illustrative support (and as a stimulant for discussion) for a series of exploratory questions: Why do you think you should eat lots of these foods? Why do you think you should only eat a small amount of these foods? What would happen if you ate lots of these foods? Foods that you can eat a lot of We have already presented data discussing the interviewees understanding of the term healthy ; unsurprisingly, interviewees provided similar responses when they were asked why they thought they should eat a lot of the foods they had selected to be in this group. Thirty children (talking about foods in the eat a lot of group) thought they should eat a lot of them because they were healthy, while (overall) 28 children provided some sort of further explanation as to why they thought these foods were healthy. 62

67 Table 5.4 Responses to Exercise 2 by year group Food item or group Lots of Small amount of Year 1 Year 2 Year 3 Year 1 Year 2 Year 3 Cereal Pasta Vegetables Cola Biscuits Chocolate Fruit Crisps Dried Fruit - Raisins Doughnut Sweets Bread N: 88 (Year 1: 31, Year 2: 30 and Year 3: 27) The foods in bold are foods you should eat a lot of In Year 3 one group of three children did not provide an answer for cereals. In Year 2 one child did not provide a response for biscuits and another for crisps. In these instances the response was recorded as not sure. Many of those interviewed linked eating a lot of these foods to helping them grow strong, helping their bones grow or to stopping their teeth rotting. The children s responses about growth are consistent with data from staff interviews: staff told us that they focused on this as an intended outcome of teaching about healthy eating. A large number of children mentioned teeth, and this finding was in part explained by interviews with staff, one NSFVS coordinator pointing to a recent disastrous dental inspection, which had resulted in increased awareness about dental hygiene. 63

68 Generally, older children were more likely than younger ones to link the consumption of a certain type of food to the physical effects it could have on them. One Year 3 child explained that he would eat a lot of cereals because they are full of goodness. They have wheat in. It makes you grow strong, while a Year 2 pupil explained I know why you need to eat all them, because they are healthy. You have to eat fruit and vegetables loads because otherwise you won t be fit or anything. Foods that you should eat a little of Children were asked why they should only eat a little of the foods they had selected to be in this group. Twenty-four children said they thought you should only eat small amounts of these foods because they had too much sugar, and 18 made the more general comment that these foods were not healthy or were bad for you. Four Year 3 pupils mentioned that some of these foods had too much fat in them as a reason for only eating a little of them, while five children mentioned high salt content as the reason for only eating a little of the crisps option. Again the level of sophistication displayed in interviewee responses varied across the year groups, with the older children generally providing more sophisticated answers, linking food ingredients to impacts on the body, rather than just saying It s bad for you. For instance, one Year 3 boy referring to cola said Some pop contains six teaspoons of sugar and sugar rots your teeth; another hinted at the importance of balance in diet thus: Chocolates and sweets have a bit of vitamin C, but you can t eat much as it will rot your teeth. However, two Year 1 children demonstrated similar sophistication in their reasoning. One boy said that they [crisps] are bad for you because salt is bad for you it makes your veins too small and blood can t get to your heart. Another Year 1 pupil (referring to chocolate) said You can eat some but not too much. Interviewees were probed further and asked what would happen to them if they did eat a lot of the foods they had said you should eat only a little of. Thirty-four children said these foods would make them sick or ill if they ate a lot of them, while 23 thought that these foods would have a detrimental effect on their teeth, causing them to rot or fall out. Older children were more likely than younger ones to mention the prospect of getting fat as a result of 64

69 eating a lot of these foods, while three Year 1 children and one Year 2 child mentioned the dangers of a heart attack in relation to the consumption of salt and or fat Where children are getting information from To enable the research to identify where children were getting knowledge and information about healthy eating from (and what information they recalled receiving) they were asked: if their teacher or anyone at school had ever talked to them about healthy eating if anyone at home had talked to them about healthy eating before. Information about healthy eating from school Sixty-two children said that someone at school had talked to them about healthy eating. One child said that someone had spoken to them on the morning of the interview, possibly providing an example of attempted coaching. Several children mentioned people who had asked them what they were eating and or provided them with a sheet of smiley faces. 16 However, the majority recalled covering the subject of healthy eating in class or during visits by various health professionals (such as dentists) and representatives from local businesses. Children were asked what they had been told about healthy eating and responses mirrored those covered in previous sections, including: being told that healthy food helps them grow being told some foods (if they eat too much of them) can make them fat or cause other physical harm to their teeth, heart etc being told that fruit and vegetables are good for them. However, many children mentioned foods that they had been told were good for them or bad for them. These responses might indicate that schools 16 It is almost certain that these responses refer to NFER test administrators who visited these schools on CADET days to administer the Pupil Questionnaire and support the completion of CADET diaries. 65

70 (and/or visitors) are using terminology which they are advised against. This observation may be further supported by the fact that only a very small number of children indicated that they had some understanding about the need for a balanced diet, in which items such as chocolate did have an appropriate place if not consumed to excess. However, data from staff interviews suggests that by and large schools follow the Qualifications Curriculum Authority (QCA, 1999) guidelines in this regard. Harm to one s body was mentioned by many as a potential result of eating too much of the foods in the eat a little of group. Data would seem to suggest that children were more likely to have been told, by either school staff or visiting professionals, about dangers to their teeth, ability to grow and potential for getting fat and damaging their heart. Below is a representative selection of children s recollections about what they had learnt at school. Three children from different year groups indicated that they had learnt about a balanced diet at school: don t eat too much chocolate and eat a little amount and we should eat loads of cereal. Milk can be good and bad, cos it s got fat in it. Some people told us about things we can only eat a bit and some people told us about things we could eat all the time. you should have a mixture, because you need a lot of things to keep your body going. You need vitamins. More usually children recalled being encouraged to eat the right foods and being told the effect eating the wrong foods would have: We were shown pictures of people who had teeth that were bleeding. We have traffic lights, where red means go easy or don t go for it, you can eat a little bit. In [Mrs X s] class we looked at our lunches and marked what was good for you and what wasn t. food that helps you grow and you should wash your teeth. keep healthy and eat healthy food. Well we had people coming in to taste things [visitors had brought different fruits in for children to try] and an assembly about it about health and growth. 66

71 Healthy eating is better for you and bad eating is not good for you. Every time you eat a bad thing you get holes in your teeth and your teeth fall out and you get fat and stuff. If you eat too much salt it could hurt your heart. They told us fruit has vitamins in, they told us about vitamin C and vitamin A. that if you eat lots of fruit you get healthy and you don t get fat. If you eat bad things you just don t grow. should eat five lots of fruit and vegetables a day. Information about healthy eating from outside school Fifty-seven pupils said that they had heard about healthy eating at home. In the main this had been from parents, most usually their mother. However, other sources of home-based information mentioned by interviewees included grandparents, siblings, books, TV and sport. Considering the current profile of young people s diets and the focus on healthy eating in the broadcast media (and through targeted social marketing campaigns) it was a little surprising that only one child mentioned TV as a source of information, none mentioning magazines or any other form of broadcast media. Furthermore it is worth noting that only one child mentioned sport as a source of information. This child belonged to a local football team and he had been told to eat healthily, so he would remain fit. Interestingly, the number of children who said that they had received information about healthy eating at home was similar to the number reporting the same at school. This suggests that some of concerns expressed by teachers to the effect that the healthy message was not carried through to home might not be justified (see Section 5.2.3). This finding could also tie in with (and has implications in regard to) those in the lunchbox section, namely that the responses from children noted above suggest that a large number of parents are aware of healthy eating issues and talk to their children about them. Therefore, it is reasonable to conclude that, for the children interviewed, this 67

72 may also have some impact on what foods they offer their children (to choose from) and/or encourage them to eat. Generally, the children interviewed recalled information coming from home that was consistent with the messages being received in school: eat plenty of fruit and vegetables eat less chocolate and sweets if you eat the wrong things you will not grow, might get sick and/or fat. One boy recalled Mum and Dad sat me down and told me what was good for me, when I was 4. When you re older you shouldn t eat a lot of doughnuts cos they ve got chocolate on and they re really bad for you. Another child stated that, My mum doesn t like me eating lots of chocolate cos she doesn t like any of the family staying off school., while one boy exclaimed Everybody in my family talks about it. They [mother and father] say when I wake up, go on eat a banana! In general what children reported having learnt at school mirrored responses about information they said they had received at home, although as we have seen in this report this does not necessarily translate into children actually eating more healthily Other ways of eating fruit and vegetables To explore children s awareness and knowledge about opportunities to consume fruit and vegetables when they were combined with other foods, researchers asked interviewees if, other than eating fruit and vegetables on their own, there were other ways they could eat them. This question proved difficult for many of the interviewees to understand and in many instances the researchers had to help the children with prompts and further explanation. Furthermore data suggests that in this instance the first answer often prompted agreement from peers and/or encouraged other responses. 68

73 Overall, 63 children suggested examples of other ways of eating fruit and vegetables rather than just on their own. Of the examples mentioned, the following were used most often: pies (vegetable and fruit) fruit salads salads dips desserts (most usually involving bananas) dinners (involving more than one vegetable e.g. Sunday dinner, a response that highlights the previously mentioned interviewee confusion about this question). Other examples mentioned less frequently included milk shakes, pizzas, soup, lollipops, pancakes, onion bhajees and spring rolls. Suggestions were made by roughly equal numbers of children in each year group, however generally the older respondents required less prompting. Our findings suggest that, when prompted most children were able to provide theoretically appropriate examples; however, we would conclude that it is unlikely that in every day circumstances many children realise when they are eating fruit and vegetables mixed with other foods. 5.4 Summary Overall, the data suggests that the issue of healthy eating has achieved a developed profile within the groups of children interviewed. However, the extent to which children can accurately recall and (are willing to) put into practice what they have learnt is unsurprisingly often dependent on several interrelated factors, such as age, school/teaching contexts and influences at home. However, evidence suggests that the majority of our interviewees have been exposed to generally consistent messages about healthy eating at school and at home. Furthermore, our data shows that many children say they have a large amount of autonomy in what they choose to eat. However, this is set in the context of both school and home-related influences, such as the food that is made 69

74 available to children to choose from, or the rules schools and parents try and impose covering what foods children can eat. Interview data also suggests that for a large number of children the healthy eating message has not been taken on board or perhaps that it requires further concerted effort to impart in a more targeted (coordinated) age appropriate way. Furthermore, our data indicates that while children may know what is healthy for them, they may not consistently choose to eat healthy options. 70

75 6. Impact of the NSFVS This chapter focuses on what those interviewed identified as the impacts of the NSFVS on: pupils (such as the impact on their consumption and demand for fruit and vegetables) staff (including the impact of the scheme on their teaching, and whether it has had any negative impacts in relation to teacher workload) schools (such as the effect of the NSFVS on any existing healthy eating schemes, the impact on provision of food, and any changes in school policy resulting from the implementation of the scheme). The findings in this chapter are largely based on staff perceptions of impact, although some sections also include the views of pupils. At the time of the case-study visits, there was little monitoring and evaluation taking place, either of consumption or of the general impact of the NSFVS. The majority of staff said they did not carry out any monitoring or evaluation of the scheme. A minority mentioned informal monitoring, such as observation of consumption, but it not appear that this took place on a regular basis to track the progress of the NSFVS. Some staff made comments like, I know in my mind who eats it and what they like but we don t keep a record or anything and We monitor consumption informally. We are aware of who eats it and how well it is received. In only two schools was any more formal monitoring mentioned, although that did not appear to be taking place at the time of the evaluation. For instance, in one, a class teacher reported that the regional NSFVS coordinator had asked for feedback on the percentage of children eating the fruit, but not recently. In the other school, a Year 2 teacher said that When it [the NSFVS] first started we monitored how it was working and what was popular with the children. A third school had sought to evaluate the response of parents to the idea of their school joining the NSFVS. To do this the school s NSFVS coordinator had sent a survey home to parents along with information about the scheme. The survey asked parents for their response to the idea of the school joining the scheme and asked parents of older children if they would be prepared to 71

76 contribute a small amount of money, so that fruit could be purchased for Year 3 and above. While the response of parents to the idea of the scheme was overwhelming supportive, few parents were willing to pay to extend the scheme to other year groups. As explained in Section 4.3.5, some schools chose to operate the scheme in the classroom so that they could monitor consumption more closely. However, it should be noted that any evidence reported by teachers discussed in this chapter is based on their perceptions. The impact of the scheme on pupils is discussed in the following section. 6.1 Impact on pupils This section explores the impact of the NSFVS on pupils in relation to the following: the type of fruit and vegetables they have tried their consumption of fruit and vegetables their demand for fruit and vegetables (as opposed to other less healthy options) whether the NSFVS has had an impact on what food parents provide their children (e.g. in their packed lunches or for snacks) their awareness of healthy eating (e.g. the 5 A DAY message) whether there is a difference in impact by pupil groups (e.g. exploring age, gender and social deprivation). In this section we also look at the impact on older children (e.g. whether pupils in key stage 2 receive any left-over fruit). Before looking specifically at impact, pupils general reactions to the NSFVS are discussed Children s response to the scheme Staff in all case-study schools perceived that, in general, the children loved the scheme and were enthusiastic. The children looked forward to receiving the fruit and vegetables and were disappointed if they did not receive it for any reason. Comments included: 72

77 The kids love it they re really excited about it. Children are enthusiastic about the scheme they look forward to finding out what it s going to be that day. The children are keen and enjoy having anything to eat. They certainly get excited when it s delivered in the morning what is it today? However, some staff perceived that children would be excited by any scheme that provided them with anything to eat; it was not necessarily the fact that they were getting fruit or vegetables that excited them. Despite positive reactions to the scheme overall, staff in the majority of schools thought that children s enthusiasm, and therefore the impact of the scheme, depended on the type and/or quality 17 of fruit received. For instance one teacher mentioned a delivery of particularly hard and bitter pears and several mentioned satsumas that were sometimes very hard to peel and bitter to taste. The impact of unpopular fruit on consumption was reinforced by comments from NFER administrators who wrote summary notes about CADET days (as previously discussed in Section 2.2), which suggested that some fruits and vegetables were consumed more than others (e.g. tomatoes were not popular). This point was also raised by more staff when asked about children s likes and dislikes, although preferences varied across schools. In one school, a member of staff thought momentum would be lost unless there was more variety of fruit. She said: They [the children] were thrilled when it first started, but I d say the novelty has worn off now. They might be a bit more interested if there was more variety. However, overall children s reactions were positive, and only in one school was there a small number [of children] who don t have it most the children love it. In general, staff reported that children love getting the fruit, enjoy it, and look forward to it. 17 It should be noted that (as mentioned in Section 4.3.3) staff reported that the overall quality of NSFVS produce was good. Staff referring to poor quality fruit did so in relation to isolated cases, albeit with the reported negative impact of those instances on consumption. 73

78 Childrens response to the scheme Overall, the perceptions of staff were confirmed by the pupils themselves. Children were asked if they thought the NSFVS was a good idea and whether they liked getting fruit and vegetables in school. Children in Year 3 were asked if they had liked receiving it in the previous school year. All of the children said that they thought the NSFVS was a good idea; none of them made any negative comments. When asked why they thought it was a good idea, responses related to fruit and vegetables being healthy for you and making you strong. When asked if they liked getting the fruit and vegetables, responses from the children were overwhelmingly positive. Reasons for liking the fruit and vegetables included, they ve got vitamins in, they give you energy, it s better to get fruit than chocolate bars, and because my mum told me that five fruits is good for you each day. Only four children made any negative comments. One boy in Year 3 said he did not like getting the fruit last year because you couldn t choose what you wanted. Another boy in Year 2 was concerned that You might get fat eating all this fruit. A boy in Year 1 said he did not always take the fruit because I m sometimes not hungry. One girl in Year 1 said I don t like raw carrots! Overall, the response from children was extremely positive The type of fruit and vegetables tried One of the potential outcomes of the NSFVS is that children are given the opportunity to try fruits and vegetables that they might not have tried before; this might make children realise that they like fruit and vegetables and thereby persuade them to eat more of them in the future (and even persuade their parents to buy more of them at home). Of the 88 children interviewed, about half (45) responded that they had tried fruits and vegetables that they had never tasted before. A total of 24 children had never tried kiwifruit before and the majority had liked them: I love it now I bring it in [from home] and I hadn t tasted kiwi before I liked it. Also, 11 children specifically mentioned that they had never tried pears before the NSFVS, although there were more mixed feelings about pears. A smaller 74

79 proportion of children had never tried cherry tomatoes, bananas, carrots, oranges, apples or strawberries before the NSFVS. By being involved in the scheme, some children had clearly found fruits and vegetables that they liked that they had never tried before: I love them [kiwi] they are sweet and delicious. I liked the tomatoes I have those at home now. Teachers were asked whether they thought being involved in the scheme had given children the opportunity to try new things, and the general consensus was that it had. A number of teachers were surprised that the children had tried things that they were not familiar with. For instance, At the beginning I was worried about them not being able to choose but it was good a positive thing lots of them tried things they wouldn t have done and we only had kiwis once, but it was amazing how many of the children tried them who had never had them before. By being encouraged to try new things, some of the children had discovered that they liked certain fruits and vegetables: They are willing to try new things as they know they won t get into trouble if they don t like it and I said just try one [cherry tomato] they re really sweet and by the end they were all eating them. It had shocked a few teachers to find out that some children in their class had not tried more common fruits. For instance, as one reception class teacher said, I was surprised that quite a lot of children hadn t even tried apples and oranges, because I thought that children were quite avid fruit eaters. Overall, the scheme had been a success at making a number of children more familiar with fruit and vegetables: They don t look on fruit as this foreign stuff they don t touch. These findings reinforced the outcomes of the pupil questionnaire, which found that the mean number of fruits which pupils reported having tried had risen, and that there was a significant difference between the intervention and comparison groups in relation to numbers of fruit tried (see Section 3.2). If children had tried new fruits and/or vegetables, they were asked whether they had since had them at home. Most children were vague in their response, although some said they had had new things at home. This is discussed below in Section 6.1.5, which focuses on food provided by parents. 75

80 6.1.3 Consumption of fruit and vegetables Although teachers were not formally monitoring consumption, most thought that the majority of pupils ate the fruit and vegetables. It was acknowledged that, in most cases, the same one or two children would not eat it, even after encouragement, but in general consumption was high and there was little waste. It was difficult for teachers to estimate the proportion of children who consumed the fruit or vegetables every day, although the majority estimated between 90 and 100 per cent 18. A few said more than three quarters of children ate the fruit and vegetables, and the most negative response was I d say it s over half [of pupils] each day. Typical comments were, Most of the children eat it every day and there is hardly any waste and they all try it. This perceived impact on consumption was reinforced by the findings from the analysis of CADET (see Section 2.2), which found evidence of an increase in consumption of fruit (although not vegetables). It is worth noting that one the Year 1 teacher said The scheme means more children are eating fruit than before the children that needed it, that weren t getting fruit at home get it now. In this particular school, some parents had previously paid a sum of money each week for their children to get fruit. Children whose parents could not afford to pay for fruit (those who arguably needed it most) were now receiving fruit each day like the other children, as it is free. In her view, the NSFVS was having an impact on fruit consumption among the children who needed it most. Similarly, in areas of social deprivation, teachers commented that some children came to school without having eaten breakfast; the NSFVS was praised for giving those children something to eat each morning ( this is the first thing they eat ). One PSHE coordinator said, This [the NSFVS] is important because of us being in an area of extreme deprivation, so it shows we re helping them [the children] as much as possible to give them a good start. In many cases, fruit would not be consumed in the home, and therefore NSVFS was having an impact on consumption. It should be considered that, in some cases (as mentioned above), schools had operated their own fruit schemes prior to the implementation of the NSFVS, but then stopped once it had been introduced. Therefore, the NSFVS would not be having an impact on consumption among all children; for some pupils, 18 As noted in Section 4.3.5, many of the children consume NSFVS produce in the playground possibly making accurate observation of consumption difficult. 76

81 fruit supplied through the NSFVS had simply replaced with what would have been provided as part of the school s own scheme. However, those children who had not previously paid for fruit would be benefiting from the NSFVS. The following quote illustrates this point: One child I had last year didn t pay for fruit and now [the NSFVS has been introduced] she eats it every day. If it hadn t been free she wouldn t have tried them and would never know she likes the fruit. Pre-existing fruit schemes, and the impact of the NSFVS, are discussed further in Section below. In one school, a teacher introduced eating competitions in her class to encourage consumption e.g. to see who can end up with the smallest apple core. Three teachers said consumption depended on the type of fruit or vegetable provided (although the most popular items differed between the schools). Moreover, one teacher said she thought consumption would increase with more variety: At first they were very keen and things were new, but that s tailed off with three apples per week. Whether the NSFVS had led to pupils choosing to consume more fruit and vegetables outside the classroom (e.g. at dinner times) is discussed in the following section Pupils demand for fruit and vegetables There were mixed views across case-study schools in terms of whether the NSFVS had led to an increase in children s general demand for fruit and vegetables. In four of the schools, there was general consensus among staff that the NSFVS had indeed led to an increase in demand. In two schools catering staff believed that the NSFVS had resulted in an increased demand for fruit and vegetables. One said: I have noticed that instead of the basic spaghetti they have the salad instead, whereas before they d just leave all the salad and the vegetables. The other catering manager observed their perceived impact of the NSFVS on demand thus: For instance we started off [before the NSFVS] with 10 bowls of mixed fruit we now do bowls the demand [for fruit and vegetables] has been much greater. The same catering manager said they 77

82 had, More than doubled the amount of fruit and vegetables they ordered and were convinced that this increased demand was connected to the NSFVS. Teaching staff at three schools perceived that more children had started to choose fruit instead of other desserts at dinner time. For instance, a reception teacher said I do find that my children are choosing fruit rather than puddings at school dinners. In the other two schools, more pupils were selecting fruit instead of sweets and biscuits at snack time. As one Year 2 teacher said, I put some fruit out last week as well as the biscuits and some chose the fruit. Staff in all four schools said the NSFVS had contributed to this change in demand. In three case-study schools there were mixed views about the impact of the NSFVS on general demand. For instance, in one of these schools there had been an increase in demand for salad at lunch time ( they have salad instead, whereas before they d just leave the salad and the vegetables ), but the staff felt unable to disentangle the possible impact of the NSFVS from the impact of general staff teaching and encouragement: A lot goes to the encouragement of the teaching staff and kitchen staff. In another of these schools staff had different views, with one teacher suggesting that The children are more likely to have fruit, whereas another said I ve not noticed a change in demand. In the other school, most staff had not noticed a change in demand, although the coordinator said, One parent has said to me that their child is choosing fruit at home more than they did before. In the three remaining schools, there was a general view among staff that the scheme had not had a positive impact on children s demand for fruit and vegetables generally. In fact, in one of these schools the cook said she had noticed a decrease in the amount consumed at lunch time and suggested that Perhaps as they get it at break they are not interested at lunch we noticed when it [the NSFVS] first started that the fruit wasn t selling. Other staff had not noticed any change in demand either. In another school, staff guessed it hadn t changed. In the remaining school, the teachers felt that demand had not changed as a result of the NSFVS, as it had always been high in their school (they reported a school ethos which had always encouraged healthy eating). 78

83 6.1.5 Food provided by parents In general, staff in case study-schools did not think that the NSFVS had a knock-on effect in terms of food provided in children s homes, or on what they parents provided in packed lunches. Only five teachers thought there had been a positive change, whereas 17 said they had not noticed any variation (those remaining, which is almost half of all staff interviewed, felt unable to comment, as they rarely witness children eating their lunch). Among the five members of staff who had noticed a change, one NSFVS coordinator said, I am pleasantly surprised by lunchbox content I would say there has been an improvement. Another coordinator commented, I think it [the NSFVS] has had an impact as quite a few children will comment that they had an apple when they got home and tea wasn t ready they said to their mums could they have an apple instead of a biscuit. In schools where staff had not noticed any change, some teachers felt frustrated at evidence that parents were still providing their children with rubbish. For instance, as one NSFVS coordinator reported, I still see them [children] going out and getting sweets from the parents. Similarly, a class teacher in another school said, At home time I often notice children being handed king-sized Mars bars and sweets and all kinds of things. Another respondent believed that the children miss the fruit in the holidays, and saw this as evidence that they do not get fruit at home on a regular basis. A catering manager had been frustrated after supervising what children brought in from home for lunch, and said There hasn t been a change they have quite a few processed foods. These findings from the case studies help to reinforce the findings from the analysis of CADET data, presented in Chapter 2: although it was clear that the NSFVS was having an impact on fruit consumption, since the daily increase was less than one portion there is no or little quantitative evidence that the scheme is having an impact on consumption in other contexts (e.g. in the home). As discussed above in Section 6.1.2, the NSFVS had given a number of children the opportunity to try fruits and vegetables that they had never tasted before (some had never tried more common fruits such as apples and oranges). Those who had tried new things were asked whether they ever had them at 79

84 home now, and a few children reported that their parents had in fact bought different fruits and vegetables at home recently. However, most children were vague when responding, and so it was difficult to assess any real impact of the scheme on what children were eating at home. The findings from children were generally unclear, although the staff suggested that, in general, the NSFVS had not had much of an impact in terms of increased consumption of fruit and vegetables outside school. One teacher summed this up by saying, Parental support is important it s good that the children are having a piece of fruit each day, which is a step in the right direction, but it would be wonderful if the parents could take it on board and support it at home as well. The key question is how can this be achieved? Pupils awareness When asked about the impact of the NSFVS on children s awareness of healthy eating, teachers expressed different views. One class teacher said, They ve got increased awareness about healthy eating and about what they should be eating. I think it does get into their heads However, two teachers specifically said they did not think the scheme had any impact on children s awareness, and a third was doubtful: I think the message is coming from all sorts of different places so it may not be just the fruit scheme that is raising awareness. Another teacher made the point that awareness does not always translate into practice: I think they are becoming aware of what s good for them but it comes down to choices whether they choose those things [fruit and vegetables] is a different matter. There were reports of the scheme stimulating discussion in relation to healthy eating, which may have contributed to reinforcing awareness. Moreover, it was clear that the scheme had given a number of children the opportunity to try new fruits and vegetables they had never tasted before (see Section 6.1.2). Thus, the scheme had evidently had an impact on the awareness of different types of fruits and vegetables The difference in impact by pupil group Members of staff in case-study schools were asked whether they thought the NSFVS was having more of an impact on particular groups of pupils (e.g. 80

85 exploring the issue of impact in relation to gender, age, ethnicity and social deprivation). A total of 18 members of staff (across all ten schools) felt able to comment. Nine teachers thought that the scheme had most impact on pupils from, what they described as, poorer or harder backgrounds. Typical comments were: Kids from a harder background are more likely to go for the fruit because they don t get it at home We are in a poor area some don t have breakfast. I know in my class kids aren t being fed at home and are coming to school hungry the fruit scheme provides food for them. Five other teachers perceived that the scheme was having most impact on the youngest pupils involved. For instance, one teacher thought that older children are more likely to make their own choices, and perhaps choose not to eat the fruit, whereas Younger ones tend to eat what they re given. Similarly, a NSFVS coordinator thought that older pupils are likely to have developed their own tastes and preferences (which links with making choices): Reception tastes are not fixed so they are more likely to try as they get older they have more fixed taste reception are so easy to manipulate. Another NSFVS coordinator agreed and thought that As they [pupils] get older they re not as keen. One teacher thought the scheme was having more of an impact on consumption amongst girls: The boys tend to be fussier and less willing to try something new, like the kiwis. The girls seem to be more willing to try The impact on older pupils Staff in case-study schools were not specifically asked about the impact of the NSFVS on older children (in key stage 2), but feedback was given which is worth reporting. As discussed in Section 4.3.5, leftover fruit and vegetables were often given to the juniors; this was the case in seven of the ten case-study schools. For instance, in one school a scheme called Free fruit on Fridays was operating, whereby any fruit not consumed by infants was given to older children. The 81

86 scheme coordinator said, There s sometimes enough for all classes or we start at the bottom and work up until everyone gets a free piece of fruit. Similarly, in another school any waste was given to older children during Friday privilege time. Nine teachers specifically criticised the NSFVS for being for infant children only, and felt that the impact would be much broader if older children were entitled too. Comments included: That s one let down they [juniors] should get it as well. I think the scheme should be extended through all years. I think it should be extended to older children we have got them to eat the fruit and then in Year 3 it stops. It s a bit elitist isn t it we value the Year 1s and Year 2s, but the rest of you we don t care what you eat! These views were reiterated when pupils in Year 3 were interviewed about their views on the fruit scheme. When asked how they felt about not getting fruit now, a number said they were upset or that they missed it a lot. As one boy said, We used to get it. It was good because it makes you healthy I miss it a lot. 6.2 Impact on staff This section explores the impact of the NSFVS on staff in relation to the following: Teaching (whether it had further stimulated or supported their teaching in relation to healthy eating) Workload (whether involvement in the scheme had a detrimental effect on staff pressures) Awareness of healthy eating Impact on teaching Teachers were asked whether being involved in the NSFVS had meant they had put additional focus on teaching about healthy eating. In three case-study schools, the consensus among staff was that the scheme had indeed raised the 82

87 profile of teaching in relation to healthy eating. One NSFVS coordinator commented, I think everyone s more open to healthy eating it generates conversation and learning. A class teacher said, It has stimulated discussion on 5 A DAY. In two of these schools, the fruit scheme had also supported other learning. For instance, one class teacher had used the scheme to support her mathematics teaching, by drawing a graph of children s favourite fruit to illustrate which was most popular. In another school, a teacher had used the scheme to support her teaching about recycling. In the other seven schools, staff agreed that the NSFVS had not triggered anything additional as healthy eating was covered in science and/or PSHE. The general view was that the scheme reinforced and contributed to what the schools were doing already. Typical comments included, I think the focus would have been there anyway, The scheme is supportive of what we do, and We ve done a lot anyway but it has contributed. Six teachers mentioned that the NSFVS had contributed to there being a relaxed social time in their class every day. For instance, one reception teacher said They re [the children] sat there chatting away and it s a really relaxed time, it s just lovely. Another teacher said, It s a nice sharing time. Evidence presented in Section suggests that, for older children, time pressures meant that NSFVS produce was more likely to be consumed in the playground. Teaching and learning One teacher said she had noticed a positive impact of the scheme on the level of concentration amongst the children in her class. Moreover, a teacher in another school praised the scheme for bringing out the quieter, shyer children in her class Impact on workload Most teachers did not report any negative impact of the scheme in term of any additional burden. This was interesting, as quite a few staff had expressed concerns initially about the scheme, in terms of an anticipated increase in their general workload. As previously discussed in Section 4.2.4, these initial concerns were not generally experienced in practice by staff. 83

88 However, this lack of impact on workload could be due to the way in which teachers were operating the scheme. For instance, in some cases, it was not the teachers themselves who took on most of the responsibilities, rather their learning support assistants took on the role. In fact, four teachers did express concern for the support staff who took responsibility for the scheme in their class. For instance, It s a shame we can t make it easier for [LSA] because she has a lot of work with the preparation it all takes time. In addition, as discussed in Chapter 4, some schools had decided from the start to give the children their fruit to take outside at break time, because they felt that implementing the scheme in class would be too disruptive. In fact, in two schools, the fruit had initially been given out in class but teachers felt it had been too disruptive (in terms of time and mess) so they changed their process and gave it to children to take outside instead. Teachers operating the scheme in this way are unlikely to experience a negative impact in terms of workload, but could miss out on the positive experiences associated with in-class consumption (such as a social time). In one school, the fruit had been given to children to take home after school on the odd occasion, or was not even given out at all, as teachers had been too busy to fit it into the school day. The NSFVS coordinator at this school said There are some days where I just have not managed to get it to the classrooms. That is not to say that all teachers operating the scheme in class had experienced workload problems; as suggested above, the majority of those distributing the NSFVS produce in this way had not as they had established a routine. It was, however, acknowledged by two teachers that it was easier for them to implement the scheme as they taught reception classes, which in their view was more flexible than teaching Year 2: I think the Year 2 teacher finds it a little time consuming, as in the foundation stage we make it a social occasion where we sit on the carpet with the pressures of literacy and numeracy in Year 2 the teacher finds it difficult to make it a social occasion. However, the general consensus was that the scheme had caused little disruption and any additional work was worth it for the children to get fruit each day. When asked if the scheme had met expectations, a number of teachers said it had been easier to implement than they first anticipated. 84

89 6.3 Impact on schools This section explores the impact of the NSFVS on schools in relation to the following: Other healthy eating initiatives Provision of food in school School policy Other healthy eating initiatives As discussed earlier in Section 4.1.1, the majority of schools were involved in other healthy eating initiatives, such as the Healthy Schools Award, and the NSFVS had helped to reinforce what schools were already doing in this area. However, in four schools the introduction of the NSFVS had led to the abandonment of other schemes, with negative consequences for older children who had been involved. For instance, two schools had purchased their own fruit prior to the NSFVS and charged pupils for it (50 pence a week in one school, and 20 pence per piece of fruit in the other). In one of these schools this had been abolished in key stage 1 once the free fruit was received; the scheme was still operating in key stage 2, although had died a death a bit for key stage 2 with people wondering why they should pay for fruit when others [in key stage 1] are getting it for free. In the other school, their own scheme had been abolished completely throughout the school as interest had dropped off, although key stage 1 children were still benefiting from the free fruit provided by the NSFVS. Therefore, in these two schools, the NSFVS had replaced the fruit previously provided through their own schemes. The NSFVS was having a positive impact on the pupils who had not previously paid for fruit and who were now consuming free fruit, but a negative impact on key stage 2 children who could no longer purchase fruit. In another school, a fruit tuck shop had existed prior to the NSFVS, although it was no longer running: We thought we couldn t charge any more for fruit if the key stage 1 children are getting it free now I don t know if key stage 2 are doing anything. Again, the introduction of the NSFVS would have been having a positive impact on children who did not previously purchased fruit 85

90 from the tuck shop but were now getting it free, but a negative impact on key stage 2 children who no longer had access to a tuck shop or the NSFVS. In the fourth school, prior to the NSFVS, parents of children in nursery and reception were encouraged to send their children to school with a piece of fruit each day for the social aspect, although this had stopped once the NSFVS was introduced. These findings reflect the possibility discussed in Chapter 2: the CADET analysis may suggest a degree of displacement i.e. the NSFVS fruit may in some cases function as a substitute for fruit which would have been eaten anyway. Staff in the other six case-study schools did not mention any other fruit and vegetable schemes Provision of food in school The NSFVS did not seem to have had much of an impact on food provided in schools (either as snacks or for meals at lunch time). Nine teachers and all eight catering managers (representing eight schools) commented on whether they thought there had been a change in provision of food since the scheme began. Only three teachers thought they had noticed a change. For instance, one reception class teacher used to give her class biscuits or cheese and crackers every day as a snack, which had been reduced to two days in favour of fruit on the other three days. In addition, the headteacher of one school was rethinking what would be provided at a forthcoming school disco. She said, We usually offer sweets, crisps and cola at these sorts of events we are considering offering fruit juice instead. In the other school, a teacher said they had noticed more fruit being provided in the canteen at lunchtime since the scheme had been introduced (including fruit salad). As discussed in Section 6.1.4, two catering managers had responded to an increased demand for fruit and vegetables. The other five teachers and six catering managers had not noticed a change in the provision of food; the majority reported that healthy food had always been provided at school and thus a change was not necessary. As one catering manager said, We ve always provided healthy and balanced meals. As 86

91 discussed in Section 4.1.3, a number of catering managers said they were restricted by external contractors who supplied school meals School policy In two schools, the introduction of the NSFVS had led to a change in snack policy. For instance: They [the children] used to bring in snacks to have at playtime in the afternoon but when we brought in the fruit scheme we banned them bringing in snacks so they are eating more fruit. I think that change is due to the scheme because it has helped to raise the profile of the fruit and they really enjoy it now. In the remaining eight schools, the scheme had not led to any changes in policy (although in six of those schools, healthy snack policies already existed prior to the scheme). 6.4 Summary Overall, children s reactions to the scheme were overwhelmingly positive and enthusiastic. More than half of the children interviewed had been given the opportunity to try fruit and vegetables that they had never tasted before, and staff were surprised at their willingness to try new things. There was a perception among staff that the scheme had a positive impact on children s consumption of fruit and vegetables in general, although there was limited evidence of any broader impact in terms of what children were eating at home. Children who came from socially deprived background were thought to benefit in particular, as they were considered more unlikely to have the opportunity to eat fruit and vegetables at home, and were often thought to go to school without breakfast. Rather then stimulate additional teaching, the scheme was thought to raise the profile of healthy eating and reinforce what schools already taught. Surprised by a lack of negative impact on workload, staff felt that the scheme was easier to implement than they initially anticipated. 87

92 7. Conclusions In this final chapter we provide a summary of our findings and an overview of ongoing and future research activity. 7.1 Summary of findings In this section, key findings are summarised under the following headings: Implementation of the NSFVS Consumption of fruit and vegetables Fruits and vegetables tried and liked Awareness of healthy eating Demand for fruit and vegetables Broader impact of the scheme in the home. The key findings are drawn from all aspects of the evaluation, which include the CADET diary, pupil questionnaire and case-study visits to ten schools Implementation of the NSFVS All ten case-study schools had promoted healthy eating prior to the introduction of the NSFVS; all schools had taught about healthy eating and the majority had taken part in related initiatives and/or had school policies on food/snack provision. Most case-study schools had been keen to take part in the scheme as it reinforced the messages about healthy eating they were already giving. The free fruit had been popular with staff and pupils, who were generally enthusiastic about being involved in the scheme. Generally, staff had not faced any of the workload challenges that some had anticipated; the scheme had been flexible enough for teachers to be able to implement it in a way which suited them. In fact, schools were operating the 88

93 scheme in a variety of ways; some were distributing fruit and vegetables in class (usually to younger children)and enjoyed the social time they experienced, whereas others felt it was less disruptive to give children fruit to take outside at play time. Where teachers gave out fruit at play time, although the scheme had not disrupted teaching time the more positive social experiences enjoyed by others would not have been experienced. Moreover, in these circumstances it would be more difficult for staff to accurately monitor fruit and vegetable consumption, compared to observation of consumption taking place in the classroom. In general, there was little waste (although this varied according to types of fruit and vegetables received) and leftovers were often given to junior children Consumption of fruit and vegetables There was clear evidence that the NSFVS had a positive impact on children s consumption of fruit. Children in the intervention group ate considerably more fruit than those in the comparison group. Since the first sweep of CADET in March, the average consumption of fruit in the comparison group had gone down by 0.11 portions, whereas that of the intervention group had increased by an average of 0.37 portions. Although the increase in consumption in the intervention group is an increase of less than half a portion (despite children being given a free fruit or vegetable every day) it should be seen in the context of a small decrease of fruit consumption in the comparison group. These findings are supported by staff in case-study schools who reported that consumption of fruit had been high. The analysis of CADET data provided some tentative indications of a very slight impact on the consumption of vegetables and fruit juice, but in general the evidence was inconclusive. Children in the intervention group were significantly more likely to achieve 5 A DAY, which suggests the introduction of the NSFVS had increased the likelihood of children reaching this goal. However, it is worth noting that, even with the addition of a free piece of fruit each day, only just over a third of children in the intervention group consumed 5 A DAY. Thus, the introduction of the scheme has made a contribution to this goal, but there is still a long way to go. 89

94 The scheme was thought by staff in case-study schools to have had a particular impact among children who came from deprived backgrounds, who often (staff perceived) went to school without having eaten breakfast and or were less likely to have fruit in the home. In relation to age, the analysis of CADET showed more of an impact on consumption among children in Years 1 and 2, suggesting their fruit was more likely to be an addition to their diet (perhaps reception children were already given fruit at school prior to the introduction of the NSFVS). It should be noted that, in some case-study schools schemes of a similar nature to the NSFVS, which existed prior to the NSFVS introduction, had since been abandoned. Therefore, in these instances the NSFVS would seem to have simply replaced what had already been provided, and potentially had not added anything. That is not to say that in such cases the NSFVS would have had no impact at all on any children in schools where this had happened; for instance in relation to schools with pre-nsfvs healthy tuck shops, those children (entitled to NSFVS produce) who had not previously paid for fruit (arguably those who would benefit the most) would as a result be receiving a free fruit or vegetable every day. However, older children who had previously purchased fruit would no longer be able to do so Trying fruit and vegetables It was clear from the analysis of the pupil questionnaire that, overall, the NSFVS had given children the opportunity to try some fruits that they had never tasted before. At Phase 2, there was a significant difference between the intervention and comparison groups regarding the average number of fruits tried. In particular, significantly more pupils in the intervention group had tried satsumas or easy-peel citrus which are distributed under the NSFVS. Moreover, at Phase 2, pupils in the intervention group liked significantly more fruits compared with pupils in the comparison group. The analysis of the pupil questionnaire revealed that there was a small increase in the average number of vegetables children reported trying. However, the comparison group had tried a larger number of vegetables than the intervention group, and the comparison group had increased slightly more over time than the intervention group. Thus, there is no evidence to suggest that the NSFVS is having an impact on the number of vegetables tried by 90

95 children, which in turn suggests that children s awareness of vegetables is unlikely to increase. As in Phase 1, children in the comparison group liked a larger number of vegetables than those in the intervention group. Half of the pupils interviewed reported trying new fruits (or, in a few cases, vegetables). In addition, staff in case-study schools were pleasantly surprised by the extent to which children had been willing to try new things, and the general consensus was that the NSFVS had helped to encourage children to try new things and provided many children with their first opportunity to do so Demand for fruit and vegetables It might be hoped that involvement in the NSFVS would lead to an increase in demand for fruit and vegetables among participating children, that they might choose to eat fruit or vegetables instead of other snacks considered to be less healthy. The CADET analysis revealed that there had been no overall change over time in the consumption of other snacks and desserts, and thus no evidence that children are switching to fruit. Moreover, although the CADET analysis indicated an increase in fruit consumption, this amounted to less than the one portion of fruit received each day, and thus there is no evidence of children choosing to eat more fruit in other contexts. However, at the time of Phase 2, children had only been involved in the fruit scheme for a short time and it is possible that such anticipated change might take more time to bring about and will therefore become evident in the longer term. The findings from the pupil questionnaire at Phase 2 were more positive (see Section 3.2.3), in that there was evidence of an increase since Phase 1 in the proportion of children (particularly those in the intervention group) choosing fruit rather than unhealthy snacks in response to a preference question. However, it remains an open question whether children would in practice choose fruit over other snacks. Overall, the evaluation yields a mixed picture regarding children s increased demand for fruit and vegetables; there was a report from one school of children choosing fruit instead of desserts, yet (in complete contrast) one report of a decrease in demand for fruit at lunch time resulting from children 91

96 eating fruit at other times. Therefore, the evidence from the staff interviews is inconclusive. About a third of pupils interviewed said that they might choose fruit as a snack, although evidence from CADET showed that snack consumption had not changed since the introduction of the NSFVS (see Section 2.2.6) Awareness of healthy eating There was some evidence of an impact of the NSFVS on children s knowledge and awareness. For instance, there were positive trends in the scores obtained in the test questions in the pupil questionnaire. Pupils in the intervention group were significantly more likely than those in the comparison group to identify the healthiest option from a choice of snacks (scores on this question had increased more over time for pupils in the intervention group compared with pupils in the comparison group). On a question about the Balance of Good Health, pupils in the intervention group scored higher at Phase 2 than pupils in the comparison group, although there was no significant difference in the extent of change in scores over time. It is worth noting, however, that there was not always a significant difference between the intervention and comparison groups in terms of scores on some knowledge items in the questionnaire, and that knowledge of 5 A DAY had increased more over time for pupils in the comparison group. However, pupils in the intervention schools did achieve higher aggregated scores than pupils in the comparison schools. Activities undertaken during discussions in case-study schools revealed a relatively high level of general awareness about healthy eating among pupils. It is, however, difficult to attribute such awareness to the NSFVS; when staff were asked about impact of the scheme, only a very small minority specifically mentioned an increase in pupil awareness, as all schools were already teaching about healthy eating prior to the introduction of the NSFVS. What the scheme had done, it would appear, was reinforce and supplement the messages about healthy eating already given in schools. In most cases, the NSFVS clearly provided a support to any existing teaching in relation to healthy eating. However, it should also be noted that there was a small minority of pupils involved in interviews who still had very limited knowledge (e.g. responded that it was ok to eat lots of chocolate or biscuits). 92

97 7.1.6 Broader impact of the scheme in the home One possible outcome of the NSFVS might be a knock-on effect in terms of the food provided in the home by parents/carers. It is clear from the CADET diary that the scheme was having an impact on children s fruit consumption. However, given that the increase in daily consumption is less than one portion, there is no evidence that the free piece of fruit provided at school is leading to increased consumption of fruit and or vegetables in the home. In general, most staff in case-study schools did not think the NSFVS had a knock-on effect in terms of what foods children eat in the home, and the responses from children were inconclusive. There was some qualitative evidence that children are provided with consistent messages about healthy eating at school and in the home, yet this does not necessarily translate into children eating healthy options at home. 7.2 The next stage of the evaluation This report has presented the findings from Phase 2 of the CADET food diary, the pupil questionnaire, and case-study visits to ten schools. The Phase 3 survey of CADET and the pupil questionnaire took place in November 2004, and data entry of this data is currently being undertaken. Future analysis will focus on any changes between all three sweeps, in children s: consumption of fruit and vegetables overall dietary patterns knowledge and awareness of healthy eating. Changes over time between the intervention and comparison groups will be compared, in order to determine the extent to which such changes may be due to the implementation of the NSFVS. It should be noted that, for the analysis of Phase 2 and Phase 3 data, the research team hoped to gain access to PLASC data (which includes a number of pupil-level background factors such as attainment, ethnicity and FSME). However, permission was not granted for PLASC data to be used for this 93

98 evaluation. Therefore, in order to be able to compare different groups of pupils, and provide a clearer picture of the factors relating to the outcomes of interest, some background questions were added to CADET. Parents were asked to comment on their child s ethnic background, and to give their postcode which will be used as a proxy measure of socio-economic status. A final report will be submitted to the Big Lottery Fund in May The report will draw together the findings from the three phases of CADET and the pupil questionnaire and provide evidence of: the impact of the school fruit scheme pilots on children s total daily consumption of fruit and vegetables, nutrient intake and overall diet the differential impact on the eating habits of subgroups of children (by gender, age, ethnicity and socio-economic background) changes in children s attitudes, awareness and knowledge of the benefits of fruit and vegetable consumption possible reasons underlying any detected changes. 94

99 References BRITISH NUTRITION FOUNDATION (2003). The Balance of Good Health [online]. Available: [16 July, 2004]. DEPARTMENT OF HEALTH (1991). Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London: HMSO. DEPARTMENT OF HEALTH (2003). 5 A Day Introduction [online]. Available: veadaygeneralinformation/fiveadaygeneralarticle/fs/en?content_id= &chk=q09GOW [20 December, 2004]. GOLDSTEIN, H. (2003). Multilevel Statistical Models. Third edn. London: Arnold. GREGORY, J., LOWE, S. and BATES, C. (2001). National Diet and Nutrition Survey: Young People Aged 4 to 18 Years. Volume 1: Report of the Diet and Nutrition Survey. London: Office of National Statistics. QUALIFICATIONS AND CURRICULUM AUTHORITY (1999). The National Curriculum: Handbook for Primary Teachers in England Key Stages 1 and 2. London: DfEE and QCA. TEEMAN, D., BLENKINSOP, S., KAYE, J., RANSLEY, J., SCHAGEN, I., SCHAGEN, S. and WHITE, G. (2004). Evaluation of the Big Lottery Fund s National School Fruit and Vegetable Scheme: Interim Report. Unpublished report. 95

100 Appendix A. Interview Question Schedules NSFVS Coordinator Interview Schedule EVALUATION OF THE National School Fruit and Vegetable Scheme Case-Study Interview Schedule NSFVS Coordinator Name of interviewer: Date of interview: Note to Researcher: explain briefly the aims and objectives of research assure the interviewee about confidentiality ask for permission to record interview. SECTION 1. BACKGROUND INFORMATION Name of School: Name of Interviewee: Post/role of Interviewee in the School: * Why did you decide to take on the role of NSFVS coordinator? Probes Did you volunteer to take on the role or were you asked? What does the role of coordinator involve? 96

101 How much time do you spend on these responsibilities? Is this enough? SECTION 2. SETTING UP THE NSFVS *1. What do you see as the main aims and objectives of the NSFVS? 2. Why did your school decide to join the pilot phase of the NSFVS? What positive outcomes did you envisage? 3. What were the attitudes and reactions of teaching staff to your schools participation in the scheme? Were teaching staff consulted prior to participation? 4. What were the attitudes and reactions of support staff and/or catering staff to your schools participation in the scheme? Were support staff consulted prior to participation? 5. How and when were parents/carers informed about the scheme? Were they given an opportunity to comment or ask questions? 6. Have any parents/carers asked for their children to be excluded from the scheme? If yes: what were their reasons? *7. How were children told about the scheme? Probes: Was this in the context of teaching/discussion about healthy eating? Were there any school assemblies on the topic? 97

102 SECTION 3. OPERATION OF THE NSFVS 8. What are the delivery arrangements for NSFVS fruit and vegetables? Probes: Generally, are deliveries reliable and as planned/notified? Have there been any problems with deliveries? How were these problems overcome? 9. What are the storage arrangements for the NSFVS fruit and vegetables? Probes: Where are they stored? Who organises the storage and retrieval? 10. Are there any problems/challenges related to storage? If yes: what were the issues and what action has been taken? 11. Have you been satisfied with the quality of the fruit and vegetables delivered? Probes: If no: Why? How have quality problems been addressed? 12. Who is involved in preparing the fruit/vegetables? Is washing or peeling frequently required? If yes: does this pose problems? 98

103 *13. Please could you describe how and when the fruit/vegetables are distributed to the children in your school? Probes: Prompt: Is the produce consumed in the same place that it is distributed? Who is involved? Parents, older children? Is this the same for every participating class? Why did you decide to operate the scheme in this way? *14. Who supervises the children during the process of collection and consumption of the fruit/vegetables? Probes: What are the arrangements for waste/leftovers? Are the children involved in this? *15. Is consumption monitored at all? Probes: Do you know if there is a lot of waste? Does this vary depending on the fruit/vegetable? SECTION 4: CHALLENGES EXPERIENCED *16. Have you experienced any difficulties so far with any aspect of implementing the NSFVS? Probes: If yes: what difficulties? What action was taken? 17. (If not mentioned so far) Have you had any difficulties in complying with health and safety and hygiene regulations (e.g. storing the fruit/vegetables in the right conditions, washing produce, washing hands)? Probes: If yes: can you explain? How were these difficulties overcome? 99

104 *18. (If not mentioned so far) Have you, for any reason, changed any aspect of the organisation of the NSFVS since it started? If yes: what and why? *19. What effect, if any, has the process, or any particular aspect of the scheme, had upon individuals workloads and/or break periods? *20. Have there been any additional burdens on school resources? Prompt: Like in: Staff time, equipment, classroom resources, cleaning materials? SECTION 5: POSITIVE OUTCOMES *21. Have you noticed any indications of positive outcomes of the NSFVS? a) b) c) On the children involved in the NSFVS? a1) Children s demand for and consumption of fruit/vegetables and other healthy foods at snack/lunchtime? Prompt: Decrease in consumption of other high fat/sugar foods such as crisps, sweets, chocolate? Prompt: any impact on what children bring from home to eat in school. Content of lunchboxes etc? a2) Probe Any differences between different groups of pupils? Prompt: boys and girls, pupils with home circumstances/background On the rest of the school? Are you aware of any impact on children s demand for and consumption of fruit/vegetables and other healthy foods? Any impact on school ethos and food culture? On the staff? Has involvement stimulated a focus on healthy eating? If yes: How Prompt: e.g. the development of Internal guidance/policies on food available at your school Prompt: Any other similar healthy eating schemes implemented alongside NSFVS 100

105 22. Has participation in NSFVS stimulated teaching in relation to healthy eating? Prompts: If yes: In what ways? encouraged any focussed work impact on curriculum provision 23. Has NSFVS aided the home-school partnership in relation to health education at all? If yes: in what way? 24. Have you received any feedback from parents/carers regarding the scheme? If yes: what? 25. Do you think parental support is important in making a success of the NSFVS? If yes: in what way? SECTION 6. OVERVIEW 26. Has taking part in the NSFVS been as you expected? If No: what has been different? *27. What, if any, guidance and support did you receive from your local area NSFVS coordinator? Probes: Was the guidance and support useful? Did it meet your needs? Probes: If no to either/both probes: Why not? What other guidance and support would have been useful? 101

106 *28. Have you monitored or evaluated the impact of the NSFVS at all? Probes: If No: Do you plan to evaluate or monitor the impact in the future? Probes: If Yes: Please give details Have children/parents been involved in this? What were the outcomes? Have these outcomes been shared and disseminated with others? 29. Are you planning to continue with the NSFVS in your school? If yes Are there any changes that you would suggest or are planning? If no : Why not? 30. Do you have any further comments you would like to make in relation to the NSFVS that you have not already made? THANK YOU FOR PARTICIPATING IN THIS INTERVIEW 102

107 PSHE Coordinator Interview Schedule EVALUATION OF THE National School Fruit and Vegetable Scheme Case-Study Interview Schedule PSHE Coordinator Name of interviewer: Date of interview: Note to Researcher: explain briefly the aims and objectives of research assure the interviewee about confidentiality ask for permission to record interview. SECTION 1. BACKGROUND INFORMATION Name of School: Name of Interviewee: Post/role of Interviewee in the School: Do you have any responsibilities related to the NSFVS? Probes: If yes: what are they? How much time do you spend on these responsibilities? Is this enough? 103

108 SECTION 2. SETTING UP THE NSFVS 1. What do you see as the main aims and objectives of the NSFVS? 2. What was your reaction to your schools participation in the scheme? Were you consulted? If yes: at what stage? 3. Has your school been involved in any other healthy eating initiatives prior to the NSFVS? Probes: If yes: when did they start? What did they involve? What was the impact? How did this alter, if at all, after NSFVS involvement? SECTION 3. POSITIVE OUTCOMES 4. Has participation in NSFVS stimulated teaching in relation to healthy eating? Probe Prompt: If yes: In what ways? encouraged any focussed work impact on curriculum provision 5. What messages were children given about healthy eating and the benefits of eating fruit and vegetables before the introduction of the NSFVS? What resources and/or guidance were used? 104

109 6. As PSHE coordinator have you received any training to assist you in teaching children about healthy eating? Probes: If Yes: What was the content? Was it useful? Probes: If No: Would you find training and/or more information useful? What kind of information/training? 7(a). Do you have a policy to address the type of snacks eaten in school? Probes: If yes: Please give details If no: Are there any plans to develop/introduce one? Has this changed since the introduction of the NSFVS? 7(b). Does your school have a wider school food policy? Probes: If yes: Please give details If no: Are there any plans to develop/introduce one? Has this changed since the introduction of the NSFVS? 8. Do you have a tuck shop in school? Probes: If yes: What type of food and drink do you sell? Has this changed since the introduction of the NSFVS? 9. Have you implemented any other healthy eating activities/initiatives alongside the NSFVS? 105

110 10. Has NSFVS aided the home-school partnership in relation to health education at all? If yes: in what way? 11. In your opinion, what, if anything, are the barriers to eating healthily in school? SECTION 4. OVERVIEW 12. Has taking part in the NSFVS been as you expected? If no: what has been different? 13. Is your school in planning to continue with the NSFVS? Probes : If yes : How do you feel about this? Are there any changes that you would suggest? If no: Why, what do you think about this? 14. Do you have any further comments you would like to make in relation to the NSFVS that you have not already made? THANK YOU FOR PARTICIPATING IN THIS INTERVIEW 106

111 Class Teacher Interview Schedule EVALUATION OF THE National School Fruit and Vegetable Scheme Case-Study Interview Schedule FS/KS1 class teacher Name of interviewer: Date of interview: Note to Researcher: explain briefly the aims and objectives of research assure the interviewee about confidentiality ask for permission to record interview. SECTION 1. BACKGROUND INFORMATION Name of School: Name of Interviewee: Post/role of Interviewee in the School: *Do you have any responsibilities related to the NSFVS? If yes: what are they? How much time do you spend on these responsibilities? Is this enough? 107

112 SECTION 2. SETTING UP THE NSFVS 1. What do you see as the main aims and objectives of the NSFVS? 2. What was your reaction to your schools participation in the scheme? Were you consulted? If yes: at what stage? *3. Have any parents/carers asked for their children to be excluded from the scheme? If yes: what were their reasons? *4. How were the children in your class told about the scheme? Probes: Was this in the context of teaching/discussion about healthy eating? Were there any school assemblies? SECTION 3. OPERATION OF THE NSFVS 5. Who is involved in preparing the fruit/vegetables? Probes: Is washing or peeling frequently required? If yes: Does this pose problems? *6. Please could you describe how and when the fruit/vegetables are distributed to the children in your class? Probes: Is the produce consumed in the same place that it is distributed? Prompt: Who is involved in the operation of the scheme? Parents/other pupils 108

113 Probes: If parents/other pupils are involved: In what way? Why did you decide to operate the scheme in this way? 7. (If not mentioned above) Who supervises the children during the process of collection and consumption of the fruit/vegetables? *8. Is consumption monitored at all? Probes: Is there waste? If yes: How much? What are the arrangements for waste/leftovers? Does this vary depending on the fruit/vegetable? SECTION 4. CHALLENGES EXPERIENCED *9. Have you experienced any difficulties so far with any aspect of implementing the NSFVS? Probes: If yes: what difficulties? What action was taken? 10. (If not mentioned so far) Have you had any difficulties in complying with health and safety and hygiene regulations? Prompt: Probes: with washing produce, washing hands If yes to difficulties: can you explain the difficulties? How were these difficulties overcome? Probes: Is the fruit/veg washed? Do children wash their hands before and after handling/eating the produce? 109

114 11. (If not mentioned so far) Have you, for any reason, changed any aspect of the organisation of the NSFVS since it started? If yes: what and why? 12. What effect, if any, has the process, or any particular aspect of the scheme, had upon your workload and/or break periods? Any effect on workload and/or break periods of support staff? *13. Have there been any additional burdens on school resources? Staff time, equipment, classroom resources, cleaning materials? SECTION 5. POSITIVE OUTCOMES *14. How have the children in your class responded to the NSFVS? *15. How many children on average eat the fruit/vegetables provided? 110

115 *16. Have you noticed any indications of positive outcomes of the NSFVS? a) b) c) On the children involved in the NSFVS? a1) Children s demand for and consumption of fruit/vegetables and other healthy foods at snack/lunchtime? Prompt: Decrease in consumption of other high fat/sugar foods such as crisps, sweets, chocolate? Prompt: any impact on what children bring from home to eat in school. Content of lunchboxes etc? a2) Probe Any differences between different groups of pupils? Prompt: boys and girls, pupils with home circumstances/background On the rest of the school? Are you aware of any impact on children s demand for and consumption of fruit/vegetables and other healthy foods? Any impact on school ethos and food culture? On the staff? Has involvement stimulated a focus on healthy eating? If yes: How Prompt: e.g. the development of Internal guidance/policies on food available at your school Prompt: Any other similar healthy eating schemes implemented alongside NSFVS *17. (If not mentioned ) Has participation in NSFVS stimulated teaching in relation to healthy eating? Prompt: If yes: In what ways? encouraged any focussed work impact on curriculum provision *18. Since the NSFVS was introduced, what messages have you given the children in your class about healthy eating and the benefits of eating fruit and vegetables? Have you used any specific guidance or resources? If yes: Please give details 19. Has NSFVS aided the home-school partnership in relation to health education at all? If yes: In what way? 111

116 *20. Have you received any feedback from parents/carers regarding the scheme? If yes: What? 21. Do you think parental support is an important factor in making a success of the NSFVS? If yes: In what way? SECTION 6. OVERVIEW 22. Has taking part in the NSFVS been as you expected? If no: What has been different? *23. Have you monitored or evaluated the impact of the NSFVS at all? Probes: If no: Are you aware of any plans to evaluate or monitor the impact in the future? If yes: Please give details: Have children/parents been involved in this? What were the outcomes? Have these outcomes been shared and disseminated with others? 24. Is your school in planning to continue with the NSFVS? Probes: If yes How do you feel about this? Are there any changes that you would suggest? If no Why, what do you think about this? 25. Do you have any further comments you would like to make in relation to the NSFVS that you have not already made? THANK YOU FOR PARTICIPATING IN THIS INTERVIEW 112

117 Catering Manager Interview Schedule EVALUATION OF THE National School Fruit and Vegetable Scheme Case-Study Interview Schedule Catering Manager Name of interviewer: Date of interview: Note to Researcher: explain briefly the aims and objectives of research assure the interviewee about confidentiality ask for permission to record interview. SECTION 1. BACKGROUND INFORMATION Name of School: Name of Interviewee: Please confirm your role at the school: Do you have any responsibilities related to the NSFVS? If yes: what are they? How much time do you spend on these responsibilities? Is this enough? 113

118 SECTION 2. SETTING UP THE NSFVS 1. What do you see as the main aims and objectives of the NSFVS? 2. How did you learn that your school was going to be involved in the NSFVS? 3. Were you involved in your school s decision to join the NSFVS? If yes: how? 4. What was your reaction to your schools participation in the NSFVS? SECTION 3. OPERATION OF THE NSFVS 5(a). Are you involved in the deliveries and or storage of NSFVS? Note to researcher. If yes to delivery and or storage, please use 5b, 5c and 5d 5(b). Generally, are deliveries reliable and as planned/notified? Probes: Have there been any problems with deliveries? How were these problems overcome? 5(c). How and where are the fruits/vegetables stored in your school? Probes: How was this decided? Who organises the storage and retrieval? Has fruit/vegetable storage impacted on your working space at all? 5(d). Generally, how would you rate the quality of the fruit/vegetables your school has received? 114

119 6. Are you and/or your staff involved in preparing the fruit/vegetables? If Yes: In what way Has this involvement impacted upon your/or their workload in any way? SECTION 4. OUTCOMES 7(a). Are you aware of any guidelines regarding the dietary composition of school meals? If yes: What guidance Prompts: National guidance (DH, DfES) Local guidance (Health promotion) 7(b). Can you tell me about the school meals that are provided at your school? Probes: How much choice do children have? How often is fruit provided?(including dried and tinned fruit and fruit juice) How often are vegetables and/or salad provided? Do you serve vegetables and or fruit included in composite meals such as vegetable burgers, soup? 7(c). Do you think that the food you serve relates to the 5 A Day message? If yes: How? 8. Have there been any changes made to school meals since the NSFVS started? If yes, what and why? Any change related to NSFVS? 8(a). Have there been any changes in school food policies since introducing the NSFVS? If yes, what and why? 115

120 9. Have you noticed any indications of positive outcomes of the NSFVS? a) On the children involved in the NSFVS? Children s demand for and consumption of fruit/vegetables and other healthy foods at snack/lunchtime? Decrease in consumption of other foods such as crisps, sweets, chocolate. Content of lunchboxes etc differences between boys and girls b) On the rest of the school? Children s demand for and consumption of fruit/vegetables and other healthy foods? Any increase or decrease in requests for school lunches? Any impact on school ethos and food culture? 10. Is your school planning to continue with the NSFVS? Probes: If yes: How do you feel about this? Are there any changes that you would suggest? Probes: If no: Why? What do you think about this? 11. Do you have any further comments you would like to make in relation to the NSFVS that you have not already made? THANK YOU FOR PARTICIPATING IN THIS INTERVIEW 116

121 Pupil Interview Schedule EVALUATION OF THE National School Fruit and Vegetable Scheme Name of interviewer: Case-Study Interview Schedule Pupils Name of note taker: Date of interview: INTRODUCTION My name is and I am a researcher which means it is my job to find out things about children, teachers and schools. I am visiting different schools to talk to lots of teachers and children about different foods. I am not going to tell your teachers or anyone else what you say. I have a mini disc recorder with me, would it be O.K. if I record what we say while we are talking? Is there anything you want to ask me before we start? SECTION 1. BACKGROUND INFORMATION Name of School: Interviewee data Pupil 1 Pupil 2 Pupil 3 Name Gender Age Year group 117

122 LUNCHBOX ACTIVITY Here are two different pictures of lunchboxes. Each lunchbox has four different things to eat inside it and a drink. Note to researcher: Place both pictures on the table in front of the children to stimulate discussion. Which box selected? Pupil 1 Pupil 2 Pupil 3 Lunchbox A Lunchbox B 1. Which lunchbox would you like to have for your lunch? Probes: Why did you choose this one? Do you like any of the things in the other lunchbox? If yes: Why didn t you choose that lunchbox? 2. (If not already mentioned) Have you ever heard the words healthy eating before? If yes: What do you think they mean? 3. Do you have a packed lunch or a school lunch? If packed lunch: Who packs your lunchbox? 4. What sorts of things do you normally have for lunch? 5. Are there things that you always have? 6. Are there any things that you have for lunch now that you didn t have before? 118

123 7. Do you get to choose what you have for lunch? Prompt: If yes: How often? Always, sometimes never? If Always/Sometimes: What do you get to choose? If Never: What would you have if you could choose? 8. If you are hungry when you are at home what sorts of things do you have to eat as a snack? 9. Can you choose what to have as a snack at home? Prompt: If yes: How often? Always, sometimes, never? If Always/Sometimes: What do you usually choose? If Never: What would you have if you could choose? 119

124 FLASHCARD ACTIVITY Here are some cards with pictures of different foods on them. I m going to ask you which you think you should eat lots of and foods that you think you should only eat a small amount of? Food Cereal Pasta Vegetables Cola Biscuits Chocolate Fruit Crisps Dried Fruit - Raisins Doughnut Sweets Bread Lots of Small amount of Note to researcher: Take the first pile of cards and spread them out across the table so that they can be used to stimulate discussion. 11. Why do you think you should eat lots of these foods? Responses as appropriate Note to researcher: Take the second pile of cards and spread them out across the table so that they can be used to stimulate discussion. 120

125 12. Why do you think you should only eat a small amount of these foods? Responses as appropriate 13. What would happen if you ate lots of these foods? Why? 14. Has your teacher or anyone at school ever talked to you about healthy eating? If yes: what did they tell you? 15. Has anyone at home talked to you about healthy eating before? If yes: what did they tell you? 16. At school you been having a piece of fruit every day (for pupils in Year 3 you had a piece of fruit every day last term). Do you think that is a good idea? If Yes or No: Why? 17. Do you like having fruit at school? If Yes or No: Why? 18. Have you had any fruits at school that you hadn t tried before? Probes: If yes: which fruits? Did you like the fruits? Do you ever have them at home now as well as at school? 121

126 19. Other than eating fruit and vegetables on their own, are there other ways you eat them? Prompt: For example, mixed with other food as part of meals, breakfast, lunch and dinner. If yes: Ask for examples 20. Do you have anything else you would like to tell me about the things we have been talking about? THANK YOU FOR TALKING TO ME TODAY 122

127 Appendix B. Pupil Interview Exercise 1 Packed Lunch, Option A. Packed Lunch, Option B 123

128 Appendix C. Pupil Interview Exercises 2 124