Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Gilliland, Jason

2nd Supervisor

Miller, Linda

Abstract

Good nutrition is an important part of maintaining a healthy lifestyle. A balanced diet can promote positive health outcomes, protecting against health problems caused by nutritional deficiencies. Canada has reported poor diet quality and high rates of overweight and obesity among children. Obesity has been linked to several non-communicable diseases including type 2 diabetes, heart disease, and some forms of cancer. Efforts to improve lifelong, healthy eating behaviours must be implemented.

This dissertation investigated the impacts of school food programming on child nutrition. A Centrally Procured School Food Program (CPSFP) was implemented at 30 elementary schools in Southwestern Ontario, Canada. This program delivered free, locally-sourced food to schools in an effort to improve child nutrition. A food literacy resource was designed and delivered to families as part of this food program.

A cross-sectional study involving 2,431 children assessed participant knowledge of food. Children’s total knowledge scores were on average 29.2 out of 46 (63.5% correct responses). Participants demonstrated nutrition competency and food skills; although, awareness of food guide recommendations and local foods were limited. Female gender, high household income, and rurality were associated with higher knowledge scores.

A randomized controlled trial including 1,836 child participants evaluated changes in food-related knowledge associated with a food literacy resource. The results presented non-significant differences in mean total knowledge scores (F = 2.7, p = .10) between intervention and control groups pre- to post-intervention. Limited increases in healthy eating efficacy, food selection, identification of local produce, and nutrition knowledge were reported.

A qualitative study involving focus groups with 208 children explored perceptions of and suggestions for the CPSFP. Results from the child focus groups indicated that the program’s food provision curbed hunger, promoted greater fruit and vegetable consumption at school and home, and enabled children to try various healthy foods. Participants recommended adding educational activities, a greater variety of foods, and increased child involvement with the program.

This dissertation identified current strengths and gaps in children’s food-related knowledge. Results from two elementary school food interventions can be used to improve current practices and develop innovative programs to promote healthy dietary habits among children.

Summary for Lay Audience

This dissertation examined the impacts of school food programs on children’s nutrition and health in Southwestern Ontario, Canada. Three studies were conducted: 1) an assessment of children’s food and nutrition knowledge; 2) an evaluation of children’s food-related knowledge associated with a take-home food literacy resource; and 3) children’s perceptions of and suggestions for a Centrally Procured School Food Program (CPSFP).

Measurements of children’s food-related knowledge revealed somewhat low total knowledge scores (63.5% correct responses). Participants demonstrated some nutrition competency and food skills; although, awareness of food guide recommendations and local foods were limited. Several sociodemographic factors, including female gender, high household income, and rurality were associated with higher knowledge scores. These findings can be used to design strategic food education interventions that address gaps in children’s knowledge.

Food literacy can be defined as the capacity to understand basic information about food and nutrition as well as the competence to use that information to make appropriate health decisions. An evaluation of a food literacy resource involving eight weeks of fruit and vegetable (F/V) information sheets, maps of local farms, parent and child-friendly recipes, and weekly educational games and activities, presented predominantly non-significant effects on children’s total food-related knowledge. Future food literacy interventions should incorporate experiential learning and be provided over a longer period of time with consistent methods of delivery. Additional long-term evaluations of food literacy interventions are recommended.

Elementary school children had positive impressions of the CPSFP. This program offers daily fruit, vegetable, and supplementary food group snacks at schools. Results from child focus groups indicated that the program’s food provision curbed hunger, promoted greater F/V consumption at school and home, and enabled children to try various healthy foods. Participants recommended adding educational activities, a greater variety of foods, and increased child involvement with the program. These suggestions can be used to design future multi-component programs that cater to children’s interests and needs.

Studies presented in this dissertation offer rich, data-driven research to support the development and sustainability of food programming regionally and beyond. In addition, this research aids in supporting school nutrition policies and practices in Canada.

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