Kelley M. Brian

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent, School-Based Nutrition Education Intervention

OBJECTIVE To provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children. DESIGN Longitudinal, pretest/posttest, randomized, controlled intervention. SETTING Four elementary schools in California. PARTICIPANTS Fourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile. INTERVENTION A multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program. MAIN OUTCOME MEASURES Dietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey. ANALYSIS Evaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.

A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes

Objective: To evaluate the effectiveness of the Shaping Healthy Choices Program (SHCP). Design: A clustered, randomized, controlled intervention lasting 1 school year. Setting: Schools in northern and central California. Participants: Fourth‐graders (aged 9–10 years) at 2 control schools (n = 179) and 2 intervention schools (n = 230). Intervention: Garden‐enhanced education, family, and community partnerships; increased regionally procured produce in the lunchroom; and school‐site wellness committees. Main Outcome Measures: Changes in body mass index (BMI) percentiles/Z‐scores; nutrition knowledge, science process skills, and vegetable identification and preferences; and reported fruit and vegetable intake. Analysis: Student t test, chi‐square, ANOVA of change, and multilevel regression mixed model to evaluate change in outcomes with school as a random effect to account for cluster design effects. Statistical significance was set at P < .05. Results: There was a greater improvement in BMI percentile (−6.08; P < 0.01), BMI Z‐score (−0.28; P < .001), and waist‐to‐height ratio (−0.02; P < .001) in the intervention compared with the control schools. Conclusions and Implications: The SHCP resulted in improvements in nutrition knowledge, vegetable identification, and a significant decrease in BMI percentiles. This supports the concept that the SHCP can be used to improve the health of upper elementary school students.

Using a Systematic Approach and Theoretical Framework to Design a Curriculum for the Shaping Healthy Choices Program

OBJECTIVE To examine the use of a systematic approach and theoretical framework to develop an inquiry-based, garden-enhanced nutrition curriculum for the Shaping Healthy Choices Program. METHODS Curriculum development occurred in 3 steps: identification of learning objectives, determination of evidence of learning, and activity development. Curriculum activities were further refined through pilot-testing, which was conducted in 2 phases. Formative data collected during pilot-testing resulted in improvements to activities. RESULTS Using a systematic, iterative process resulted in a curriculum called Discovering Healthy Choices, which has a strong foundation in Social Cognitive Theory and constructivist learning theory. Furthermore, the Backward Design method provided the design team with a systematic approach to ensure activities addressed targeted learning objectives and overall Shaping Healthy Choices Program goals. CONCLUSIONS AND IMPLICATIONS The process by which a nutrition curriculum is developed may have a direct effect on student outcomes. Processes by which nutrition curricula are designed and learning objectives are selected, and how theory and pedagogy are applied should be further investigated so that effective approaches to developing garden-enhanced nutrition interventions can be determined and replicated.

Evaluating the Relationships Among Teacher Characteristics, Implementation Factors, and Student Outcomes of Children Participating in an Experiential School-Based Nutrition Program

The purpose of this study was to examine whether teacher characteristics and implementation factors influenced the effectiveness of a multicomponent nutrition education program to improve nutrition-related knowledge and behavior among fourth-grade children. Schools implemented the Shaping Healthy Choices Program (SHCP), a multicomponent nutrition intervention, during 2013-2014. Fourth-grade teachers (n = 8) at two schools facilitated nutrition education using an experiential, garden-enhanced nutrition curriculum among students (n = 173) in their classrooms. Teacher characteristics of teaching experience, self-efficacy in teaching nutrition, and knowledge about nutrition were collected at baseline. Implementation factors of fidelity and completion were measured using self-reports and qualitative observations. Student outcomes included body mass index percentile-for-age, nutrition knowledge, critical thinking skills, and identification of vegetables and were measured pre/post. Relationships were analyzed using multivariate mixed-model regression with classroom as a random effect. Pre/post changes were analyzed using t tests. Students improved body mass index percentile-for-age (−1.99 ± 7.95) and increased nutrition knowledge (2.28 ± 3.40), critical thinking skills (1.98 ± 3.28), and the ability to identify vegetables (0.87 ± 1.09). Teachers’ characteristics of teaching experience, experience teaching nutrition, attendance in a college nutrition course, self-efficacy, and nutrition knowledge were significantly related to fidelity and completeness of program implementation. This study demonstrated implementation of SHCP by teachers can positively influence student outcomes, though program implementation depends on teacher characteristics.