A summative evaluation study

Overview

Dairy Council of California conducted a summative evaluation of their kindergarten nutrition program—Building a healthy me! Stacking up choices for good nutrition. This school-based nutrition program targets kindergarten-age children and their parents. It draws heavily on studies linking nutrition to improved school performance and utilizes brain-based research to enhance learning. Designed to be fun and flexible, it blends easily with teachers' usual instructional sequences. Six lessons include a classroom and a home component to educate both parents and students.

Dairy Council of California is dedicated to giving Californians the knowledge to make healthy food choices for a lifetime. Building a healthy me! offers parents a review of good nutrition for their families and builds a foundation for healthy eating for kindergarten students. In the 1998-1999 school year, the new program was field-tested by 45 kindergarten teachers. The results of this formative testing were very positive. The program underwent final revisions June-August 1999 and teacher recruitment for the summative evaluation began Fall 2000. The purpose of this study was to determine if the program could improve the knowledge, attitude and behavior of students, parents and teachers.

Implementation

Fifty teachers conducted extensive field-testing January-May 2001 that included two intervention groups and a control group. School sites were systematically assigned, which were chosen to be representative of California public school demographics for ethnicity/race, percent English language learners, and percent free/reduced lunch. The sample was geographically diverse, with sites statewide from San Diego to Sacramento. There were 19, 21 and 11 classes assigned to Groups 1, 2 and 3, respectively. One Group 1 class dropped out before completing the study. Teachers received a $50 gift certificate for completing the study.

The sample matched the state composite at baseline, except that the sample had 4 percent Asians compared with 8 percent in public elementary schools. There was a 93 percent response rate for the three student tests. Out of 1,100 eligible families, parent response rates were 67 percent for survey one, 54 percent for survey two, and 50 percent for survey three. Consistent with prior Dairy Council of California survey responses, 85.4 percent of surveys were completed by the mother. Groups were similar except that Group 3 had more college graduates and more white, non-Latino families with incomes above $75,000.

Student tests and parent and teacher Surveys were administered at three time points, six weeks apart (see Table). All three groups of teachers, students and parents were asked to take the Tests and surveys within one week of the test dates of January 1, February 21 and April 25. Intervention Group 1 completed Test 1 followed by program implementation and two post-tests. The lessons were implemented in intervention Group 2 after the completion of tests one and two The purpose of two intervention groups was to identify if students would retain information in Group 1, and if Group 2 performed better as their skill level increased later in the year. Test 3 functioned as the post-test. Group 3 served as the control group, administering parent and teacher surveys and student tests only.

Table

Intervention classroom teachers taught all of the program lessons and sent home via students the family homework, nutrition newsletter information, and a parent information booklet- the Home Connection—on nutrition. Teachers completed a questionnaire regarding each program component and a questionnaire on their knowledge, attitudes and behaviors toward nutrition. Fourteen Dairy Council of California nutrition education staff conducted 26 classroom lesson observations to document implementation intensity and student reaction.

Results

Parents observed significant changes in their child's behavior at the conclusion of the program. Group 1 and 2 students demonstrated changes in knowledge such as naming the food group colors (28 percent and 20 percent, respectively), talking about the food groups (37 percent and 56 percent), and singing songs about the food groups (14 percent and 11 percent). Parents also noted healthier behaviors such as asking more often for breakfast (19 percent and 9 percent), interest in cooking (26 percent and18 percent), and requesting healthy snacks (28 percent and 21 percent).

Parents completed three 24-hour dietary recalls for the children. Analysis of the recalls showed some significant changes immediately following the program, but the changes in Group 1 were not sustained until Test 3. Fruit consumption increased in Group 1 and 2 (4 percent and 28 percent, respectively). There was a decrease in extras, which includes Sweets, Oils and Fats, (13 percent and 22 percent). Consumption of Meats, Beans and Nut group foods also decreased in both groups (2.8 percent and 8.3 percent). Consumption of Bread, Dairy and Vegetable group foods remained stable in all three groups throughout the test period.

The nutrition education information parents received from Dairy Council of California via take-home pieces from their child had a positive impact. The booklet was read by 93 percent of the intervention families that recalled receiving the booklet. Over two-thirds of the Group 2 parents found the Home Connection booklet useful and half of all intervention parents discussed nutrition with their child (55 percent and 70 percent).

Teachers administered three tests to students in class. Immediately following the program, students in the intervention groups were 60 percent more knowledgeable compared to the control group. Both intervention groups also had twice as much understanding of the USDA's Food Guide Pyramid. In addition, 40 percent more students correctly chose dairy as the most important food for strong teeth and bones post-intervention.

For the first time, teacher nutrition knowledge was assessed. Group 1 showed knowledge gains immediately following the program, and remained slightly above baseline six weeks post-intervention. Group 2 had a steady linear increase in knowledge from Test 1 to Test 3. Teachers reported that the program encouraged them to make personal improvements: "This really helped me to be conscious of my own eating." As a role model in the classroom, it is imperative that educators have a good understanding of nutrition and follow these principles.

Conclusions

Evaluation of Building a healthy me! Stacking up choices for good nutrition validated the initial testing that the program achieves its desired outcomes. Students understood the Food Guide Pyramid and improved their nutrition knowledge, which is the first step toward making healthy food choices. They also improved their attitude toward breakfast and were willing to try new foods, according to both parents and teachers.

The ultimate goal of the program is to empower students and parents to have a well-balanced diet. Behavior was positively impacted—healthier snacks were requested and more parents reported their children helped plan and prepare meals. Post intervention, the mean consumption of student servings was close to the recommended number of servings for the milk and dairy products group (2.26 servings), the bread, cereal and grain group (5.12 servings), the fruit group (1.83 servings), and meats, beans and nuts food group (2.85 servings). Mean vegetable servings were 1.38, less than the 3-5 recommended daily servings. Students in Groups 1 and 2 had a statistically significant increase in their fruit intake and decrease in their extra consumption. This might suggest the program encouraged parents to replace less-nutritious snacks from the Extra group with fruit. Parents noticed these changes and nutrition became a conversation topic at home. The Home Connection booklet, nutrition newsletter and family homework were received and read, supporting the information students shared in the home. These multiple influences reinforced the program's nutrition concepts to students as well as to the parent who prepares most of the child's meals.

Group 1 and 2 results were not parallel, with Group 2 attaining better results overall. Likely, teacher talent plays a substantial role in student, parent and teacher outcome. This was the first time a change in teacher knowledge was measured and the results were positive, demonstrating that the program improves teacher nutrition knowledge. Teachers' reports indicated there was an improvement in their own diets. Any dietary improvements educators make will reinforce the positive health habits modeled to students in the program.

The program met its major objectives of improving the knowledge, attitudes and behaviors of students. Parents and teachers also made improvements in these three areas. Building a healthy me! Stacking up choices for good nutrition is a valuable component of school health.

Check out this link to Building a healthy me! to review these kindergarten program materials.