5-a-day Power Plus: process evaluation of a multicomponent elementary school program to increase fruit and vegetable consumption
Abstract
The 5-a-Day Power Plus program targeted multiethnic fourth- and fifth-grade students in 10 intervention and 10 control urban elementary schools in St. Paul, Minnesota, to increase fruit and vegetable consumption. The intervention included behavioral curricula in classrooms, parental involvement, school food service changes, and food industry support. Process evaluation was conducted by using surveys and classroom and lunchroom observations to assess the characteristics of teachers and food service staff, the degree the intervention was implemented as intended, and exteral factors that may have affected the program results. Results showed high levels of participation, dose, and fidelity for all of the intervention components, with the exception of parental involvement. The process evaluation findings help explain why the increase in fruit and vegetable consumption occurred mostly at school lunch and not at home. Future intervention research should focus on creating new and potent strategies for parental involvement and for increasing the appeal and availability of vegetables.
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Thirteen studies, including four RCTs, were assessed as unclear risk of selection bias as methods of sequence generation and allocation were not reported.
“Thirteen studies, including four RCTs were assessed as unclear risk of selection bias as methods of sequence generation and allocation were not reported [44, 46, 47, 50, 51, 54–56, 58, 64, 66, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [58]
For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups.
“For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups [37, 38, 41, 46, 47, 55, 56, 58, 60, 64, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [58]
For studies using a cluster-RCT design (n = 15), potential risk of recruitment to cluster was assessed as low for seven studies as randomization occurred either postrecruitment or postbaseline data collection.
“Potential risk of recruitment (to cluster) was assessed as low for seven studies as randomization occurred either postrecruitment or postbaseline data collection [47, 54–56, 58, 60, 64].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [58]
Three studies were high risk of bias due to incorrect analysis.
“Three studies were high risk of bias due to incorrect analysis [42, 46, 58], while eight studies were assessed as low risk [27, 37, 38, 41, 54, 56, 64, 67] and the remaining studies (n = 4) at unclear risk [26, 47, 55, 60].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [58]
Across the three studies assessing the availability of fruit and vegetables within schools, the median effect size was 1.15 and ranged from 0.64 to 1.23.
“For example, across the three studies assessing the availability of fruit and vegetables within schools, the median effect size was 1.15 and ranged from 0.64 to 1.23 [42, 55, 58].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [58]
U.S. studies targeting improvements in the availability of fruits and vegetables in à la carte lines typically significantly increased the mean number of fruit and vegetable options available by between 0.5 and 1.37.
“U.S. studies targeting improvements in the availability of fruits and vegetables in à la carte lines typically significantly increased the mean number of fruit and vegetables options available by between 0.5 to 1.37 [58]”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [58]
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- Authors
- Story, M., Mays, R. W., Bishop, D. B., Perry, C. L., Taylor, G., Smyth, M., & Gray, C.
- Affiliations
- University of Minnesota (US)
- Minnesota Department of Health (US)
- Corresponding author
- Story, Mary
- ORCID
- Perry, Cheryl L.
- Venue
- Health Education & Behavior
- Publisher
- SAGE Publications
- Published
- 2000-04
- Volume
- 27
- Issue
- 2
- Pages
- 187-200
- ISSN
- 1090-1981 (ISSN-L)
- 1552-6127
- OpenAlex
- W2156110759
- Cited by
- 112
- References
- 6
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 7 · 2016: 5 · 2015: 10 · 2014: 6 · 2013: 6 · 2012: 10
- FWCI
- 20.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (R01CA059805, CA59805)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- fruit and vegetable intake, school-based nutrition intervention, elementary school students, process evaluation, intervention fidelity, dosage, parental involvement, school meals, multicomponent intervention, urban schools, multi-ethnic students
- MeSH terms
- Child, Curriculum, Diet, Fruit, Health Promotion, Humans, Inservice Training, Minnesota, Outcome and Process Assessment, Health Care, Schools, Vegetables, Program Evaluation, Nutritional Sciences
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