Investigating factors that influence the effectiveness of school-based nutrition education programs to improve children's health

The first objective of this research was to evaluate the use of a systematic approach and theoretical framework to develop a garden-enhanced, inquiry-based nutrition curriculum for the Shaping Healthy Choices Program (SHCP). The curriculum development team used Backward Design, a process that involves three steps: identification of learning objectives; determination of acceptable evidence of learning; and activity development. The design team met weekly and engaged in reflective practice to discuss drafts of curriculum activities. Activities were further refined using formative assessment methods during pilot-testing with 40 children. Qualitative observations were used to improve activity procedures and materials. Using a systematic, iterative process resulted in a comprehensive nutrition curriculum with a strong foundation in social cognitive theory and constructivist learning theory, and activities that have focused learning objectives that meet SHCP goals. This study has been submitted as a manuscript for peer-review.;The objective of the second experiment was to evaluate the use of professional development to improve barriers to teaching nutrition in public elementary schools. Commonly reported barriers include lack of knowledge about nutrition, self-efficacy, and training. Lesson study (LS) is a professional development method demonstrated to reduce these barriers in the subjects of mathematics and science, and may be effective for nutrition education. It was hypothesized that teachers engaging in LS would improve self-efficacy and knowledge about nutrition. Eight teachers at two schools completed questionnaires at baseline and follow-up to measure changes in self-efficacy and nutrition knowledge. Using LS, teachers worked collaboratively to plan to implement SHCP activities, facilitate SHCP activities, and discuss observations of student learning to improve subsequent lessons.;The purpose of the third investigation was to evaluate whether the influence of SHCP on student outcomes was affected by teachers' characteristics and factors of program implementation. Participating teachers (n=8) from two schools implemented SHCP in their classrooms. The following characteristics were measured through questionnaires administered at baseline: teaching experience; college-level nutrition courses taken; experience teaching nutrition; self-efficacy of teaching nutrition; and knowledge about nutrition. Implementation factors included fidelity of implementation and degree of completion of the program. Fidelity was measured through direct observation in classrooms by trained researchers to observe whether teachers followed the procedures in the curriculum. Degree of completion was reported by teachers through self-report checklists of activities completed. Outcome measures of participating children (n=173) included knowledge about nutrition, critical thinking skills, vegetable identification, and body mass index for age percentile (BMI). Data were analyzed using mixed model linear regression using STATA 12. Children participating in SHCP significantly decreased BMI percentile-for-age, and increased knowledge, critical thinking skills, and ability to identify vegetables. Results indicated a significant influence of multiple teacher characteristics upon degree of completion and fidelity, including years of teaching experience, attendance in nutrition course in college, self-efficacy, and knowledge. Self-efficacy was observed to be a significant influence on changes in students' ability to identify vegetables, though no other relationships were observed. The results of this study demonstrate that SHCP, when implemented by teachers, can positively influence student outcomes related to diet and health. These results also indicated that program implementation depends upon a variety of teacher characteristics. Future studies should investigate how implementation can be improved through professional development to increase the likelihood that nutrition education interventions are implemented fully and with high fidelity of implementation. (Abstract shortened by UMI.).