Fruit in Schools

Healthy Futures: The evaluation of Fruit in Schools - Summary of the 2007 implementation report: “Taking a bite of the apple”

New Zealand Council for Educational Research (NZCER) and Health Outcomes International (HOI), September 2007

What is Fruit in Schools?
The Ministry of Health commissioned NZCER and HOI to evaluate the Fruit in Schools (FIS) initiative. FIS is part of the Ministry of Health’s strategy to improve the health and wellbeing of New Zealanders. Three main government agencies are involved: the Ministry of Health; the Ministry of Education; and Sport and Recreation NZ (SPARC).

FIS has two parts. One is offering a free daily piece of fruit to students who attend about 280 (mostly decile 1) schools in the primary sector. A second part is about supporting these schools to make connections with local health agencies and parents/whänau to address four health areas:

healthy eating
physical activity
sun protection
smokefree

Over three years, schools are expected to develop approaches to these four health areas which encourage students, schools, and the wider school community to make healthy choices.

FIS schools are organised in regional clusters, and lead teachers from FIS schools meet together. Fruit in Schools Coordinators (FISCs) organise the meetings and help schools connect with a team of agency partners from the National Heart Foundation, the Cancer Society, regional sports trusts, and School Support Services, as well as public health nurses and other local health promoters.

What information are we collecting?
As part of the Healthy Futures evaluation we are collecting different types of information about FIS. We are following a group of Year 4 students who go to schools that joined FIS at the start of 2006. Before their school joined FIS, we sent these students a survey about the four health areas. Through 2006-2008 we are asking these students to complete a yearly survey. We are also sending yearly surveys to school staff at FIS schools, and interviewing some of the agency partners who are working with schools. We are also visiting some FIS schools to talk to school staff, students, and parents/whänau.

This summary tells you some of the key findings from a report which summarises all the information we collected in 2006 about FIS. The report is called “Taking a bite of the apple”.

What were the main findings?
The information we collected from different groups of people told similar stories. Principals, teachers, students, and agency partners were enthusiastic about FIS and considered it to be a successful initiative. School staff reported that being part of FIS had increased the focus on health and wellbeing at their school. FIS had also assisted them to develop new or stronger connections with FISC and some agency partners such as public health nurses, the Cancer Society, the National Heart Foundation, and regional sports trusts. As a result, all but a few school staff considered FIS was supporting them to make a range of changes to policies and school activities.

Over 2006, the 591 students we tracked had developed more positive attitudes towards healthy behaviours, increased their knowledge about these behaviours, and in some cases, had started to change their behaviours. In 2006, schools had prioritised two areas – healthy eating and physical activity – and the information we collected from students shows the most change in these two areas. The main changes are summarised below.

Healthy eating
Before FIS, most schools already taught students about healthy eating and had healthy eating policies, but staff recognised the potential to do more. About half of schools had connections with the National Heart Foundation, and three-quarters with public health nurses, which were assisting them to focus on healthy eating. By the end of 2006, staff at most schools reported they had made a number of changes to school policies, practices, and curriculum activities about healthy eating (such as developing units or expos about healthy lifestyles, starting healthy lunch box initiatives, or offering healthier food in school shops). Likewise, most students reported they had learnt “a lot” about healthy eating in 2006. Compared to the baseline survey, the end of 2006 survey showed that:

students’ knowledge about healthy eating behaviours had increased; and
the number of students who ate fruit and vegetables, and the amount they ate, had increased (Some of this increase can be explained by the daily piece of fruit students got at school. But this increase also includes a small change in students’ home eating patterns).

Overall, students also ate a lot of unhealthier foods such as fizzy drinks, takeaways, chips and chippies. With the exception of chips and chippies, most of this food was eaten at home.

These findings suggest that FIS is supporting schools to create a healthy eating environment, and students to increase their knowledge about healthy foods and start to make changes to the food they eat.

Physical activity
The information we collected from students and school staff data about physical activity tells a similar story to the healthy eating information. Before FIS, many schools were already focused on developing a physical activity culture. Even so, school staff noted that this area was also a key focus in 2006, and most reported making a number of changes to the way they did things. These changes included increasing the amount of active things students did in class time or organising community sports days. About half also reported getting help from agency partners such as regional sports trusts or Active Schools facilitators.
Most students reported they had learnt “a lot” about physical activity in 2006. Compared to the baseline survey, the end of 2006 survey showed that:

students’ attitudes towards exercise had become more positive;
students reported doing more active things in the day before the survey;
students reported watching less TV or playing computer games less often in the day before the survey; and
students reported they were doing more active things with their family/whänau.

These findings suggest that FIS was supporting changes to how both schools and students approached physical activity. It is less clear what some of the changes to home behaviours are due to. These changes may be influenced by initiatives other than FIS such as the SPARC Push Play campaign or lifestyle TV programmes.

Sunsmart
Sunsmart was the third priority at the schools, and many staff reported making changes in this area. Examples included making sure their school actioned their sunsmart policy by encouraging students to wear sunhats at school or providing sunscreen, or developing new shade areas. Just under half of schools had connections with the Cancer Society. Most students reported they had learnt “a lot” at school during 2006 about being sunsmart. In line with the changes staff reported, students’ awareness of the importance of being sunsmart, and knowledge about how to be sunsmart, increased over 2006. No changes in students’ actual behaviours were noted.

Smokefree
Schools approached the smokefree area in a different way to the other three health areas. A story runs through the data: although about one-tenth of the Year 4 students reported they had tried smoking, and about half of these smoked one or more cigarettes a week, school staff placed less priority on this area compared with the other health areas. Approximately half of the students reported they had learnt “nothing” at school during 2006 about staying smokefree.

Schools tended to cover smoking with older students. This could be because staff were not aware that younger students were smoking. Many schools did not focus on smokefree in 2006, or plan to in 2007. Schools often explored the other health areas first because of the programmes and support that was available in these areas. In addition, some staff thought the smokefree component of FIS was about smokefree legislation (and not smokefree education for students), and therefore they were “already smokefree”.

Nethertheless, some schools did focus on smokefree and some changes occurred. Over 2006 students’ awareness of the health risks of passive smoking increased and the number of students who reported smoking one or more cigarettes a week decreased. The information we collected suggests that these changes are not necessarily connected to FIS. Instead they result from messages that come from many places including home, school, and the media (such as recent campaigns on TV about smoking in houses and cars).

What do these findings mean?
International and New Zealand research suggests that the changes mentioned above in students’ physical activity behaviours, combined with the changes to healthy eating, are likely to have a positive longer-term impact on young peoples’ health and wellbeing, and success at school. Research also shows that a sense of wellbeing and connectedness to family and school is a preventative factor against risk behaviours such as smoking. The Healthy Futures student data shows a similar connection. Alongside the four health areas, many FIS schools also had a focus on social and emotional health and wellbeing.

Which aspect of school practices were changing?
As you can see above, the information we collected suggests that FIS was supporting many positive changes to occur in schools, and in students’ attitudes, knowledge, and behaviours. Many of the changes schools made were focused around policies and creating a healthy school environment. FIS was also supporting an increased focus on the three of the four health areas within the classroom. Students considered the activities they learnt the most from were those that involved them learning by “doing” or taking action, rather than just learning “about” something. One example of this was students learning about healthy foods then getting points for bringing healthy lunchboxes to school or cooking healthy food at school. Another example was students being given leadership training so they were able to assist other students to develop lunchtime games. FIS appeared to be supporting an increase in these types of activities, but the information we collected suggests that teachers did not always take advantage of the active learning or leadership opportunities they could offer students.

Through FIS schools are encouraged to make connections with their parent/whänau community to work together on health goals. Although staff reported that parents/whänau supported FIS, parental/whänau involvement in FIS was one aspect of the initiative that did not show much change over 2006. Currently, most schools appeared to be using an “information provision” model to make these connections (that is, informing parents/whänau about school activities and encouraging them to support these activities). Fewer activities fitted within an “empowerment” model (that is, developing ways to work alongside parents/whänau on health concerns identified by the community). It is likely that making this change will take time. School staff noted they needed more support in this area. School staff also wanted more support to assist them to teach about the four health areas and were concerned about continuing the free fruit beyond the three-year timeframe of FIS.

Connections with agency partners
Like school staff, representatives from the national and regional agencies involved in FIS showed strong support and enthusiasm for FIS. Working together to support FIS schools had improved communication between agencies and was assisting them to work with schools and coordinate the services they offered. The information collected from schools shows that over 2006, there had been an increase in the depth to which agency partners worked with schools to support them to develop ways to approach the health areas.

Whilst very positive about the success of the interagency approach, agency representatives commonly saw room for improving the effectiveness of FIS. One key issue they identified was their capacity to work with the number of schools involved in FIS. Other issues included the need for those involved in FIS to work in a more consultative way with Mäori and Pasifika communities. They also considered that three years was not enough time for schools to address all four health areas and make longer-term changes. These agency partners were clear that FIS required ongoing leadership at a national level to work through these and other issues, and maintain the high levels of commitment that have been demonstrated.

What next?
School, staff, students, and agency partners thought FIS was a successful initiative, and the changes shown in students’ attitudes, knowledge, and behaviours support this view. School staff considered that many of the changes they were making were becoming part of everyday school practice. Staff at many schools thought that continuing to provide free fruit was necessary to keep the momentum of FIS going, but most had not started planning ways to continue offering fruit once the funding stopped.

One of the purposes of the Healthy Futures study is to suggest ways that the FIS initiative might be strengthened. In the main report seven key ideas about how this could be done are suggested. These are:

offering further resources or professional development to teachers to assist them to teach about the four health areas and use processes that support students to learn by “doing”.
offering further resources and support for school staff about how to involve their parent/whänau community in FIS;
exploring national models of smokefree education for younger students;
exploring ways to focus on social and emotional health and wellbeing alongside the four health areas;
exploring existing and new ways of developing partnerships with Mäori and Pasifika groups at a national, regional, and school level;
exploring ways to support agency partners to work together at both a national and regional level; and
exploring ways to address workforce capacity issues for interagency partners.

Page last updated: 4 September 2007