Grab 5!

Background

In June 2000, Sustain began the three-year project, Grab 5!, to promote fruit and vegetables consumption among 7-11 year olds, with a focus on low income families. In August 2000, two project officers began to coordinate the project, build coalitions and review the existing work.

Between September 2001 and July 2002 the project was tested in primary schools in Lambeth, Leeds and Plymouth.

What is the problem you are trying to solve?

It is now well documented that eating at least five portions of fruit and vegetables a day can help protect against coronary heart disease and some cancers ¹ . People in the UK, however, consume less fruit and vegetables than consumers in many other EU countries, with average intakes of barely three portions a day. Back in 1994, the COMA report on Nutritional Aspects of Cardiovascular Disease recommended a 50% increase in fruit and vegetable consumption. Current Government public health policy sets targets for coronary heart disease and cancers and has incorporated this recommendation as a way of reaching these targets. Grab 5! focused on tackling the main obstacles to increased consumption, namely the acceptability, accessibility and affordability of fruit and vegetables.

What local organisations are involved?

The project officers drew on the expertise and advice of a national working party chaired by Joe Harvey of the Health Education Trust. Members of the working party represented key interest groups from the public, private and voluntary sectors.

How many people are running this project and who are they?

For the first three years of the project, two full time officers worked on the project. For the fourth year, one person worked on the project part-time before it was wrapped up.

What local population are you targeting?

Grab 5! worked with pupils in years 3, 4, 5 and 6 attending schools in Lambeth, Leeds and Plymouth

The project targeted 7-11 year olds because:

• One in five children eats no fruit in a week;
• Eating habits are formed in childhood and there is therefore potential to break unhealthy habits and form healthy ones for years to come;
• Children are keen to learn and schools provide an ideal environment to carry out the work; and by influencing children's eating habits, the diets of whole families can be affected.

Children from poorer families have the lowest consumption of all of fruit and vegetable. The higher rates of morbidity and mortality from all diseases (including coronary heart disease and cancer) amongst poor people are partly due to such dietary differences. The potential health gains from eating more fruit and vegetables are therefore the highest. Working with low income groups is in line with government policy to reduce health inequalities.

How many people are you targeting?

Beyond the small number (26) of primary schools in the three pilot areas, Lambeth, Leeds and Plymouth – Grab 5! will eventually spread to around 1000 schools around the country, reaching approximately 20 000 children.

Interventions

What interventions are you using to address the problem?

We provided schools and school workers with training, practical support, curriculum materials and a toolkit that equipped them with the knowledge and enthusiasm required to promote fruit and vegetables in schools.

We set up a school nutrition action group and developed an action plan so that schools could implement a range of fun, practical activities that encourage children to taste and learn about fruit and vegetables and healthy eating. Typical activities undertaken by schools included setting up fruit tuck shops, growing clubs, cooking classes, fruit and vegetable tasting sessions and health focus weeks.

Is the project design based on evidence? If so, please state reference.

The design of the project was informed by work of the Health Education Trust ² including their publication The Chips are Down ³ , as well as analysis of various other national and international projects and research papers such as those of the National Healthy Schools Standard, the British Heart Foundation Health Promotion Research Group, University of Bangor Food Dudes programme and the Heath Development Agency.

Outcome

What outcomes or planned outcomes are you measuring?

Sustain commissioned an external evaluation which was conducted by the British Heart Foundation Health Promotion Research Group in Oxford University. They used validated surveys appropriate for school children of that age (7-11 years old), as well as interviews with the children and teachers. They measured any change in fruit and vegetable consumption, and change in knowledge, attitudes and beliefs relating to fruit and vegetables.

Do you have any outcomes or results yet? If so, what are they?

1. Changes in consumption

In 2001 the average consumption was 1.7 items of fruit, vegetables or fruit juice per day. In 2002, at the end of the project, there was a significant increase to 2.2 items per day. In particular there was a significant increase in fruit consumption. There was also a significant reduction in high fat snacks. Girls reported a greater increase in consumption than boys, but both increased their fruit and vegetable consumption during the year.

2. Changes in knowledge, attitudes and beliefs

There was a significant increase in knowledge about fruit and vegetables. At the end of the project children also showed a significant increase in preference for healthy food choices.

3. Grab 5! activities

Schools reported a large increase in activities promoting fruit and vegetables involving staff, parents and governors. These included fruit tuck shops, growing clubs, tasting sessions and health focus weeks.

At the end of the year, the children showed that they were aware of the Grab 5! message, that they enjoyed the Grab 5! activities in their schools and that many thought they were eating more fruit and vegetables. Some of the children reported a positive impact at home. Some of the activities generated by the Grab 5! project had made a lasting impression.

Members of the local steering groups revealed that the Grab 5! project officers had successfully established effective multi-agency groups capable of supporting the project. Key members were representatives from the local authority, school meals service and school personnel. All valued the holistic approach of the Grab 5! project.

Is your project relevant to a government target or guideline?

Yes, the Government targets for fruit and vegetable consumption and school food as outlined in ‘Choosing a better diet: a food and health action plan’ ⁴ .

Feedback

What obstacles did you have to overcome to set up this project?

The most difficult thing was getting time with very hard pressed schools with a lot of other demands on their attention. Persuading them of the value of the project was very intensive at the beginning of project. We began at a very low base when healthy eating was not on the agenda of most schools.

What have you learned about the project so far?

The external environment is important. For example, there was no free fruit in schools when the project began and the context of healthy eating in schools has now changed rapidly. It was also difficult managing pilot projects in different parts of the country which required quite a stretch for the two staff members.

What would you do differently?

Nothing

References:

1. World Cancer Research Fund. Food Nutrition and the Prevention of Cancer: a global perspective. 1997.
2. Health Education Trust. 2007. www.healthedtrust.com (accessed 11 April 2007).
3. Harvey J. The Chips are Down: A Guide to Food Policy in Schools. Health Education Trust and Design Dimension Educational Trust. 2000.
4. Department of Health. Choosing a better diet: a food and health action plan. 2005. www.dh.gov.uk (search for 4618, accessed 11 April 2007).