LARIA Research Impact Award 2013: Best use of health research 2013 sponsored by Centre for Health Informatics (CHI)
Food Dudes Health Social Enterprise, partnered with Public Health Walsall MBC and Bangor University
The Food-Dudes Early Years Programme effectively combats obesity and enhances life-long health by improving the eating habits of very young children. It uses the very latest scientific advances in the field of behaviour change. This is a major break-through in approaches to dietary change and the prevention of ill health.
It is now widely recognised that to prevent obesity and improve children’s health it is important to establish healthy eating habits as early as possible. This is the aim of the newly developed Food Dudes Early-Years Programme, which brings about major increases in 2-4 year olds’ consumption of fruit and vegetables (F&V).
The Programme was developed from a partnership between Food Dudes Health Social Enterprise (FDH), Public Health Walsall MBC, and Bangor University. The Food Dudes Primary-School Programme for 5 to 11 year olds has a strong evidence base and has had international success. It brings about big increases in consumption of F&V, reduces consumption of high-energy dense snacks, and transfers effects to the home and to families. The Early-Years Programme featured here is based on the same principles.
In the Walsall trial, the Food Dudes Early-Years Programme increased consumption of fruit by 55% and vegetables by 129% at 3-month follow-up. The results suggest that an evidence-based behaviour change programme is required to change children’s eating habits. The Early-Years trial has driven evidence-based decision-making; the Programme will now be implemented in Walsall, Wolverhampton and the Grampian region of Scotland, before wider roll-out across the UK and further afield.
Developing an Innovative Programme. Because 24.1% of children enter primary-school overweight/obese in Walsall (NCMP 2011/12), Public Health Walsall MBC (PHWMBC) is rolling out the Food-Dudes Full Force Primary-School Programme. This evidence-based programme increases fruit and vegetable (F&V) consumption, reduces consumption of high-energy dense snacks, and transfers the effects to the home and families. Based on the international success and evidence for the Primary-School programme, PHWMBC has taken an innovative step and invested in the development of the Food-Dudes Early-Years Programme that can be delivered in any early-years setting.
Partnership Working. The development, evaluation and funding of this new programme has involved partnership working between Food-Dudes Health Social Enterprise (FDH), PHWMBC and Bangor University (BU). Led by FDH, school caterers prepared F&V, nursery-nurses delivered the programme, PHWMBC invested in and supported the project, and FDH and BU recruited staff though research and growth funding and monitored and evaluated the programme.
Objectives. To create an outcomes based, cost-effective, combined video role-modelling and rewards intervention that is effective in increasing the F&V consumption of 2-4 year olds, in both the short- and long-term that can be run by nursery-nurses and rolled-out anywhere in the world. To create a programme that when commissioned on a large-scale creates jobs and supports the reengineering of local retail outlets by creating demand for healthy foods i.e. local F&V as opposed to unhealthy snacks.
Methodology. The Controlled Evaluation Study from October 2012 to March 2013 consisted of 300+ pupils in 6 nurseries in Walsall schools, with random allocation to Food-Dudes or waiting-control conditions. Settings were matched on class sizes, socio-economic-status and geographic location.#
Food-Dudes Early-Years Programme:
Phase-1 (32 days) – Food-Dudes DVD, one pair of target F&V (8 different F&V identified from our pilot research to be less preferred by preschool children including fig, spinach and cabbage) presented each day on a 4-day cycle, passports to healthy eating and small customized tangible prizes to reward consumption.
Phase-2 (indefinite) – Weekly Food-Dudes picnics with new F&V, group contingency rewards and parental involvement.
Control-settings – Received same F&V as intervention nurseries without DVD or rewards.
Measures. Direct visual measurements of children’s F&V consumption at snack-time was taken over 4 periods: Baseline (before the programme started); Mid Phase-1 (after 16 days); End of Phase-1; Follow-up 3 months after end of Phase-1. Consumption was blind-recorded, and dual-coded from photographs, on a 5-point scale from plate residue.
Results. Analysis showed baseline consumption of F&V was matched across both conditions. At 3-month follow-up children at Food-Dudes nurseries ate twice as many vegetables (consumption increased by 129%), and they ate significantly higher quantities of fruit (consumption increased by 55%), compared to control-settings.
Discussion. The results show the power of an early-intervention based on behaviour change principles and how it can transform children’s eating habits. Importantly, providing F&V alone does not make an impact – an evidence-based behaviour change programme must accompany provision.
Impact. This research has led to evidence-based decision-making by public sector bodies in Walsall, Wolverhampton and the Grampian region of Scotland where they are starting the programme in September 2013. This research will provide the platform to showcase the Food-Dudes Early-Years programme worldwide.
- The success of the Food Dudes Early Years Programme shows the effectiveness of behaviour change principles, which have a very general application.
- The psychological principles include role-modelling, rewards and repeated tasting of F&V. Again these drivers of behaviour change have very general applicability.
- The Food Dudes Full Force Primary School Programme for 5 to 11 year olds has over 20 years of evidence and research and has worldwide success and critical acclaim. It has been shown to increase consumption of F&V, reduce consumption of high-energy dense snacks, and to transfer the effects to the home and to families. The Early Years Programme for 2-4 year olds is based on the same principles and components and these initial results suggest that it is at least as effective as the Primary School Programme.
- The Food Dudes Early Years Programme increases consumption of fruit by 55% and vegetables by 129%, and importantly it increases consumption of F&V that are less preferred by 2-4 year olds including watermelon, broccoli, fig, spinach, cabbage and apricot.
- The results critically demonstrate that providing F&V with no accompanying intervention is ineffective at increasing consumption. An evidence-based programme based on behaviour change principles is essential to initiate behaviour change.
There are supporting research data from: (a) an initial small scale nursery pilot study and (b) related studies with older children
The key findings and published papers from this research are provided via the Food Dudes website.
Photo credit: Food Dudes Health Social Enterprise, partnered with Public Health Walsall MBC and Bangor University winning the 2013 awards.