Advertisement

The effect of a school-based fruit and vegetable promotion program on adolescents' fruit and vegetable consumption behavior in Turkey

      Highlights

      • Researchers have noted that especially adolescents tend to eat amounts of fruit and vegetables that are less than the recommended amount for daily consumption.
      • This study was designed with pre-post and follow-up pattern control group and random clustering method.
      • The school-based F&V consumption promotion program was effective in increasing the number of portions of fruits and vegetables students consumed and their behaviors had improved in this regard.
      • The study indicates that the interventions described may be recommended to school nurses for use in their efforts to increase levels of F&V consumption.

      Abstract

      Purpose

      The aim of this study was to analyze the effect of a school-based F&V promotion program developed in line with the transtheoretical model (TTM) on the consumption behavior of middle school students.

      Design and methods

      The study was designed as semi-experimental research with pre−/post- and follow-up tests and a control group. It was conducted at a total of six middle schools in the district of Fethiye/Muğla, Turkey. Three of the schools were selected with the random clustering method as an intervention group and the others as the control group. The F&V promotion program was executed in the intervention group for a period of 24 weeks.

      Results

      It was found in the 6th and 12th months after the intervention that the daily number of portions of fruits (p < .01) and vegetables (p < .01) consumed by the students in the intervention group was significantly more compared to the control group. The perception of the pros of F&V consumption and self-efficacy in the intervention group were higher than in the controls (p < .01).

      Conclusions

      The school-based F&V consumption promotion program was effective in increasing the number of portions of fruits and vegetables students consumed and in improving their behaviors in this regard.

      Application to practice

      The study indicates that the interventions described may be recommended to school nurses for use in their efforts to increase levels of F&V consumption.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Adams M.A.
        • Ohri-Vachaspati P.
        • Richards T.J.
        • Todd M.
        • Bruening M.
        Design and rationale for evaluating salad bars and students’ fruit and vegetable consumption: A cluster randomized factorial trial with objective assessments.
        Contemporary Clinical Trials. 2019; 77: 37-45
        • Arrizabalaga-López M.
        • de Jáuregui D.R.F.
        • Portillo M.P.
        • Martinez O.
        • Etaio I.
        • Mauleon J.R.
        • Rodríguez V.M.
        A randomised controlled trial of a program based on the theory of planned behavior to promote fruit and vegetable intake among schoolchildren: PROFRUVE study protocol.
        BMC Public Health. 2018; 18: 827
        • Atıcı Şimşek M.
        • İlhan N.
        Adolesanlarda obezite ile ilişkili faktörler: Kesitsel bir çalışma Halk Sağlığı Hemşireliği Dergisi.
        . 2021; 3: 31-44
        • Aygün Ö.
        • Muslu G.K.
        Vegetable and fruit consumption behaviours of secondary and high school students (Ortaokul ve lise öğrencilerinin sebze ve meyve tüketimi davranışları [Turkish]).
        Turkish Journal of Family Medicine and Primary Care. 2017; 11: 245-255
        • Aygun O.
        • Muslu G.K.
        The effect of a school-based sun protection program on students’ sun protection behavior in Turkey.
        Journal of Pediatric Nursing. 2021; 59: e61-e69
        • Brick L.A.
        • Redding C.A.
        • Paiva A.L.
        • Harlow L.L.
        • Velicer W.F.
        Intervention effects on stage of change membership and transitions among adolescent energy balance behaviors.
        Multivariate Behavioral Research. 2017; 52: 485-498
        • Carfora V.
        • Caso D.
        • Conner M.
        Randomized controlled trial of a messaging intervention to increase fruit and vegetable intake in adolescents: Affective versus instrumental messages.
        British Journal of Health Psychology. 2016; 21: 937-955
        • Çavdar S.
        • Sümer E.Ç.
        • Eliaçık Arslan A.
        • Koyun B.
        • Korkmaz N.
        • Kanık A.
        • Alikaşifoğlu M.
        Health behaviors in high school students in İzmir, Turkey.
        Turkish Pediatrics Archive/Turk Pediatri Arsivi. 2016; 51: 22-34
        • Daly A.N.
        • O’Sullivan E.J.
        • Kearney J.M.
        Considerations for health and food choice in adolescents.
        Proceedings of the Nutrition Society. 2021; 1-30
        • De Carvalho M.C.R.
        • de Menezes M.C.
        • Toral N.
        • Lopes A.C.S.
        Effect of a Transtheoretical model-based intervention on fruit and vegetable intake according to perception of intake adequacy: A randomized controlled community trial.
        Appetite. 2021; 161105159
        • De Menezes M.C.
        • de Deus Mendonça R.
        • Ferreira N.L.
        • Guimarães L.M.F.
        • Lopes A.C.S.
        Promoting fruit and vegetable consumption: Methodological protocol of a randomized controlled community trial.
        Contemporary Clinical Trials Communications. 2018; 10: 131-136
        • Di Noia J.
        • Byrd-Bredbenner C.
        Determinants of fruit and vegetable intake in low-income children and adolescents.
        Nutrition Reviews. 2014; 72: 575-590
        • Di Noia J.
        • Contento I.R.
        • Prochaska J.O.
        Computer-mediated intervention tailored on transtheoretical model stages and processes of change increases fruit and vegetable consumption among urban African-American adolescents.
        American Journal of Health Promotion. 2008; 22: 336-341
        • Di Noia J.
        • Schinke S.P.
        • Prochaska J.O.
        • Contento I.R.
        Application of the transtheoretical model to fruit and vegetable consumption among economically disadvantaged African-American adolescents: Preliminary findings.
        American Journal of Health Promotion. 2006; 20: 342-348
        • Duncan M.J.
        • Eyre E.
        • Bryant E.
        • Clarke N.
        • Birch S.
        • Staples V.
        • Sheffield D.
        The impact of a school-based gardening intervention on intentions and behaviour related to fruit and vegetable consumption in children.
        Journal of Health Psychology. 2015; 20: 765-773
        • Ergün A.
        • Kadıoğlu H.
        • Erol S.
        Adölesan sebze meyve tüketimi karar alma ölçeğinin türkçe formunun geçerlik ve güvenirliği. [S Üner, E Irgil, H Erengin et al., editors]. Antalya: HASUDER. In 16.
        Ulusal Halk Sağlığı Kongresi Kitabı, 2013: 411
        • Erol S.
        • Ergün A.
        • Kadıoğlu H.
        Transtheoretic model-based adolescent vegetable and validity and reliability study of fruit consumption scales. (Transteoretik model temelli adölesan sebze ve meyve tüketimi ölçeklerinin geçerlilik ve güvenirlik çalışması [Turkish]). Vehbi Koc Foundation Nursing Fund.
        2012 (2011–2)
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.
        G* power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behavior Research Methods. 2007; 39: 175-191
        • Grosso G.
        • Micek A.
        • Godos J.
        • Pajak A.
        • Sciacca S.
        • Galvano F.
        • Boffetta P.
        Health risk factors associated with meat, fruit and vegetable consumption in cohort studies: A comprehensive meta-analysis.
        PLoS One. 2017; 12e0183787
        • Gür K.
        • Erol S.
        • Kadıoğlu H.
        • Ergün A.
        Transteoritik model temelli sebze meyvedostu programının ortaokul öğrencilerinin sebze ve meyve tüketimine etkisi. 1. Ulusal Halk Sağlığı Hemşireliği Kongresi, İzmir, Türkiye, 17–21 Haziran 2015, ss.81.
        2015
        • Gur K.
        • Erol S.
        • Kadioglu H.
        • Ergun A.
        • Boluktas R.
        The impact on adolescents of a Transtheoretical model-based programme on fruit and vegetable consumption.
        Public Health Nutrition. 2019; 22: 2500-2508
        • Gür K.
        • Toptaner N.E.
        • Alkulak F.
        • Ergitürk Ö.
        • Yumuşak N.
        • Güneş N.
        The effects of fruit and vegetable friendly programme on visually-ımpaired students’ decision-making and change processes (Sebze-meyve dostu programı″nın görme engelli öğrencilerin karar alma ve değişim sürecine etkisi [Turkish]).
        Turkiye Klinikleri J Public Health Nurs-Special Topics. 2016; 2: 41-46
        • Gustafson A.
        • Jilcott Pitts S.B.
        • McQuerry K.
        • Babtunde O.
        • Mullins J.
        A Mentor-led text-messaging intervention increases intake of fruits and vegetables and goal setting for healthier dietary consumption among rural adolescents in Kentucky and North Carolina, 2017.
        Nutrients. 2019; 11: 593
        • Hargreaves D.
        • Mates E.
        • Menon P.
        • Alderman H.
        • Devakumar D.
        • Fawzi W.
        • Patton G.C.
        Strategies and interventions for healthy adolescent growth, nutrition, and development.
        The Lancet. 2021; 399: 198-210
        • Hashemzadeh M.
        • Rahimi A.
        • Zare-Farashbandi F.
        • Alavi-Naeini A.M.
        • Daei A.
        Transtheoretical model of health behavioral change: A systematic review.
        Iranian Journal of Nursing and Midwifery Research. 2019; 24: 83
        • Hildebrand D.A.
        • Betts N.M.
        Assessment of stage of change, decisional balance, self-efficacy, and use of processes of change of low-income parents for increasing servings of fruits and vegetables to preschool-aged children.
        Journal of nutrition education and behavior. 2009; 41: 110-119https://doi.org/10.1016/j.jneb.2008.09.007
        • Hodder R.K.
        • O’Brien K.M.
        • Tzelepis F.
        • Wyse R.J.
        • Wolfenden L.
        Interventions for increasing fruit and vegetable consumption in children aged five years and under.
        Cochrane Database of Systematic Reviews. 2020; 5
        • Horwath C.C.
        • Nigg C.R.
        • Motl R.W.
        • Wong K.T.
        • Dishman R.K.
        Investigating fruit and vegetable consumption using the transtheoretical model.
        American Journal of Health Promotion. 2010; 24: 324-333
        • Hutchinson J.
        • Christian M.S.
        • Evans C.E.L.
        • Nykjaer C.
        • Hancock N.
        • Cade J.E.
        Evaluation of the impact of school gardening interventions on children’s knowledge of and attitudes towards fruit and vegetables. A cluster randomised controlled trial.
        Appetite. 2015; 91: 405-414
        • Ismail M.R.
        • Seabrook J.A.
        • Gilliland J.A.
        Process evaluation of fruit and vegetables distribution interventions in school-based settings: A systematic review.
        Preventive Medicine Reports. 2021; 21101281
        • Jalambadani Z.
        • Garmarodi G.
        • Yaseri M.
        • Tavousi M.
        • Jafarian K.
        The effect of education on reducing fast food consumption in obese ıranian female adolescents: An application of the transtheoretical model and the theory of planned behaviour.
        Iranian Red Crescent Medical Journal. 2017; 19
        • Kadioglu H.
        • Erol S.
        • Ergun A.
        Reliability and validity of the Turkish version of the situational self-efficacy scale for fruit and vegetable consumption in adolescents.
        American Journal of Health Promotion. 2015; 29: 273-275
        • Kebbe M.
        • Perez A.
        • Buchholz A.
        • McHugh T.L.F.
        • Scott S.S.
        • Richard C.
        • Ball G.D.
        Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity: A multi-Centre, qualitative study.
        PLoS One. 2018; 13e0209219
        • Kibr G.
        The health benefits of vegetables; preventive ımplications for chronic non-communicable diseases.
        • Kolbe L.J.
        School health as a strategy to improve both public health and education.
        Annual Review of Public Health. 2019; 40: 443-463
        • Mandracchia F.
        • Llauradó E.
        • Tarro
        • del Bas J.M.
        • Valls R.M.
        • Pedret A.
        • Radeva P.
        • Arola L.
        • Solà R.
        • Boqué N.
        Potential use of mobile phone applications for self-monitoring and increasing daily fruit and vegetable consumption: A systematized review.
        Nutrients. 2019; 11: 686
        • Nakabayashi J.
        • Melo G.R.I.
        • Toral N.
        Transtheoretical model-based nutritional interventions in adolescents: A systematic review.
        BMC Public Health. 2020; 20: 1-14
        • Ng W.M.
        • Cheung K.
        A feasibility study of a WhatsApp-delivered Transtheoretical model-based intervention to promote healthy eating habits for firefighters in Hong Kong: A cluster randomized controlled trial.
        Trials. 2020; 21: 1-11
        • Pedersen S.
        • Grønhøj A.
        • Thøgersen J.
        Texting your way to healthier eating? Effects of participating in a feedback intervention using text messaging on adolescents’ fruit and vegetable intake.
        Health Education Research. 2016; 31: 171-184
        • Pekcan G.
        Turkey dietary guidelines. Republic of Turkey Ministry of Health Public Health Agency of Turkey. 1046, Ankara.
        (Retrived from)
        • Prochaska J.O.
        • Redding C.A.
        • Evers K.E.
        The transtheoretical model and stages of change.
        Health Behavior: Theory, Research, and Practice. 2015; : 97
        • Ragelienė T.
        • Aschemann-Witzel J.
        • Grønhøj A.
        Efficacy of a smartphone application-based intervention for encouraging children’s healthy eating in Denmark.
        Health Promotion International. 2021; 37
        • Selamat R.
        • Raib J.
        • Aziz N.A.A.
        • Zulkafly N.
        • Ismail A.N.
        • Mohamad W.
        • Mokhtar A.H.
        Fruit and vegetable intake among overweight and obese school children: A cluster randomised control trial.
        Malaysian Journal of Nutrition. 2021; 27: 67-79
        • Wang D.D.
        • Li Y.
        • Bhupathiraju S.N.
        • Rosner B.A.
        • Sun Q.
        • Giovannucci E.L.
        • Hu F.B.
        Fruit and vegetable intake and mortality: Results from 2 prospective cohort studies of US men and women and a meta-analysis of 26 cohort studies.
        Circulation. 2021; 143: 1642-1654
        • Yip C.S.C.
        • Chan W.
        • Fielding R.
        The associations of fruit and vegetable intakes with burden of diseases: A systematic review of meta-analyses.
        Journal of the Academy of Nutrition and Dietetics. 2019; 119: 464-481