Adoption of nutrition education programmes at primary schools

Abstract

Many nutrition education programmes currently face issues with implementation at schools. Little is known about causes for these issues. Research has shown that implementation of innovations like nutrition education programmes is influenced by adoption which in turn is affected by a multitude of determinants. The first objective of this thesis was to investigate the adoption of nutrition education programmes at primary schools and the association with implementation dose. The second objective was to create a tool to support the adoption of Taste Lessons. School-based nutrition education programmes are regarded as educational innovations in this thesis. An innovation is defined in this thesis as a novel, inventive and useable solutions related to people’s needs. In this context adoption is defined as the process which starts from the moment the teacher hears about the programme until the decision is made whether to use it. The number lessons implemented by the teachers is referred to as the implementation dose in this thesis. To reach the first objective, the adoption of Taste Lessons, EU-Schoolfruit and school-based nutrition education programmes in general, was evaluated. Data analyses were performed to investigate the association of the score on adoption determinants with implementation dose of Taste Lessons. Multilevel analyses were performed to compare the changes in intended programme outcomes over time between implementation dose categories. To reach the second objective, a Delphi study was performed to gain insight into the key stakeholders’ needs in the adoption process of Taste Lessons. In addition to these insights, literature and expert consults were used to develop a tool. This tool aims to support the adoption of Taste Lessons. Twenty-eight determinants important for adoption have been established. Several determinants that could be barriers for the adoption of Taste Lessons and EU-Schoolfruit have been identified. Significant positive associations have been found between implementation dose and the number of support staff, awareness of the programme’s contents, descriptive and subjective norm, and correctness of the programme. A significant negative association has been found with the teacher experiencing support from professionals. The implementation dose was significant positively associated with change in children’s nutrition knowledge. No significant association of the implementation dose with change of children’s fruit and vegetable consumption was found. Based on the above mentioned results in combination with the results from second part of the thesis a tool to support the adoption of Taste Lessons was developed. The digital tool should show teachers how they can tailor the programme to their needs, inform them about the contents, effectiveness and substation of the programme, and stimulate them to take action for implementation. The take home message of this research is that adoption determinants are associated with implementation dose, which in turn, is associated with the programme’s effectiveness. Context specific strategies for support of the adoption phase in the dissemination of nutrition education programmes should be developed, of which the tool developed in this research is an example. The strategy should be based on literature and practice, to ensure the feasibility, desirability and viability.