External  Evaluation  of  Fruit  in  Schools  Final  Report  

January  2015  

 

 

 

Prepared  for  

5+  A  Day  Charitable  Trust  

By    

Judith  Ball  and  Carolyn  Watts  

 

 

                                                                                     

   The  5+  A  Day  Charitable  Trust,  PO  Box  66047,  Beach  Haven,  Auckland  0749  Ph:  09  480  5057  Fax:  09  480  5058  Web:  www.5aday.co.nz  

 

 

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Contents  Contents  .......................................................................................................................................................  2  

Executive  summary  ......................................................................................................................................  3  

1.  Introduction  .............................................................................................................................................  7  

2.  Fruit  in  Schools  Programme  description  ..................................................................................................  9  

2.1  History  of  Fruit  in  Schools  ..................................................................................................................  9  

2.2  International  context  .......................................................................................................................  11  

2.3  Findings  of  Previous  Evaluations  ......................................................................................................  12  

2.4  Current  structure  and  operation  of  Fruit  in  Schools  ........................................................................  13  

3.  Findings:  Benefits  of  Fruit  in  Schools  .....................................................................................................  15  

3.1  Fruit  in  Schools  feeds  hungry  children  .............................................................................................  15  

3.2  Fruit  in  Schools  contributes  to  academic  outcomes  ........................................................................  16  

3.3  Fruit  in  Schools  Improves  health  ......................................................................................................  18  

3.4  Fruit  in  Schools  supports  a  healthy  school  environment  .................................................................  20  

3.5  Fruit  in  Schools  supports  a  healthy  home  environment  ..................................................................  24  

3.6  Overall  benefit  of  Fruit  in  Schools  ....................................................................................................  25  

4.  Findings:  Success  Factors  and  Suggestions  ............................................................................................  27  

4.1  Which  programmes  are  most  valued  by  schools  and  why?  .............................................................  27  

4.2  Success  factors  for  Fruit  in  Schools  ..................................................................................................  28  

4.3  How  could  the  Fruit  in  Schools  programme  and  resources  be  improved?  ......................................  29  

5.  Evaluative  conclusions  ...........................................................................................................................  30  

References  .................................................................................................................................................  33  

Appendix  A:  Evaluation  methods  ...............................................................................................................  34  

 

 

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Executive  summary    Evaluation  outline  This  report  presents  the  findings  of  an  independent  evaluation  of  Fruit  in  Schools  conducted  by  Quigley  and  Watts  Ltd  in  late  2014.  The  primary  purpose  of  the  evaluation  was  to  understand  and  document  the  benefits  of  Fruit  in  Schools,  in  particular  any  wider  health  promotion  impacts,  with  a  particular  focus  on  nutrition  and  healthy  eating.          The  evaluation  drew  on  a  range  of  information  sources  including  findings  from  an  online  survey  of  principals  of  Fruit  in  Schools  schools  (n=378)  with  a  response  rate  of  81%;  16  key  informant  interviews  with  school  principals,  Health  Promoting  Schools  facilitators,  and  a  Ministry  of  Health  official;  and  previous  Fruit  in  Schools  evaluations.  

Programme  description  The  Fruit  in  Schools  programme  is  funded  by  the  Ministry  of  Health  and  provides  a  piece  of  fresh  produce  for  each  child  each  school  day  in  low  decile  primary  and  intermediate  schools.  A  wide  range  of  high  quality  fruit  and  vegetables  are  supplied,  with  an  emphasis  on  seasonal  local  produce.  Each  school  has  developed  its  own  processes  for  storage  and  distribution  of  the  fruit.    As  at  September  2014,  there  were  about  480  schools  participating  in  the  Fruit  in  Schools  programme.      Benefits  of  Fruit  in  Schools      Principals  valued  Fruit  in  Schools  highly,  and  believed  it  was  very  beneficial  for  their  school  and  the  wider  community.  Survey  respondents  were  asked  to  rate  the  overall  effect  of  Fruit  in  Schools  on  a  scale  from  1  (‘Has  had  no  positive  effect’)  to  10  (‘Has  had  a  very  positive  effect’).  87%  rated  it  8,  9,  or  10,  with  46%  of  principals  giving  Fruit  in  Schools  the  highest  possible  rating  –  10.        

Key  informants  advocated  strongly  for  the  continuation  of  the  programme,  and  expressed  concern  about  what  would  happen  if  Fruit  in  Schools  ended.  Findings  about  the  specific  benefits  of  the  programme  are  summarised  below.    

Feeding  hungry  children  

According  to  principals,  feeding  hungry  children  is  the  number  one  benefit  of  Fruit  in  Schools.  85%  of  principals  surveyed  reported  their  school  had  fewer  hungry  children  as  a  result  of  Fruit  in  Schools.  80%  reported  reduced  stigma  as  a  result  of  Fruit  in  Schools,  and  said  that  children  were  more  willing  to  ask  for  food  if  they  were  hungry.  Principals  said  that  children  coming  to  school  hungry  or  bringing  little  or  no  lunch  was  a  significant  issue  in  low  decile  schools.    

Educational  benefits  

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In  the  survey,  72%  of  principals  agreed  or  strongly  agreed  that  ‘if  Fruit  in  Schools  was  ended,  academic  outcomes  would  suffer.’  Principals  explained  that  the  main  way  fruit  provision  contributed  to  academic  outcomes  was  by  providing  ‘brain  food’  that  enabled  children  to  concentrate  and  stay  on  task,  and  74%  reported  they  had  observed  increased  concentration  in  class  as  a  result  of  Fruit  in  Schools.  Many  principals  also  observed  that  Fruit  in  Schools  was  contributing  to  learning  by  providing  authentic  learning  opportunities  (89%),  reducing  behaviour  problems  (46%),  and  improving  attendance  and  engagement  (60%).    

Health  benefits  

Both  principals  and  Health  Promoting  Schools  facilitators  agreed  that  Fruit  in  Schools  was  providing  direct  health  benefits  for  children  in  low  decile  schools  due  to  increased  consumption  of  fresh  produce,  and  wider  dietary  changes  triggered  by  Fruit  in  Schools.  For  example,  in  the  survey:  

• 66%  of  principals  reported  they  had  observed  an  improvement  in  students’  general  health  as  a  result  of  Fruit  in  Schools;    

• 43%  had  observed  fewer  cases  of  school  sores  and  skin  infections;    • 35%  said  students  had  fewer  sick  days  due  to  Fruit  in  Schools;    • 91%  agreed  or  strongly  agreed  that  ‘the  overall  health  of  children  would  decline’  if  Fruit  in  

Schools  was  ended;  and    • 97%  agreed  or  strongly  agreed  that  ‘if  fruit  in  schools  was  ended  many  of  our  kids  would  eat  

little  or  no  fruit’.  

Interviewees  agreed  that  a  key  benefit  of  Fruit  in  Schools  was  the  normalising  of  fruit  eating,  and  the  instilling  of  positive  habits  and  attitudes  to  healthy  eating.    

• All  principals  (100%)  reported  that  Fruit  in  Schools  contributes  to  awareness  among  staff  and  pupils  about  the  importance  of  healthy  eating  

• All  principals  (100%)  said  Fruit  in  Schools  contributed  to  positive  attitudes  among  pupils  about  eating  fruit  and  vegetables  

• Almost  all  reported  that  the  programme  contributed  to  awareness  about  the  ‘5+  a  day’  message  (99%),  and  increased  knowledge  among  pupils  about  nutrition  and  health  (98%).  

Supporting  a  healthy  school  environment  

Key  informants  reported  that  Fruit  in  Schools  had  been  part  of  a  culture  change  towards  addressing  child  health  and  wellbeing  as  a  core  education  issue.  Fruit  in  Schools  was  seen  as  having  cultural  and  social  benefits  as  well  as  educational  and  health  benefits,  for  example  95%  of  principals  said  Fruit  in  School  contributes  to  a  sense  of  equality  between  pupils  regardless  of  their  family  circumstances.    

Almost  all  participating  schools  had  broader  nutrition  and  healthy  lifestyle  initiatives  in  place,  including  healthy  food  policies,  school  gardens  and  orchards,  and  healthy  lunchbox  initiatives  for  example.    Health  Promoting  Schools  facilitators  commented  that  such  changes  made  by  schools  were  generally  

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maintained  long  term.    96%  of  survey  respondents  agreed  or  strongly  agreed  that  Fruit  in  Schools  helps  to  keep  health  and  wellbeing  on  the  agenda.    

Schools  differed  in  the  extent  to  which  wider  health  promotion  initiatives  were  directly  attributable  to  Fruit  in  Schools.  Some  schools  saw  Fruit  in  Schools  as  the  catalyst  and  foundation  for  their  wider  healthy  lifestyle  approach,  whereas  other  schools  introduced  health  promotion  initiatives  before  or  at  the  same  time  as  Fruit  in  Schools  and  therefore  saw  it  as  a  complementary  programme  rather  than  a  catalyst.    

Supporting  a  healthy  home  environment  

Principals  reported  that  Fruit  in  Schools  was  having  a  positive  impact  on  children’s  home  environment  and  parental  behaviours,  at  least  in  some  families.  For  example  44%  of  principals  reported  that  ‘many  families’  were  providing  less  sugary  drinks  and  junk  food  in  school  lunches,  and  a  further  40%  said  ‘a  few  families’  were  doing  so.    

Success  factors  for  Fruit  in  Schools  

The  majority  of  key  informants  agreed  that  Fruit  in  Schools  was  successful  because:  

• It  is  meeting  a  genuine  need  and  making  a  real  difference  • It  is  very  well  managed,  and  easy  for  schools  to  participate  • The  fruit  and  vegetables  provided  are  varied  and  of  high  quality    • It  has  been  consistent  and  reliable  over  many  years  

These  factors,  and  that  fact  that  the  programme  is  delivered  at  no  cost  to  schools  or  communities,  have  made  Fruit  in  Schools  sustainable  from  the  schools’  perspective.      

How  could  Fruit  in  Schools  be  improved?  

Several  principals  and  Health  Promoting  Schools  facilitators  said  the  programme  should  be  expanded  to  higher  decile  schools,  since  food  insecurity  and  poor  nutrition  are  not  limited  to  decile  one  and  two  schools.    This  finding  was  also  reflected  in  the  survey  with  83%  of  principals  agreeing  or  strongly  agreeing  that  ‘Fruit  in  Schools  should  be  extended  and  made  available  to  all  decile  3  and  4  schools.’  One  Health  Promoting  Schools  facilitator  said  the  programme  should  be  expanded  to  low  decile  secondary  schools  so  that  the  good  eating  habits  continue  to  be  supported  as  children  grow  up.    

Most  principals  were  satisfied  with  the  nutrition-­‐related  teaching  resources  available,  however  a  lack  of  resources  in  Te  Reo  Māori  was  an  issue  for  Māori  immersion  schools.    

Conclusion    

Based  on  the  findings  of  the  current  evaluation,  we  conclude  that  Fruit  in  Schools  is  an  effective  food  and  nutrition  programme  with  wide  ranging  benefits.  It  is  highly  valued  by  schools  and  well  aligned  with  international  evidence  on  how  to  improve  nutrition  and  reduce  obesity  in  children.  

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The  findings  of  the  current  evaluation  reinforce  and  update  the  findings  of  previous  evaluations  and  show  that  Fruit  in  Schools  is  still  a  much  needed  and  highly  valued  programme.  We  recommend  that  Fruit  in  Schools  is  continued  and  consideration  is  given  to  the  expansion  of  the  programme  to  decile  3  and  4  schools,  and  low  decile  secondary  schools.    

 

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1.  Introduction    

The  Fruit  in  Schools  programme  is  funded  by  the  Ministry  of  Health  and  supplies  a  piece  of  fresh  produce  for  each  child  each  school  day  in  low  decile  schools.  United  Fresh  New  Zealand  Incorporated  delivers  the  fresh  produce  and  The  5+  A  Day  Charitable  Trust  supports  the  programme  with  curriculum-­‐linked  resources  sent  free  to  schools.  

In  mid-­‐2014,  5+  A  Day  commissioned  Quigley  and  Watts  Ltd  to  conduct  an  independent  evaluation  of  the  programme.  This  report  presents  the  findings  of  the  external  evaluation.    

Evaluation  objectives      The  primary  purpose  of  the  evaluation  was:  

• to  understand  and  document  the  benefits  of  Fruit  in  Schools,  in  particular  any  wider  health  promotion  impacts,  with  a  particular  focus  on  nutrition  and  healthy  eating.        

 Secondary  aims  were:  

• to  explore  success  factors  for  Fruit  in  Schools,  and  other  programmes  that  support  child  health  and  health  promotion  in  schools    

• to  gain  feedback  on  teaching  resources  provided  through  the  5+  A  Day  Charitable  Trust    • to  explore  how  the  programme  could  be  improved.  

 

Evaluation  methods  The  evaluation  used  both  quantitative  and  qualitative  methods  and  drew  on  a  range  of  information  including:  

• Findings  from  an  online  survey  of  principals  of  Fruit  in  Schools  schools  (n=378)  • 10  key  informant  interviews  with  principals  at  Fruit  in  Schools  schools  • 5  key  informant  interviews  with  Health  Promoting  Schools  facilitators    • 1  key  informant  interview  with  a  Ministry  of  Health  official  • Previous  evaluations  of  Fruit  in  Schools,  and  other  programme  documents.    

The  methods  are  described  in  full  in  Appendix  A.    

Structure  of  the  evaluation  report  The  report  is  organised  around  the  evaluation  objectives  above.  It  begins  with  a  programme  description,  including  a  brief  summary  of  findings  from  previous  evaluations,  and  international  findings  about  similar  programmes.  This  is  followed  by  two  sections  detailing  the  findings  of  the  current  evaluation  about  the  benefits  of  Fruit  in  Schools,  and  about  success  factors  of  the  programme  and  suggestions  for  

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improvement.    The  concluding  section  brings  the  evaluation  findings  together  and  presents  conclusions  about  the  overall  effectiveness  of  the  programme.    Appendix  A  provides  detail  about  the  evaluation  methods  and  Appendix  B  contains  the  full  findings  of  the  Fruit  in  Schools  survey  of  principals.  

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2.  Fruit  in  Schools  Programme  description    

This  section  describes  the  purpose,  history  and  current  operation  of  Fruit  in  Schools.  It  also  presents  a  summary  of  the  findings  of  previous  Fruit  in  Schools  evaluations.  It  is  based  primarily  on  programme  documents  and  evaluation  reports,  supplemented  by  key  informant  interviews.    

 

2.1  History  of  Fruit  in  Schools    

Origins  

United  Fresh  became  aware  of  Fruit  in  Schools  type  programmes  in  the  late  1990s  at  an  international  5  A  Day  symposium.  After  researching  the  Fruit  Programme  in  the  UK  and  visiting  the  Department  of  Health  in  London,  United  Fresh  proposed  a  similar  programme  to  New  Zealand’s  Ministry  of  Health  in  2002  (P  Dudley,  personal  communication,  December  10,  2014).    In  2004  the  provision  of  fruit  to  schools  was  piloted  in  10  low  decile  Auckland  primary  schools  with  10  other  low  decile  Auckland  schools  acting  as  control  schools.  In  addition  5  low  decile  schools  in  Northland  were  included  in  the  pilot  to  determine  the  feasibility  of  supplying  fruit  to  remote  schools.  The  pilot,  evaluated  by  Massey  University,  demonstrated  that  schools  and  students  accepted  the  fruit  and  that  produce  could  be  supplied  to  schools  remote  from  a  main  centre  (Ministry  of  Health,  personal  communication,  December  10,  2014).    

Following  the  success  of  the  pilot,  the  Ministry  developed  the  Fruit  in  Schools  programme,  linking  fruit  provision  with  a  wider  health  promotion  agenda.      Purpose  

The  Fruit  in  Schools  programme  was  launched  in  2005  as  part  of  the  Ministry  of  Health’s  overall  strategy  to  improve  health  outcomes  for  New  Zealanders.  Fruit  in  Schools  originally  had  two  main  objectives:  

1.  To  promote  healthy  eating  through  offering  students  in  low-­‐decile  primary  schools  a  piece  of  high  quality  fruit  for  each  school  day.    

2.  To  encourage  schools  to  use  a  Health  Promoting  Schools  approach  to  further  promote  healthy  lifestyles  in  four  priority  areas:  

  healthy  eating    

  physical  activity    

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  Sunsmart    

  Smokefree    

According  to  a  Ministry  of  Health  official,  ‘The  free  fruit  of  Fruit  in  Schools  was  seen  by  both  the  government  officials  and  the  programme’s  evaluators  as  a  “carrot”  or  a  “foot  in  the  door”  to  a  suite  of  health  promotion  activities,  as  schools  had  to  agree  to  sign  up  to  the  Health  Promoting  Schools  programme’  (Ministry  of  Health,  personal  communication,  15  October,  2014).    

Roll  out  

Fruit  in  Schools  was  not  mandatory,  but  the  majority  of  schools  with  primary  aged  children  (years  0-­‐8)  that  were  invited  to  participate  agreed  to  take  part.  The  programme  was  rolled  out  in  phases,  with  the  first  three  phases  targeting  mainly  decile  1  schools  and  beginning  in  late  2005,  early  2006  and  late  2006  respectively.    At  the  end  of  Phase  3  there  were  about  268  schools  participating  in  the  programme  (Walton,  2014).  Initially,  each  phase  was  funded  for  three  years  and  it  was  envisaged  the  programme  would  end  in  2009  (Boyd  et  al,  2009).  

Following  the  recommendations  of  the  Health  Select  Committee  report  on  obesity  and  type  2  diabetes  in  2007,  Fruit  in  Schools  was  extended  to  decile  2  primary  schools  and  decile  1  and  2  intermediate  schools.  The  timeframe  was  also  extended,  with  additional  funding  agreed  by  the  Ministry  of  Health  for  2008/09  and  out  years  (Ministry  of  Health,  personal  communication,  15  October  2014).  By  the  end  of  2008  about  470  low  decile  schools  and  over  95,000  students  were  part  of  Fruit  in  Schools  (Boyd  et  al,  2009).    

Operation  

A  Fruit  in  Schools  agreement  was  signed  between  each  school  (the  Board  of  Trustees  chair  and  the  principal)  and  the  manager  of  the  local  Public  Health  Unit,  laying  out  the  roles  and  commitments  of  each  (Ministry  of  Health,  2006).    

Support  and  professional  development  was  offered  to  schools,  and  funding  was  provided  to  support  teacher  release  for  professional  development  and  resources  relating  to  Fruit  in  Schools.  Fruit  in  Schools  advisors  were  employed  by  DHB  Public  Health  Units  to  provide  the  school  support  and  professional  development  aspect  of  the  programme.      

The  5+  A  Day  Charitable  Trust  provided  participating  schools  with  equipment  including  buckets,  chopping  boards,  aprons,  knives,  posters,  teaching  resources,  fruit  monitor  certificates,  stickers,  and  food  safety  and  storage  information.  Each  school  then  received  delivery  of  fresh  produce  each  week  –  at  least  enough  for  one  piece  per  child  per  school  day,  with  a  wide  variety  of  produce  made  available.    United  Fresh  was  contracted  to  supply  the  fresh  produce  and  freight.    

Health  Promoting  Schools  

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Health  Promoting  Schools  is  a  holistic,  whole-­‐of-­‐school  initiative  that  promotes  the  wellbeing  of  students,  staff  and  community  and  removes  barriers  to  learning,  teaching  and  participation.  It  establishes  a  framework  and  a  process  for  schools  to  identify  priority  issues  and  make  positive  changes  through  three  building  blocks:    

• Curriculum,  teaching  and  learning  • School  organisation  and  ethos  • Community  links  and  partnerships  (Ministry  of  Health,  2006).    

New  Zealand  policy  context  

Fruit  in  Schools  was  originally  part  of  a  suite  of  initiatives  funded  with  the  release  of  the  Cancer  Control  Strategy  Action  Plan  2005  -­‐2010  (Ministry  of  Health,  2005).  The  programme  was  also  aligned  with  the  goals  and  priorities  of  the  Healthy  Eating,  Healthy  Action  Strategy  (Ministry  of  Health,  2003).  Its  establishment  did  not  require  Cabinet  decisions:  the  funding  was  agreed  via  Health  Reports  with  Ministers  (Ministry  of  Health,  personal  communication,  15  October  2014).  As  noted  above  the  Health  Select  Committee  Inquiry  into  Obesity  and  Type  2  Diabetes  led  to  an  expansion  of  Fruit  in  Schools,  via  a  re-­‐prioritisation  of  funding  within  the  Ministry  of  Health.    

2.2  International  context  Nutrition  and  physical  activity  have  long  been  recognised  as  key  determinants  of  health,  and  the  rise  of  childhood  obesity  is  of  global  concern.  There  is  growing  evidence  internationally  about  what  works  to  improve  nutrition  and  prevent  obesity  in  young  people.  International  research  consistently  shows  that  teaching  children  about  healthy  eating  is  not,  by  itself,  an  effective  strategy  for  changing  eating  habits.  Rather:  ‘Interventions  should  focus  on  changing  elements  of  the  physical  and  social  environments,  such  as  changing  foods  available  in  schools  or  increasing  physical  activity  options  and  rewarding  and  incentivizing  healthful  choices’  (Lytle,  2013).  A  recent  systematic  review  found  strong  evidence  to  support  beneficial  effects  of  child  obesity  prevention  programmes  on  body  mass  index,  particularly  programmes  targeting  children  aged  six  to  12  years  (Waters  et  al,  2011).  The  reviewers  concluded  ‘our  synthesis  indicates  the  following  to  be  promising  policies  and  strategies:    

·∙ school  curriculum  that  includes  healthy  eating,  physical  activity  and  body  image  ·∙ increased  sessions  for  physical  activity  and  the  development  of  fundamental  movement  

skills  throughout  the  school  week  ·∙ improvements  in  nutritional  quality  of  the  food  supply  in  schools  ·∙ environments  and  cultural  practices  that  support  children  eating  healthier  foods  and  

being  active  throughout  each  day  ·∙ support  for  teachers  and  other  staff  to  implement  health  promotion  strategies  and  

activities  (e.g.  professional  development,  capacity  building  activities)  ·∙ parent  support  and  home  activities  that  encourage  children  to  be  more  active,  eat  more  

nutritious  foods  and  spend  less  time  in  screen  based  activities.’    

Based  on  these  findings,  New  Zealand’s  Fruit  in  Schools  programme  can  be  seen  as  an  evidence-­‐based  approach  that  incorporates  many  elements  of  best  practice.  School-­‐based  fruit  and  vegetable  provision  is  increasingly  being  adopted  worldwide,  as  outlined  below.      

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The  idea  of  Fruit  in  Schools  had  been  talked  about  internationally  since  the  late  1990s.  The  UK  government  introduced  a  nationwide  School  Fruit  and  Vegetable  Scheme  in  20041,  targeting  children  aged  4  -­‐7  years,  and  providing  a  piece  of  fresh  produce  for  each  child  each  school  day.    Evaluation  showed  that  attitudes  to  and  consumption  of  fruit  and  vegetables  improved  while  children  were  part  of  the  programme,  but  this  did  not  lead  to  sustained  changes  in  consumption  as  children  got  older  and  left  the  scheme  (European  Commission,  2012).  

In  2009  The  European  Commission  launched  a  European  School  Fruit  Scheme,  providing  a  50%  subsidy  to  encourage  member  states  to  introduce  fruit  provision  in  schools.  The  key  elements  of  the  Scheme  were  as  follows:  

(a)  distribution  of  products  in  educational  establishments,  ranging  from  nurseries  to  secondary  schools.  

(b)  accompanying  measures  to  raise  awareness  about  the  importance  of  fruit  and  vegetable  consumption  as  well  as  healthy  eating  habits,  and  to  strengthen  the  link  with  agriculture  through  for  example  farms  visits  or  gardening  sessions.  

(c)  networking,  monitoring  and  evaluation  of  the  implementation  of  Schemes  in  individual  Member  States  (European  Commission,  2012).    

An  evaluation  of  the  first  three  years  of  the  scheme  concludes:  ‘National  evaluations  indicate  that  the  Scheme  has  strong  potential  and  is  an  appropriate  tool  to  exercise  a  positive  influence  on  the  eating  habits  of  children  and  parents  alike,  encouraging  them  towards  consuming  more  fruit  and  vegetables  in  the  future,  provided  that  the  Scheme’s  long-­‐term  continuation  is  ensured’  (European  Commission,  2012).  

2.3  Findings  of  Previous  Evaluations    The  Ministry  of  Health  commissioned  a  comprehensive  process  and  outcome  evaluation  of  Fruit  in  Schools,  which  was  carried  out  by  the  New  Zealand  Council  for  Educational  Research  (NZCER)  from  2005-­‐2009  using  both  quantitative  and  qualitative  methods.  The  final  report  was  published  in  2009  and  concluded  ‘FiS  has  had  a  positive  impact  on  schools’  and  students’  approaches  to  healthy  lifestyles,  is  starting  to  impact  on  home  behaviours,  and  is  strengthening  public  health  infrastructure’  (Boyd  et  al,  2009,  p  viii).  Quantitative  findings  showed  that  Fruit  in  Schools  students  were  more  likely  than  comparison  students  to  have  either  maintained  their  initial  positive  health  related  practices  (which  generally  decline  as  children  get  older)  or  made  small  positive  improvements.  This  pattern  was  evident  across  all  four  health  areas:  nutrition,  physical  activity,  Smokefree  and  Sunsmart.  Other  positive  changes  identified  in  the  evaluation  included:  School  level  

                                                                                                                         1  Prior  to  this  national  programme  funded  by  the  NHS,  there  was  a  pilot  of  500  schools  in  2000-­‐2001,  and  the  programme  operated  regionally,  funded  through  a  Lotteries  Grant,  until  2004  when  it  was  nationalised.  http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/FiveADay/FiveADaygeneralinformation/DH_4002149    

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• higher  priority  placed  on  health  and  wellbeing  • strengthened  healthy  eating  and  sunsmart  policies    • increased  opportunities  given  to  students  for  physical  activity  • increased  engagement  with  other  health  initiatives  and  agencies    • students  given  more  health-­‐related  leadership  opportunities    

Individual  student  level  

• maintained  positive  attitudes  towards,  and  awareness  of,  healthy  behaviours  • increased  consumption  of  fruit  and  vegetables  • increased  physical  activity  • had  positive  attitudes  toward  school  

Internal  surveys  carried  out  by  5+  A  Day  in  2008  and  2009  supported  the  finding  that  Fruit  in  Schools  was  starting  to  impact  on  home  behaviours.  In  both  years  about  80%  of  schools  reported  that  teachers  had  noticed  a  difference  in  lunchboxes.  In  2009,  40%  reported  more  fruit  in  lunchboxes,  and  77%  reported  healthier  lunches  (5+  A  Day,  n.d.).    

Subsequently  Colmar  Brunton  was  commissioned  by  5+  A  Day  to  conduct  two  surveys  in  2010:  one  gauging  public  opinion  of  the  Fruit  in  Schools  initiative,  and  the  other  measuring  the  impact  of  the  programme  according  to  school  principals.  The  public  opinion  survey  found  that  38%  of  New  Zealanders  were  aware  of  Fruit  in  Schools;  9  out  of  10  believed  the  programme  should  be  government  funded,  and  87%  wanted  to  see  Fruit  in  Schools  funded  beyond  2010  (Colmar  Brunton,  2010a).    

In  the  survey  of  200  principals  (about  45%  of  participating  schools),  all  reported  that  Fruit  in  Schools  had  helped  reinforce  healthy  eating  messages  in  their  school,  and  all  had  seen  an  increase  in  pupil  consumption  of  fruit  and  vegetables  as  a  result  of  participating  in  the  programme.  89%  of  principals  reported  increased  concentration  in  class  as  a  result  of  Fruit  in  Schools;  84%  said  pupils  were  generally  healthier;  and  67%  said  pupils  had  fewer  sick  days.  Other  programme  benefits  reported  by  over  85%  of  principals  were:  pupils  gaining  more  knowledge  about  fruit  and  vegetables;  pupils  taking  more  interest  in  fruit  and  vegetables;  pupils  eating  a  wider  variety  of  fruit;  pupils  eating  healthier  lunches;  and  pupils  encouraging  each  other  to  eat  more  fruit  and  vegetables.  Principals  valued  the  programme  very  highly,  and  when  asked  to  rate  its  impact  on  a  scale  of  1  to  10,  90%  rated  it  8,  9,  or  10  (Colamr  Brunton,  2010b).    

The  current  evaluation  updates  and  extends  this  previous  work.    

 

2.4  Current  structure  and  operation  of  Fruit  in  Schools  As  at  September  2014,  there  were  about  480  schools  participating  in  the  Fruit  in  Schools  programme.    

In  2009,  the  new  Government  reviewed  the  programme  and  decided  to  continue  fruit  provision  for  all  qualifying  low-­‐decile  schools  but  cut  the  ‘administrative  component’.  The  Minister  of  Health  announced  

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‘We  will  no  longer  pay  for  DHB  provider  staff  to  oversee  the  programme  nor  will  the  programme  fund  teacher  release  time’  (Ryall,  2009).    

The  Fruit  in  Schools  programme  continues  to  be  funded  by  the  Ministry  of  Health.  United  Fresh  New  Zealand  Incorporated  manages  the  freight  and  delivery  of  the  fresh  produce  and  The  5+  A  Day  Charitable  Trust  supports  the  programme  with  curriculum-­‐linked  resources  sent  free  to  schools.  A  wide  variety  of  quality  fresh  produce  is  delivered  nationwide  to  participating  schools.  Priority  is  given  to  provide  locally  grown,  seasonal,  New  Zealand  produce  whenever  possible.  The  5+  A  Day  Charitable  Trust  continue  to  develop  and  provide  participating  schools  with  curriculum-­‐linked  teaching  resources  to  support  the  fresh  produce  provision.  5+  A  Day  also  engage  in  ongoing  communication  with  principals,  teachers  and  school-­‐appointed  Fruit  in  Schools  coordinators  through  newsletters  and  phone  calls  for  example.    

Schools  have  developed  their  own  systems  for  storing,  managing  and  distributing  the  fruit,  often  with  student  leaders  playing  a  key  role.  In  many  schools  the  class  teacher  chooses  when  the  class  will  have  a  fruit  break,  and  the  class  all  eat  together;  at  other  schools  the  whole  school  eats  the  fruit  at  a  particular  time  (at  the  beginning  of  morning  break  for  example);  and  a  few  schools  opt  for  a  ‘grazing’  option  where  children  help  themselves  to  fruit  as  and  when  they  want.  Schools  reported  they  received  an  ample  supply,  and  that  fruit  was  never  wasted:  any  surplus  was  used  in  cooking  projects,  distributed  to  nearby  preschools  or  kohanga  reo,  or  sent  home  with  children  for  example.    

Since  the  announcement  of  changes  to  the  Fruit  in  Schools  programme  in  2009,  the  Ministry  of  Health  has  not  released  any  policies  or  plans  about  addressing  nutrition  and  physical  activity.  That  being  the  case,  the  current  purpose  of  the  programme  has  not  been  made  explicit,  nor  where  it  sits  in  the  current  policy  environment.    

In  this  context,  there  is  some  ambiguity  about  the  relationship  between  Health  Promoting  Schools  and  Fruit  in  Schools.  According  to  a  Ministry  of  Health  official:  ‘When  the  Minister  cut  funding  for  Fruit  in  Schools  advisors  his  decision  was…  that  that  work  would  be  picked  up  by  existing  Health  Promoting  Schools  staff.’  However  in  practice  there  appear  to  be  regional  differences:  in  some  regions  the  relationship  between  Fruit  in  Schools  and  Health  Promoting  Schools  has  continued  much  as  it  did  pre-­‐2009  albeit  with  fewer  DHB  staff  providing  support,  while  in  other  regions  Health  Promoting  Schools  staff  do  not  see  themselves  as  having  any  role  in  relation  to  Fruit  in  Schools.  It  should  be  noted  that  the  structure  and  delivery  of  Health  Promoting  Schools  has  itself  undergone  major  changes  in  recent  years.    

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3.  Findings:  Benefits  of  Fruit  in  Schools    

The  findings  in  this  section  are  drawn  from  an  online  survey  of  principals  of  Fruit  in  Schools  schools,  and  interviews  with  15  key  informants  –  10  principals  and  5  regional  Health  Promoting  Schools  facilitators.      

The  survey  was  conducted  in  October  2014  and  all  467  principals  of  Fruit  in  Schools  schools  were  invited  to  participate.  The  response  rate  was  81%;  a  very  high  response  rate  for  this  type  of  survey.    

Ten  principals  were  randomly  selected  from  the  186  who  were  willing  to  be  contacted  for  a  follow  up  interview,  and  were  interviewed  over  the  phone  in  November  2014.  There  was  a  good  geographical  spread,  and  a  range  of  different  school  types  represented.  Four  were  in  a  main  urban  centre,  four  in  provincial  towns,  and  two  in  rural  settings.  School  size  ranged  from  two  classes  to  over  470  children,  and  school  types  included  Kura  Kaupapa  Māori  ,  an  area  school  (Years  0-­‐13),  contributing  schools  (Year  0-­‐6)  and  full  primary  schools  (Year  0-­‐8).    

Five  Health  Promoting  Schools  facilitators  were  interviewed  to  inform  the  evaluation.  Health  Promoting  Schools  facilitators  work  with  schools  across  their  region  to  support  the  implementation  of  the  Health  Promoting  Schools  programme.  They  are  generally  employed  by  the  District  Health  Board  in  each  region.    

 

3.1  Fruit  in  Schools  feeds  hungry  children  According  to  principals,  feeding  hungry  children  is  the  number  one  benefit  of  Fruit  in  Schools.  85%  of  principals  surveyed  reported  their  school  had  fewer  hungry  children  as  a  result  of  Fruit  in  Schools.  80%  reported  reduced  stigma  as  a  result  of  Fruit  in  Schools,  and  said  that  children  are  more  willing  to  ask  for  food  if  they  were  hungry.    

The  importance  of  Fruit  in  Schools  as  a  food  security  initiative  was  also  reflected  in  the  interviews  with  principals,  who  reported  that  children  coming  to  school  hungry  and/or  bringing  little  or  no  lunch  was  a  major  issue.    

‘Our  children  have  pathetic  lunches,  or  none  at  all...  so  Fruit  in  Schools  and  other  programmes  we  have,  like  the  milk  and  other  things,  offset  that  and  give  these  children  maybe  the  only  fruit-­‐slash-­‐vegetable  that  they  might  have  that  day’  (Principal).  

Both  principals  and  Health  Promoting  Schools  facilitators  stressed  that  Fruit  in  Schools  was  valuable  not  only  because  it  was  filling  children’s  tummies,  but  because  it  was  doing  so  with  nutritious  food:  

‘For  some  of  our  kids,  coming  to  school  hungry  is  a  big  issue…The  key  thing  is  ensuring  that  the  kids  get  quality  nutrition  during  the  day…so  for  us  it  has  established  really  good  eating  patterns  for  our  kids;  our  kids  aren’t  hungry,  and  everyone  benefits’  (Principal).  

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The  health  and  nutritional  benefits  of  Fruit  in  School  are  discussed  further  in  3.3  below.    

Principals  generally  framed  hunger  primarily  as  an  educational  issue,  rather  than  (or  as  well  as)  a  health  or  social  issue.  For  example:  

‘It  makes  a  huge  difference.  Some  of  our  children  don’t  come  to  school  with  adequate  food,  particularly  on  benefit  days,  and  therefore  the  Fruit  in  Schools  allows  those  children  to  be  fed  and  to  nurture  their  brain  ready  for  learning’  (Principal).    

One  Health  Promoting  Schools  facilitator  (who  had  been  a  high  school  teacher  prior  to  her  current  role),  commented  that  before  Fruit  in  Schools,  the  issue  of  hunger  had  not  really  been  on  the  radar  as  an  education  issue.  She  said:  

‘(Fruit  in  Schools)  was  really  the  core,  the  beginning  of  really  looking  at  ‘how  hungry  are  our  young  people?’  It  was  the  foundation  (for  addressing  hunger  and  lack  of  food  security)’  (Health  Promoting  Schools  facilitator).    

Another  said  that  feeding  hungry  children  is  now  part  of  the  culture  of  primary  schools:  

‘It’s  part  and  parcel  of  the  ethos  and  the  culture  of  the  school  now.  It’s  not  a  priority  area,  it’s  just  normal.  “If  we’ve  got  hungry  kids  we  just  feed  them”’(Health  Promoting  Schools  facilitator).  

A  Health  Promoting  Schools  facilitator  explained  that  this  culture  change  came  about  largely  because  teachers  and  principals  saw  for  themselves,  through  Fruit  in  Schools,  what  a  difference  nutrition  made  to  learning  and  classroom  management.  Another  Health  Promoting  Schools  facilitator  had  a  different  view,  and  said  most  schools  were  already  aware  of  the  link  between  nutrition  and  learning  prior  to  Fruit  in  Schools.    

3.2  Fruit  in  Schools  contributes  to  academic  outcomes  Many  principals  believed  Fruit  in  Schools  was  making  a  valuable  contribution  to  academic  outcomes.  For  example,  one  principal  of  a  Kura  Kaupapa  Māori    felt  Fruit  in  Schools  had  played  a  key  role  in  lifting  achievement  at  her  school:  

‘We  know  in  the  long  run  the  fruit  is  good  for  achievement,  for  Māori    achievement,  and  it’s  happening  at  this  school  because  of  Fruit  in  Schools’(Principal).    

Another  principal  noted  that  a  range  of  factors  come  together  to  support  achievement,  and  Fruit  in  Schools  was  one  of  those  factors:  

‘In  our  school  these  kids  enter  our  school  with  low  levels  of  literacy  and  numeracy,  and  they  very  quickly  accelerate.  We  don’t  attribute  that  necessarily  to  Fruit  in  Schools,  but  it  helps.  The  kids  are  able  to  concentrate  through  the  day,  their  energy  levels  are  maintained  through  the  day,  so  that’s  definitely  a  factor’  (Principal).    

In  the  survey,  72%  of  principals  agreed  or  strongly  agreed  that  ‘if  Fruit  in  Schools  was  ended,  academic  outcomes  would  suffer.’  Principals  explained  that  the  main  way  fruit  provision  contributed  to  academic  

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outcomes  was  by  providing  ‘brain  food’  that  enabled  children  to  concentrate  and  stay  on  task.  Some  also  felt  Fruit  in  Schools  was  contributing  to  learning  by  providing  authentic  learning  opportunities,  reducing  behaviour  problems,  and  improving  attendance  and  engagement.  These  four  pathways  to  improved  academic  outcomes  are  described  in  more  detail  below.    

Concentration  

In  the  survey  74%  of  Principals  reported  that  they  had  observed  increased  concentration  in  class  as  a  result  of  Fruit  in  Schools.  Furthermore,  82%  agreed  or  strongly  agreed  that  ‘if  Fruit  in  Schools  was  ended,  concentration  would  suffer.’  The  principals  who  were  interviewed  saw  a  direct  relationship  between  nutrition  and  children’s  ability  to  concentrate  and  learn.  For  example:  

‘You  can’t  learn  if  you’re  hungry’  (Principal).  

‘(The  children  have  a  fruit  break),  and  they  return  to  their  learning  and  they’re  focused  and  ready  to  go  again’  (Principal)  

‘We  believe  that  healthy  food  supports  a  healthy  brain,  which  therefore  is  better  energised  to  support  learning  opportunities…that’s  good  logic,  and  we  certainly  observe  that  food  in  a  child’s  stomach  early  in  the  day  at  least  it  takes  away  that  distracter  from  learning  which  otherwise  would  be  there’  (Principal).    

Learning  opportunities  

89%  of  the  principals  surveyed  agreed  or  strongly  agreed  that  ‘Fruit  in  Schools  provides  a  range  of  authentic  learning  opportunities.’  The  principals  who  were  interviewed  described  some  of  these,  for  example:  

• linking  the  fruit  provision  with  mathematics:  counting,  fractions  and  so  on  • learning  about  cooking  and  food  preparation  by  making  cakes,  smoothies  etc  with  the  fruit  • triggering  inquiry  learning  e.g.  about  grafting  fruit  trees  • linking  with  the  health  curriculum  • leadership  opportunities  e.g.  fruit  monitors  • learning  to  recognise  and  name  a  wide  range  of  fruit  and  vegetables.  

One  principal  commented:  

‘There’s  been  maths  links  made  at  times,  there’s  obviously  been  health  links  made  at  other  times,  and  sometimes  even  –  I  mean,  when  we  first  started  (Fruit  in  Schools)  there  were  children  who  didn’t  even  know  what  a  pear  was,  they’d  never  seen  one,  and  so…there  have  been  times  when  our  children  have  been  introduced  to  fruit  that  they’ve  never  tasted  or  seen  before’  (Principal).  

Both  principals  and  Health  Promoting  Schools  facilitators  commented  that  basic  knowledge  (e.g.  knowing  what  a  pear  or  a  pineapple  was)  could  not  necessarily  be  taken  for  granted  in  low  decile  

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schools.  Eating  a  range  of  fruit  was  seen  as  a  valuable  experiential  learning  opportunity  in  itself,  and  helped  to  build  both  knowledge  and  appreciation:  

‘We’ve  had  to  teach  them  how  to  love  fruit  because  they  haven’t  had  it.  Sometimes  you  get  a  bit  of  a  lump  in  your  throat  when  they  see  (a  fruit  they  haven’t  seen  before)  and  say  “What’s  that  whaea?  What’s  it  taste  like?”’(Principal).    

Behaviour  

Many  principals  observed  a  relationship  between  nutrition  and  behaviour,  with  46%  reporting  fewer  behaviour  problems  as  a  result  of  Fruit  in  Schools.  One  survey  respondent  commented:  

‘The  nutritious  fruit  available  on  demand  -­‐  Year  0-­‐6  are  able  to  help  themselves  to  as  much  as  they  want  during  play  and  lunch  times  -­‐  has  had,  I  believe,  a  noticeable  effect  on  behaviour.  The  whole  school  is  more  settled,  kids  feel  good’  (Principal).    

Three  out  of  ten  of  the  principals  interviewed  also  mentioned  that  improved  behaviour  was  a  key  benefit  of  Fruit  in  Schools.  For  example:  

‘If  you’re  hungry  you’re  going  to  be  cross,  you’re  going  to  be  unhappy,  so  children  need  food  –  it’s  not  rocket  science  –  and  for  children  in  some  families,  they  rely  on  the  fruit  in  schools  (Principal).  

‘The  key  benefits  are  –  it  feeds  the  hungry.  And  when  you’re  hungry,  that  can  produce  behavioural  issues,  so  it’s  helped  to  diminish  that’  (Principal).  

Attendance  and  engagement  

One  principal  noted  that  attendance  had  improved  because  of  Fruit  in  Schools,  since  parents  were  no  longer  keeping  children  at  home  because  of  inability  to  provide  a  school  lunch:  

‘Over  the  time  that  we’ve  had  Fruit  in  Schools,  we  certainly  don’t  have  a  problem  with  absence  any  more  at  all…Parents  at  one  time  were  not  sending  their  child  because  they  didn’t  have  any  money  (to  provide  food),  but  now  all  our  parents,  our  community  knows  “send  the  kids  to  school”.  It’s  huge’  (Principal).    

This  comment  was  supported  by  the  survey  findings:  54%  of  principals  agreed  or  strongly  agreed  that  ‘if  Fruit  in  Schools  was  ended  absenteeism  would  increase’  and  60%  of  principals  observed  that  children  were  more  engaged  with  school  as  a  result  of  Fruit  in  Schools.    

 

3.3  Fruit  in  Schools  Improves  health    

Impacts  of  increased  fruit  consumption  

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Both  principals  and  Health  Promoting  Schools  facilitators  agreed  that  Fruit  in  Schools  was  providing  direct  health  benefits  for  children  in  low  decile  schools  due  to  increased  consumption  of  fresh  produce,  and  wider  dietary  changes  triggered  by  Fruit  in  Schools.  For  example,  in  the  survey:  

• 66%  of  principals  reported  they  had  observed  an  improvement  in  students’  general  health  as  a  result  of  Fruit  in  Schools;    

• 43%  had  observed  fewer  cases  of  school  sores  and  skin  infections;    • 35%  said  students  had  fewer  sick  days  due  to  Fruit  in  Schools;  and    • 91%  agreed  or  strongly  agreed  that  ‘the  overall  health  of  children  would  decline’  if  Fruit  in  

Schools  was  ended.    

These  findings  were  backed  up  in  the  key  informant  interviews,  for  example  one  principal  said:  

‘It’s  been  a  huge  benefit  in  terms  of  raising  the  health  outcomes  of  our  children,  keeping  them  healthy,  particularly  through  the  winter  months.  [So  you’ve  noticed  quite  a  difference?]  Oh,  absolutely.    I  don’t  have  data  in  front  of  me  but  there  certainly  have  been  times  when  there  have  been  outbreaks  of  colds  and  things  like  that  in  different  schools…  and  we’ve  noticed,  anecdotally,  that  our  children  survive  those  (outbreaks)  much  better  than  they  have  in  the  past.  We’re  less  likely  to  have  children  away  than  we’ve  had  in  the  past’  (Principal).    

Several  principals  and  one  Health  Promoting  Schools  facilitator  also  noted  the  impact  on  emotional  and  mental  health,  saying  that  the  kids  ‘felt  good’  because  of  the  fruit  provision.  One  said:  

‘I  think  it’s  the  best  thing  they  ever  did…Because  when  you  see  how  that  one  piece  of  fruit  a  day  has  changed  the  outlook  of  all  these  young  people,  you  cannot  be  anything  but  eternally  grateful  for  that  to  have  happened’  (Health  Promoting  Schools  facilitator).    

Principals  said  that  fruit  was  unaffordable  for  many  families.    One  commented:  

‘For  many  children  that’s  the  one  piece  of  fruit  they  will  get  for  that  day,  which  they  will  get  five  days  a  week.  They  won’t  get  it  on  Saturday  and  Sunday,  and  they  so  look  forward  to  it.  It’s  not  because  the  whānau  expect  it  to  be  there,  it’s  just  the  reality  that  fruit  is  a  luxury  in  a  low  decile  area’  (Principal).  

In  the  survey  almost  all  principals  (97%)  agreed  or  strongly  agreed  that  ‘if  fruit  in  schools  was  ended  many  of  our  kids  would  eat  little  or  no  fruit’.    

Improving  awareness,  attitudes  and  knowledge  about  healthy  eating  

The  key  benefit  of  Fruit  in  Schools  from  the  perspective  of  Health  Promoting  Schools  facilitators  was  the  normalising  of  fruit  eating  and  creation  of  healthy  habits.  Some  considered  that,  from  a  health  perspective,  the  potential  life-­‐long  impact  of  the  programme  on  the  young  participants  may  be  even  more  valuable  than  any  immediate  impacts  observed.  This  point  was  also  raised  by  several  principals  who  said  for  example:  

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‘It’s  getting  to  children  and  helping  them  see  the  importance  of  eating  fruit,  and  making  sure  they  get  into  the  habit  of  eating  it  regularly’  (Principal).  

‘I  think  for  a  school  like  ours  it’s  a  really  key  thing,  and  it  not  only  has  health  benefits  but  introduces  children  to  the  idea  that  fruit  should  be  part  of  your  diet’  (Principal).  

In  the  survey,  all  principals  (100%)  reported  that  Fruit  in  Schools  contributes  to  awareness  among  staff  and  pupils  about  the  importance  of  healthy  eating,  and  92%  said  the  programme  contributed  ‘a  lot’  to  this  outcome.  Similarly  all  (100%)  said  Fruit  in  Schools  contributed  to  positive  attitudes  among  pupils  about  eating  fruit  and  vegetables,  with  91%  saying  it  contributed  ‘a  lot’.  Almost  all  reported  that  the  programme  contributed  to  awareness  about  the  ‘5+  a  day’  message  (99%),  and  increased  knowledge  among  pupils  about  nutrition  and  health  (98%).    

3.4  Fruit  in  Schools  supports  a  healthy  school  environment  Nutrition  and  healthy  eating    

86%  of  principals  agreed  or  strongly  agreed  that  ‘nurturing  the  health  and  wellbeing  of  pupils  is  core  business  for  primary  schools,’  and  evaluation  findings  indicate  that  almost  all  Fruit  in  Schools  schools  have  broader  nutrition  and  healthy  lifestyle  initiatives  in  place.    Examples  include  a  school  garden  (82%  of  schools),  cooking  at  school  (72%),  initiatives  to  encourage  parents/whānau  to  pack  healthy  lunches  (63%),  and  changes  to  what  is  sold  in  the  tuck  shop  (37%).  School  orchards  were  a  widespread  new  initiative,  with  four  out  of  ten  principals  interviewed  reporting  their  school  had  planted  fruit  trees  in  recent  years.  Other  measures  mentioned  by  principals  were  a  healthy  food  policy,  inclusion  of  food  and  nutrition  goals  in  the  school  charter  and/or  strategic  plan,  a  decision  not  to  sell  chocolate  as  a  fundraiser,  and  a  ‘water-­‐only’  policy  at  school.  

Health  Promoting  Schools  facilitators  commented  that  environmental  and  policy  changes  made  by  schools  were  generally  sustained  long  term,  and  almost  all  Health  Promoting  Schools  continue  to  include  a  focus  on  nutrition:  

‘They’ve  looked  at  various  things  around  the  whole  nutrition  aspect…Nearly  every  one  of  our  schools  have  got  something  around  nutrition.  Some  have  done  it  through  nutrition  policies,  some  have  looked  at  canteen  practices,  there’s  been  a  wide  range  of  different  approaches’  (Health  Promoting  Schools  facilitator).    

The  extent  to  which  these  wider  nutrition  and  healthy  eating  initiatives  were  attributed  to  Fruit  in  Schools  varied  from  school  to  school.  In  the  survey  84%  of  principals  agreed  or  strongly  agreed  that  ‘Fruit  in  schools  has  been  a  catalyst  for  action  on  other  issues  in  our  school.’  When  Fruit  in  Schools  was  first  rolled  out,  schools  were  required  to  become  a  Health  Promoting  School  in  order  to  receive  the  fruit  and  there  was  professional  development  for  teachers  attached  to  the  programme,  and  so  for  some  schools  Fruit  in  Schools  was  definitely  a  trigger  for  wider  consideration  of  health  issues.  As  one  Health  Promoting  Schools  facilitator  explained,  once  schools  were  engaged  with  Health  Promoting  Schools  they  could  see  the  value  in  it  for  its  own  sake,  and  it  became  self-­‐sustaining:  

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‘(Fruit  in  Schools)  was  a  carrot  to  get  people  to  engage  with  us  [Health  Promoting  Schools]  and  to  look  at  health  as  an  issue  within  the  school  or  kura.  And  it  was  quite  a  good  carrot  for  getting  schools  on  board.  And  some  schools  then  realised  that  actually  they  didn’t  need  the  carrot,  that  actually  it  is  something  that’s  good  to  do’  (Health  Promoting  Schools  facilitator).    

To  be  clear:  this  did  not  mean  that  schools  no  longer  wanted  the  fruit  provision  –  quite  the  opposite.  Some  schools  still  see  Fruit  in  Schools  as  the  foundation  of  their  wider  food  and  nutrition  approach,  as  demonstrated  in  the  following  quotes:    

‘Fruit  in  Schools  has  actually  pushed  us  to  push  other  things  out  that  weren’t  so  good  like  sweets  in  lunchboxes  and  replacing  them  with  fruit.  We’re  a  water  drinking  school  now…and  that’s  part  of  the  Fruit  in  Schools,  it’s  like  salt  and  pepper  -­‐  they  go  together.    It  sits  in  the  middle,  the  fruit,  and  then  around  that  we  build  all  the  other  things’  (Principal).  

‘We’ve  taken  deliberate  steps  to  be  a  Health  Promoting  School,  and  with  that  (we  encourage)  healthy  food  choices,  so…  we  don’t  allow  sugar  sweetened  drinks  on  site,  we  save  any  fatty  or  fried  food  for  one  day  a  week,  and  our  staff  are  aware  that  if  we  have  any  kind  of  promotion  on  site  –  like  today  is  pet  day  -­‐  that  there  are  only  healthy  options  out  there.  So  there  has  been  a  link  to  that,  and  really  that  did  stem  out  of  that  initial  work  with  Fruit  in  Schools  and  the  four  pillars  of  health’  (Principal).    

However  some  schools  were  already  active  Health  Promoting  Schools  at  the  time  Fruit  in  Schools  was  rolled  out  and  some  introduced  a  range  of  health  and  wellbeing  initiatives  (including  Fruit  in  Schools)  at  around  the  same  time.    These  schools  tended  to  view  Fruit  in  Schools  and  other  health  initiatives  as  complimentary  to  one  another,  and  did  not  attribute  wider  changes  to  Fruit  in  Schools  specifically.  For  example,  principals  commented:  

‘It  works  together  with  other  initiatives.  It  works  together  with  our  healthy  food  policy,  and  it  works  together  with  our  kaupapa  it  takes  a  village  to  raise  a  child.  It  all  fits  nicely  together.  We’re  a  project  Energise  school,  so  it  works  in  with  that  too,  and  it  fits  into  our  charter,  our  vision  of  what  our  community  sees  as  important,  which  is  our  kids  being  healthy’  (Principal).  

‘It  is  hard  to  attribute  changes  to  one  particular  component,  however  Fruit  in  Schools  is  a  big  part  of  our  healthy  lifestyles  push’  (Principal).    

‘We  had  a  healthy  eating  policy  before  Fruit  in  Schools.  This  programme  compliments  what  we  do  in  our  kura’  (Principal).  

Interviewees  said  Fruit  in  Schools  supported  other  initiatives  by  providing  a  tangible  daily  reminder  about  healthy  eating.    Almost  all  survey  respondents  (96%)  agreed  or  strongly  agreed  that  ‘Fruit  in  Schools  helps  to  keep  health  and  wellbeing  on  the  agenda.’    93%  of  principals  reported  that  Fruit  in  Schools  contributes  a  lot  to  staff  and  student  awareness  about  healthy  eating  (with  the  remaining  7%  reporting  that  it  contributes  ‘a  little’  to  this  outcome).  75%  said  Fruit  in  Schools  contributes  a  lot  (and  a  further  24%  said  it  contributes  a  little)  to  staff  and  student  awareness  about  the  ‘5+  a  Day’  message.    

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Physical  Activity,  Sunsmart  &  Smokefree  

Some  interviewees  observed  that  there  was  a  continuing  focus  on  the  ‘four  pillars  of  health’  that  were  promoted  at  the  outset  of  Fruit  in  Schools:  healthy  eating,  physical  activity,  sun  protection  and  Smokefree.  For  example  one  Health  Promoting  Schools  facilitator  said:  

It’s  ongoing.    I  mean  the  Cancer  Society  says  that  in  (this  region)  nearly  all  the  schools  are  Sunsmart  accredited  and  re-­‐accredited,  the  National  Heart  Foundation  are  there,  all  the  schools  are  actively  involved  in  Smokefree  initiatives,  and  physical  activity.  It’s  ongoing,  it’s  become  sustainable,  and  I  think  that  is  also  because  of  Health  Promoting  Schools’(Health  Promoting  Schools  facilitator).    

However,  this  did  not  seem  to  be  the  case  in  all  regions.  Another  Health  Promoting  Schools  facilitator  said  that,  of  the  four  issues  originally  introduced  with  Fruit  in  Schools,  the  one  that  schools  were  still  focused  on  as  a  priority  in  his  area  was  food  and  nutrition,  and  also  physical  activity  to  a  degree.  ‘Sunsmart  yes,  but  it’s  not  a  priority,  and  Smokefree  is  not  a  priority’  (Health  Promoting  Schools  facilitator).    

Physical  activity  certainly  seemed  to  be  a  focus  in  many  schools  nationwide  with  59%  of  principals  reporting  that  Fruit  in  Schools  has  triggered  or  supported  increased  opportunities/encouragement  for  kids  to  be  physically  active  during  breaks,  and  41%  reporting  increased  physical  activity  during  class  time.  Half  said  that  a  local  sports  trust  had  supported  health  promotion  initiatives  in  the  school  in  the  past  year,  and  a  number  of  schools  mentioned  that  they  were  part  of  Project  Energize.    

Oral  Health  

Although  it  was  not  initially  a  focus-­‐area  for  Fruit  in  Schools,  40%  of  schools  mentioned  that  Fruit  in  Schools  had  triggered  or  supported  oral  health  initiatives,  such  as  provision  of  toothbrushes  to  children  and/or  tooth-­‐brushing  promotion.  Principals  also  mentioned  that  initiatives  like  a  water-­‐only  policy,  and  banning  fizzy  drinks  and  lollies  from  lunches  and  tuck  shops  had  a  positive  knock-­‐on  effect  on  oral  health.  One  principal  commented:  

‘Our  teeth  are  not  good  in  this  area,  because  many  of  the  kids  don’t  own  a  toothbrush,  but  she  (the  dental  nurse)  had  to  admit  a  big  improvement  since  Fruit  in  Schools  was  introduced  so  there’s  got  to  be  a  connection’  (Principal).  

Overall  30%  of  principals  said  they  had  observed  improved  dental  health/hygiene  as  a  result  of  Fruit  in  Schools.    

Overall  school  environment  

One  Health  Promoting  Schools  facilitator  said  that  the  whole  environment  in  schools  has  become  healthier  -­‐  mentally,  physically  and  emotionally  -­‐  and  that  Fruit  in  Schools  has  played  a  key  part,  because  it  demonstrated  –  even  to  those  initially  sceptical  or  opposed  to  the  programme  -­‐  that  children  learn  better  if  their  physical  and  emotional  needs  are  met.    Other  Health  Promoting  Schools  facilitators  and  

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principals  agreed  that  addressing  child  health  and  wellbeing  was  now  part  of  the  ethos  of  many  schools:  ‘It’s  just  who  we  are’  (Principal).    

Comments  suggested  that  Fruit  in  Schools  also  contributed  to  cultural  wellbeing  by  supporting  Māori    values  and  practices  such  as  manaakitanga,  for  example:  

‘(Fruit  in  Schools  supports)  manaakitanga  -­‐  taking  school  fruit  to  share  with  others  when  attending  school  events/trips  and  sharing  with  manuhiri  when  and  if  we  can’  (Principal).    

The  principal  at  one  school  where  students  were  allowed  to  help  themselves  to  fruit  at  any  time  said:  

‘The  food  is  available  to  them  ‘just  like  being  at  home’.  It  contributes  to  the  ‘whānau’  learning  environment  which  we  put  a  lot  of  energy  into  creating’  (Principal).    

Social  benefits  

According  to  80%  of  principals,  Fruit  in  Schools  contributes  ‘a  lot’  to  a  sense  of  equality  between  pupils,  regardless  of  their  family  circumstances.  A  further  15%  thought  Fruit  in  Schools  contributed  ‘a  little’  to  that  outcome.  Principals  explained:  

‘We  call  the  ‘read  and  feed’  time  (when  children  eat  their  fruit)  ‘social  time’,  and  because  it’s  social  time  there  isn’t  any  child  that  stands  out  more  than  anyone  else’  (Principal).  

‘It  takes  the  stigma  away,  and  that’s  huge…When  you’re  giving  someone  fruit,  you’re  not  giving  them  rubbish,  you’re  giving  them  quality,  and  it’s  a  very  even,  equal  thing  to  be  giving  out.  It  doesn’t  create  a  divide  and  it  doesn’t  create  judgement’  (Principal).  

Environmental  benefits  

Several  principals  saw  links  between  Fruit  in  Schools  and  environmental  initiatives  such  as  composting,  waste  management  and  Enviroschools.  

Community  and  health  sector  engagement  

47%  of  principals  said  Fruit  in  Schools  contributes  ‘a  lot’  to  engagement  between  school  and  families/whānau,  and  a  further  41%  said  it  contributes  ‘a  little’  to  this  outcome.  Interviewees  explained  that  families  were  appreciative  and  supportive  of  Fruit  in  Schools,  it  raised  awareness  about  the  importance  of  fruit  and  vegetables  with  whānau,  and  also  said  that  fruit  was  often  sent  home  to  families  when  there  were  leftovers.  However  principals  reported  it  was  the  wider  Health  Promoting  Schools  approach  that  had  really  made  a  difference  to  this  outcome.  One  principal  said:  

‘Fruit  in  Schools  has  helped  indirectly  by  raising  awareness,  but  linkage  with  the  community  hasn’t  been  a  direct  result  of  Fruit  in  Schools.  It  was  certainly  part  of  the  discussions  we  were  having  with  the  community,  but  it  was  more  due  to  Health  Promoting  Schools  and  the  general  approach,  not  Fruit  in  Schools  specifically’  (Principal).    

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One  Health  Promoting  Schools  facilitator  commented  that  initiatives  like  school  gardens  had  helped  to  enhance  community  spirit  and  broken  down  barriers:  

‘Parents  of  the  lower  social  and  economic  strata,  and  in  particular  young  Māori    parents,  felt  very  intimidated  coming  into  a  school,  where  now  those  barriers  are  dropping  away  and  they  are  actively  becoming  involved’  (Health  Promoting  Schools  Facilitator).  

The  same  facilitator  commented  that  Fruit  in  Schools  had  strengthened  pre-­‐existing  relationships  between  schools  and  health  promotion  agencies,  and  helped  to  forge  new  ones.  Although  Fruit  in  Schools  no  longer  ‘officially’  has  a  focus  on  physical  activity,  Sunsmart  or  Smokefree,  schools  reported  ongoing  linkages  with  a  range  of  health  promotion  agencies.  For  example,  67%  reported  getting  support  from  a  DHB  Health  Promoting  Schools  facilitator  in  the  past  year,  51%  had  recieved  support  from  a  sports  trust,  43%  from  the  Heart  Foundation,  35%  from  the  Cancer  Society,  and  25%  from  Smokefree.    

 

3.5  Fruit  in  Schools  supports  a  healthy  home  environment    

Principals  reported  that  Fruit  in  Schools  was  having  a  positive  impact  on  children’s  home  environment  and  parental  behaviours,  at  least  in  some  families.  For  example  44%  of  principals  reported  that  ‘many  families’  were  providing  less  sugary  drinks  and  junk  food  in  school  lunches,  and  a  further  40%  said  ‘a  few  families’  were  doing  so.  Table  1  below  presents  findings  from  the  survey:  

Table  1:  Based  on  feedback  from  parents,  pupils  and  staff,  has  Fruit  in  Schools  contributed  to  any  of  the  following  changes  at  home?  

  Yes,  many  families  

Yes,  a  few  families  

No   Don’t  know  

Less  sugary  drinks  and  junk  food  in  school  lunches  

44%   40%   8%   7%  

More  fruit  in  kids’  lunchboxes   25%   47%   18%   11%  Families  grow  more  fruit  and  veges  at  home  

8%   34%   12%   45%  

Positive  changes  to  food  shopping  habits   11%   35%   5%   49%  Children  are  more  involved  in  preparing  meals  

10%   31%   5%   54%  

Kids  eat  more  fruit  and  veges  at  family  meals  

15%   27%   4%   53%    

 

Although  many  principals  had  limited  knowledge  about  what  was  happening  in  pupils’  homes,  the  general  picture  was  one  of  positive  change.    Participants  explained  that  families  were  influenced  by  children  bringing  ideas  and  attitudes  home  from  school,  for  example:  

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‘Our  school  gardeners  report  that  some  of  them  have  started  family  gardens  at  home’  (Principal).  

However,  as  the  following  quote  illustrates,  financial  barriers  may  limit  the  extent  that  children  can  influence  their  parents:    

‘It’s  also  feeding  through  into  the  community  as  well,  because  the  kids  are  used  to  eating  fruit  and  they’re  encouraging  their  parents  to  buy  it.  But  I  still  don’t  believe  that  parents  have  the  financial  ability  to  be  able  to  buy  fresh  fruit  all  the  time  for  their  kids’  (Health  Promoting  Schools  facilitator).    

Families  were  also  potentially  influenced  through  school  policies  (e.g.  bans  of  certain  items  from  lunchboxes)  and  initiatives  such  as  nutrition  tips  and  recipes  in  the  school  newsletter.  One  principal  explained:  

‘It’s  not  just  a  hand  out.  It’s  got  to  have  an  associated  message  with  it,  and  we  certainly  emphasise  that  both  with  the  children…and  also  in  our  fortnightly  school  newsletters  that  go  out  to  parents.  We  do  have  a  ‘healthy  tip’  and  we  often  allude  to  the  importance  of  healthy  food,  fruit  and  so  on,  and  recommended  foods  to  allow  for  in  the  home’  (Principal).    

According  to  some  principals,  particularly  those  in  urban  areas,  their  school  went  to  considerable  lengths  to  try  to  influence,  educate  and  support  parents  in  relation  to  healthy  food  and  nutrition,  sometimes  with  rather  limited  success.  For  example  one  principal  said  his  school  had  provided  parent  workshops  about  nutrition  and  healthy  lunchboxes,  but  these  had  been  poorly  attended.  Another  had  partnered  with  a  local  NGO  to  offer  a  fruit  and  vegetable  co-­‐op  enabling  families  to  receive  a  box  of  produce  for  $10  per  week.  However  there  was  little  up-­‐take  from  parents,  which  the  principal  was  at  a  loss  to  explain.  She  said:  

‘The  thing  I  worry  about  is  whether  or  not  we  are  actually  shifting  attitudes.  And  I  think  with  this  generation,  the  kids  may  grow  up  with  this  because  they’ve  lived  with  it  for  so  long,  which  is  a  good  reason  for  continuing  it,  but  I’m  not  sure  that  we’ve  shifted  their  parents  and  their  thinking’  (Principal).    

This  concern  was  also  shared  by  other  principals,  who  talked  about  the  ‘uphill  battle’  against  ‘rubbish’  in  lunchboxes.    

 

3.6  Overall  benefit  of  Fruit  in  Schools    

Principals  valued  Fruit  in  Schools  highly,  and  believed  it  was  very  beneficial  for  their  school  and  the  wider  community.  Survey  respondents  were  asked  to  rate  the  overall  effect  of  Fruit  in  Schools  on  a  scale  from  1  (‘Has  had  no  positive  effect’)  to  10  (‘Has  had  a  very  positive  effect’).  87%  rated  it  8,  9,  or  10,  with  46%  of  principals  giving  Fruit  in  Schools  the  highest  possible  rating  –  10.        

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Interviewees  all  talked  about  Fruit  in  Schools  in  very  positive  terms,  for  example:    

‘I’m  one  happy  principal,  I  wouldn’t  change  it  for  the  world,  and  I’d  be  devastated  if  it  stopped’  (Principal).    

‘I  think  it’s  one  of  the  best  initiatives  that’s  ever  come  out  to  schools’.  […]I  believe  it  does  have  an  impact  on  our  children  –  on  their  health,  on  their  wellbeing,  on  their  behaviour,  on  their  effort  in  class  –  and  those  are  the  types  of  things  that  we’re  really  keen  on  when  we’re  looking  at  how  we  can  support  children.  And  because  we  see  it  as  such  a  gap  in  our  community  -­‐  fruit  and  vegetables,  healthy  lunches,  and  actually  having  food  (at  all)  -­‐    this  is  a  way  that  our  children  are  provided  with  those  things  that  we  might  call  basics,  but  they’re  not  for  them,  sometimes  they’re  luxuries’  (Principal).    

Almost  all  of  the  principals  interviewed  expressed  concern  about  the  possibility  of  the  programme  being  cut,  even  though  the  interview  did  not  include  specific  questions  on  this  issue.  Principals’  unsolicited  comments  included:  

‘I  just  ask  myself  –  how  could  we  sustain  this  if  the  government  turned  around  and  said  “we’re  not  paying  for  this  anymore”?  How  could  we  sustain  it?  Because  we  would  have  to.  And  that’s  my  big  question  –  I  don’t  know.  What  would  we  do?’  (Principal).  

‘I’ve  always  thought  it  could  happen,  but  I’d  be  devastated  if  Fruit  in  Schools  stopped,  I  really  would.  I  think  I’d  honestly  cry  for  a  few  days’  (Principal).  

Health  Promoting  Schools  facilitators  were  also  strong  advocates  of  the  programme,  due  to  its  wide  reaching  benefits.  One  had  the  following  message:  

‘Please  don’t  stop  the  fruit.  That  is  our  biggest  fear  up  here:  that  it’ll  stop’  (Health  Promoting  Schools  facilitator).  

 

 

 

 

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4.  Findings:  Success  Factors  and  Suggestions    

4.1  Which  programmes  are  most  valued  by  schools  and  why?      

A  range  of  programmes  and  agencies  that  support  child  health  in  schools  were  highly  valued  by  principals.  These  included  Regional  Sports  Trusts,  Fruit  in  Schools,  Milk  in  Schools,  other  food  provision  programmes,  the  Heart  Foundation,  social  services  providers,  public  health  nurses  and  school  health  clinics.  Schools  also  valued  local  support  for  food  and  nutrition  initiatives  from  local  businesses,  church  groups,  voluntary  organisations  and  parents/whānau.  

Such  support  was  valued  because  principals  saw  a  clear  need  in  low  decile  communities  to  address  the  impacts  of  poverty  so  that  children’s  health  and  educational  achievement  did  not  suffer.  They  also  appreciated  the  specialist  skills  and  knowledge  that  external  agencies  were  able  to  bring.    

Most  principals  saw  the  various  programmes  as  mutually  supportive,  each  making  a  valued  contribution  to  the  school’s  overall  goals.  For  example  one  South  Auckland  school  said  their  environmental  and  health  promotion  initiatives  worked  together:  

‘It’s  all  a  complete  package.  The  other  thing  we’ve  got  now  is  a  health  clinic  at  school  with  a  focus  on  rheumatic  fever  and  skin  conditions–  that’s  making  a  huge  difference.  Now  any  child  with  a  sore  throat  is  swabbed,  and  in  the  winter  we  were  coming  up  with  11  positive  throat  swabs  a  week’  (Principal).  

However  one  principal  of  the  ten  interviewed  valued  Fruit  in  Schools  above  other  initiatives:  

‘It’s  a  clear  winner  because  1)  the  easy  access  to  it;  2)  the  nutrition  and  health  benefits  to  the  child;  3)  keeping  them  focused  and  on-­‐task,  and  also  the  learning  spin  offs  from  it’  (Principal).    

Interestingly,  two  of  the  principals  interviewed  (both  at  large  urban  schools)  said  they  had  chosen  not  to  have  a  breakfast  programme  at  school.  One  explained  that  he  did  not  believe  in  breakfast  programmes  because  they  took  away  responsibility  from  parents,  and  he  objected  to  schools  becoming  a  ‘welfare  state  extension’  loaded  with  ever-­‐growing  expectations  on  top  of  their  core  role.  Both  schools  took  the  approach  of  monitoring  if  children  were  coming  to  school  hungry  or  without  lunch  and  approaching  the  parents:  

‘Then  we  say  “right,  we’ve  got  a  social  worker  in  the  school  who’s  going  to  work  with  you  and  assist  you  to  contact  the  right  agencies  and  get  that  support”’  (Principal).    

Another  principal  said  they  had  tried  to  link  with  a  particular  health  promotion  agency  ‘but  there  was  just  too  much  work  involved…to  move  through  all  these  levels,  it  was  just  too  much  to  do’  (Principal).    

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4.2  Success  factors  for  Fruit  in  Schools    

The  majority  of  principals  and  Health  Promoting  Schools  facilitators  were  in  agreement  about  a  number  of  success  factors  for  Fruit  in  Schools:  

• It  is  meeting  a  genuine  need  and  making  a  real  difference  • It  is  very  well  managed,  and  easy  for  schools  to  participate  • The  fruit  and  vegetables  provided  are  varied  and  of  high  quality    • It  has  been  consistent  and  reliable  over  many  years  

These  factors,  and  that  fact  that  the  programme  is  delivered  at  no  cost  to  schools  or  communities,  have  made  Fruit  in  Schools  sustainable  from  the  schools’  perspective.      

Easy  

5+  A  Day  was  praised  by  several  key  informants  for  the  smooth  running  of  the  programme,  good  communication  with  schools,  and  their  quick  response  on  the  rare  occasions  that  something  went  wrong  with  the  delivery  or  the  quality  of  the  produce.  A  couple  of  principals  mentioned  that  the  lack  of  paperwork  and  the  ‘no  strings  attached’  nature  of  the  programme  also  made  it  easy  for  schools:  

‘Fruit  in  Schools  is  great  because  it  arrives,  the  kids  need  the  food,  we  know  that  fruit’s  healthy  for  them…and  we’re  not  having  to  prove  ourselves  all  the  time  or  fill  out  forms’  (Principal).    

Principals  commented  that  because  they  had  set  up  good  internal  processes  and  the  delivery  of  fruit  was  so  reliable,  the  programme  worked  ‘like  clockwork’  and  took  very  little  day  to  day  effort.    

Universal  

The  fact  that  the  fruit  is  provided  to  all  the  children  in  the  school  was  seen  as  important  by  two  of  the  interviewed  principals.  One  said:  

‘I  think  the  best  thing  about  it  is  that…there’s  no  baggage  around  its  delivery  –  it’s  for  everybody.  I  think  if  you  actually  targeted  it  to  ‘at  risk’  families  there  would  be  issues  around  it’  (Principal).  

Tangible  

Two  principals  commented  that  the  fruit  provision  set  Fruit  in  Schools  apart  from  many  other  programmes  because  it  provided  a  tangible  and  experiential  daily  reminder  for  schools  and  communities:  

‘It’s  visual,  you  know.  Not  just  talking  about  it,  but  you  can  see  it,  it’s  visual,  it’s  here.  It’s  in  all  our  classrooms  and  our  whānau  know  about  it,  and  our  community’  (Principal).  

 

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4.3  How  could  the  Fruit  in  Schools  programme  and  resources  be  improved?    

All  of  the  principals  interviewed  were  happy  with  the  way  Fruit  in  Schools  was  being  delivered  and  most  could  not  think  of  any  way  in  which  the  programme  could  be  improved.  However  there  were  a  few  suggestions  made  by  key  informants  which  are  outlined  below.    

Expand  the  programme  

Several  principals  and  Health  Promoting  Schools  facilitators  said  the  programme  should  be  expanded  to  higher  decile  schools,  since  food  insecurity  and  poor  nutrition  are  not  limited  to  decile  one  and  two  schools:  

‘I  think  it  should  go  to  every  school...Even  in  high  decile  schools  there  are  still  pockets  of  poverty  we  see  in  those  areas.  That  would  be  my  biggest  thing’  (Health  Promoting  Schools  facilitator).    

This  finding  was  also  reflected  in  the  survey  in  which  83%  of  principals  agreed  or  strongly  agreed  that  ‘Fruit  in  Schools  should  be  extended  and  made  available  to  all  decile  3  and  4  schools.’  One  Health  Promoting  Schools  facilitator  said  the  programme  should  be  expanded  to  low  decile  secondary  schools  so  that  the  good  eating  habits  continue  to  be  supported  as  children  grow  up.    

Opportunities  to  engage  and  say  thank  you  

Several  principals  wanted  to  ensure  that  students  did  not  take  the  fruit  provision  for  granted,  and  were  concerned  about  young  people  becoming  dependent  on  handouts.  Ideas  included  putting  a  face  to  the  programme,  and  providing  opportunities  for  students  to  write  thank  you  letters:  

‘It  would  be  really  good  to  have  someone  from  Fruit  in  Schools...to  come  in  when  we  do  our  PB4L2  assemblies,  and  introduce  themselves  and  have  a  wee  chat...I’d  like  the  children  to  understand  that  this  is  fantastic  and  maybe  have  a  relationship  with  the  Fruit  in  Schools  person,  even  if  they  just  see  that  person  once  a  year,  then  they’re  able  to  send  a  thank  you  card  or  an  email...  “Look  we  made  a  recipe  from  your  fruit!”’  (Principal).    

Connecting  with  other  schools  

One  principle  said  it  would  be  valuable  to  have  some  way  of  schools  being  about  to  connect  with  each  other  around  how  they  use  Fruit  in  Schools,  for  example  sharing  what  they  have  done  to  capitalise  on  learning  opportunities  and  the  way  they’ve  linked  with  other  programmes.    

Teaching  resources  

                                                                                                                         2  PB4L  stands  for  ‘Positive  Behaviour  for  Learning’.  This  is  a  Ministry  of  Education  initiative  that  provides  a  range  of  evidence-­‐based  programmes  and  frameworks  to  support  schools  to  improve  the  behaviour  of  young  people.  PB4L  is  aimed  at  improving  learner  engagement  and  achievement  by  improving  behaviour.    

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95%  of  principals  agreed  or  strongly  agreed  that  ‘The  5+  A  Day  teaching  resources  help  to  reinforce  healthy  eating  messages’.  The  principals  who  were  interviewed  were  in  broad  agreement  that  the  resources  available  for  teaching  about  food  and  nutrition  were  plentiful  and  of  good  quality.  In  practice,  they  did  not  differentiate  between  resources  provided  by  5+  A  Day  and  other  resources  in  this  topic  area,  so  feedback  is  general  rather  than  specific  to  the  5+  A  Day  resources.  Principals  either  said  they  could  not  comment,  or  were  positive  about  the  resources,  e.g.  

‘I  think  they’re  very  cool,  they’re  very  neat  and  engaging  as  far  as  younger  people  are  concerned,  and  I  know  the  junior  teachers  manage  them  really  well’  (Principal).  

The  only  gap  mentioned  was  a  lack  of  resources  in  Te  Reo  Māori  .  One  principal  explained  that  her  Māori    medium  school  only  uses  classroom  resources  that  are  in  the  Māori    language,  so  Māori    translations  (e.g.  on  a  website,  if  not  hard  copy)  would  be  valued.  Another  teacher  in  a  predominantly  Māori    school  mentioned  the  importance  of  using  pictures  and  stories  that  rural  Māori    children  could  identify  with:  

‘Our  kids  find  it  hard  to  relate  to  some  of  the  pictures  because  they’re  quite  town-­‐orientated.  We  live  next  to  a  mountain,  surrounded  by  the  natural  forest  and  farms  so  when  we  see  the  books,  we  can’t  relate  to  it  because…it’s  not  what  they  see  (in  their  daily  life)’  (Principal).  

She  also  suggested  the  idea  of  incorporating  health  and  nutrition  messages  into  reading  books,  or  a  theatre  production  that  visits  schools,  similar  to  the  Books  in  Homes3  initiative,  or  linked  to  that  programme.    

Principals  said  that  teachers  and  pupils  are  increasingly  using  the  internet  for  teaching  resources  and  inquiry  learning,  so  provision  of  electronic  resources  should  be  a  priority.  One  commented:  

‘The  times  of  having  a  big  resource  room  with  all  sorts  of  different  (hard  copy)  resources  are  coming  to  an  end…So  I  think  that  organisations  like  5  +  A  Day  and  others  need  to  be  looking  at  what  they’re  providing  around  e-­‐learning,  because  I  think  that’s  the  future  for  schools’  (Principals).  

5.  Evaluative  conclusions    

Based  on  the  findings  of  the  current  evaluation,  we  conclude  that  Fruit  in  Schools  is  an  effective  food  and  nutrition  programme  with  wide  ranging  benefits.  It  is  highly  valued  by  schools  and  well  aligned  with  international  evidence  on  how  to  improve  nutrition  and  reduce  obesity  in  children.  Demonstrated  benefits  in  the  New  Zealand  context  include:  

Educational  benefits  

• Improved  concentration  in  class  

                                                                                                                         3  See  http://www.booksinhomes.org.nz/Page/AboutUs/WhatWeDo.aspx    

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• Provision  of  authentic  learning  opportunities  • Fewer  behaviour  problems  • Improved  attendance    • Improved  engagement  with  school  

Health  benefits  

• Improved  awareness,  attitudes  and  knowledge  about  healthy  eating  • Increased  consumption  of  fruit  and  vegetables  • improved  general  health  and  resistance  to  illness  • Fewer  cases  of  school  sores  and  other  skin  infections  • Fewer  sick  days  • Improved  oral  health  

Social  benefits  

• feeds  hungry  children  • reduces  stigma  associated  with  hunger  and  poverty  • contributes  to  a  sense  of  equality  amongst  pupils  • supports  Māori    values  and  practices  such  as  manaakitanga  

Wider  health  promotion  benefits  

• keeps  health  and  wellbeing  on  the  agenda  in  schools  • acts  as  a  catalyst  for  other  food  and  nutrition  initiatives  • complements  and  supports  other  health  and  sustainability  initiatives  such  as  school  gardens  and  

orchards,  healthy  food  policies,  Project  Energize  and  other  physical  activity  programmes,  Enviroschools  etc  

• has  some  impact  on  children’s  home  environment  and  parents’  behaviour  

Principals  and  Health  Promoting  Schools  facilitators  viewed  Fruit  in  Schools  as  a  successful  and  sustainable  programme  within  schools  and  identified  the  following  key  success  factors:  

• It  is  meeting  a  genuine  need  and  making  a  real  difference  • It  is  very  well  managed,  and  easy  for  schools  to  participate  • The  fresh  produce  provided  is  varied  and  of  high  quality    • It  has  been  consistent  and  reliable  over  many  years.  

The  only  suggestion  for  improvement  that  was  widely  voiced  was  an  expansion  of  Fruit  in  Schools  beyond  decile  one  and  two  primary  schools.  Other  suggestions  were  to  make  resources  available  in  Te  Reo  Māori  ,  and  ensure  that  they  appeal  to  young  Māori    including  those  in  rural  areas.    

The  findings  of  the  current  evaluation  reinforce  and  update  the  findings  of  previous  evaluations  and  show  that  Fruit  in  Schools  is  still  a  much  needed  and  highly  valued  programme.  We  recommend  that  

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Fruit  in  Schools  is  continued  and  consideration  is  given  to  the  expansion  of  the  programme  to  decile  3  and  4  schools,  and  low  decile  secondary  schools.    

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References      

5+  A  Day  (n.d.)  Fruit  in  Schools  Telephone  Survey  Comparison-­‐  2008  and  2009.  Unpublished  report.    

Boyd  S,  Dingle,  R  &  Hodgen  E  (2009)  The  changing  face  of  Fruit  in  Schools:  2009  overview  report.  Final  Health  Futures  evalution  report  prepared  for  the  Ministry  of  Health.  Wellington:  New  Zealand  Council  for  Educational  Research.    

Colmar  Brunton  (May  2010a)  Fruit  in  Schools  research:  Gauging  public  opinion  of  Fruit  in  Schools  initiative  [Presentation].  Auckland:  Colmar  Brunton.    

Colmar  Brunton  (July  2010)  Fruit  in  Schools  [Presentation].  Auckland:  Colmar  Brunton.      

European  Commission  (2012a)  Annex  5:  Overview  of  the  British  School  Fruit  and  Vegetable  Scheme.  Retrieved  from  http://ec.europa.eu/agriculture/evaluation/market-­‐and-­‐income-­‐reports/2012/school-­‐fruit-­‐scheme/annex5_en.pdf    

European  Commission  (2012b)  Report  from  the  Commission  to  the  European  Parliament  and  the  Council  in  accordance  with  Article  184(5)  of  Council  Regulation  (EC)  No  1234/2007  on  the  implementation  of  the  European  School  Fruit  Scheme.  Brussels:  European  Commission.  

Lytle  l  (2012)  Dealing  with  the  childhood  obesity  epidemic:  a  public  health  approach.  Abdom  Imaging  37(5):719-­‐24.  

Ministry  of  Health  (2003)  Healthy  Eating,  Healthy  Action  Strategy.  Wellington:  Ministry  of  Health.  

Ministry  of  Health  (2003)  New  Zealand  Cancer  Control  Strategy.  Wellington:  Ministry  of  Health.    

Ministry  of  Health  (2005)  New  Zealand  Cancer  Control  Strategy:  Action  Plan  2005-­‐2010.  Wellington:  Ministry  of  Health.    

Ministry  of  Health  (2006)  Fruit  in  Schools  loose-­‐leaf  kit  May  2006.  Wellington:  Ministry  of  Health.  

Ryall  T  (2009,  October  29)  Fruit  in  schools  future  confirmed  [Press  release].  Retrieved  from  http://www.beehive.govt.nz/release/fruit-­‐schools-­‐future-­‐confirmed    

Walton,  M  (2014)  Applying  a  complexity  lens  to  health  policy  and  evaluation,  unpublished  manuscript,  Wellington,  Massey  University.  

Waters  E,  de  Silva-­‐Sanigorski  A,  Hall  BJ,  Brown  T,  Campbell  KJ,  Gao  Y,  Armstrong  R,  Prosser  L,  Summerbell  CD.  (2011)  Interventions  for  preventing  obesity  in  children.  Cochrane  Database  of  Systematic  Reviews  2011,  Issue  12.  Art.  No.:  CD001871.  DOI:  10.1002/14651858.CD001871.pub3.    

Appendix  A:  Evaluation  methods    

Project  Plan  A  project  plan,  outlining  the  scope  and  methods  for  the  evaluation,  was  developed  by  Quigley  and  Watts  in  collaboration  with  5+  A  Day  Charitable  Trust,  and  signed  off  on  October  2nd  2014.    Minor  adjustments,  for  clarification,  were  made  as  the  project  progressed.    

Evaluation  objectives  The  primary  purpose  of  the  evaluation  was:  

• to  understand  and  document  the  benefits  of  Fruit  in  Schools,  in  particular  any  wider  health  promotion  impacts,  with  a  particular  focus  on  nutrition  and  healthy  eating.        

 Secondary  aims  were  to:  

• explore  success  factors  for  Fruit  in  Schools,  and  other  programmes  that  support  child  health  and  health  promotion  in  schools.    

• gain  feedback  on  teaching  resources  provided  through  the  5+  A  Day  Charitable  Trust    • explore  how  the  programme  could  be  improved  

 

Research  Questions    The  data  collection  and  analysis  were  guided  by  the  following  overarching  research  questions:    

1. What  are  the  impacts  that  FIS  is  having  on  children/families/schools?  Impacts  may  include:  a. Knowledge,  awareness  and  attitudes  about  nutrition  and  other  health  issues  

(staff/students/parents)  b. Health  promoting  behaviour  (e.g.  changes  in  eating  habits,  contents  of  lunchboxes,  

physical  activity  etc)  c. Health  promoting  school  activities  (e.g.  gardening,  cooking,  physical  activity  initiatives,  

smokefree  initiatives  ,  sunsmart  initiatives)  d. Health  outcomes  (e.g.  general  health,  sick  days,  dental  health,  skin  health)  e. Education  (e.g.  concentration,  behaviour)    f. School-­‐community  linkage  (e.g.    new  or  better  links  with  parents/whānau,  community  

groups,  health  promotion  organisations)    

2. What  is  the  value  of  FIS  to  schools,  and  what  is  it  about  FIS  that  makes  it  effective  (particularly  in  comparison  to  other  programmes  that  provide  food  in  schools)?      

3. What  are  stakeholders’  perceptions  about  teaching  resources  provided  by  5+  a  Day  Charitable  Trust?    

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4. How  could  FIS  be  improved?  

Document  and  Literature  Scan  This  phase  of  the  work  involved  a  review  of  programme  documents  and  a  relevant  New  Zealand  and  international  literature.  Based  on  this  review  a  programme  description  was  developed,  including  background  information  on  the  history  and  purpose  of  Fruit  in  Schools,  and  the  current  context  and  operation  of  the  programme.    Evaluation  findings  to  date  about  New  Zealand’s  Fruit  in  Schools  programme  were  also  summarised,  along  with  findings  about  similar  programmes  internationally.    

Fruit  in  Schools  Survey  A  brief  online  survey  was  prepared  using  Survey  Monkey.  The  questions  were  developed  in  collaboration  with  5+  A  Day,  based  on  previous  evaluations  and  the  aims  of  the  current  evaluation.  The  survey  was  pre-­‐tested  internally  before  being  finalised.      

Quigley  and  Watts  Ltd  emailed  a  link  to  the  survey  to  all  467  participating  schools  for  whom  email  addresses  were  available  (provided  by  5+  A  Day)  on  October  20th.  Where  possible,  the  survey  was  sent  directly  to  the  principal,  but  for  some  schools  only  an  ‘office’  or  general  email  address  was  available.    The  subject  line  and  brief  cover  message  made  it  clear  that  the  survey  was  to  be  completed  by  the  principal.    

Only  one  person  opted  out  of  the  survey.  Eight  emails  ‘bounced’  and  5+  A  Day  followed  up  with  these  schools  to  obtain  the  correct  email  address,  where  possible.  Subsequently  Quigley  and  Watts  re-­‐sent  the  survey  link  to  four  schools.  Two  reminder  emails  were  sent  out  to  principals  who  had  not  yet  responded,  and  the  survey  closed  on  October  31st.    

378  responses  were  received,  a  response  rate  of  81%.    The  results  of  the  survey  are  provided  in  full  in  Appendix  B.    

Key  informant  interviews  Data  collection  also  included  16  key  informant  interviews  with  10  school  principals,  5  Health  Promoting  Schools  facilitators  and  1  Ministry  of  Health  official.    

Principals  

The  survey  included  a  question  asking  principals  if  they  would  be  willing  to  participate  in  a  follow  up  interview;  186  responded  ‘yes’.  These  records  were  numbered  and  an  online  random  number  generator  was  used  to  randomly  select  10  principals  to  be  interviewed.  Principals  were  contacted  in  the  order  that  they  were  selected,  and  in  all  14  principals  were  contacted  since  four  were  unavailable  or  declined  to  be  interviewed.    

There  was  a  good  geographical  spread,  and  a  range  of  different  school  types  represented.  Four  were  principals  of  a  school  in  a  main  urban  centre,  four  in  provincial  towns,  and  two  in  rural  settings.  School  size  ranged  from  two  classes  to  over  470  children,  and  school  types  included  Kura  Kaupapa  Māori  ,  an  area  school  (Years  0-­‐13),  contributing  schools  (Year  0-­‐6)  and  full  primary  schools  (Year  0-­‐8).  

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Health  Promoting  Schools  facilitators  

Health  Promoting  Schools  facilitators  work  with  schools  across  their  region  to  support  the  implementation  of  the  Health  Promoting  Schools  programme.  They  are  generally  employed  by  the  District  Health  Board  in  each  region.  5+  A  Day  provided  contact  details  for  Health  Promoting  Schools  facilitators  around  the  country.  The  evaluators  made  a  purposive  selection  to  ensure  a  wide  geographical  spread.    

Ministry  of  Health  

The  Ministry  of  Health  official  contacted  had  been  involved  in  the  Fruit  in  Schools  programme  from  its  outset,  and  provided  a  funder’s  perspective.    

Materials  An  information  sheet  was  prepared  for  potential  key  informants  explaining  the  purpose  of  the  evaluation,  the  interview  procedure,  and  explaining  that  their  name  would  not  be  used  in  the  final  report.    

Three  semi-­‐structured  interview  schedules  were  prepared  to  guide  the  interviews  with  principals,  Health  Promoting  Schools  facilitators  and  the  Ministry  of  Health  official.  The  questions  were  based  on  the  aims  of  the  evaluation,  and  sought  add  depth  to  the  survey  findings.    

Procedure    In  most  cases  potential  participants  were  invited  to  be  interviewed  by  email,  which  included  the  information  sheet  about  the  evaluation.  This  was  followed  up  by  a  phone  call  to  establish  willingness  to  be  involved,  and  arrange  an  interview  time.  In  a  few  cases  the  initial  contact  was  by  phone  (because  an  email  address  was  unavailable),  but  in  either  case,  all  participants  received  an  information  sheet  by  email.  Each  interview  began  with  a  brief  discussion  about  the  purpose  of  the  interview,  confidentiality  and  anonymity,  and  each  interviewee  had  an  opportunity  to  ask  questions.  Participants  gave  verbal  consent  for  the  interview  to  be  recorded.  They  were  recorded  using  a  digital  voice  recorder.    

All  the  interviews  were  conducted  by  telephone.  The  interviews  follow  a  semi-­‐structured  format  based  on  a  pre-­‐prepared  interview  schedule.  The  questions  differed  depending  on  the  interviewee’s  role  in  relation  to  Fruit  in  Schools,  and  sought  both  factual  information  and  key  informant  perceptions  about  the  programme.    

Notes  were  written  up  immediately  after  each  interview  with  reference  to  the  interview  recording.  Verbatim  quotes  were  marked  as  such  in  the  notes,  and  other  sections  paraphrased.    

Analysis  The  evaluation  objectives  and  research  questions  formed  the  framework  for  analysis.  Material  relevant  to  each  objective  and  question  was  identified  in  each  data  source.  Material  from  each  data  source  was  analysed  and  summarised  separately,  and  then  brought  together  and  overall  findings  identified.    

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Reporting  The  evaluation  report  was  organised  according  to  the  evaluation  objectives.  The  draft  report  was  internally  peer  reviewed  by  a  senior  Quigley  and  Watts  staff  member  before  being  submitted  to  the  client.    

Strengths  and  limitations  There  was  an  excellent  response  rate  of  to  the  survey  (81%),  so  we  can  be  confident  that  the  findings  accurately  reflect  the  majority  views  of  principals.  The  use  of  both  qualitative  and  quantitative  methods  adds  depth  to  the  findings,  and  triangulation  of  data  sources  further  adds  to  the  validity  of  the  findings.    

A  limitation  of  the  evaluation  is  that  it  is  based  on  the  perceptions  and  observations  of  school  principals  and  Health  Promoting  Schools  facilitators.  Objective  measurement  of  outcomes  was  beyond  the  scope  of  the  current  evaluation,  as  was  inclusion  of  whānau  or  pupil  perspectives.