Effectiveness of the Apprenti en Action School-based Culinary Program on 9-10-year-old Children's Food Literacy

Study Overview
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Brief Summary
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In New Brunswick, Canada, only 53% of Kindergarten to Grade 5 students reported eating five or more vegetables and fruits per day in 2016-2017. Low intakes of vegetables and fruits are a marker for poor nutrition, which may impair the growth and cognitive development of children and adolescents and may put them at risk of developing certain non-communicable diseases earlier in life. It has been suggested that increasing children's food literacy may be an effective way of promoting healthier diets, including increasing vegetable and fruit intake among students. Since children spend most of their waking hours at school, this may be a key setting for promoting food literacy and healthy eating behaviors. Previous studies have found that culinary interventions that include taste testing and nutrition education may improve students' food literacy and vegetable and fruit consumption. Therefore, this quasi-experimental study aimed to assess the effectiveness of a school-based culinary program titled Apprenti en Action on primary school children's food literacy, breakfast, and vegetable and fruit consumption. Specifically, data were collected among Grade 5 students from ten francophone elementary schools, five of which received the Apprenti en Action program and five who did not. The Apprenti en Action program consisted of six, one-hour culinary workshops given once a week, at school, during school hours. Data on students' food literacy, breakfast, vegetable, and fruit consumption were collected via online questionnaires before and after the program. In addition to collecting quantitative data, qualitative data were collected from program participants and their parents to assess their perceptions of Apprenti en Action.

Detailed Description
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This study used a quasi-experimental design. Quantitative data from Grade 5 students from five francophone elementary schools in the province of New Brunswick, Canada, who participated in the Apprenti en Action culinary program were compared to those of Grade 5 students from five other elementary schools who did not receive the program. Apprenti en Action consists of six, one-hour culinary workshops offered once a week during school hours. The program aims to teach students how to read and follow recipes, prepare and cook various foods using various culinary techniques, and apply food safety practices. Students are also taught the basics of healthy food, nutrition, and cooking. A questionnaire was developed based on previously-validated questionnaires and it measured vegetable and fruit consumption, breakfast consumption, concepts of food literacy including food and cooking skills as well as nutrition knowledge. All students will complete this self-administered online questionnaire before and after the program. Multilevel regressions will be used to assess the effectiveness of the culinary class on students' food literacy, breakfast, vegetable, and fruit consumption. Additionally, focus groups with children who participated in the Apprenti en Action program and their parents will be invited to share their perceptions of the program and how/if it has impacted the children's food literacy and eating behaviors.

Official Title
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Effectiveness of the Apprenti en Action School-based Culinary Program on 9-10-year-old Children's Food Literacy and Vegetable and Fruit Consumption

Conditions
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Fruit and Vegetable Intake, Eating Behavior

Intervention / Treatment
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* Behavioral: Apprenti en Action program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be enrolled in a Grade 5 or mixed Grade 4 and 5 class Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 11 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Apprenti en Action (intervention group)<br>Apprenti en Action consists of six, one-hour culinary workshops offered once a week during school hours. | Behavioral: Apprenti en Action program<br>* The Apprenti en Action program aims to teach students how to read and follow recipes, prepare and cook various foods using various culinary techniques, and apply food safety practices. Students are also taught the basics of healthy food, nutrition, and cooking.<br>|
| Control group<br>Students in the control group do not receive the Apprenti en Action program. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in vegetable and fruit consumption at the end of the program | Students' consumption of vegetables and fruits was measured using two questions from the provincial New Brunswick Student Wellness Survey (New Brunswick Student Wellness Survey, 2016). These questions asked how many vegetables and fruits they had eaten the day before the survey. This was measured using a scale from 0 (None), to 7 (7 or more). | Baseline and Endpoint (Week 6) | 
| Change from baseline in breakfast consumption at the end of the program | Students' breakfast consumption was assessed based on one question from the provincial New Brunswick Student Wellness Survey (New Brunswick Student Wellness Survey, 2016). Students were asked to report how often they ate breakfast during the last school week. This question was scored from 0 (none) to 7 (7 days of the week). | Baseline and Endpoint (Week 6) | 
| Change from baseline in cooking skills at the end of the program | Cooking skills include all skills needed to prepare and cook foods, including cooking methods and food preparation techniques, and were measured using 18 questions. Among the questions, one was assessed with a five-point, downwards Likert-type scale (e.g. Rate your ability to make the different breakfast foods), and 17 questions were multiple-choice questions (e.g. How long does it take to cook hard- and soft-boiled eggs?). All cooking skills included in the questionnaire were skills that children were expected to have practiced during the program. The questionnaire was based on three previously-validated tools (Skeaff et al. 2020, Dean et al. 2021, Lavelle et al. 2017). Specifically, these questions measured children's ability to prepare breakfast, to use various cooking methods, to use kitchen equipment, to apply food safety practices, and to use various food preparation techniques. In total, a score ranging from 0 to 83 points was possible for this outcome variable. | Baseline and Endpoint (Week 6) | 
| Change from baseline in nutrition knowledge at the end of the program | Nine multiple-choice questions were used to assess children's nutrition knowledge, including their understanding of a balanced plate and food safety. These questions were inspired by those used in Skeaff et al.'s (2020) validated questionnaire. In total, a score of 0 to 9 points was possible for this outcome variable. | Baseline and Endpoint (Week 6) | 
| Change from baseline in food skills at the end of the program | Food skills represent the knowledge and skills required to choose and prepare food according to available resources and to cook balanced meals. They include meal planning, following a recipe, using leftovers, making and following a grocery list, reading nutrition labels, etc. Of the three questions used to measure food skills, two questions were multiple-choice questions (e.g. The above picture is of French toast. What are three ingredients you need for French toast?) and one was a five-point downwards Likert-type scale (From this list, indicate how good you are at performing these actions.). These questions were based on previously-validated questionnaires (Skeaff et al. 2020, Lavelle et al. 2017). In total, a score of 0 to 53 points was possible for this outcome variable. | Baseline and Endpoint (Week 6) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Student perception of the program | Students' perception of the program will be measured via virtual semi-structured focus groups. Two 40-45 minute sessions with 8-10 students per group are anticipated. Students will be asked to share their perception of the program's impact on their knowledge, skills, appreciation for healthy foods, and self-efficacy, as well as the strengths, weaknesses, and perceived relevancy of the program. | One week after the end of the program (Week 7) | 
| Parent perception of the program | Students' parents' perception of the program will be measured via virtual semi-structured focus groups. Two 40-45 minute sessions with 8-10 parents per group are anticipated. Parents will be asked to share their perception of the program's impact on their children's knowledge, skills, appreciation for healthy foods, and self-efficacy, as well as the strengths, weaknesses, and perceived relevancy of the program. | One week after the end of the program (Week 7) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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School, Food skills, Cooking skills, Food literacy, Culinary program, Cooking program, Nutrition knowledge