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Evaluation of the effectiveness of an innovative nutrition education program (Foodstyles : K) Hammond, Gail Kathleen 1992

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EVALUATION OF THE EFFECTIVENESS OF AN INNOVATIVENUTRITION EDUCATION PROGRAM (FOODSTYLES:K)byGAIL KATHLEEN HAMMONDB.Sc. (Chemistry), University of Victoria, Victoria BC, 1989A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF SCIENCEinTHE FACULTY OF GRADUATE STUDIESDIVISION OF HUMAN NUTRITIONSCHOOL OF FAMILY AND NUTRITIONAL SCIENCESWe accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAOctober 1992(c) Gail Hammond, 1992In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of ^Human NutritionThe University of British ColumbiaVancouver, CanadaDate^October 9 1992DE-6 (2/88)ABSTRACTABSTRACTThe nutrition of young children has been recognized as a priority health promotion issue forCanadians by Health and Welfare Canada. Childhood offers an opportunity, unlike any other timein the life cycle, to establish lifelong healthful eating patterns. By providing young children withthe necessary tools to attain a basic understanding of nutrition concepts, we are making aninvestment in their future. Program evaluation is an essential key to obtaining the greatest gainsfrom this investment.The focus of this program evaluation was two-fold. First, Phase I was designed to assessteachers' perceptions of an existing early childhood nutrition education program (Foodstyles:K),with the intention of maximizing the effectiveness of future editions of the program. Second,Phase II was designed to evaluate the impact of this program on student's familiarity with 16specific foods and their stated willingness to eat them, and to offer parents of the students anopportunity to contribute their perceptions of any effects of the program on their child's foodbehaviours.A questionnaire was developed and pretested for Phase I to assess teacher use of the program.A return rate of 49% (n=404) was achieved with a maximum of 4 contacts per teacher. Threequarters of the teachers taught the program at some point following attendance at a Foodstyles:Kworkshop, and 47% of all respondents reported "current" use of the program during the schoolyear which was evaluated (1989-1990). The outstanding reason for non-use of the program was alack of both in class and out of class time. However, almost 1 out of every 5 teachers whoiiABSTRACTindicated past use of the program, voluntarily commented that the program was "good,""excellent," or "terrific."An interview protocol was developed and pretested for Phase II to assess kindergarten student'sfamiliarity with the 16 test foods and their stated willingness to eat them. Two questionnaires werealso developed (pretest and posttest) to assess parents' perceptions of their children'swillingness to eat the test foods. Several questionnaire items appeared on both the pretest andposttest questionnaires to permit a comparison of parents' responses at the start of the schoolyear and again near the end. In addition, one question which appeared on both the pretest andposttest questionnaires, coincided with the same question asked of the children in terms of theirstated willingness to eat the test foods. This permitted a comparison between parentalperceptions of their child's willingness to eat the test foods and their child's actual responses.Overall, students familiarity with the 16 test foods increased significantly from pretest to posttestwith the most significant increase appearing with foods that were introduced to the group ofchildren who received program intervention.No change was observed overall from pretest to posttest for student's stated willingness to eatthe 16 test foods. Comparatively, no significant change was observed for parents' perceptions oftheir child's willingness to eat the test foods.Significant differences did appear between parents and children in the intervention group for theirresponses indicating the child's willingness to eat both the introduced and non-introduced foodsat pretest and again at posttest, with the child consistently stating s/he was willing to eat a greateriiiABSTRACTnumber of foods than perceived by her/his parent. With the exception at posttest with non-introduced foods only, there was no significant difference between parents and children in thecontrol group for their responses to the child's willingness to eat the test foods.Overall, agreement between parents' perceptions of their child's willingness to eat the test foodsand their child's responses was 73.4%.ivTABLE OF CONTENTSTABLE OF CONTENTSABSTRACT^ iiLIST OF TABLES xiLIST OF FIGURES^ xiiiACKNOWLEDGEMENT xivI. INTRODUCTION^ 11. BACKGROUND^ 1A. A Case for Nutrition Education in the Kindergarten Curriculum^2B. Foodstyles:K: A Description^ 4I. Program Objectives 4II. Food Introduction 6III. Cooking^ 6IV. Journals 7V. "I Tried It!" Stickers and Class Club^ 7VI. Supplemental Activities^ 82. STATEMENT OF THE PROBLEM 8A. Purpose of the Study^ 83. RESEARCH QUESTIONS 9A. Primary Research Questions^ 9B. Secondary Research Questions 10C. Descriptive Research Questions 1 14. HYPOTHESES^ 11A. Primary Hypotheses^ 1 1B. Secondary Hypotheses 125. ASSUMPTIONS^ 13II. LITERATURE REVIEW 141. OVERVIEW^ 142. EDUCATIONAL GOALS FOR CHILDREN IN KINDERGARTEN^ 15vTABLE OF CONTENTS3. CHARACTERISTIC TRAITS OF KINDERGARTEN-AGED CHILDREN^17A. Concept Development^ 17B. Intellectual Development 18C. Social Development 20D. Emotional Development^ 21E. Physical Development 21F. Summary^ 224. EVOLUTION OF NUTRITION EDUCATION^ 23A. Origins of Nutrition Education 23B. Integration of Nutrition Education Into Lessons^ 25C. A Change in Focus from Providing Nutrition Information to InfluencingFood Behaviour^ 26D. Attempts to Improve Childrens' Food Habits^ 28I. Familiarity 28II. Social Influence Techniques^ 29E. Appearance of Early Childhood Nutrition Education Programs^31F. Attempts to Increase the Efficacy of Early Childhood NutritionEducation Programs^ 32I. Curriculum Guides^ 32II. Teacher Training 33III. In-Service Nutrition Education Workshops^ 335. EVALUATION^ 34A. Evaluation Research^ 35B. Qualitative Methods in Evaluation Research^ 37III. EXPERIMENTAL DESIGN AND METHODS^ 401. STUDY DESIGN^ 402. PRE-EVALUATION PROTOCOL^ 41A. Data Collection Tools 41I. Questionnaires^ 41a.) Phase I 41i.) Development of Teacher Questionnaire^41ii.) Validation of Teacher Questionnaire 42iii.) Pretesting Teacher Questionnaire 42b.) Phase II^ 44i.) Development of Parental Questionnaires^44ii.) Validation of Parental Questionnaires 45II. Interviews^ 45a.) Phase II 45i.) Development of Appropriate Testing Procedure^45ii.) Pilot Testing the Student Interview Process 46b.) Sixteen Test Foods - Food Models^ 47i.) Food Model Selection 47ii.) Food Models vs. Pictures 48B. School District and Principal Permission^ 50viTABLE OF CONTENTS3. EVALUATION PROTOCOL^ 50A. Data Collection Procedures^ 50I. Phase I -- Teachers' Perceptions of Foodstyles:K^ 50a.) Recruitment of P-1 Teachers^ 50b.) Protocol of Teacher Questionnaire Mailings 51i.) First Mailing of Teacher Questionnaire^ 51ii.) First Follow-up^ 51iii.) Second Mailing of Teacher Questionnaire 52iv.) Second Reminder Mailout^ 52II. Phase II -- Evaluation of Foodstyles:K Nutrition EducationProgram - Student and Parent Participation 52a.) Evaluation Design^ 52b.) Recruitment of P-1 Classes^ 54c.) Pretest Data Collection Procedures^ 57i.) Parental Pretest Questionnaire 57ii.) Student Pretest Interviews 58d.) Teacher Contact Through the School Year^ 63e.) Posttest Data Collection Procedures^ 64i.) Student Posttest Interviews 64ii.) Parental Posttest Questionnaire 65B. Compilation of Data^ 67I. Phase I^ 67II. Phase II 67a.) Coding of Identification Numbers^ 67b.) Parental Questionnaire Data 68c.) Student Interview Data^ 68d.) Parent/Child Merged File 684. STATISTICAL ANALYSIS OF DATA^ 69A. Phase I^ 69B. Phase II 69I. Parental Pretest Questionnaire Data^ 69II. Parental Pretest and Posttest Questionnaires Data^70III. Parental Posttest Questionnaire Data 71IV. Student Pretest and Posttest Interview Data^ 71V. Parents' Perceptions of their Child's Willingness to Eatthe Test Foods Compared with Their Child's Actual Response ^72VI. Parent/Child Merged Data^ 72TABLE OF CONTENTSIV. RESULTS^ 741. PHASE I - TEACHER QUESTIONNAIRE^ 74A. Rural versus Urban Responses 75B. Use^ 75I. "Past but not Present" Use Teacher Group^ 75II. "Never" Use Teacher Group^ 81III. "Current" Use Teacher Group 86a.) Method of Teaching Foodstyles:K^ 86b.) Frequency of Teaching Foodstyles:K 89c.) Teacher Satisfaction with Foodstyles:K 95d.) The Three Most Relevant Core Activities^96e.) Student Interest in Foodstyles:K^ 98f.) Use of Recipes^ 98g.) Use of the "Look What I Tried!" Journal 98h.) Use of "I Tried It!" Stickers^ 99i.) Use of the Class Club Activity 99j.) Parental Support for Foodstyles:K^ 1002. PHASE II - EVALUATION OF FOODSTYLES:K - PARENT ANDSTUDENT PARTICIPATION^ 100A. Parental Pretest Questionnaire 100I. Food-related Restrictive Conditions^ 103a.) Food Allergies^ 104b.) Special Dietary Restrictions 104c.) Medical Conditions 104II. Age and Gender Distributions^ 109III. Sibling Distributions^ 109IV. Previous Daycare Attendance 111V. Parental Awareness of Nutrition Education at Daycare^111VI. Cultural Heritage^ 111B. Parental Pretest and Posttest Questionnaires^ 116C. Parental Posttest Questionnaire^ 117D. Student Familiarity Data - Pretest and Posttest 118E. Student and Parent Willingness Data - Pretest and Posttest^121I. Student Willingness^ 121II. Parents' Perceptions of Their Child's Willingness to Eatthe Test Foods 121III. Parents' Perceptions of Their Child's Willingness to Eatthe Test Foods Compared with Their Child's Actual Response ^124F. Parent/Student Matching Data^ 124G. Summary of Results with Reference to the Study Hypotheses^127viiiTABLE OF CONTENTSV. DISCUSSION^ 1311. INTRODUCTION^ 1312. PHASE I - TEACHERS' PERCEPTIONS^ 131A. Use^ 133I. "Past but not Present" Use Teacher Group^ 133II. "Never" Use Teacher Group^ 134III. "Current" Use Teacher Group 136a.) Method of Teaching Foodstyles:K^ 137b.) Frequency of Teaching Foodstyles:K 138c.) Teacher Satisfaction with Foodstyles:K 140d.) Foodstyles:K Core Activities^ 140i.) Successful Core Activities 140ii.) Less-successful Core Activities^ 142e.) Student Interest in Foodstyles:K 144B. Summary^ 145C. Suggested Future Revisions to the Teacher Questionnaire^146D. Suggested Recommendations for Change to the Foodstyles:KProgram Based on the Teachers' Perceptions^ 1513. PHASE II - EVALUATION OF FOODSTYLES:K - PARENT AND STUDENTPARTICIPATION^ 153A. Parental Pretest Questionnaire^ 153B. Parental Pretest and Posttest Questionnaires^ 154C. Parental Posttest Questionnaire 157D. Student Familiarity Data - Pretest and Posttest 158E. Student and Parent Willingness Data- Pretest and Posttest^160I. Student Willingness^ 160II. Parents' Perceptions of Their Child's Willingness to Eatthe Test Foods 161III. Parents' Perceptions of Their Child's Willingness to Eatthe Test Foods Compared with Their Child's Actual Response^ 162F. Parent/Student Matching Data^ 1624. IMPLICATIONS FOR FUTURE RESEARCH 163VI. CONCLUSION^ 164BIBLIOGRAPHY 166APPENDIX 1. Year 2000 Document^ 174APPENDIX 2. Piaget's Profile of Cognitive Development^ 175APPENDIX 3. UBC Ethics Approval - Phase I^ 178APPENDIX 4. UBC Ethics Approval - Phase II 179APPENDIX 5. Pretester's Questionnaire^ 180APPENDIX 6. School District Authorization 181ixTABLE OF CONTENTSAPPENDIX 7. Teacher Questionnaire^ 186APPENDIX 8. Notice of Willingness to Participate in Phase II ^ 195APPENDIX 9. First Follow-up Notice^ 196APPENDIX 10 . Updated Cover Letter to Non-respondents^ 197APPENDIX 11. Second Follow-up Notice^ 198APPENDIX 12. Parental Pretest Questionnaire 199APPENDIX 13. Monthly Telephone Queries to Teachers of Control Classes^207APPENDIX 14. Monthly Telephone Queries to Teachers of Intervention Classes^208APPENDIX 15. Parental Posttest Questionnaire^ 211APPENDIX 16. Teacher Descriptions of the "Other" Method they Reported Using toTeach Foodstyles:K^ 216APPENDIX 17. Teacher Descriptions of the "Other" Method they Reported Using inConjunction with Teaching Foodstyles:K on It's Own, in Some ClassroomActivities, or in All Classroom Activities^ 218APPENDIX 18. List of Foods Requested by Children as Reported by Their Parents(Control Group)^ 222APPENDIX 19. List of Foods Requested by Children as Reported by Their Parents(Intervention Group)^ 223APPENDIX 20. Noticeable Changes in Childrens' Food Habits Over the School Yearas Reported by Their Parents (Control Group)^ 226APPENDIX 21. Noticeable Changes in Childrens' Food Habits Over the School Yearas Reported by Their Parents (Intervention Group)^ 228APPENDIX 22. Glossary^ 231LIST OF TABLESLIST OF TABLESTable 1. School Districts Considered to be Within Urban Areas in British Columbia^43Table 2. Reasons for Ineligibility of 15 Volunteer Teachers^ 56Table 3. Schedule of Pretest Interviews by Date of Interview 59Table 4. Number of "Test" Foods Introduced in the Month Preceding Telephone Contact ^64Table 5. Schedule of Posttest Interviews by Date of Interview.^ 66Table 6. Open Responses from Teachers in the "Past but not Present" Use GroupIndicating Their Primary Reason(s) for Discontinuing Use of Foodstyles:K^76Table 7. Reasons Given by 11 Teachers in the "Past but not Present" Use GroupWho Provided Multiple Primary Reasons for Their Discontinued Useof Foodstyles:K^ 78Table 8. Frequency of Factors Which Contributed to the Decision by Teachersin the "Past but not Present" Use Group to Discontinue Their Useof Foodstyles:K^ 80Table 9. Open Responses from Teachers in the "Never" Use Group Indicatingthe Primary Re,ason(s) for Their Decision Not to Use Foodstyles:K^82Table 10. Multiple Primary Reasons Provided by the 5 Respondents in the "Never"Use Group for Their Decision Not to Use Foodstyles:K^ 83Table 11. Frequency of Factors Contributing to the Decision by Teachers in the"Never" Use Group Not to Teach Foodstyles:K^ 85Table 12. Choice of Methods for Teaching Foodstyles:K 88Table 13. Percent Frequencies of the Most Relevant Core Activities Reportedby Teachers in the "Current" Use Group.^ 97Table 14. Response Rate for Parents Returning Their Pretest Questionnaires^102Table 15. Table of Parental Responses Indicating Restrictive Food-relatedConditions for Their Children. ^ 106Table 16. Summary of Sibling Distribution Data Provided by Parents at Pretest^110Table 17. Detailed Account of Students with a Canadian/British/English CulturalHeritage as Reported by Their Parents. ^ 112x iLIST OF TABLESTable 18. Detailed Account of Students with a Cultural Heritage "Other" thanCanadian/E3ritish/English as Reported by Their Parents.^ 113Table 19. Demographic Variables by Study Group.^ 115Table 20. Parent's Ranking of their Child's Willingness to Eat a Variety of Foodsand Unfamiliar Foods.^ 116Table 21. Table of Student's Familiarity with all 16 Test Foods.^ 118Table 22. Table of Student's Familiarity with Introduced and Non-introduced Foods.^120Table 23. Table of Student's Willingness to Eat the 16 Test Foods and Parents'Perceptions of Their Children's Willingness to Eat the Test Foods^122Table 24. Table of Student's Willingness to Eat the 16 Test Foods and Parents'Perceptions of Their Child's Willingness to Eat the 16 Test Foods^123Table 25. Percent Agreement Between Parents' Perceptions of Their Child'sWillingness to Eat the 16 Test Foods and the Children's Responses^125xiiLIST OF FIGURESFigure 1. The Number of Times Per Month in the School Year Teachers in the"Current" Use Group Reported Teaching Foodstyles:K^ 90Figure 2. The Number of Months Per School Year that Teachers in the "Current"Use Group Reported Teaching Foodstyles:K^ 92Figure 3. The Number of Foods Teachers in the "Current" Use Group ReportedIntroducing Using Foodstyles:K^ 94Figure 4. Flow Chart of the Steps Where Loss of Potential Study Participants Occurred ^107ACKNOWLEDGEMENTI sincerely appreciate and thank my co-supervisors, Dr. Linda McCargar and Dr. Susan Barr,for their constructive advice, excellent guidance, and continual support, par excellence,throughout completion of this thesis.I would also like to express my most grateful appreciation to Dr. Hannah Polowy and SydneyMassey, for the invaluable input and continued interest they offered as research committeemembers.A special thanks to Sara Pare for her unfailing accompaniment as data recorder and for her joiede vivre she brought to the project. Merci beaucoup, Sara.I also wish to thank Frank Ho at the University Computing Services for his infinite patience andexpertise working on the statistics for this project.I gratefully acknowledge the British Columbia Dairy Foundation for funding this project and forhelpful comments from the nutrition educators there.Many thanks are extended to the school board administrators, principals, teachers, students andparents whose cooperative participation made this research project possible.Finally, extra special thanks goes to my mother, Phyllis, and my father, Joseph, for theirencouragement, understanding and loving support in so many ways throughout this challengingexperience, and to all my other family members for their direct and indirect contributions to thisproject. Thank you all!xivINTRODUCTIONCHAPTER IINTRODUCTION1. BACKGROUNDLearning to make wise food choices and developing good food habits in early childhood arebelieved to affect food selection and consequently nutritional status throughout life (Splett andStory, 1991; Lawatsch, 1990; Canada, 1985; Birch, 1979(b)). Early childhood educators havelong acknowledged the importance of young childrens' early experiences on later attitudestoward education and life itself. Nutrition education is no exception. The kindergarten classroomprovides young children with an ideal stimulating and supportive environment in which they canbegin to learn elementary concepts of sound nutrition. It is critical that at an early age children beprovided with the tools necessary to develop healthy eating habits. Support for this concept isstressed in Canada's Food Guide as the need for young children to "establish patterns of goodnutrition, normal weight and an active lifestyle which will last them a lifetime" (Canada, 1982(b)).Nutrition education goals for the kindergarten child should include: the acquisition of knowledgeabout their nutritional needs, the development of positive attitudes toward eating a wide variety offoods and the development of eating habits which foster health and well-being (McEwen andKieren, 1984).Through structured nutrition education programs with age-appropriate activities for learningnutrition concepts, kindergarten children can develop prerequisite knowledge and1INTRODUCTIONunderstanding that lay the foundation for later more advanced nutrition concepts. With anappropriate introduction to the "discovery" of food, this foundation can lead to a genuine interestin foods and nutrition. To achieve such short-term and long-term goals, nutrition educationprograms need to be systematically designed, implemented and evaluated. Determining theeffect of an early childhood nutrition education program requires evaluation at all levels ofpotential impact. To illustrate, consider a nutrition education program designed for use in thekindergarten classroom. It is imperative to conduct research which allows data collection (input)from teachers and students within the classroom, as well as the parents outside the classroom.Without such a comprehensive approach, the potential impact of the program may not be realized(Schwartz, 1985; Edwards, 1986; Crockett et al., 1988).P-1 (formerly kindergarten) teachers in British Columbia have available for use a comprehensivenutrition education program, Foodstyles:K. This program was specifically developed anddesigned by nutrition educators at the British Columbia Dairy Foundation (BCDF) to introducekindergarten children to a wide variety of foods. The program, however, has not yet beenevaluated.A. A CASE FOR NUTRITION EDUCATION IN THE KINDERGARTEN CURRICULUMThe atmosphere prevalent in kindergarten classrooms accommodates the naturally active learningstyles of children aged 5-6 years. Kindergarten children come from as varied backgrounds asthere are children in the class. For any one food, a wide range of frequency of exposure may beexpected, from a child having no exposure to one being very familiar with a food. Children whohave attended daycare or an organized preschool may have been exposed to a wider variety of2INTRODUCTIONfoods than children who have remained at home. Arrival at kindergarten presents a uniqueopportunity for children to discover new tastes and smells and foods, and to learn about culturesother than their own in a secure, caring, and stimulating setting.Multi-sensory experiences enable the child to form functional concepts which lay the foundationfor further development (Nelson, 1979). Because food is a familiar object that children canexperience through all five senses, cooking offers varied and stimulating opportunities foracquiring long lasting learning. As acknowledged in the Province of British Columbia kindergartencurriculum guide (1984), in addition to experiencing and discovering new foods, cooking activitiesprovide a means of reinforcing concepts from other curriculum areas.Across the province, unified goals for P-1 children have been established by the Province ofBritish Columbia, Ministry of Education. This denotes a major change from any previouseducation to which the kindergarten child may have had access in the past. Few, if any, pre-kindergarten programs are widely used in preschools or daycares across this province. Thecombination of uniform province-wide P-1 educational goals, the developmental stage of thekindergarten child, the fact that the kindergarten year is a critical one in terms of the childdeveloping positive attitudes towards education and life itself, and the physical need for 5-6 yearold children to consume healthy snacks throughout the day in addition to their regular meals allculminate to strongly support the need for official incorporation of nutrition into P-1 curricularactivities.3INTRODUCTIONB. FOODSTYLES:K: A DESCRIPTIONI. Program ObjectivesFoodstyles:K is a comprehensive early childhood nutrition education program designedspecifically for use in the kindergarten (P-1) classroom. The program, developed by nutritioneducators at the British Columbia Dairy Foundation (BCDF), is available to all kindergarten (P-1)teachers in British Columbia. Recognizing the developmental stage of most kindergartenchildren, the program objectives are focused on identification of and experiences with a widevariety of foods. The program goal is for the children to develop positive feelings about trying newfoods. It is well documented that increased variety in one's diet is a key to good nutrition (Canada,1990).In order to build positive feelings about trying new foods, the Foodstyles:K program provides theopportunity for children to experience real foods. Through identification and practical "hands-on/minds-on" experiences with foods the program provides a first structured, yet fun, introductionto launch the children on their journey into good nutrition. Program activities encourage tasting,cooking, discussion and keeping journals which allow expression of their feelings related to theintroduced foods while the children develop new concepts about food. The skills of languageand thought developed around this age assist the child to construct a relationship between wisefood choices and the functions of foods for continued growth, maintenance of health and as asource of energy for learning and playing.Teachers who choose to use Foodstyles:K in their classroom are required to attend an in-serviceworkshop where they are provided with sound nutritional information, innovative teachingmaterials and a step-by-step teacher's guide. The teacher's guide contains colour pictures of4INTRODUCTIONfoods and master pages for the journal and class club activities. Easy and more challengingrecipes for the cooking activity and a supply of "I tried it!" stickers are also included.A major advantage of Foodstyles:K is that it is a very flexible nutrition education program in termsof teaching plans and the variety of foods which can be introduced. Foodstyles:K can be taughtas single unit. The teacher may wish to introduce the foods suggested in the program all within ashort period of time (eg. 12 foods in a month, -3 foods per week). Alternatively, the teacher maychoose a variety of foods other than those suggested in the kit for the children to become familiarwith, taking into account the ethnic make-up of the class. Another option is for Foodstyles:K to betaught as an adjunct activity under a central theme, for example, a special occasion theme such asChinese New Year. Children develop an appreciation of their own and other's cultural identity andcan sample fortune cookies, cook stir-fried vegetables or chow mein, steam rice and/or make tea.Use of chopsticks provides another fun way to introduce the children to Chinese food.A further advantage of Foodstyles:K is that the objectives are confined to identifying andexperiencing a wide variety of foods. Given the limitations of the preoperational child, theseobjectives are suitable to the child's capabilities, thereby promoting a sense of positive self-concept derived from participation in Foodstyles:K activities. One of the characteristic limitationsof preoperational childrens' thought processes is the inability to classify objects (Scarr et al, 1986;Yussen and Santrock, 1982). Therefore, the exclusion of this objective from Foodstyles:Kincreases the likelihood that the child's interest and motivation towards food will be heightened bytheir participation in tasks which lead to a successful end result.5INTRODUCTIONThe Foodstyles:K program consists of four core areas:1. Food Introduction,2. Foodstyles:K Cooking,3. "Look what I tried" Journal, and4. "I tried it!" Stickers and Class Club.II. Food IntroductionThe teacher's guide suggests two activities for introducing foods. The first is the Mystery Foodcan. This consists of a large, clean and empty tin can with the top part of a sock secured to the rimof the can. Pictures may be glued to the outside of the can. The food to be introduced is placedinside the can then passed amongst the children. Through sensory exploration (touching,smelling, listening to the sound it makes) the children describe what they are discovering aboutthe food. After every child has had a turn, they are asked to identify the food. Removal of thefood from the can confirms their identification. The second method of food introduction is the"Who am I?" activity. The food to be introduced is kept out of sight and the children areencouraged to ask questions about its properties to try to identify the food. The skills involved incognitive and language development as well as prosocial behaviour are practiced with foodintroduction activities.III. CookingMany recipes for Foodstyles:K cooking from easy (eg. peanut butter) to more challenging (eg.mini pizzas) are suggested in the teacher's guide. As safety is of primary importance for youngchildren, safety precautions for each recipe are indicated where appropriate. The value ofcooking extends beyond its obvious nutrition education aspect. Children want and need to6INTRODUCTIONparticipate in food preparation. They feel a sense of responsibility by participating in an "adult"activity. Children develop a sense of social competence in preparing something for members oftheir group (Seefeldt, 1990). Age-appropriate cooking activities incorporate concepts as diverseas physical change, mathematical, temporal sequence, and language as well as reading and motorskills, cultural awareness and cooperation.IV. JournalsThe third core activity of Foodstyles:K is the "Look what I tried" journal. Children have theopportunity to express their feelings about each food introduced by printing and drawing on thejournal pages. By referring back to their journals, children recall their new food experiences whichhelps to reinforce a sense of achievement in trying new foods. Language, aesthetic, artistic andintellectual development are all stimulated through completion of the journals. The creation oftheir own book will fulfill a strong sense of accomplishment in the children, particularly as theypresent their book to family members.V. "I Tried It!" Stickers and Class ClubFoodstyles:K core activities conclude with the "I tried it!" stickers and class club activities.Following introduction of a food, the cooking activity and completion of a page in their journal, thechildren wear home an "I tried it!" sticker. The sticker is meant to alert the parent at home to beaware and curious about the food which was introduced at school that day. The sticker is notmeant to serve as a reward. Birch et al. (1984(b)) have shown that children who are rewarded fortrying a new food may increase consumption while the reward is in place. However, suchcontingencies produce negative shifts in preference, thereby reducing the probability ofconsumption once the reward is removed. A further link between the child's food-learning7INTRODUCTIONexperiences in their home environment and those at school is the "I tried it!" class club activity. Amaster copy of the parental letter and the form to be completed at home when a child tries a newfood is included in the teacher's guide. Children return a form complete with their name and thename of the new food they tried outside the classroom. A bulletin board can be posted and asnew foods are tried, magazine pictures of the foods can be displayed on the board. In ourmulticultural society, many different foods may be brought to the attention of the students. In thisway, the "I tried it!" class club activity serves as an effective forum for exposing new foods toyoung children. With successive exposures, novel foods which are often rejected by youngchildren, frequently become accepted (Birch, 1987(a)). Teachers may wish to incorporate someof these new foods into the cooking activity as a child who contributes to food preparationactivities rarely refuses to eat the food introduced (National Dairy Council, 1988). This wouldincrease the likelihood of achieving the objectives of Foodstyles:K.VI. Supplemental ActivitiesIn addition to the core activities, supplemental activities are suggested in the teacher's guideincluding; field trips, theme incorporation and children's literature with an extensive bibliographyprovided.2. STATEMENT OF THE PROBLEMA. PURPOSE OF THE STUDYThe nutrition of preschool children was identified as a high priority issue for the health promotionof Canadians (Canada, 1985). Yet, there is a paucity of documentation for evaluations of existingearly childhood nutrition education programs in Canada and for describing the effectiveness ofthese programs on preschool children's eating behaviours.8INTRODUCTIONThis study was designed to evaluate; 1.) teachers' perceptions of the Foodstyles:K earlychildhood nutrition education program, 2.) effects of Foodstyles:K on kindergarten children'sfamiliarity with and willingness to eat 16 test foods, and 3.) parents' perceptions of the effect ofFoodstyles:K on their kindergarten child's eating behaviours. It encompassed the use of open-and close-ended questions in mail surveys to the teachers and parents. In terms of the children,Birch (1979(a)) has argued that preschoolers do not hesitate to communicate their likes anddislikes about food. They are, therefore, the preferred candidates (versus their parents) forcollecting information regarding their food choices. In this study, dietary information was collecteddirectly from each child in one-to-one interviews and was also collected from their parents througha mail survey, to test for a possible relationship.Although Foodstyles:K in the present format has been available to P-1 teachers in BritishColumbia since 1987, it has never been evaluated. As evaluation is a critical component of anynutrition education program, it was important to determine if instruction using Foodstyles:K wasmeeting the program objectives.3. RESEARCH QUESTIONSA. PRIMARY RESEARCH QUESTIONSThis evaluation of the Foodstyles:K nutrition education program was designed to address thefollowing 2 primary research questions:1. Does exposure to the Foodstyles:K nutrition education program during thekindergarten year favourably affect student's recognition of a variety of selected foods?9INTRODUCTION2. Does exposure to the Foodstyles:K nutrition education program during thekindergarten year favourably affect student's stated willingness to eat a variety of selectedfoods?B. SECONDARY RESEARCH QUESTIONSThis study was also designed to investigate the following secondary research questions:3. Does the ability of kindergarten students to identify a variety of selected foods changeover the period of one year of attendance at kindergarten?4. Do food-related behaviours of kindergarten students (measured by willingness to eat aselection of foods) change over the period of one year of attendance at kindergarten?5. Do parents' perceptions of their child's willingness to eat unfamiliar foods change overthe course of the kindergarten year?6. Do parents' perceptions of their child's willingness to eat a variety of selected foodschange over the course of the kindergarten year?7. Do parents' perceptions of their child's willingness to eat a variety of selected foodsagree with their child's stated willingness to eat the same foods measured near the startand near the end of the school year?10INTRODUCTIONC. DESCRIPTIVE RESEARCH QUESTIONS8. To what extent is Foodstyles:K being taught by qualified P-1 (kindergarten) teachers inBritish Columbia?9. For those teachers not currently using Foodstyles:K, why have they chosen todiscontinue Foodstyles:K use or why have they chosen never to use Foodstyles:K intheir classrooms?4. HYPOTHESESA. PRIMARY HYPOTHESESQuestion 1:There will be no significant difference between students exposed to Foodstyles:K duringtheir kindergarten year compared with students not exposed to Foodstyles:K during theirkindergarten year, in terms of the student's stated recognition of a variety of selectedfoods.Question 2:There will be no significant difference between students exposed to Foodstyles:K duringtheir kindergarten year compared with students not exposed to Foodstyles:K during theirkindergarten year, in terms of their food behaviour towards a variety of selected foods, asmeasured by their stated willingness to eat these foods.11INTRODUCTIONB. SECONDARY HYPOTHESESQuestion 3:There will be no significant difference in the identification of a variety of selected foodsnear the start versus near the end of the school year for kindergarten students notexposed to the subject of nutrition during their kindergarten school year.Question 4:There will be no significant difference in the stated willingness to eat a variety of selectedfoods near the start versus near the end of their school year for kindergarten students notexposed to the subject of nutrition during their kindergarten school year.Question 5:There will be no significant difference in parents' perceptions of their kindergarten child'swillingness to eat a variety of foods over the course of the school year.Question 6:There will be no significant difference in parents' perceptions of their kindergarten child'swillingness to eat unfamiliar foods over the course of the school year.Question 7:For a variety of selected foods, there will be no significant difference between theparents' perceptions of their child's willingness to eat the foods, and their child's statedwillingness to eat the same foods.12INTRODUCTION5, ASSUMPTIONSFor the purpose of this study, the following assumptions were made:1. the questionnaires returned by the teachers were completed by the person to whomthey were addressed,2. the questionnaires returned by the parents were completed by one parent of the child,3. the pretest and posttest parental questionnaires were completed by the same parent,4. there would be no difference in responses to questionnaire items whether completedby either parent,5. the teachers of the intervention classes complied with the requirement that they followthe steps in the Foodstyles:K teacher's guide to introduce the 8 test foods,6. the teachers of the control classes complied with the requirement that they not discussthe subject of nutrition with their students in any organized or structured manner andkept all incidental discussion of food to a minimum,7. the 8 "test" foods as well as the 8 non-"test" foods were easily recognizable as foodmodels, and8. the socio-economic status of the two study groups was similar.13LITERATURE REVIEWCHAPTER IILITERATURE REVIEW1. OVERVIEWAttendance at kindergarten exposes young children to an environment of discovery; both aboutthemselves and their world. Through assimilating and accommodating new experiences,kindergarten-aged children readily process new information into their individual frameworks forlearning. To introduce basic, healthy nutrition concepts, the kindergarten teacher canadvantageously use these early childhood information processing characteristics in thestimulating and supportive environment of the kindergarten classroom.The prospect of a healthy lifetime lies ahead of these children; however, this is dependent uponthe condition that young children be provided with the essential keys to good health. Withoutinstruction in the basic concepts for early development of healthy food patterns, the very realprospect of a healthy lifetime ahead may only be a vision. Children who eat properly do better inschool and are livelier in their play than poorly nourished children (Canada, 1982(b)). Inacknowledgement of this, the federal government has identified young Canadian preschoolers asa priority target population for the promotion of good nutrition (Nielsen, 1983). Numerous earlychildhood nutrition education programs have appeared in community and educational settingsacross the country in response to the government's position (Schwartz, 1985). Even thoughmuch progress has been made in this field over the past decade, there still remains a great needfor evaluation studies of nutrition intervention programs in Canada (Canada, 1990).14LITERATURE REVIEWA review of nutrition education from its simple beginnings circa the turn of this century through tothe contemporary goals of early childhood nutrition education programs will be presented in thischapter. However, prior to this it is important to understand the capabilities and development ofkindergarten-aged children. Thus, a brief review of the educational goals for kindergartenchildren and characteristics of children aged 5-6 years will be provided. The overall literaturereview will focus on the development of early childhood nutrition education programs in the publicschool system followed by their evaluation.2. EDUCATIONAL GOALS FOR CHILDREN IN KINDERGARTENThe first day of school is a landmark in every child's life. For many children, attendance atkindergarten is their first exposure to the school system of which they will be a part for the nextthirteen years. It is a critical period in the young child's life as initial experiences and impressionsleave indelible imprints which may later affect their achievement potential. It is, therefore, ofutmost importance that educational materials, strategies and activities be aimed toward thedevelopment of self-worth in the kindergarten child. "The acquisition of a positive self-concept isparticularly important, for then the [kindergarten] child is better able to develop cognitively"(Canadian Education Association, 1972). A thorough understanding of the capabilities of thekindergarten child is essential for education program goals to be achieved. To be specific, in1984, the Province of British Columbia, Ministry of Education, defined seven goals of theprovincial kindergarten curriculum. These goals included providing a variety of experiences thatfoster the child's:-emotional development and well being,-social development,15LITERATURE REVIEW-development of social responsibility in a changing world,-physical development and well being,-aesthetic and artistic development,-intellectual development, and-language development.Nutrition was considered a component of the goal of physical development and well being.Awareness of and the practice of good nutrition habits was considered possible throughchildrens' frequent exposure to and experiences with a variety of foods. Involvement of childrenin the preparation of food was recognized for its contribution to many facets of the kindergartencurriculum including; "increasing cultural awareness, expanding social, physical and logicalknowledge and for integrating appropriate art and music activities" (Province of British Columbia,1985).Recently this curriculum guide was replaced by the document, Year 2000: A Framework forLearning (Province of British Columbia, 1989(a),(b)) (Appendix 1). However, the basic intentionsof the kindergarten (P-1) curriculum have not changed.The central purposes of a kindergarten program should be "to strengthen the desire to learn, andto provide opportunities to investigate, to observe and to create. There must [also] be provisionfor success and acceptance of the mistakes that are made as children seek to find answers thatgive satisfaction. [And] there must be opportunities and equipment for sound physical growth, forintellectual stimulation and development, and for the social learning that enable children to growtoward responsible citizenship" (Canadian Education Association, 1972).16LITERATURE REVIEW3. CHARACTERISTIC TRAITS OF KINDERGARTEN-AGED CHILDRENFor many children, kindergarten corresponds to a time of reducing social dependence on theirparent(s) and increasing reliance on their peers and on themselves. The important role of theparent begins to shift from that of control to that of coregulation with the child. Parents startguiding children from a distance as the child's world expands to include new "significant others,"that is, those people whose opinion the child values and respects (Scarr et al., 1986).The thought processes of children at this age can often be perplexing to adults. When engagedin dialogue with a 5 or 6 year old child, the adult is often left in a state of wonder as the child carriesforth, verbalizing one idea followed by a seemingly unrelated idea. In order for the adult tounderstand the complexities of communicating and working with kindergarten-aged children, it isnecessary to be cognizant of the conceptual, social, intellectual, physical and emotionaldevelopment of these children. A brief review of the key features of a "normative" kindergarten-aged child follows.A. CONCEPT DEVELOPMENTYoung children have limited thinking, language and representational abilities. They require firsthand experiences for "concept formation" (Whitener and Keeling, 1984). Children's verbalabilities can often mislead adults. Children may speak using words as labels for concepts,although the child has not yet learned the concept. Through sensory exploration involving reallife experiences, kindergarten-aged children develop concepts, or mental categories, in which toplace new information. Concepts are general ideas which apply to many individual cases and arethe building blocks of mature thought. Piaget has established that concepts have their origins insensory experiences (Piaget, 1954). "The more varied, involving and direct those experiences17LITERATURE REVIEWare, the better young children develop concepts and expand their horizons" (Christenberry andStevens, 1984). Therefore, it is essential to use objective language when communicatingconcepts with kindergarten-aged children. The use of abstract words such as "willingness"should be avoided. To use food as an example of a concept, properties which can be introducedthat are common to foods include: food is edible; plants and animals are sources of food; there arehealthy and less healthy foods, and food supplies our bodies with the energy necessary for workand play. These and other nutrition-related concepts can be taught to 5 and 6 year olds, providedthey are presented in a manner synchronous with the developmental stage of these children.B. INTELLECTUAL DEVELOPMENTYoung children from 2 years up to the age of about 6 or 7 exhibit what Piaget termed"preoperational" thinking. Preoperational children require sensory exploration and physical"hands-on" experiences to develop and expand their knowledge base. Operations refer tointernalized sets of actions that allow the child to do mentally what before was done by physical orsensory actions. While young children progress through the preoperational stage, they come torely less on the physical and sensory explorations while increasing their ability to mentally solveproblems. Piaget saw the child as an active learner and architect of her/his own learningexperiences. He probed the process of how young children come to understand the basicprinciples of time and space, and cause and effect which serve to organize adult thinking. Fromhis exhaustive research, Piaget developed a profile consisting of 4 stages of the qualitativechanges in cognitive development which has become accepted as a golden standard in the fieldof child development (Appendix 2). The preoperational stage is the second stage in Piaget'sprofile.18LITERATURE REVIEWKey features of this stage of cognitive development are described below (Scarr et al., 1986). Thefirst two characteristics may be considered attributes while the remaining features may beconsidered limitations of young childrens' thought processes.1.) Expansion of the child's symbolic system. He/she can form mental images based onconcrete experiences.2.) The acquisition of language. By age 6, a child may have a vocabulary of up to 14 000words and may be able to readily create compound phrases (Scarr et al., 1986).3.) The child's inability to use causal reasoning. Preoperational children use perceptionrather than logic in their reasoning.4.) The appearance of egocentrism is probably the most salient feature of preoperationalthought. The child can only view situations from her/his own perspective and not fromthat of another.5.) The ability to learn based on intuition or insight. The preschooler is in transitionbetween solving problems through physical trial and error and solving problems simply byconsidering the alternative.6.) Animism, the practice of magical thinking. Children reason that inanimate phenomenamust think and feel just as they do.19LITERATURE REVIEW7.) The inability to understand the concept of conservation, the fact that some propertiesstay the same even though the shape or spatial arrangement has changed. This isprimarily a result of centering, the inability to consider more than one dimension at a time.The preoperational child centres his/her attention on a single striking feature of whateverhe/she is trying to think about and ignores other important and relevant features.Irreversibility of thought, or the inability to retrace mental steps, is another key feature ofpreoperational thought which also contributes to the lack of conservation in thepreoperational child.8.) Preoperational children also have difficulty with arranging objects or events in a logicalorder. Seriation or relational concepts, such as A may be bigger than B but smaller than C,are beyond the grasp of most preoperational children.9.) Finally, the preoperational child is unable to form and reason with hierarchicalclassification. When given a random collection of objects that can be grouped on thebasis of two or more properties (eg. colour and size), the child is seldom able to use theseproperties consistently to sort the objects.C. SOCIAL DEVELOPMENTFor preschoolers, play is an integral part of their social development. Attention-seeking from theirpeers begins to replace affection-seeking from adults. In short, play reflects developmentalchanges. The infrastructure of the kindergarten curriculum and classroom reinforces childrens'attempts at prosocial behaviour. Play is established with self-imposed goals which may readilychange at the whim of a player. There are no external rules with which to conform. Thus, through20LITERATURE REVIEWtrial and error, children learn how to behave with others, on their own terms. Nevertheless, peersexpect and enforce self-approved behaviour and are quick to punish unacceptable behaviour(Scarr et al., 1986). To function well within a peer group, preschoolers must be flexible in theirsocial behaviour. The development of social competence requires that kindergarten-agedchildren learn to manage their impulses, learn how to initiate social interaction, and know when toexpress or suppress their views. In general, they must learn appropriate "give and take". Throughactive practice of prosocial behaviour, the kindergarten child will achieve one of the mostchallenging and rewarding tasks of the school year, making friends.D. EMOTIONAL DEVELOPMENTEmotionally secure children increase the likelihood of achieving kindergarten goals. A major aimof the kindergarten curriculum is to promote a positive sense of self-worth in the child (Province ofBritish Columbia, 1985; Canadian Educational Association, 1972). Confident children are readyfor new learning, and in a cyclic nature, successful learning enhances self confidence. They are"more enthusiastic, more willing to accept challenges, and more able to concentrate and topersevere. They are [also] capable of showing a sensitivity to others while maintaining theirunique identities" (Province of British Columbia, 1985).E. PHYSICAL DEVELOPMENTAs with all aspects of development, the child's genetic potential is affected by environmentalconditions. No aspect of child development is more visibly influenced by the quality of a child'sdiet than is his/her physical development. Muscular development occurs more rapidly in the largemuscles than in the small ones; therefore, children learn motor skills progressively from gross tofine control. The 2 year old gains control of big arm muscles used, for example, to wipe a table.21LITERATURE REVIEWThe 3 year old has control of hand muscles such as those used for pouring liquids. The 4 year oldis gaining control of his/her finger muscles necessary for such tasks as peeling or cracking an egg.By the time the child has reached 5 years, he/she has developed very fine muscle control andgood hand-eye coordination suitable for such tasks as cutting and measuring (Hertzler, 1989).Physical-motor development results from an interaction between growth and learning. Thekindergarten child is naturally active and curious and tends to involve her/his whole body inactivities. This is possibly due to increased coordination developed during the preschool period.F. SUMMARYUpon entering kindergarten, the 5-6 year old has acquired gross and fine motor controls,cognitive skills, language abilities and social competencies. Well designed early childhoodnutrition education programs reinforce these recent acquisitions of the kindergarten child at thesame time as associating healthy eating habits with social fun and learning. Young children needto practice good nutrition habits for optimum growth and development, so they can enjoy thefreedom of running, jumping and playing. Without proper nutrition, the incidence of conditionssuch as childhood obesity and dental caries increases (National Dairy Council, 1979).Nutrition may have a powerful effect upon each of the above aspects of child development. It,therefore, is important that nutrition education programs designed for the preoperational childinclude age-appropriate activities which permit active participation by the child and that programobjectives be harmonious with the developmental stage of these children. With this briefoverview in mind, the evolution of early childhood nutrition education programs is presented.22LITERATURE REVIEW4. EVOLUTION OF NUTRITION EDUCATIONA. ORIGINS OF NUTRITION EDUCATIONThe origins of nutrition education in the classroom date back to the turn of the century whenconcerted efforts were undertaken to reverse the common occurrence of malnutrition and hungerin school children (Whitehead, 1957(a); Whitehead, 1957(b)).In 1908, Dr. W.R.P. Emerson of Boston was credited with instructing the first nutrition educationclass for malnourished children. In a clinical setting, his "Class Method" segregated underweightchildren and encouraged competition amongst them for weight gain. Under these conditions theresults were spectacular. It wasn't until ten years later that Emerson's "Class Method" was testedoutside the clinical setting and within the classroom of Public School 64 in New York City(Whitehead, 1957(a)).Evaluation after one term of school showed "no spectacular gains had been made by the childrenenrolled in the nutrition classes" of Public School 64 (Whitehead, 1957(a)). Majorrecommendations resulting from this study suggested that "under par" children should notcompete with each other for weight gain in the presence of their normal weight peers, and thatnutrition education needed to be taught in the regular classroom, but not under the conditions ofthe "Class Method."In 1918, Dr. Lydia Roberts, a researcher and trained teacher, investigated the effects of nutritioneducation in a clinical setting using both the "individual method" and the "class method"approaches. The class method was considered more successful than the individual method dueto the "group spirit" present in the "nutrition-clinic classes" (Roberts, 1935). Roberts realized the23LITERATURE REVIEWlower grades in the public school system were not only a logical starting place for education innutrition, but also represented a critical developmental stage at which nutrition information shouldbe introduced (Cooper and Philip, 1974). Mary Harper, a nutritionist for the New York Associationfor Improving the Conditions of the Poor, and Dr. Mary Rose of Teachers College at ColumbiaUniversity were also pioneers in the development of nutrition education in the classroom. Rosebelieved in "learning by doing" and that a food common to all the children's diets was theappropriate instrument around which to build her nutrition education lessons (Martin, 1978). Sheencouraged the children to take an active role in the implementation of food-related activities.Results from the work of both Rose and Harper confirmed that nutrition education could be donemore effectively in a school situation rather than in a clinical setting and that active participation bythe children was a key component in achieving nutrition education goals. Not just the "under par,"but every child could be introduced to nutrition in an organized and uniform manner, and aprospective widespread improvement of childrens' nutrition could be anticipated. Thus,emphasis was placed on the instruction of nutrition with the overall goal of improving children'snutrition.In 1929, the studies of Brown indicated that instruction designed to improve food habits was mosteffective when taught during the child's early school years (Whitehead, 1957(a)). The first toresearch the effects of peer influence on modifying preschool childrens' food preferences wasDuncker, whose results clearly showed that younger children were more willing to imitate olderones than the reverse situation (Duncker, 1938).In a subsequent study, Marinho extended the work of Duncker to test the social influence of 4-6year old preschoolers' food preferences using a pretest/posttest design. This study was24LITERATURE REVIEWconducted over a five week period, followed by a repeated posttest one year later to verify theduration of the peer effects (Marinho, 1942). She noted that success in modifying the childrens'preferences was a function of how well established were the initial preferences. Modificationoccurred more readily in younger preschool children who had less well established preferences.The new preferences of all these children (n=6) remained five weeks after the original peerinfluence had been removed, and persisted one year later.B. INTEGRATION OF NUTRITION EDUCATION INTO LESSONSDuncker's study of peer influence affecting the preschool child's food preferences, and Marinho'ssubsequent study of the longitudinal effects of social influence, pointed to the importance ofteaching the foundations for developing good eating habits at this critical age of physical,intellectual, social and emotional development. In support of the earlier work by Rose and Harper,these studies strongly endorsed use of integrated nutrition education programs to include everychild in the classroom; and to combine the teaching of nutrition with science lessons, math andspelling (Contento, 1980). This approach set the foundation for nutrition education programsover the ensuing fifty years.In 1946, Bosley noted: "Nutritionists and educators should not lose sight of the real reason fornutrition education in their eagerness to disseminate information. The aim of nutrition educationis a simple one: to establish good habits which will result in intelligent food selection, day by day,throughout life" (Contento, 1980).25LITERATURE REVIEWC. A CHANGE IN FOCUS FROM PROVIDING NUTRITION INFORMATION TOINFLUENCING FOOD BEHAVIOURAs nutrition educators became increasingly aware of the effectiveness of social influence towardachievement of the desired positive change in preschool children's eating habits, investigationsof behavioural changes arising from such influences came to the forefront in nutrition educationresearch. Numerous accounts in the literature indicate this shift from emphasis on nutritioninformation alone to that of influencing behaviour (Close and Sabry, 1978; Dierks and Morse,1965; Lamb and Ling, 1946; Whitehead, 1957(b)).Attention was turned toward principles of education which might serve as directives in theplanning and development of effective nutrition education programs. Whitehead described thecharacteristics of such programs as including: (a) planning, development, and evaluationperformed by those concerned directly with the existing nutrition education programs, (b)assessments of food habits that include customs, beliefs and attitudes as well as food intake, (c) abehaviour-centered rather than an information-centered approach, (d) increased communityinvolvement, not just confined to classrooms or selected groups of children, and (e) developmentof the concepts of the science of nutrition and its related disciplines (Whitehead, 1957(b)).To promote a behaviour-centered approach, teachers were encouraged to allow the children toactively participate in nutrition-related activities; for example, cooking. Martin and Reynoldsstudied the effects of improving children's acceptance of vegetables by teaching first gradechildren how to cook vegetable soup. Direct involvement in the cooking process resulted in thechildren readily accepting the vegetables. The observed significant improvement in eating habits26LITERATURE REVIEWremained in effect well after the study was completed, thus supporting the theory of children'sactive participation by Rose (Martin, 1978).It wasn't until the 1960s that the eating behaviour of preschoolers was studied more intently.Attitudes toward foods were putatively correlated with acceptance, choice, or preference offoods. Since the concept of attitude is difficult to define and even more difficult to measure, moststudies relied on inference derived from the individual's words and actions as proxies for attitude(Henerson et al., 1987). For example, Dudley's work studying childrens' attitudes towardvegetables was based upon choices made from the presentation of one vegetable prepared infour different ways, and the proportion of food that was consumed (Dudley et al., 1960). Thesefactors provided an indication of the attitude of these children toward different vegetablepreparations. Other studies have selected the criteria of like/dislike (Eppright et al., 1969; Dierksand Morse, 1965; Breckenridge, 1959); willingness/unwillingness (Birch, 1980(a)); andacceptance/non-acceptance (Close and Sabry, 1978; Harrill et al., 1972; Glaser, 1964;).Furthermore, many studies utilized maternal reports to determine food attitudes of the preschoolchild. The general results from these studies indicate a low correlation between the mother'sreports and the children's food habits (Pliner and Pelchat, 1986; Birch et al., 1981; Birch, 1980(b);Sabry et al., 1974; Emmons and Hayes, 1973; Eppright et al., 1969; Dierks and Morse, 1965;Breckenridge, 1959). This led to studies that obtained data on food behaviour directly fromyoung children themselves. Birch (1979(a)) found children to be reliable sources of informationregarding their food likes and dislikes.27LITERATURE REVIEWD. ATTEMPTS TO IMPROVE CHILDRENS' FOOD HABITSSeveral studies used various change strategies borrowed from educational and behaviouraltheories to improve the nutritional status of children (Kerrey et al., 1968; Cook et al., 1977). Thenature of social interactions during snack times and the influence of change strategies on theacquisition and modification of preschoolers' food preferences was actively researched during themid-1970s.I.^FamiliarityCreating a familiarity with foods through repeated exposure proved to be a particularly suitablechange strategy for improving preschoolers' nutritional status, as measured by their food intake(Pliner, 1982). Zajonc stated that "mere exposure of the individual to a stimulus is a sufficientcondition for the advancement of his[/her] attitude toward it" (Zajonc, 1968). Birch et al. (1987)later expanded upon this research to show that tasting (versus looking) exposure was necessaryto obtain significantly positive changes in food preferences.Food practices and attitudes that are established early during the preschool years are believed toaffect an individual's food behaviour, and consequently nutritional status throughout life (Splettand Story, 1991; Lawatsch, 1990; Rozin, 1990; Hendricks et al., 1988; Davis et al., 1983; Birch1979(b); Sipple, 1971; Kerrey et al., 1968). Therefore, fostering preschoolers' interest in foodand food-related activities so they learn to make wise food choices and develop good food habitsis critical to the success of any nutrition education program.Since the ultimate goal of nutrition education for the preschooler is to establish good eatinghabits, investigation of the correlation between stated preference data and observed28LITERATURE REVIEWconsumption patterns was necessary. Birch designed and conducted an experiment to evaluatethis correlation (Birch, 1979(b)). For the preference assessment procedures, each child wasindividually presented with 2 each of 8 different kinds of small open-faced sandwiches. The childwas asked to take a small bite of each sandwich and to tell the investigator what type of sandwichhe/she had tasted. The child was then told to point to the sandwich he/she liked to eat the verybest. Once a food had been designated, it was removed from the set and the routine continued.For the consumption assessment procedures, children were instructed to take their plate to atable where the same type of sandwiches were located. They were also told to take moresandwiches when they wanted. The order of preference or consumption procedures wasalternated over 4 days. Plate waste was recorded. The results indicated that the preference datawas a very effective indicator of childrens' consumption patterns. Preschool children do nothesitate to reveal their likes and dislikes for food, furthermore, preference data could be directly,reliably, and easily obtained. When she studied preference data for sets of fruit obtained directlyfrom preschool children, the results showed that familiarity accounted for the greatest proportionof variance in the preferences of three-year-olds, while sweetness was the most salient for four-year-olds (Birch, 1979(a)). This suggested a relatively rapid developmental shift in the preferencestructure between three and four years of age. Therefore, it was found critical to repeatedlyintroduce young children to as wide a variety of foods as possible, so they learn positive foodattitudes and eating practices. The development of such behaviours results in an increasedlikelihood of adequate nutrient intake necessary for normal, healthy growth and development.II. Social Influence TechniquesOther strategies derived from social learning theories advocated the motivation of changes inpreschoolers' eating behaviours by emphasizing imitative learning or peer modelling.29LITERATURE REVIEWObservations by Birch showed that peer modelling amongst preschoolers had a significant impacton food preference, choice, and consumption patterns of these children (Birch, 1980(a); Birch,1987(b)). In one study, Birch directly obtained preference rankings for nine vegetables (Birch,1980(a)). She then placed the preschoolers, aged 3-5 years, at a lunch table so that a "target"child who strongly preferred one vegetable (ranked first or second) was seated with three peerswho had strong preferences for a vegetable that the target child had ranked eighth or ninth. Onday 1, the target child selected first from a pair of vegetables offered on a tray and on days 2, 3 and4 the target child chose last following the peers' selections. By day 4, 67% of the target childrenchose the vegetable preferred by the peer group, indicating the strong influence of peers onfood consumption of children at this age. It was also noted that the younger children were moreinfluenced by peer modelling than the older children. The results from Birch's study confirmthose of Duncker (Duncker, 1938) and have been successfully replicated in other research whichhas studied the effects of social influence on the formation of child food preferences (Birch,1987(a), Birch, 1987(b) ; Birch et al., 1981; Pliner and Pelchat, 1986).Although parents shape a child's familiarity, behaviour and attitude toward foods (Perry et al.,1988; Birch et al., 1984(a); Birch et al., 1984(b); Birch et al., 1982; Alford and Tibbets, 1971),researchers who studied the relationship between parental food preferences and those of theirchildren have shown consistently low positive correlations (Rozen et al., 1984; Pliner, 1983;Klesges et al., 1983; Harrill et al., 1972; Marinho, 1942). Birch explored this relationship between128 preschool children and their parents. When preference rankings were obtained for a varietyof foods, including fruits, vegetables, sandwiches and snack foods, only 10% of the mother-childand 6% of the father-child correlations were significant (Birch, 1980(b)). In contrast, young30LITERATURE REVIEWchildrens' food preferences significantly correlate with those of their siblings (Eppright et al.,1969) and other young children rather than those of their parents (Pliner and Pelchat, 1986).E. APPEARANCE OF EARLY CHILDHOOD NUTRITION EDUCATION PROGRAMSThe compelling need for effective nutrition education curriculum guides was documented byeducators and administrators (Cooper and Go, 1976). By the mid-1970s, a growing awareness ofthe importance of effective nutrition education resulted in an increasing number of curriculumguides being produced to assist teachers in nutrition instruction. One such curriculum guide,"Food...Your Choice" was developed by the National Dairy Council in the United States (NationalDairy Council, 1979). A field test of the curriculum involved 1750 students in 79 experimentalclasses from K-6 and 1169 students in 50 control classes (Talmage et al., 1978). All studentswere pretested and posttested on a nutrition achievement test. The salient findings showedstudents across grades reported interest in the materials and particularly in activities requiringactive student participation. Teachers also noted the high interest level of the students.Teachers indicated implementation of the curriculum was not difficult. Increased affective learningwas observed from the 1st to the 3rd classroom observations, and finally, achievement gains ofthe experimental group from pretest to posttest were significant at all levels of the curriculum.Other data collected included a measure of the students' perceptions of their classroom learningenvironment as well as teacher and student interviews. As part of this study, documentation forneed of a nutrition education curriculum was provided by teachers and administrators across theUnited States. Six characteristics of a nutrition education curriculum were identified as beingessential. They included that it: (a) be sequential from kindergarten through the grade levels, (b)correlate with the existing curriculum, (c) be activity-centered, (d) be evaluated for effectiveness,(e) be comprehensive, and (f) be free of biases about people's food habits. The results of this31LITERATURE REVIEWexploratory research served as a catalyst for developing subsequent K-12 nutrition educationcurriculums (Talmage et al., 1978).F. ATTEMPTS TO INCREASE THE EFFICACY OF EARLY CHILDHOOD NUTRITIONEDUCATION PROGRAMSI. Curriculum GuidesCurriculum guides that detailed how to develop socially relevant nutritional concepts andobjectives, how to design and implement learning activities, and how to evaluate the outcomeresulted in increased positive learning effects on young children compared with the curriculumguides which lacked these essential components (Cooper and Go, 1976).Further to the development of stimulating and comprehensive curriculum guides, attention wasbeing focused on other techniques that would increase the effectiveness of nutrition instruction.Teacher's nutrition knowledge, attitudes and practices came under scrutiny. For the kindergartenchild, their teacher is commonly an admired role model. Behaviour modification and effectivelearning is often achieved through young childrens' participation in role-taking, therefore, actionstaken by the teacher may profoundly affect the child's present and future nutritional habits. Tothis end, it was essential that teachers receive adequate basic nutritional training in the form ofstrategies to encourage positive dietary practices, and training which facilitates dissemination ofsound nutritional information at levels conducive to their students' developmental abilities.32LITERATURE REVIEWII. Teacher TrainingTeacher training in basic nutrition and instructional strategies aids in achieving effective andsuccessful results from a nutrition education program. Research has shown that such trainingsignificantly improves instructor's nutrition knowledge, and influences the amount of time spentteaching nutrition in the classroom. Through the use of a nutrition education assessmentinstrument, both Olson and Soliah reported that teachers who had completed one or morenutrition courses in college, attended a workshop, or who were currently teaching nutrition,scored higher on the assessment of nutrition knowledge and nutrition-related attitudes andpractices, than did teachers with no nutrition training or who were not teaching nutrition (Olson etal., 1986; Soliah et al., 1983). In general, nutrition education and increased knowledge ofnutrition positively correlated with teachers' nutrition-related attitudes and practices .III. In-Service Nutrition Education WorkshopsFor kindergarten and primary teachers, attendance at workshops is one frequent and convenienttechnique employed. The purpose of such workshops is two-fold: first, to provide teachers withbasic nutrition information so that, second, they can teach their students how to select balancedand varied diets.In Canada, the Ontario Milk Marketing Board offered nutrition education workshops to Ontarioelementary teachers to aid them in the instruction of an early childhood nutrition educationprogram. From January 1972 to June 1974, more than 7800 teachers participated in the threehour workshops (Cooper and Philip, 1974). Essential resource materials were provided and astep-by-step program guide for teaching nutrition to young children was distributed. After33LITERATURE REVIEWattending the workshops, over 70% of the teachers decided to teach nutrition in their classrooms.The students of these teachers showed improved nutrition knowledge and eating behaviourscompared with the students of the remaining 30% of teachers who had decided not to teachnutrition education in their classrooms (Cooper and Philip, 1974). It is noted, however, that achange in eating behaviour was based on a record of food consumption for one meal (breakfast)on both the day of the pretest and the posttest. This is a very short term measurement, hence itmust not be considered as an absolute indicator of changes in eating behaviour.The results of nutrition education workshops for K-6 teachers in the United States have shown agreater integration of nutrition into the school curriculum and increased enthusiasm for foodamongst the children, and firmly established support of the workshop approach for nutritioneducators of young children (Cook et al., 1977; Sodowsky, 1973).All of these provisions, including curriculum guides, teacher training and in-service workshops,increase the likelihood that a teacher will decide to teach nutrition, with workshop attendancealone showing a significant association (Canada, 1990; Soliah, 1983; Cook et al., 1977; Cooperand Go, 1976; Sodowsky, 1973).5. EVALUATIONResearch into increasing the effectiveness of nutrition education programs and efforts to improveyoung childrens' eating behaviours, has led to nutrition education programs designed specificallyfor the preschool child. With the appearance of these early childhood nutrition educationprograms, research also branched toward the evaluation of nutrition education programs in an34LITERATURE REVIEWattempt to optimize their effectiveness and to achieve the ultimate goal of nutrition education thatBosley had stated back in 1946.Evaluation became a focus of nutrition education programs. The omission of this criticalcomponent serves to undermine the strengths of such programs. Teachers require objectivefeedback to be informed of the success rate of their instruction. Without ongoing feedback, thelimitations of such programs often go unnoticed. Program planners also require feedback to makechanges which serve to increase the efficacy of nutrition education programs. In response to thisneed for feedback and accountability, recent trends find more nutrition educators involved inevaluation than in other research activities (Achterberg, 1988).A. EVALUATION RESEARCHEvaluation research takes into account the dynamic nature of the classroom (Edwards et al.,1986). The classroom represents a situation where seldom can conditions be stringentlycontrolled or students within the class randomized, hence, the teachers are often manipulatedthrough randomization. Evaluation research compensates for these constraints and has thusbecome a valuable tool for studying school-based nutrition education programs (Talmage et al.,1978). Evaluation research serves to highlight the strengths and weaknesses of nutritioneducation programs and facilitates new direction for design and content of future programs.In general, evaluation research is concerned with the effects of a treatment and the processes forimplementing a treatment on behaviour. The dimensions of a theoretical model of evaluationresearch have been delineated in 6 steps (Talmage et al., 1978):35LITERATURE REVIEWStep 1 DESCRIPTION OF THE INSTITUTIONAL CONTEXT-the evaluator has a clear picture of the experimental conditions that form thecontext in which the change will take place,Step 2 DESCRIPTION OF THE CHANGE-the evaluator needs a clear picture of the proposed change, strategies forimplementation, role descriptions of personnel involved, and relations of thechange to other facets of institutional responsibilities,Step 3 STATEMENT OF GOALS AND OBJECTIVES-the evaluator needs a clear picture of the goals and objectives of the proposedchange,Step 4 EVALUATION DESIGN-the evaluator maps out the design of the study, making decisions related to:-model-methodology-data sources-instrumentation-data collection-data analysis,LITERATURE REVIEWStep 5 TIME FRAME-a task analysis, breakdown of institutional and evaluator responsibilities and timeschedule,Step 6 REPORTING-the focus of the report is based on the needs of the client, and the report shouldfacilitate decision making.Theoretical models such as the one outlined above provide a framework to systematically plan andevaluate nutrition education programs. The model must provide a basis for establishing programobjectives, identifying intervention targets and determining appropriate teaching strategies fornew nutrition education programs (Gillespie, 1981), as well as serve as an important function in therevision of existing programs. Evaluation research models are often designed to be usedthroughout the developmental stages of nutrition education programs, however, they may alsobe used after the program has been in place (Edwards et al., 1986). Because evaluation researchis a dynamic process, it requires sensitivity to the needs and constraints of each specific programand may be considered as, "both a measuring rod and a diagnostic tool; it [should] document thedegree of effect and inform educators about what works (or not) and why" (Achterberg, 1988).B. QUALITATIVE METHODS IN EVALUATION RESEARCHQualitative methods, in particular, have appeared with increased frequency over the past 5 or soyears. Qualitative findings in evaluation research are highly responsive to input from the programparticipants. The evaluator seeks to collect data which reveal the participant's experiences with37LITERATURE REVIEWthe program activities and seeks to understand the participant's perceptions of the program.Qualitative methods can "provide the context of meanings in which the quantitative methods canbe understood" (Filstead, 1979).A combination of both innovative qualitative and traditional quantitative methods for evaluatingnutrition education programs serves to compensate for the weaknesses of one method by thestrengths of the other method, and vice versa. There is no single correct approach to allevaluation problems; some will be best addressed using a qualitative approach, others will need aquantitative approach, but probably most will benefit from a combination of the two (Herman et al.,1987). And, there are no rigid rules for making decisions for data collection methods inevaluation. The researcher must create a design to gather the best possible information that isappropriate for each specific situation (Patton, 1987).The need to evaluate nutrition education programs available to teachers in British Columbia hasnever been greater than it is now. The Ministry of Education has committed itself to reorganizingthe K-12 curriculum into an upgraded system. The level of education formerly known askindergarten, is now referred to as P-1 (Primary-1), grade 1 becomes P-2, grade 2 becomes P-3,and grade 3 is referred to as P-4 in the new Primary Program. In this program, a child will beadvanced from a lower to higher level when the teacher decides the child is ready to move on.In the Primary Program, children from the ages of 5 to 8 will have opportunities to work side-by-side at various learner-based activity centres. The learning will come from the children, with theteacher present in the role of a facilitator. Within this structure, the occasion to introduce a38LITERATURE REVIEWsequential, integrated nutrition program from P-1 through P-4 may be more fully realized in light ofthe increased social interactions amongst children of different age groups.However, prior to considering the possibility of a nutrition education program that could be usedfrom P-1 through P-4, existing programs need to be evaluated. Due to its ready availability to allBritish Columbia P-1 (kindergarten) teachers and to its potentially significant impact onkindergarten children's future health, Foodstyles:K is a logical program to evaluate for studyingthe effectiveness of nutrition education at the primary level. Childrens' willingness to try a widevariety of foods is a key to good nutrition and to developing good food habits. By observing andinquiring about various foods their peers consume, childrens' exposure to foods increases andthe likelihood of trying new foods also increases (Birch, 1987(a)). It is, therefore, important toassess the effects of exposure to the Foodstyles:K program on childrens' knowledge of andwillingness to try a variety of foods.39EXPERIMENTAL DESIGN AND METHODSCHAPTER IIIEXPERIMENTAL DESIGN AND METHODS1. STUDY DESIGNThis evaluation was conducted in two consecutive phases: PHASE I, Teachers'Perceptions of Foodstyles:K and PHASE II, Evaluation of the NutritionEducation Program. Foodstyles:K - Student and Parent Participation.  Phase I wasdesigned to evaluate the perceptions of all eligible P-1 teachers in British Columbia regarding theFoodstyles:K nutrition education program. The choice of a mail survey was made to collect datafor Phase I because of the necessity to contact a large number of teachers representing manyregions of British Columbia (Berdie et al., 1986). Another main purpose of Phase I (April - June1990) was to initialize contact with P-1 teachers in the Lower Mainland. This provided theopportunity for Lower Mainland teachers to volunteer to participate in Phase II beginning inSeptember 1990. Due to the characteristics of the study design, teachers from outside theLower Mainland were excluded from the opportunity to participate. Phase II was primarilydesigned to gather cognitive and behavioural information about a wide variety of foods from P-1students through the use of one-to-one private interviews. Complementary parental informationwas gathered indirectly through the use of a questionnaire distributed to the parents of thesestudents. A certificate of approval was received from the University of British ColumbiaBehavioural Sciences Screening Committee for Research and Other Studies Involving HumanSubjects for both Phase I and Phase II of the study (Appendices 3 and 4).40EXPERIMENTAL DESIGN AND METHODS2. PRE-EVALUATION PROTOCOLA. DATA COLLECTION TOOLSI.^Questionnairesa.) Phase Ii.)^Development of Teacher QuestionnaireA questionnaire was developed to measure teachers' perceptions of the Foodstyles:K program.The questionnaire was divided into 3 sections: 1.) current use of Foodstyles:K in the classroom,2.) past but not current use of Foodstyles:K in the classroom, and 3.) never having usedFoodstyles:K in the classroom. Teachers were instructed to complete only the section whichdescribed their current use or non-use of Foodstyles:K. For teachers indicating past but notpresent use or having never used Foodstyles:K, items in the questionnaire were designed tocollect the reasons why teachers did not currently use Foodstyles:K. For teachers indicatingcurrent use of Foodstyles:K in their classroom, items in the questionnaire sought to collect dataon: 1.) the practical use of Foodstyles:K in the classroom, 2.) the teachers' perceptions ofFoodstyles:K and its effect on the students, and 3.) the teachers' perceptions of parental supportof the program.Formative and summative approaches were used in tandem to obtain the desired data. Aformative approach was taken with the intention of determining how the program may beimproved, or how it could be more effective. These considerations represent process measuresof the program which are in contrast to outcome measures. Inquiries leading to how effective theprogram actually is and what conclusions could be made about the effect of the program arerepresentative of outcome measures. For these latter 2 considerations a summative approachwas used in the questionnaire to evaluate teachers' perceptions of Foodstyles:K. Both closed-41EXPERIMENTAL DESIGN AND METHODSand open-ended questions were included in the questionnaire, which permitted some depth ofunderstanding of the teachers' responses (King et al., 1987).ii.) Validation of Teacher QuestionnaireIn developing the questionnaire, several steps were taken to ensure a high credibility of theinstrument. To address the content validity of the questionnaire, consultation was made with; 1.)2 Registered Dietitian/Nutritionists (RDN) with an interest in early childhood nutrition education,2.) a group of nutrition educators at British Columbia Dairy Foundation (BCDF), 3.) 2 primaryteachers; one who had attended a Foodstyles:K workshop prior to the date of inclusion for thisstudy and had taught Foodstyles:K in the classroom and the other who was aware of the programbut had not attended a Foodstyles:K workshop and therefore viewed the questionnaire strictlyfrom a primary teacher's perspective, and 4.) 6 randomly selected teachers from the Foodstyles:Kdata base who participated in the evaluation as questionnaire pretesters.iii.) Pretesting Teacher QuestionnaireA listing of all P-1 teachers who had attended a Foodstyles:K workshop between June 1987 andJune 1989 was supplied by nutrition educators at BCDF. Randomly selected from this listing, sixP-1 teachers were approached to pretest the teacher questionnaire (Appendix 5). Upon receiptof all pretesters' responses, modifications were made to the teacher questionnaire prior to itsrelease to eligible P-1 teachers throughout the province. All 6 pretesters would be considered tobe from urban areas of the province as defined by centres within the greater metropolitan Victoriaand Vancouver areas.42EXPERIMENTAL DESIGN AND METHODSTable 1 provides a list of the school districts and locations considered to be urban areas in BritishColumbia.Table 1. School Districts Considered to be Within Urban Areas in BritishColumbia.URBAN^LOCATIONSCHOOLDISTRICT # 36^Surrey37^Delta38^Richmond39^Vancouver40^New Westminster41^Burnaby42^Maple Ridge43^Coquitlam44^North Vancouver61^Victoria62^Sooke63^Saanich43EXPERIMENTAL DESIGN AND METHODSb.) Phase IIi.)^Development of Parental QuestionnairesTwo questionnaires were developed to obtain data from the parents of the students; the pretestand posttest parental questionnaires.The pretest parental questionnaire, distributed to all parents of the students in participatingclasses, was designed to collect: 1.) demographic information about their child, 2.) informationregarding any food restrictions for their child, and 3.) general information regarding their child'sfood intake. The posttest questionnaire was designed to follow up on information provided in thepretest questionnaire. The items designed to collect general information regarding their child'sfood intake were repeated. Two other questions were also included. One question addressedwhether parents had noticed any effects of exposure to Foodstyles:K over the school yearthrough their child's request for specific foods introduced using the Foodstyles:K program. Theother question was designed to allow parents to comment on any changes they may haveobserved in their child's food habits over the school year.The pretest parental questionnaire included a consent form on the front page. The questionnaireitself contained selected-response items. Completion of this type of questionnaire required lesstime and effort from the parents compared with a construct-response type questionnaire.Although the information obtained was limited to that provided by the available responses,Henerson et al. (1987) recommend with greater than 20 or 30 respondents, a closed-responseformat be used to permit an accurate and quick summary of the results.44EXPERIMENTAL DESIGN AND METHODSThe posttest parental questionnaire principally consisted of closed-response items, but alsoincluded a few open-response items. This allowed the parents to supply helpful informationregarding any possible effects of Foodstyles:K activities. The open-response formataccommodates expression of the respondents' exact opinions such that they do not have to feeltheir responses are slotted into categories which do not accurately match their opinions(Henerson et al., 1987).ii.) Validation of Parental QuestionnairesContent validation of both parental questionnaires followed a similar process to that used for theteacher questionnaire. Two RDNs with an interest in early childhood nutrition education wereconsulted as were several nutrition educators at BCDF. Two parents of kindergarten-agedchildren enrolled in classes using Foodstyles:K were also informally consulted and asked tocomment on the content and wording of the questionnaires.II. Interviewsa.) Phase IIi.) Development of Appropriate Testing ProcedureThe purpose of the student interviews was to assess the participating children's identification ofand willingness to eat a variety of selected foods. To aid in maximizing the potential effectivenessof the actual evaluation technique to be implemented in Phase II, the principle investigatorattended two P-1 classrooms in separate elementary schools in Richmond, BC during April 1990.While visiting the first classroom observations of student-student and student-teacherinteractions were recorded. In addition, this visit provided the principle researcher an opportunity45EXPERIMENTAL DESIGN AND METHODSto practice appropriate dialogue with 5 and 6 year old children; attempting to communicate insimple, understandable language comprehended by both child and adult alike. This dialoguecentered around activities in which each student was involved at the time of interaction. In thesecond classroom, the teacher encouraged active communication with the students, permittingfood related questions to be asked individually of each student. The limitations of how questionsmust be conveyed to children operating in the Piagetian preoperational stage of cognitivedevelopment became obvious to the researcher. For example, "Would you please tell me whichfoods you like the most?" is an open ended, abstract question which provides very little guidanceto the child. Children at this age must mentally imagine the food(s) then transform their thoughtsinto spoken language and rarely do preschoolers analyze their own thoughts and mentalrepresentations (Scarr, et al., 1986). Without having a direct question asked of them it is difficultfor children of this age to develop clear thoughts and make an appropriate verbal response(Sundberg and Endres, 1984).ii.) Pilot Testing the Student Interview ProcessA selection of 3-dimensional plastic food models was pilot tested in June 1990 with a morning andafternoon kindergarten class in Creston BC. Phrasing of the questions was refined as a result ofpilot testing the 16 food models with 14 students enrolled in each class. Exclusion of abstractwords such as "willing" and "familiar" was necessary for the kindergarten student to understandthe question being asked. Therefore, the question, "Which of these foods are you familiar with?"was modified to "If you know the names of any of these foods, please tell me the name of eachfood that you know." and the request, "Tell me which of these foods you are willing to eat." waschanged to "If these foods were real, tell me which of these foods you would eat." The use ofobjective language in communicating with these children was essential to obtain the desired data.46EXPERIMENTAL DESIGN AND METHODSInasmuch as interviews involve greater costs, time and energy than questionnaires, presentingquestions orally is a particularly appropriate method for gathering information from children (VanDalen, 1979). To decrease possible confounding factors for interviewer bias, a skilled researchassistant recorded all responses of the students. The recorder was introduced to all classes justprior to the pretest interviews with the same recorder present at both the pretest and posttestinterviews.Every attempt was made to make the interview a friendly and fun occasion for each student.Some students had their own story to tell, which was attentively listened to and responded to withsupportive enthusiasm. Once a story was finished, the child's attention was focused back to theestablished interview procedure.Structured interviews were conducted using a standardized procedure, with the same questionspresented in the same manner and in the same order to each student (King et al., 1987). Ineliciting information from the students, these interviews did not attempt to draw out informationregarding beliefs and backgrounds, but sought to collect channelled responses to the two directquestions. Background information was obtained through a pretest questionnaire distributed tothe children's parents.b.) Sixteen Test Foods - Food Modelsi.)^Food Model SelectionThe basic premise for selection of the food models was to equally represent all 4 food groups inCanada's Food Guide. Selection of 16 foods was made to accommodate 8 "test" foods47EXPERIMENTAL DESIGN AND METHODSintroduced using Foodstyles:K and 8 non-introduced foods. Each of these distinct groupsconsisted of 2 foods representing each of the 4 food groups in Canada's Food Guide. Foodmodels were purchased from Directional Learning Canada Ltd., Elora ON.FOOD MODELSCATEGORY^MFP^GRAINS^V/F^DAIRYIntroduced^fried egg^cornflakes^broccoli^yoghurtwhite fish^tortilla^salad cottage cheeseNon-introduced chicken drumstick spaghetti^carrots^milkshrimp^cornbread^lima beans^swiss cheeseMFP: Meat, Fish, PoultryV/F: Vegetables, FruitIL) Food Models yl.. PicturesIn August 1990, at University Hill Pacific Spirit Daycare at the University of British Columbiapreliminary testing was conducted to assess for possible child preference for one data collectiontool over another. Parental permission was obtained for all 5 year olds in attendance (n=8). Totest for a preference of 4-colour food pictures versus 3-d food models, a duplicate set was madeof 15 foods which were available in both mediums.48EXPERIMENTAL DESIGN AND METHODSThe previously refined questions were asked regarding identification of foods, and which foodsthe child would like to eat if the representations were real foods. With 4 children, the questionswere posed using the food models first followed with the food pictures. With the other 4 children,the food pictures preceded the food models. Therefore, each child was asked to proceedthrough the testing procedure two times, one following directly after the other.The children were then asked directly which set of foods they liked the best. Six out of eightchildren chose the food models, one child chose the food pictures, and one child did not expressa preference.From this sampling, there was no noticeable difference between the child's two sets of responses(models versus pictures). Also, there was no strong difference in responses between those 4children who were tested with the food models first versus the other 4 children who were testedwith the food pictures first.These results were based on a very small number of children and could not, therefore, bestatistically analyzed with confidence. However, they did provide an indication of preference forthe food models over the pictures. These kindergarten-aged children were more animated withand preferred the food models; therefore, considering this information, the decision was made toproceed with the food models as the data collection tool.49EXPERIMENTAL DESIGN AND METHODSB. SCHOOL DISTRICT AND PRINCIPAL PERMISSIONIn June 1990, telephone contact was made with the volunteer teachers to review the inclusioncriteria and to confirm their continued interest in participating in the evaluation during thesubsequent school year.Once participation had been confirmed, in July 1990 application was made to conduct researchwithin each of the 7 school districts represented by the volunteer teachers. By October 1990,authorization had been granted (5 written and 2 verbal authorizations) to conduct the proposedresearch in all 7 school districts (Appendix 6) and by all principals of the schools involved.3. EVALUATION PROTOCOLA. DATA COLLECTION PROCEDURESI. Phase I -- Teachers' Perceptions of Foodstyles:Ka.) Recruitment of P-1 TeachersFrom their data base, nutrition educators at BCDF supplied the teacher names and schooladdresses of all eligible P-1 teachers in British Columbia. Eligible teachers were those who hadattended a Foodstyles:K workshop in the period from June 1987 to June 1989. These teacherswere recruited to participate in Phase I.50EXPERIMENTAL DESIGN AND METHODSb.) Protocol of Teacher Questionnaire MailingsThe chronological sequence of mailouts to P-1 teachers was modelled after "The Total DesignModel" (TDM) developed by Dillman (1978) for mail surveys and was modified to meet the timeconstraints of the school year. The implementation process of TDM is built on a set ofcomplementary techniques that together are designed to produce a high quality and quantity ofresponse.i.) First Mailing of Teacher QuestionnaireA packet consisting of a covering letter, a coded questionnaire to ensure confidentiality of theinformation upon its return, and a self-addressed stamped return envelope was mailed on May 71990 to a total of 845 P-1 teachers in all areas of the province of British Columbia (Appendix 7).The code on each questionnaire consisted of a specific record number supplied by BCDF foreach teacher. An opportunity to participate in Phase II of this study was given to all teachers(n=283) whose school address (point of contact) was located in the Lower Mainland (Appendix 8).The school districts considered to be located in the Lower Mainland included:Burnaby (n=34)^Maple Ridge (n=22)^Richmond (n=25)Coquitlam (n=42)^New Westminster (n=9)^Surrey (n=44)Delta (n=20) North Vancouver (n=23)^Vancouver (n=64)ii.) First Follow-upOne week following the initial mailing, on May 14 1990 a postcard reminder was posted to all 845teachers (Appendix 9). This postcard served as both a thank you for those who had respondedand a courteous reminder for those who had not. It also provided a toll-free telephone number to51EXPERIMENTAL DESIGN AND METHODScall for teachers who had misplaced their copy of the questionnaire and required another beissued to them.iii.) Second Mailing of Teacher QuestionnaireThree weeks following the first follow-up, on June 4 1990 a second packet including a codedquestionnaire, distinguishable from the one sent in the first, was mailed to all non-respondents.This consisted of an updated cover letter (Appendix 10) with a replacement questionnaireidentical to that issued in the first mailout. Inserts were again included in packets addressed toteachers in the Lower Mainland.iv.) Second Reminder MailoutOne and one half weeks following the mailout of the second teacher questionnaire, a secondfollow-up reminder postcard (Appendix 11) was mailed on June 15 1990 to all recipients of thesecond packet. Similar to the first reminder notice, again this served as both a thank you and angentle reminder notice for those who had not returned their questionnaire. This noticerepresented the final approach attempting to contact all non-respondents to the date of mailout.II. Phase II -- Evaluation of Foodstyles:K Nutrition Education Program - Studentand Parent Participationa.) Evaluation DesignThe experimental design used for Phase II was a quasi-experimental, randomized groups,pretest/posttest design. The final number of volunteer Lower Mainland P-1 teachers from Phase Iwho met all the set criteria for eligibility to participate in Phase II, totalled 13. Using a random52EXPERIMENTAL DESIGN AND METHODSnumber table (Mendenhall, 1983), each teacher was randomly assigned to either a "control" or"intervention" group.If assigned to the intervention group, the teacher would continue with her usual method ofteaching Foodstyles:K throughout the 1990-1991 school year. The only adjustment was therequirement for each teacher of an intervention group to introduce 8 specific "test" foods.eggs fish cornflakes tortillabroccoli salad yoghurt cottage cheeseThese 8 test foods equally represented the 4 food groups in Canada's Food Guide andcorresponded with 8 of the 16 3-d plastic food models utilized in the one-to-one interviews witheach child.If assigned to a control group, Foodstyles:K instruction would be excluded from the classroomcurriculum for the 1990-1991 school year. All other direct instruction of nutrition would also beexcluded. Beyond these restrictions, it was requested of each teacher of a control class to keepany incidental discussion of foods and nutrition to an absolute minimum. There was no additionalworkload for teachers of either group.Following random assignment to either a control or intervention group, a group-appropriate coverletter and a general questionnaire was distributed to the parents of children attending all 13classes. The purpose of this questionnaire was two-fold; first, to seek consent for their child toparticipate in the evaluation, and second, to collect specific information regarding their child's53EXPERIMENTAL DESIGN AND METHODSeating habits including demographic information, food restrictions, and parental beliefs regardingtheir child's food preferences and habits. All those students for whom parental consent had beengranted were then interviewed in an identical manner on a one-to-one basis both near thebeginning of the school year (October/November) and again near the end (May/June).b.) Recruitment of P-1 ClassesA total of 283 Lower Mainland P-1 teachers were approached in Phase Ito volunteer to participatein Phase II, the evaluation of Foodstyles:K. From these 283 teachers, 161 returned theirquestionnaires and 28 included completed inserts indicating they were willing to allow theirclasses to be considered as possible participants in the evaluation. Twenty eight out of 161returned questionnaires represented a 17% volunteer rate.The criteria set to establish eligibility for participation included:1. previous teaching of Foodstyles:K with at least one P-1 class,2. willingness to be assigned to either a "control" or "intervention" group for the 1990-1991 school year,3. agreement to allow the principal investigator and an assistant to assess childrens'willingness to try a variety of foods near the start and end of the 1990-1991 schoolyear, and4. agreement to introduce a minimum of 8 test foods throughout the school year.From these 28 volunteer teachers, 15 were ineligible due to various reasons (Table 2), resulting in13 teachers meeting all the established criteria. These 13 teachers represented 7 separateschool districts, including:54EXPERIMENTAL DESIGN AND METHODSBurnaby (n=2)^New Westminster (n=1)Coquitlam (n=3) Richmond (n=1)Delta (n=1)^ Surrey (n=3)Maple Ridge (n=2)EXPERIMENTAL DESIGN AND METHODSTable 2.^Reasons for Ineligibility of 15 Volunteer Teachers.TeacherNumber 123456789101112131415VancouverVancouverNorth VancouverSurreyMaple RidgeVancouverVancouverSurreyMaple RidgeBurnabyNew WestminsterVancouverNorth VancouverSchool DistrictBurnabyRichmondReason for IneligibilityInitially interested, but once school started shedeclined to participate.Cancelled because she was principal and had aIQ1 split class.Maternity leave.Independent school.Teacher attended workshop outside the timeperiod allowed in the study.Teaching a multi-age grouping.Changed from K to grade 1.Changed from K to grade 1.Changed mind not to participate.Family leave.Not willing to be randomly assigned to eitherstudy group.Teachers ESL only.Changed grade level.Changed mind not to participate.Too busy with school construction, dual entry,new Primary program.56EXPERIMENTAL DESIGN AND METHODSFollowing authorization from all the school districts and principals, a visit was made to theparticipating classes. This visit served as a means of; 1.) introducing the principle investigator andthe project to the students, 2.) answering any questions the teacher or students may have had,and 3.) distributing the parental questionnaire packets for the students to take home.Because of the delay in obtaining authorization from the appropriate school districts andprincipals, followed by the time necessary for the parents to return their consent forms andquestionnaires, the actual student interviews did not commence until late October and werecompleted in late November 1990. All teachers had agreed not to introduce nutrition conceptsprior to the pretest interviews.c.) Pretest Data Collection ProceduresCollection of data at pretest was gathered from 2 sources, 1.) the parent pretest questionnaire,and 2.) the student interviews.i.) Parental Pretest QuestionnaireThe parental pretest questionnaire (Appendix 12) was completed by parents of students in boththe control and intervention classes. A choice of "do" or "do not" give consent was available onthe consent form which constituted the first page of the pretest questionnaire.The parental pretest questionnaire consisted of 3 sections:1.) GENERAL INFORMATION ABOUT YOUR CHILD,2.) INFORMATION REGARDING FOOD RESTRICTIONS, and3.)^GENERAL INFORMATION REGARDING FOOD INTAKE.57EXPERIMENTAL DESIGN AND METHODSThe parental pretest questionnaire was distributed to the parents directly by the students in theparticipating classes. Parents were requested to complete the consent form and questionnaireand return it as soon as possible to BCDF in the enclosed self-addressed, stamped envelope.Alternatively, if the teacher was willing to collect the questionnaires, this route was followed. Twoclasses in the control group and 3 classes in the intervention group returned their questionnairesby mail. Four classes in each of the intervention and control groups returned their questionnairesdirectly to the teacher. For those questionnaires returned directly to the teacher, a code wasplaced on the outside of the return envelope and the teacher could check off the correspondingstudent on the class list. This way the teacher could request non-returned questionnaires(usually directly from the parent/caregiver when s/he collected their child after class). If anyquestionnaires were returned in an unsealed envelope, the teacher was asked to seal theenvelope immediately upon receipt to ensure confidentiality of the information.ii.) Student Pretest InterviewsUpon receipt of the consent forms and parental pretest questionnaires, the student interviewscommenced. The interview schedule was generally guided by day plans of the teachers and themethod and proportion of questionnaires returned. The following table indicates thequestionnaire distribution pattern and the interview dates.58EXPERIMENTAL DESIGN AND METHODSTable 3. Schedule of Pretest Interviews by Date of Interview.Date of Date of Pat # of Intervening Class Group* Method ofInterview Distribution Days P Q tReturnOct. 22 Oct. 1 21 13 I TEACHEROct. 24 Oct. 1 23 12 C TEACHEROct. 25 Sept. 28 27 10 C MAILOct. 26 Oct. 3 23 04 I MAILOct. 26 Oct. 3 23 06 I TEACHERNov. 2 Oct. 3 30 05 C MAILNov. 5 Oct. 5 31 11 C TEACHERNov. 7 Oct. 10 28 01 C TEACHERNov. 9 Oct. 15 25 09 C TEACHERNov. 14 Oct. 10 36 03 I MAILNov. 16 Oct. 12 36 02 I TEACHERNov. 21 Oct. 15 37 08 I TEACHERNov. 26 Oct. 12 45 07 I MAIL*I = Intervention group^*C = Control grouptPQ = Parental pretest questionnaireStudents in both the control and intervention classes were treated identically during theinterviews. Upon arrival at the school, the principal researcher and assistant introducedthemselves at the office then met with the teacher of the participating class. A table was removedfrom the classroom and placed in the hall around the corner from the door to the classroom. Thislocation was familiar to all the students in the class. This procedure prevented other students from59EXPERIMENTAL DESIGN AND METHODSlistening in which could influence their responses and prevented unnecessary distractions for thestudent being interviewed. The 16 food models were placed on one tray . A second empty traywas placed beside the first tray.If the parental pretest questionnaires had been returned by mail, prior to visiting the school a datacollection sheet had been prepared listing the participating childrens' names, record numbers andthe 16 foods corresponding to the food models. If the parental pretest questionnaires had beenreturned to the teacher, the questionnaires were collected and the childrens' names and recordnumbers were recorded on the data collection sheet prior to commencement of the class.Following re-introduction of the principal researcher and introduction of the research assistant,the student whose name appeared first on the class list and who had parental permission toparticipate was led to where the food models were in the hall. The student sat facing theresearcher with the assistant sitting to the side and a little behind the student.The typical interview proceeded as follows: (S=student, 1=investigator)I:^"Hi ^(NAME) ^."S:^"Hi."I:^"How are you this morning/afternoon?"S:^"Good."I:^"That's good. Now ^(NAME) ^, what we have here are plastic models of different foods.You may feel them if you like, but they are not to be put in your mouth."S:^May or may not feel them and/or comment.60EXPERIMENTAL DESIGN AND METHODSI: "What I would like you to do is look at all the foods and pick up one food that you know thename of, tell me the name then put it onto this empty tray. I would like you to repeat thiswith each food you know the name of. If there are any foods that you don't know thename of, I will tell you the name when you have finished telling me the foods you know.Do you understand what to do?"S: If "yes" then process begins. If "no" then the instructions were repeated and theresearcher may ask, "Are there any foods here you know the name of?" to begin theprocess. Some students may have nodded their head indicating that they knew thename of a food. In this case, the researcher would ask, "Please point to the food youknow the name of and tell me its name." to begin the process.As the student named each food s/he knew, the assistant would record an "F" (for familiar)underthe first column for that food.I: Once the student had stopped naming foods, the researcher would say "Look at thefoods on this tray (tray 1) and tell me if there are any foods left here that you know thename of." Once the student had finished, the researcher would provide the student withthe names of any unfamiliar foods.Once the first question was finished, any foods remaining on tray 1 were recorded as "UF" (forunfamiliar) on the data collection sheet. If, for any of the foods, the response by the studentdiffered from the actual name of the food, that response was recorded. However, only true namesof foods were accepted as familiar. For example, "peanuts" used to name lima "beans" wasunacceptable, but "cereal" used to describe a bowl of "cornflakes" was acceptable.61EXPERIMENTAL DESIGN AND METHODSThe student was then asked to help the researcher transfer any remaining unfamiliar food modelsleft on tray 1 to tray 2, and was told there was one more question regarding the foods.I:^"Now I have a second question for you. What I would now like you to do is to tell me,"Which of these foods, if they were real, would you like to eat?" For those foods youwould like to eat, please move them back to this tray (tray 1) and tell me the name of thefood once again as you move them over. If there are any foods that you can't rememberthe name of, point to that food and I will tell you its name. For foods you wouldn't like toeat, just leave them on this tray. Do you understand what to do?"S:^"Yes" was the usual response and the process began. Very little prompting was requiredwith this second request.As the student named each food s/he would like to eat, the assistant would record an "W" (forwilling) under the first column for that food.I:^Once the student had finished, the researcher would ask the student, "Are you surethere no foods left on this tray (tray 2) that you would like to eat." Once this wasconfirmed, the researcher ended with, "Great. Thanks very much  (NAME)  . Would youplease ask (NemEDENFx-r PARTICIPATING STUDENT oN CLASS LIST) to come out. Thank you."Once the first question was finished, any foods remaining on tray 2 were recorded as "UW" (forunwilling) on the data collection sheet. Then all food models would be randomly distributed ontray 1 to prevent any pattern of familiar foods or foods students were more willing to eat being62EXPERIMENTAL DESIGN AND METHODSlocated on the tray closest to the child's seat. This routine continued until all the participatingstudents in the class had been interviewed. Accommodation was made for students who did nothave consent to participate but wished to take part in the activity. No data were collected fromthese students. Upon completion of pretest interviews for each class, the teacher of anintervention class was free to use the Foodstyles:K program to introduce the 8 "test" foods, whilethe teacher of a control class was required not to use Foodstyles:K, not to introduce or discussfoods and to keep any incidental talk of food to a minimum.d.) Teacher Contact Through the School YearThrough the school year, the principle investigator contacted each teacher by phone to ensurethat she was adhering to the requirements of the study group to which she had been randomlyassigned. A standard set of questions was asked of each teacher depending on her assignmentto either the control or intervention group (Appendices 13 and 14). These regular contactsserved to remind each teacher of her responsibilities in the evaluation and helped to motivatesome of the teachers in the intervention group to begin introducing the 8 "test" foods. See Table4.63EXPERIMENTAL DESIGN AND METHODSTable^4.^Number of "Test" Foods Introduced in the Month PrecedingTelephone Contact.INTERVENTIONCLASS NUMBERMONTH OF TELEPHONE CONTACT # OF FOODS LEFT TOINTRODUCEBEFORE POSTTEST INTERVIEWFEBRUARY MARCH APRIL01 3 1 2 202 3 2 303 6 204 3 505 2 5 106 1 3 3 107 5 1 1 1At the final phone check during April 1991, a tentative posttest interview date was arranged forMay 1991. All teachers of the intervention classes said they would comply with the requirement ofintroducing all 8 "test" foods by the time of the posttest interviews.e.) Posttest Data Collection ProceduresI.)^Student Posttest InterviewsA week prior to the tentative date arranged to conduct the posttest interviews, each teacher wascontacted to confirm that all 8 "test" foods had been introduced using Foodstyles:K. If necessary,the posttest interview date was postponed to allow the teacher to fulfill the task of introducing all 8"test" foods. Day plans and school activities were also taken into consideration when establishing64EXPERIMENTAL DESIGN AND METHODSthe posttest interview date. The posttest interviews were conducted in a manner whichduplicated that used for the pretest interviews.ii.) Parental Posttest QuestionnaireUpon completion of the interviews for each class, a parental posttest packet similar to the parentalpretest packet was distributed to the students of each class to give directly to their parent(s)(Appendix 15). Parents were requested to complete the questionnaire and return it as soon aspossible to their child's teacher. This procedure was followed for all classes. Again, the returnenvelopes were coded on the outside with each child's record number to aid the teacher incontacting those parents who had not returned their posttest questionnaire. As in collection ofthe pretest questionnaires, if any envelopes were returned unsealed, the teacher was asked toseal the envelope immediately upon its receipt to ensure confidentiality of the information.65EXPERIMENTAL DESIGN AND METHODSTable 5. Schedule of Posttest Interviews by Date of Interview.DATE OF POSTTEST DATE OF PRETEST # OF INTERVENING CLASS GROUP*INTERVIEW INTERVIEW DAYSMAY 2 1991 NOV. 5 1990 178 11 CMAY 2 1991 OCT. 25 1990 190 10 CMAY 3 1991 OCT. 22 1990 194 13 IMAY 6 1991 NOV. 7 1990 180 01 CMAY 7 1991 OCT. 26 1990 194 04 IMAY 7 1991 OCT. 24 1990 196 12 CMAY 8 1991 OCT. 26 1990 195 06 IMAY 14 1991 NOV. 2 1990 193 05 CMAY 22 1991 NOV. 21 1990 182 08 IMAY 22 1991 NOV. 9 1990 194 09 CMAY 23 1991 NOV. 16 1990 188 02 IMAY 24 1991 NOV. 26 1990 179 07 IMAY 27 1991 NOV. 14 1990 194 03 I*I = Intervention group^*C = Control group66EXPERIMENTAL DESIGN AND METHODSB. COMPILATION OF DATAI. Phase IA coding system was developed for each of the 83 variables in the teacher questionnaire. Datasheets were prepared for use when the teacher data were entered into the computer. All recordswere identified by the teacher record number and by return of the first, or if necessary, the secondquestionnaire distributed to that teacher. A hard copy of all data was printed. Data for each recordwere reviewed for correctness by comparing the original questionnaire responses with the codeson the printout.II. Phase IIa.) Coding of Identification NumbersA system of coding was developed to differentiate every record in Phase II, including bothstudent and parent data. The code consisted of 7 digits. A generic example is provided toillustrate the system developed.Generic Example:IOIOIOI 00 I 00 a b c^d^eFor a: If=1, then record belongs in the control groupIf=2, then record belongs in the intervention groupFor b: If=1, then record represents a student fileIf=2, then record represents a parent fileFor c: If=1, then record represents pretest dataIf=2, then record represents posttest dataFor d: If=01, then class #1 is representedFor e: If=01, then student #1 is represented67EXPERIMENTAL DESIGN AND METHODSb.) Parental Questionnaire DataIn a procedure similar to that used for the teacher questionnaire, a coding system was developedfor both parental pretest and posttest questionnaires. Two questions on the pretestquestionnaire appeared identically on the posttest questionnaire. When 2 items appearedidentically in both the pretest and posttest files, they were given the same variable label, with eachpretest and posttest file made distinguishable by coding in its identification number. With itemswhich appeared on only the pretest parental questionnaire, a code of 0 (non-applicable) wasassigned to those same variable labels on the posttest file, and vice versa. Both pretest andposttest parental questionnaires were entered into the computer together as one file. A hardcopy was printed of the parental questionnaires file. Coding on the printout was verified with theresponses on each original questionnaire.c.) Student Interview DataData entry sheets were prepared by translating the F, UF, W, and UW notations on the studentrecord sheets into codes 1, 2, 3, and 4, respectively. Both pretest and posttest interview datawere entered into the computer as one file, distinguishable by a code in the respectiveidentification numbers. A comparison of coding on the student data file printout with theresponses on the original record sheets verified all data entered into the computer file.d.) Parent/Child Merged FileTo analyze for potential relationships between parents and their corresponding child's responsesat both pretest and posttest periods, a merged file was generated from the parent and studentfiles. One record was produced for each child and corresponding parent data at pretest and asecond record for each child and corresponding parent at posttest. The identification number68EXPERIMENTAL DESIGN AND METHODSfrom the child file served to function as the identification number for each record with the variablelabels differentiating the parent's responses from those of the corresponding child's.4. STATISTICAL ANALYSIS OF DATAAll statistical analyses were conducted on the University of British Columbia mainframe computerusing SAS (Statistical Analytical System) Version 5.08 (SAS, 1985). Statistical assistance wasprovided by Frank Ho of the University Computing Services.A. PHASE IFrequency distributions were generated for variables in the teacher questionnaire correspondingto questions 1 to 6, and 8 to 14, inclusive, using SAS Version 5.08. Pearson product-momentcorrelation coefficients were also generated for questions 5 and 6 to determine any relationshipsbetween the number of foods introduced using Foodstyles:K, the number of months teacherstaught Foodstyles:K during the school year, and the number of times per month that teachersreported teaching Foodstyles:K. For question 7, means (± S.D.) were determined to describeteacher satisfaction with the program in reference to how easy the program was to teach, whetherthe introduction of a minimum of 8 foods was sufficient to meet the Foodstyles:K objectives, andwhether the program objectives were easy to meet when teaching Foodstyles:K.B. PHASE III.^Parental Pretest Questionnaire DataFrequency distributions were generated for questions 2, 3, 4, 5, 6, 7, 8, and 9 on the parentalpretest questionnaire. These variables corresponded to parental reports of their child's sex, age,69EXPERIMENTAL DESIGN AND METHODSsibling distributions, daycare attendance, nutrition at daycare, cultural background, and anyinformation regarding food restrictions for their child. For variables in questions 2 to 6 inclusive, achi -square analysis in the SAS CATMOD procedure was used to determine statistical differencesbetween the frequency counts of two study groups. Missing data, or a response of "yes" to anyone or more of the variables regarding food restrictions (questions 7, 8, and 9) resulted in theparental file and the corresponding child's file being flagged. Flagged files were excluded from alldata analyses.II. Parental Pretest and Posttest Questionnaires DataOn a scale of 5 to 1, parents were asked to rank their child's willingness to eat a wide variety offoods and to eat unfamiliar foods, (questions 10(a) and 10(b) on the parental pretestquestionnaire, and questions 2(a) and 2(b) on the parental posttest questionnaire). Fiveindicated they "strongly agree" with the statement, 4 indicated they "somewhat agree, 3 indicatedthey were "neutral," 2 indicated they "somewhat disagree" with the statement, and 1 indicatedthey "strongly disagree" with the statement. A Wilcoxon rank sum procedure was used to analyzefor statistical differences between pretest and posttest for each study group, and between eachgroup at pretest and again at posttest.a.) Parents' Perceptions of their Child's Willingness to Eat the Test FoodsDue to the discrete nature of the data for parents' perceptions of their child's willingness to eat thetest foods, sums were generated from all positive responses and means were then performed onthe sums. Because of the unbalanced nature of the 2 study groups, a 3 way General LinearModel (GLM) procedure was employed to determine statistical differences for the simple main70EXPERIMENTAL DESIGN AND METHODSeffects of the independent variables including; study group (control and intervention), time(pretest and posttest), and food category (introduced and non-introduced), and for all possibleinteractions. The sum of all positive responses for parents' perceptions of their child's willingnessto eat the test foods, across study groups, food categories and time was the dependent variablein each GLM. To investigate significant results, a comparison of the means for the appropriatemain effects was carried out using the independent Student's t-test (Hock et al., 1974).III. Parental Posttest Questionnaire DataFrequency distributions were generated for questions 4 and 5 on the parental posttestquestionnaire. These variables corresponded to: 1.) whether or not their child had mentionedexposure at school to a food s/he requested at home, and 2.) whether the parents had noticedany changes in their child's eating habits over the school year.IV. Student Pretest and Posttest Interview DataFor the initial analysis, all student data were grouped together at pretest, based on the fact thatboth groups did not differ significantly at the start of the school year, as was expected duerandomization of the classes. Further analyses were conducted for each study group. Sumswere generated for all positive responses and means were then performed on the sums. A 3 wayGLM for 2 (study group) X 2 (food category) X 2 (time) was used to determine statistical differencesbetween means of the sums for student familiarity and willingness parameters. An independentStudent's t-test of the applicable means was used to determine the statistical significance ofpaired comparisons.71EXPERIMENTAL DESIGN AND METHODSV. Parents' Perceptions of their Child's Willingness to Eat the Test FoodsCompared with Their Child's Actual ResponseSums were generated for all positive responses and means were then performed on the sums. A3 way GLM for 2 (study group) X 2 (food category) X 2 (time) was used to determine statisticaldifferences between means of the sums for student familiarity and willingness parameters. Anindependent Student's t-test of the applicable means was used to determine the statisticalsignificance of paired comparisons.VI. Parent/Child Merged DataParents were asked at both pretest and posttest to report their perceptions of their child'swillingness to eat the 16 test foods. The children directly provided this information through theuse of food models in individual interviews. The degree of agreement between these tworesponses was then measured.All variables corresponding to the introduced and non-introduced foods for both parent and childin each group were compared at pretest and then again at posttest. When a parent indicated theirchild was willing to eat a food and the child indicated s/he was willing to eat that same food at thesame test time then a match was generated. Likewise , if a parent indicated their child was notwilling to eat a food and the child also indicated s/he was not willing to eat that same food at thesame test time, then a match was also generated. All other combinations of responses generateda non-match situation. Frequency counts were generated for agreement between parents'perceptions of their child's willingness to eat the 16 test foods and their corresponding child'sresponses. A chi square analysis of agreement between the responses was performed to72EXPERIMENTAL DESIGN AND METHODSdetermine if any significant differences existed for the simple main effects including; group(control and intervention), time (pretest and posttest), and food category (introduced and non-introduced), and for all interactions.73RESULTSCHAPTER IVRESULTS 1. PHASE I - TEACHER QUESTIONNAIREThe British Columbia Dairy Foundation (BCDF) data base of 855 kindergarten teachers who hadattended a Foodstyles:K workshop between June 1987 and June 1989 contained 4 names induplicate. These names were excluded as were the 6 pretesters resulting in 845 packets issuedin the initial mailout.Prior to the second mailout, a total of 219 out of 845 teachers (26%) had returned theirquestionnaires and 16 packets had been returned as undeliverable for the two following reasonsincluding: "Moved, address unknown" (n=14), and "No longer there" (n=2) with no forwardingaddress. Six hundred and ten packets were posted in the second mailout on June 4 1990. Fromthe second mailout, a further 6 packets were returned as undeliverable for the reasons of "Moved,address unknown" (n=5), and "No longer there" (n=1) with no forwarding address.By the conclusion of the school year in June 1990, a total of 404 teacher questionnaires hadbeen returned. This represented an overall response rate of 49% from 823 questionnaires thatwere delivered or forwarded to the correct address (845-6-16=823). Since the first questionnairemailed out was distinguishable from the second, it was possible to monitor the return of eachmailing. From the grand total of 404 questionnaires, the percentage of returns received from thefirst mailing was 69% (n=278) and the percentage of returns received from the second mailing was31% (n=126).74RESULTSThroughout the Results chapter all percentage figures are reported based on the actual numberof responses to each questionnaire item. These figures exclude missing data.A. RURAL VERSUS URBAN RESPONSESUsing the general definition of rural schools in British Columbia as being those schools outsidethe metropolitan Victoria and Vancouver areas, 178 urban teachers (44%) and 226 rural teachers(56%) returned their questionnaires. In the Foodstyles:K survey, the urban:rural response ratiowas approximately equivalent compared with the distinctive 1:3 ratio obtained in Alberta.B. USEOf the 404 teachers who returned a questionnaire, 47% (n=190) indicated "current" use of theFoodstyles:K program, 29% (n=118) indicated "past-but-not present" use of Foodstyles:K and24% (n=96) reported they had "never" used Foodstyles:K in their classroom following theirattendance at a workshop.I. "Past but not Present" Use Teacher GroupOf the 118 teachers indicating "past but not present" use, 112 (95%) provided their primaryreason(s) for discontinuing use of Foodstyles:K in their classroom. The 3 principal reasonsincluded (note: multiple responses were possible.):1. Not teaching kindergarten (n=35/112; 31%),2. Teaching plans were already established (n=18/112; 16%), and3. General (not specific) time restrictions (n=18/112; 16%).The figures in the brackets represent the actual number of responses over the potential numberof responses, followed by that value represented as a percentage.75RESULTSTable 6 details all teacher responses to this open-ended question (a. 2(a)) requesting a primaryreason for discontinuing use of Foodstyles:K in their classroom.Table 6. Open Responses from Teachers in the "Past but not Present" UseGroup Indicating Their Primary Reason(s) for Discontinuing Use ofFoodstyles: K.NUMBER of REASON provided for Question 2(a)TEACHERS35^Not teaching kindergarten18^Teaching plans already established18^General time restrictions6^Organizational time requirements5^Problems with reordering supplies5^Lack of child interest5^Multi-age grouping5^Partial use of Foodstyles:K4^Budgetary restrictions4^Classroom time restrictions4^Preference to teach nutrition incidentally at a suitable timerather than as a unit4^Inappropriate level of activity4^Competition with similar programs used in the classroom3^Not suitable to teaching style2^English as a Second Language (ESL) teacher2^Teacher often ill1^Nutrition incorporated into themes1^Too many child allergies1^Too large a class size 127^TOTAL76RESULTSThe majority of teachers who indicated "not teaching kindergarten" as their primary reason fordiscontinued use of the program reported a reassignment of teaching position from kindergarten(P-1) to a different level. Almost 20% of teachers who were "not teaching kindergarten" simplyreported "no longer teaching kindergarten" with no further explanation for this change incircumstance.Most teachers provided a single primary reason for no longer using Foodstyles:K, however,eleven teachers provided multiple reasons ranging from 2 to 3; hence, the total number ofreasons (n=127) exceeds the total number of respondents (n=112) to this questionnaire item.The multiple reasons for this subset of 11 respondents in the "past-but-not present" use groupare provided in Table 7. In as much as these teachers no longer taught Foodstyles:K, 24voluntarily reported that they thought the program was "good" or "excellent."77RESULTSTable 7.^Reasons Given by 11 Teachers in the "Past but not Present" UseGroup Who Provided Multiple Primary Reasons for Their Discontinued Use ofFoodstyles: K.TEACHER REASONS1 2 31 Teaching plans alreadyestablishedGeneral time restrictions2 Teaching plans alreadyestablishedOrganizational timerequirements3 Teaching plans alreadyestablishedMulti-age grouping4 General time restrictions Partial use ofFoodstyles:K5 General time restrictions Budgetary restrictions6 Lack of child interest Competition with similarprograms used in theclassroom7 Lack of child interest Not teachingkindergarten8 Inappropriate level ofactivityProblems reorderingsupplies9 Teaching plans alreadyestablishedGeneral time restrictions Lack of child interest10 Teaching plans alreadyestablishedClassroom timerestrictionsLack of child interest11 Teaching plans already Classroom time Partial use ofestablished restrictions Foodstyles:KA selection of potential factors which may explain reasons for discontinued use of Foodstyles:Kby teachers in the "past-but-not present" use group appeared in question 2(b). Many of theprimary reasons provided in the open-ended question (2(a)) corresponded to the itemized factors78RESULTSpresented in question 2(b) of the questionnaire. The 5 factors most frequently chosen by theseteachers were:*1. Classroom time restrictions (n=66/99; 67%),2. A preference to teach nutrition incidentally at a suitable time rather than as a unitn=49/88; 56%),3. Teaching plans were already established (n=36/80; 45%),4. Budgetary constraints (n=31/82; 38%), and5. Organizational time requirements (n=32/89; 36%).*Note: The number of positive responses and the total number of respondents to eachquestionnaire item is provided. Percentages are calculated from these data for each factor.Eight or fewer teachers reported the 5 factors least frequently chosen for discontinued use ofFoodstyles:K. These factors included: the unavailability of supplemental books (n=8/76; 10%), alack of child interest (n=7/77; 9%), the unsuitability of graphic materials (n=3/77; 4%), and a tiebetween a lack of colleague support (n=2/74; 3%), and unappealing aspects of the Teacher'sGuide (n=2/75; 3%).Table 8 provides a complete list of the frequency of factors reported by respondents in the"past-but-not present" use group.79RESULTSTable 8. Frequency of Factors Which Contributed to the Decision by Teachersin the "Past but not Present" Use Group to Discontinue Their Use ofFoodstyles: K.*FACTOR # of ACTUAL RESPONSE^# of YES^# of NO^YESRESPONSES RATE from RESPONSES RESPONSES RESPONSESPOTENTIAL PER # ofRESPONSES^ ACTUAL=118 (%) RESPONSES(%)Classroom timerestrictions99 84 66 33 67Preference to teachnutrition incidentally88 75 49 39 56Teaching plans alreadyestablished80 68 36 44 45Budgetary constraints 82 69 31 51 38Organizational timerequirements89 75 32 57 36Inappropriate level ofactivities78 66 19 59 24Competition with similarprograms in theclassroom76 64 17 59 22Reordering supplies 79 67 16 63 20Lack of facilities 77 65 15 62 19Unlikelihood of fieldtrips76 64 12 64 17Management ofpaperwork79 67 13 66 16Lack of inclusion as arecommendedresource73 62 9 64 12Unavailability ofsupplemental books76 64 8 68 10Lack of children'sinterest77 65 7 70 9Unsuitable graphicmaterials77 65 3 74 4Unappealing aspects ofthe Teacher's Guide75 63 2 73 3Lack of colleaguesupport74 63 2 72 3Other 87 74 1 86 1*The potential number of responses was 118 for each factor in the "past -but -not present" use group.80RESULTSII. "Never" Use Teacher GroupOf the total number of 96 teachers who indicated they had "never" used the Foodstyles:Kprogram following attendance at a workshop, 3 (3%) reported they made their decision during theworkshop, 25 (26%) decided after the workshop, and 68 (71%) did not respond to this iteminquiring about the time of their decision not to teach Foodstyles:K.A total of 78 out of 96 (81%) teachers in the "never" use group, including the 28 teachers whoindicated when they made their decision not to use Foodstyles:K, reported their primary reason(s)for not using Foodstyles:K in their classrooms. In response to open-ended question 3(b), thethree leading reasons reported were:1. Not teaching kindergarten (n=32/78; 41%),2. General (not specific) time restrictions (n=10/78; 13%), and3. Employed as a French language teacher (n=9/78; 11%).Table 9 details the reasons provided by all teachers who responded to this open-ended questioninquiring about their primary reasons for not teaching Foodstyles:K to their students.81RESULTSTable 9. Open Responses from Teachers in the "Never" Use Group Indicatingthe Primary Reason(s) for Their Decision Not to Use Foodstyles:K.NUMBER OF REASONTEACHERS32^Not teaching kindergarten10^General time restrictions9^French language teacher8^Nutrition incorporated into themes7^Teaching plans already established6^Never attended a Foodstyles:K workshop4^Organizational time requirements2^Budgetary restrictions1^Inadequate initial supply of materials in the kit1^Classroom time restrictions1^Preference to teach nutrition incidentally at asuitable time rather than as a unit1^Too many child allergies1^Unsuitability of recipes 83^TOTAL82RESULTSAs can be seen in Table 10, most teachers in the "never" use group provided a single primaryreason for deciding not to teach Foodstyles:K in their classroom, however, 5 teachers providedtwo primary reasons. Therefore, the number of reasons (n=83) is greater than the actual numberof teachers (n=78) responding to this question. The multiple reasons given by this subset of 5teachers in the "never" use group are provided in Table 10.Table 10. Multiple Primary Reasons Provided by the 5 Respondents in the"Never" Use Group for Their Decision Not to Use Foodstyles:K.TEACHER REASONS1 21 General time restrictions Teaching plans already established2 General time restrictions Not teaching kindergarten3 General time restrictions Not teaching kindergarten4 General time restrictions Budgetary restrictions5 Teaching plans already established Organizational time requirementsA selection of potential factors which could explain reasons for non-use of Foodstyles:K byteachers in the "never" use group was provided in the questionnaire. Many of the primaryreasons teachers provided in the open-ended question 3(b), also appeared as itemized factors inquestion 3(c) of the questionnaire. The 5 factors most frequently chosen were:*83RESULTS1. Classroom time restrictions (n=38/50; 76%),2. Teaching plans were already established (n=36/48; 75%),3 A preference to teach nutrition incidentally at a suitable time rather than as a unit(n=31/49; 63%),4. Organizational time requirements (n=20/43; 46%), and5. Budgetary constraints (n=17/40; 42%).*Note: The number of positive responses and the total number of respondents for eachquestionnaire item is provided . Percentages are calculated from these data for each factor.The 5 least frequently chosen factors which contributed to these teachers decision never to useFoodstyles:K were reported by 3 or fewer teachers and included a tie between the unavailabilityof supplemental books (n=3/32; 9%), a lack of colleague support (n=3/34; 9%), the unsuitabilityof graphic materials (n=3/34; 9%), and the lack of inclusion as a recommended resource (n=3/35;9%), followed by a single response to unappealing aspects of the Teacher's Guide (n=1/35; 3%).Table 11 provides a complete list of the frequency of factors reported by respondents in the"never" use teacher group.84RESULTSTable 11. Frequency of Factors Contributing to the Decision by Teachers in the"Never" Use Group Not to Teach Foodstyles:K.*FACTOR # of ACTUALRESPONSESRESPONSERATE fromPOTENTIALRESPONSES=96^(%)# of YESRESPONSES# of NO^YESRESPONSES RESPONSESPER # ofACTUALRESPONSES(%)Classroom timerestrictions50 52 38 12 76Teaching plans alreadyestablished48 50 36 12 75Preference to teachnutrition incidentally49 51 31 18 63Organizational timerequirements43 45 20 23 46Budgetary constraints 40 42 17 23 42Competition withsimilar programs inthe classroom38 40 13 25 34Unlikelihood of fieldtrips38 40 10 28 26Lack of facilities 36 37 9 27 25Management ofpaperwork37 38 8 29 22Inappropriate level ofactivities37 38 5 32 13Unsuitable graphicmaterials34 35 3 31 9Unavailability ofsupplemental books34 35 3 31 9Lack of inclusion as arecommendedresource35 36 3 32 9Lack of colleaguesupport34 35 3 31 9Unappealing aspectsof the Teachers35 36 1 34 3GuideOther 38 40 38*The potential number of responses was 96 for each factor in the "never" use group.85RESULTSIII. "Current" Use Teacher Groupa.) Method of Teaching Foodstyles:KFrom the total of 404 teachers who returned a questionnaire, 190 (47%) reported they currentlyused Foodstyles:K in their classrooms. When asked to select their method of teachingFoodstyles:K, 125 teachers in the "current" use group indicated a single method of teachingFoodstyles:K, 60 teachers indicated use of multiple methods and 5 teachers did not respond tothis questionnaire item.Of the 125 teachers who indicated a single method, 42 (34%) favoured incorporatingFoodstyles:K into some classroom activities, 38 (30%) indicated they incorporated Foodstyles:Kinto all classroom activities, 24 (19%) reported teaching Foodstyles:K on its own, and 21 (17%)teachers indicated they used a method "other" than the 3 mentioned above. When asked todescribe the "other" method used, 13 of the 21 teachers provided a description. UsingFoodstyles:K materials to augment a theme on "Nutrition" (n=6) was the most frequent "other"method reported, followed by incorporation of Foodstyles:K into general classroom themes (n=3)(eg. "Holidays", "The Farm"). The 2 "other" methods described by these teachers were the useof Foodstyles:K worksheets after cooking (n=2) and using Foodstyles:K activities in a nutritionhealth unit (n=2). See Appendix 16 for teacher descriptions of the "other" method they reportedusing to teach Foodstyles:K.Of the 60 teachers who indicated they used greater than one method when teachingFoodstyles:K, the most frequent pattern of multiple method use (n=12) was reported as teachingFoodstyles:K at times on its own and at other times incorporating it into some classroom activities.Another pattern of multiple method use which teachers reported they used almost as frequently86RESULTS(n=11) as the above pattern was incorporating Foodstyles:K into some classroom activities incombination with a method "other" than teaching Foodstyles:K on its own or incorporating it intoall classroom activities. Nine of these 11 teachers provided a description of the "other" methodthey used to teach Foodstyles:K in combination with incorporating Foodstyles:K into someclassroom activities. The program was reported to be incorporated into a "Nutrition" theme by 3teachers, incorporated into general themes (eg. "Chinese New Year", the "Three Bears", theletter "B") by 3 teachers, 2 teachers reported using it in conjunction with their cooking program,and one teacher reported using some of the Foodstyles:K ideas in her "Restaurant" theme.The third most frequent pattern of multiple method use was tied by 9 teachers who reported theytaught Foodstyles:K in some activities at times and in all classroom activities at other times, and byanother 9 teachers who reported they used Foodstyles:K on its own at times and in all classroomactivities at other times. See Table 12 for a detailed account of the choice of teaching methodsand their frequency of use by teachers in the "current" use group. Descriptions of the "other"methods used in conjunction with teaching Foodstyles:K on its own, in some classroom activitiesor in all classroom activities appears in Appendix 17. These descriptions of the "other" methodsused appear exactly as reported by teachers in the "current" use group.87RESULTSTable 12. Choice of Methods for Teaching Foodstyles:K Reported by Teachersin the "Current" Use Group.ON ITSOWNINCORPORATEDINTO SOMEACTIVITIESINCORPORATEDINTO ALLACTIVITIES"OTHER" TOTALX 24X 42X 38X 21X X 12X X 9X X 4X X X 1X X X 5X X X X 1X X 9X X 11X X X 3X X 518588RESULTSb.) Frequency of Teaching Foodstyles:KA total of 139 teachers in the "current" use group (73%) indicated the number of times per monththey taught Foodstyles:K in their classroom. The frequency of teaching Foodstyles:K during theprevious school year was reported to range from 1 to 20 times per month. Twenty nine percent(n=41) of all teachers in the "current" use group who responded to this question indicated theytaught Foodstyles:K once a month while a further 29% (n=41) indicated they taught Foodstyles:Ktwice a month. The third most common frequency (15%; n=21) at which "current" use teacherstaught Foodstyles:K was 4 times per month .See Figure 1 for a detailed account of the times per month the "current" use respondents(n=139) indicated they taught Foodstyles:K throughout the 1988-1989 school year.89RESULTSNUMBER OF TIMES PER MONTH OF TEACHING FOODSTYLES:K"Current" Use Teachers50454035302520151050 1^2 3 4 5 6 8^9 10 >10Times per MonthFigure 1. The Number of Times Per Month in the School Year Teachers in the"Current" Use Group Reported Teaching Foodstyles:K.90RESULTSA total of 146 teachers in the "current" use group (77%) indicated the number of months theytaught Foodstyles:K during the past school year. A range from 1 to 10 represented the numberof months the teachers reported teaching Foodstyles:K during the 1988-1989 school year, withthe exception of one teacher who indicated teaching Foodstyles:K 12 months during the schoolyear. This datum was excluded from data analysis resulting in 145 valid responses. Mostfrequently, Foodstyles:K was reportedly taught during all 10 months of the school year (n=33;23%). This was followed in frequency by 1 month of teaching Foodstyles:K (n=26; 18%), andthirdly, by teaching Foodstyles:K 8 months of the school year (n=19; 13%).Figure 2 illustrates the frequency of months in which Foodstyles:K was taught in the 1988-1989school year by teachers in the "current" use group.912 3 4 5 6 7Number of Months8 9 1040353025201510501RESULTSNUMBER OF MONTHS PER SCHOOL YEAROF TEACHING FOODSTYLES:K "Current" Use TeachersFigure 2. The Number of Months Per School Year that Teachers in the"Current" Use Group Reported Teaching Foodstyles:K.92RESULTSA total of 165 teachers in the "current" use group (87%) reported the number of foods theyintroduced using Foodstyles:K in their classroom during the 1988-1989 school year. Thenumber of foods introduced ranged from 1 to 24. The 3 most frequently reported number offoods introduced were:1. 8 foods (n=32/165; 19%),2. 10 foods (n=27/165; 16%), and3. 6 foods (n=22/165; 13%).Figure 3 provides a graphic account of the number of foods teachers in the "current" use groupreported they introduced using Foodstyles:K during the 1988-1989 school year.93RESULTSNUMBER OF FOODS INTRODUCED PER SCHOOL YEAR USING FOODSTYLES:K"Current" Use Teachers6050Ea) 40.c0asa)H13 30stJog 20z1001-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24Number of Foods IntroducedFigure 3. The Number of Foods Teachers in the "Current" Use Group ReportedIntroducing Using Foodstyles:K During the School Year.94RESULTSA significant (p<0.0001) inverse correlation was found between the number of months per schoolyear for teaching Foodstyles:K and the times per month which it was taught with a Pearsonproduct-moment correlation coefficient of 1-.-0.572.No significant (p<0.05) correlation was found between the number of months of teachingFoodstyles:K and the number of foods introduced using Foodstyles:K nor between the times permonth of teaching Foodstyles:K and the number of foods introduced.c.) Teacher Satisfaction with Foodstyles:KResponses to 3 questionnaire items regarding teacher satisfaction with Foodstyles:K used ascale of 5 = "strongly agree"; 4 = "somewhat agree"; 3 = "neutral"; 2 = "somewhat disagree"; and,1 = "strongly disagree." Of the 190 teachers in the "current" use group, 182 teachers (96%)indicated by a mean value of 4.7 that they "strongly agreed" the Foodstyles:K program was easyto teach. In response to the suggested minimum number of 8 introduced foods being sufficientto meet the program objectives, an average value of 4.2 was reported by 181 (96%) teachersindicating they "somewhat agreed" with this suggestion in the Teacher's Guide. Finally, 182(96%) teachers in the "current" use group reported an average value of 4.6 in response to theitem requesting teachers' perceptions as to whether they found they could easily meet theobjectives of Foodstyles:K when teaching the program. The average value of 4.6 representsteacher agreement with this statement as roughly half way between "strongly agree" and"somewhat agree."95RESULTSd.) The Three Most Relevant Core ActivitiesTo address their perceptions of the 6 core activities of Foodstyles:K; "Mystery Foods", "Who AmI?", "Cooking", "Journals", "Stickers", and "Class Club" activities, 4 questions were asked ofteachers in the "current" use group. They were asked to choose the 3 activities which theythought were most relevant to each question. This left 3 core activities which would beconsidered least relevant to each particular question. Of the 3 MOST relevant activities chosen,the teachers were asked to rank these 3 activities in the following manner:1 = most relevant activity,2 = 2nd most relevant of the 3 chosen activities,3 = 3rd most relevant of the 3 chosen activities.Table 13 represents percent frequencies of the 3 most relevant activities chosen for eachquestion.96Which core activity do you most enjoyteaching?COOKING^"MYSTERYFOODS"(50) (26)STICKERS/JOURNALS(6)1(6)RESULTSTable 13. Percent Frequencies of the Most Relevant Core Activities Reportedby Teachers in the "Current" Use Group.QUESTION^THREE MOST RELEVANT ACTIVITIESHIGHEST^SECOND^THIRD^FREQUENCY HIGHEST^HIGHESTFREQUENCY FREQUENCY(%)^(%)^(%)How important do you feel it is for thechildren to complete this activity in orderto meet the objectives of Foodstyles:K?How effective do you feel this activity istowards stimulating the children's interestin foods?COOKING^"MYSTERYFOODS"(59)^(16)COOKING^"MYSTERYFOODS"(47) (28)STICKERS(13)STICKERS(14)What is the children's favourite core^COOKING^STICKERS^"MYSTERYactivity?^FOODS"(61)^(15)^(14)97RESULTSe.) Student Interest in Foodstyles:KAgain on a scale of 5 to 1, representing "very interested", "somewhat interested", "neutral","somewhat disinterested", and "very disinterested", respectively, teachers were asked to ratestudents' interest in the Foodstyles:K program. The average value of the responses from 183 of190 (96%) potential respondents was 4.7, indicating the students were "very interested" in theFoodstyles:K program.f.) Use of RecipesThe next set of items in the teacher questionnaire addressed teacher's use of specific activities ofthe Foodstyles:K program. A total of 183 (96%) teachers responded to the question requestinginformation on the use of recipes provided in the Teacher's Guide for the cooking activity. Ofthese 183 teachers, 157 (86%) indicated they used the recipes provided for the core cookingactivity in the Teacher's Guide, and 26 (14%) reported they did not use the provided recipes.g.) Use of the "Look What I Tried!" JournalIn terms of using the journals titled, "Look What I Tried!", a total of 182 (96%) teachers in the"current" use group responded with 133 (73%) indicating they used the journals and 49 (27%)indicating they did not use this core activity. Of those indicating use of the journal activity, 106(80%) teachers reported reordering the food picture pages from BCDF, while a further 25 (19%)teachers reported they did not reorder food pictures from BCDF. Two (1%) teachers whoindicated use of the journal activity did not respond to the question of reordering food pictures.Thirteen of the 25 teachers who reported they did not reorder food pictures provided informationabout what they substituted for the food pictures when the students completed the journalactivity. Six of these teachers described 2 types of substitutes they used. The most frequent98RESULTSsubstitute for food picture pages was obtained by cutting food pictures out of magazines (n=8).This was followed in frequency by using grocery store flyers/posters (n=4), using hand drawnfoods by either the teacher or the student (n=3), and using pictures from packages (n=2). Twoteachers reported they used old food models.h.) Use of "I Tried It!" StickersA total of 183 (96%) teachers in the "current" use group responded to the question of using "ITried It" stickers when they taught Foodstyles:K. Of these teachers, 174 (95%) indicated theyused the stickers while 9 (5%) chose not to use this activity. Seventy five percent (n=131) of theteachers who reported use of the stickers also indicated they reordered stickers from BCDF while20% (n=34) reported they did not reorder stickers from BCDF. A further 5% (n=9) who indicatedthey used "I Tried It" stickers as a Foodstyles:K activity did not respond to the question ofreordering supplies. Of the 34 teachers who did not reorder stickers, 5 described the materialsthey used as a substitute. Three of these teachers reported making their own stickers, onereported using "happy face" stickers and one teacher reported photocopying stickers for thestudents.i.) Use of the Class Club ActivityA total of 183 (96%) teachers in the "current" use group responded to the question asking if theymade use of the "I Tried It" Class Club activity. Of these teachers, 64% (n=117) reported they didnot use this activity while 36% (n=66) reported use of the Class Club activity. All respondents whoreported use of the Class Club activity were asked to categorically indicate the number of studentswho had returned their Class Club activity forms from home which indicated the students had tried99RESULTSa new food outside the classroom. Four of the 66 teachers did not respond to the questionrequesting the approximate number of students participating in the Class Club activity.1. Most children (16/62; 26%),2. More than half the children (16/62; 26%),3. Almost half the children (16/62; 26%), and4. Very few or none of the children (14/62; 22%).j.) Parental Support for Foodstyles:KThe final item on the teacher questionnaire asked for teachers' perceptions of the amount ofparental support for this program. Ranked from 5 to 1 representing "very supportive," "somewhatsupportive," "neutral," "somewhat non-supportive," and "non-supportive," respectively, theaverage value of 4.1 for 177 (93%) respondents indicated teachers felt parents were "somewhatsupportive" of the Foodstyles:K program.2. PHASE II - EVALUATION OF FOODSTYLES:K - PARENT AND STUDENTPARTICIPATIONA. PARENTAL PRETEST QUESTIONNAIRERandomization of the classes into either the control or intervention group resulted in six classes inthe control group and seven classes in the intervention group. Overall, 217 packets containing aconsent form, cover letter, questionnaire and return envelope were distributed to the students totake home to their parents. The parental pretest questionnaire was completed by parents of bothcontrol and intervention classes. A choice of "do" or "do not" give consent was available on the100RESULTSconsent form which constituted the first page of the pretest questionnaire. The number ofstudents enrolled in all the participating classes totalled 217. Of this total; 188 pretestquestionnaires were returned indicating consent was given for their child to participate in theevaluation, 4 indicated that consent was not given, and 25 did not return a questionnaire. Thetotal number of returned questionnaires was 192 representing an overall return rate of 89%, with90 in the control group and 102 in the intervention group. Of the 4 who did not give consent, 1was in the control group and 3 were in the intervention group, and of the 25 who did not returnthe pretest questionnaire, 10 were in the control group and 15 were in the intervention group.Questionnaire data returned with a form indicating "no consent" were not used in the dataanalyses. Consequently, the number of students with parental consent to participate was 89(89%) in the control group and 99 (85%) in the intervention group.For the classes where parents returned their pretest questionnaire by mail directly to BCDF, apotential total return by mail of 33 pretest questionnaires in the control group and 57 in theintervention group was possible. The actual totals were 28 (85%) and 46 (81%), respectively.For classes where the parents returned their pretest questionnaire directly to the teacher, apotential total return directly to the teacher of 67 pretest questionnaires in the control group and60 in the intervention group was possible. The actual totals were 62 (92%) and 56 (93%),respectively. See Table 14.101RESULTSTable 14. Response Rate for Parents Returning Their Pretest Questionnaires.Class Group* Return byMail or toTeachertPotential^#of ReturnsActual # ofReturns ResponseRate01 C T 21 21 10002 I T 20 19 9503 I M 20 18 9004 I M 17 12 7105 C M 20 17 8506 I T 8 7 8807 I M 20 16 8008 I T 17 17 10009 C T 13 13 10010 C M 13 11 8511 C T 12 9 7512 C T 21 19 9013 I T 15 13 87*I = Intervention group^*C = Control groupVA = Mail^ tT = Teacher102RESULTSSix of the 89 students in the control group who had parental permission to participate, did not doso. Four of these students were English as a Second Language (ESL) students who could notcommunicate fluently in English, and the other two students did not wish to participate. Eightythree students participated in the control group at pretest.Eight of the 99 students in the intervention group who had parental permission to participate inthe study, did not participate. Five of these students were absent at the initial interview sessionand at one further contact, 1 child had moved between the time the parental questionnaire withconsent form was returned and the pretest interviews were conducted, 1 student did not wish toparticipate, and consent for 1 student was received one month after the pretest interviews hadtaken place. Ninety one students participated in the intervention group at pretest. A sum total of175 students from both groups participated in pretest interviews.I. Food-related Restrictive ConditionsHowever, parents were asked to provide information regarding 3 restrictive conditions whichmight affect their child's food choices. These food-related restrictive conditions included: 1.) foodallergies, 2.) special dietary restrictions, and 3.) medical conditions that affect the child's foodintake. This is the only case in the Results chapter where missing data was included for dataanalyses. This action was necessary since if parents did not provide any information regardingthese conditions it could not be assumed that their child was free from any one or all of theserestrictive food-related conditions.103RESULTSa.) Food AllergiesParents were asked to report any food allergies their child may have. Three parents in the controlgroup and 6 parents in the intervention group indicated food allergies as the only conditionapplicable to their child.b.) Special Dietary RestrictionsEight parents in the control group and 2 in the intervention group indicated special dietaryrestrictions (eg. meat-free, milk-free, wheat-free diets and food restrictions due to religiouspractices), as the only condition applicable to their child. One parent in the control group did notrespond to this condition alone but did respond to the questionnaire items pertaining to the other2 conditions. Therefore, this record was considered the same as a positive response.c.) Medical ConditionsIn terms of only medical conditions (eg. phenylketonuria (PKU), diabetes) affecting food intake, 1parent in the control group failed to indicate an answer to this condition but did indicate the other2 conditions did not apply to her/his child. Because it could not be assumed that a medicalcondition did not apply to this child, this record was excluded from data analyses.A combination of food allergies and special dietary restrictions was reported by 2 parents in thecontrol group. One parent in the control group did not respond to the food allergies half of thiscombination of conditions but did indicate that special dietary restrictions were applicable to theirchild. One parent in the intervention group did not respond to these 2 conditions but didrespond to the item pertaining to a medical condition. The only other combination reported byparents was one where all 3 conditions applied to their child. Two parents in the intervention104RESULTSgroup indicated this was true for their children. One parent in each of the control and interventiongroups did not respond to any of the the 3 questionnaire items.Results from the data are presented in Table 15. Missing data or a positive response by parents toone or more of the above three conditions (food allergies, special dietary restrictions, and/ormedical conditions) resulted in the parent's and the corresponding child's files being flagged.Neither the parent data nor the child data from flagged files were used in the statistical analyses.There were 17 children in the control group and 12 children in the intervention group who fit intoat least one of the above categories. Special dietary restrictions accounted for the majority of thepositive responses for students in the control group (11 out of 17). Food allergies was reportedby parents with the greatest frequency for students in the intervention group (8 out of 12). Thenumber of students without any of the above three conditions was 67 and 79 in the control andintervention groups, respectively.105RESULTSTable 15. Table of Parental Responses Indicating Restrictive Food-relatedConditions for Their Children.CONDITION(S)CONTROLGROUPINTERVENTIONGROUPFood Allergies 3 6Special Dietary Restrictions 9 2Medical Conditions 1Food Allergies & Special Dietary Restrictions 3 1Food Allergies & Medical ConditionsSpecial Dietary Restrictions & MedicalConditionsFood Allergies & Special Dietary Restrictions & 1 3Medical ConditionsTOTAL^ 17^12In addition, both parent and student data which were complete at pretest but incomplete atposttest were excluded from the data analyses. Reasons for deletion of 10 records in the controlgroup were attributable to 6 students being absent during 2 visits by the research team to theirclassroom and to 4 parents who did not return their questionnaire following the teacher's requestto do so. Reasons for deletion of 12 records in the intervention group were attributable to 6students being absent during 2 visits by the research team to their classroom and to 6 parentswho did not return their questionnaire following the teacher's request to do so.As a result of these deletions, a final tally of 56 and 67 records in the control and interventiongroups, respectively, were used in the data analyses for Phase II. From the initial to the final106Total # of studentswho did not n=8participate.Total # of studentswho did notparticipate.n=6RESULTSsample size, there was a 44% loss of potential study participants in the control group and a 43%loss in the intervention group. Figure 4 provides an overview of the places where a loss ofpotential study participants occurred.TOTAL NUMBER OFQUESTIONNAIRES DISTRIBUTEDn=100 controln=117 interventionTOTAL NUMBER OFQUESTIONNAIRES RETURNEDn=90 controln=102 interventionNumber of parentsn=1^indicating NO consentin control group.TOTAL NUMBER WITH PARENTALCONSENT IN CONTROL GROUPn=89 controlNumber of parentsindicating NO consentin interventiongroup.TOTAL NUMBER WITH PARENTALCONSENT IN INTERVENTIONGROUPn=99 interventionFigure 4. Flow Chart of the Steps Where Loss of Potential Study ParticipantsOccurred.107RESULTSTOTAL NUMBER OF PARTICIPATINGSTUDENTSn=83 controlTOTAL NUMBER OF PARTICIPATINGSTUDENTSn=91 interventionTotal # of students^ Total # of studentsn=17^with restrictive n=12^with restrictivefood-related food-relatedconditions.^ conditions.TOTAL NUMBER OF STUDENTSWITHOUT RESTRICTIVE FOOD-RELATED CONDITIONSn=66 controlTOTAL NUMBER OF STUDENTSWITHOUT RESTRICTIVE FOOD-RELATED CONDITIONSn=79 interventionTotal # of^Total # ofn=10^incomplete data n=12^incomplete datarecords at posttest.^ records at posttest.TOTAL = 123TOTAL NUMBER OF VALIDSTUDENT AND PARENT RECORDSUSEDIN DATA ANALYSESn=56 controlTOTAL NUMBER OF VALIDSTUDENT AND PARENT RECORDSUSEDIN DATA ANALYSESn=67 interventionFigure 4. (cont'd.) Flow Chart of the Steps Where Loss of Potential StudyParticipants Occurred.108RESULTSII. Age and Gender DistributionsAt pretest, the control group data consisted of 25 male and 31 female students. Of the 25 boys,24 were 5 years old and 1 was 6 years old. Of the 31 girls, all were 5 years old. There were 38male and 29 female students without any restrictive food-related conditions who participated inthe intervention group. Of the 38 boys, 2 were 4 years old at pretest and 36 were 5 years old. Ofthe 29 girls at pretest, 2 were 4 years old, and 27 were 5 years old.Overall, at pretest the mean (± S.D.) age of 56 students in the control group was 5.0 (±0.2) yearsand the mean age of 67 students in the intervention group was 5.0 (±0.2) years. The mean age ofthe 31 girls in the control group at pretest was 5.0 (±0.2) years and the mean age of the 25 boyswas 5.1 (±0.2) years. In the intervention group, the mean age of the 29 girls was 5.0 (±0.2) yearsand the mean age of the 38 boys was 5.0 (±0.2) years.Ill. Sibling DistributionsOf the 56 students in the control group, 50 parents indicated at pretest their kindergarten childhad siblings and 6 parents indicated their child did not have siblings. In terms of older siblings, 21students had only 1 older sibling, 7 had 2 older siblings and no younger siblings , 1 had 3 oldersiblings and no younger siblings, and 1 had 4 older siblings with no younger siblings. In terms ofyounger siblings 12 children had only 1 younger sibling. Four students in the control group had 1older and 1 younger sibling; 1 student had 1 older and 2 younger siblings; and, 3 students had 2older and 1 younger siblings.Of the 67 students in the intervention group, 60 parents indicated at pretest their kindergartenchild had siblings, 6 parents indicated their child did not have siblings, and 1 parent did not109RESULTSrespond to this questionnaire item. In terms of older siblings, 19 students had 1 older sibling andno younger siblings, 9 had 2 older siblings only, and 2 had 3 older siblings with no youngersiblings. In terms of younger siblings, 17 children had 1 younger sibling only and 3 children had 2younger siblings but no older siblings. Seven students in the intervention group had 1 older and1 younger sibling; 2 students had 2 older and 1 younger sibling; and, 1 student had 2 older and 2younger siblings. A summary of these results is presented in Table 16.Table 16. Summary of Sibling Distribution Data Provided by Parents at Pretest.NUMBER OF OLDER & YOUNGER SIBLINGS CONTROLGROUPINTERVENTIONGROUPOLDER YOUNGERnone none 6 6one none 21 19none one 12 17one one 4 7two none 7 9none two 3one two 1two one 3 2two two 1three none 1 2four none 1TOTAL 56 66110RESULTSIV. Previous Daycare AttendanceOf the 56 students in the control group, 29 (52%) had previously attended daycare while 27(48%) had not. One parent did not respond to this questionnaire item. In the intervention group,42 (63%) students had previously attended daycare and 25 (37%) had not.V. Parental Awareness of Nutrition Education at DaycareIn terms of parental awareness of any nutrition information being introduced to their child atdaycare, 16 of the 29 (55%) parents in the control group who reported their child attendeddaycare also reported they were aware of their child being exposed to some form of nutritioninformation at daycare. Thirteen parents (45%) reported they were unaware of any nutritioninformation introduced at daycare. In the intervention group, 28 of the 42 parents (67%) whoreported their child attended daycare also reported they were aware of their child being exposedto some form of nutrition information at daycare. Fourteen parents (33%) reported they wereunaware of any nutrition information introduced at daycare.VI. Cultural HeritageIn the control group, ten parents did not provide information regarding their child's culturalheritage. Of the 46 respondents, 27 parents (59%) indicated their children had aCanadian/British/English cultural heritage while 19 parents (41%) reported their children had acultural heritage "Other" than Canadian/British/English.In the intervention group, thirteen parents did not provide information regarding their child'scultural heritage. Of the 54 respondents, 45 parents (83%) indicated their children had anCanadian/British/English cultural heritage while 9 parents (17%) reported their children had a111RESULTScultural heritage "Other" than Canadian/British/English. Tables 17 and 18 provide a detailedaccount of the study group breakdown for the children's cultural heritage as reported by theirparents.Table 17.^Detailed Account of Students with a Canadian/British/EnglishCultural Heritage as Reported by Their Parents.CULTURAL HERITAGE CONTROLGROUPINTERVENTIONGROUPCANADIAN 25 30ENGLISH 8CANADIAN/AMERICAN 1CANADIAN/DUTCH 1CANADIAN/FILIPINO 1CANADIAN/SCOTTISH 1CANADIAN/UKRAINIAN 1FRENCH CANADIAN/DANISH/ENGLISH 1ENGLISH/DUTCH 2ENGLISH/IRISH 1TOTAL: CANADIAN/BRITISH/ENGLISH 2 7 4 5112RESULTSTable 18. Detailed Account of Students with a Cultural Heritage "Other" thanCanadian/British/English as Reported by Their Parents.CULTURAL HERITAGE^CONTROL INTERVENTIONGROUP^GROUPCHINESE^ 9 2EAST INDIAN 3^1CHINESE/FILIPINO^ 1CROATIAN/POLISH 1DUTCH^ 1FILIPINO 1FINNISH^ 1GERMAN 1ITALIAN^ 1JAPANESE 1LAOTIAN/CHINESE/THAI^ 1POLISH^ 1POLISH/ENGLISH/SPANISH^ 1UKRAINIAN^ 1^1TOTAL: "OTHER"^19 9113RESULTSChi-square analysis of the demographic variables (Table 19) showed no significant differences(p<0.05) between groups in sex, age, sibling distribution, attendance at daycare, or parentalawareness of nutrition education at daycare. The one demographic variable where a significantdifference existed between the 2 study groups was cultural heritage. All reports of Canadian,British, and/or English cultural heritage were clustered to form one measure of this variable and allreports of cultural heritage "Other" than Canadian/British/English were clustered to form the othermeasure of this variable. The proportion of students with a cultural heritage "Other" thanCanadian/British/English was significantly greater (p=0.01) in the control group than in theintervention group.114RESULTSTable 19.^Demographic Variables by Study Group.DEMOGRAPHICVARIABLECONTROLGROUPINTERVENTIONGROUPSEX: MALE: #, (%) 25 (45) 38 (57)FEMALE: #, (%) 31 (55) 29 (43)AGE: Mean ± S.D. 5.0 ± 0.2 5.0 ± 0.2SIBLINGS:^TOTAL: #, (%) 50 (89) 60 (90)OLDER: Mean ± S.D. 1.4 ± 0.7 1.4 ± 0.6YOUNGER:Mean ± S.D. 1.0 ± 0.2 1.1 ± 0.3DAYCARE: #, (%) 29 (52) 42 (63)NUTRITION at DAYCARE: #, (%) 16 (55) 29 (69)CULTURAL HERITAGE: #, (%)CANADIAN/BRITISH/ENGLISH: 27 (59)t 45 (81) -1-"OTHER": 19 (41)f 9 (19)tf = Chi-square analysis revealed a significant difference between groups at p=0.01.115RESULTSB. PARENTAL PRETEST AND POSTTEST QUESTIONNAIRESParents overall ranking of their child's willingness to eat a wide variety of foods and to eat unfamiliarfoods did not change significantly (p>0.05) from pretest to posttest for either group, asdetermined by a Wilcoxon comparison of the rank sums. Also, the rank sums obtained fromparents describing their child's willingness to eat a variety of foods and their child's willingness toeat unfamiliar foods were similar and did not differ significantly (p>0.05) between groups atpretest, nor at posttest.Table 20. Parent's Ranking of their Child's Willingness to Eat a Variety of Foodsand to Eat Unfamiliar Foods.QUESTIONNAIRE ITEM PRETEST POSTTESTN MEAN (± S.D.) N MEAN (± S.D.)Parental reports of their child's willingness toeat a VARIETY of foods.CONTROL GROUP 56 3.6 + 1.1 54 3.8 + 1.1INTERVENTION GROUP 66 3.7 ± 1.1 67 3.8 ± 1.2Parental reports of their child's willingness toeat UNFAMILIAR foods.CONTROL GROUP 54 3.0 ± 1.1 55 3.1 ± 1.2INTERVENTION GROUP 66 3.1 ± 1.0 67 3.3 + 1.1116RESULTSC. PARENTAL POSTTEST QUESTIONNAIREAt posttest, parents were asked to indicate any food(s) that their child had requested over theschool year as a result of exposure to the food(s) at school. In the control group, 14 parents(25%) reported when their child requested food(s), that s/he had mentioned her/his exposure tothe food(s) at school. Twelve of these parents reported the food(s) requested and 2 did notreport the food(s). Forty one parents (73%) indicated their child had not mentioned exposure tofood(s) at school and 1 parent in the control group did not respond to this questionnaire item.In the intervention group, 39 parents (59%) reported their children had mentioned exposure atschool to the food(s) s/he requested. Of these 39 parents, 34 reported the food(s) requestedwhile 5 did not. Twenty seven parents (41%) indicated no mention by their child of food(s)exposure at school when s/he requested food(s). One parent in the intervention group did notrespond to this questionnaire item.Chi square analysis revealed a significant difference (p=0.0003) between groups for the numberof foods children had mentioned being exposed to at school when they requested a food. Whenanalyzed by study group, the percentage of test foods from the total number of foods requestedwas 19% and 51% for the control and intervention groups, respectively. Appendices 18 and 19provide a list of the foods reported by the parents of students in each study group.Also at posttest, parents were asked to describe any changes they may have noticed in theirchild's food habits over the school year. Twenty three parents (41%) in the control groupreported the change(s) in their child's food habits while 33 parents (59%) reported no observablechange(s).117RESULTSIn the intervention group, 32 parents (48%) reported a noticeable change in their child's foodhabits over the school year and 35 parents (52%) reported no observable change in their child'sfood habits. No significant difference existed between the groups. The noticeable changes inchildrens' food habits over the course of the school year as reported by their parents arepresented in Appendices 20 and 21.D. STUDENT FAMILIARITY DATA - PRETEST AND POSTTESTWith both study groups combined, the student's familiarity with the 16 test foods, increasedsignificantly (p<.0001) from 7.7 foods at pretest to 9.1 foods at posttest. See Table 21.In comparing the two study groups, no significant difference was determined between groups atpretest and at posttest for either introduced or non-introduced foods.Table 21. Table of Student's Familiarity with all 16 Test Foods.CONTROL &^RESPONSE^PRETEST^POSTTESTINTERVENTION MEAN # of MEAN # ofGROUPS N^FOODS^N^FOODSCOMBINED^ (± S.D.) (± S.D.)Student's familiarity^Familiar^123^7.7 ± 2.0**^123^9.1 ± 2.0**with all 16 test foods.—p<.0001118RESULTSWhen analyzed by study group, results from students in the control group indicated a significantincrease in their familiarity with both introduced (p<.01) and non-introduced foods (p<.05) frompretest to posttest. A significant difference (p<.0001) existed in the control group at pretestbetween the introduced and non-introduced foods, with students in this study group indicatingthey were more familiar with the non-introduced foods. This trend was also observed at posttestat the same p level. See Table 22.In the intervention group, a significant increase in student's familiarity with the introduced foods(p<.0001) was noted between pretest and posttest, but this did not appear with the non-introduced foods. A significant difference existed in the intervention group between theintroduced and non-introduced foods, with students in this study group indicating they weremore familiar with the non-introduced foods than with the introduced foods at both pretest(p<.0001) and posttest (p<.0001). See Table 22.119RESULTSTable 22. Table of Student's Familiarity with Introduced and Non-introducedFoods.INTRODUCED FOODS (n=8)GROUP^RESPONSE ^PRETEST^POSTTESTMEAN # of MEAN # ofN^FOODS^N^FOODS(± S.D.) (± S.D.) CONTROL^Familiarity^56^2.8 ± 1.34e^56^3.7 ± 1.4b,eINTERVENTION Familiarity^67^2.9 ± 1.2b,9^67^4.0 ± 1.2d, gNON-INTRODUCED FOODS (n=8)GROUP^RESPONSE ^PRETEST^POSTTESTMEAN # of MEAN # ofN^FOODS^N^FOODS(± S.D.) (± S.D.) CONTROL^Familiarity^56^4.8 ± 1.24f^56^5.2 ± 1.00INTERVENTION Familiarity^67^5.0 + 1.0b^67^5.2 ± 1.1dp<.05 fp<.01 ep<.0001 a,b,c,d,gMeans sharing a common superscript letter are significantly different at the noted p level.120RESULTSE. STUDENT AND PARENT WILLINGNESS DATA - PRETEST AND POSTTESTI. Student WillingnessWith both groups combined, the student's willingness to eat an average 11.4 of the 16 test foodsdid not change from pretest to posttest. See Table 23.In comparing the 2 study groups, no significant difference was determined between groups atpretest and at posttest for either introduced or non-introduced foods.When analyzing by each study group, in the control group, there were no significant differencesin the student's willingness to eat the test foods. In the intervention group, a significantdifference existed between the introduced and non-introduced foods, with students in this studygroup indicating they were more willing to eat the non-introduced foods than the introducedfoods at both pretest (p<.05) and posttest (p<.05). No significant difference was noted in theintervention group for students' willingness to eat either introduced or non-introduced foodsbetween pretest and posttest. See Table 23.II. Parents' Perceptions of Their Child's Willingness to Eat the Test FoodsWith both groups combined, parents' perceptions of their child's willingness to eat the 16 testfoods did not change significantly from 10.4 foods at pretest to 10.5 foods at posttest. See Table23.121RESULTSTable 23. Table of Student's Willingness to Eat the 16 Test Foods and Parents'Perceptions of Their Children's Willingness to Eat the Test Foods.GROUP:STUDENT ORPARENTStudent's willingness toeat all 16 test foods.Parent's perceptions oftheir child's willingnessto eat all 16 test foods.RESPONSE PRETEST POSTTESTNMEAN # ofFOODS(±^S.D.)MEAN # ofN^FOODS(±^S.D.)WillingWilling12312311.4 ± 3.910.4 ± 2.712312311.4 ± 3.510.5 ± 2.6In comparing parental perceptions for the 2 study groups, no significant difference wasdetermined between groups at pretest and at posttest for either introduced or non-introducedfoods. When analyzing by each study group, there were no significant results to report forparents' perceptions of their child's willingness to eat the test foods. See Table 24.122RESULTSTable 24. Table of Student's Willingness to Eat the 16 Test Foods and Parents'Perceptions of Their Child's Willingness to Eat the 16 Test Foods.INTRODUCED FOODS (n=8)PRETEST ^POSTTEST GROUP^WILLINGNESS^MEAN # of MEAN # ofRESPONSE^N^FOODS^N^FOODS(± S.D.) (± S.D.) CONTROL^Student^56^5.4 ± 2.1^56^5.1 ± 2.3Parent 56^5.0 ± 1.8^56^5.2 ± 1.7INTERVENTION Student^67^5.5 ± 2.24d^67^5.6 +1 . 7b,eParent 67^5.0 + 1.5d^67^5.1 ± 1.6eNON-INTRODUCED FOODS (n=8)PRETEST ^POSTTEST GROUP^WILLINGNESS^MEAN # of MEAN # ofRESPONSE^N^FOODS^N^FOODS(± S.D.) (± S.D.) CONTROL^Student^56^5.6 ± 2.3^56^5.8 ± 1.9cParent 56^5.4 ± 1.5^56^5.3 ± 1.3cINTERVENTION Student^67^6.2 ± 1.54f^67^6.3 ± 1.4b,gParent 67^5.4 ± 1.4f^67^5.4 ± 1.49p<.05 e,bActep<.0001 f ,gMeans sharing a common superscript letter are significantly different at the noted p level.123RESULTSIll. Parents' Perceptions of Their Child's Willingness to Eat the Test FoodsCompared with Their Child's Actual ResponseWhen analyzed by group, significant differences existed between parents' perceptions of theirchild's willingness to eat the test foods compared with their child's responses in the interventiongroup. For introduced foods at pretest (p<.05) and at posttest (p<.05), and for non-introducedfoods at pretest (p<.0001) and posttest (p<.0001), the children consistently indicated they werewilling to eat a significantly greater number of foods than perceived by their parents. See Table24.For the control group, a significant difference (p<.05) between parent and student responsesexisted at posttest for non-introduced foods only, with the children indicating they were willing toeat a significantly greater number of foods than perceived by their parents. No significantdifferences existed at posttest for introduced foods or at pretest for either food category.F. PARENT/STUDENT MATCHING DATAChi-square analysis of frequency counts for percent agreement of the simple main effectsincluding; study group (control and intervention), time (pretest and posttest), and food category(introduced and non-introduced), and all possible interactions revealed statistical differences forgroup (p<0.01) and food category (p<.0001), but not for time or any interactions. There wassignificantly greater agreement between parents and their children in the intervention groupcompared with the control group and, there was significantly greater agreement between parentsand their children for the non-introduced foods compared with the introduced foods. See Table25.124RESULTSTable 25. Percent Agreement Between Parents' Perceptions of Their Child'sWillingness to Eat the 16 Test Foods and the Children's Responses.INTRODUCED FOODS (n=8)GROUP RESPONSE PRETEST POSTTESTAGREEMENT AGREEMENT(%) (%)CONTROL Agreement 67.3a 69.0INTERVENTION Agreement 66.7 13,c 74.013x1NON-INTRODUCED FOODS (n=8)GROUP RESPONSE PRETEST POSTTESTAGREEMENT(%)AGREEMENT(%)CONTROLINTERVENTIONAgreementAgreement75.2a80.8c73.0e81.2ctep<.05 0p<.01 d,ep<.0001 cPercentages sharing a common superscript letter are significantly different at the noted p level.125RESULTSThe overall agreement between parents' perceptions of their child's willingness to eat the testfoods and their child's response was 73.4%. At pretest, with both groups combined, theagreement between parents and their children for all 16 foods was 72.5%, representing 67.0%for introduced foods and 78.0% for non-introduced foods. At posttest, with both groupscombined, the overall agreement between parents and their children for the 16 foods was 74.3%,representing 71.5% for introduced foods and 77.1% for non-introduced foods.The percent agreement between parents and children at pretest for the control group wassignificantly greater (p<.05) for the non-introduced foods than the introduced foods. This wasalso observed for the intervention group at pretest (p<.0001), and additionally at posttest (p<.01).No significant difference was discovered at posttest for the control group.A significant difference (p<.05) in percent agreement from pretest to posttest was observed forintroduced foods in the intervention group, with a greater agreement between parents and theirchildren found at posttest.The only significant difference between study groups was found at posttest with the non-introduced foods with the percent agreement between parents and their children significantlygreater (p<.01) for the intervention group compared with the control group.126RESULTSG. SUMMARY OF RESULTS WITH REFERENCE TO THE STUDY HYPOTHESESPRIMARY HYPOTHESESQuestion 1:There will be no significant difference between children exposed to Foodstyles:K duringtheir kindergarten year compared with children not exposed to Foodstyles:K during theirkindergarten year, in terms of the children's stated recognition of a variety of selectedfoods.This null hypothesis was generally confirmed by results from the study. A significant increase instudents' familiarity with the introduced foods was observed for both the intervention group(p<.0001) and the control group (p<.01) over the school year. However, familiarity with the non-introduced foods by students in the control group also increased significantly (p<.05) while that ofthe intervention group did not.Question 2:There will be no significant difference between children exposed to Foodstyles:K duringtheir kindergarten year compared with children not exposed to Foodstyles:K during theirkindergarten year, in terms of their food behaviour towards a variety of selected foods, asmeasured by their stated willingness to eat these foods.This null hypothesis was confirmed by results from the study. Students' stated willingness to eatboth the introduced and non-introduced foods did not change in either study group over thecourse of the school year. This was an unanticipated finding as one objective of the program is for127RESULTSthe students to build positive feelings about trying new foods through their experiences with theprogram activities. This also somewhat contradicts teachers' reports that the students were "veryinterested" in the program.SECONDARY HYPOTHESESQuestion 3:There will be no significant difference in the identification of a variety of selected foodsnear the start versus near the end of the school year for kindergarten children notexposed to the subject of nutrition during their kindergarten school year.An unanticipated finding of this study was revealed for students in the control group. A significantincrease in their familiarity with both introduced (p<.0001) and non-introduced foods (p<.01) frompretest to posttest was observed. A suggested explanation for this result may simply be thenatural maturational development of kindergarten-aged children over the course of a school year.Question 4:There will be no significant difference in the stated willingness to eat a variety of selectedfoods near the start versus near the end of their school year for kindergarten children notexposed to the subject of nutrition during their kindergarten school year.This null hypothesis was confirmed by results from the study. Stated willingness to eat both theintroduced and non-introduced foods did not change over the course of the school year forstudents in the control group.128RESULTSQuestion 5:There will be no significant difference in parents' perceptions of their kindergarten child'swillingness to eat a variety of foods over the course of the school year.This null hypothesis was confirmed with no significant change noted for parents in either studygroup in terms of their perceptions of their child's willingness to eat a variety of foods over thecourse of the school year.Question 6:There will be no significant difference in parents' perceptions of their kindergarten child'swillingness to eat unfamiliar foods over the course of the school year.This null hypothesis was confirmed with no significant change noted for parents' perceptions oftheir child's willingness to eat unfamiliar foods in either study group over the course of the schoolyear.Question 7:For a variety of selected foods, there will be no significant difference between theparents' perceptions of their child's willingness to eat the foods, and their child's statedwillingness to eat the same foods.Results from the study indicated a significant difference existed at both pretest (p<.0001) andposttest (p<.0001) in the intervention group between parents' perceptions of their child's129RESULTSwillingness to eat the introduced foods and their child's stated willingness to eat these foods.Similar results were obtained for the non-introduced foods at both pretest (p<.05) and posttest(p<.05). For the control group, parents and their childrens' responses generally were similar, withthe only significant difference appearing at posttest with non-introduced foods (p<.05).130DISCUSSIONCHAPTER VDISCUSSION1. INTRODUCTIONFor the purpose of discussion, major findings of the descriptive results from Phase I - Teachers'Perceptions of Foodstyles:K will be commented on first, followed by a discussion of the majorfindings from Phase II - Evaluation of Foodstyles:K - Student and Parent Participation. For PhaseII, results from the parental questionnaire data will be discussed followed by results from thestudent data. Finally, to conclude this chapter, the degree of agreement between the parent'sand their corresponding child's results in reference to the children's willingness to eat the 16 testfoods will be discussed.2. PHASE I - TEACHERS' PERCEPTIONSDistribution of the teacher questionnaire took place in Spring 1990 and was limited to all BritishColumbia kindergarten (P-1) teachers who had attended a Foodstyles:K workshop between June1987 and June 1989. Some questionnaire items pertained to use of the program over the courseof a full school year. Therefore, the potential existed for bias from inaccurate or missing data ifdistribution of the teacher questionnaire had reached teachers who had attended a Foodstyles:Kworkshop later than June 1989 (ie. during Fall 1989 or Winter 1990).131DISCUSSIONAs each school year draws to a close, there are increased demands on teacher's time for suchevents as field trips, sports day, school fairs, recognition ceremonies, thank you events forparents, and the preparation of report cards. The initial distribution of the teacher questionnairepacket occurred in the first week of May 1990, and it was anticipated that teachers could affordtime at this point in the school year to complete the questionnaire and return it in the self-addressed, stamped envelope supplied in their questionnaire packet. However, prior to thescheduled time for distribution of an updated packet to all non-respondents, only 219 out of 845teachers (26%) had completed and returned their questionnaires. Six hundred and ten packetswere mailed to non-respondents on June 4 1990. By the conclusion of the school year, 404teacher questionnaires had been returned representing an overall response rate of 49% from atotal of 823 questionnaires that were delivered or forwarded to the correct address. While thisresponse rate indicated half the teachers who had taken a Foodstyles:K workshop did not wish toparticipate in the evaluation, it did, however, represent almost double the response rate reportedby Berenbaum (1986). In evaluating a similar program during the Spring of 1985 in Ontario, titled"Good Beginnings: A Nutrition Education Program for Preschoolers," Berenbaum achieved a25% response rate from a total of 1247 early childhood educators who had attended a workshopfor the program within the previous 2 years, using a single questionnaire mailout and one followup letter 2 weeks later. In an evaluation study of teacher involvement in the "Nutrition at School"program in Alberta, McEwen and Kieren (1984) achieved a response rate of 55% from a province-wide mail survey to a random 500 K-6 teachers. These authors reported a single questionnairewas sent but provided no details regarding follow up.132DISCUSSIONResponse rate is effectively increased through follow up contacts with the number of contactsbeing the best predictor of the final response rate (Lockhart, 1984). In the present study, amaximum of 4 contacts resulted in a 49% overall teacher response rate for the evaluation ofFoodstyles:K. This seems reasonable given the constraints of time and resources. The timing ofdata collection may also have had implications for the response rate. Data collection during lessdemanding months of the school year such as February, March, and/or April may have enhancedthe number of responses. However, it was necessary to approach the teachers during Spring1990. This permitted distribution of an invitation to teachers in the Lower Mainland to participatein Phase II - Evaluation of Foodstyles:K - Student and Parent Participation, scheduled tocommence in September 1990.A. US EThe results indicated that approximately 3/4 of all teachers who had attended a Foodstyles:Kworkshop taught at least some aspect of the Foodstyles:K program to their students followingattendance at the workshop. It appears that during the school year, close to one half of theteachers who had previously attended a Foodstyles:K workshop could be found teaching at leastone Foodstyles:K activity in their classrooms.I. "Past but not Present" Use Teacher GroupTeachers who had previously taught Foodstyles:K, but indicated they no longer did sorepresented the second largest use group in the study; larger than the "never" use group, andsmaller than the "current" use group.133DISCUSSIONDemands on teacher's time appear to have the greatest influence for discontinued use ofFoodstyles:K. "Not teaching kindergarten" was cited most frequently, and "teaching plansalready established" for the school year and "general time restrictions" appeared to be of concernto the teachers. The demands on teacher's time was of such great concern that teachers wouldforego teaching Foodstyles:K for the school year, when in the past, they would have taught theprogram to their students. Several teachers indicated that the demands of the new primaryprogram in British Columbia elementary schools had strained both their teaching and non-teaching time such that activities like Foodstyles:K were deferred. This is not a reflection of theprogram but rather of extenuating circumstances that have altered their planning.Although this group of teachers no longer used Foodstyles:K in the classroom, 1 out of every 5 ofthese teachers voluntarily reported that they perceived the program as "good", "excellent" or"terrific." These voluntary comments represent a true reflection of the teachers feelings in theirown words, and as such they are a valuable addition to the qualitative component of Phase I.II. "Never" Use Teacher GroupVery few of the teachers in the "never" use group reported that they made their decision not toteach the program while attending the workshop. This suggests that for most teachers, the focus,content and duration of the workshop did not appear to be a deterrent to teaching the program.The majority of teachers in the "never" use group who cited "not teaching kindergarten" as theirprimary reason for never teaching Foodstyles:K indicated they had a reassignment of their134DISCUSSIONteaching position from kindergarten (P-1) to a different primary level (eg. P-2, P-3, P-4).Reassignment is not a reflection of the Foodstyles:K program itself and is influenced bycircumstances beyond the control of the teacher. However, it should be noted that approximately10% of teachers in the "never" use group reported no longer teaching kindergarten, and of theseteachers almost 20% reported teaching grade 1 (P-2) while attending the workshop. To reducethe number of teachers in the "never" use group, it may be advisable to ensure that all teacherswho attend a Foodstyles:K workshop are indeed teaching kindergarten."Classroom time restrictions" and "teaching plans already established" also created a deterrent forimplementation of Foodstyles:K in the classroom. Given the demands on teacher's time bycurrent changes in the British Columbia public school system, it is not surprising to find that timewas a major impedance to incorporating Foodstyles:K into classroom activities, and not theprogram itself.When both the "never" and "past but not present" use groups were combined, 67 teachers (32 inthe "never" use group, 35 in the "past but not present" use group) from a total of 404 teachersindicated they no longer taught kindergarten. These data represent an approximate annualturnover rate of 17% for all kindergarten teachers in British Columbia. Generally, the annualkindergarten teacher turnover rate is not tracked in British Columbia school districts, however, aconsultant in Maple Ridge School District (a school district in the study), indicated an annualkindergarten teacher turnover rate of less than 10% (Newson (personal communication), 1992)would be likely for that school district. This survey included teachers from across the province inboth large metropolitan areas and smaller rural centres. The high turnover rate calculated in thisstudy may be a result of teachers staying in the smaller centres for only a few years and then135DISCUSSIONmoving into the metropolitan areas. Given this high flux of teachers at the kindergarten (P-1) level,a recommendation suggesting that all kindergarten teachers teach kindergarten for at least onefull year prior to attendance at a Foodstyles:K workshop may potentially reduce the number ofnon-users of the program. Teachers in their first year of teaching kindergarten are oftenenthusiastic, however, in accordance with the factors reported by experienced teachers in boththe "never" and "past but not present" use groups, they are likely to have their teaching plansestablished for the year. Results from teachers in these 2 groups suggest that teachers whoattend a Foodstyles:K workshop are unlikely to modify their teaching plans within that year toaccommodate the program into their classroom activities.Time restrictions appeared to be the primary factor that inhibited teacher's use of the program.McEwen and Kieren (1984) reported the same finding in their evaluation of teacher involvementin the "Nutrition at School" program in Alberta. Together, responses to both the open-ended andclosed questions provide a comprehensive acumen for discontinued use and non-use of theFoodstyles:K program.III. "Current" Use Teacher GroupAlmost half of all study respondents (47%) who attended a Foodstyles:K workshop allotted time intheir teaching plans to teach the program. This moderate result is similar to results fromevaluations of nutrition education programs offered by provincial marketing boards in BritishColumbia (Schwartz and Clampett, 1983), Alberta (McEwen and Kieren, 1984), and in Ontario(Health and Welfare Canada, 1990). The reported methods of incorporating Foodstyles:K into136DISCUSSIONteaching plans differed widely and the selection of core activities also differed. This variety ofapproaches to teaching Foodstyles:K reflects the very flexible nature of the program.An established routine is important for young children to develop appropriate behaviours and tolearn life skills. At the same time, young learners also require a variety of new experiences to buildand expand upon their understanding of the world around them (Province of British Columbia,1985). It is, therefore, necessary for activities in the classroom to be flexible enough toaccommodate a wide range of teaching conditions found in classrooms. As some teachers in the"current" use group reported, often a core activity (eg. Class Club or Journals) was omitted fromteaching the complete Foodstyles:K program. Reasons for the omissions often were notprovided, however, positive comments about the program often were noted in the open space onthe questionnaire. The voluntary reporting of these comments indicated that teachers felt therewas substantial strength in the Foodstyles:K program without certain core activities, to warrantincorporation of the remainder of the program into their teaching plans.a.) Method of Teaching Foodstyles:KTwo thirds of the teachers in the "current" use group reported using a single method of teachingFoodstyles:K while the other third indicated use of multiple methods to teach Foodstyles:K.Again, this reflects the suitability of the program to a wide variety of teaching conditions. Byincorporating Foodstyles:K into some classroom activities, teachers had the greatest flexibility asactivities relevant to the food introduced would be necessary at only one or a couple of activitycentres in the classroom. This would require less organizational time on the part of the teachercompared with incorporating Foodstyles:K into all classroom activities.137DISCUSSIONHowever, a major benefit of incorporating Foodstyles:K into all classroom activities, is that thechildren could more thoroughly familiarize themselves with the food through a wider range ofexperiences and exploration from their own perspectives. For example, if a child played at thedramatic play centre and created an imaginative role for the food (ie. animation), then proceededto the listen centre and listened to a story on cassette about the food with a read-along book, andsoon afterward went to the art centre and painted a picture of the food, and finally heard aboutsome aspects of the food while in a teacher-directed, large group meeting area, the child wouldbecome very familiar with that food. It has been shown in preschoolers and in children as youngas 2 years old that preference is an increasing function of exposure (Birch and Marlin, 1982; Birch1979(a); Birch et al., 1987(b)). Consequently, increased exposure to a food increases thelikelihood that the preschooler would taste that food. Since Foodstyles:K objectives include that:1. the student identify a wide variety of foods, and2. the student experience foods through tasting, cooking, discussion andrecord-keeping activities, thus building positive feelings about trying newfoods,exposure of the students to a wide variety of foods at all classroom activity centres would achievethese objectives. Moreover, as variety is an essential component of a healthy diet (Canada,1990), this goal of nutrition educators would almost certainly be accomplished.b.) Frequency of Teaching Foodstyles:KTeachers indicated a preference to teach the Foodstyles:K program throughout most of theschool year or for a very short time during the school year. Most teachers appeared to eithercluster their teaching of Foodstyles:K in 1-3 months per school year (37%) or in 8-10 months of138DISCUSSIONthe school year (39%). Several teachers indicated they focused Foodstyles:K into one month ofthe school year, usually tying it into a theme they were studying. Throughout the rest of the yearnutrition was discussed, but not with the same intensity as during the month when Foodstyles:Kwas taught. Furthermore, most teachers taught Foodstyles:K from 1 to 4 times during eachmonth that they incorporated the program into their classroom activities. Those teachers whotaught Foodstyles:K over a few months of the school year were significantly more likely tointroduce the program more frequently per month over those few months than teachers whotaught the program throughout most months of the school year.Four out of five teachers introduced between 4 to 12 foods throughout the school year. Whenclustered into groups of 4-6, 7-9 and 10-12 foods, each group was reported with approximateequal frequency. These results show that many teachers introduced fewer than the 8 foodsrecommended as a minimum in the Teacher's Guide to meet the program objectives. It was alsoclear that the number of foods introduced using Foodstyles:K seldom surpasses 12 foods, thesame number of foods for which materials are provided in the Foodstyles:K teacher's kit. Thisimplies that teachers who are eager to teach Foodstyles:K will do so, however, should additionalwork be necessary, teachers are reluctant to prepare the extra materials required for completion ofFoodstyles:K activities.The practical versatility of the program was clearly evident from the wide range of times per month,and number of months teachers reported using Foodstyles:K, as well as from the wide number ofintroduced foods reported over the duration of one school year.139DISCUSSIONc.) Teacher Satisfaction with Foodstyles:KSatisfaction with the practical use of Foodstyles:K was revealed by teachers who reported, first,that they strongly felt the Foodstyles:K program was easy to teach. One teacher commented thatthe program was, "Excellent. Well thought out." Second, most teachers felt that introduction of atleast 8 foods was sufficient to meet the Foodstyles:K objectives, although numerous teachers feltthat this number should be greater than 8. One teacher commented that a minimum of 8 foodswas "too much at times for my class," but went on to state that "some years I do 8 and more."Finally, teachers strongly agreed that it was easy to meet the program objectives teachingFoodstyles:K. These impressions of the program support the unsolicited comments submittedby teachers in the "past but not present" use group who voluntarily described the program as"good", "excellent" or "terrific."d.) Foodstyles:K Core Activitiesi.) Successful Core ActivitiesUnquestionably, cooking was the most successful Foodstyles:K core activity from the teacher'sperspective for both the students and themselves in terms of ease and enjoyment of teaching,and of greatest importance for the students to complete in order to meet the objectives of theprogram. Cooking was also the favoured activity for stimulating the student's interest in foods.Because of their natural curiosity children are motivated by action-oriented activities. The activitiesassociated with cooking are mostly of an interactive nature, well suited to the developmental levelof the kindergarten student (Whitener and Keeling, 1984). The multitude of experiencesassociated with cooking, aid in achieving the ultimate goal of early childhood nutrition educationprograms, to help children learn to make wise food choices.140DISCUSSIONThe frequency of use of recipes in either the "Easy Ideas" or "More Challenging Cooking"categories of recipes was not taken into account in the design of the teacher questionnaire,however, with almost 90% of the "current" use teachers reporting use of the recipes, theinclusion of recipes in the Teacher's Guide seems ostensibly desirable to the teachers. In supportof this, one teacher commented, "Appreciate your prepared activities for teachers. It's anincentive to use them as the activity is already done and saves time for teachers or helps me doother spin-off activities."The "Mystery Food" and "I Tried It!" sticker activities were also popular with the teachers tostimulate the student's interest in foods. Popularity of the "Mystery Food" activity may beattributed to the element of surprise involved, combined with the first hand experience of sensoryexploration. Smelling, poking, shaking, tasting and squeezing are but a few of the natural learningbehaviours of young children (Scarr et al., 1986). When introducing young children to new foods,worksheets and food pictures are less effective than first hand experiences, however, for foodsthat have been previously introduced, pictorial representations can be effective (Whitener andKeeling, 1984). Sensory exploration allows young children to solve problems and extend theirknowledge. The "Mystery Food" activity encourages this by permitting the students to use theirtactile, olfactory and audible senses while restricting their senses of sight and taste. For foodintroduction, the popularity of the "Mystery Food" activity versus the "Who Am I?" activity may inlarge part be due to the presence of sensory exploration with "Mystery Food" and its absence with"Who Am I?." It has been well documented that the experience of sensory exploration with foodsis a prerequisite for the formation of advanced nutrition concepts (Seefeldt and Barbour, 1990;Christenberry and Stevens, 1984; Whitener and Keeling, 1984; Yussen and Santrock, 1982;Vancouver School Board, 1981).141DISCUSSIONChildren love stickers. Contributing to their popularity may be a sense of pride the children haveacquired by accomplishing a task associated with the Foodstyles:K program and of being able toshare that pride with members of their family as they wear the stickers home. Almost all teachersused the sticker activity but did so with a variety of approaches. Some teachers did not give outthe stickers every time as they did not want their students to expect them. Yet, other teachersreported making their own stickers. Although this requires greater organization and preparationtime by the teacher, it does add an individualized dimension to the program, particularly if thestudents are involved in creating their own stickers.IL) Less-successful Core ActivitiesIn contrast to cooking, "Mystery Foods" and "I Tried It!" stickers, teachers perceived the ClassClub, "Who Am I?" and "Look What I Tried" journal activities as the least favoured activities in termsof their ease and enjoyment of teaching the program, stimulating the student's interest in foods,and of being important for the students to complete in order to meet the objectives ofFoodstyles:K.Teachers attributed the lack of success of the journal activity to the "tedious," "repetitive," and"boring" nature of completing the journal pages or of being "too time consuming" to becompleted within the daily time frame of the P-1 classroom schedule. These results aresupported by comments from teachers in the "past but not present" use group. One teacherrequested that only one food appear per sheet. She commented, "It's very difficult for thechildren to cut out one picture and have to care for and return the remaining pictures for futureuse. Perhaps something different could be done in the future!" One teacher reported that142DISCUSSIONalthough the children were not fond of the journals, she felt the journals were important to do sothat the parents could see them, and they were useful for teacher evaluation. Another teacherfelt the journals were a more appropriate activity for later on in the year, once the students hadadvanced their concept development and printing skills.Although the Class Club activity is designed to facilitate a link between school and home, theimportance of this activity was ranked lowest of all core activities by the teachers, with only about1/3 of the teachers reporting use of the Class Club activity. Several teachers who tried using theClass Club activity reported finding "very few [parents] participated by returning forms." This mayin large part be due to language barriers, since many of the children's parents would have beenraised in their country of origin and may only speak the language of that country. One teachernoted, "As long as parents did not have to take part in returning forms" they were somewhatsupportive of the program. Most of the support she received was verbal. Another teacher notedparental support changes from year to year and it is unpredictable to determine how much of theprogram is carried through at home. On the other hand, several teachers reported positiveparental support. From one class the teacher wrote, "Moms have suggested that they [originalemphasis] should send the list of foods they would like to get their child to eat." From anotherclass the teacher noted, "I enjoyed using the program and so did my students. The parents evencommented that they were more willing to try new foods at home. Parents seldom comment onschool programs." As noted in the Teacher's Guide, "parent involvement is the key to thesuccess of this activity." Changes in the cultural make-up of British Columbia have resulted in anincreasingly multicultural society. The percent distribution of population by ethnic origin in BritishColumbia has changed dramatically since 1966 when Canadian immigration laws were altered tofacilitate the immigration of persons from all regions of the world, thus abandoning the country's143DISCUSSIONlong history of selective European and British immigration (White, 1990). As a result of this, manyof the parents of children in the public school system struggle with English and are not able tocommunicate adequately enough to complete the Class Club cards with the name of the newfood the child tried at home. Since parental involvement is essential to the overall success ofFoodstyles:K, not only to the Class Club activity, it is important to be able to effectivelycommunicate with the parents, to encourage them to become involved in the classroom activities.Translation of the parent letter and the attached forms into some of the more common firstlanguages spoken by children in British Columbia could act as an aid for the parents and mayresult in an increased participation in classroom activities.In the past, immigrants tended to settle in the rural areas of the province, but more recently,immigrants have settled in the urban areas of British Columbia. In 1986, 62% of the immigrantpopulation of B.C. resided in the Vancouver metropolitan area. As a result, immigration to BritishColumbia has created a culturally heterogeneous society, particularly in the Lower Mainland(White, 1990). No where is this more visible than in the classrooms of the province. It thus seemsimperative that parents of the students in the public school system be reached and invited toparticipate in school activities.e.) Student Interest in Foodstyles:KStudent interest in Foodstyles:K was rated high by the teachers. Although there was no measureof student interest in other classroom activities, from the teacher's perspective it is apparent thatstudents found this program appealing. This high level of student interest indicates that thematerials used in Foodstyles:K activities are challenging and attractive to the students. When144DISCUSSIONteachers choose to include activities related to the introduced food into some or all of theirclassroom activity centres, they may find it more effective to combine materials from one centrewith those from another. In effect, this provides variety in the classroom activities the childrenhave come to associate with Foodstyles:K and may be effective in maintaining the high level ofstudent interest reported by the teachers. Again, the flexibility of the program would easilyaccommodate this.B. SUMMARYFrom voluntary comments and the results obtained, it appears that the Foodstyles:K program isenjoyed by teachers, students, and parents. Approximately half of all teachers who attended aFoodstyles:K workshop made continued use of the program in their classroom activities. Manyteachers in both the "past but not present" and "current" use groups voluntarily commented thatFoodstyles:K was an "excellent," "good," or "terrific" program. From both the quantitative andqualitative data collected through the teacher questionnaire it is apparent that teachers who teachthe program find it appealing to teach and to be of substantial educational value to their students.Of those teachers who do not teach the program, constraints on their time, both inside school andoutside school appear to be the major impedance to teaching Foodstyles:K.145DISCUSSIONC. SUGGESTED FUTURE REVISIONS TO THE TEACHER QUESTIONNAIREThe abundance of mostly voluntary qualitative data helped to substantiate and expand ourunderstanding of the quantitative results. With a well designed questionnaire, all study questionsshould be answered. Development of the teacher questionnaire was in consultation withdietitian/nutritionists familiar with the Foodstyles:K program, as well as with primary teachers.While the design of this specific questionnaire was original and met the requirements of thisstudy, some limitations became apparent when discussing the results. Should a futureassessment of teachers' perceptions of Foodstyles:K be conducted, suggestions which addressthe limitations and which may be of some utility are presented here.I. "Never" Use GroupAdjunct to Question 3(a) 1. response.If they indicate they made their decision not to teach Foodstyles:K during the workshop, then asecondary question to this response could be:Please describe any particular aspect(s) of the workshop which contributed to yourdecision at the workshop not to use Foodstyles:K with your students.146DISCUSSIONAdjunct to Question 3(a) 2. response.If they indicate they made their decision not to teach Foodstyles:K after the workshop, then asecondary question to this response could be:Please describe the circumstances responsible for your decision not to teachFoodstyles:K following your attendance at the workshop.II. "Past but not Present" Use GroupInsert after Question 2(a).Please indicate your overall impression of Foodstyles:K when you taught the program.^ EXCELLENT^ GOOD1.3 SO SO^ POOR^ UNSATISFACTORYUnder what conditions would you reintroduce Foodstyles:K into your classroom activities? Pleasedescribe.147DISCUSSIONIII. "Current" Use GroupChanges to Question 4.More specific wording of the question.1. ON ITS OWN^Use of the program is not tied into other activities in theclassroom. The program stands on it's own.2. INCORPORATED INTO SOME CLASSROOM ACTIVITY CENTRES3. INCORPORATED INTO ALL CLASSROOM ACTIVITY CENTRES4. INCORPORATED INTO SOME CLASSROOM THEMES5. INCORPORATED INTO ALL CLASSROOM THEMES6. OTHER. Please be specific.^Adjunct to Question 6.Please indicate which foods you have introduced using Foodstyles:K during the past school year.YES^NO^ YES^NOAppleO 0^CabbageO ^BroccoliO El^BreadO 0RiceEl^0^CerealO 0YoghurtO 0^Cottage CheeseO 0CheeseO 0^Peanut Butter O 0EggsO 0^Fish O 0148DISCUSSIONAdjunct to Question 9.We would like you to rate the children's interest in Foodstyles:K compared with the children'sinterest in other classroom activities. Please describe the activities as appropriate.Classroom activities of greater interest to the children than Foodstyles:K.Classroom activities of as equal interest to the children as Foodstyles:K.Classroom activities of lesser interest to the children than Foodstyles:K.149DISCUSSIONAdjunct to Question 10.Please indicate which recipes you have used from the Teacher's Guide.EASY IDEAS^ MORE CHALLENGING COOKINGYES NOYoghurt Sundaes^^ ^Yoghurt Pops^^ ^Vegetable Dip^^ ^Hard-Cooked Eggs^^ ^Peanut Butter^^ ^Tuna or Salmon Salad ^ ^Bread Smorgasbord ^ ^Picnic Mix^0 ^Crunchy Granola^^ ^Rice^^ ^Dried Apples^^ ^Raw Vegetable Tastees ^ ^Fruit Salad ^ ^Fruit 'n Peanut Butter ^ ^YES NOCheese Fondue a ^Cream of Broccoli Soup ^ ^Devilled Eggs ^ ^Eggs in a Nest ^ ^Bread Pinwheels ^ ^Oatmeal Peanut Butter ^ ^Crunchies ^ ^Cheese Biscuits ^ ^Savory Crackers ^ ^Mini Pizzas ^ ^Fried Rice ^ ^Rice Pudding ^ ^Cabbage Roll-ups ^ ^Coleslaw ^ ^150DISCUSSIOND. SUGGESTED RECOMMENDATIONS FOR CHANGE TO THE FOODSTYLES: KPROGRAM BASED ON THE TEACHERS' PERCEPTIONSTo increase its effectiveness, some recommended modifications to the Foodstyles:K program areproposed. Results from both the qualitative and quantitative aspects of Phase I have indicatedthat childrens' interest in Foodstyles:K was rated high by the teachers. However, a limitation ofthe program that was highlighted by these results was the "tedious" nature of completing thejournal pages. In the Teacher's Guide it is suggested that a copy of the food picture be distributedto each student. The feedback from teachers through both the teacher questionnaire and directcontact in Phase II indicates that the students themselves cut out the appropriate food picturefrom the sheet, which leaves a sheet with many cut out areas. As the number of introduced foodsincreases, the cut out sheet becomes increasingly awkward for the students to manage. To be ofadvantage to the students, a recommendation is made for 12 copies of one food per sheet. Whileone student cuts out her/his food pictures, the other students could be working on other areas ofthe journal page until the sheet was passed on to them. This arrangement permits greaterinteraction between the students and encourages socially appropriate behaviour as theycomplete their journal pages.Given the multicultural make-up of the Lower Mainland area, a greater diversity of ethnic foods inthe food pictures is recommended. An additional set of 4-colour representations of foods wouldsuffice. It is recommended that a master journal page with no food named on the page and asecond perforated page with the names of each food in the pictures be available in the Teacher'sGuide. The teachers could simply tape the name of each food into the appropriate space on theblank master page and photocopy as many sheets as required. This arrangement would also be151DISCUSSIONapplicable to the 12 foods currently presented in the program, thus reducing the number ofpages in the Teacher's Guide.To provide parents with a better understanding of the nutrition education that takes place in theclassroom, a recommendation is made for an information sheet in the Teacher's Guide thatprovides parents with general background information, including Canada's Food Guide, onnutrition for young children with examples of foods available in British Columbia. Translation ofthis sheet into several of the more commonly spoken languages would be necessary so theteachers could simply photocopy and distribute the sheets appropriately.From observation, many students tended to create similar images for each different food in theirjournals. A broader background experience with some foods, other than just food introductionand cooking, may help stimulate their natural ability to visually represent their mental images. Tofacilitate this, it is recommended that a suggestion appear in the Teacher's Guide for teachers toset up a "Garden Centre" where the students could plant seeds (eg. carrots, a root crop; beans, avine crop), nurture the seedlings and watch the plants grow. As the plants mature the studentscould harvest the "crop", compost the inedible portion, participate in preparing the food forconsumption and taste the end product. The students could be encouraged to use their sensesfrom observing the changes in plant growth to tasting the food they prepare. Associated with avariety of experiences, the "Garden Centre" could lead to increased enthusiasm for completingthe journal worksheet.A final recommendation is to have a French language edition of the Teacher's Guide and programmaterials. Increased numbers in French immersion classes throughout the Lower Mainland152DISCUSSIONresulted in numerous teachers commenting that they would use Foodstyles:K if it were availablein French.3. PHASE II - EVALUATION OF FOODSTYLES:K - PARENT AND STUDENTPARTICIPATIONA. PARENTAL PRETEST QUESTIONNAIREFor the most part, there were no striking differences between the demographic variables of the 2study groups obtained from information provided in the parental pretest questionnaire. The 2groups exhibited similar characteristics with the exception of the children's cultural heritage. Asignificantly greater proportion of children in the control group than in the intervention group hada reported cultural heritage "Other" than Canadian/British/English. Considering this statisticalone, it could be speculated that student's familiarity with the test foods would be lower in thecontrol group versus the intervention group, given the preponderance of Western-type foodsrepresented by the food models. However, in contrast to studies illustrating cultural influence onfood choices, this effect was not observed. This suggests that although a significant differenceexisted between the two study groups, the effect of cultural heritage on this study sample wassmall.It has been documented that ethnicity can be a predictor of dietary behaviour (Axelson, 1986;Rozin and Vollmecke, 1986), and dietary behaviour, in turn, is determined by multidimensionalvariables, including; economic, environmental, biological and social variables in addition to culture(Johns and Kuhnlein, 1990). While learning about the cultural meaning of food during the153DISCUSSIONpreschool period, children rapidly acquire food preferences and dietary behaviours (Birch,1987(b)). It is these food acceptance patterns acquired early in life that are important not only toensure adequate nutrition for normal growth and development, but also because they arereflected in food acceptance patterns later in life (Birch, 1987(b); Cooper and Philip, 1974;Hendricks et al., 1988). It is, therefore, necessary to acknowledge not only the foods associatedwith different cultures, but also their traditional preparation, and to incorporate ethnic foods intoearly childhood nutrition education programs such as Foodstyles:K. Cultural influences on foodselection by young children should not be underestimated.B. PARENTAL PRETEST AND POSTTEST QUESTIONNAIRESParents of children in both study groups indicated a slight increase in their child's willingness toeat a variety of foods and unfamiliar foods over the course of a school year. Previously publishedreports of kindergarten children's familiarity with and willingness to eat specific foods are lacking.However, early childhood nutrition education programs have shown, in general, that programintervention has a positive effect. In evaluating the Ontario Milk Marketing Board "Big Ideas"nutrition education program for teachers from kindergarten to grade 3, Cooper and Philip (1974)reported improvement in nutrition knowledge and in eating behaviour of children taught nutritioneducation by a workshop-trained teacher. The authors acknowledged their measurement ofchange in behaviour (records of what the student ate for breakfast on the day of the test) was notcompletely reliable and considered their results to reflect more of a change in attitude than achange in behaviour. Even so, the change in attitude was in the right direction relative to thegoals of the program.154DISCUSSIONBerenbaum (1986) reported results from a Master's thesis by ME MacDonald at the University ofGuelph (1985). A significant increase was observed in nutrition knowledge of preschoolersexposed to the Ontario Milk Marketing Board "Good Beginnings" early childhood nutritioneducation program over a 10 week period. The time frame of this evaluation was much shorterthan the evaluation of Foodstyles:K. Reduced effects of confounding factors such asmaturational effects, changes in class make-up, and deterioration of recall, would be associatedwith shorter term versus longer term evaluations. Because of these factors, evaluationsextending over a longer term may not reveal subtle effects of the program. The flexible nature ofFoodstyles:K is an attribute of the program, and hence, evaluation of the program was designedto accommodate this flexibility. While a shorter term evaluation may have unveiled more subtleeffects, it would not have reflected the true nature of the program.Reports from the United States on the effects of early childhood nutrition education programs onpreschool children's knowledge, attitudes and food behaviour are consistent with results from theCanadian studies. Lawatsch (1990) reported a significant effect of 2 teaching strategies onchildren in a benefit appeal group and children in a threat appeal group compared with children ina control group in terms of their nutrition knowledge, attitudes and food behaviour. The 2experimental groups were each exposed to 3 different nutrition education presentations (fairytales) over 3 days and the control group did not hear the fairy tales. Gorelick and Clark (1985)reported an overall significant improvement in food and nutrition knowledge as measured by aproject-developed test. Again, the intervention was confined within a short time frame. In thisstudy, the intervention occurred twice a week over a 6 week period. As discussed previously,employment of a short term evaluation may enhance the unveiling of subtle program effects innutrition knowledge, attitudes and food behaviours.155DISCUSSIONA recent longer term evaluation conducted by Hendricks et al. (1989) assessed the effect of apreschool health education curriculum on the health knowledge of children aged 3 to 6 years,over the course of a school year. Although this study was not confined to nutrition alone, andinvolved areas as diverse as medicine and drugs, safety, hygiene, dental health, responsibilityand nutrition, the evaluation employed a quasi-experimental pretest (October)-posttest (April)comparison group design, similar to the experimental design used to evaluate Foodstyles:K.These authors reported significant increases in preschoolers health knowledge scores for bothintervention and control study groups when using their modified version of an existing andreliable instrument for preschool children. Unlike willingness which represents behaviour,familiarity could cautiously be compared with knowledge as both represent recognition of aperson, place or thing. With the Foodstyles:K evaluation, the general trend observed in terms ofstudents' increased familiarity with the test foods, was similar to the results reported for student'shealth knowledge by Hendricks et al. (1989).Overall, it appears that short term evaluations have an advantage of being more responsive tosubtle effects of a program. Yet, a possible disadvantage could be that short term changes maynot persist over time. Whereas, the longer term evaluation may have a greater number ofconfounding factors which reduce the potential for detecting an impact of the program, they arepossibly more indicative of a true impact.156DISCUSSIONC. PARENTAL POSTTEST QUESTIONNAIREThe percentage of parents in the intervention group who reported their child had mentionedexposure at school to a food s/he requested was greater than double that found in the controlgroup. This significant result (p<.001) reflects achievement of one objective of the program, tostimulate dialogue between parents and their children about foods the children were exposed toat school. Since most teachers who teach Foodstyles:K reported using the "I Tried It!" stickersand fewer reported use of the "Look What I Tried!" journals and still fewer reported use of theClass Club activities, all of which facilitate a link between home and school, the inclusion of stickersin the program kit appears to have the greatest influence on achieving one program goal, tostimulate discussion between parent and child.The percentage of parents who reported changes in their child's food habits over the school year,was similar for both study groups, and therefore, no definitive conclusions could be made as toany effect of the program on changes in childrens' food habits over the kindergarten year. As withany study, all conclusions drawn are dependent upon the measures used in the study. Wheninterpreting the measure of change in food habit, the questionnaire item may have beenconfusing to the parents. Adoption of a new food behaviour does not necessarily lead to habit, asdefined by achieving maintenance of that specific food behaviour (Glanz, 1981). Therefore,because the concept of habit is difficult to interpret, elimination of this questionnaire item isrecommended on any future revisions of the parental posttest questionnaire.157DISCUSSIOND. STUDENT FAMILIARITY DATA - PRETEST AND POSTTESTMajor research questions in this study were designed to investigate whether Foodstyles:Kincreased kindergarten students' familiarity with a variety of foods and their stated willingness toeat the foods. From this study, a direct impact of Foodstyles:K was not detected for childrens'familiarity with the foods and for childrens' stated willingness to eat the foods. However, as will bediscussed below, a potential impact of Foodstyles:K may have been concealed by limitationsinherent in the study.As expected at pretest, due to randomization of the study groups, both study groups were similarin terms of the student's familiarity with the test foods. Generally, where significant changesappeared in students' familiarity with the foods for the intervention group, similar results wereobtained for students in the control group. This suggests that the observed increase in familiarityfrom pretest to posttest for both study groups may be representational of an unfolding of thenatural maturational process which occurs over the course of a school year. The magnitude ofdifference between the 2 study groups did not change from pretest to posttest, and supports thisinterpretation of the results.The greatest gain in familiarity of foods was observed with students in the intervention group andfor introduced foods. However, because the increase in familiarity for the control group wasalmost as large as for the intervention group, an effect of the program could not be demonstrated.Student recall of the names of the foods should be considered as a possible contributing factor tothe significant increases observed from pretest to posttest. Two types of memory are found inpreschool children; 1.) episodic, and 2.) semantic memory. Young children are relatively deficient158DISCUSSIONin strategies for retrieving episodic memories (Brown, 1975; Reese, 1976; Bee and Mitchell,1980). Episodic memory would have been primarily used in this evaluation. Children wereexposed to the food models once and then once again approximately 7 months later. During theindividual interviews, the students were actively involved in transferring the food models from onetray to another. It has been documented that active involvement of a preschool child in a situationof interest to her/him will more likely result in accurate memory later on (Kastenbaum, 1979).Students whose interest was piqued by participating in the interviews may have a better and moreaccurate recall than students who lacked interest in the procedure. Therefore, recall of the namesof foods by some students at posttest could not be entirely ruled out.The trend for students to be more familiar with the non-introduced foods than the introducedfoods at pretest and at posttest was consistent for both study groups. The designation of foodsinto either food category (introduced or non-introduced), which may account for this trend, wasrestricted by the foods available as food models and by the design of the study which includedequal representation of all 4 food groups in each food category.A major limitation of this study was the basis for the selection of foods and their designation intoeither of the introduced or non-introduced food categories. Studies describing preschoolchildren's familiarity with specific foods are lacking in the literature. Selection and designation ofthe test foods was determined primarily on personal observation of and dialogue withkindergarten-aged children regarding the foods with which they were familiar and unfamiliar.Randomization of the foods into the two food categories would have eliminated any possible bias.159DISCUSSIONE. STUDENT AND PARENT WILLINGNESS DATA- PRETEST AND POSTTESTI.^Student WillingnessInvestigation of the student's willingness to eat the 16 test foods revealed few significant findingswith the exception of willingness to eat a greater number of the non-introduced foods over theintroduced foods at both pretest and posttest for the intervention group. This followed the sametrend observed for students in both the intervention and control groups who showed familiaritywith a larger number of the non-introduced foods over the introduced foods at both pretest andposttest. However, a direct association between student's familiarity with the test foods and theirwillingness to eat them cannot be drawn from these results as this trend of increased willingnessto eat non-introduced over introduced foods was not observed with students in the controlgroup.The use of food models in this evaluation reflects a limitation of the study. For some foods, therepresentations were not as real nor did they look as appetizing as for other foods, which couldinfluence the student's willingness to eat the test foods. Birch (1979(b)) reported a strongcorrelation between measures of preference and consumption of real foods with 3 and 4 yearolds. Although the present study did not address consumption, only willingness, the logisticaluse of real foods was precluded due to the design of the study extending over the period of oneschool year.A second confounding factor may have been the nature of each study group. Students in theintervention group with a cultural heritage "Other" than Canadian/British/English constituted only17% of the study group compared with 41% of students in the control group. A substantialproportion of the food models available were representations of mostly Western-type foods.160DISCUSSIONAlthough the two groups differed significantly in cultural heritage, the food models used in thestudent interviews may have been biased toward being more recognizable by students with aCanadian/British/English cultural heritage. This could account in part for the non-significant, butgeneral, trend observed of students in the intervention group to state they were willing to eat agreater number of foods at pretest and at posttest, compared with students in the control group.Gender distribution should also be considered when addressing the nature of each study group.Although there was 12% more girls in the control group than in the intervention group, andconversely, 12% more boys in the intervention group than in the control group, this differencewas not significant. Essentially, there is no evidence to suggest that either sex is consistentlyfaster in development of sensorimotor, preoperational or concrete operational skills (Bee andMitchell, 1980). This should dispense of a potential argument for gender bias in the studypopulation.II. Parents' Perceptions of Their Child's Willingness to Eat the Test FoodsInvestigation of parents' perceptions of their child's willingness to eat the 16 test foods revealedvery consistent findings which suggested parents do not perceive a substantial change in theirchild's food acceptance behaviour over the school year in which the child attends kindergarten.This is supported by similar results obtained for each study group when parents reported anychanges they had noticed in their child's food habits over the course of the kindergarten year.However, these results should be interpreted with caution, as once again, the ambiguity of theterm "food habits" may have led to confusion when parents interpreted the term.161DISCUSSIONIII. Parents' Perceptions of Their Child's Willingness to Eat the Test FoodsCompared with Their Child's Actual ResponseOverall, students consistently indicated they were willing to eat more of the 16 test foods thantheir parents perceived. These results could reflect the different methods of data collection forthe parents and their children. Parents were asked simply to recall their responses, whereas thechildren's responses were collected using visual aids, a situation where the representation of thefoods may have influenced the children's responses. Use of the same data collection tools forboth parent and child would have eliminated any bias resulting from the use of visual aids in onecase and recall in the other.F. PARENT/STUDENT MATCHING DATAReports in the literature suggest maternal reports of their child's eating behaviour are not veryaccurate and that preschool children themselves are reliable sources of their food intake (Basch etal., 1990; Birch, 1979(b); Emmons and Hayes, 1973). In the parent questionnaire, no questionasked the respondent's relationship to the child, and therefore, it cannot be assumed that themother completed it, although most often questionnaires returned directly to the teacher weredone so by mothers. An overall 73.4% agreement between parent and child compares favourablywith the 71 % agreement Pliner and Pelchat (1986) reported between mothers' reports of theirchild's food preferences for 26 foods and their children's reports, and the 71% agreementreported by Emmons and Hayes (1973) between mothers and their 6 year old child when using a24 hour recall method of data collection.162DISCUSSIONResults from the present study indicate that parents can be useful sources of informationregarding their preschool child's willingness to eat specific foods, but parental reports should notbe entirely relied upon for this information. As discussed previously, changes in themethodological design of future research investigating the agreement between parents'perceptions of their preschool child's willingness to eat specific foods and the child's responsesshould include employment of the same data collection tools for both parent and child. Thechoice of visual aids seems appropriate as kindergarten children span a range of developmentskills and many are unable to read proficiently at this age (Gorelick and Clark, 1985: Herr andMorse, 1982; Contento, 1981). Even with the use of the same data collection tool for bothparents and children, where the opportunity exists, data should be collected directly from thechildren (Birch, 1979(b)) and used as their indication of willingness to eat specific foods.4. IMPLICATIONS FOR FUTURE RESEARCHImplications for future research based on the results from this evaluation include:1. Increased demands on teachers' time must be considered in the development,implementation, evaluation and revision of nutrition education programs.2. With a multicultural population, foods used in program activities should be representative of theethnic groups present in the population.3. There is a need to address parental attitudes toward nutrition, as parents greatly influenceyoung children's familiarity with foods.163CONCLUSIONCONCLUSIONThe need for early childhood nutrition education programs is not a new issue in the field of healthpromotion. The present concern lies in how to maximize the effectiveness of available programsand of equal importance is how to evaluate whether the programs have an impact on the targetgroup.Results from this evaluation suggest the Foodstyles:K program was well received by teacherswho had attended a workshop. Seventy five percent of teachers taught the program followingattendance at a workshop. Furthermore, during the school year which was evaluated, almost halfthe teachers were teaching at least one activity of Foodstyles:K to their students. An increaseddemand on both in-class and out of class time was largely due to implementation of the dual entrysystem and the new primary program in British Columbia. Lack of time accounted for the majorityof reasons why kindergarten teachers were not teaching Foodstyles:K during the school year forwhich the evaluation was conducted. Many of these teachers, however, voluntarily commentedthat the program was "good," "excellent," or "terrific" - a testament to their belief in the value of theprogram.No direct impact on student's familiarity with specific foods and their stated willingness to eat themwas observed. The wide ethnic diversity of the study sample and the selection of foodsrepresented as food models may have potentially affected the detection of an impact of theprogram.164CONCLUSIONResults from parents' perceptions of effects of the program also indicated no direct effect on theirchild's nutrition knowledge and food behaviour.The impact of nutrition education is often difficult to measure as results are not always visible in theshort term. Early childhood nutrition education, as with any education program, must beconsidered as a long term investment in the overall education of young children. Encouraginghealthy eating habits during this period of initial behaviour development is often easier than tryingto alter existing behaviour (Hendricks et al., 1989). Since early childhood is a time when foodhabits are developing, the best opportunity we can offer young children is one in which theirinterest in foods is piqued and they feel good about trying new foods. 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J Nutr Educ 15(1):4-5.Dierks EC, and Morse LM. 1965. Food habits and nutrient intakes of preschool children. J AmDiet Assoc 47:292-296.Dillman DA. 1978. Mail and Telephone Surveys: The Total Design Method.  New York, NY: JohnWiley & Sons. pp. 79-199.Dudley DT, Moore ME, and Sunderlin EM. 1960. Children& attitudes toward food. J HomeEcon 52(8):678-681.Duncker K. 1938. Experimental modification of childrens' food preferences through socialsuggestion. J Abnorm Soc Psycho! 33:489-501.Edwards PK, Mullis RM, and Clarke B. 1986. A comprehensive model for evaluating innovativenutrition education programs. J Nutr Educ 18(1):10-15.Emmons L, and Hayes M. 1973. Nutrition knowledge of mothers and children. J Nutr Educ5(2):134-142.Eppright ES, Fox HM, Fryer BA, Lamkin GH, and Vivian VM. 1969. Eating behaviour of preschoolchildren. J Nutr Educ Summer:16-19.Filstead WJ. 1979. Qualitative methods, a needed perspective in evaluation research. In:Qualitative and quantitative methods in evaluation research. Cook TD, and Reichardt CS(eds.). Beverly Hills, CA: Sage Publications Inc.. pp.33-48.Gillespie AH. 1981. A theoretical framework for studying school nutrition education programs. JNutr Educ 13(4):150-152.Glanz K. 1981. Social psychological perspectives and applications to nutrition education. J NutrEduc 13(1):S66-S69.168BIBLIOGRAPHYGlaser A. 1964. Nursery school can influence food acceptance. J Home Econ 56(9):680-683.Gorelick MC, and Clark EA. 1985. Effects of a nutrition program on knowledge of preschoolchildren. J Nutr Educ 17(3):88-92.Hanson RA, and Schutz RE. 1981. Rethinking evaluation design for nutrition educationprograms. J Nutr Educ 13(3):86-89.Harrill I, Smith C, and Gangever JA. 1972. Food acceptance and nutrient intake of preschoolchildren. J Nutr Educ Summer:102-106.Hendricks CM, Peterson F, Windsor R, Poehler D, and Young M. 1988. Reliability of healthknowledge measurement in very young children. J Sch Health 58(1):21-25.Henerson ME, Morris LL, and Fitz-Gibbon CT. 1987. How to Measure Attitudes  (2nd ed.).Newbury Park, CA: Sage Publications Inc..Herman JL, Morris LL, and Fitz-Gibbons CT. 1987. Evaluator's Handbook (2nd ed.). NewburyPark, CA: Sage Publications Inc..Herr J, and Morse W. 1982. Food for thought: Nutrition education for young children. YoungChildren 38:3-11.Hertzler AA. 1989. Preschoolers' food handling skills-motor development. J Nutr Educ21:100B.Hock S, Cormier W, and Bounds W. 1974. In : Reading Statistics and Research.  London,England: pp. 88-90.Jarman R. 1991. Personal Communication. Professor, University of British Columbia, Faculty ofEducation, Vancouver BC.Johns T, and Kuhnlein HV. 1990. In : Diet and Behaviour: Multidisciplinary Approaches. GHAnderson (ed.). London: Springer-Verlag. pp. 17-31.Johnson DW, and Johnson RT. 1985. Nutrition education: A model for effectiveness, asynthesis of research. J Nutr Educ 17(2):S1-S45.Kastenbaum R. 1979. In : Humans Developing A Lifespan Perspective. Boston, MA: Allyn andBacon, Inc.. pp. 253-256.Kerrey E, Crispin S, Fox HM, and Kies C. 1968. Nutritional status of preschool children. I. Dietaryand biochemical findings. Am J Clin Nutr 21(11):1274-1279.King JA, Morris LL, and Fitz-Gibbon CT. 1987. How to Assess Program Implementation.Newbury Park, CA: Sage Publications.169BIBLIOGRAPHYKlesges RC, Coates TJ, Brown G, Sturgeon-Tillisch J, Moldenhauer-Klesges LM, Holzer B,Woolfrey J, and Vollmer J. 1983. Parental influences on children's eating behaviour andrelative weight. J Appl Behav Anal 16:371-378.Lamb MW, and Ling BC. 1946. An analysis of food consumption and preferences of nurseryschool children. Child Dev 17(4):187-217.Lawatsch DE. 1990. A comparison of two teaching strategies on nutrition knowledge, attitudesand food behavior of preschool children. J Nutr Educ 22(3):117-123.Lockhart DC. (ed.) 1984. Making Effective Use of Mailed Questionnaires. San Fransisco, CA:Jossey-Bass Inc. Publ..Marinho H. 1942. Social influence in the formation of enduring preferences. J Abnorm SocPsychol 37:448-468.Martin EA. 1978. Nutrition in Action. 4th ed. New York, NY: Holt, Reinhart and Winston.McEwen BE, and Kieren DK. 1984. Evaluation of the nutrition at school program teacherinvolvement. Can Home Econ J 34(2):102-108.Mendenhall W. 1983. Introduction to Probability and Statistics (6th ed.). Boston, MA:PWSPublishers, Duxbury Press.National Dairy Council. 1979. Food...Early choices. Rosemont, IL..Nelson K. 1979. Explorations in the development of a functional semantic system. In: Children'slanguage and communication.  WA Collins (ed.), Hillsdale, NJ: Erlbaum.Newson K. 1992. Personal Communication. Teacher Personnel Assistant, Maple Ridge SchoolDistrict.Nielsen H. 1983. Nutrition in health promotion programs: A Canadian perspective. HumanNutr:Appl Nutr 37A(3):165-171.Olson CM, Frongillo Jr EA, and Schardt DG. 1986. Status of nutrition education in elementaryschools: 1981 vs. 1975. J Nutr Educ 18(2):49-54.Patton MO. 1987. How to Use Qualitative Methods in Evaluation  (2nd ed.). Newbury Park, CA:Sage Publications Inc..Perry CL, Lueker RV, Murray DM, Kurth C, Mullis R, Crockett S, and Jacobs Jr DR. 1988. Parentinvolvement with children's health promotion: The Minnesota home team. Am J PubHealth 78(9):1156-1160.Piaget J. 1954. The Construction of Reality in the Child. New York, NY: Basic Books, Inc..170BIBLIOGRAPHYPliner P. 1982. The effects of mere exposure on liking for edible substances. Appetite 3:283-290.Pliner P. 1983. Family resemblances in food preferences. J Nutr Educ 15(4):137-140.Pliner P, and Pelchat ML. 1986. Similarities in food preferences between children and theirsiblings and parents. Appetite 7:333-342.Province of British Columbia. 1985. Ministry of Education. Kindergarten Curriculum Guide and Resource Book. Victoria, BC: Queens Printer for British Columbia.Province of British Columbia. 1989(a). Ministry of Education. Year 2000: A Framework forLearning. Victoria, BC: Queens Printer for British Columbia.Province of British Columbia. 1989(b). Ministry of Education. Highlights. Year 2000: AFramework for Learning. Victoria, BC: Queens Printer for British Columbia.Province of British Columbia. 1991(a). Ministry of Education. Education Reform in British Columbia: Building a Sustainable School System.  Victoria, BC: Queens Printer for BritishColumbia.Province of British Columbia. 1991(b). Ministry of Education. Learning for Living Primary-Graduation Curriculum Guide. Victoria, BC: Queens Printer for British Columbia.Reese HW (ed.) 1976. In : Advances in Child Development and Behaviour. Volume 11. NewYork, NY: Academic Press.Roberts LJ. 1935. Nutrition work with children.  Chicago IL: The University of Chicago Press.Rozen P, Fallon A, and Mandell R. 1984. Family resemblance in attitudes toward food. DevPsycho! 20:309-314.Rozin P. 1990. Acquisition of stable food preferences. Nutr Rev 48(2):106-113.Rozin P, and Volimecke TA. 1986. Food likes and dislikes. Ann Rev Nutr 6:433-456.SAS Institute. 1985. SAS User's Guide: Statistics.  Version 5 Edition. Cary, NC: SAS InstituteInc..Schwartz NE. 1985. Nutrition education in Canada: Progress and challenges. Can HomeEcon J 35(1):35-40.Sabry JH, Ford DY, Roberts ML, and Wardlaw JM. 1974. Evaluative techniques fr use withchildren's diets. J Nutr Educ 6(2):52-56.Scarr S, Weinberg RA, and Levine A. 1986. Understanding Development. San Diego: HarcourtBrace Jovanovich, Publishers. pp. 132-601.171BIBLIOGRAPHYSchwartz NE, and Clampett DM. 1983. Evaluation of a nutrition innovation in secondary schoolhome economics education. Human Nutr:Appl Nutr 37A:180-188.Seefeldt C, and Barbour N. 1990. Early Childhood Education: An Introduction (2nd ed.).Columbus, OH: Merrill Publishing Company. pp. 445-455.Sipple HL. 1971. Problems and progress in nutrition education. J Am Diet Assoc 59:18-21.Sodowsky JD. 1973. In-service education for elementary teachers. J Nutr Educ 5(2):139-142.Soliah LL, Newell K, Vaden AG, and Dayton AD. 1983. Establishing the need for nutritioneducation : II. Elementary teachers' nutrition knowledge, attitudes, and practices. J AmDiet Assoc 83(4):447-453.Splett PL, and Story M. 1991. Child nutrition: Objectives for the decade. J Am Diet Assoc91 (6):665-668.Sullivan BM. 1988.  A Legacy for Learners: A Report of the Royal Commission on Education.Victoria, BC: Queens Printer for British Columbia.Sunderberg JA, and Endres J. 1984. Assessing food preferences: A quick procedure. EarlyChild Devel Care 13:213-224.Talmage H, Hughes M, Eash M. 1978. The role of evaluation research in nutrition education. JNutr Educ 10(4):169-172.Vancouver School Board. 1981. Department of Home Economics. Nutri-ed: A Nutrition Education Resource and Instructional Guide. Vancouver, BC: Vancouver School Board.Van Dalen DB. 1979. Understanding Educational Research: An Introduction (4th ed.). NewYork: McGraw-Hill Book Company. pp. 39-452.White PM. 1990. Statistics Canada: Ethnic Diversity in Canada. Ottawa, ON: Minister of Supplyand Services, Canada.Whitehead FE. 1957(a). Nutrition education for children in the U.S. since 1900 - Part I. J AmDiet Assoc 33:880-884.Whitehead FE. 1957(b). Nutrition education for children in the U.S. since 1900 - Part II. J AmDiet Assoc 33:885-889.Whitener CB, and Keeling M. 1984. Nutrition Education for Young Children: Strategies and Activities. Englewood Cliffs, NJ: Prentice-Hall, Inc. pp. 7-37, 57-85, 127-187.Wiersma W. 1986. Research Methods in Education: An Introduction (4th ed.). Boston, MA: Allynand Bacon, Inc.. pp. 1-22, 139-169.172BIBLIOGRAPHYYussen SR, and Santrock JW. 1978. Child Development: An Introduction.  Dubuque, IA: WilliamC. Brown Company Publishers. pp. 2-287.Zajonc RB. 1968. Attitudinal effects of mere exposure. J Personal Soc Psychol 9(2):Part11:1-27.173APPENDIXAPPENDIX 1. Year 2000 DocumentYear 2000 is an ambitious response by the Government of British Columbia to therecommendations made by the Royal Commission on Education (Sullivan, 1988). The BritishColumbia public school grade system is no longer structured as kindergarten, followed by grades1 through 12, but is now divided into three programs; Primary, Intermediate, and Graduation. Onekey feature of the new Primary Program (P-1 to P-4; formerly kindergarten and grades 1-3) is that itno longer is a series of grades, but is a single program entity. For most learners, the "PrimaryProgram will constitute the first 4 years of schooling, the Intermediate Program the next 7 years,and the Graduation Program the last 2 years" (Province of British Columbia, 1991 (a), (b)). Thethree programs are structured around four "strands"; Humanities, Science, Fine Arts and PracticalArts, all of which are comprised of subjects (Province of British Columbia, 1989 (a)). Nutrition iscategorized under the subject titled "Learning for Living" which is a component of the Humanitiesstrand. Eighteen goals are at the heart of the subject "Learning for Living." Each of these goals isgeneral in nature and can be targeted to any of the Primary, Intermediate or Graduation Programs.Within the "Learning for Living" subject, nutrition directly falls under the content area termed"Healthy Living." Goals for "Healthy Living" at the primary level encourage students to participatein activities which will direct their development towards recognizing the value in, and the practiceof positive health practices.174APPENDIXAPPENDIX 2. Piaget's Profile of Cognitive DevelopmentThe manner in which young children think ceases to amaze many adults and researchers alike.Piaget focused on the qualitative changes in intellectual abilities, as he probed the process ofhow children come to understand the basic principles of time and space and cause and effect thatserve to organize adult thinking. His research interests concentrated on the properties ofadaptation and organization of human thought.Piaget is well known for his profile of the qualitative changes in thinking. He developed a profile of4 stages in the development of cognition processes:1.) the sensorimotor stage,2.) the preoperational stage,3.) the concrete operational stage, and4.) the formal operational stage.The first sensorimotor stage (infancy-2 years) is characterized by the infant developing actionplans in response to sensory stimuli. The cornerstone of the sensorimotor stage is objectpermanence, that is learning that an object which is out of sight is not permanently out ofexistence. The 2-3 month old infant loses interest is an object is hidden whereas the 18-20month old toddler is certain that the object exists and delights in playing hide and seek. Sincemotivation is a key to education, one can say that the process of cognitive development begins inearnest in this stage.175APPENDIXThe following preoperational stage (2-6 years) is typified by many characteristics, but probably thetwo most significant advances of the preoperational stage are the ability to form mental images andto use symbols. The cornerstone of this stage is the development of language. Othercharacteristics of this second stage of cognitive development as described in the LiteratureReview include:1. Inability to use causal reasoning,2. Egocentrism,3. Intuition,4. Animism,5. Centering,6. Inability to complete conservation, seriation and hierarchical classification tasks.Piaget called the third stage of cognitive development (7-11 years) the concrete operationalstage. According to Piaget, there is a cognitive shift from egocentrism to relativism; thinkingbecomes more logical; and manipulation and transformation of information can be achieved in themind. The cornerstones of the concrete operational stage include:1. CONSERVATION, which requires the child to decentre attention, reverse thoughtsand consider functional relationships and transformations,2. CLASSIFICATION, which depends on understanding how relationships among thingscreate classes and subclasses,3. SERIATION, which involves logical ordering.The limitation to logical thought in this stage is that it must be tied to concrete experience, that is,the child must see the problem in order to solve it.176APPENDIXThe final stage of Piaget's cognitive development theory (11+ years) is termed the formaloperational stage; a time when logical manipulations can be made of abstract propositions. Thistype of thinker can deal with hypothetical situations in a verbal manner conjuring up manyhypotheses to account for some event and then testing these out in a deductive fashion (Jarman,personal communication).The ages noted for the various stages are only approximate, however, and more importantly, anormal healthy child moves through the stages in the established sequence and does not skipstages nor regress to an earlier stage.For the kindergarten child, their teacher is commonly an admired role model. Behaviourmodification and effective learning may be achieved through young children's participation in role-taking, hence, actions taken by the teacher may profoundly affect the child's present and futurenutritional habits.177Dr. R.D .pratleyDirector, Research -rvicesAPPENDIXAPPENDIX 3. UBC Ethics Approval - Phase IThe University of British Columbia^B90-120Office of Research ServicesBEHAVIOURAL SCIENCES SCREENING COMMITTEE FOR RESEARCHAND OTHER STUDIES INVOLVING HUMAN SUBJECTSCERTIFICATE^of APPROVALINVESTIGATOR: Barr, S.I.UBC DEPT:^Family & Nutr SciINSTITUTION:^UBC-CampusTITLE:^The effect of an innovative nutritioneducation program (Foodstyles:K) onkindergarten children's willingness to trya variety of foods. Phase I Teachers'perceptions of the program.NUMBER:^B90-120CO-INVEST:^McCargar, L.J.^Hammond, G.APPROVED:^APR 2 6 1990The protocol describing the above-named project has beenreviewed by the Committee and the experimental procedures werefound to be acceptable on ethical grounds for researchinvolving human subjects.Dr. R.G.C. Johnston, ChairmanBehavioural SciencesScreening CommitteeTHIS CERTIFICATE OF APPROVAL IS VALID FOR THREE YEARSFROM THE ABOVE APPROVAL DATE PROVIDED THERE IS NOCHANGE IN THE EXPERIMENTAL PROCEDURES178Dr. R.D. Spr leyDirector, Research Serv i cesAPPENDIXAPPENDIX 4. UBC Ethics Approval - Phase IIThe University of British Columbia^B90-213Office of Research ServicesBEHAVIOURAL SCIENCES SCREENING COMMITTEE FOR RESEARCHAND OTHER STUDIES INVOLVING HUMAN SUBJECTSCERTIFICATE^of APPROVALINVESTIGATOR: Barr, S.I.UBC DEPT:^Family & Nutr SciINSTITUTION:^Vancouver SchoolsTITLE:^The effect of an innovative nutritioneducation program (foodstyles:K) onkindergarten childrens willingness to try avariety of foods - Phase II-evaluation offoodstyles:KNUMBER:^B90-213CO-INVEST:^McCargar, L.J.^Hammond, G.APPROVED:^AU6 9 1990The protocol describing the above-named project has beenreviewed by the Committee and the experimental procedures werefound to be acceptable on ethical grounds for researchinvolving human subjects.Dr. R.G.C. Johnston, ChairmanBehavioural SciencesScreening CommitteeTHIS CERTIFICATE OF APPROVAL IS VALID FOR THREE YEARSFROM THE ABOVE APPROVAL DATE PROVIDED THERE IS NOCHANGE IN THE EXPERIMENTAL PROCEDURES179APPENDIXAPPENDIX 5. Pretester's QuestionnairePRETESTER'S QUESTIONNAIREIn addition to responding to these questions, please feel free to write comments directlyon the instrument itself.1. How long did it take you to complete the instrument?About^minutes.2. Was this a reasonable amount of time?Yes^ NoComments. ^3. Were any of the questions difficult to understand? If so, please specify the onesyou found confusing and the^reason(s) why.The questions were easily understood.The following questions were confusing, because:4. Did the instrument adequately address the subject matter (i.e. teachers'perceptions of the Foodstyles:K program)? If not, please specify which additionalareas you feel should be addressed.5.^Other comments*Following receipt of your response, we will be revising the instrument to address concernsyou have raised. Many thanks for your valuable assistance with this phase of theresearch.180APPENDIXAPPENDIX 6. School District AuthorizationBurnaby School District #4141 ,,, H, ^,,,,, R I ( I -I'1990-09-10Ms. Gail Hammond,3954 West 30th Avenue,Vancouver, B.C.V6S 1X3Dear Ms. Hammond:Thank you for your research proposal "The Effect of anInnovative Nutrition Education Program on Kindergarten Chidrens'Willingness to Try a Variety of Foods". As indicated during ourtelephone conversation, approval has been granted for your toapproach the teachers in our district who have been involved inyour nutrition education workshops. Naturally, theadministrators of the schools involved will need to be consultedand parental approval must be obtained before studentsparticipate in the project.Good luck with your data collection.Yours truly,Blake Ford,Director of InstructionBGF/jkir,:C •ItJ(I \ \• •181Please contact me prior to contacting schools and makingfurther arrangements.Yours truly,Alan R. Taylor, Ed.D.,Director of Instruction, Curriculum/AssessmentART/pksSchool District No. 43 (Coquitlam)550 Wrier Srreer -C_oquoiarn. ac^647 - Tel 939-9201 - Fax 939-70281990-08-01Ms. Gail Hammond,University of British Columbia,School of Family & Nutritional Science,Division of Human Nutrition,2205 East Mall,Vancouver, B.C.V6T 1W5Dear Ms. Hammond:I am writing to acknowledge receipt of your letter of July10th, to which was attached a proposal to undertake aresearch study on the effect of an Innovative NutritionEducation Program on students' eating habits.I have reviewed the intent and design of your study and cansupport its administration in Coquitlam School District. Asyou may be aware, participation in the project, however, ison a voluntary basis by schools, students and parents.APPENDIXAPPENDIX 6. (cont'd) School District Authorization Coquitlam School District #43182School District No. 42(Maple Ridge - Pitt Meadows)22225 Omen Avenue, Maine Ridge, Mash Coltenbk Camels V2X 046Toiephone: (504) 463-4200^Fax, (We) ♦63-4181August 28, 1990.Ms. Gail Hammond,3954 W. 301n Avenue,Vancouver, B. C.,V6S 1X3Dear Ms. Hammond:Re:^Your Application for Permission to Conduct Nesearch in School District No. 42Permission is granted for you to conduct research on the "Effect of Foodstyles - K onKindergarten Childrens' Willingness to Try a Variety of Foods" with two teachers, forty studentsand forty parents in School District No. 42. My understanding is that at least two teachers havealready volunteered to be included in this study. I wish to remind you that final approval forparticipation will rest with the principals of the schools in which you wish to conduct theresearch. I would also like to request that the final results of this study be made available to theSchool District.May I wish you good luck with your study.Yours truly,B ry T. Tietjen,Director of Elementary EducationBTT:jac.c.^J. M. SuddabyAPPENDIXAPPENDIX 6. (cont'd) School District AuthorizationMaple Ridge - Pitt Meadows School District #42183APPENDIXAPPENDIX 6. (cont'd) School District AuthorizationRichmond School District #38SCHOOL DISTRICT No.38^(RICHMOND)7811 GRANVILLE AVENUE / RICHMOND B.C. / VOY 1E4; ibleh n68-6000Office of the Superintendent of Schools1990.07.16Gail Hammond3954 W. 30th AvenueVancouver, B.C. V6S 1X3Dear Ms. Hammond:Having reviewed your application to conduct research on the subject of kindergarten chi ldren s'willingness to try a variety of foods, I am pleased to give you permission to approach individualteachers and schools for their voluntary participation in your study.I would appreciate receiving a copy of the report of your findings when the study is complete.If you require assistance in identifying possible study participants please contact our PrimaryCurriculum Coordinator, Gina Rae. If I can be of any further assistance in the conduct of yourreseamh please do not hesitate to contact me.Yours truly,1. .B. BeairstoSupervisor of CurriculumJA B B/swc c. Elementary Principals/Head TeachersGina RaeOUR FOCUS IS ON THE LEARNER184Maureen M3cDOnald,District PrincipalAPPENDIXAPPENDIX 6. (cont'd) School District AuthorizationSurrey School District #36SCHOOL iDISTRICT 36SURREYBOARD OF SCHOOL TRUSTEES14225 - 56th Avenue, Surrey. B.C.V3W 1H9 • Telephone (6041 596-7733 • Facsimile (604) 597-01911990 09 06 Gail Hammond3954 W. 30th Avenuevancouver, BCV6S 1X3Dear Gail:This is to confirm acceptance of your research study (The Effect of anInnovative Nutrition Education Program on Kindergarten Children's Willingnessto Try a Variety of Foods). It is our understanding that you will be workingwith the following four teachers:Robin Abercrombie, Serpentine Heights ElementaryBarbara Cook, Ray Shepherd ElementaryWendy Curteis, Jessie Lee ElementaryMary Johnson, Simon Cunningham ElementaryAs discussed by telephone with Barbara, we will initiate contact withprincipals of these schools to advise them of your involvement withrespective teachers. It is our request that you submit a copy of your freport to our office on completion of your study.We wish you good luck with your work. Please don't hesitate to call if youhave questions or problems.Sincerely,Barbara Holmes,Resmi rch AssociateDo a VanSant,Re arch Associatethethenal185Sincerely,al Hammond, B.Sc.^ Susan I. Barr, Ph.D.Masters StudentGillian Ackhurst, B.H.E.Nutrition EducatorImperial Square. 3236 Beta Avenue. Burnaby British Columbia V5G 4K4 • Fax 294-8199 • Tel. 294-3775Linda McCargar, Ph.D.APPENDIXAPPENDIX 7. Teacher QuestionnaireCover Letter to TeachersINNOVATION INNUTRITIONEDUCATIONB.C. DAIRY FOUNDATIONMay 7, 1990Dear Teacher:The Foodstyles:K program has been available to B.C. kindergarten teachers for the lastthree years. Many kindergarten teachers, like yourself, have attended a Foodstyles:Kworkshop. Although there has been much feedback regarding Foodstyles:K, the programhas yet to be evaluated. At present, it is our purpose to determine its usefulness in theclassroom, and to assess the effects it may have on children's willingness to try newfoods.Because you have attended a Foodstyles:K workshop, you can assist us with thisevaluation. In order for the results to reflect a true assessment of Foodstyles:K, it isimportant for you to complete and return the enclosed questionnaire by May 14,1990. Itis not critical that you be currently using Foodstyles:K, as there are appropriate sectionsfor both users and non-users alike. Each one of you can provide valuable information thatwill facilitate a comprehensive evaluation of the program.You may be assured of complete confidentiality. The questionnaire has an identificationnumber for mailing purposes only. This is so your name can be checked off the mailinglist when your completed questionnaire is returned. At no time will your name appear onthe questionnaire you complete. We will assume you have given your consent toparticipate in this phase of the study by completing the questionnaire. You may withdrawfrom the study at any time or refuse to answer any questions without prejudice.A summary of the results of this research will be made available to all interestedparticipants. You may receive a summary of the results by marking the box labelled"summary of results requested" on page 1.We would be happy to answer any questions you may have. If you live outside the LowerMainland, please phone 1-800-242-6455 or if you live in the Lower Mainland please phone294-3775 to leave a message for Gail Hammond and you will be contacted shortlythereafter. Thank you for your participation in this evaluation.186APPENDIXAPPENDIX 7. (cont'd) Teacher QuestionnaireEVALUATION OF THE FOODSTYLES:K NUTRITION EDUCATION PROGRAMThis evaluation is being conducted to determine the usefulness of Foodstyles:K in thekindergarten classroom and to determine whether or not it has an influence on thedevelopment of children's food habits. The information obtained may serve as a basisfor future revisions of the Foodstyles:K program, as well as contribute to anunderstanding of the food choices made by kindergarten children.Completion of the questionnaire represents a vital component of this project. It shouldtake about 10 to 15 minutes of your time to complete.Thank you for your participation in this evaluation.^ Summary of results requested.Throughout the survey, please CHECK the BOX beside your response, whereappropriate. Please note, items appear on both sides of the page.PART A -- PRACTICAL ASPECTS OF THE FOODSTYLES:K PROGRAM The first part of this survey addresses the PRACTICAL ASPECTS of the Foodstyles:Kprogram.1.^Have you incorporated Foodstyles:K into your classroom activities?^ a. YES, I CURRENTLY USE FOODSTYLES:K IN MY CLASSROOM.^ b. YES, I HAVE USED FOODSTYLES:K IN THE PAST, BUT I NOLONGER USE FOODSTYLES:K IN MY CLASSROOM.^ c. NO, I HAVE NEVER USED FOODSTYLES:K IN MY CLASSROOM.If your answer to question 1 was (a), please proceed to page 4, beginning withquestion 4.If your answer to question 1 was (b), please proceed to page 2, question 2.If your answer to question 1 was (c), please proceed to page 3, question 3.1187APPENDIXAPPENDIX 7. (cont'd) Teacher Questionnaire2.^Your experience using Foodstyles:K and your decision to no longer useFoodstyles:K can provide valuable information about the program. Yourparticipation, will make possible a comprehensive assessment of the program.2.(a) What was your primary reason for discontinuing use of Foodstyles:K?2.(b) Did any of the following factors contribute to your decision to discontinue useof Foodstyles:K? Please indicate YES or NO for each item.YES NOo a ^Classroom time restrictions^ ^ ^Teaching plans already established^ ^ ^Budgetary constraintsa^o ^Organizational time requirementso 0 ^ Lack of facilities^ ^ ^ Lack of inclusion as a recommended resourcea^o ^Competition with similar programs used in the classroom^ ^ ^Management of paperwork^ ^ ^Reordering supplies^ o ^ Inappropriate level of activitieso ^ ^Preference to teach nutrition incidentally at a suitable time, rather thanas a unit^ ^ ^Unsuitable graphic materialso ^ Unavailability of supplemental books and music^ o ^Unlikelihood of field trips^ o ^Unappealing aspects of the Teacher's Guide^ o ^Lack of colleague support^ ^ ^Lack of children's interesto a ^Other. Please specify ^Thank you for your contribution to this study.2188APPENDIXAPPENDIX 7. (cont'd) Teacher Questionnaire3.^By completing the following questions, 3(a) to 3(c), the information you providewill enable a comprehensive evaluation of the Foodstyles:K program.3.(a) When did you decide to NOT use the Foodstyles:K program?o 1. DURING THE WORKSHOP^ 2. AFTER THE WORKSHOP3.(b) What was your primary reason for deciding not to use Foodstyles:K?3.(c) Did any of the following factors contribute to your decision not to useFoodstyles:K? Please indicate YES or NO for each item.YES NOo o ^Classroom time restrictions^ o ^Teaching plans already established^ ^ ^Budgetary constraints^ ^ ^Organizational time requirementso ^ ^ Lack of facilitieso o ^Lack of inclusion as recommended resourceo o ^Competition with similar programs used in the classroom^ ^ ^Management of paperwork^ ^ ^ Inappropriate level of activities^ ^ ^Preference to teach nutrition incidentally at a suitable time, rather thanas a unito o ^Unsuitable graphic materials^ ^ ^Unavailability of supplemental books and music^ ^ ^Unlikelihood of field tripso ^ ^Unappealing aspects of the Teacher's Guide^ ^ ^Lack of colleague support^ o ^Other. Please specify ^Your participation is greatly appreciated. Thank you for your contribution to thissurvey of the Foodstyles:K program.3189APPENDIXAPPENDIX 7. (cont'd) Teacher QuestionnairePART B -- THE PRACTICAL USE OF FOODSTYLES:K IN THE CLASSROOM4. Please indicate the method you use to teach Foodstyles:K.^ 1.^ON ITS OWN (i.e. a specific time has been alloted in your schedule toteach Foodstyles: K)^ 2. INCORPORATED INTO SOME ACTIVITIES (for example, if the food beingintroduced is apples, you may use apples in the "discovery" activities tostimulate discussion about the source of apples, or how they grow from aseed, etc.)^ 3. INCORPORATED INTO ALL ACTIVITIES (again, using apples as anexample, at every activity center there would be some stimulus for thechildren to learn about apples [i.e. read a book about apples at thereading center, paint apples at the art center, serve apples at the housecenter, etc.])^ 4. OTHER. PLEASE DESCRIBE ^5. During the last school year, how often did you teach Foodstyles:K in yourclassroom?TIMES PER MONTH, and,NUMBER OF MONTHS6. During the last school year, how many foods did you introduce usingFoodstyles:K?FOOD(S)4190iz) 47.)^45'4D 1/443"1 yo aYle„?APPENDIXAPPENDIX 7. (cont'd) Teacher QuestionnairePART C — TEACHER'S PERCEPTIONS OF FOODSTYLES:K AND OF ITSEFFECT ON THE CHILDRENThis section pertains to your observations and utilization of the Foodstyles:K program,and its effect on the children's interest in food.The objectives of the Foodstyles:K program are for the student to IDENTIFY andEXPERIENCE a wide variety of foods through tasting, cooking, discussion and recordkeeping activities, thus, building POSITIVE FEELINGS about trying new foods.7.^Item 7 addresses three general areas that correspond to actual use of theFoodstyles:K program. Space has been provided for other comments you mayhave regarding the practical use of Foodstyles:K.7.(a) I feel the Foodstyles:K program is easy toteach.7.(b) The introduction of a minimum of 8 foods(suggested in the Teacher's Guide) issufficient to meet the Foodstyles:K objectives.7.(c) When teaching Foodstyles:K, the aboveobjectives are easily met.COMMENTS:51911§17^/0/(-\ Tc^(t,8.(a) How important do you feel it is for thechildren to complete this activity in order tomeet the objectives of Foodstyles:K?8.(b) How effective do you feel this activity istowards stimulating the children's interest infoods?8.(c) Which core activity do you most enjoyteaching?8.(d) What is the children's favourite core activity?APPENDIXAPPENDIX 7. (cont'd) Teacher Questionnaire8. The following items address the six core activities; Mystery Food, Who Am I?",Cooking, Journals, "I Tried It" Stickers and "I Tried It" Class Club. For EACH partof question 8, choose the THREE most RELEVANT activities. Then, rank thesethree activities using the following system:1 = most relevant activity,2 = second most relevant activity, and3 = least relevant activity of the 3 chosen activities.For each part of question 8, there will be a total of three unscored activities. Theseactivities should represent the activities that you feel have the least significance tothe question. We acknowledge the complexity of this question, however, bycarefully following the directions difficulties should not be encountered.6192APPENDIXAPPENDIX 7. (cont'd) Teacher Questionnaire9. How would you rate the children's interest in the Foodstyles:K program?^ 1. VERY INTERESTED^ 2. SOMEWHAT INTERESTED^ 3. NEUTRAL^ 4. SOMEWHAT DISINTERESTED^ 5. VERY DISINTERESTED10. Do you use the recipes in the core COOKING activity?^ 1. YES^ 2. NO11. Do you use the JOURNAL, "Look What I Tried"?^ 1. NO -- If no, please proceed to question 12.^ 2. YES -- If yes, please proceed to question 11(a).11.(a) Do you re-order the food picture pages from the B.C. Dairy Foundation?^ 1. YES --Please proceed to question 12.^ 2. NO --If you use resources that substitute for the food pictures,please describe the materials you use ^7193APPENDIXAPPENDIX 7. (cont'd) Teacher QuestionnaireUse of the "I Tried It" stickers and "I Tried It" Class Club are meant to facilitate a linkbetween school and home. The following questions address this aspect of theFoodstyles:K program.12. Do you use the "I Tried It" STICKERS?^ 1. NO -- If no, please proceed to question 13.^ 2. YES -- If yes, please proceed to question 12(a).12.(a)^Do you re-order the "I Tried It" stickers from the B.C. Dairy Foundation?^ 1. YES --^If yes, proceed to question 13.^ 2. NO --^If you use resources to substitute for the "I Tried It" stickers,please describe the materials you use ^13. Do you make use of the "I Tried It" CLASS CLUB activity?^ 1. NO -- If no, please proceed to question 14.^ 2. YES -- If yes, please proceed to question 13(a).13.(a)^How many children returned their forms from home indicating that theyhave tried a new food?^ 1. MOST CHILDREN^ 2. MORE THAN HALF THE CHILDREN^ 3. ALMOST HALF THE CHILDREN^ 4. VERY FEW OR NONE OF THE CHILDREN14. How would you rate parental support of this program?^ 1. VERY SUPPORTIVE^ 2. SOMEWHAT SUPPORTIVE^ 3. NEUTRAL^ 4. SOMEWHAT NON-SUPPORTIVE^ 5. NON-SUPPORTIVETHANK YOU for your participation in this survey of the Foodstyles:K program.8194APPENDIXAPPENDIX 8. Notice of Willingness to Participate in Phase IIPARTICIPATION IN THE FOODSTYLES:K EVALUATIONIf you are willing to allow your class to be considered as possible participants in an evaluation ofthe Foodstyles:K program commencing September 1990, please complete your name and addressbelow. Classes will be randomly assigned to either a Foodstyles:K "use" or Foodstyles:K "non-use"(control) group. If your class is assigned to the "use" group, then you would continue with yourusual method of teaching Foodstyles:K throughout the 1990-1991 school year. If your class isassigned to the "non-use" group, then Foodstyles:K instruction would be excluded from yourclassroom activities over the 1990-1991 school year. There will be no additional workload as ateacher of either group. The researcher will be responsible for evaluation of the program. This willinclude a pre-test conducted early in the school year (September) to assess childrens' willingnessto try new foods and an identical post-test conducted near the end of the school year (May).Further information will be distributed upon receipt of this card with your name and addresscompleted. Please return along with the completed questionnaire today. Please print.NAMENAME OF SCHOOLADDRESS OF SCHOOLTOWN / CfTY / POSTAL CODECI Summary of results requested.195APPENDIXAPPENDIX 9. First Follow-up NoticeMay 14, 1990Dear Teacher:Last week a questionnaire requesting your perceptions of the Foodstyles:K nutrition educationprogram was mailed to you. Your name was selected from BC kindergarten teachers who hadattended a Foodstyles:K workshop between June 1987 and June 1989. If you have alreadycompleted and returned it to us, please accept our sincere thanks.If you have not completed the questionnaire. please do so today. It is extremely important thatyour opinions be included, whether they be positive or negative. Otherwise, the results will notprovide an accurate representation of teachers' perceptions of the Foodstyles:K program.If by some chance you did not receive the questionnaire, or if it was misplaced, please call rightnow, toll-free if you live outside the Lower Mainland (1-800-242-6455) or phone 294-3775 if youlive within the Lower Mainland, and another will be mailed to you today. Thanks again for yourvaluable assistance.Sincerely,Gail Hammond, B.Sc.^ Susan I. Barr. Ph.D.Masters CandidateLinda J McCargar, Ph.D.^ Gillian Ackhurst, B.H.E.Nutrition Educator196APPENDIXAPPENDIX 10. Updated Cover Letter to Non-respondentsJune 4, 1990Dear Teacher:About four weeks ago, we wrote to you seeking your perceptions of the FOODSTYLES:Knutrition education program. Feedback we have received indicates that many of you didnot receive your questionnaire until the day it was due to be returned. We acknowledgethe confusion this created and apologize for the delayed delivery by Canada Post.YOUR responses are a CRITICAL component of this survey. We ask that you take 5-10minutes from your busy schedule to complete this questionnaire and return it to us withina week of receipt or as shortly thereafter as is convenient for you. It is not critical that yoube currently using Foodstyles:K, as there are appropriate sections for both users andnon-users alike.You may be assured of complete confidentiality. The questionnaire has an identificationnumber for mailing purposes only. This is so your name can be checked off the mailinglist when your completed questionnaire is returned. At no time will your name appear onthe questionnaire you complete. We will assume you have given your consent toparticipate in this phase of the study by completing the questionnaire. You may withdrawfrom the study at any time or refuse to answer any questions without prejudice.A summary of the results of this research will be made available to all interestedparticipants. You may receive a summary by marking the box labelled "summary ofresults requested" on page 1 of the questionnaire.We would be happy to answer any questions you may have. If you live outside the LowerMainland, please phone 1-800-242-6455 or if you live in the Lower Mainland, please phone294-3775 to leave a message for Gail Hammond and you will be contacted shortlythereafter. Thank you for your participation in this evaluation.Sincerely,Gail Hammond, B.Sc.^ Susan I. Barr, Ph.D.Masters StudentLinda McCargar, Ph.D.^ Gillian Ackhurst, B.H.E.Nutrition Educator197APPENDIXAPPENDIX 11. Second Follow-up NoticeJune 15, 1990Dear Teacher:We are writing to you about our study of kindergarten teachers' perceptions of the Foodstyles:Knutrition education program. We have not yet received your completed questionnaire.We understand this is a very busy time of the year to be asking you to complete one more form,n=but your response is very important for two reasons. First, Foodstyles:K has never beenevaluated so results are of particular importance for future improvements to the program. Wewould like any changes that are made to meet the needs of teachers like yourself. Second, tohave a meaningful picture of kindergarten teachers' perceptions of Foodstyles:K, we requireinformation from those of you who have not responded, as you may have quite differentperceptions of the Foodstyles:K program from those whose questionnaires we have alreadyreceived. May we urge you to complete and return the questionnaire as quickly as possible.If by some chance you did not receive a questionnaire, or it has been misplaced, please call toll-free if you live outside the Lower Mainland, 1-800-242-6455, or phone 294-3775 if you live withinthe Lower Mainland and another will be immediately mailed to you.Your contribution to the success of this study will be greatly appreciated.Sincerely,Gail Hammond, B.Sc.^ Susan I. Barr. Ph.D.Masters CandidateLinda J McCargar, Ph.D.^ Gillian Ackhurst, B.H.E.Nutrition Educator198APPENDIXAPPENDIX 12. Parental Pretest QuestionnaireCover Letter to All Parents1=1NUIRMONEDUCATKADAIRY FOUNDATION3236 BETA AVEAUFH.684 BCVIG 4464 1696 294-3775September, 1990Hello Parents:The new school year has arrived. In the kindergarten classroom, your child along with theother children, will encounter many new experiences that help to create an awareness andunderstanding of themselves and the world about them.The nutrition education program called Foodstyles:K, developed by the B.C. Dairy Foundation,has been available to all B.C. kindergarten teachers over the last several years. During theschool year from September 1990 through May 1991, your child's teacher has agreed toparticipate in our evaluation of the Foodstyles:K program. We are now requesting that youagree to your child's participation in our evaluation.The purpose of the evaluation is to determine the effects this nutrition education program mayhave on kindergarten childrens' willingness to try a variety of foods. This will involve a 5minute interview using plastic food models to assess your child's willingness to try foods nearthe beginning of the school year and an identical repeat of the assessment again near the endof the school year.Two copies of the consent form are enclosed. Please sign both copies. Return ONE copywith the completed survey and retain the other for your records: By completing the enclosedsurvey, you can provide important information regarding your child's food experiences. Wewould appreciate your answering all questions, however, you may refuse to answer anyquestions or withdraw from the study at any time without prejudice.We would be happy to answer any questions you may have. Please write to the addressbelow or phone 228-2502 to leave a message for Gail Hammond with the departmentalsecretary and your call will be returned shortly thereafter. Thank you for your contribution tothis evaluation.Sincerely,I Hammond, B.Sc.Masters StudentLinda McCargar, Ph.D.Susan I. Barr, Ph.D.Gillian Ackhurst, B.H.E.Nutrition EducatorImperial Square, 3236 Beta Avenue, Bumaby British Columbia V5G 41:(4 • Telephone: 294-3775199APPENDIXAPPENDIX 12. (cont'd) Parental Pretest QuestionnaireInsert to Parents of Children in the Control GroupPlease keep this information page for your records.EVALUATION OF THE FOODSTYLES:K NUTRMON EDUCATION PROGRAMThis study is the first evaluation of the Foodstyles:K program. It is being conducted to determinethe effectiveness of this program in developing good food habits in your kindergarten child. Theinformation obtained may contribute to future revisions of the Foodstyles:K program as well ascontribute to an understanding of the food choices made by kindergarten children.Your completion of this questionnaire represents an important component of this evaluation. Itwill require about 5-10 minutes to complete. Your participation will Involve completing this surveynow to provide us with baseline data. Near the end of the school year, a second survey will bedistributed to you. The purpose of the second questionnaire will be for you to describe anychanges you have noticed in your child's food habits over the school year.Your child's participation will involve an individual interview with the researcher. Each child will beasked two questions during the interview. First, to sort a variety of foods, represented by foodmodels, into familiar and unfamiliar categories. Second, to indicate which foods he/she would bewilling to eat. This process wilt take approximately 5 minutes for each child and will be conductedboth early in the school year and again near the end of the school year. This study will notinfluence your child's evaluation by his/her teacher.Below is a consent form for you to complete, sign and return with the completed questionnaire inthe envelope provided. Upon our receipt of the completed and signed form, it will be assumedthat you have given permission for your child to participate in this evaluation.You may be assured that all the information you provide will be completely confidential. You mayrefuse to participate or withdraw from the study at any time without prejudice. If you wish tocomment any questions, or qualify your answers, please feel free to use the space in themargins. Your additional comments will be taken into consideration.Thank you for your participation in this project.CONSENT FORM^  do/do not (circle one) give consent for myFirst and last Nam of ParanVGuardanchild . to participate in two 5 -minute interviews for thisFos: and Last Name of Childevaluation of the nutrition education program, Foodstyles:K, during the 1990 - 1991 school year.&Eaton of Parent/Goan:LanI:I I acknowledge receipt of a copy of this consent form.200APPENDIXAPPENDIX 12. (cont'd) Parental Pretest QuestionnaireInsert to Parents of Children in the Intervention GroupPlease keep this information page for your records.EVALUATION OF THE FOODSTYLES:K NUTRITION EDUCATION PROGRAMThis study is the first evaluation of the Foodstyles:K program. It is being conducted to determinethe effectiveness of this program in developing good food habits in your kindergarten child. Theinformation obtained may contribute to future revisions of the Foodstyles:K program as well ascontribute to an understanding of the food choices made by kindergarten children.Your completion of this questionnaire represents an important component of this evaluation. Itwill require about 5-10 minutes to complete. Your participation will involve completing this surveynow to provide us with baseline data. Following implementation of the Foodstyles:K programthroughout the school year, a second survey will be distributed to you. The purpose of thesecond questionnaire will be for you to describe any changes you may have noticed in yourchild's food habits resulting from exposure to the Foodstyles:K program over the school year.Your child's participation will involve an individual interview with the researcher. Each child will beasked two questions during the interview. First, to son a variety of foods, represented by foodmodels, into familiar and unfamiliar categories. Second, to indicate which foods he/she is willingto eat. This process will take approximately 5-10 minutes for each child and will be conductedboth early in the school year and again near the end of the school year. This study will notinfluence your child's evaluation by his/her teacher.Below is a consent form for you to complete, sign and return with the completed questionnaire inthe envelope provided. Upon our receipt of the completed and signed form, it will be assumedthat you have given permission for your child to participate in this evaluation.You may be assured that all the information you provide will be completely confidential. You mayrefuse to participate or withdraw from the study at any time without prejudice. If you wish tocomment on any questions, or qualify your responses, please feel free to use the space in themargins. Your additional comments will be taken into consideration.Thank you for your participation in this project.CONSENT FORMFirst and Last Name of Parent/Gran:Gan^do/do not (circle one) give consent for mychildFirst and Last Nam. of Child^to participate in two 5-minute interviews for thisevaluation of the nutrition education program, Foodstyles:K, during the 1990-1991 school year.signature of Parent/Guar:WI^ I acknowledge receipt of a copy of this consent form.201APPENDIXAPPENDIX 12. (cont'd) Parental Pretest QuestionnaireCONSENT FORM AND QUESTIONNAIRECONSENT FORMI ^ , do/do not (circle one) give consent for myFirst and Last Name of Parent/Guardianchild , to participate in two 5-minute interviews for thisFirst and Last Name of Childevaluation of the nutrition education program, Foodstyles:K, during the 1990-1991 school year.Signature of Parent/Guardian0 I acknowledge receipt of a copy of this consent form.Please complete, sign and return as soon as possible in the self-addressed, stamped envelope provided.202APPENDIXAPPENDIX 12. (cont'd) Parental Pretest QuestionnaireINFORMATION ABOUT YOUR CHILD1. Child's record number ^2. Child's sex^Male ^Female^3. Child's age ^ years4. Does this child have brothers or sisters living at home?YesNoIf yes, how many brothers or sisters live at home?Number of older brothers or sisters^Number of younger brothers or sisters ^5. Has your child previously attended an organized daycare program?^Yes^NoIf yes, are you aware of nutrition information being introduced toyour child where he/she previously attended?^Yes^No6. Since cultural background may greatly influence food choices, pleaseindicate your child's ethnic background (eg. Spanish, Chinese, EastIndian).Over203APPENDIXAPPENDIX 12. (cont'd) Parental Pretest QuestionnaireINFORMATION REGARDING FOOD RESTRICTIONSThe information you supply in this section will ensure that your child will not beoffered foods that may be harmful to him/her.7. Does your child have food allergies?^ Yes^ NoIf yes, please describe.8. Does your child have special dietary restrictions (for example: meat-free, milk-free, wheat-free diets; food restrictions due to religious practices)?^ Yes^ NoIf yes, please describe.9. Does your child have a medical condition that affects his/her food intake (forexample: diabetes; PKU)?YesNoIf yes, please describe.^204/04, 4 ii. p 6, ,.$9?? 1/4 P.'13- ea 4' ,z, Cb^$- 47 o 0c10.(a) My child is willing to eat a wide VARIETY offoods.10.(b) My child is willing to eat UNFAMILIAR foods.APPENDIXAPPENDIX 12. (cont'd) Parental Pretest QuestionnaireGENERAL INFORMATION REGARDING FOOD INTAKEIn this final section of the survey, your responses will be used to constructan evaluation of kindergarten childrens' attitudes toward foods. Yourresponses will provide valuable information in a field of research where verylittle data presently exist.Over --,•205APPENDIXAPPENDIX 12. (cont'd) Parental Pretest Questionnaire11.^Is your child willing to eat the following foods?YES NO DON'T KNOWWhite fish^ ^ ^ ^Shrimp ^ ^ ^Chicken drumstick,fried^ ^ ^ ^Eggs, fried^ ^ ^ ^Lima beans ^ ^ ^Broccoli, cooked^ ^ ^ ^Carrots, cooked^ ^ ^ ^Cole slaw^ ^ ^ ^Cottage cheese^ ^ ^ ^Swiss cheese^ ^ ^ ^Milk^ ^ ^ ^Yoghurt, plain^ ^ ^ ^Cornflakes ^ ^ ^Cornbread^ ^ ^ ^Spaghetti ^ ^ ^Tortilla, flour^ ^ ^ ^Thank you for your cooperation in completing and returning this survey.206APPENDIXAPPENDIX 13. Monthly Telephone Queries to Teachers of Control ClassesCONTROL GROUP1. Have you introduced any foods to the children?^ YES ^ NO—GREAT!!!!2. Which foods have been introduced?3.^How was the food presented to the children?FOOD^PRESENTATION/DISCUSSIONTHANKS FOR YOUR HELP ANDPARTICIPATIONum207APPENDIXAPPENDIX 14. Monthly Telephone Queries to Teachers of Intervention ClassesINTERVENTION GROUP1. Have you introduced any of the 8 test foods?^ YES ---> Q.3^NO ---> Q.22. If no, when will you be introducing the test foods?3. Please list the foods you have introduced to the children in thepast month.4. Did you use the "Mystery Food" activity with these foods?^YES^List foods: ^^ NO 5.^Did you use the Who Am I?" activity with these foods?^ YES^ NOList foods: 208APPENDIXAPPENDIX 14. (cont'd) Monthly Telephone Queries to Teachers of InterventionClasses6. If you used methods other than "Mystery Foods" or "Who AmI?"^to introduce the foods, please indicate how the foods wereintroduced.7. Did you cook with these foods?NOYES8. If yes, what cooking activities did you do?FOOD^ COOKING9. Have the children made their journals for the food(s)?^YES^List foods: ^^ NO 1 0 . Did the children receive "I Tried It stickers to take home?^ YESList foods: ^^ NO209APPENDIXAPPENDIX 14. (cont'd) Monthly Telephone Queries to Teachers of InterventionClasses11. Do you make use of the "I Tried It" Class Club activity?^ YES ^ NO1 2 . How many of the children were willing to taste the foodpresented?FOOD^ALMOST ABOUT^LESS THANALL^HALF HALF1 3 . Have you introduced any foods other than the test foods?^YES^List foods: ^^NO THANKS FOR YOUR HELP ANDPARTICIPATION , "210APPENDIXAPPENDIX 15. Parental Posttest QuestionnaireCover Letter to Parents of Children in the Control GroupMay, 1991Dear Parents:The end of the school year is approaching and so is the conclusion of our study, An Evaluationof Foodstyles:K. The posttest interviews will be conducted shortly to assess any changessince last September in your child's willingness to try a variety of foods.At the start of the school year we contacted you for baseline data regarding your child's foodhistory. Over the school year your child has participated in the "control" group of this study.These students have provided us with useful information on changes in attitudes towards foodduring the natural development of kindergarten children. Now, we would appreciate yourcomments regarding changes you may have noticed in your child's food habits over the schoolyear. You may refuse to answer any questions in this survey or withdraw from the studywithout prejudice.Please find enclosed a self-addressed, stamped envelope for you to return this survey directlyto us. Should you have any questions, please phone 228-2502 to leave a message with thedepartmental secretary for Gail Hammond and you will be contacted shortly thereafter.We would like to take this opportunity to thank you for allowing your child to participate in ourstudy and for your valuable input in both the pretest and posttest questionnaires.Sincerely,Gail Hammond, B.Sc.^ Susan I. Barr, Ph.D.Masters StudentLinda J. McCargar, Ph.D.^ Gillian Ackhurst, B.H.E.Nutrition Educator211APPENDIXAPPENDIX 15. (cont'd) Parental Posttest QuestionnaireCover letter to Parents of Children in the Intervention GroupMay, 1991Dear Parents:The end of the school year is approaching and so is the conclusion of our study, An Evaluationof Foodstvles:K. The posttest interviews will be conducted shortly to assess any changessince last September in your child's willingness to try a variety of foods.At the start of the school year we contacted you for baseline data regarding your child's foodhistory. Over the school year your child has participated in the "intervention" group of thisstudy. These students have been exposed to nutrition education through the Foodstyles:Kprogram and have provided us with useful information on changes in attitudes towards foods.Now, we would appreciate your comments regarding changes you may have noticed in yourchild's food habits over the school year. You may refuse to answer any questions in thissurvey or withdraw from the study without prejudice.Please find enclosed a self-addressed, stamped envelope for you to return this survey directlyto us. Should you have any questions, please phone 228-2502 to leave a message with thedepartmental secretary for Gail Hammond and you will be contacted shortly thereafter.We would like to take this opportunity to thank you for allowing your child to participate in ourstudy and for your valuable input in both the pretest and posttest questionnaires.Sincerely,Gail Hammond, B.Sc.^ Susan I. Barr, Ph.D.Masters StudentLinda J. McCargar, Ph.D.^ Gillian Ackhurst, B.H.E.Nutrition Educator212APPENDIXAPPENDIX 15. (cont'd) Parental Posttest QuestionnaireEVALUATION OF THE FOODSTYLES:K NUTRITION EDUCATION PROGRAMThis study was initiated to evaluate the effectiveness of the Foodstyles:K nutrition educationprogram, designed by the B.C. Dairy Foundation, in developing good food habits in thekindergarten child.At the start of the school year you may recall completing a preliminary survey regarding yourchild's food habits. This information provided us with baseline data that allowed us to gainknowledge about kindergarten childrens' food habits. Upon completion of this second and finalsurvey, the information you provide now will allow us to assess any changes since lastSeptember in the food habits of your child. Without this information, an essential component ofour study will be missing. We would appreciate your answering all questions and returning thecompleted questionnaire directly to our office in the stamped, self-addressed envelopeprovided. However, you may refuse to answer any questions or withdraw from the studywithout prejudice. This survey should require 5-10 minutes to complete.You may be assured that all information you provide will be completely confidential. A recordnumber will be used for each child. This will facilitate checking your child's name from theclass list upon receipt of your completed questionnaire.1.^Child's record number/7/ti /1/4 0^000^-*^GIs'^is coc 0 0 452.(a) My child is willing to eat a wide VARIETY offoods.2.(b) My child is willing to eat UNFAMILIAR foods.Over213APPENDIXAPPENDIX 15. (cont'd) Parental Posttest Questionnaire3.^Is your child willing to eat the following foods?YES NO DON'T KNOWWhite fish^ ^ ^ ^Shrimp ^ ^ ^Chicken drumstick..fried^^ ^ ^Egg, fried ^ ^ ^ ^Lima beans ^ ^ ^Broccoli, cooked^ ^ ^ ^Carrots, cooked^ ^ ^ ^Cole slaw^ ^ ^ ^Cottage cheese^ ^ ^ ^Swiss cheese^ ^ ^ ^Milk^ ^ ^ ^Yoghurt, plain^ ^ 0 0Cornflakes ^ ^ ^Cornbread^ ^ ^ ^Spaghetti 0 ^ ^Tortilla, flour^ ^ ^ ^214APPENDIXAPPENDIX 15. (cont'd) Parental Posttest Questionnaire4. When requesting food(s), has your child mentioned his/her exposure to the foods(s) atschool?^YES, please proceed to question 4(a).^NO, please proceed to question 5.4.(a) Please indicate the food(s) your child has requested as a result of exposure atschool.5. Have you noticed any changes in your child's food habits over the past school year?^YES, please proceed to question 5(a).NO.5.(a) Please describe any changes you have observed in your child's food habitsover the past school year.Thank you for your participation in this evaluation.215APPENDIXAPPENDIX 16. Teacher Descriptions of the "Other" Method they Reported Using to Teach Foodstyles:KCategory: Augmentation of a nutrition theme1^I did a theme on nutrition and picked appropriate material from the kit to go along with it.2^Nutrition theme month of March3^Currently using Foodstyles:K in a food theme.4^I am doing a food theme and do a variety of activities using assorted food. Twice or threetimes a week I say that I brought a "Mystery Food" to school. We play a guessing game,taste the food then do the page.5^I am doing a 4 week nutrition theme and am mainly using the recipes and "I Tried It"stickers.6^Incorporated into a health and nutrition unit and then continued at snack time for theremainder of the year.Category: Incorporation of Foodstyles:K into general classroom themes7^I use those foods that relate to the themes I am teaching. eg . Theme "The Farm" then Iused dairy products. For my theme on Easter, I used the egg activities.8^Integrated within a theme.9^I incorporate the pages, stickers, etc., with themes and cooking experiences. For eg. fishwhen we are studying bears.Category: Use of Foodstyles:K worksheets after cooking10^I used it along with other nutrition activities, and tied it into cooking lesson.11^I used your worksheets to reinforce the children's concept of foods. The sheets werehelpful after our cooking and tasting activity.216APPENDIXAPPENDIX 16. (cont'd) Teacher Descriptions of the "Other" Method theyReported Using to Teach FoodstylesKCategory: Use of Foodstyles:K in a nutrition health unit12^I use it a part of a unit on "Me" where I include health nutrition likes/dislikes, etc.13^I have done a nutrition unit with the kindergarten for a few years and have incorporatedFoodstyles into my unit. The ideas, pictures are very useful. The children at this schoolare particularly capable and I carry the program a step further into classification of foodsinto food groups. The children have no problem classifying foods. I usually do thenutrition theme for 3-4 weeks in the Spring and then we continue to classify our snacks tothe end of the year. We cook occasionally throughout the year.217APPENDIXAPPENDIX 17. Teacher Descriptions of the "Other" Method they ReportedUsing in Conjunction with Teaching Foodstyles:K on It's Own. in SomeClassroom Activities. or in All Classroom ActivitiesMETHOD OF TEACHING FOODSTYLES:K = At times on its own and at othertimes using an "other" method herein described. (n=4)1^To augment the learning in our weekly cooking classes (we cook snack for that day). If anyof the foodstyle sheets relate to our food choice we incorporate it into our learningexperience.2^I used it as a unit on nutrition therefore all activities and centres were of a nutritionalsubject.3^I teach cooking once a week to both of my kindergarten classes. I have used manyFoodstyles:K recipes very successfully.4^I use it as a unit. Stands on its own.METHOD OF TEACHING FOODSTYLES:K = At times in some classroom activitiesand at other times using an "other" method herein described. (n=11)5^For apples, only #3 would be applicable as they are used as a complete theme / otherfoods not so extensively6^I use some of Foodstyles:K during a nutrition unit in winter, and when introducing newfoods.7^Some of the ideas adapted to use with other than foods.8^Theme related with restaurants. A different food is featured every day at the restaurant.Also nutrition is being discussed.218APPENDIXAPPENDIX 17. (cont'd) Teacher Descriptions of the "Other" Method theyReported Using in Conjunction with Teaching FoodstylesK on It's Own. in SomeClassroom Activities, or in All Classroom ActivitiesMETHOD OF TEACHING FOODSTYLES:K = At times in some classroom activitiesand at other times using an "other" method herein described. (cont'd)9^I use it in my integrated theme on "nutrition" and when I am cooking in other themes suchas making porridge in the fairytale unit.10^Use "I Tried It" stickers for other taste experiences.11^As a part of my themes. ie . apples in my apple theme, rice in Chinese New Year, bread in"Little Red Hen" theme, broccoli for the letter "B", cereal for the "Three Bears".12^I use the nutrition theme in March. Foodstyles is part of my program.13^At times in conjunction with our weekly cooking program (ie. when our recipe included onof the Foodstyles:K foods.)14^The foods chosen are often drawn from (related to) the theme being studied as much aspossible.15^We are a multigrade year 1, 2 ,3. Pilot class K, 1, 2.METHOD OF TEACHING FOODSTYLES:K = At times into all classroom activitiesand at other times using an "other" method herein described. (n=5)16^I incorporate many foods not in the kit but in some way related to themes focussed on.eg. Mexican fruits & vegetables when theme is Mexico.17^I did not always use the suggested foods, but made substitutions. We did not use therecord sheets.18^I use vegetables & fruits thematically, eg. eggs with Spring; picnic mix for trip to pond, etc.219APPENDIXAPPENDIX 17. (cont'd) Teacher Descriptions of the "Other" Method theyReported Using in Conjunction with Teaching FoodstylesK on It's Own. in SomeClassroom Activities. or in All Classroom ActivitiesMETHOD OF TEACHING FOODSTYLES:K = At times into all classroom activitiesand at other times using an "other" method herein described. (cont'd)19^In conjunction with a specific book "The Enormous Turnip" serve turnip sticks afterfeeling, smelling, talking about it.20^Nutrition theme, 4 food groups, etc.METHOD OF TEACHING FOODSTYLES:K = At times on it's own and at othertimes into some classroom activities or using an "other" method hereindescribed. (n=1)21^Two years ago I did it on it's own. This year I am incorporating it into my themes. Eitherway it works well.METHOD OF TEACHING FOODSTYLES:K = At times on it's own and and at othertimes into all classroom activities or using an "other" method herein described.(n=5)22^I use methods 1 and 3 depending on the themes I am teaching and how it fits.23^I photocopy the booklet with some changes of my own and each child uses the bookletwhen trying foods.24^It varied with the food item we were studying.25^We cook every Thursday in our class. I do nutrition as a theme in November. We also lookat some foods. We discuss nutrition on an ongoing basis.26^A poem has a "sticky date" - date was introduced while baking gingerbread man - gingerroot shown, powder smelled, some tasted. Peanut butter - made butter. Daily stress:healthy snacks fruit, vegetables, nuts.220APPENDIXAPPENDIX 17. (cont'd) Teacher Descriptions of the "Other" Method theyReported Using in Conjunction with Teaching FoodstylesK on It's Own. in SomeClassroom Activities. or in All Classroom ActivitiesMETHOD OF TEACHING FOODSTYLES:K = At times into some classroomactivities and at other times into all classroom activities or using an "other"method herein described. (n=3)27^Incorporated into a theme such as Thanksgiving, Hallowe'en, Farms, Easter.28^Depends on the theme being taught and whether the Foodstyles material can becompletely integrated.29^#2 and #3 used during "apples" theme and then "nutrition" theme. "I Tried It" stickersused throughout the year. I use the program during the time that I do the abovementioned theme but I do not teach it as it is intended. I use parts of it.METHOD OF TEACHING FOODSTYLES:K = At times on it's own and at othertimes into some classroom activities or into all classroom activities or using an"other" method herein described. (n=1)30^For parent presentations.221APPENDIXAPPENDIX 18. List of Foods Requested by Children as Reported by TheirParents^(Control Group)CONTROL GROUP Food Requested Food Requested Food RequestedChild #1 fish chicken carrotsChild #2 donuts macaroni Kentucky^FriedchickenChild #3 hard eggs raw carrotsChild #4 chicken;^eggs carrots milk;^yoghurtChild #5 cottage^cheese;yoghurtmilk;^chicken noodles;^fishChild #6 cupcake;^cookies popcorn;sandwichespancakes;applesauce;gingerbreadChild #7Child #8potatoe^pancakeschicken soupT-rex burgers wontonsChild #9 pineapple kiwiChild #10 cheese;^crackers;pickleshoney pizza^withspaghetti;^cheese;meatballsChild^#11Child^#12different^breadsstrawberry^juicegranola mix soup222APPENDIXAPPENDIX 19. List of Foods Requested by Children as Reported by TheirParents (Intervention Group) INTERVENTION^Food Requested^Food Requested^Food RequestedGROUPChild #1Child #2Child #3Child #4Child #5Child #6Child #7Child #8tortillatortillacrackerscornbreadtortillas w/ jamscrambled eggs in"folded" breadcottage cheesecottage cheese ona crackercoleslawcookiesyoghurt w/ fruitchipsChild #9^does NOT want to^no requestseat coleslawChild #10^does NOT want to^no requestseat coleslawChild #11^pita breadChild #12^broccoli^carrotsChild #13^cottage cheese^yoghurt223broccoli; rawcarrotscottage cheeseyoghurtsomething sweet w/peanutssaladyoghurtdried soup noodlesmuffinscornbreadstring cheeseapple w/ peanutbutter on itkiwi; yoghurtcornflakeskiwi fruitscottage cheese;yoghurt (plain)cornflakespeanut buttertortillacornjello jigglersbagelsyoghurtcornflakescerealveggies/diphoneydew melonAPPENDIXAPPENDIX 19. (cont'd) List of Foods Requested by Children as Reported byTheir Parents (Intervention Group)INTERVENTION^Food Requested^Food Requested^Food RequestedGROUPChild #14Child #15Child #16Child #17Child #18Child #19Child #20Child #21Child #22Child #23Child #24Child #25Child #26Child #27224APPENDIXAPPENDIX 19. (cont'd) List of Foods Requested by Children as Reported byTheir Parents (Intervention Group) INTERVENTIONGROUPFood Requested Food Requested Food RequestedChild #28Child #29Child #30fish^steak;^cereal;yoghurtcottage^cheesepita breadvegetable;^soup fresh^fruit^eg.honeydew melonChild #31 trail^mix tuna saladChild #32Child #33fruit^kebabscelery w/ peanutbuttercranberry^sauce apple sauceChild #34 pizza yoghurt coleslaww/ = with225APPENDIXAPPENDIX 20. Noticeable Changes in Childrens' Food Habits Over the SchoolYear as Reported by Their Parents (Control Group) CONTROL GROUP CHANGES NOTED^CHANGES NOTEDChild #1Child #2Child #3Child #4Child #5Child #6Child #7Child #8Child #9Child #10Child #11Child #12Child #13Child #14more veggiesmore junk foodno longer eats carrotsdoesn't like to eat anythingeats most of what is giveneats more uncooked fruits& vegetableseats lots of fruits but notveggiesnot so easy to try newfoodsmore willing at least totaste a new foodmore set in likes & dislikeswilling to eat things thatbrother & sister don't likemore willing to try differentfoods esp. ones she didn'tlike beforemore willing to try newfoodsrarely commentsnegatively, used toconstantly complainmuch better appetitemore willing to try newfoodsused to eat fish, now onlysometimesloves any kind of cheesemore willing to eat coldfoods eg. sandwiches; coldmeat; rollseats more variety atbreakfasttries lots of vegetablesmore structured in eatinghabits eg breakfast, lunch,suppereats foods he won't eatbefore226APPENDIXAPPENDIX 20. (cont'd) Noticeable Changes in Childrens' Food Habits Over theSchool Year as Reported by Their Parents (Control Group) CONTROL GROUP CHANGES NOTED^CHANGES NOTEDChild #15Child #16Child #17Child #18Child #19Child #20Child #21Child #22Child #23tries more different thingstries new things^will like a food "all thetime" if she's seen otherslike iteats more noweats more now^tries to eat everything likevegetablesmore willing to try a widervariety of foodstries to eat foods from the knows the food groups;different food groups^eats more cookedvegetableseats morewilling to try more foods^eating more & bettereats a bit more than before227APPENDIXAPPENDIX 21. Noticeable Changes in Childrens' Food Habits Over the SchoolYear as Reported by Their Parents (Intervention Group) INTERVENTION GROUP CHANGES NOTED^CHANGES NOTEDChild #1Child #2Child #3Child #4Child #5Child #6Child #7Child #8Child #9Child #10Child #11Child #12Child #13used to eat cheese & bread needs snacks noweats small amounts, butmore frequentlymore aware of healthysnacks eg. fruitmore willing to try newfoodslittle more fussy^likes a snack before bedbecause she's hungryoften asks if food is goodfor you; if yes, tends toenjoy it moremore interest in tryingdifferent things eg. relish& mustard instead of justketchup on hot dogwilling to try a new food -doesn't necessarily end upliking itmore willing to try a newfoodwants to eat all the time^eats a lot more fruitmore willing to try newfoodseats canned pasta &^eats more radishes; beef;meats; eats more varieties and pork (loves animal fat)of cheesewilling to try more foods228APPENDIXAPPENDIX 21. (cont'd) Noticeable Changes in Childrens' Food Habits Over theSchool Year as Reported by Their Parents (Intervention Group) INTERVENTION GROUP CHANGES NOTED^CHANGES NOTEDChild #14Child #15Child #16Child #17Child #18Child #19Child #20Child #21Child #22Child #23Child #24Child #25Child #26not as fussylikes Caesar salad; corn;strawberrieseats a few more fruitswilling to try more foods &to eat a greater variety offoodsmore variety nowmore willing to finish mealseven if he doesn't like itpreviously disliked foodsare now liked eg.mushrooms; salad; eggsmore willing now to acceptmeals as they are preparedincreased appetiteincreased appetiteeats a wider variety of rawvegetables; fruits &cheesemore willing to try foodswilling to try differentfruits & foods he has neverhad beforeenjoys eating a widervariety of foodsprefers macaroni noodlesinstead of spaghettiliked the cornbreadsometimes tries new foodslikes raw veggies & dipmore willing to try newfoods; willing to eat a widevariety of foodsbefore this program hewould refuse to samplefoods229APPENDIXAPPENDIX 21. (cont'd) Noticeable Changes in Childrens' Food Habits Over theSchool Year as Reported by Their Parents (Intervention Group) INTERVENTION GROUP CHANGES NOTED^CHANGES NOTEDChild #27Child #28Child #29Child #30Child #31Child #32likes to try different foods;eats more veggies & fruitmore suspicious ofunfamiliar foods, but sayshe tries new foods atschooleats more homemade pastawilling to sample some newfoodsa very fussy eatertrying more new foods, orrequesting to try new foodswhich she did not do beforesuggests foods for mealsat grocery storemore adamant about noteating certain thingseats cucumber; bananas;cheese & crackersperhaps some improvementin attitude about trying newfoods230APPENDIXAPPENDIX 22. GlossaryAttitudeConcreteOperationalDaycare- an internal state which affects an individual's choice of action toward someobject, person or event (AECT, 1977).- a stage of the Piagetian cognitive development that follows the preoperationalstage. It is characterized by a need to anchor thoughts to concrete events andoccurs from approximately 7 to 11 years of age.- centres which provide supervision and facilities for preschool children during theday in a relatively noneducational, unstructured manner.Early childhood- the time from birth to 6 years of age.EducationNursery school- the aggregate of all the processes by means of which a person developsabilities, attitudes, and other forms of positive behaviour of positive value in thesociety in which the individual lives.- the storage and retrieval of specific events that once happened at a certain timeand place (Kastenbaum, 1979).- in Piaget's model, it is the most advanced stage of thinking, emerging between11 and 14 years of age. The main characteristic is the ability to think aboutabstractions.- a semi-structured class lead by a professionally trained teacher, sponsored bythe public school system, located in an elementary school for children usuallyfrom 5 to 6 years of age.- a cognitive objective which emphasizes the remembering, either by recognitionor recall, of ideas, material or phenomena; knowledge involves the recall ofspecifics and universals, the recall of methods and processes, or the recall of apattern, structure or setting (AECT, 1977).- government sponsored play groups for young children (3-4 years) in which theemphasis is placed on the"whole child," teaching children to get along with otherchildren and adults and encouraging children to have fun.EpisodicmemoryFormalKindergartenKnowledgePrecausalreasoning- patterns of activity directed towards the intake of food (Johnson and Johnson,1985).- the process by which beliefs, attitudes, environmental influences, andunderstandings about food lead to practices that are scientifically sound,practical, and consistent with individual needs and available food resources(American Dietetic Association, 1973).- characteristic of a kindergarten child's cognitive preoperational stage. Theinability to distinguish between psychological and physical causes, and betweensubjective experiences and objective events (Scarr et al., 1986).NutritionbehaviourNutritioneducation231APPENDIXPreschoolPreschoolersP-1(Primary-1)ProgramevaluationProsocialbehaviourQuasi-experimentalSemanticmemoryValue- generally, a semi-structured educational class lead by an early childhoodeducator, located outside an elementary school and having little or no affiliationwith the public school system. Attendance at a preschool may precedeattendance at an elementary school.- children aged 2 to 6 years, inclusive.- a new term defined by the British Columbia government, Ministry of Education,to replace the term kindergarten in all British Columbia schools.- the process of improving a program through application of analytical andempirical methods to examine the resources and expenditures involved inattaining the programs intentions (Hanson and Schutz, 1981).- behaviour that benefits or aids another person (Scarr et al., 1986).- an approximation to an experiment in which there is some loss of control overthe independent variables due to the real-life research manner in which they aredefined. It involves the use of intact groups of subjects rather than assigningsubjects at random to experimental treatments (Wiersma, 1986).- an individual's system for storing and utilizing information (Kastenbaum,1979).- any characteristic deemed important because of psychological, social, moral oraesthetic considerations (AECT, 1977).232

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