Public Health Analysis

Public Health Analysis

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Public Health Analysis

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Public Health Analysis

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“Analysing the impact of operating vegetable and fruit garden on the students fruit and vegetable intake behaviour in the low socio-economic Australian schools”. 


Research questions

What is the impact of having vegetable and fruit gardens in low socio-economic schools on the dietary intake of students in that school?
How effective are the existence of vegetable and fruit gardens in improving the dietary intake of children studying in low socio-economic schools of Australia?
What is the difference in student’s dietary intake of schools having gardens and schools not having the gardens in the low socio-economic zone of Australia?
What are the challenges related to enhancing the fruit and vegetable dietary intake for students in low socio-economic schools of Australia?
What are the suitable recommendations for improving the fruit and vegetable dietary intake for students in low socio-economic schools of Australia? 

Since ancient believes along with scientific evidential support it is proven that fruits and vegetables are one of the essential dietary elements or foods that help in controlling poor health effects by increasing immunity, providing essential nutrition’s, and minimizing the risk to diseases[1]. In the recent era, there are more and more interventions and activities to improve the health diet consumption that includes fruit and vegetables as major components of the nutritious diet. As per WHO studies, food and vegetables can minimise the risk factors related to obesity, hypertension, stroke, cardiovascular disease, diabetes and several types of cancer producing elements. The low fibrous diet (no fruits and vegetables) is one of the top ten global mortality risk factors[2],[3].
While studying the social determinants affecting the dietary behaviour of people it was proven that poverty, low income, unemployment and lack of proper health education are major social determinants that lead to poor dietary consumption in adults as well as children. It was also indicated that low socio-economic regions persist the habit of poor diet resulting in high rate of infections and diseases in these regions. The children living in low socio-economic zones of developed countries like Australia, Untied States and the United Kingdom show a very low daily fruit and vegetable intake with only 224g/day due to bad eating habits containing foods like chips, chocolates, biscuits and trans foods[4].
The school-based community gardens are one such practice that helps to re-establish the traditional practice of eating and developing health food relationships for children[5]. The viewpoint of feeding children with good eating habits and diet along with education in schools, there are school gardens established by public and private sector to maximise the healthy eating habit in initial ages of life. The school gardens containing fruits and vegetable targets to improve the eating habits, enhance nutritious diet, minimise risk to diseases and pollution to overcome the increasing mortality rate for future generations[6].
As per biological and behavioural aspects the overall physical, mental and psychological development of human’s occur at the age of 5 to 17 years, therefore, the behaviour developed within this period becomes a lifetime habit of the individual. Hence, getting children involves in healthy eating habits will assure an increased life expectancy1. The research of indicates that school-based health programmes and interventions are working as good measures to control health inequalities in children. The existence of school-based vegetable and fruit gardens help to enhance the fruit and vegetable dietary intake in children. However, developing school gardens persist potential to improve the eating habits of children but there is a lack of research and experiments confirming the impact of this practice[7].
As school gardening is an innovative practice there are missing literature sources to confirm the positive impact of school gardening on the dietary habits of children. Secondly, there is less focus on analysing the dietary behaviour of children living in low socio-economic zones. There are very less random controlled trials that analyse the impact of school gardening on the dietary impact of specific regions children’s especially belonging to the low socio-economic group. Further, there are researches only comparing the dietary habits of boys and girls living in remote regions 3 or only analysing the lunchtime vegetable intake habits of children, a recent study 6implemented researches on either fruit or vegetable intake, not both together [8].
In the research field, the low socio-economic regions somehow due to unclear reasons, get neglected in health promotions studies related to dietary habits. However, even the available research data on school gardening and dietary behaviour of children limit sample size as well as time duration for research 1,[9],[10]. All the above-mentioned literature gaps are governed in the current research making it a unique and exception research work. A comparison of student dietary habits of low socio-economic schools having vegetable and fruit gardens with schools not having such gardens will provide a complete outlook on the impact of the effective gardening practice on the food eating habits. Further, an appropriate sample size and workable research time also implemented in this research. 
Rationale of research
Due to lack of specific research sources on analysing the impact of fruit and vegetable gardens in low socio-economic schools of Australia as well as lack of experimental research on the impact of school gardening on the dietary habit of students in low socio-economic schools, the research focuses specifically on analysing the effect of fruit and vegetable garden presence on the fruit and vegetable intake habits of children studying in low socio-economic schools compared to intake habits of children in low socio-economic schools not having fruit and vegetable garden. 
Research plan
Study design
The research method will involve the use of descriptive study design to perform a comparative analysis on the basis of the survey. The descriptive design is supported with positivism research philosophy and deductive research approach that will initiate an objective based research along with a hypothesis development to observation making study[11].
Participants and sample size
The Non-probability sampling technique will be employed in research to select low socio-economic schools from the two major low-socio economic locations in Australia[12]. These regions will be selected as per the Australian Bureau of Statistics (ABS) released Socio-Economic Indexes for Areas (SEIFA). The five selected regions are Belyuen and Napranum that belongs to the Northern Territory and Queensland of Australia that is considered as most disadvantaged areas of the country[13].
The participants of research will be ten low socio-economic schools randomly belonging to these two regions. These ten schools will be distributed into two research groups that are Research group –I, 5-low-socio economic schools having fruit and vegetable gardens existing minimum from last 1 year and Research group-II (control group), 5- low socio-economic schools having no fruit and vegetable gardens. The schools having independent and existing vegetable and fruit gardens will only be selected as Research group-I and schools having an absence of such gardens will be selected as Research group-II or control group.
A large sample size of (n=200) students from each group belonging to age group 7 to 10 years will be taken as research sample to analyse their fruit and vegetable dietary intake habit. It means the testing sample group (Research group-I) will have n1 =200 participants and control sample group (Research group-II) will have n =200 participants. The overall sample size will be 400.  
Study procedure and participant recruitment
For the purpose of initiating the research, a letter will be forwarded to the respective authorities of participating schools as well as parents of the sampled children to gather informed consent. Further, a permission letter from specific area councils of all the ten schools will be collected to obtain a legal permission for performing research activity. After obtaining permission from schools and parents an information sheet containing research details will be forwarded to the authorities that will provide authenticity to the research work.
After recruiting the research participant a demographic analysis will be performed to determine the average age, height, body height, sex and gender of the participant children (Test-1, baseline measurement). The statistical tools will be implemented to measure the average dynamics and dimensions of both the research group (control and experiment group) separately.
The measurement of dietary intake using specific tools will provide quantitative data that will be collected and managed for further analysis by the researchers. The researchers will collect data itself in participating school premises. The research will be performed in two experiments, the first experiment will be baseline measurement and the second experiment will be dietary measurement within seven days for next 24-hours.
As the research involves human participation as a sample population, therefore, the National Statement on Ethical Conduct in Human Research Guidelines will be followed to provide ethically reliable research. These guidelines procedures will protect the autonomy of research participants and will provide beneficence understanding to researchers. There will be no forceful participation and participants will be accomplished with sovereignty to vacate research at the time as per their will. Further, the participant’s consent will be an ethical priority of research as per National Statement Content. Lastly, the confidentiality of research data will be maintained as per the Data Protection Act 1998 because research contains biological and personal information about participants. The research monitoring process will involve checking the reliability of source information, the validity of measuring instruments, and collecting evidential proof of research conduct to support the overall ethical principles in research.
Measures and Instruments

Measurement Tool

Age-group of participants

Measurement outcomes

Assessment method

A Child Nutrition Questionnaire
(7-day food checklist)[14]

7-10 years

1) Fruit and vegetable intake and noncore foods and beverages
2) Environment, knowledge and behaviours associated with these foods

1) Seven-day diet checklist
2) Brief nutrition questionnaire completed by child

The measurement tool for experiments in research is “A child Nutrition questionnaire” that will be used in research is a 14-item questionnaire developed to fulfil the purpose of getting a dietary pattern of participants as well as knowledge on attitude and behaviours related to healthy eating (Test-2). This tool will help to measure the key nutritions and noticeable increases in any specific food consumption that can be vegetables, fruits, water, sweetened beverages etc.  The response pattern involves the use of five-point Likert scales and frequency difference between the current and previous intake. A twelve score is involved for questionnaire distributed in five categories. The participants will be directed to complete the 7-day food checklist that will determine the consumption of vegetables, fruits, water, sweetened beverages, noncore food items and food plus parameters. This test will be completed by the participant (students) themselves within provided time duration[15]. 
Validity and reliability
There are three most effective dietary intake measurement tools for children belonging to age group 5- 15 years that are A child Nutrition Questionnaire, Children’s Dietary Questionnaire (CDQ) and School Checklist. These three tools can be considered effective as per research requirements but the School Checklist involved the purpose of determining the energy gain from consumed food that is not suitable for the present research purpose. Out of other mentioned tools that are Child Nutrition Questionnaire and CDQ, where the CDQ test is usually performed parents or children but the Child Nutrition Questionnaire is more reliable and efficient performed by children themselves. Further, CDQ holds face, construct, concurrent validity but the Child Nutrition Questionnaire persist face, criterion, concurrent validity as well as reliability. The reliability of child nutrition questionnaire was estimated using 95% confidence intervals and intraclass correlation coefficient (ICC) for the baseline measures Test- 1(demographic analysis) and Test-2 (questionnaire test) of participants[16],[17].  
Data analysis
The collected research data will be analysed using SPSS to determine the mean, median and standard error indicating statistical significance and error in the data obtained from Test-1 and Test-2. Further, the average score of fruit and vegetable consumption within seven days duration by two research groups will be compared by using T-test and chi-square test determining the difference in dietary intake patterns of two research groups. 
Significance of study
The research on analysing the impact of vegetable and fruit gardening in school on the dietary intake habits of students will help in determining the possible outcomes of school gardening effect on the overall healthy eating habits as well as the impact of environmental changes on the attitude of children. This study is essential to understand the importance of school gardening in low socio-economic zones. The expected outcomes of study should involve a better fruit and vegetable dietary intake by student’s having availability of fruits and vegetables in school campus indicating a cost effective, reliable and healthy approach. This will help to understand the importance of school gardening for improving the dietary habits to students. Hence, the research persists potential to improve the dietary habits of low socio-economic children. Further, the research will work as valuable literature source for future researches related to this research topic. The research will add a good literature source for studying the impact of school gardening practice in low socioeconomic schools of Australia. 
[1] Brownson RC, Baker EA, Leet TL, Gillespie KN, True WR. Evidence-based public health. Oxford University Press; 2010 Nov 3. 
[2] Du Pre A. Communicating about health: current issues and perspectives. 
[3] Hoelscher DM, Springer AE, Ranjit N, Perry CL, Evans AE, Stigler M, Kelder SH. Reductions in child obesity among disadvantaged school children with community involvement: the Travis County CATCH Trial. Obesity. 2010 Feb 1; 18(S1):S36-44. 
[4] Craig LC, McNeill G, Macdiarmid JI, Masson LF, Holmes BA. Dietary patterns of school-age children in Scotland: association with socio-economic indicators, physical activity and obesity. British journal of nutrition. 2010 Feb 1; 103(03):319-34. 
[5] Oxenham E, King AD. School gardens as a strategy for increasing fruit and vegetable consumption. J Child Nutr Manag. 2010; 34(1). 
[6] Ratcliffe MM, Merrigan KA, Rogers BL, Goldberg JP. The effects of school garden experiences on middle school-aged students’ knowledge, attitudes, and behaviors associated with vegetable consumption. Health promotion practice. 2011 Jan 1;12(1):36-43. 
[7] Nutbeam D, Harris E, Wise W. Theory in a nutshell: a practical guide to health promotion theories. McGraw-Hill; 2010.
[8] Blas E, Kurup AS. Equity, social determinants and public health programmes. World Health Organization; 2010. 
[9] Christian MS, Evans CE, Nykjaer C, Hancock N, Cade JE. Evaluation of the impact of a school gardening intervention on children’s fruit and vegetable intake: a randomised controlled trial. Int J Behav Nutr Phys Act. 2014 Aug 16;11:99. 
[10] Gibbs L, Staiger PK, Johnson B, Block K, Macfarlane S, Gold L, Kulas J, Townsend M, Long C, Ukoumunne O. Expanding children’s food experiences: the impact of a school-based kitchen garden program. Journal of nutrition education and behavior. 2013 Apr 30; 45(2):137-46. 
[11] Saunders, M., Lewis, P., and Thornhill, A. Research Methods for Business Students, (6th ed.) London: Pearson; 2009 
[12] Truscott, D. M., Smith, S., Thornton-Reid, F., Williams, B., Matthews, M. A cross-disciplinary examination of the prevalence of mixed methods in educational research: 1995-2005, International Journal of Social Research Methodology, 2010; 13(4), pp. 317-28. 

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