LEARNING OUTCOME: Identify Process Evaluation procedures that can be used to assess the effectiveness, quality and quantity of implementation of a multi-component intervention program.

The purpose of the 5 a Day Power Plus study is to implement and assess the effectiveness of a school-based intervention for promoting increased consumption of fruits and vegetables among multicultural urban elementary school children to reduce future risk of cancer. Twenty schools from one urban school district were randomly assigned to Intervention and Control conditions. A cohort of students, originally in the fourth grade, participated in the program during two school years (1994-96). The Intervention components included school foodservice environmental changes, classroom curricula, family involvement, and food industry support. Process Evaluations were one of the methods used to assess the effectiveness, quality and quantity of implementation of these four inter-dependent areas. Trained observers recorded student choices of fruits and vegetables at lunch and also observed the implementation of the food service intervention. Teachers were observed in classrooms and completed questionnaires and weekly checklists. Students used self-reported scorecards and were asked for their opinions using a survey. Home involvement was assessed by parent return cards. Industry support was assessed by teacher, student and industry surveys. Results were similar in both 4th and 5th grades. Standardized lunch room observations conducted monthly in all schools proved an effective method to follow the progress of the program. Results showed, on average, students in Intervention Schools chose 0.5 more servings of fruit and vegetables at lunch than students in Control Schools. Teachers rated taste testing, snack preparations and home snack packs as the most effective parts of the curricula. The industry component was also highly rated. 45% of the students reported they liked taste testing and snack packs best, while only 5% rated the incentives as most important. However, only 33% of the parents sent return cards to verify they were involved. Process Evaluation is a valuable tool to verify that the program was completed according to protocol, to determine the level of participation and to explain impact on eating habits. Effective, easy-to-use Process Evaluations, such as described here, are feasible and critical for evaluation of all nutrition education programs.