Using several different approaches to deliver nutrition education (multi-component) to children may be more effective than just using one approach (single-component). This summary of a NEL review presents what we know from research about the effects of multiple versus single part nutrition education on what children eat.

Conclusion

There is inconsistent evidence to suggest that multi-component nutrition education interventions may be more effective for improving children’s and adolescents’ dietary intake-related behaviors than single-component interventions. Limited evidence also suggests that multi-component nutrition education interventions that combine classroom nutrition education with a hands-on educational component may be particularly effective.

What the Research Says

• The results of the 14 studies in this review were mixed.
• There was no agreement on whether nutrition education programs with two or more components were either more, less, or equally effective for improving what children ate than programs with just one component.
• Three studies found that using a “hands-on” approach, such as cooking or gardening, along with nutrition education taught in the classroom seemed to be very effective.
• It is difficult to make stronger conclusions, because the results were mixed, and the studies were so different. More research is needed in this area to determine which components, when combined, are most effective.

Background

It has been suggested that nutrition education interventions with multiple different components (i.e., nutrition education provided via two or more methods) may be more effective than single-component nutrition education interventions, as they engage students on a variety of different levels. The objective of this systematic review was to determine the effects of multi- vs. single-component nutrition education interventions on children’s dietary intake-related behaviors.

Conclusion Statement

There is inconsistent evidence to suggest that multi-component nutrition education interventions may be more effective for improving children’s and adolescents’ dietary intake-related behaviors than single-component interventions. Limited evidence also suggests that multi-component nutrition education interventions that combine classroom nutrition education with a hands-on educational component may be particularly effective.

Grade: Limited

Methods

Literature searches were conducted using PubMed, EBSCOhost, Education Fulltext, and Global Health to identify studies that compared multi-component nutrition education interventions to single-component nutrition education interventions.

• Inclusion criteria: published between January 1995 and December 2010; conducted in subjects aged 0–18 years; randomized controlled trials, non-randomized controlled trials, or quasi-experimental studies; subjects from countries with high or very high human development (based on the Human Development Index); subjects who were healthy or at elevated chronic disease risk; published in English in a peer-reviewed journal
• Exclusion criteria: systematic reviews, meta-analyses, narrative reviews, or prospective cohort, cross-sectional, or case-control designs; studies with no control group; subjects hospitalized, diagnosed with disease, and/or receiving medical treatment
• For this review, an intervention is described as a “single-component” intervention when subjects are provided nutrition education using one distinct method. An intervention is described as a “multi-component” intervention when subjects are provided nutrition education via two or more different methods. Some of the included studies also had a control group that received no intervention.

The results of each included study were summarized in evidence worksheets (including a study quality rating), an evidence paragraph, and evidence table. A group of subject matter experts were involved in a qualitative synthesis of the body of evidence, development of a conclusion statement, and assessment of the strength of the evidence (grade) using pre-established criteria including evaluation of the quality, quantity, consistency, magnitude of effect and generalizability of available evidence.

Findings

• Fourteen studies were included in this systematic review; 10 randomized controlled trials and four non-randomized controlled trials. Four studies received a positive quality rating (4 RCTs, 1 non-RCT), and 10 received a neutral quality rating (6 RCTs, 4 non-RCTs).
• Results of the studies were mixed: Six studies found that multi-component nutrition education interventions were better than single-component interventions for improving dietary intake; though, three of these studies had mixed results that differed depending on the outcome being considered.
  • A number of studies showed that multi-and single-component interventions were equally effective for improving dietary intake (two studies, one with mixed results), or, conversely, had no effect on dietary intake (four studies, three with mixed results).
  • Some of the studies included in the review (three studies, two with mixed results) found that single-component nutrition education interventions were better than multi-component interventions for improving dietary intake.
• Three studies that found a multi-component intervention to be better than a single-component intervention included a “hands-on” component, such as cooking or gardening, combined with classroom-based nutrition education.