Process evaluation of fruit and vegetables distribution interventions in school-based settings: A systematic review

Area of Science:

• Public Health Nutrition
• Program Evaluation
• Childhood Obesity Prevention

Background:

• Research often overlooks process evaluation in fruit and vegetable (FV) distribution interventions for children.
• Existing studies predominantly focus on intervention effectiveness rather than implementation details.

Purpose of the Study:

• To systematically review implementation research on snack-based FV distribution interventions for school-aged children.
• To identify factors influencing the success and challenges of these programs.

Main Methods:

• Systematic literature search across five databases (Embase, PubMed, ProQuest, Scopus, Web of Science) in June 2019.
• Inclusion of studies focused on implementing FV distribution to children as snacks.
• Risk of bias appraisal using the Critical Appraisal Skills Programme (CASP) tool.

Main Results:

• Most included studies had limited implementation research, lacking theoretical frameworks and robust data collection.
• Key success factors included school community participation, school characteristics, prior knowledge, and parental engagement.
• Challenges comprised delayed FV delivery, funding issues, poor program awareness, time constraints, and food waste.

Conclusions:

• Snack-based FV distribution can increase consumption in children, but effective implementation is crucial.
• Further evaluative research is needed to enhance future school-based FV distribution interventions.