Public Health Nutrition

Research Article

School-based Internet-tailored fruit and vegetable education combined with brief counselling increases children's awareness of intake levels

Resiti T Mangunkusumoa1, Johannes Bruga1, Harry J de Koninga1, Johan van der Leia2 and Hein Raata1 c1

a1 Department of Public Health, Erasmus MC–University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands

a2 Department of Medical Informatics, Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands


Objective Children's fruit/vegetable intake is still below recommended levels. This study applied Internet-tailored advice for schoolchildren and Internet-supported brief dietary counselling (with child and parent) within preventive health care to promote fruit/vegetable intake.

Setting/subjects The study involved 30 seventh-grade classes (16 in the intervention group and 14 in the control group) with a total of 675 children aged 9–12 years, of whom 495 were allowed to participate.

Design A cluster-randomised baseline–post-test experimental design was applied. During school hours, all children completed Internet-administered questionnaires on fruit/vegetable intake and related determinants. Children in the intervention group received immediate online individually tailored nutrition feedback. For each child in the intervention group, a nurse received information concerning the assessment of fruit/vegetable intake via the Internet to support a 5 min counselling protocol to promote fruit/vegetable intake. Children completed a similar post-test questionnaire 3 months after the first assessment. Intention-to-treat analyses were conducted using multilevel regression analyses.

Results A total of 486 children (98% of 495) participated (263 in the intervention group, 223 in the control group); 240 child–parent couples in the intervention group attended the counselling. Awareness of inadequate fruit intake (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.8–5.3) and knowledge of recommended vegetable intake levels (OR = 2.7; 95% CI = 1.8–4.1) were significantly more likely at post-test in the intervention group than in the control group. No significant effects were found on intake or other determinants.

Conclusions A compact, integrated two-component intervention can induce positive changes in knowledge and awareness of intake levels of fruit/vegetables among schoolchildren. To induce changes in intake levels, more comprehensive interventions may be needed.

(Received March 22 2006)

(Accepted August 09 2006)


c1 *Corresponding author: Email