Suggestions for a programme to support families establish healthy eating habits
A large majority of respondents agreed that the Scottish Government should be looking beyond providing payments to families and seek to support families in establishing healthy eating patterns. Several strands to this programme were identified, including:
- A nationwide campaign
- Education through resources and workshops
- Accessibility and affordability of health food
- Other views on wider support for improving diet and nutrition
- Evidencing the impact of the programme.
Each of these points is explored in further detail below.
4.1 A nationwide campaign
Many respondents believed that the Best Start Food campaign should be part of a nationwide campaign aimed at all families, promoting healthy eating and lifestyle change. This should be a 'whole country' approach, adopting consistent messaging and branding. Specific ideas included engaging a high-profile personality to represent the campaign ( e.g. a famous chef) and creating a television advertisement (possibly using cartoons to engage both parents and children). It was suggested that this campaign be disseminated through different media channels, including social media.
Some respondents thought a new nationwide campaign could be linked to existing strategies and programmes. The most frequently mentioned one was Eat Better Feel Better. For example, one respondent suggested that 'the Eat Better Feel Better branding could be built on, with a specific campaign for pregnant / new parents'. Other campaigns and strategies suggested by respondents included: Setting the Table; the First Steps Nutrition Trust website; the Healthy Weight Strategy; the Eatwell Guide; the Baby Box; Inch By Inch For Scotland; Menu for Change; the Scottish Grocers Federation Healthy Living Programme; and the Scottish Attainment Challenge.
4.2 Education through resources and workshops
A range of educational resources and activities were suggested by respondents, involving several partners. The main two elements were providing information and resources to families and providing or cooking lessons for parents.
A range of stakeholders could be involved in an education programme:
‘Health visitors used to have weaning groups which taught healthy family cooking for babies - these were stopped due to funding. […] Many families need this one to one advice and demonstration.’ (Health Visitor)
‘My daughter rediscovered her need for fruit consumption after she researched to complete her poem on fruit, health & wealth...’ (Parent)
‘To have an even greater impact, involve parents/carers
too. Cook with the children in school/nursery and set up after
school/Saturday clubs where parents can come along for Big Chef
Little Chef […]. Make these open to everyone, but
target in particular vulnerable families who use BSG/ BSF’ (Third sector/ community organisation)
‘The families we spoke to were interested in more availability of cookery classes for parents, linked to Best Start but open to everyone and covering family foods from weaning age right through to adult meals. It was also highlighted that the social aspects of classes like this in communities can be very important, especially as research shows new parents can become isolated.’ (Third sector/ community organisation)
It's important to align this work with the wider [dietary] and obesity strategy being developed by the Scottish Government, and which retailers are already heavily engaged with. Our members already promote healthy products, provide nutritional information, and have reformulated products to ensure consumers can make healthy choices. Aligning with the existing work in this area is likely to be the most effective approach. (Scottish Retail Consortium)
4.2.1 Information and resources
Many respondents suggested providing meal ideas, recipe cards or a Best Start Foods cookbook as a way to support families in cooking nutritious meals. These should use easily available, affordable and seasonal ingredients that can be purchased through the Best Start Foods smartcard. Other resources suggested were: information on diet and nutrition, food storage, healthy lifestyles, and budgeting.
Some respondents suggested that resources could be posted to families alongside the smartcard, as well as being distributed through retailers and other partners. The idea of an App where families can access these resources – the same where families can also manage their smartcard and provide feedback – was particularly popular. Some respondents also mentioned a range of social media – including Facebook, YouTube or Instagram – as alternative channels to distribute information.
‘Simple advice needs to be given on what to buy with the Best Start Foods allowance, what could be cooked from the purchased items, and what portion sizes are appropriate for babies and young children. This advice needs to be consistent and the same from everyone: from health visitor to midwife to retailer’. (Obesity Action Scotland)
4.2.2 An education programme for the whole family
Many respondents suggested an education programme for families consisting of cooking lessons and demonstrations, and weaning classes for parents, as well as education on healthy eating for children. These would provide knowledge, practical skills and confidence for families to adopt healthy eating patterns. A range of stakeholders were identified that could help deliver such a programme, some of whom were already delivering something similar. In particular, the role of health professionals, early years practitioners, statutory services, the community and voluntary sector ( CVS) and retailers were emphasised.
Many respondents identified health professionals – particularly Health Visitors, midwives and GPs – as key points of contact with families. It was suggested that health professionals can refer families to appropriate sessions in their communities, organise weaning groups and other peer support groups, or even offer one-to-one support and advice.
The potential role of early years providers and schools was also highlighted by many respondents. NHS Health Scotland cited research evidence suggesting that interventions in early care settings lead to positive changes regarding children's healthy behaviours.Respondents believe that healthy eating patterns could be promoted to the whole family through: open days, breakfast clubs, parent lunches and after school meal clubs, as well as snack provisions. Respondents also emphasised the importance of teaching children from a young age, by including education on healthy eating in the school curriculum. Some respondents suggested that education on healthy eating should be included in training programmes for teachers and early years practitioners.
Many respondents saw a role for the voluntary and community sector in delivering a family cooking programmes and healthy eating initiatives around Best Start Foods. Benefits of community-based approaches that were identified by respondents included: creating social networks of peer support, the benefits of place-based interventions, and drawing on the existing knowledge and resources of local organisations.
Finally, many respondents saw a role for retailers in supporting families to improve their diet and nutrition, over and beyond promoting Best Start Foods. As well as distributing Best Start Foods educational resources, such as recipes and information leaflets, respondents believe that retailers could offer cooking demonstrations and taster sessions in stores for the whole family. Another point that was made by some respondents is the need for retailers to more actively market healthy products – beyond Best Start Foods products – and reduce their marketing of unhealthy ones.
4.3 Accessibility and affordability of healthy food
Some respondents pointed out that Best Start Foods payments, awareness-raising and education are insufficient as long as some low-income families continue to face 'food deserts' – i.e. the lack of affordable healthy food in their area. A solution that was suggested was to support local and sustainable food initiatives to reach a wider population. These include: local farmers, food co-operatives, social enterprises, and vegetable box schemes. Campaigns around the right to food such as 'Seat at the Table' by Nourish Scotland were mentioned as already working in this area. The possibility to negotiate discounts on Best Start Foods with a range of retailers was also mentioned by a few respondents.
‘Improving access to a healthy and affordable diet by identifying “food deserts” and then consider with retailers and local planners how best to provide food in an economical and sustainable way. Best Start Foods in the initial step on that journey but is extended and encompass nutritional requirements across the lifespan.’ (Deep End GPs)
4.4 Other views on wider support for improving diet and nutrition
Other views mentioned by a few respondents included:
- Making sure families are involved in the design of programme from the beginning
- Helping families access cooking utensils and adequate food storage facilities
- Offer the programme to all families, not just those in receipt of Best Start Foods or Best Start Grant
- Make an explicit link between healthy eating and physical exercise.
4.5 Evidencing the impact of the programme
Many respondents argued that the evidence gathered should cover, at least: the uptake of the programme, its impact on families and its impact on children's health. The need to include views from early years providers and schools, health staff and retailers was also suggested by some respondents.
Some respondents identified the need to measure families' participation in broader educational initiatives as well as the reach of the educational resources developed. Regarding the latter, it was suggested that for App-based or online resources, the number of visits to the App or website could be monitored. Uptake data could then be contrasted with the outcomes achieved by the programme.
Health outcomes for children were identified by many respondents as important evidence to include in order to evidence the impact of the programme. Quantitative, longitudinal ( i.e. over time) analysis was the preferred approach, with data prior to the introduction of the programme being used as a baseline. Suggested sources of data included: ISD Scotland, data gathered by Health Visitors or GPs from a sample of participants, the national Maternal and Infant Nutrition Survey, or the Scottish Household Survey. Indicators of health that were frequently mentioned were: childhood obesity rates, the body mass index ( BMI), and dental health.
Gathering evidence of the impact of the programme on families was also mentioned by many respondents. Two complementary strands of evidence from families were identified in the responses. Firstly, many respondents suggested gathering in-depth, qualitative data from families regarding their journey through the programme, their experiences, and the impact it has made to their confidence and their choices. It was suggested that this could be presented in the form of case studies, videos or blogs. Secondly, more quantitative data on changes in consumption patterns within families was also suggested. This would seek to identify how the programme influenced: which products were bought, fruit and vegetable intake, and the percentage of a family's budget spent on food. It was believed that this data would be best gathered through surveys and questionnaires.
The views of health professionals, early years practitioners and teachers, and community services were also seen by some respondents as useful evidence regarding the impact of the programme. In particular, it was suggested that evidence could be sought from early learning centres or schools regarding the impact of the programme on children's educational attainment.
‘There have been evaluations of Healthy Start but these have been mostly qualitative and have failed to determine how food vouchers are spent, how they contribute to family eating patterns and any benefit the scheme may have had on health and wellbeing.’ (First Steps Nutrition Trust)