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The Team Nutrition Pilot Study: Lessons Learned from Implementing a Comprehensive School-Based Intervention.

Author: Elyse Levine

Levine, Elyse, et al. “The Team Nutrition Pilot Study: Lessons Learned from Implementing a Comprehensive School-Based Intervention.” Journal of Nutrition Education & Behavior, vol. 34, no. 2, Mar. 2002, pp. 109–116. EBSCOhost, doi:10.1016/S1499-4046(06)60076-6.

Team Nutrition (TN) is an educational and promotional initiative developed by the US Department of Agriculture to change children's eating behaviors through social marketing techniques. This article reports on the process evaluation of a TN pilot project targeting students in kindergarten to grade 4 and systematically documents the implementation experience. Even with a very short start-up period, schools implemented most components of this multichannel nutrition intervention and formed new, supportive relationships with local media and community partners. School teachers and administrators, along with foodservice professionals, generally expressed support for and satisfaction with TN, citing the positive experience and gains for students. The lessons learned from this study highlight the management and organizational issues involved in a comprehensive intervention. These include the importance of local coordinators to support and create a bridge between teachers and cafeteria staff and to forge links with key external partners. To function effectively, coordinators themselves may need training in coalition building and working with media. Relationships formed with parents, local businesses, other educational institutions, health organizations, and the media offer promise for helping to sustain nutrition education efforts. The TN process evaluation identified multiple ideas for pursuing these partnerships more successfully.


(J Nutr Educ Behav. 2002;34:109-116.)


Health educators and policy makers have long called for institutionalizing nutrition education in schools.[ 1–5] Nevertheless, its inclusion is often left to the discretion of individual districts, schools, or teachers. With limited resources available for multiple and competing concerns, the nutrition education approaches most likely to be pursued will be those that result in positive student impacts and are reasonable to implement. The research literature, however, suggests that the most effective nutrition education approaches, using multiple channels of communication and based on theories of behavior change, are also the most challenging and costly to implement.[ 6] Incorporating such comprehensive initiatives is more likely when the needs, desires, and constraints of implementers are also addressed.

With these goals in mind, the US Department of Agriculture's (USDA) Food and Nutrition Service sponsored a pilot test of Team Nutrition (TN). Team Nutrition is an intervention focused on changing eating behaviors through interactive classroom lessons that are reinforced by activities and messages in a variety of settings. It is designed to reduce fat consumption and increase consumption of fruits, vegetables, and grains, as well as to broaden the variety of foods that are eaten. An outcome evaluation assessed the pilot's impact on meeting these goals,[ 7] whereas the TN process evaluation, and the subject of this article, documents the implementation of the TN program in 7 pilot communities, provides an explanatory context for observed outcomes among students, and offers concrete guidance to schools implementing nutrition education.

The process evaluation relied on both qualitative and quantitative methods to capture a more complete implementation picture. By interviewing stakeholders with semi-structured instruments of open-ended questions, we obtained richer descriptions of their experiences, including the context for their decisions and explanations for their reactions. Data collection also included activity logs completed by the district coordinators and teachers, observations in classrooms and cafeterias, and surveys of teachers and parents. Collectively, this information provides a detailed and comprehensible picture of how the TN implementation unfolded.

Team Nutrition follows the example of recent nutrition campaigns that are based on Social or Cognitive Learning Theory.[ 8–13] Social marketing models also guided the TN pilot implementation. Together they provide a framework for successful health promotions.[ 14] At the same time, applying this framework requires comprehensive interventions targeted to specific audience requirements. Such interventions are relatively costly and logistically complex. Key findings from a process evaluation of the pilot implementation are presented to identify both potential obstacles and problem-solving strategies.


Team Nutrition was designed to support USDA's School Meals Initiative for Healthy Children and consists of two interrelated components. Training and technical assistance provide school nutrition and foodservice personnel with the motivation and skill-based knowledge needed to provide healthy meals that appeal to children and meet the Dietary Guidelines for Americans. They are also intended to provide foodservice managers and staff with a dear vision of their role as integral team members of a comprehensive school nutrition program. Multifaceted nutrition education, the second focus of TN, is delivered largely through schools but includes the home, media, and community to build children's skills and motivate them to make food choices for a healthful diet. In-school education is provided through the use of flexible curriculum modules designed by Scholastic, Inc, in partnership with the USDA. The approach addresses behavioral goals in a manner that engages students and has them routinely apply new information. Students practice making food choices and assessing those choices.

During each of the 2 pilot semesters, implementation schools were expected to teach all 8 or 9 Scholastic lessons in each of 3 modules. Modules are designed for multiple age ranges or grades, and districts targeted an appropriate grade for each. In every TN school, the third module was directed to fourth graders.

Team Nutrition also touches the wider school community. Cafeteria staff and other students were involved through activities linked with the lunchroom, such as information displays, food tastings, and other special events. Parents heard formally about TN through school newsletters and local media coverage. They could participate by getting involved in take-home activities, contributing to classroom events (eg, sending in a recipe), or attending school and community events.

Each TN implementation school was also expected to conduct at least 2 school-wide cafeteria events, 3 parent contact activities, 2 chef activities, 1 district-wide TN community event, and 1 district-wide media event. Although some of these activities could overlap, all schools were expected to conduct at least 5 distinct core activities during each of 2 pilot phases. Finally, TN implementation schools committed to providing at least 10 hours of training for foodservice managers and staff over both pilot phases and to changing menus and food preparation procedures to make lunches consistent with the Dietary Guidelines.

Teachers and foodservice professionals were trained separately and differently. Two on-site teacher training sessions (4 hours each) were provided by USDA's contractor in each district for all TN teachers in phase 1. The first session took place just prior to the start of the intervention, whereas the second was conducted 3 to 4 weeks later to incorporate teacher experiences. Both the training approach and content were uniform across districts. The purpose of the training was to provide an overview of TN and the pilot project, introduce some basic nutrition information, and provide both a rationale and techniques for effecting changes in children's eating behavior. In contrast, districts had considerable latitude in training foodservice managers and staff. All districts included some training on the Dietary Guidelines and menu changes needed to meet the Guidelines, but otherwise topics ranged from low-fat cooking techniques for staff to marketing and public relations skills for foodservice managers.

Introducing TN presented all of the expected challenges of a real-world application. The new lessons competed for limited class time and standardized test preparation. Foodservice staff began with little experience working with teachers as part of a nutrition education team.

In anticipation of these challenges, TN pilot plans considered the needs and interests of specific groups of people. This is a social marketing strategy used in many nutrition education and public health programs.[ 14] For this project, the target groups included students, teachers, foodservice managers and staff, district TN coordinators (TNCs), and school administrators.

Each group had unique preferences and concerns. Students prefer to learn in an interactive and engaging environment and have lunches that taste good. Teachers need to be familiar with basic nutrition concepts so that they are comfortable teaching the curriculum. The possibilities for integrating nutrition activities into other lessons help address teacher needs to balance competing demands on classroom time. Foodservice managers and staff need to learn new meal preparation methods, but they also want to be viewed as making a contribution to the quality of the school experience. School administrators are challenged to juggle limited resources and to motivate staff to assume the additional responsibility of a new initiative. The process evaluation provides useful information on accommodating these various needs.


Site Selection and Characteristics The TN Pilot Implementation Project was designed to assess whether the intervention can be implemented as intended and determine what impact such an intervention has on student eating behavior. It was conducted in a field setting of 7 school districts that were chosen competitively (see Table 1 for district profiles).Their applications indicated a capacity to meet both the intervention and evaluation requirements of the project.

Pilot study schools were recommended by each district, usually in consultation with the principal. However, since schools were nominated as matched pairs and randomly assigned to intervention or comparison groups for the impact evaluation, neither districts nor schools had the final decision on which became a TN implementation school. Among the 7 districts, 19 pilot schools, and almost 300 TN classrooms, there was considerable diversity in the school size and the socioeconomic, ethnic, and racial make-up of students.

Teacher characteristics of particular relevance include total teaching experience, previous nutrition training, and initial attitudes about teaching nutrition. Although their prior experiences varied, a majority of teachers in each district expressed an interest in teaching nutrition and believed in the value of doing so. At the same time, a majority indicated that they did not have sufficient time or resources to teach nutrition.

District foodservice managers had a strong investment in the project, in some instances having initiated the pilot study application. In all 7 locations, the foodservice manager or comparable district-level professional served as the project coordinator or co-coordinator.

Key Evaluation Procedures The USDA provided some classroom materials, training resources, technical assistance, and a stipend to cover evaluation expenses. Pilot participation also imposed special requirements and implementation challenges. These included a short start-up period in the first phase and a condensed, 8- to 10-week implementation period in each phase.

The TN pilot was conducted in 2 phases: once in the spring of 1996 and again in the fall of 1996. Phase 2 was essentially a replication with a new set of students. The 2-phase design provided the opportunity to track changes in implementation that come with experience and additional time for planning.

Through the data collection methods and sources detailed in Table 2, it is possible to describe TN activities in detail, compare TN approaches across pilot districts, and document the reactions of key implementers. Case study reports for each district were developed through a process of compiling, reviewing, and synthesizing information pertinent to these process research questions. District profiles were then compared with attention to explaining or pointing out the context for differences.


Although TN teachers and coordinators valued nutrition education, they encountered a variety of anticipated and unanticipated constraints. Their experiences and lessons offer a tangible map to those involved in similar initiatives. Presented here are key findings and lessons learned with respect to 6 core process evaluation questions.

To What Extent Were the Major Team Nutrition Components Implemented in Each District? Most classroom requirements of the pilot project were met. On average and in each project phase, teachers taught more than 7 of the 8 or 9 lessons from each module. The average duration per lesson taught, across modules, was about 2 hours. Team Nutrition students were exposed to an average of 14.4 hours of lessons in phase 1 and 16 hours in phase 2.

This classroom “dose” is less in total hours but more compressed in terms of total calendar time than that provided in other comprehensive nutrition interventions.[ 15-18] Behavior change theories generally predict that more exposure is better, and existing research indicates that large and stable impacts require considerably more than 15 hours. The dose-response relationship may be more complex, however. Perry et al[ 18] found no differences in fruit and vegetable consumption even after more than 50 nutrition lessons when the primary message was to reduce fat. Definitive conclusions about minimum dose requirements are still not established.

Teachers used the lesson materials (eg, information sheets, magazines, videotapes) about two thirds of the recommended times. They typically cited a lack of time and copying expenses as reasons for not using them more often. Similarly, teachers used the lunchroom activity links slightly less than two thirds of the recommended number of times. No more than half of the teachers rated these activities as effective in supporting TN goals; they were, however, generally positive about student reactions to the activities. Perhaps teachers experience some ambivalence given the out-of-classroom time required by the lunchroom links.

Pilot communities exhibited both variety and creativity in the school-wide and community events implemented to support TN messages. Some districts capitalized on existing activities, whereas others launched entirely new events. Among the activities pursued more frequently were food-tasting events, cooking demonstrations, health fairs, and student performances with a nutrition focus.

All TN schools made efforts to reach parents through school and community events, take-home materials, and the media. In both phases, over 90% of the fourth-grade parents indicated their awareness of TN activities, especially classroom events. Teachers, foodservice managers, and principals all reported hearing from parents about TN. Reflective of these reports is the parent who told a cafeteria manager, “My child actually asked for broccoli at the grocery store.” Parents' involvement occurred primarily through the TN take-home materials (77% in phase 1 and 83% in phase 2). Most parents who used these materials found them interesting, important, and fun. At the same time, one third said that there was not enough time to complete the activities.

Drawing parents to the school or community events proved more difficult. In phase 1, parent participation in any event ranged across districts from 18% to 31%, whereas in phase 2, it was between 22% and 48%. These figures are comparable to those reported elsewhere; for example, in a process evaluation of the High 5 program,[ 19] at least 74% of parents reported using take-home materials, but only 24% of families attended a kick-off event at the school.

In the TN pilot, one parent activity implemented frequently and viewed as appealing was to invite parents to be guests at a school meal. Breakfast was recommended as the meal that most easily fits into the schedules of working parents. Project coordinators noted several other factors that they think affect parent involvement, including language barriers and how events are advertised. Recent research also suggests that training parents to conduct some nutrition activities at school may engage them.[ 9, 13]

Although there is a theoretical rationale for involving parents, the impact of their participation is less clear. Contento et al concluded that parent involvement in school-based nutrition education makes a positive difference for younger children.[ 20] However, some studies focused on older children indicate no impact from parent involvement on student diet or physiologic risk factors.[ 21, 22]

The key message about how to facilitate implementation of a multifaceted initiative is that schools and districts should adequately coordinate the efforts of and provide assistance to teachers and foodservice staff. Teachers need training and/or resources that will provide them with background information on nutrition, particularly if they have not taught nutrition. Research shows that teachers report a lack of nutrition education to be a barrier.[ 6, 13, 23, 24]

Coordinating the acquisition of supplies for classroom and cafeteria activities is also critical as mentioned by many TN school personnel and noted in Probart et al.[ 15] Although TNCs generally served this function, there was some variability in how proactive each coordinator was. Teachers and staff expressed more dissatisfaction when left to their own devices to get supplies.

A second important lesson is to allow reasonable time for planning and implementation. Although TN lessons can be incorporated into other core subjects, thereby reducing competition for classroom time, this requires planning and sometimes coordination among teachers responsible for particular subjects. The tight start-up time and compressed implementation schedule precluded pursuing this option in most TN schools. All TNCs and most teachers were critical of the abbreviated time frames and suggested spreading nutrition lessons and activities over the entire school year instead of one semester.

How Well Was Team Nutrition Received by School Foodservice Managers and Staff, Teachers, and School Administrators? The likelihood that TN and similar interventions will be widely implemented depends, in part, on the importance given to nutrition education and the quality of school food services. School administrators at TN schools consistently stated that nutrition education is valuable. One principal said, “It is as important to teach nutrition as it is the basic academics—to help children form good habits that will last them the rest of their lives.” Ninety-nine percent of teachers surveyed prior to the start of TN also indicated interest in incorporating nutrition activities into their classrooms. Ninety-eight percent agreed that good nutrition can positively affect students' class performances.

However, the content and amount of nutrition education actually offered in the pilot schools prior to TN varied considerably. District policy ranged from having no nutrition education requirement to having a very general requirement. Even among districts with established requirements, considerable discretion is left to teachers.

Not surprisingly, teachers, foodservice managers, staff, and project coordinators reported that TN required a significant effort to implement, but they agreed that it was a very positive experience for the students. Over 80% of teachers across all grades reported that they were satisfied with the Scholastic materials and that the materials were developmentally, educationally, and culturally appropriate for their students. Teachers offered multiple examples of TN's effect on student behavior. Typical of these is a second-grade teacher who remarked, “At the beginning of the year, kids would say ‘no carrots,’ but now they say ‘I want carrots,’ and they eat more fruit than ever before.” Teachers reported that in response to TN, students began to read labels, were interested in the ingredients in their food, and knew about the different food groups.

In both phases, foodservice managers and staff indicated that they felt involved with the TN program and expressed confidence in its effectiveness. Many remarked that they heard students discussing nutrition issues in the cafeteria line. One observed, ”before, they came through the line and just wanted a sandwich and fries, but since the training in the classroom, they are a lot more educated about what their body needs and are eating a lot more vegetables.”

Despite this positive view, time remained a concern. After phase 1, only half of the teachers agreed that the amount of time needed to prepare and deliver TN lessons was reasonable (Table 3). These numbers increased somewhat in phase 2, even though the schedule was tight and teachers spent comparable amounts of time. Similarly, TNCs said that although they plan to continue TN, they will be more selective in choosing activities and will schedule more time to implement them.

Perhaps the most significant recommendation for increasing stakeholder acceptance is to encourage teamwork. With time constraints being a general concern, sharing the responsibilities is a key strategy. Although creating and maintaining a team involves time for recruitment and coordination and a leader with motivational skills, the benefit is a broad sense of ownership and distributed responsibility. Numerous examples of teamwork were reported. Team Nutrition Coordinators noted that building relationships between classroom teachers and foodservice staff should begin early and that future implementations would introduce the 2 groups during initial training sessions. In a couple of pilot districts, the role of the TNC was shared by a curriculum specialist and foodservice manager. Two pilot districts created internships for students in local college nutrition programs to help meet some TN needs.

How were community partners, such as chefs, businesses, and health organizations, recruited and involved in Team Nutrition activities? All of the pilot districts successfully engaged community partners who not only provided material support but also helped to shape the local environment in ways that reinforced TN messages. Although the evaluation activity logs did not adequately capture the supplies and time donated by community partners, the general descriptions indicate that substantial expertise and resources were provided.

A wide range of outside organizations was involved. Partners included chefs, Extension agents, hospital and local health department professionals, wholesale food vendors, and food store managers. Assistance sometimes came from untraditional sources, such as insurance companies.

Outreach to community partners was a relatively new activity, but TNCs generally found that businesses and agencies were willing to participate if provided with well-defined responsibilities. Of the community partners interviewed, many reported that time constraints were also an issue. However, almost all of the respondents expressed the desire to continue working on TN activities and viewed the partnerships as a natural fit with their organization's goals.

Several clear recommendations for maximizing the value of community partners emerged from the study. Some TNCs looked to existing networks and relationships to engage in partnerships. For example, suppliers doing business with school food services were approached for donations to food-tasting events. Although popular, chef events were difficult to arrange given the busy and unpredictable schedules of these professionals. Advance planning and securing a back-up chef were important to the success of this activity.

How successful were the districts in garnering media attention for Team Nutrition efforts? Although working with the mass media was a relatively new experience for the pilot districts, all were able to generate television and newspaper coverage for their school-wide and community activities.

Media coverage of TN successfully reached parents. About half of the parents surveyed in each phase reported hearing and/or seeing some TN news coverage. This occurred most often by newspaper in phase 1 and through television in phase 2.

Team Nutrition Coordinators pointed out that because working with the media was an unfamiliar task for most, some up-front training or technical assistance would have been useful. In addition, they suggested relying on any media relationships that already exist with community partners, school district officials, or TN team members.

What Kinds of Organizational Features Characterized Team Nutrition Implementation Approaches, and How Did Stakeholders React to Them? Successful implementation of a comprehensive intervention requires skillful leadership, management, and coordination at many levels. The USDA required a coordinator in each pilot district to manage implementation and evaluation activities. However, each district was free to decide who and how many people should carry out the coordinator responsibilities. A couple of districts divided the job between 2 or 3 people, one with a regular foodservices background and another specializing in curriculum development. Although sharing the TNC role should reduce the workload assumed by any one person, pilot coordinators uniformly reported that project coordination required more time than anticipated. Most observed that the job required the commitment of a full-time equivalent.

Another organizational difference between pilot communities involved who made decisions about the kinds of school-wide and community events to be implemented. In some districts, TNCs individually or with their project team made the choices and replicated them across pilot schools. Other districts encouraged more decentralized decision making, which resulted in events unique to each school. This difference in approach reflected a more general variation among districts in the autonomy typically provided to schools and teachers.

There is evidence that satisfaction with some components of TN among teachers and foodservice staff is a function of their burden. For example, in districts in which the TNC organized the purchase and preparation of food for classroom tasting events, teachers reported general satisfaction. This reaction stands in contrast to teachers who did the shopping and preparation themselves and subsequently were more likely to complain about the effort and wasted food.

Whether these teachers would have reacted positively with more assistance is unknown. A recent study indicates that the inclusion of hands-on activities can present additional barriers to teachers.[ 25] Since such experiences are important to behavior change, however, it will be important to obtain teachers' support. Recruiting parents and college nutrition students may make these activities more feasible, as demonstrated in some pilot sites and by Liquori et al.[ 13]

In general, coordinators are likely to find that responding to the local culture and taking time to build a consensus have long-term benefits. Two pilot districts stand out as having a methodical approach to introducing TN to teachers, food-service staff, administrators, and community partners. The resulting rapport provides a foundation for integrating TN more firmly.

What Were the Key Challenges for Institutionalizing Team Nutrition or Nutrition Education in General, and What Were the Suggestions for Overcoming Them? Successful implementation will aid efforts to establish a comprehensive nutrition education initiative but does not guarantee institutionalization. The challenges most often reported are the competition for scarce resources, both time and dollars.

Integrating nutrition curriculum across the full range of school subjects offers a means of reducing the conflict with other academic priorities. This approach is recommended by major nutrition associations[ 3, 20] and is demonstrated in recent research.[ 8] The TN classroom modules are designed for such integration but were most often implemented as part of health lessons or a separate subject. This is consistent with national survey data showing that 74% of kindergarten through fifth-grade teachers follow the same pattern for nutrition curriculum.[ 26] Most TN teachers reported that they intend to pursue integration in the future, but doing so requires additional planning time and a year-long implementation period. Probart et al also reported on the importance of setting aside common planning time to facilitate subject integration.[ 15]

Dependable and adequate financial support is also prerequisite to institutionalizing a comprehensive nutrition education approach. The starting point is to have a clear picture of costs associated with ongoing operations, along with potential funding sources. Although the TN pilot was not intended to produce this, a more recent USDA initiative will offer implementation guidance. Team Nutrition pilot districts demonstrated the potential value of partnerships. Since the project ended, districts have pursued a variety of grant opportunities and/or worked to formally adopt TN as part of the curriculum requirement.

Curriculum adoption opens the door to some funding but is by no means a certain or easy goal. The finding that TN administrators, teachers, and parents value nutrition education does not ensure curriculum adoption. Team Nutrition Coordinators in several districts emphasized the importance of demonstrating the knowledge, skills, and behavioral improvements an educational package like TN can provide. Nutrition education research may be the bridge to nutrition education policy.


Because widespread institutionalization of nutrition education is still a long-term goal, proponents need to make optimal use of the opportunities available. This means not only choosing interventions that work but also ensuring that they are successfully implemented. The key findings and lessons learned from the TN pilot implementation evaluation stress the importance of providing a support system that reduces the burden for front-line practitioners—teachers, foodservice managers and staff, community partners, and other “Team” members. Future nutrition education campaigns can aim to be more user friendly by borrowing from social marketing and customer satisfaction models that address the needs of our immediate (implementers) and ultimate consumers (in this case, school-aged children).

The labor required to provide and coordinate this level of support and the combination of skills needed—to foster teamwork and develop networks, etc—are considerable. Several TN implementation sites shared the coordination among specialists and/or sought out interns from local colleges to help meet the time and cost demands of this intervention. Adding parents to the mix of active implementers (ie, training them to teach specific school-based activities versus inviting them to attend occasional events) may also bolster resources.[ 9, 13] At the same time, actively involving parents in treatment delivery helps to address the goal of having them behave as role models. The importance of parents for changing the nutrition behavior of school-aged children warrants future research on how to best engage them.

DMU Timestamp: February 03, 2020 23:30

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