To describe the rationale, development and implementation of the quantitative component of evaluation of a multi-setting, multi-strategy, community-based childhood obesity prevention project (the eat well be active (ewba) Community Programs) and the challenges associated with this process and some potential solutions.

ewba has a quasi-experimental design with intervention and comparison communities. Baseline data were collected in 2006 and post-intervention measures will be taken from a non-matched cohort in 2009. Schoolchildren aged 10–12 years were chosen as one litmus group for evaluation purposes.

Thirty-nine primary schools in two metropolitan and two rural communities in South Australia.

A total of 1732 10–12-year-old school students completed a nutrition and/or a physical activity questionnaire and 1637 had anthropometric measures taken; 983 parents, 286 teachers, thirty-six principals, twenty-six canteen and thirteen out-of-school-hours care (OSHC) workers completed Program-specific questionnaires developed for each of these target groups.

The overall child response rate for the study was 49 %. Sixty-five per cent, 43 %, 90 %, 90 % and 68 % of parent, teachers, principals, canteen and OSHC workers respectively, completed and returned questionnaires. A number of practical, logistical and methodological challenges were experienced when undertaking this data collection.

Learnings from the process of quantitative baseline data collection for the ewba Community Programs can provide insights for other researchers planning similar studies with similar methods, particularly those evaluating multi-strategy programmes across multiple settings.

To identify lifestyle and sociodemographic risk factors of overweight among male college students.

A retrospective cohort study.

Annual health checkup in a single university in Japan.

Male students who underwent two successive health checkups from their third school year between 2000 and 2007 and whose BMI at baseline of this study was 22·0 kg/m2 or more (n 4634).

During the 1-year follow-up, 598 students (12·9 %) reached the study endpoint, i.e. more than a 5 % increase in BMI. Independent risk factors for substantial BMI increase included infrequent exercise (OR = 1·33; 95 % CI 1·11, 1·60), no or infrequent alcohol drinking (OR = 1·30; 95 % CI 1·08, 1·57), frequently skipping breakfast (OR = 1·34; 95 % CI 1·12, 1·61), preference for fatty food (OR 1·36; 95 % CI 1·04, 1·78) and living alone (OR = 1·23; 95 % CI 0·99, 1·52). Students were readily stratified according to risk for substantial BMI gain by counting the number of their risk factors. OR (95 % CI) for the risk between the no risk factor group and students with two, three, four and five risk factors were 1·61 (0·96, 2·70), 2·24 (1·34, 3·75), 2·42 (1·39, 4·23) and 6·22 (2·58, 15·0), respectively.

These data suggest that avoidance of certain risk factors in college life is associated with a decrease in incidence of overweight among male students.

To evaluate the feasibility and effectiveness of a pilot family-based newsletter intervention to increase fruit and vegetable (FV) consumption among adolescents.

Family-based, two-group randomised control trial with baseline, post-intervention and follow-up measures. The intervention group received two FV newsletter packs over a 1 month period by postal mail. Social cognitive and behavioural choice theories provide the theoretical framework for the design and development of intervention materials. Control families were provided with all intervention materials at the end of the study. Adolescent FV consumption was assessed by an FFQ. Adolescent-reported barriers to eating FV, FV habits and preferences were the secondary outcomes, along with parent FV consumption, and parents reported knowledge, encouragement, home availability and accessibility of FV. Repeated-measures ANOVA was used to detect differences in behavioural and psychosocial outcomes between groups, time and group-by-time.

East Midlands, UK.

Forty-nine parents and adolescents aged 12–14 years.

Process evaluation indicated high reach, dose acceptability and fidelity of the intervention. At post-intervention and 6 weeks later at follow-up, adolescents in the intervention group had significantly higher fruit: (P < 0·01) and vegetable (P < 0·05) consumption and higher preferences for vegetables (P < 0·01), compared with the control group. At post-intervention and follow-up, parents in the intervention group had significantly higher fruit (P < 0·001) and vegetable (P < 0·01) consumption and reported higher accessibility of fruit and vegetables (P < 0·001), compared with those in the control group.

Family-based, newsletter interventions promoting FV consumption to adolescents appear to be feasible and effective at increasing FV consumption.

Valid and simple instruments to assess physical activity (PA) in specific populations are required for health-related research. The aim of the present study was to assess the validity of the Bouchard activity diary (AD) in Spanish adolescents using an activity monitor to compare total PA and moderate-to-vigorous PA (MVPA) obtained by both instruments.

Sixty-one Spanish adolescents, aged 12–16 years, completed the Bouchard AD and wore the ActiGraph activity monitor for three consecutive days. Validity was assessed with the Spearman correlation coefficient (ρ), the Bland–Altman method and the κ coefficient.

Thirty-seven adolescents were included in the final analysis. Correlations between the activity monitor and the AD administered over the three days (Thursday–Saturday) were moderate (ρ = 0·33–0·35, P < 0·05) or non-significant for total PA and moderate (ρ = 0·36, P < 0·05) for MVPA. Correlations between the two methods were progressively lower for each subsequent day of testing, for both total PA and MVPA. The Bland–Altman plot illustrated that the Bouchard AD overestimated MVPA (mean difference −32·05 (sd 74·56) min; 95 % limits of agreement 109·61, −173·31 min). Agreements for classification into MVPA tertiles and accordance with the international recommendations of MVPA were fair and moderate, respectively, for the 3 d means.

The Bouchard AD has reasonable validity to assess total PA and MVPA in Spanish adolescents. The results show lower levels of agreement on the third day but it is not clear if this is due to design features (weekday v. weekend) or to participant compliance with the survey or the activity monitoring protocol.

We evaluated the effects of peanut consumption on lipid profiles, atherogenic index of plasma (AIP) and CHD risk in hypercholesterolaemic men.

Randomised crossover clinical trial.

Participants were randomly assigned to two groups. They were asked to consume peanut supplements (about 77 g) with their habitual diet for 4 weeks.

Fifty-four hypercholesterolaemic men with total cholesterol (TC) concentrations between 200 and 350 mg/dl.

Compared with the habitual diet, peanut supplementation of the habitual diet significantly reduced TC/HDL cholesterol (HDL-C) ratio (mean 1 (se 0·3) P = 0·001) and LDL cholesterol (LDL-C)/HDL-C ratio (mean 0·7 (se 0·2); P = 0·001). Peanut consumption increased HDL-C (mean 6·1 (se 1·5) mg/dl; P < 0·001) and total antioxidant capacity (TAC) (mean 1·2 (se 0·6) U/mL P = 0·04). In addition, peanut consumption significantly reduced the AIP (mean 0·1 (se 0·03) P = 0·01) and CHD estimated risk over 10 years based on systolic and diastolic blood pressures (mean 1·4 % (se 0·5 %) P = 0·004 and mean 2·2 % (se 0·5 %) P < 0·001, respectively).

Short-term peanut consumption might improve lipid profiles, the AIP and CHD risk in free-living hypercholesterolaemic men.

To evaluate the effectiveness of a computer-generated tailored intervention leaflet compared with a generic leaflet aimed at increasing brown bread, wholegrain cereal, fruit and vegetable intakes in adolescent girls.

Clustered randomised controlled trial. Dietary intake was assessed via three 24 h dietary recalls.

Eight secondary schools in areas of low income and/or high ethnic diversity, five in London and three in the West Midlands, UK.

Girls aged 12–16 years participated (n 823) and were randomised by school class to receive either the tailored intervention (n 406) or a generic leaflet (n 417).

At follow-up 637 (77 %) participants completed both baseline and follow-up dietary recalls. The tailored intervention leaflet had a statistically significant effect on brown bread intake (increasing from 0·39 to 0·51 servings/d) with a smaller but significant increase in the control group also (increasing from 0·28 to 0·35 servings/d). The intervention group achieved 0·05 more servings of brown bread daily than the control group (P < 0·05), which is equivalent to 0·35 servings/week. For the other foods there were no significant effects of the tailored intervention.

The intervention group consumed approximately 0·35 more servings of brown bread weekly than the control group from baseline. Although this change between groups was statistically significant the magnitude was small. Evaluation of the intervention was disappointing but the tailored leaflet was received more positively in some respects than the control leaflet. More needs to be done to increase motivation to change dietary intake in adolescent girls.

To assess whether Swiss residents aged 15–24 years follow current nutritional guidelines and whether differences exist according to gender and weight status.

Cross-sectional national survey.

Switzerland.

The 1786 participants (48·4 % women) were divided into overweight, normal weight and underweight. We used traditional BMI cut-offs for people ≥18 years of age (underweight = BMI < 18·5 kg/m2, normal weight = BMI ≥ 18·5 kg/m2 and <25 kg/m2, overweight = BMI ≥ 25 kg/m2) and age- and gender-appropriate tables for people aged <18 years, with BMI calculated from self-reported weight and height. We performed bivariate analyses by gender, and then bivariate and multivariate analyses comparing overweight to normal weight people (excluding underweight, n 129, 71·6 % women) regarding adherence to recommendations for fruit, vegetables, meat, fish and dairy products; physical activity; attitude towards body weight; depression, smoking and alcohol consumption.

Overall, adherence to nutritional guidelines was low, particularly for vegetables and dairy products. Women had a higher adherence than men except for fish and dairy products. In the multivariate analyses, overweight women had a lower vegetable intake, were less satisfied with body weight and had more often been on a diet, whereas overweight men were less satisfied with body weight and wanted to lose weight more often than their normal weight peers. There were no significant differences for physical activity.

Overweight prevention programmes should target youth specifically by gender and promote an appropriate self-perception. Overweight women should be encouraged to eat more vegetables and men to be more sensitised on healthy food. Further research is needed to assess how to make nutritional guidelines more adaptable to young people’s daily life.

To examine the sociodemographic, parental and child factors that predict fruit and vegetable consumption in 7-year-old children.

Diet was assessed using three 1d unweighed food diaries. The child’s daily fruit and vegetable consumption was calculated by summing the weight of each type of fruit, fruit juice and vegetable consumed. The various others factors measured were assessed by a questionnaire at different time points.

The Avon Longitudinal Study of Parents and Children (ALSPAC).

A total of 7285 children aged 7 years residing in the south-west of England during 1999–2000.

Median daily fruit and vegetable consumption (201 g) was below the recommendations for this age group (320 g). Girls ate more fruit and vegetables per unit energy (30·3 g/MJ) than boys (26·7 g/MJ; P =< 0·001). The predictors of fruit and vegetable consumption were mostly similar. Fruit and vegetable consumption was associated with maternal consumption, maternal education status and parental rules about serving fruit/vegetables every day, food expenditure per person and whether the child was choosy about food. Vegetable consumption was also associated with the other characteristics of the child, such as whether the child enjoyed food and whether the child tried a variety of foods.

Children are not eating recommended amounts of fruit and vegetables, particularly boys. Consumption of fruit and vegetables appears to be influenced by parental rules about daily consumption and parental consumption and by the child’s choosiness. Parent’s actions could influence this. These findings may prove useful for those planning healthy eating campaigns for children.

A front-of-pack nutrition logo on products with relatively favourable product compositions might help consumers to make more healthful choices. Studies investigating actual nutrition label use in point-of-purchase settings are scarce. The present study investigates the use of the ‘Choices’ nutrition logo in Dutch supermarkets.

Adults were asked to complete a validated questionnaire about motivation for food choice and their purchased products were scored for the Choices logo after they had done their shopping.

Nine supermarkets in The Netherlands.

A total of 404 respondents participated.

Of the respondents, 62 % reported familiarity with the logo. The motivations for food choice that were positively associated with actually purchasing products with the logo were attention to ‘weight control’ and ‘product information’. The food choice motive ‘hedonism’ was negatively associated with purchasing products with the logo.

This is the first study to investigate actual use of the Choices logo. In order to stimulate consumers to purchase more products with a favourable product composition, extra attention should be paid to hedonistic aspects such as the tastefulness and the image of healthy products.

To provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).

Standard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.

Population-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12 500 per disability-adjusted life year (DALY) averted ($US 9893, £5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138 500 per DALY ($US 109 609, £56 216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.

Several options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.

To assess the impact of the 1996–2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas.

Prospective study of three large-scale cross-sectional surveys conducted in 1996, 2000 and 2004 in MICAH and Comparison populations.

Rural areas in Malawi.

Preschool children (6·0–59·9 months) from randomly selected households (474 from the 1996 baseline survey; 1264 from 2000 MICAH areas; 1500 from 2000 Comparison areas; 1959 from 2004 MICAH areas; and 1008 from 2004 Comparison areas), who responded to a household questionnaire, were weighed and measured using standard protocols.

At the baseline in 1996, the prevalence of stunting (60·2 %) was very high. By 2000, the prevalence of stunting had declined to 50·6 % and 56·0 % (χ2 = 7·8, P = 0·005) in MICAH and Comparison areas, respectively. In 2004, the prevalence of stunting did not differ significantly between MICAH and Comparison areas (43·0 % v. 45·1 %; χ2 = 1·11, P = 0·3). Severe stunting affected 34·7 % of children at baseline, which declined to 15·8 % and 17·1 % (χ2 = 0·86, P = 0·4) in MICAH and Comparison areas, respectively, by 2004. Regional variations existed, with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts.

Given the length of implementation, wide-scale coverage and positive impact on child growth in Phase I (1996–2000), the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi, although the catch-up improvement in Comparison areas during Phase II (2000–2004) cannot be adequately explained.

The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.

In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.

A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27·7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5–15 ppm) of iodine from salt.

Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

To evaluate the acceptability of iron and iron-alloy cooking pots prior to an intervention trial and to investigate factors affecting retention and use.

Pre-trial research was conducted on five types of iron and iron-alloy pots using focus group discussions and a laboratory evaluation of Fe transfer during cooking was undertaken. Usage and retention during the subsequent intervention trial were investigated using focus group discussions and market monitoring.

Three refugee camps in western Tanzania.

Refugee health workers were selected for pre-trial research. Mothers of children aged 6–59 months participated in the investigation of retention and use.

Pre-trial research indicated that the stainless steel pot would be the only acceptable type for use in this population due to excessive rusting and/or the high weight of other types. Cooking three typical refugee dishes in stainless steel pots led to an increase in Fe content of 3·2 to 17·1 mg/100 g food (P < 0·001). During the trial, the acceptability of the stainless steel pots was lower than expected owing to difficulties with using, cleaning and their utility for other purposes. Households also continued to use their pre-existing pots, and stainless steel pots were sold to increase household income.

Pre-trial research led to the selection of a stainless steel pot that met basic acceptability criteria. The relatively low usage reported during the trial highlights the limitations of using high-value iron-alloy cooking pots as an intervention in populations where poverty and the availability of other pots may lead to selling.

To describe food habits and associated sociodemographic factors.

Cross-sectional survey in 2005.

Ninety-six school classes in Ramallah, Nablus and Hebron governorates, Occupied Palestinian Territory.

Grade 8 and 9 students aged 13–15 years (n 2952).

Self-administered student and parent questionnaires.

High standard of living (STL) index and residence in Ramallah were positively associated with intake of animal foods, Western-style foods, dairy products, fruits and vegetables, sweets and salty snacks. Only 26·1 % of the students ate three main meals daily; 26·2 % of the boys and 51·0 % of the girls had breakfast one to two times per week or less often (P < 0·001). Only one-quarter of students drank milk daily (32·9 % of boys and 18·3 % of girls, P < 0·001). The majority of students, boys and girls in similar proportions, consumed vegetables daily (72·8 % v. 73·8 %, respectively). Daily fruit consumption was also equally common among boys and girls (58·9 % v. 55·2 %, respectively), but with clear differences by STL, region and parents’ education. Daily intake of sweets and salty snacks was common among girls, and daily intake of soft drinks was common among boys.

Irregular meal patterns were common among Palestinian adolescents. High STL and residence in Ramallah were associated with frequent intake of foods high in sugar and fat, but also with frequent intake of fruits and vegetables. Effective interventions are needed to establish healthy dietary habits.

To estimate the physical activity level among Mexican adults and to establish the sociodemographic variables that may be linked to active lifestyles.

Data from a cross-sectional survey were analysed. Physical activity was assessed using the short version of the International Physical Activity Questionnaire. The independent variables were sex, age, socio-economic status and size of town. Ordinal regression models were fitted to assess the association of physical activity levels with sociodemographic factors.

Fieldwork was conducted from November 2002 through April 2003; the non-response rate was 3·1 %.

Data from a national representative sample (n 38 746) of Mexican adults aged >18 years old were analysed.

Almost 60 % of the population was classified into the high physical activity level. Women were less active than men in rural areas; in urban areas, the opposite trend was observed. In women, higher socio-economic status was associated with less physical activity, while among men there were no differences. People from rural and urban areas had a higher probability of engaging in physical activity than those from cities. In urban localities and cities, respondents of low socio-economic status had a lower probability of engaging in physical activity.

Using a validated instrument to measure physical activity, we found that the prevalence of active lifestyle among Mexican adults was high. The socio-economic and gender inequalities are different according to size of town (i.e. an effect modifier), which must be considered in the design of policies and programmes to promote physical activity.

The aim of the present work was to calculate the current cost of the Mediterranean diet in Greece and to evaluate the role of diet cost in the development of cardiovascular events after a 5-year follow-up.

Cross-sectional. Cost of diet was measured in €/week based on common Greek dietary choices, while baseline dietary habits were assessed through a semi-quantitative FFQ (Greek-EPIC). The Mediterranean Diet Score (MedDietScore) was applied to assess overall adherence to this pattern using scores of eleven food variables and alcohol, according to the principles of the Mediterranean diet.

Five-year follow-up of the ATTICA study, a nutrition and health survey of a representative, free-living sample of the Greek population resident in the province of Attica, where Athens is a major metropolis.

From 2001 to 2002, 1514 men and 1528 women (aged >18 years) without known CVD were enrolled. In 2006, the 5-year follow-up was performed.

The weekly cost of participants’ diets varied from 5·35 to 83·57 €/week in men (mean 25·45 (sd 6·80) €/week) and from 10·89 to 55·49 €/week in women (mean 25·63 (sd 6·30) €/week). Diet cost was correlated marginally to MedDietScore (r = 0·060, P = 0·05) as well as being associated with history of hypercholesterolaemia (mean (sd), yes v. no: 24·90 (5·73) v. 25·82 (6·95) €/week, P = 0·027), physical activity (mean (sd), yes v. no: 26·42 (6·90) v. 24·82 (6·20) €/week, P < 0·001) and current smoking (mean (sd), yes v. no: 24·99 (6·40) v. 25·98 (6·70) €/week, P = 0·017). No significant association was found between diet cost and 5-year incidence of CVD (hazard ratio = 1·021, 95 % CI 0·965, 1·081). However, adherence to the traditional Mediterranean diet was inversely associated with the development of CVD (relative risk per 1-unit increase in MedDietScore = 0·92, 95 % CI 0·89, 0·94) after adjustment for various potential confounders including diet cost.

Quality but not cost of the diet is associated with the development of CVD.

First, to describe the prevalence of both full and partial breast-feeding during the first 6 months; second, to study the associations between selected health service-related factors and cessation of full breast-feeding at three time intervals.

Retrospective questionnaires, 6 months after birth.

The Norwegian Mother and Child Cohort Study (MoBa).

In total, 29 621 women.

While 96·6 %, 94·0 %, 90·8 %, 86·9 %, 83·8 % and 80·0 % of the infants were breast-fed at 1, 2, 3, 4, 5 and 6 months, respectively, the corresponding proportions for full breast-feeding were 84·6 %, 79·1 %, 70·9 %, 44·0 %, 16·7 % and 2·1 %. An increased risk of cessation of full breast-feeding during the first month was associated with supplementation during the first week of life with water (relative risk (RR) 1·77; 95 % CI 1·52, 2·06), sugar water (RR 1·73; 95 % CI 1·49, 2·00) or formula (RR 5·99; 95 % CI 5·58, 6·42). An increased risk was also associated with Caesarean delivery (RR 1·08; 95 % CI 1·00, 1·16) and breast-feeding problems (RR 1·56; 95 % CI 1·45, 1·67). Between months 1 and 3, the risk of cessation of full breast-feeding remained elevated in the case of supplementation during the first week of life with water (RR 1·29; 95 % CI 1·14, 1·45), sugar water (RR 1·48; 95 % CI 1·34, 1·64) or formula (RR 1·18; 95 % CI 1·07, 1·29). The same applied to Caesarean delivery (RR 1·15; 95 % CI 1·06, 1·25).

Supplementation during the first week, breast-feeding problems and Caesarean delivery are associated with early cessation of full breast-feeding. The results support a cautious approach to supplementation during the first week of life.

To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases.

A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed.

Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified.

Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.

To demonstrate the use of four different qualitative methods in creating content, including text and graphic design for print interventions to support better nutrition in low-income households that rely on charitable pantries.

Four methods were used for measuring household cooks’ responses to the content and design of recipes and food-use tips especially designed for low-income households: (i) focus groups with pantry clients; (ii) questionnaires administered at sites where the Women, Infants and Children (WIC) programme beneficiaries gather, to survey cooks’ judgements about the appeal of recipes; (iii) recruitment of WIC clients to prepare recipes at home, followed by phone interviews about the cooks’ actual experiences preparing and serving dishes; and (iv) a new technique to gauge pantry clients’ preferred ordering of print information, using bits of content backed by Velcro™ strips that participants applied to felt boards. Ten sets of illustrated recipes and food-use tips were prepared, each set focusing on a different fresh vegetable that is periodically available from charitable sources.

Low-income recipients of food from community pantries in the USA, and beneficiaries of the WIC programme.

Illustrative findings show how the four types of qualitative evaluations can inform decisions about content and about graphic design. Discoveries from this formative research illuminate challenges of supporting better nutrition among households that depend on charitable sources of food supply.

These multi-method evaluation techniques can be adapted to the development of any print material, whether intended for widespread dissemination or for field research into nutrition behaviour.