Designing Child-Centred Health Promotion Interventions

Integrating Child Perspectives
Effective health promotion begins by involving children in every stage of programme design. Understanding their motivations, preferences, and social environments helps create interventions that feel relevant and empowering.

Creative Engagement Strategies
Storytelling, gamification, and digital tools can enhance participation and sustain healthy habits. Examples from community programmes show how playful, narrative-driven approaches can support learning and long-term behaviour change.

Evidence-Informed Design Principles
Successful interventions combine theory-based frameworks with iterative testing and feedback from children, parents, and schools. This ensures cultural adaptation, accessibility, and measurable impact.

Health Promotion vs. Obesity Prevention
Speakers emphasised that health promotion is different from obesity (disease) prevention. Rather than focusing on risk reduction alone, child-centred approaches prioritise wellbeing, participation, and environments that make healthy choices easy and enjoyable for all children.

Case Study: Heróis da Fruta (Fruit Heroes)
The “Fruit Heroes” initiative demonstrates how fun, community-based actions can promote healthier eating among children. The project highlights the importance of collaboration between educators, families, and local partners.

Lessons for Researchers and Practitioners
Designing child-centred interventions requires cross-disciplinary skills and collaboration across sectors. Embedding co-creation and continuous evaluation can improve scalability and sustainability.

Future Directions and Next Steps

• Expand use of digital and gamified tools to reach diverse settings
• Strengthen participatory research with children and families
• Integrate evaluation frameworks focused on enjoyment, empowerment, and equity

Summaries are generated from meeting transcripts.

Transcripts are auto generated, if you spot an error, please email enquiries@easo.org

Speaker 1
00:00 – 02:21
Hi everyone, welcome to this month’s EASO Early Career Network event. Thank you all for joining. So today the event is about designing child-centred health promotion interventions. So you can expect to gain insights on how to design, implement and evaluate engaging health promotion interventions for children and communities. So the Novo Nordisk Foundation has provided support to EASO for ECN development activities, which includes this webinar series. But the Novo Nordisk Foundation has had no influence over content. So today, it’s going to be myself, Becky, and also Sabina, who are going to be hosting this webinar. And I’d just like to remind you as well that the webinar is going to be recorded, and you will receive the recording and any relevant links after the event. So this webinar is part of our e-learning hub online events which are held by the EASO ECN around monthly and the idea is to promote knowledge sharing and skill development amongst students and also early career professionals in this area. And just another reminder that the ECN is free to join and so are these monthly webinars So if you do have any colleagues that you think would benefit from this, please do encourage them to join. So today we’ve got two speakers. In terms of asking questions, we’re going to have a Q&A session at the end. Starts roughly 15 minutes before the end, but you can pop any questions that come to mind in the chat during, and also you can ask them at the end as well, just by popping your hands up and speaking on the mic. I think as well, because we do have two speakers, if you just indicate if the question’s for a specific speaker as well. And then finally, we do have a feedback form, so it’d be great if you could complete that at the end of the event. And this is something that will be posted in the chat. Okay, so I’m going to just quickly hand over to Sabina, who’s going to talk through some current updates in the ECN.

Speaker 2
02:22 – 04:51
Yes, thank you very much and also one welcome for me. So yeah, there are several awards and opportunities available to members of the ECN. So you’re all encouraged to join or to apply and also the link and all opportunities will be posted in the chat so you’re going to see that there. So first of all the ECN board looks forward to welcoming delegates to the ECN masterclass on hot topics in obesity which is taking place in Portugal from the 20th through the 22nd of November. We’ve received many strong applications this year so congratulations to those who are selected. If you haven’t yet participated in one of these events please continue to apply in the future. I’ve been there last year I can definitely recommend it. Also the abstract submissions for the European Congress on Obesity, the ECO, which has taken place on the 12th to the 15th of May 2026 in Istanbul and Turkey are open now. So submit your abstract by the 11th of January 2026 to share your research. Also the ECN gathers at ECO to network and to build knowledge at ECO so keep an eye out for updates. EASO is pleased to announce that the EASO Novo Discondition, the new Envigester awards, oh my god this is a long word, in fact there are like four awards in basic science, in clinical research, in childhood obesity, in public health, they will be supported till 2030 and each of the for awards will be accompanied by 300,000 DKK research grants. So for 2026, the winners will be supported to attend and speak at a special award session at ICO in Istanbul. And last but not least, talking about Istanbul, the ICO 2026 program will include an ECN session for the best theater award. So the submission will open soon. Please consider applying if you are nearly completing or if you have recently completed your thesis. Two last points, we run a regular ACN spotlight feature showing across the ASO website and social media. This features ACN members and their research and are shared widely with the whole research community. So if you’d like your work to be spotlighted, get in touch with us.

Speaker 1
04:52 – 06:04
Okay, so our first speaker today is Mario Silva. So Mario has a professional background in PR and marketing with expertise in awareness campaigns and advocacy. And he has a strong commitment to supporting people affected by obesity, especially children. So since 2012, he has served as president of the Childhood Obesity Association in Portugal. And he works closely with researchers and scientists from the Institute of Environmental Health at the Faculty of Medicine at the University of Lisbon. And then since 2019, he’s represented Portugal at the European Coalition for People Living with Obesity, where he is actively involved in obesity advocacy and policy at the European level. And in 2020, he became a founding member of the EASO ECN board. And finally, he is also the main author of the recent children’s book, “Mum, What is Obesity?” which was written in honor of his maternal grandmother who lived with obesity her entire life without ever receiving any treatment. And yeah, thank you for being here, Mario. And please go ahead and share your slides when you’re ready.

Speaker 3
06:05 – 36:16
– Thank you so much, Rebecca. And thank you, Sabina. And thank you, Lisa, for this invitation. Let me see if I can share the slides. All right, so thank you, first of all, for this kind invitation. It’s really a pleasure to talk about this work journey that we have been doing in Portugal for about 15 years. I’m working for the Portuguese Association for Childhood Obesity. And what we brought here is some reflections about designing child-centered health promotion interventions inspired by these case study, Fruit Heroes, which is the name of our program, and Raquel, which is working with us through the Faculty of Medicine through this Institute of Health in Portugal, who have been studying our initiative and the results. She will talk about that, the methodology, how we achieve the results, how we redesign some parts of the initiative. I will start to speak as a project manager of this program for 15 years. So I will talk about how to building partnerships is fulcrum, is essential, securing funding, learning from not only success, but failure also. And of course, identifying some of the best practices that we can identify on this case and share with you because sharing is also caring. I think someone said that before. And this kind of work in progress keeps the initiative sustainable in the longterm. So to start, let me just clarify two concepts that are often very confusing and used in a way as we equals, but in our vision and the way we perceive it, there’s a big difference. So let me start to clarify that health promotion, it’s not obesity prevention. So they have in the long-term vision, they are connected, but they follow very different paths. So, and that’s why it’s important to clarify that our program, Fruit Heroes, it’s about health promotion, okay? Health promotion, it’s for everyone. So it’s to empower people of any age and non-specific targeting any people living and health promotion is to adopt healthy habits. It focuses on some positive behaviors, such as good nutrition, physical activity, emotion, well-being, which all can act as supportive tools across all stages of any Ansteady journey, when they are combined with the most effective and evidence-based treatments. So health promotion is universal, inclusive, and it’s more focused on the behaviors rather than the problems themselves. So obesity prevention, on the other hand, means identifying and supporting people that are at risk or in the early stages of a disease. So it’s a concept more clinical, it requires assessment and it requires ongoing management by trained health professionals and it’s much more targeted. So it’s not universal, it’s not for all of the children in the case of the children that we are going to talk in this presentation. So with Fruit Heroes, our initiative, we don’t do obesity prevention, we promote health. So we motivate children to follow the WHO, the World Health Organization recommendations for daily portions of fruits and vegetables, for water intake, for physical activity. And we combine that with very funny and engaging educational formats that Raquel will develop on her part. So for us, obesity prevention begins with early diagnosis. And for us, that’s a very important statement. Obesity prevention should never focus on something blame. So we want to clarify those two things. And still, we also like to build bridges. So what we try to do after 15 years of doing health promotion with Fruit Heroes, we incorporated also a side project that I have here on the next slide. So through this side project that is inspired on a book that was launched two years ago, “Mom, What is Obesity?” We try to do a bridge between these two concepts. So we are focusing on bringing awareness of obesity to the audience that we already have doing these health promotion program. So we visit schools that already are running the Fruit Heroes program, and we visit these schools with trained patient advocate volunteers. So they are people living with obesity, caregivers, or even healthcare professionals that go and read the book and facilitate sessions with the children, the teachers, and sometimes also parents to bring some clarification and understanding of obesity as a chronic multifactorial disease, and try also to help some way of when a person is sick people understand it that way, we are contributing for reducing stigma and reducing bullying based on WAVE. So we are doing this and also encouraging families and children to seek help from trained health professionals or connect also with the local patient associations. So we wanted to bring this first topic to this conversation because we believe that obesity understanding also starts with empathy and we need these three things happening together and not isolated in aisles. So we try to connect and build bridges between all these concepts and being respectful, especially for people that are living with this disease. So with this said, now I’m going to focus a little bit more on what brings us here. And thank you all for being interested in knowing more about what we are doing in Portugal with this program. So I will focus on some of the topics that sometimes in this kind of conversations, people ask us questions. So I decided to also bring these topics and develop it a little bit more. So we designed the program for scale. So many times people say, “Whoa, I’m starting a project. Should I go for just one region? Should I start with a very small pilot or should I be more, should I go for a project a little bit bigger? So for that, I can say that from our experience, we never thought about going small. So we decided that we were going to be focusing on digital, on digital resources and on ways for the program to be scaled at a very low cost and using technology. So this was 15 years ago. So you need to understand that 15 years ago, the world was a little bit different from what it is today. But so for just one example, we started by doing the teacher’s training because this program is about teaching the teachers and then the teachers are volunteers that implement on their classrooms all of the activities. And we started from day one on online training for teachers And with the focus on with this, we could have schools from all around the country, including the islands, without having a huge budget to do local trainings in each region. So this is what I want to say to you. Now in 2025, we have a lot of new tools, tech tools. So we have AI that maybe can be incorporated somewhere in your project, but use what people are using. So from our expertise at the time, it was not easy to bring the teachers to online trainings because they were not used to it. So Zoom was not even a word that people knew at the time. But now we have things like WhatsApp channels that people just join and channels are not groups. So their contact is not seen by the other teachers. And so it’s really safe. Things like that can be incorporated on nowadays projects. And I wanted also to add to this part that we were working on this project in a way that it was not only for Portugal. So since day one, we wanted to experience this project in different countries. We are now working with Portuguese speaking nations like Brazil and Angola, Mozambique and a few African countries. But also we did some pilot with different cultures but all in the Mediterranean region. So Spain, Italy, Greece, Cyprus and Turkey. And now we are also expanding this research. So if you are in one country and you are interested in this kind of projects. Now we are looking for researchers in Romania because we have a partner there that wants to bring this project there. So this project is designed to scale and through technology with resources that are almost all digital, it’s possible to bring it and to translate it in a very short budget. So the second topic that I want to talk about this is that partnerships matter a lot. So no national change happens alone. And this is true for governments. This is true for NGOs. This is true for everyone. So partnerships are really the heart of everything that we all do. And in our case, we work closely with national governments and including the local governments, the municipalities that have public health teams and health promotion teams that work very close to the schools. And we try to align the projects with all of the policy are going on, not only in Portugal, but we try to align it as much as possible with international recommendations. And just for you, if you don’t know, maybe you don’t know, but Portugal just received from the United Nations Interagency Task Force an award for the work on obesity policy. And this was amazing because on public comments, on a public message, they include us directly on this. So they said this wasn’t possible if it was not the NGOs like yours. So this for you to understand that your work can be seen and sometimes it’s better to be sure working with the right stakeholders. Also, I wanted to just bring two more notes on this slide. So, this year we are celebrating the 15 years of the Fruit Heroes Project. So, we reached 1 million children reached by this program. And I don’t know why this happened, but we just received a public message from the President of Portugal thanking us for the contribution for the health of children with this program. So this is really what happened when you are working with the stakeholders that are in the field. And I want to extend also all of these messages to all of our network because we work very close with the European coalition of people living with obesity. We are members of this coalition and also to the IAZU team because we try to align as much as possible with what is happening on the European level. So this recognition should remind us all that when governments and academia and NGOs work together, these interventions become sustainable movements and not only isolated short-term projects. So keep this slogan on your mind, which is the ECPO slogan, addressing obesity together. We should be all addressing obesity together. And because we are talking about partnerships, I want to answer to one of the most asked questions, which is how do you engage with thousands of schools? How did this happen? And my answer to this, the honest answer is we started with a very short number of schools and we grow. But how did we do that? So we focus on relationships, not databases. And for us, listening to the teachers, having a real engagement with the schools, it’s really important. That’s why a lot of schools repeat the participation in our program. Some of them for 15 years, and they still on our program because they have new students, of course. So it’s not just about sending emails or collecting data, it’s talking with people. We created in the first years, we created on an office on Caxcais where the ECN Winter School will be held. We had there an office for many years and we created there kind of internal call center center for schools to contact. So we trained our team for doing some kind of motivational interviewing. And our team was with background in health and communication and human resources. And what we did was we contacted lists and lists and lists schools and we updated the lists with new contacts and we contacted it one by one. So it was a team of 10 people at the time and the only thing that, oh sorry this is going, okay, yes, yeah, and for many years what this team was doing was only contacting schools every day and making sure that people knew about the program. For you to understand what is the percentage, the rate of adherence at the moment, so the adoption rate for our program at the moment it’s around 90 percent, so nine in ten schools join the program when they are invited and we try to invite as much as possible. And of course, one thing is also that the program is free, universal free, so independently of being a public school or a private school, it’s free for all. And to close this part of the topic, so we talked about technology, but the secret, it’s not technology. The secret is always empathy. It’s a human being talking with a human being. So schools join our program because they felt, seen, listened, valued, and they understand that they are being part of something bigger. So they see the results happening on the classroom, but they also see the power of being part of a movement that goes on the media, that goes on the local government, on a presentation. So they are part of this volunteer team that do this extracurriculum program and they are proud of it. So we are building relationships, we are building a community of fruit heroes, adults fruit heroes. But to do this all for free we need funding, all right? And this is the second most asked question, which is how do you do this? how do you finance this program? And I wanted to bring how we do this. Of course, we go on the classical model of grants, of course, so we as a non-profit, and I think that everyone has done this. If you are working on academia or an NGO, we look for grants, whatever, if they are public or private partnerships or sponsorships. We work with different areas of among corporate sponsorships. So we received finance from banks and supermarkets and insurers, also pharmaceutical companies. And of course, there are a few at least here in my country, but when there is government funds, of course, we try to look for them. But I’m not sure if this is a question. I don’t think so. So but we didn’t want to be honestly relying on these call opportunities because many times if you know, they ask for spin-offs and new versions and projects that never happen. And in our case, we wanted to run exactly the program that we designed and we didn’t want to reinvent the wheel every time. So we wanted to find a way of funding the ongoing program and we decided to go on something a little bit more creative for what is happening on the NGO world. So we decided to go on licensing and loyalties. So we actually explore our intellectual property rights. So we have brands, all our programs are registered branding, and we have the characters, and we have all of this. So we use all of these intellectual property to create children books, educational board games, school goods, or even we did it also a TV show. And so we sell all of these and we earn royalties from that. So every time a pencil of Fruit Heroes is sold on a supermarket, a small percentage comes as a donation for the association. But all of these happening at the same time through the years also brings some extra funding that we can rely on. And it’s even more certain because some calls are not approved and this is an ongoing funding strategy. So you can see here on the image, some products. We also did some food products. So it’s apples and pears and carrots and waters, all with the branding of the characters of the program. So the answer of this is creativity. So you don’t need to do the same that we are doing, but try to think creatively and out of the box. So you can find ways of funding your own programs. And you can join us if you want to bring this program to your country. We are open to that also to bring more partners to this network that we are building here. So next slide is about failure because not everything is a success. And I wanted to bring these example, first because it was the intention of the organizers to focus this at the beginning. The challenge that they gave us was to focus this presentation on this specific science project that we launched a few years ago in 2022. we launched an app. So as I told you before, we are trying all channels of expanding the effects of the program, not being only on the school. So we try to do it as much as possible. And I think this is the last slide, okay? I’m saying to count. So this is the last slide. So we launched this app. It was a huge success. It was a lot of downloads in the first week, a lot of media attention. We won an award from ECPO and it was a EASO-ECPO award at the time for the World of Busy DJ 2022. And we did a great awareness campaign, but we couldn’t keep up this project because this is because of the technology. I started with technology and I will end with technology too, because some technologies, you are just not in the control. So you cannot imagine the ways that, the things that needs to happen on the background. And for an app, we had no idea and we were not prepared by our provider that this was going to be a never ending story of technical updates with high maintenance costs. So for you to understand, since the end of the first week, we had claims on about 100 claims every week because people could, they downloaded and it doesn’t work on their system because they have these specific characteristics on their smartphone and the technology is not working correctly there and blah, blah, blah. So what I wanted to bring with this is that sometimes you have to face the true and you need to just give up. And in our case, we decided that we didn’t want to go further with this app because it was going to consume all our funding. (laughs) So this is just the takeaway messages, but I will not talk about it because Raquel will come up with the part that probably most of you are interested, which is the evidence-based and the measurable impact of this project. And so for my side, this is it. And if you have questions, I’m happy to answer.

Speaker 1
36:19 – 37:33
– Thanks, Mario. That was a really interesting overview of Brute Heroes. And it’s great to hear that it got the recognition it deserved as well. So next we’re gonna pass over to Raquel. So just while Raquel shares her slides, I’ll briefly introduce her. So Raquel Martins is a PhD student in nutrition at the Lisbon School of Medicine, University of Lisbon. Her doctoral research aims to evaluate the effectiveness of a school-based intervention using gamification and storytelling techniques to promote fruit and vegetable consumption among children. She holds a bachelor’s degree in nutrition and dietetics and a master’s in metabolic diseases and eating behaviour. And since 2019 Raquel’s worked as a nutritionist and a researcher at the Environmental Health Institute of Lisbon School of Medicine, collaborating on several projects focused on public and environmental health, nutrition education, behavioral interventions and health literacy. So thanks again for being here Raquel and feel free to share your slides when you’re ready. I’m sharing already. Can you? Oh brilliant. Yeah, Yeah, I can see them.

Speaker 4
37:34 – 52:17
Thank you, Rebecca, Lisa, and Mario, of course. So to preserve time for the Q&A session, I will skip the first part of my presentation. But to briefly give you an idea, it was about the fruit and vegetable consumption, the impact on health, what are the dietary recommendations currently, and what are the consumption in children. I believe it’s not a new information for anyone is below that WHO recommendations. And I will skip to the school-based interventions because schools have been identified as ideal settings for promote for this health promotion interventions because schools provide a structured environment where teachers, caregivers and peers can act as role models and so reinforcing healthy behaviours in children and also because these interventions in schools have the potential to reach children from diverse ethnic and socio-economic backgrounds. And when we look at the literature, there’s been diverse approaches described when you talk about school-based interventions that goes from nutrition education in the curriculum, environmental changes to promote healthier behaviours and also distributing fruits and vegetables or other foods for free to the schools. But when we look to the literature and when we think about designing interventions targeting children, what really works and what the literature tells us is that first we need to have activities that are adapted to the age of the participants and of course their school level. And it is also important to include mascots or cartoon characters related to the eating habits because when we do this, we are creating, when creating these elements, children basically start to associate the project with the character and this is important to ensure their engagement. Another gold standard about these interventions is to include these food-related topics into the school curriculum. And one other aspect that determines the success of the interventions is the time and frequency, and this means that it’s preferable to have a structured intervention for a period of time when we are comparing this to single or isolated sessions, especially if these sessions are not evaluated. On the teacher and parental level, it is important to ensure training to teachers on food-related topics, and it is important to include both parents and the teachers, because these are the two environments, so school and home, where children spend most of their time. And the family, specifically, is important to include so that the changes that we are trying to begin at school can be extended to the family environment as well. And of course, it is important also to consider the socio-economic background of the place or the environment where the intervention will take place. Lastly, it is important to ensure that the activities are not only theoretical or practical, it should be a balance between these two. And also to ensure that interventions have a progress in time and this means that we should integrate new information along the way and we also need to ensure that the information that was previously acquired is maintained on a daily basis. So passing on to a practical example of the Fruits Heroes, this is a five-week school-based program designed for prayer and primary schools and it is implemented across all regions of Portugal. It is developed and promoted by the Childhood Obesity Association in Portugal since 2011 and so it is implemented annually and over these past 15 years we have reached more than 1 million children as Mario told you before. And what are our objectives? We have three main objectives that are first to increase children’s intake of superfoods, that is fruits and vegetables. Second is to reduce children’s consumption of ultra-processed foods, that is foods that are high in sugar, salt and saturated fats. And we also aim to promote food sustainability literacy to encourage healthier family routines for children and the planet. So, how do we promote the consumption of fruits and vegetables? We call it the 3R method, that is role modeling, repetition and rewarding. So, in the first component, the role modeling, we use storytelling techniques, where basically every day in the school environment, in the classroom, The teachers spend like 5 to 10 minutes and they read or play an audio version of a playful pedagogic tale of the fruit heroes and basically in these videos and these tales, the characters gain superpowers, that is, health benefits through the consumption of fruits and vegetables and for this component teachers have access to masks, finger puppets, musics and videos. I will not show you any material in detail, but I put here some prints of the materials so you can have an idea how they look like. These, for example, are a set of videos, it was a TV show actually, and teachers can use these materials to the role modeling component of the intervention. Then we have the gamification techniques in the repetition component and here Each children receives this tool that we call the Fruit Heroes Daily Passport. And basically, if the children consume fruits and vegetables at school that day, and only if they do this, they earn a star in this tool. They basically can color a star of that day. And this tool is important because it allows us to track each child progress and reinforces the engagement with the healthy behaviors. And basically, we are promoting the formation of a habit by this repeated daily practice of food consumption. And then you can earn a star on your passport. And lastly, we have the rewarding component where we use positive reinforcement techniques where basically at the end of each week, children receive rewards to keep them motivated to consume fruits and vegetables every day. And these rewards can be bracelets, flags or bookmarks. I have here the bracelets and the bookmarks that children can color after printed, of course. We have some additional components to the intervention. One of them is food diversity that we try to do by promoting the consumption of fruits and vegetables of different colors. We have five weeks and we based our methodology on the Harvard Rainbow construct that basically categorizes fruits and vegetables in five groups according to their content in some nutrients. And just for you to have an idea on the week number two of the intervention, it promote the consumption of fruits and vegetables that are orange like carrots and oranges. And that we say to children that these help her with their vision. And this is because of their continent in vitamin A. And this is all based on this Harvard rainbow construct. And we also promote food diversity by incentivizing children to taste new fruits and vegetables from each color every week. As I told you earlier, we also have a focus on sustainability and we try to do this by promoting the consumption of local and seasonal fruits and vegetables. and also by school garden activities, namely planting fruit trees. And we implemented this activity in 2021. And since then, we have more than 1000 fruit trees planted in schools across Portugal. And so over these last 15 years, what have we learned by implementing the intervention across the country? So the first thing was about the duration of the intervention. With data from the 2018-2019 school year, by then the intervention had 12 weeks long instead of the five that are actually in the present. By then, we were studying the regular fruit and vegetable intake that we define as consuming fruits and vegetables in at least 75 percent of the school days for a minimum of four weeks and maintain this behaviour until the end of the intervention. And with data from that school year, we saw that at fourth week, already 40% of the children have achieved this regular fruit and vegetable consumption and maintained until the last week of the intervention. And by then, 55% of the children had this behaviour. And since this 40% are already an expressive result, we decided to shorten the intervention to five weeks. and although I do not have here specific results to show you, we see that consistently, independent of the duration of the intervention, we consistently see an increase in the consumption of fruits and vegetables in the children that participated in the intervention in the monetarization that we do every year. One other thing that we learned, it was about the burden related to data collection, because until the 2018-2019 school year, data were collected by teachers through paper and pen questionnaires, and the sample unit was the students. And with this, we had around 27 inscriptions from students, but we only collected the data from about 5,000. But with some changes, first, the duration of the intervention, and we also started to have data collected through online forms, and we started to have as a sample unit, the class instead of the students, And we increased significantly the number of inscriptions and data collected. As you can see, we received around 80 inscriptions for students and we collect data for almost 20,000. Of course, these changes, some of them have some limitations, but I will talk to you about that in just one minute. Just to finish the lessons that we have learned over the 15 years, we have perceived that are some facilitators and barriers to adhering to the intervention as a facilitators. Basically, we have an annual presentation of the guides to the teachers and we send those guides to the teachers and they are responsible for printing the intervention materials and distributing them for the children. And from feedback for the teachers, we see that if these materials could be provided for free, there would be a higher likelihood for them to adhere to the intervention. Other thing that facilitates the adherence to the intervention is if we can give incentives to the teachers and at the end of the year, we give exclusive edition books about the intervention, classroom board games, mission accomplished facts and fruit and vegetable seeds. And other thing that promotes adherence is the possibility of that classroom to have an interaction with the fruitivores characters in person. Some of the barriers are, of course, the involvement of the families in the school activities and the overload of school projects that teachers have access every year and what they prioritize at the end of the day. And just to finish our future testing that are already ongoing, as I told you before, we started to have as a sample unit the classroom. so we started to have an ecological approach. These of course have some limitations. The intervention itself had already another limitation that was the lack of a control group. And we are trying to address these limitations with my PhD, which we will conduct the two-armed cluster randomized control trial with an intervention and a control group. The control group will be a passive one. We will have as a sample units, the child and the primary outcome will be fruit and vegetable consumption assessed by the number of portions eaten at school at three time points, baseline, during the intervention and after the end of the intervention. And this is a strength of the project because we will have a long-term evaluation, which is not usual. And we will also look at the nutritional quality of school snacks that children brought from home. hypothesis here is, okay, if children are eating more fruits and vegetables, what is happening to the nutritional quality of their snacks? Are they eating less ultra-processed foods? And just to finish, we are still conducting a pilot study, still with an ecological approach, but here the idea is to see what happens to the intervention when we remove some of the barriers that we have already identified. Basically, what happens to the intervention if we can provide the intervention materials for free, if we provide fruits and vegetables for free, and also if the data collection is not performed by the teachers but instead by trained professionals. And with this pilot study and also my PhD, we will also be able to identify some other facilitators and and barriers to adherence and implementation of the intervention by conducting focus groups with teachers, children, and parents. So this is it for me. Thank you and sorry for being long.

Speaker 1
52:18 – 52:50
– Thanks Raquel, that was brilliant. Yeah, it’s great to see all the different creative components and also that you’re seeing some positive results as well. So we’ll move on to our Q&A. I can see there’s one question in the chat already feel free to add some more in the meantime. But the first question is, can I ask if there’s been any feedback or analysis of the program with diverse or special populations? I’m thinking about sensory aversion in certain populations and if the behavior reward approach was successful.

Speaker 3
52:57 – 58:39
– Hey, Cal, do you want to start? Do you want me to start? – Okay, so I think the behavioral reward approach is one of the most successful. So if we include the reward charts as part of this, the daily reward of earning superstars on behalf of others, is reward chart, it’s definitely the most successful approach because it’s the repetition that makes the behavior becoming an habit. So, and these, the research is very strong about that. but I think Raquel maybe can add to that. Regarding the diverse or special populations, we don’t have formal data, I think, but informal feedback from teachers from 15 years of working with 10,000 schools. So yes, we have very few cases of sensory bias aversion. But because the program focuses not only on one fruit or vegetable, so the idea, the main idea is to try different fruits and vegetables. So the sensory aversion sometimes It’s not for all, so it works the same way. But I have some reports on children that have very strong sensory aversion for some foods or for fruits in general. And the final feedback is that they still improved daily repetition for the five weeks, and they could at least taste it or touch it because some versions are even to touch the fruits and vegetables. It works on improving the stage of the children on each specific situation, but we are not prepared to share formal data about it, only informal feedback. On diverse and special populations, we have some data. So in almost every year we collect the, one of the data that we collect is if the children are classified, We have a classification on schools based on a score. Basically, it is to determine if they can have free food at school or the prices are lower for their, for their children because of family low income situation. And this has a score that teachers are aware of. So when they share that, it is volunteer, it’s not, of course, it’s not mandatory, but we have some data about it. So if we want, we could try to understand if there’s more impact per se of the program in low income populations. if we want to do this, we could definitely make this kind of deep analysis as well as in very specific populations. We have communities that not only are low income, but from a very specific culture that are more subtle on some regions. And that is not data that we collect, but we know by the field work that we also do. And it’s working transversely on every kind of diverse of the population. So the results are the same and are virtually the same. But actually one of the pilots that we are starting this year, we’ll also have deeper information about this because it’s a very specific district of Lisbon that was chosen specially because of the diverse of the population. So we will have more data about it in the future. Raquel, I don’t know if you want to add something.

Speaker 4
58:41 – 59:34
– I believe you already said everything, but when you were talking, I remembered that about food diversity, even though we do not have data about this sensory version, we have feedback from teachers. I mean, I can say about all the teachers that we talk to that says we encourage the children to try to taste new fruits and vegetables. we have the pilot study in a clinical setting and one feedback that we are always receiving is that the children are able to taste these new fruits and vegetables and they liked it after all and they started to say that I like carrots, I like tomatoes and before the intervention I didn’t like it so this is also a positive result that we see. Okay thank you both,

Speaker 1
59:34 – 59:59
Thanks for the great question as well Ronan. I don’t think we’ve got any more questions in the chat. Is anyone wanting to ask a final quick question? No I’m not seeing any hands come up. Okay well thanks again Mario and Raquel, that was a brilliant session and thank you all for attending and we hope to see you in the next one.