the impacts of jamie™s ministry of food...

The Impacts of Jamie’s Ministry of

Food Australia

Jessica Kate Herbert, BHS (Hons)

A thesis submitted in fulfilment of the requirements for the

degree of Doctor of Philosophy

Deakin University

March 2015

sfol

Retracted Stamp

iii

Acknowledgements This thesis forms part of a commissioned evaluation of Jamie’s Ministry of Food

Australia. In doing this research, I have had the privilege to work with an amazing

team. I would like to express my sincere thanks to my supervisors who supported

and encouraged me throughout this PhD process. Firstly, my primary supervisor

Professor Marj Moodie has provided constant support and encouragement and

never doubted my abilities. Thanks to both associate supervisors, Lisa Gibbs and

Boyd Swinburn. Associate Professor Lisa Gibbs has provided invaluable

knowledge, guidance and patience while I figured out the world of qualitative

analysis. Professor Boyd Swinburn has an inspiring mind, and I feel very

privileged to have had the opportunity to work with him.

other members of the Jamie’s Ministry of Food evaluation team. Anna Flego wa

v

Declaration I declare this thesis does not exceed 100,000 words.

Abbreviations EPPI-centre the Evidence for Policy and Practice Information and

Co-ordinating Centre

GBP English pounds

GEE Generalised estimating equations

HILDA the Household, Income and Labour Dynamics in Australia

JMoF Jamie’s Ministry of Food

NCD Non-communicable disease

PRISMA the Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SD Standard Deviation

SE Standard Error

SEP Socio-economic position

TGF The Good Foundation

UK the United Kingdom

US the United States of America

USD United States of America Dollars ($)

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Papers and presentations arising from this thesis Peer-reviewed journal articles

Herbert J, Flego A, Gibbs L, Waters E, Swinburn B, Reynolds J, Moodie M. Wider impacts of a 10-week community cooking skills program - Jamie’s Ministry of Food, Australia. BMC Public Health. 2014; 14 (1):1161. Flego A, Herbert J, Waters E, Gibbs L, Swinburn B, Reynolds J, Moodie M. Jamie’s Ministry of Food: Quasi-experimental evaluation of immediate and sustained impacts of a cooking skills program in Australia. PLoS One. 2014; 9(12). Flego A, Herbert J, Gibbs L, Swinburn B, Keating C, Waters E, Moodie M. Methods for the evaluation of the Jamie Oliver Ministry of Food program, Australia. BMC Public Health. 2013; 13(1):411.

Flego A, Herbert J, Gibbs L, Waters E, Keating C, Swinburn B, Moodie M. The evaluation of Jamie’s Ministry of Food, Ipswich: Final evaluation report. Melbourne Deakin University, 2014. Available from: http://www.jamieoliver.com/jamies-ministry-of-food-australia/ Conference presentations

Herbert J, Flego A, Gibbs L, Waters E, Swinburn B, Reynolds J, Moodie M. Jamie’s Ministry of Food reduces take away/fast food expenditure [Poster]. Australian New Zealand Obesity Society; October; Sydney, Australia. 2014. Herbert J, Gibbs L, Moodie M. “More than just a meal in a box”. Early findings from the evaluation of Jamie’s Ministry of Food Australia programme [Poster]. International Congress of Obesity; March; Kuala Lumpur, Malaysia. 2014.

Herbert J, Flego A, Gibbs L, Waters E, Swinburn B, M. M. A longitudinal qualitative study of Jamie’s Ministry of Food Australia programme [Poster]. European Congress of Obesity; May; Liverpool, UK. 2013.

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Abstract Australians are facing a number of challenges that discourage home cooking.

Healthy eating is vital for healthy living and meals prepared at home from fresh

ingredients or “scratch” are invariably more nutritious than meals purchased

away from home. There are a number of factors that influence people’s abilities

and opportunities to prepare meals from scratch at home. As a result, there has

been a decline in the consumption of home-cooked meals from scratch. There are

a number of public health initiatives in Australia and internationally aimed at

promoting cooking skills in the population as a means of improving the

population’s diet. The benefits of community-based cooking skills interventions

for individuals have been reported. However, the evidence surrounding the

impacts of these programmes is insufficient and further research is required to

understand their effectiveness. Celebrity chef Jamie Oliver auspices one such

cooking skills intervention named Jamie’s Ministry of Food (JMoF), which is

currently being implemented in the UK, US and Australia. Participants attending

JMoF Australia participate in weekly 90-minute classes over a ten week period.

The programme teaches basic skills to participants to enable them to prepare

simple, fresh, healthy food quickly and cheaply. This PhD sets out to determine

what were the impacts of JMoF Ipswich Australia as a community-based cooking

skills intervention?

increased participants’ skills,

viii

A longitudinal qualitative study sought to explore participants’ expectations

participants’ skills, knowledge, attitudes, enjoyment and satisfaction of cooking

ix

participants’ cooking self

participants’ enjoyment of preparing meals. Findings suggested the

environment. Improvements in participants’ confidence and enjoyment of cooking

’s

x

Table of Contents

Acknowledgements ................................................................................................ iiiDeclaration vAbbreviations vPapers and presentations arising from this thesis ................................................... viAbstract viiChapter 1. Overview ......................................................................................... 1

1.1 Background ............................................................................................. 11.2 Aim and scope ......................................................................................... 21.3 PhD candidate’s role in the evaluation .................................................... 21.4 Outline of this thesis ................................................................................ 3

Chapter 2. Literature review ............................................................................. 62.1 Chapter overview .................................................................................... 62.2 The importance of cooking skills for health ............................................ 62.3 The impacts of community-based cooking skills interventions ............ 152.4 Jamie’s Ministry of Food (JMoF) ......................................................... 532.5 Summary ............................................................................................... 59

Chapter 3. Mixed methods evaluation of Jamie’s Ministry of Food Australia programme 60

3.1 Chapter overview .................................................................................. 603.2 Evaluation and rationale ........................................................................ 603.3 Theoretical framework to guide evaluation ........................................... 613.4 Programme logic model ........................................................................ 653.5 Evaluation research questions ............................................................... 663.6 Mixed methods evaluation design ......................................................... 683.7 Summary ............................................................................................... 72

Chapter 4. Quantitative methods ..................................................................... 734.1 Chapter overview .................................................................................. 734.2 Quantitative paradigm ........................................................................... 734.3 Research aims and objectives ................................................................ 754.4 Quantitative study parameters ............................................................... 764.5 Ethical considerations ............................................................................ 924.6 Summary ............................................................................................... 93

Chapter 5. Qualitative methods ....................................................................... 945.1 Chapter overview .................................................................................. 945.2 Qualitative paradigm ............................................................................. 945.3 Research aims and objectives ................................................................ 985.4 Qualitative study parameters ................................................................. 985.5 Ethical considerations .......................................................................... 1095.6 Summary ............................................................................................. 110

Chapter 6. Quantitative results ...................................................................... 1116.1 Chapter overview ................................................................................ 1116.2 Participants: quantitative study ........................................................... 112

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6.3 Jamie’s Ministry of Food sample compared to the Ipswich population 1166.4 Programme outcomes .......................................................................... 1206.5 Adjusted analyses of outcomes ........................................................... 1316.6 Supplementary analysis ....................................................................... 1356.7 Summary ............................................................................................. 138

Chapter 7. Qualitative results ........................................................................ 1397.1 Chapter overview ................................................................................ 1397.2 Participants: qualitative study ............................................................. 1407.3 Participants’ motivations and intentions ............................................. 1447.4 Cooking social norms and cooking identity ........................................ 1467.5 The celebrity factor, Jamie Oliver’s influence .................................... 1517.6 Social benefits of the programme ........................................................ 1547.7 Food purchasing behaviours ................................................................ 1587.8 Barriers and facilitators to cooking ..................................................... 1597.9 Summary ............................................................................................. 165

Chapter 8. Discussion of findings ................................................................. 1668.1 Chapter overview ................................................................................ 1668.2 Research questions and programme logic model ................................ 1668.3 Major findings ..................................................................................... 1688.4 Evaluation strengths and limitations ................................................... 1878.5 Summary ............................................................................................. 192

Chapter 9. Implications and conclusions ...................................................... 1949.1 Research implications .......................................................................... 1949.2 Significance of this PhD ...................................................................... 2029.3 Conclusions ......................................................................................... 203

References ..................................................................................................... 204Appendices ..................................................................................................... 225

Appendix 1. Quality Assessment Tool for Quantitative Studies…………… 226 Appendix 2. Jamie’s Ministry of Food Australia manifesto……………....... 231 Appendix 3. JMoF protocol journal article ……………...…………...……. 235 Appendix 4. Jamie’s Ministry of Food Australia questionnaire…...………. 244 Appendix 5. Ethics documents……………………………………….......... 252 Appendix 6. Interview guide……………………………………………...... 261 Appendix 7. JMoF Australia primary outcomes journal article…………….. 263 Appendix 8. JMoF Australia secondary outcomes journal article…….……. 282 Appendix 9. Adjusted results for age, gender, employment and combined... 297

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List of Tables

Table 1: Cooking skills interventions – intervention and control groups ............. 21

Table 2: Cooking skills interventions – pre-post design, no control group .......... 26

Table 3: Cooking skills interventions – measured post-intervention only, no control group ......................................................................................................... 36

Table 4: Interventions with a follow-up period ..................................................... 43

Table 5: Cooking skills interventions reporting significant change over time by outcome measure ................................................................................................... 45

Table 6: Introduction of the researcher ................................................................. 95

Table 7: Demographic characteristics of participants by time point ................... 117

Table 8: Prevalence of health indicators, population 18 years and over ............. 119

Table 9: Predicted mean scores in cooking confidence, knowledge, attitudes beliefs, skills, enjoyment and satisfaction outcomes by group (T1 and T2) ....... 124

Table 10: Predicted mean scores in cooking confidence, knowledge, attitudes beliefs, skills, enjoyment and satisfaction outcomes for the intervention group (T1, T2, T3) ......................................................................................................... 125

Table 11: Predicted mean scores in behaviours and health and well-being by group (T1 and T2) ............................................................................................... 133

Table 12: Predicted mean scores in behaviours and health and well-being for the intervention group (T1, T2, T3) .......................................................................... 134

Table 13: Supplementary analysis: ordinal logistic regression and multilevel mixed model analysis .......................................................................................... 136

Table 14: Supplementary analysis: secondary logistic model (generalised estimated equation) for cooking confidence ....................................................... 137

Table 15: Summary of interview themes and domains ....................................... 139

Table 16: Qualitative participant profile at time of first interview ..................... 144

Table 17: Summary of complementary quantitative and qualitative findings ... 169

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List of Figures

Figure 1 Ecological framework for cooking influences ........................................ 10

Figure 2: Literature search .................................................................................... 20

Figure 3: Jamie’s Ministry of Food Centre, Ipswich, Queensland, Australia. ...... 58

Figure 4: Jamie’s Ministry of Food programme logic model ............................... 67

Figure 5: Quantitative and qualitative paradigms ................................................. 69

Figure 6: Mixed methods design ........................................................................... 71

Figure 7: Quantitative study design ....................................................................... 77

Figure 8: Qualitative evaluation time frame and study design ............................ 100

Figure 9: Qualitative data analysis process ......................................................... 106

Figure 10: Questionnaire response rates ............................................................. 113

Figure 11: Correctly answered nutrition knowledge by group and over time ..... 123

Figure 12: Mean daily fruit and vegetable consumption - comparison of JMoF intervention participants and Queensland (QLD) state-wide 2012 data ............. 127

Figure 13: Take-away food consumption comparison between intervention participants and Queensland ................................................................................ 128

Figure 14: Jamie’s Ministry of Food evaluation - qualitative participation, August 2012 to July 2013 ................................................................................................ 142

Figure 15: Improved programme logic model .................................................... 167

1

Chapter 1. Overview

1.1 Background

In today’s society, Australians are facing a number of challenges that discourage

home cooking. Changes in the western world’s dietary patterns and lifestyles have

resulted in an excess energy intake that contributes to dietary-related disease and

conditions such as obesity and diabetes (1). In a world of increasing demands and

opportunities, time is a precious commodity and supermarket shelves are stocked

with quick and easy meal solutions in the form of convenience foods (2).

However, these meals are often high in energy and contain high levels of salt,

saturated fat and sugar. The decline in the population’s cooking skills and cooking

confidence may prevent the preparation of food at home (3, 4). This is

concerning, because preparing food from fresh ingredients generally produces

more nutritious and healthier food (5).

e the population’s cooking

cal interest is celebrity chef Jamie Oliver’s Jamie’s Ministry of Food

2

1.2 Aim and scope

This PhD aims to determine the impacts and effectiveness of JMoF Australia as a

community-based cooking skills intervention. This thesis specifically evaluated

the first Australian fixed-site, ten-week JMoF programme in Ipswich,

Queensland. The evaluation adopted a broad socio-ecological approach and

employed mixed methods to determine the impacts and sustained effects of the

programme.

1.3 PhD candidate’s role in the evaluation

In 2010, The Good Foundation and the Queensland Department of Health

commissioned Deakin University to evaluate the JMoF Ipswich programme. All

data from the evaluation of JMoF Ipswich are presented in this thesis and the

contribution of the PhD candidate to each component of the evaluation is clearly

specified below. The candidate was instrumental in the initial planning and design

of the evaluation together with the evaluation coordinator and the evaluation

investigators (three of whom are also the candidate’s PhD supervisors).

The evaluation team included the following people:

Principal Investigator:

Professor Marj Moodie (Principal PhD supervisor) Deakin Health Economics,Deakin University

Investigators: Associate Professor Lisa Gibbs (Associate PhD supervisor) Jack Brockhoff Child Health and Wellbeing Programme, Melbourne School of Population and Global Health The University of Melbourne

Professor Elizabeth Waters Jack Brockhoff Child Health and Wellbeing Programme Melbourne School of Population and Global Health, The University of Melbourne

Professor Boyd Swinburn (Associate PhD supervisor) WHO Collaborating Centre for Obesity Prevention, Deakin University

Project Coordinator:

Anna Flego Deakin Health Economics, Deakin University

PhD Candidate:

Jessica Herbert Deakin Health Economics, Deakin University

3

1.4 Outline of this thesis

This section provides an outline of the structure of the thesis. Chapter 2, Literature

review, describes the importance of home-cooked meals and their role in healthy

diets. The barriers and influences on home-cooked meals that have contributed to

a decline in cooking skills are described, followed by a systematic examination of

cooking skills interventions. The findings from this systematic review indicated a

lack of conclusive evidence of the sustained effectiveness of such programmes

and the consequent need for stronger evaluations. The evaluation of JMoF

contributes to the evidence base in this area. The final section of the literature

review describes the JMoF Ipswich programme.

Chapter 3, Mixed methods evaluation of Jamie’s Ministry of Food

programme, provides a rationale for the mixed methods evaluation. This chapter

4

outlines the programme logic, the research questions that were used to guide both

the quantitative and qualitative studies, and how both studies will be brought

together.

Chapter 4, Quantitative methods, sets out the methodology used in the

quantitative evaluation of JMoF Ipswich. The quantitative study used a pre- and

post-assessment of the intervention with a six-month follow-up and a ten-week

wait-list control. The programme’s effectiveness was measured against two

primary outcome measures, namely cooking confidence and vegetable intake. A

range of secondary outcomes relating to healthy diets, personal development,

social connectedness and affordability of healthy meals were also measured.

Chapter 5, Qualitative methods, details the methodology used in the

qualitative evaluation. Repeat interviews over three time points were conducted

with a small sample of participants to understand their expectations and

experiences of the programme, the facilitators and barriers to cooking and any

unanticipated programme outcomes.

Chapter 6, Quantitative results, presents the findings from the analysis of

the pre- and post-questionnaires to measure changes in outcomes over time as a

result of the JMoF Ipswich intervention. Six-month follow-up data are also

presented to explore sustainability of effects over time.

Chapter 7, Qualitative results, presents the findings from the thematic

analysis of the longitudinal qualitative interview data from JMoF participants to

answer the research questions around programme expectations and experiences,

and participant barriers and facilitators to cooking. In addition, emergent findings

around the celebrity impact of Jamie Oliver are highlighted as well as the social

norms and identities that participants place around cooking.

Chapter 8, Discussion, brings together the findings from the quantitative

and qualitative studies. Results are compared and contrasted to paint a broader

understanding of the outcomes of the JMoF Ipswich programme in the context of

5

the literature and social theory. The strengths and limitations of the research are

addressed.

Chapter 9, Implications and conclusions, the implications and significance

of the findings are addressed followed by the drawing of a short conclusion.

6

Chapter 2. Literature review 2.1 Chapter overview

This chapter begins by describing the importance of cooking in a broad context. It

details the significance of a healthy diet for disease prevention. It explores the role

of home-cooked meals in the promotion of healthy lifestyles and how lifestyles

have changed to incorporate fewer home-cooked meals made from raw

ingredients. The term made “from scratch” has been used going forward to

represent foods prepared from raw ingredients and is a term frequently used by

celebrity chef Jamie Oliver. This chapter describes the influences that impact on

the preparation of home-cooked meals. The literature around cooking skills

interventions is systematically reviewed, and the impact and effectiveness of such

programmes appraised. The chapter closes with a description of JMoF Ipswich,

the cooking intervention which is the focus of this PhD research.

2.2 The importance of cooking skills for health

2.2.1 Non-communicable disease and diet

Adequate nutrition and healthy diets are important determinants of health. They

assist in the prevention of non-communicable diseases (NCD) such as Type-2

diabetes (11), cardiovascular disease (12), stroke (13) and some cancers (14, 15).

Obesity is associated with a higher risk of NCDs and it is forecast that the burden

of obesity and its associated health costs will only continue to rise (1, 16, 17). In

Australia, three in five adults are either overweight or obese (18, 19). In 2005, the

direct annual cost of overweight and obesity was estimated at AUD 21 billion,

with an additional average annual cost in terms of government subsidies of AUD

35.6 billion (20).

2.2.2 Changes in dietary patterns and diet quality

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Changes in the global food system are reflected in shifting dietary patterns and

lifestyle choices (1). There has been a dramatic increase in the consumption of

energy-dense foods that are high in saturated fat, salt and refined carbohydrates

and a decrease in the consumption of fruits, vegetables, complex carbohydrates

and dietary fibre (1). These changes in consumption patterns have led to excess

energy intake and over nutrition in today’s society (2). Changing lifestyles have

endorsed a high demand for fast-food, ready-made meals and convenience foods

which are high in energy and low in fruit and vegetables (17). The food industry

has strategically responded by offering quick and easy meal solutions for

consumers; the promotion and intense marketing of these products have

accelerated their increased consumption (2, 21). The use of “pre-prepared” foods

at home as a full meal or as part of a meal has become normal and acceptable

behaviour (22). As a result eating meals at home may not always be the healthy

option, due to a greater reliance on convenient, part or fully prepared meals and

take-away foods (23).

2.2.3 Food preparation and consumption today

There are a number of barriers that discourage or prevent people from cooking

meals at home, and there is a discourse about the lack of home-cooking and food

skills in today’s society. Lack of time is a commonly cited barrier to meal

preparation at home (25-27). Women are predominantly the food preparers and

8

are responsible for cooking in the household (28, 29). Working mothers report

time constraints in terms of both preparing meals and teaching cooking at home,

resulting in the greater use of convenient and fast foods to feed their families (30).

As previously mentioned, such pre-prepared foods are readily available in today’s

food environment (31). Changing lifestyle patterns have created a shift in the way

people prepare and eat meals; for example, it is acceptable to eat meals either

away from home in restaurants or at home using take-away or purchased pre-

prepared meals (22).

based on food prepared from “ ”

“ ”

one’s

9

“ ”

2.2.4 Environmental and personal influences on cooking

There are a number of different influences in today’s environment that impact on

individual choices. A review by Bisogni et al (2012) explained that healthy eating

is complex and diverse, and carries different meanings for different people

particularly at different life stages and through various life experiences (44). In

addition to life experience, an ecological perspective suggests that there is no

single factor to account for a particular behaviour such as cooking. Instead,

multiple factors – social, cultural and economic – contribute to behavioural

choices and actions (45). The use of an ecological model aids understanding of

the dynamic interplay between human behaviour and social and physical

environments (46, 47). Behaviour through an ecological perspective is presented

in terms of five levels, namely interpersonal, intrapersonal, organisational and

institutional, community and public policy, or societal (47-50). A social-

ecological model can be used to map the various variables at play at each level,

thereby facilitating the visual depiction of the multiple influences impacting on

individual behaviour (50). Figure 1 (adapted from Fitzgerald et al (2009) and

Robinson et al (2008) (51, 52)) illustrates the social-ecological framework used to

explain cooking choices. There are often multiple variables operating at each level

that influence behaviour. It is important to note that these interact cumulatively

and broadly across the different levels influencing an individual’s physical,

emotional and social well-being (47, 50). The next section describes some of

these influences that impact on an individual’s cooking behaviours.

10

Figure 1 Ecological framework for cooking influences*

*Adapted from Fitzgerald et al (2009) and Robinson et al (2008) (51, 52)

Cooking and consumption patterns have been shown to vary according to

demographic factors such as gender, socio-economic position, race and place of

residence (29, 53, 54). Cooking knowledge and cooking confidence are negatively

associated with education level and income (21, 29). For example, increased

income is linked to increased confidence to prepare certain foods (29). In one

Australian study, results showed that more vegetables were bought by households

where the main cook had the confidence to prepare them (55). Confidence to cook

and prepare vegetables was influenced in turn by the main cook’s level of

education and income (55).

11

One’s attitude and beliefs may also influence food choice

Self-efficacy, or confidence in one’s ability, is a good predictor of behaviour

change and shapes the outcomes that people expect to achieve (59, 60). Low

cooking confidence not only affects cooking skills but also people’s attitudes

towards meal preparation (61). In contrast, confident cooks have been found to

like the experience of cooking and tend to have a larger repertoire of cooking

techniques and dishes (61). In a cross-sectional study in Canada, children with

greater cooking self-efficacy and who were involved in the dinner preparation

increased the odds of increased family dinner frequency (62). Cooking confidence

was seen to rise with tacit skills such as skills of judgement, timing and planning,

12

allowing people to decrease the effort associated with cooking and encouraging

them to cook more (22).

Short showed an inter-relationship between cooking, cooking skills and people’s

cooking practices and food choices (22). Food choices are influenced by many

different factors such as personal tastes, cultural beliefs, public and private sector

policies and financial pressures (63, 64). Socio-cultural influences have been

shown to influence people’s food choice and consumption. For example in US,

African Americans eating healthy has meant their conformance with the dominant

culture and relinquishment of their cultural heritage (65). In addition to socio-

cultural influences, personal eating and food preferences of other family members

may influence household food purchasing and preparation of food in the home

(61). This suggests that it may not be the cook who ultimately controls a family’s

eating habits (61).

In a qualitative study conducted by Spence and van Teijlingen (2005), mothers

reported that they put their children’s diet and well-being before their own, and

this was found to be a motivator towards learning new skills in order to improve

their children’s diet (66). This links in closely with the next section on

provisioning, which is another key societal influence on food preparation

attitudes.

Domestic work has been conceptualised using the term "provisioning".

Provisioning refers to "the work of securing resources and providing the

necessities of life to those for whom one has a relationship of responsibility" (67,

p.383). This work is never-ending given that activities must regularly be

performed to ensure a family’s health and well-being. Food provisioning is one

sub-category of provisioning and refers to activities associated with securing and

providing food resources including the choices and actions involved in feeding

13

oneself and others (68). Women are typically the key caregivers and the

responsible food providers within the home (22, 28, 37). Women are central to

food choices and preparation (38). Whilst this gender difference may change over

time, as more men contribute to domestic food preparation, for the most part there

is still a consistent division of labour in terms of household food preparation. The

current literature shows that women are more likely to carry this responsibility

compared to men (37, 38, 67, 69).

a “

” for those “ ” was coined by

. The notion of a “ ” conveys complex inter

instead of their preferred idea of a “ ”

to prepare healthy meals due to work and children’s extracurricular activities

14

There is limited evidence in the academic literature on the role of celebrity chefs

and their influence on cooking and behaviour change. In Australia, there is

currently an abundance of cooking demonstration and cooking reality

programmes which often air during prime time television viewing. These are, for

example, Master Chef, My Kitchen Rules, Save with Jamie just to name a few.

Caraher (2000) states that celebrity cooks and television (TV) cooking

programmes are not likely to have a major impact on cooking behaviour, but may

influence and broaden cultural trends (70).

years old in an effort to promote children’s appreciation of healthy foods

’

change, Jamie Oliver’s television Jamie’s School Dinners

. Oliver’s second social cause –

–

15

argues that Jamie Oliver as an “ ”

what is acceptable “

”, foster individual self

2.3 The impacts of community-based cooking skills

interventions

With the decline in cooking skills, the response by public health practitioners has

been to try to improve the population’s ability to prepare food from “scratch”. In

recent years, there has been a proliferation of community-based cooking skills

interventions which aim to improve people’s cooking and change attitudes and

behaviours towards healthy eating patterns. The use of a hands-on practical

learning approach through cooking classes has been shown to be an excellent

starting point towards behaviour change, particularly in the short term (29, 77).

Incorporating cooking activities within nutrition education interventions can

increase programme participation and show gains in terms of food-related

preferences, attitudes, awareness, knowledge, self-efficacy and consumption

behaviours in both adults (3) and children (78).

16

2.3.1 Methods

A systematic review of community-based cooking skills interventions targeted at

adults was conducted with the aim of identifying positive impacts in terms of

cooking skills, behaviours and dietary outcomes comparative to a control group.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses

(PRISMA) (79) and Cochrane guidelines for the systematic review of health

promotion and public health interventions (80) were used as guides for this

review.

17

For an intervention to be included in this review, it needed to meet specific

inclusion criteria. The intervention needed to target adults over the age of 18

years. Secondly, it had to entail a hands-on practical cooking element

incorporated as the primary activity of the intervention or as a key and sizable

component within a broader intervention. Interventions without a practical hands-

on element, for example, nutrition education only or cooking demonstrations

without a practical element, were excluded. Multifaceted programmes

incorporating more than just a cooking intervention were also excluded. For

example, interventions including physical activity as a component were excluded

because of the difficulty in determining the extent to which the outcomes were

attributable to the cooking component. Thirdly, the intervention had to be set in a

community-based setting, such as community health, hospitals, schools

communities and faith-based settings. This community-based criterion excluded

interventions that provided for one-on-one programmes or commercially-driven

programmes, such as an Italian cuisine cooking school.

18

The following databases were searched to identify literature published in peer-

reviewed journals: Academic Search Complete, CINAHL Complete, Education

Research Complete, Global Health, Health Source: Nursing/Academic Edition,

MEDLINE Complete, Psychology and Behavioural Sciences Collection,

PsycINFO, SocINDEX with Full Text, and PubMed.

The following terms were used to search the databases: (Cook* OR “food

skills”) AND (Health OR diet OR behaviour OR behavior OR skill OR

esteem OR “healthy eating” OR social) AND (

based OR “community level” OR “population level” OR kitchen).

All interventions with a control group and reporting effectiveness were assessed

using a quality assessment checklist (82, 83) called the Quality Assessment Tool

for Quantitative Studies (84). The strength of each study with a control group was

ranked as strong, moderate or weak. The ranking criteria are found in Appendix 1.

For all qualitative studies, appraisal was based on the Cochrane Collaboration’s

Guidelines for systematic reviews of health promotion and public health

interventions (80). The Cochrane Collaboration states that whilst there is no

formal consensus on the guidelines for reviewing qualitative studies, it is

important to include qualitative studies within reviews of public health

interventions. The tools used incorporate three quality assessment

recommendations detailed in the literature: (I) Quality in Qualitative evaluation: a

19

framework for assessing research evidence (85); (II) How to read a paper:

Papers that go beyond numbers (qualitative research) (86); and (III) The critical

appraisal skills programme (CASP) ten questions to help make sense of

qualitative research (87).

2.3.2 Findings from community-based cooking skills interventions reviewed

Figure 2 shows the number of studies screened and included for review at each

stage of the process. A total of 7,973 studies were located during the database

search, with an additional 17 sourced from the grey literature. After accounting

for duplication and performing a title scan, 358 abstracts were reviewed and 69

full-text studies were examined to determine eligibility. A total of 47 full-text

studies were included and reviewed, ten included a control group (Table 1) whilst

the other 37 did not include a control group (Tables 2 and 3).

The ten studies including a control group are documented in Table 1. Five

randomly allocated participants to the control or intervention groups (88-92),

whilst five studies (four interventions) used non-randomised methods of

allocation to the control and intervention groups (77, 93-96). Twenty-six studies

entailed pre- and post-assessment of the intervention without a control group

(Table 2) (57, 97-121). The remaining eleven studies provided post-assessment

measurements of the intervention effect (Table 3); most of these eleven used

qualitative methods (56, 66, 122-129), except for one (130). All 47 studies were

reviewed and findings are presented; however, particular attention is paid to those

studies with a control group, especially when summarising the impacts and

outcomes of the intervention.

20

Figure 2: Literature search

*large numbers of duplicates were found because multiple databases were searched.

Duplicates removed (n=3,889*)

Records identified through database searching

(n=7,973) Id

entif

icat

ion

Additional records identified through other sources (such as non-peer reviewed evaluation

reports) (n=17)

Total studies found (n=7,990)

Titles screened (n=4,101)

Records excluded, (n=3,743) Titles did not relate to nutrition

or cooking intervention

Scre

enin

g In

clud

ed

Elig

ibili

ty

Full-text articles assessed for eligibility

(n=69)

Total articles included (n=47)

Studies including a control group

(n=10)

Abstracts screened (n=358)

Records excluded, (n=289)Abstract did not match

eligibility criteria

Full-text articles excluded (n=22)

Reasons included; population group <18 years old, did not

included “hands-on” practical cooking element, included physical activity or other

intervention which would not help indicated cooking impact

Studies without a control group

(n=37)

Table 1: Cooking skills interventions – intervention and control groups

Author, Year Country

Study design Appraisal score

Population and sample

Intervention constructs and duration

Measurement tools Outcomes

Randomised controlled trials UK studies Curtis et al 2012, UK (88)

Randomised parallel-design, comparing three interventions. Pre and post- assessment of intervention, with 6 and 18month follow-up.

Strong* Some confounders in terms of SES, and no blinding.

Socially deprived families with poor diets. Equal sample among interventions A, B, C. Baseline n=589, 3months post-intervention n=444, 6-month follow-up n=369, 18-month follow-up n=198.

Family Food and Health Project Three interventions: A) 2h education only session B) 2h x 6weeks ‘cook and eat’ intervention C) personalised goal setting + ‘cook and eat’.

3-day food diary at baseline, 3months post intervention, 6months follow-up and 18months follow-up.

Three months post-intervention intervention C consumed less fat ((P=0.02), starch (P=0.04) and more total carbohydrates (P=0.001) compared to intervention A, carbohydrates were significantly sustained at 18months follow-up (P<0.05). Significant reduction in energy density of diets at 18months follow-up in both intervention B (P<0.001) and C (P<0.001) compared to A. Intervention B participants consumed more carbohydrates than intervention A (P=0.04).

US Studies Gold et al 2014, Dakota, US (90)

Randomised parallel-design, comparing three interventions. Pre and post- assessment (2weeks) of intervention.

Strong* While sample size small, only 15 participants in each group were required.

Refugees and immigrants (<3years in the US); part of the English language learning community. Food map (n=27), Cooking class (n=21), control (n=25).

Three interventions: A. 2h food safety map discussion. B. 2h x 2 cooking classes C. Control – no intervention. Both A and B received a food safety kit.

Self-report survey; paper based pre-intervention survey and telephone interview post-intervention measuring food safety knowledge and behaviours and behavioural intentions.

Food safety knowledge significantly increased in the food map (A) and cooking (B) interventions compared to the control (C) for knowledge of cooking meat (P<0.001) and refrigeration of food (P<0.001). All food safety behaviours significantly increased in food map and cooking class compared to control group (P<0.05) including washing hands, cross contamination, refrigeration of food and cooking of food. Significant differences found between food map (mean=3.7) and cooking intervention

22






(mean=4.7) and the intended use of a food thermometer (P0.002).

Wenrich et al 2012, Pennsylvania, US (92)

Random allocation to control and intervention group. Pre and post- assessment of intervention, with 3month follow-up.

Moderate* Outcome assessors were not blinded. Limited valid and reliable data collection tools available.

Low income families living in rural area, n=25 couples in both intervention controls (couples included one food preparer and one partner).

8 x 2h weekly session. The intervention group were taught skills through taste testing and hands-on cooking; the control group received written materials only.

Self-reported survey using some validated items and measuring: readiness to eat vegetables, self-efficacy, and vegetable intake, and dietary history. Meal diaries were kept over the course of the intervention.

No significant differences were found between intervention and control groups. In both intervention and control groups, consumption of deep-orange vegetables and total carrots, broccoli and lettuce, plus total vegetables in a recipe significantly increased. Amongst partners, significant improvements in all vegetable categories in both intervention and control groups over time, but not between groups. Intervention food preparers with a high Meal Diary score (meaning greater improvement in target vegetables) had significant improvements in total target vegetables (P=0.009), total carrots, broccoli and lettuce (P=0.007) and total vegetables in recipes (P=0.008) compared to food prepares with a low Meal Diary score. Amongst control participants, the number of family meals per week significantly decreased by 1 meal/week compared to the intervention group which stayed the same.

Fulkerson et al 2010, US, Minnesota (89)

Random allocation to control and intervention group. Pre and post-

Strong* Low sample size, not powered to detect behavioural outcomes. No

Parent/child pairs of healthy children aged 8-10 years old and their parents who prepared the meals at home (n=44 families).

Healthy Home Offerings via the Mealtime Environment 5 x 90 min sessions, over 3 months. Focus on

Child anthropometry, 24 hour dietary recall of children, Self-reported validated and reliable psychosocial surveys measuring family dinner frequency

While not significant, an increase in parental self-efficacy (P=0.55) compared to control. No significant change in dietary outcomes for children (P=0.08). Intervention children reported significantly higher food skills development (P<0.01) and frequency of helping to make the family dinner (P<0.001).

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assessment of the intervention, with 6 month follow-up.

mention of 6-month follow-up results, except in abstract.

improving meals prepared at home for children.

and source of food, parent cooking self-efficacy, child food preparation skills.

Levy and Auld 2004, Colorado, US (91)

Random allocation to control and intervention group. Pre and post- assessment of intervention with a 3month follow-up.

Strong* Self-selected students. Tested questionnaire for face validity and reliability using test-retest methods

College students (n=33 intervention and n=32 control).

2h x 4 cooking sessions, plus a 45 minute supermarket tour. Control group attended a 1h cooking demonstration.

Valid and reliable self-reported questionnaires; eating habits survey measuring baseline eating history and experience, cooking habits survey measuring cooking attitudes, behaviour and knowledge and post-intervention 72 hour food preparation recall.

Significant increase in attitudes around liking to cook in intervention group (0.4 mean gain) compared to control (0.1 mean gain) (P<0.01). Significant increased confidence to use different cooking techniques in intervention (0.7 mean gain) compared to control group (0.3) (P<0.01). While not significant, results showed the intervention group was more likely to prepare dinner than eat out and ate out less frequently than control group.

Non- randomised control trials UK studies McKellar et al 2007, Scotland, UK (95)

Pre and post (3months) assessment of the intervention and 6-month follow-up.

Moderate* Confounders between intervention and control groups (more deprived in the intervention group).

Females aged 30-70 years old with rheumatoid arthritis living in socially deprived areas. (Sample at 6-month follow-up n=130, intervention n=75 and control n=55)

2h session for 6 weeks, cooking skills classes emphasised the use of a Mediterranean-type diet.

Dietary assessment measured with food frequency questionnaires; cardiovascular risk measured using anthropometry. Clinical and laboratory assessment (such as blood test, blood pressure and joint assessments) and clinical

Significant increase in weekly portions of: fruit, vegetable and legume consumption (P=0.016) and decreased consumption of monounsaturated and saturated fats (P=0.022) post intervention compared to control. Cardiovascular risk factors reduction in intervention group with a significant drop in systolic blood pressure (P=0.016) compared to no change in the control group. No change in other measures over time and between groups. Significant reduction in clinical global assessment (P=0.002) and pain scores

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assessment measured through global pain measurements and laboratory assessment. Measured baseline, 3 month and 6-month.

(P=0.049) at 6 months compared to control group.

Wrieden et al 2007, Scotland, UK (77, 96)

Pre and post- assessment of intervention and6-month s follow-up, with a wait-list control.

Moderate* High dropout rate at follow-up (44%). Low sample size, not sufficiently powered to detect behavioural outcomes.

Participants were from areas of social deprivation (T1 n= 113, T3 n=63)

Cook Well programme 2h session for 10 weeks (7 sessions were practical)

Self-reported general, cooking skills and food frequency questionnaire and 7-day food and shopping diaries. Measured at baseline, post intervention and follow-up. Qualitative interviews with small sample at T3.

No change in food frequency at baseline and six month follow-up. Increase in fruit and vegetable consumption, however fruit consumption was the only food to show a significant change of one portion per week (P>0.05) between baseline and post intervention. Increased food preparation from cooking with basic ingredients by the intervention group (68% at baseline to 90% at follow-up) compared to no change in control group. Significant increase in confidence to follow a recipe (P>0.05) between baseline and follow-up, compared to control group. Small significant difference in weight gain between intervention and control group between baseline and 6-month follow-up (P=0.049). The intervention group observed a slight decrease in weight (mean -0.6kg) from T1-T3, which differed to a slight increase in the control group (mean 1.8kg).

Kennedy et al 1998, UK (94)

Pre and post- assessment of the intervention

Moderate§ The researchers’ perspective

Low income mothers from socially deprived urban neighbourhood (n=23

Friends with Food 2h sessions for 10 weeks.

12 x programme development baseline focus groups. Session observations.

Intervention participants reported lifestyle barriers such as financial constraints, influences from their partner and family and nutrition education as barriers impacting on

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with 3month follow-up; control was assessed post- intervention (no baseline data for control group).

and ethical issues or approval was not reported.

intervention, n=13 matched controls)

Qualitative 1h semi-structured interviews to measure and quantitatively score nutrition knowledge and allow for emerging themes (post-intervention and 3 month follow-up between intervention and matched control group).

their cooking. Participants also indicated successful cooking was more likely with family support. Intervention participants significantly increased nutrition knowledge in 2 out of the 4 intervention groups (P<0.05) compared to no change in control group.

US studies Birkhead et al 2014, Louisiana, US (93)

Interrupted time series. Post- assessment of intervention with retrospective control.

Weak* Limited details of the data collection and analysis methods used.

First and second year medical students attending cooking learning module, n=125

Medial students received 2h training then delivered 6 cooking classes to underserved urban communities in New Orleans.

Cross-sectional annual school wide self-report surveys measuring competencies, attitudes, health habits and participation in cooking learning module. Retrospective annual reports, prior to leaning module implementation, were used as comparison, n=352

Compared to the prior year when the curriculum was not available, students who completed the cooking learning module were more likely to perceive proficiency in nutrition knowledge for weight loss (P=0.021), antioxidants in health (P=0.012), aerobic exercise (P=0.001) and hydration (P0.008).

* Quality Assessment Tool for Quantitative Studies (84) § Qualitative critical appraisal skills programme (CASP) 10 questions were used to appraise qualitative research (87) (44). BMI = Body Mass Index

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Table 2: Cooking skills interventions – pre-post design, no control group


Study design Population and sample Intervention constructs and duration


Australian studies Lee et al 2010, Victoria, Australia (114)

Pre and post- assessment of intervention.

Community Kitchens in Frankston on the Mornington Peninsula. Participants (n=63), facilitators (n=17) and project partners (n=10).

Duration unknown. Community Kitchen where participants are led by a facilitator to plan, cook and share a nutrition meal.

Written surveys (to determine reach of programme), 11 x focus groups before and after cooking session and telephone interviews with facilitators.

Qualitative findings reported perceived benefits from participants after attending including the development of cooking, food and kitchen skills, new recipe modification, ability to make quick and easy meals and increased confidence to try new recipes. Social support was also common with participants reporting a positive experience to establish friendships, socialised and enjoy with others.

Porter et al 2000, Queensland, Australia (117)


Participants with chronic mental illness returning to the community after hospitalization (n=3).

16 x 1h individual life-skills programme sessions, 2 times per week for 8 weeks.

Qualitative case study approach and The Functional Needs Assessment-Programme for Chronic Psychiatric Patients (FNA) to assess food skills.

Improvements in FNA levels for all three participants. This includes improvements in skills relating to dining, kitchen, food preparation, money management, shopping and purchasing and social etiquette.

Foley and Pollard 1998, Western Australia, Australia (57)

Pre and post- assessment of intervention, 4year follow-up.

Food Cent$ targets low income earners. Evaluation measured community advisors training to be Food advisors (n=150) and participants attending budgeting and cooking session (n=373). N=83 paired pre-post and

Food Cent$ 1.5h x 4 classes (food advisor training, budgeting session, and cooking and supermarket tour).

Pre-post diet check measuring dietary change, post-session questionnaire measuring demographics, intention to change, 6-week follow-up and 4year follow-up questionnaire measuring confidence to run session, dietary and spending change. Focus group with

Significant dietary change was reported after attending the budgeting session with a significant increase in persons who spread margarine thinly (P=0.004), which rarely ate sweets (P=0.013) or bought cakes (P=0.001).

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follow-up attending cooking and budgeting session.

advisors who did not conduct a session.

UK studies Garcia et al 2013, Scotland, UK (110)

Pre and post- assessment of intervention, 12month follow-up

Parents of young children. (baseline n=102 and follow-up n=44)

2h session for 4-8 weeks Self-reported questionnaires measuring food consumption patterns, confidence, knowledge, enjoyment and any perceived benefits to participants’ families (which were only measured at follow-up)

12 months after the intervention there were significant increases in all confidence measures, a significant reduction in the number of times ready-made meals were consumed from 2-4 times/week to 1 time/week (P=0.001). Significant sustained increases in fruit (P<0.05) and vegetable (P=0.001) consumption measured in times/week at follow-up. Majority of participants at follow-up agreed there were benefits to their family and their families’ nutrition.

Caraher and Lloyd 2013, South Liverpool UK (99)

Pre and post- assessment of intervention, 3 month follow-up

Socially disadvantaged families (n=11 families)

Can Cook Families Programme 2 day training course, where chefs lead the programme.

Pre/post assessment using: semi-structured interviews, cooking skills questionnaire, 24hour food recall, food storage photographs and 7day shopping records.

Significant mean increase in fruit by 0.8 serves/day (P=0.01) and vegetable by 1.5 serves/day (P=0.009) after the intervention. Increased spending on fruit and vegetables and significant increase in skills and confidence of using basic ingredients (P=0.001), following a recipe (P=0.01), tasting new foods (P=0.025) and preparing new recipes (P=0.038).

Lawe 2013 Nottingham, UK (113)

Pre-post assessment of intervention.

College students at Nottingham Trend University. (n=unknown).

Student cookery clubs including 2h x 4 weekly sessions.

Mixed methods evaluation: Self-report pre/post questionnaire about eating habits and knowledge of

Results did not report change over time nor did they indicate analysis methods or sample size. Post-intervention participants reported “good-excellent” levels of confidence in

28




healthy eating. Qualitative class observation in first and last classes, with informal participant discussion. Focus group with first year university students

trying different recipes and improved likelihood that participants would eat healthy after attending the course.

Children's Food Trust 2011, Sheffield, UK (102)

Pre and post- assessment of intervention, 6-month follow-up of some participants.

Areas of high deprivation targeting families, children and adults. The number of adults and children unclear (n=1,754 in total).

Let’s Get Cooking 8-6 week activity cycle. National English cooking skills programme targeting children and their parents implemented across the UK.

Self-report pre-post questionnaire measuring change in eating habits.

Methods indicated that adults completed the questionnaire however all results presented appear to refer to children sampled. 92% of participants indicated they were using skills learnt at home. On average, participants had also shared that knowledge and skills with at least one other person. 58% of participants reported eating healthier after the programme, with results being sustained 6months after the intervention.

Davis et al 2009, Southampton UK (107)

Pre and post- assessment of the intervention, 12month follow-up.

Mostly women (81%) of South Asian decent (n=46).

Breaking the Cycle Project Duration unknown, however during implementation 330 people participated in 10 taster sessions and 28 cookery club sessions providing practical skills to improve diets.

Self-reported questionnaires, reflection sheets, focus groups and telephone interviews.

Positive dietary behaviours were shown: 42% of participants were using low fat milk at baseline which increase to 86%, there was a decrease in consumption of sugary foods from 23% to 5% and an increase in the consumption of fruit and vegetable from 85% to 100%, however significant of results were not reported. Other outcome measures were not reported such as attitude to healthy eating, changes in eating patterns, changes in shopping and cooking practices, barriers to changes and maintenance of changes.

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Participants indicated that their motivation to become food trainers was led by a need in the community and a family history of nutrition-related ill health.

US Studies Kokkonen-May et al 2014, Minnesota, US (112)


Supplemental Nutrition Assistance Programme (SNAP) eligible participants in three regions of Minnesota (n=45).

Simple Good Cooking 2h x 6 sessions (with a choice of 20 hands-on activity lessons with options ranging from general, fruits, vegetables, protein, grains, and dairy.

Self-report survey measuring self-efficacy, confidence, food behaviours and food and health knowledge.

After the intervention there were significant increases in confidence to plan a health meal (P<0.000), prepare a healthy meal (P<0.000) and make food from scratch (P<0.03). After the intervention there were significant increases in fruit and vegetable consumption (P<0.001). Fruit increase from 0.8cups/day to 1.3cups/day. Vegetables increase from 1.1cups most days to 1.4cups most days. Behaviour changes after the intervention included shopping from a list (P<0.001), making a dish with beans (P<0.001) and doing physical activity at least 30minutes/day (P<0.001).

Bielamowicz et al 2013, US (97)

Pre, mid and post-assessment of intervention.

Participants attending Do Well, Be Well with Diabetes (DWBW) Programme in 86 counties. DWBW was a 9 week diabetes education programme Pre-test n= 2,853, Post-test n=1026

Cooking Well with Diabetes 4 lessons. The Cooking Well with Diabetes was an extension of the DWBW intervention.

Mixed methods. Quantitative questionnaire measured at baseline, after third class, and post-intervention during last class. Measuring self-report blood glucose, haemoglobin A1Ctest, cooking behaviours, knowledge of healthy cooking practices for diabetes.

Knowledge scores increased significantly (P<0.05) between baseline and after the intervention. Behaviours measuring healthy cooking for diabetes practices increased in 8 out of 10 measures (P<0.01) after the intervention. Qualitative findings indicated that participants were able to put knowledge into practice after attending the intervention.

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Qualitative open-ended questions to provide insights into the programme.

Condrasky et al 2013, South Carolina, US (106)

Pre-post assessment of intervention, 3month follow-up with monthly phone calls every three months for 15months.

Cooks within African America churches (n=100).

Cooking with a Chef One 8 hour workshop, plus monthly mailed information on cooking tips and recipes for 15 months post intervention and a half day booster session around Easter and Christmas (for a five year period).

Mixed methods. Pre-intervention Cooking with a Chef validated questionnaire measuring cooking attitudes, self-efficacy, behaviours, cooking techniques and fruit and vegetable use. Pre and post cooking skills and cooking confidence measure. Feedback over the phone via ‘technical assistance phone calls to participants three month post-intervention and every third month thereafter for 15months.

Significant increases were found post intervention in cooking skills (P<0.0001) and confidence (P<0.0001). Qualitative findings indicated that participants were using less salt and incorporating more fruit and vegetables into their menu planning.

Condrasky, Hegler and Sharp 2011, South Carolina, US (105)

Pre and post- assessment of the intervention.

School food services workers (n=111).

Cooking with a Chef 1 x 8 hour workshop Hands-on nutrition education programme adapted from the original Cooking with a Chef aimed school nutrition operators.

Cooking with a Chef validated questionnaire measuring cooking attitude, produce consumption self-efficacy, cooking self-efficacy, self-efficacy for basic cooking and self-efficacy for using fruit and vegetables.

Significant change in attitudes (P=0.03) and cooking skills (P<0.0005). Significant correlation between produce consumption self-efficacy with cooking technique self-efficacy and self-efficacy for using fruit, vegetables and seasonings.

Condrasky et al Pre and post- Parents and caregivers of Cooking with a Chef Mixed methods No change in fruit and vegetable

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2006 South Carolina, US (103, 104)

assessment of the intervention.

preschool aged children, n=29 (intervention n=15, control n=14).

2h session x 6 lessons. The intervention included interactive sessions facilitated by a chef and nutrition educator who taught culinary skills and hands-on learning.

24h Food recall, food behavioural checklist and pre and post questionnaire measuring mealtime practices, use of flavours in cooking at home, fruit and vegetable intake and parental support. Post-intervention focus groups were also conducted.

consumption, however small increases were reported in children’s fruit intake (P<0.096). Parents and caregivers increased confidence, skills and awareness of the use of flavours and confidence to prepare healthy meals at home.

Rustad and Smith 2013, Minneapolis, US (118)


Ethnically diverse, low income women aged 23-45 years of age (n=118).

6 x 75-90 min session. 3 sessions included hands-on interactive nutrition education via cooking.

Food frequency questionnaire and self-reported questionnaire measuring nutrition and health knowledge and behaviours.

Significant increase in 7 out of 11 knowledge questions (P<0.01) in statements around sodium in food, diet and cancer, nutrients in foods, nutrition labels, use of herbs and spices and physical activity. Significant increase in nine out of 11 behavioural questions (P<0.01) with increased vegetable intake, use of herbs and spices in cooking, use of nutrition labels, doing physical activity, preparing healthy meals for their families. There was also a significant correlation between knowledge and behaviour.

Francis S 2012, Wyoming, US (109)

Pre and post- assessment of the intervention, 16week follow-up.

Adults Wyoming communities (86% females). n=19 (n=14 at follow-up).

Eat to Your Heart’s Content 2h x 4 sessions. Each session consisted of cooking practicum and nutrition education.

Self-report questionnaire measuring heart-healthy lifestyle practices.

Significant improvements were found for all measures between baseline/post intervention and baseline/follow-up (P<0.02) including improvements in knowledge, cardiovascular disease risk factors, dietary improvements in fibre, fruit and vegetables, health food choices, cooking methods and behaviours.

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Chavent et al 2012, Connecticut, US (101)


Child care professionals (n=15).

Share Our Strengths Cooking Matters Two weekends between 9am and 2pm. Modules included: creating positive time, setting a healthy example, recipe ingredients, food safety, nurturing a healthy eating, food labels, healthy food, portion size and food allergies.

Pre and post surveys. Significant improvements were found after the programme in confidence to add healthy food to a recipe (P=0.0003), compare food prices (P=0.005), and plan meals within a budget (P=0.04).

Shankar et al 2007, Washington DC, US (119)

Pre and post-assessment of the intervention, 4month follow-up.

African American women living in 11 public housing communities (n=212).

7 x 90 minute sessions in total (2 sessions a week for 3 weeks, followed by 1 “booster” session 6weeks post intervention).

Self-reported change in dietary knowledge, attitudes and behaviours.

There were no significant changes in fruit and vegetables consumption after the intervention and at follow-up. Participants who attended 5 or more sessions experienced a significant reduction in % calories from fat between baseline and post intervention (3.08% less P<0.001) and between baseline and follow-up (2.97% less P<0.001). For participants who attended 1-4 session2, there was a significant 3.86% reduction in calories from fat (P≤0.05), however this was not sustained.

Swindle et al., 2007, Denver, US (120)

Pre and retrospective pre-post assessment of the intervention, 3 and 6months

Limited income families (>90% women) in the Denver metropolitan area. Baseline, n=19, retrospective pre-post n=53 (n=12 completed

Operation Frontline’s Eating Right 6 week community targeted nutrition education programme taught in English and

Two forms of ‘pre-test’ were measured, one at baseline before the intervention and a retrospective pre-test. Self-reported retrospective

Retrospective pre/post test indicated that all shopping, general and eating behaviours significantly changed (P<0.001) post- intervention. Behaviours were not sustained between post- test and 3 (n=27) or 6 (n=12) month follow-up.

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follow-up.

initial pre-test), n=27 completed 3month follow-up, n=14 completed 6month follow-up.

Spanish. Curriculum includes meal planning, cooking, shopping smartly and food safety.

pre-post standard Operation Frontline survey was used plus the pre-intervention survey measuring eating, shopping and general behaviours.

Comparing the traditional pre-test with the retrospective pre-post-test (n=12) results showed that the only significant difference between was in shopping behaviours which had a higher mean (2.5, SEM 0.2) compared to the retrospective pre-test (1.9, SEM 0.1), however both were significantly different post intervention (2.9, SEM 0.1).

Newman et al 2005, US (116)

Baseline and 12months follow-up.

Women who had been previously treated for breast cancer (n=739).

12 x monthly cooking classes, newsletters and 15-23 telephone counselling session (median number of classes attended was 5). The primary intervention was whether telephone counselling improved dietary targets. This study reported on whether the use of cooking classes (and newsletters) over a 12 month period improved adherence to study dietary targets.

3-day 24 hour dietary recall via the phone.

Mean dietary intake were reported: vegetable intake increased from 4 to 8.1 (including juice) serves per day (P<0.001), fruit intake increase from 3.6 to 4.2 (P<0.001), fibre increased from 22.1 to 30.3 grams per day and fat decreased from 27.7 to 21.7 % energy. Dietary adherence was aided by cooking class attendance (P for trend <0.01).

Woodson et al 2005, Nevada, US (121)


African American faith communities through church facilities (n=326).

Food for Health and Soul 6 x 60 min classes aiming to retain cultural food and reduce dietary fat, sodium, sugar and

Pre and post self-report Eating Style Questionnaire measuring behaviours plus stages of change and perceived benefits from the programme.

Significant improvements in fat (P<0.001) and sodium intake (P<0.001) after the intervention. There was advancement throughout the stages of change indicators; however there was no significant difference post-

34




increase fibre. intervention.

Brown and Hermann 2005, Oklahoma, US (98)


Members of 29 Oklahoma Counties (n=229 youths with mean age of 12 and n=373 adults with a mean age of 57).

Duration of intervention unclear, trainers provided an average of 8 classes over 2 months.

Self-report questionnaire reflecting class content around fruit and vegetable consumption and food safety behaviours.

Fruit significantly increased in adults from 1.5 to 2.1 serves per day (P<0.0001), Vegetable significantly increased from 2.1 to 2.7 serves per day (P=0.0001). 11% significant increase in washing hands before preparing food in adults (P<0.0001), 8% of adults significantly increased washing produce before using them (P<0.0008).

Chapman-Novakofski et al 2005, West Virginia, US (100)


Adults with diabetes or their care givers. (N=239).

Dining with Diabetes Programme 2h session x 3 classes.

Self-report measures of knowledge based on Stages of Change Theory and Social Cognitive Theory.

Significant change in healthy eating practices (P<0.05), confidence to change their meals (P<0.05) and knowledge around diabetes and nutrition (P<0.05) post-intervention.

Canadian Studies

Keller et al 2004, Ontario, Canada, (111)

Pre and post- assessment of the intervention during the evaluation year.

Senior men aged 65 years and over and retired n=19 pre (1 year after intervention began) and post measurements during evaluation year, n=10 key informant interviews.

Men Can Cook 2h classes run once a month over 8 months. Classes involved preparing and consuming a meal.

Mixed methods. Pre and post self-reported questionnaires assessing change in cooking habits, nutritional knowledge and eating habits. Semi-structured interviews mid-way through intervention relating to men’s experience and outcomes of the cooking group.

No statistical significant change over time, however improvements were shown in pleasure for cooking and cooking confidence, improved appreciation and attitude towards healthy eating and new foods. Qualitative results found programme had a positive effect on sense of self-worth and connection with others. The men reported a positive experience of the intervention.

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Dewolfe and Greaves 2003, Canada (108)

Pre and post- assessment of the intervention, 3month follow-up.

Low income (majority female, some low education) Baseline n=42, post intervention n= 20, 3 month follow-up n=17.

The Basic Shelf Experience. 6 week programme where participants would plan, prepare and eat the meal.

Mixed methods. Self-reported questionnaire measuring food resource utilisation, food insecurity and self-esteem. Focus groups measured at follow-up to understand participants’ perspective and programme experience.

No significant change in food security or change in self-esteem. Qualitative results found the programme could not change the amount of money that people had but participants felt they were doing something positive to stretch their food dollars further. Participants received support from other group members. Participants felt they built confidence in themselves and in others, around shopping, planning, and preparing meals and using a cookbook.

Marquis et al 2001, British Columbia, Canada (115)


Participants using Tillicum Haus Friendship Centre’s Community Kitchen in Nanimo, British Columbia. N= 14.

Q’wlut tu cicut (My Parents are cooking). Total intervention of 30 weeks. 20 weeks education and practice training to run a cooking group, followed by 10weeks of running their own cooking clubs, recruiting friends and families and cooked together on average 3.3 time (range 1-12 times).

Two qualitative focus groups. The first focus group determined participants’ goals and expectations, subsequent focus groups determined if goals were met.

Perceived benefits of attending the intervention included socialisation, budgeting skills, food shopping knowledge, obtaining a food certificate (which led to employment for some), making new meals, enjoyment of cooking and the programme and sharing knowledge. There were also reports on improvements on food security.

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Table 3: Cooking skills interventions – measured post-intervention only, no control group




Australian Studies Abbot et al Sydney, Australia (56, 122)

Post-assessment of intervention.

Aboriginal community in western Sydney, Australia (n=23).

4h classes over 18 sessions. Participants ranged from attending 2-9 classes. The intervention focused on home cooking on a budget, and health eating for weight and diabetes management.

Semi-structured in-depth interviews exploring participant experience, benefits after the course in healthy eating behaviours and cooking skills.

Participants reported strong motivating factors for change that included a recent health diagnosis and desire to influence family dietary habits. Participants reported improvements in cooking skills and knowledge as well as positive health changes such as weight loss, increased well-being and diabetes self-management.

Foley et al 2011, Queensland, Australia (126)


Intervention targeted Aboriginal and Torres Strait Islander (young mothers group and men’s groups) (n = not reported).

3x 3h workshops or 4x 2h workshops.

Focus group conducted post-intervention.

Intervention was successful from perspective of nutrition professionals, students and community leaders; participants were motivated and increased cooking healthy meals at home and were provided with an opportunity to cook and taste new foods. Additional benefits to the facilitators to engage with participants.

UK studies Spence et al 2005, Scotland, UK (66)


Lower class areas targeting low income families (n=6).

Now You’re Cooking 8 week programme teaching basic cookery skills and inexpensive health and tasty dishes

Semi-structured interviews conducted six month post-intervention

Key motivation to attending cooking classes was to improve their children's diet. Participants learnt cooking skills, budgeting skills, boosted self-esteem leading to employment opportunities. Participants reported improvements in their children’s diet, yet not their own, while participants without children were more likely to change their own diet.

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Snowdon, W 1999, Bedfordshire, UK (128)


Local Southern Asian community (n=60).

3 x 2h sessions. Post-intervention evaluation form n=60. Qualitative end of club evaluation session discussion n=20 Qualitative follow-up evaluation session discussion (face-to-face n=5 and phone interviews n=2).

In the short term, participants commented that they enjoyed the course and felt they had learnt how to make cooking healthier. Many also commented that a motivating factor for change was a family member’s illness (for example, diabetes). In the long term, participants maintained nutrition knowledge and perceived changes in their diet by improving the nutritional quality of their cooking. Some also passed on nutrition messages to others.

US Studies Archuleta et al 2012, New Mexico, US (130)

Post-assessment of intervention during last class and one month follow-up.

People with diabetes and their family members in New Mexico baseline n=614

Kitchen Creations 3h x 4 session consisting of diabetes nutrition education followed by meal preparation and consumption. Each participant received materials and cookbooks.

Pre-survey measured demographics only. Post and follow-up surveys measured knowledge and behaviours.

Improvements were shown in knowledge around food and cooking for diabetes (significance testing was not reported). Overall knowledge was high post intervention, with significantly higher knowledge score between Hispanics compared whites (P=0.0004) and females compared to males (P=0.0199). On average, participants’ intention to change behaviours improved.

38




Canadian Studies Engler-Stringer and Berenbaum 2006, Canada (123-125)


Collective Kitchen attendees including: low income single mothers, men, seniors, and disabled, homeless or under-housed people. n=9 informant interviews for example staff members who support community kitchens, n=10 group leaders, n=20 participants

Observation of ongoing collective kitchen period for 6 weeks-6 months.

Participant observation, in-depth individual interviews about their experience with the community kitchens.

Participants described; learning about the nutritional value of food, new methods of cooking, changing grocery shopping habits, label reading and bulk buying. Programme facilitated formal and informal peer-assisted learning around cooking and nutrition, with opportunities for participant and leaders to share information and skills. Qualitative findings included decreased social isolation, increased social support, participation and sharing resources in their community as well as knowledge of where to find help. Participants perceived an increase in short-term food security, decreased psychological distress associated with food insecurity, food produced were favourable in terms of quality and acceptability in comparison to charitable handouts and gained the ability to cook greater quantities of food.

Tarasuk and Reynolds 1999, Toronto, Canada (129)


Low-income household participants and community kitchen facilitators (participants interviewed n=14, facilitators interviewed n=6, no control group)

Programme duration not stated. Community Kitchens were ongoing facilities for the community to regularly come together to cook and prepare food for their families.

Observational methods and semi-structured interviews of kitchen users with 4 months to 5 years use of kitchen.

Community Kitchens aided participants with coping skills and provided social support. Could not resolve food insecurity because the programme could not change household economic circumstances.

39




Moldofsky Z 2000, Toronto, Canada (127)

Post-assessment of the intervention.

Large low-income immigrant population from a Food Bank (n=10).

Meals Made Easy Ten series of cooking classes. 2h classes once per week in blocks of 3-6 classes. Interactive cooking programme to help Food Bank clients.

Self-assessments at the end of each class and focus group.

The programme challenged participants’ negative thoughts around food and cooking to improve cooking attitudes and baking skills. The programme encouraged self-esteem, social acceptance and a reduction in social isolation. Participants perceived improvements in their cooking self-efficacy, cooking more economically and more nutritiously and incorporating more variety into their diet.

The studies included were from Australia (n=6), UK (n=12), US (n=21) and

Canada (n=8). Whilst the study settings varied they were all conducted in

community-based settings. These included: community centres (n=29),

community kitchens or food banks (n=7), hospitals (n=2), schools or other

education settings (n=7) such as language centres, and religious settings such as

churches (n=2).

Overall, there were few studies with a large sample size. The majority of studies

had a small sample size with only 14 out of 47 studies reporting a sample size of

over n=100 participants. The Family Food and Health Project was the only

controlled intervention to claim to have achieved the sample size required to

41

detect a change in percentage food energy from changes to dietary fat and

carbohydrate intake; it had 55 participants in each group (88). Compared to other

interventions, McKellar et al (2007) also included a larger sample size with 130

participants (n=75 intervention and n=55 control); however, sample size

calculations were not discussed (95). The Cook Well programme addressed issues

of maintenance of sample size over the course of the evaluation and reported a

44% dropout rate at six-month follow-up. Difficulties were reported in retaining

participants in socially deprived population groups, and in potential research

fatigue given the multiple measurement tools used (77).

All interventions included in this review had an element of hands-on cooking.

Cooking skills were used as a mechanism to improve participants’ diets, target

cooking confidence, knowledge and attitudes to increase food preparation at

home, and reduce risk factors associated with lifestyle diseases. In addition to

teaching cooking skills, many interventions also included elements of nutrition

education, food knowledge and goal setting (88). Some programmes worked with

chefs to teach culinary skills to the population. For example, the Cooking with a

Chef programme in the US entailed an interactive chef facilitated hands-on

learning intervention with a number of different community groups who then

influenced other people (103-106). The Can Cook Families Programme in the UK

also worked with chefs to pass on cooking skills to others (99).

42

Intervention duration ranged from one day workshops (105, 106) to interventions

running for over 12 months (116). Most interventions were in four and 10 or 12-

week blocks.

The studies variously used quantitative and qualitative methods in the collection

of data. The majority of intervention studies used self-report measures to

quantitatively measure changes in outcomes such as skills, knowledge,

confidence, attitudes and behaviours. Self-report measures included: food diaries

of shopping, preparation and consumption, food frequency questionnaires or

validated questionnaires. The Barton et al (2011) Short Cooking Skills

Intervention Questionnaire (131) was used in a number of studies (77, 99, 110).

Other quantitative measures included anthropometric measures (weight, height

and waist circumference) and clinical and laboratory assessments such as blood

tests, pain measures, glucose levels and blood pressure. Qualitative measures,

including semi-structured interviews, class observation and focus groups, were

used to gain an understanding of participant experiences, behaviours and attitudes.

43

Table 4: Interventions with a follow-up period

Follow-up period* Number of interventions (n=47)

3 to 4 months post-intervention Interventions with a control (91, 92, 94) 3 Interventions without a control (99, 106, 108, 109, 119, 120) 4 6 months post-intervention Interventions with a control (77, 89, 95, 96) 4 Interventions without a control (102, 120) 2 12 months post-intervention Interventions with a control 0 Interventions without a control (107, 110) 2 More than 12 months post-intervention Interventions with a control (88) 1 Interventions without a control (57, 106) 2 No follow-up period Interventions with a control (90, 93) 2 Interventions without a control (56, 66, 97, 98, 100, 101, 103-105, 111-118, 121-130)

27

*Follow-up period taken from the longest measured time point.

As part of this thesis, the nine studies (Table 1) that reported results and contained

a control group were critically appraised. Four were classified as “strong” studies

(88-91), four as “moderate” (77, 92, 94, 95) and one “weak” (93). The difference

between the ranking of strong, moderate and weak was the presence of bias. Bias

included: selection bias, study design, confounders, blinding, data collection

methods, withdrawals and dropouts (84). No studies reported being blinded or

double blinded, however this would be difficult in a community-based setting.

Sample size was low in most of the studies, and they often lacked sufficient power

to detect behavioural outcomes. In the majority of studies the data were based on

self-reported responses and therefore were open to bias.

The cooking skills interventions reported a variety of outcomes, as outlined in

Tables 1, 2 and 3. The outcomes information is summarised in Table 5. Cooking

44

skills interventions have been shown to make significant improvements in dietary

outcomes (77, 88, 95, 96), cooking behaviours (77, 90, 96), knowledge (90, 93,

94), skills (89), confidence (77, 91, 96), attitudes (91) and health outcomes (95,

96), as shown in Table 5. The most frequently measured outcomes were related to

diet and cooking behaviours. Multiple outcomes were reported in four of the 10

studies with a control group. Three studies reported changes in two different

outcomes (90, 91, 95) and Wrieden et al (77, 96) reported changes in four

different outcomes. Eleven of the 26 studies with a pre-post design and no control

group reported multiple outcomes. Two studies reported changes in four outcomes

(99, 109), four studies reported changes in three different outcomes (100, 105,

112, 118) and five studies reported changes in two different outcomes (97, 98,

101, 106, 110). Each outcome will be discussed separately. Not all found

significant improvements post-intervention.

Three out of the nine cooking skills interventions (with a control group) showed a

significant positive impact in terms of dietary outcomes (77, 88, 95). The Cook

Well Programme showed significant increases in fruit consumption post-

intervention (P>0.05), however improvements in fruit intake were not sustained

six months after the intervention (77, 96). Sustained dietary outcomes were shown

by McKellar et al (2007) who found significant changes in healthy eating

behaviours three months post-intervention, with improvements in fruit, vegetable

and legume consumption and a reduction in monounsaturated and saturated fat

(95). Eighteen months after the Family Food and Health Project, which compared

three interventions (education only, cooking classes and goal setting with cooking

classes), persons attending the cooking classes reported significant reductions in

energy-dense diets and increases in carbohydrates and starchy foods compared to

the education-only group (88).

45

Table 5: Cooking skills interventions reporting significant change over time by outcome measure1 Outcome measured Studies measuring

outcome (n= 37), (study citation)

Studies indicating significant change in outcomes over time (n=24) (study citation)

Interventions with a control Dietary outcomes 4

(77, 88, 92, 95, 96)b

3 (77, 88, 95, 96)b

Cooking behaviour 5 (77, 89-91, 93, 96)b

2 (77, 90, 96)b

Confidence 4 (77, 89, 91, 92, 96)b

2 (77, 91, 96)b

Knowledge 3 (90, 93, 94)

3 (90, 93, 94)

Skills 2 (77, 89, 96) b

1 (89)

Attitudes 2 (91, 93)

1 (91)

Health outcomes 3 (89, 95, 96)

2 (95, 96)

Interventions without a control Dietary outcomes 17

(57, 98, 99, 102-104, 107, 109-113, 116, 118-121)

10 (98, 99, 109, 110, 112, 116, 118, 119, 121, 126)

Cooking behaviour 19 (57, 97-101, 103-109, 111, 112, 118-121)

10 (57, 97-101, 109, 112, 118, 120)

Confidence 7 (99-101, 105, 106, 110, 112)

7 (99-101, 105, 106, 110, 112)

Knowledge 10 (97, 100, 101, 109-113, 118, 119)

5 (97, 100, 101, 109, 118)

Skills 4 (99, 105, 106, 117)

3 (99, 105, 106)

Attitudes 8 (105-107, 110, 111, 115, 119, 121)

1 (105)

Health outcomes 3 (97, 108, 109)

1 (109)

1Total number of studies included n=37a, some intervention effects measured in multiple studies, significant outcomes P<0.05. aStudies in Table 3 not included, because outcomes did not report change over time. bWrieden et al’s Cook Well intervention was reported twice via a report (96) and publication (77).

46

A total of 12 interventions (two with a control group and 10 without) reported

significant improvements in cooking and food-related behaviours. In the

interventions with a control group, the 10-week Cook Well programme influenced

participants’ food preparation behaviours six months after the programme (77,

96). Participants increased their frequency of cooking with basic ingredients at

home from 68% at baseline to 90% at follow-up, with no changes found in the

control group’s behaviours (77, 96). A food safety intervention targeting refugees

and immigrants in the US showed significant improvements in food safety

behaviour after attending a cooking class compared to the control group (90).

There were significant improvements in behaviours around washing hands, food

cross contamination, refrigeration and safe cooking of foods (90).

improvements in participants’ behaviours aro

47

Nine interventions reported significant improvements in participants’ confidence

and self-efficacy after attending a cooking skills intervention. Two interventions

had a control group (77, 91) and seven interventions used pre-post designs

without a control group (99-101, 105, 106, 110, 112). College students in the US

were randomly assigned to cooking classes or a cooking demonstration to

improve knowledge, attitudes and behaviours towards cooking (91). Participants’

confidence to use different cooking techniques significantly increased in those

attending the cooking classes compared to those who attended cooking

demonstrations (P<0.01). The Cook Well Programme measured cooking

confidence using five validated cooking confidence questions (77, 96). Results

showed significant improvements in confidence to follow a recipe (P>0.05)

between baseline and six-month follow-up in the intervention group only (77).

The same validated cooking confidence questions were used to by Garcia et al

(2013) (110) and the Can Cook Families Programme (2013) (99). The Can Cook

Families Programme reported significant increases in confidence in using basic

ingredients (P=0.001), following a recipe (P=0.01), tasting new foods (P=0.025)

and preparing new recipes (P=0.038) post-intervention (99). In addition, the

Cooking with a Chef programme in the US reported significant improvements in

participants’ cooking confidence after attending this hands-on culinary nutrition

intervention. The Cooking with a Chef model has been used with a number of

different population groups and significant increases in participants’ confidence

were shown when the programme targeted school (105) and church (106) food

services providers.

A total of eight interventions reported improvements in cooking and food

knowledge after attending a cooking skills intervention. Three interventions with

48

a control group reported significant improvements in participants’ cooking and

food knowledge around food safety (90) or improvements in nutrition awareness

(93, 94). Five interventions using pre-post designs and no control group also

showed significant improvements in cooking and food knowledge post-

intervention. Knowledge around cooking for diabetes prevention was targeted in

Cooking Well with Diabetes, a cooking extension from a diabetes education

programme implemented in 86 counties (97). This study reported increased

knowledge of healthy cooking practices for people with diabetes and nutrition

knowledge around recipe modifications in order to incorporate less salt, fat and

sugar, and add more fibre (97).

Cooking skills and techniques are relatively hard to measure because of the wide

differences in the definition and interpretation of the term “cooking” (22). Four

interventions out of six that attempted to measure cooking skills reported

significant improvements. A randomised controlled trial, Healthy Home Offerings

via the Mealtime Environment, measured child-parent pairs after completing the

interactive nutrition education and meal planning intervention together as a child

parent dyad. Children are reported on in this instance as the intervention targeted

both children and their parents. They found that children in the intervention group

reported significantly higher food skills development (P<0.01) and increased

frequency of helping to make the family dinner (P<0.001) compared to control

children, whilst parental mean self-efficacy for making healthful changes was

higher, although not statistically significant in the intervention group compared to

the control group(P=0.55) (89). Amongst interventions without a control group,

the Cooking with a Chef programme improved participants’ cooking skills over

time (105, 106). In addition, the Can Cook Families Programme increased

participant skills and confidence (99).

49

A number of studies attempted to change cooking and food attitudes but only two

out of 10 interventions reported significant changes in attitudes. Levy et al (2004)

reported significant increases in cooking enjoyment in the intervention group but

not in the control group (P<0.01) (91). Secondly, the Cooking with a Chef

programme reported improved attitudes in the school food services workers after

attending the programme. However, this intervention did not have a control group

with which to make a comparison (105).

Three studies reported significant changes in health-related outcomes. The Cook

Well evaluation reported small, yet significant differences in weight gain between

baseline and the six-month follow-up (P=0.049). The intervention group observed

a slight decrease in weight (mean -0.6 kg) from time 1 to time 3 compared to a

slight increase in the control group (mean 1.8 kg) (96). McKellar et al (2007)

reported improvements in the health status of participants with rheumatoid

arthritis after attending a cooking course that taught them the preparation of a

Mediterranean-type diet (95). Results showed significant reductions in blood

pressure and pain scores in the intervention group at six months follow-up (95).

Lastly, the Eat to Your Heart's Content intervention found significant

improvements in cardiovascular disease risk factors after attending the four-

session intervention which consisted of cooking and nutrition education (109).

Results could not be compared to a control group (109).

Qualitative findings offered some additional insights into outcomes that were not

reported within the quantitative studies. Findings related to food security, social

support and flow-on outcomes to family members after participating in an

intervention. Engler-Stringer and Berenbaum (2006) conducted an evaluation of

the Collective Kitchens programme (123-125) based on participant observations

50

and interviews with programme participants, facilitators and stakeholders. The

benefits reported included enhanced opportunities to develop cooking skills,

cooking and food knowledge, social support and decreased stress relating to food

security. Tarasuk and Reynolds (1999) evaluated community kitchens using

observation and concluded that they enabled social support but were not a means

to resolving food insecurity in participants (129). In Australia, an evaluation of a

Victorian Community Kitchen, which involved a facilitator-led programme where

participants planned, cooked and shared a nutritious meal, found that enhanced

social support was common; participants reported that the programme provided a

positive opportunity to establish friendships, socialise and enjoy cooking and

eating with others (114).

resulted in a positive effect on participants’ sense of self

Now You’re Cooking

Participants reported improvements in their children’s diet

51

Six of the 47 interventions reported on programme costs (90, 91, 95, 96, 126,

129). The cost per person varied widely depending on the nature of the

intervention. Gold et al (2014) indicated that the cost to run their intervention was

approximately USD 5 per person for food supplies (90); whilst Levy et al (2004)

reported the average the food cost per participant in their programme as USD 22

for the programme (91). A practical cooking workshop in Australia for Aboriginal

and Torres Strait Islanders reported an approximate cost of AUD 2.20 to AUD

5.20 per person or a total of AUD 68 per workshop (126). In a six-week

intervention in the UK the cost per person was GBP 84 (95).

52

2.3.3 Review discussion and conclusion

Findings showed that cooking skills interventions can improve reported dietary

outcomes, cooking and eating behaviours, cooking knowledge, skills, confidence

and attitudes. They may also have an impact on some health outcomes, such as

reducing cardiovascular risk factors which was shown in one study. In addition, a

number of qualitative evaluations of cooking skill programmes reported increased

opportunities for social support and decreased stress relating to food security

issues, outcomes that were not present in the quantitative assessments.

53

2.4 Jamie’s Ministry of Food (JMoF)

2.4.1 Programme history

JMoF is a community-based programme that teaches basic cooking skills to non-

cooks. Celebrity chef Jamie Oliver introduced the programme in the UK in 2008.

A British initiative during World War II inspired JMoF. During the war, the

government introduced a national network of food advisors and cooking teachers

to assist the public in using available food rations (133). The programme in its

current form is about “keeping cooking skills alive” by passing cooking skills on

and teaching people how to cook from fresh ingredients (133). The programme

originated in the UK and is currently operating in Australia, the UK and the US.

54

Jamie’s Food Revolution. This television series showed Jamie working on a

continues to operate and is called Huntington’s Kitchen

used a “ ” model to explore participants’ actions and

“ ” to “ ” “ ” to “ ”

was positively impacting participants’

55

2.4.2 Jamie’s Ministry of Food (JMoF), Australia

The JMoF programme was brought to Australia by The Good Foundation (TGF),

a philanthropic independent charity established by the electrical and white goods

retailer The Good Guys. The Foundations aim is to “inspire all Australians to

embrace a healthy lifestyle” (139). At the commencement of the Australian

programme in 2010, the programme’s mission statement was to “provide an

engaging community focused programme that teaches basic cooking skills and

good nutrition to non-cooks all over Australia, regardless of age, demographic or

ethnicity, to improve their quality of life and health” (140). A manifesto to the

programme is also available, see Appendix 2. In 2014, this mission statement was

changed to read, “Jamie’s Ministry of Food aims to educate, empower and inspire

people to love and enjoy good food, learning how to cook, understanding where it

comes from and recognising the power it can have on health, happiness and

finances” (140).

56

Jamie’s Ministry of Food

The first of the JMoF Australia programmes was launched in Ipswich,

Queensland in April 2011. The Ipswich site was jointly funded by philanthropist

Mr Andrew Muir (owner of The Good Guys) and the Queensland State

Government, as well as local partners. Ipswich was intentionally chosen because

it is an area of significant social disadvantage (141) and has high prevalence

levels of overweight and obesity (142).

57

Ipswich is located 40 km from the Queensland capital city of Brisbane. It is a

mid-sized regional city with an estimated population of 183,105 persons; it is

currently experiencing modest but sustained population growth of 4.6% per year

(143). In 2011, the majority of the Ipswich population (81.2%) spoke only English

at home; amongst the remaining 18.8%, the most common languages were

Vietnamese (3.6%), Samoan (1.6%), Spanish (0.6%), Hindi (0.4%) and Mandarin

(0.4%) (144). Only 3.5% of the population was of Aboriginal or Torres Strait

Islander descent, which is a similar proportion to that in the total Queensland

population (3.6%) and marginally higher than in the Australian population (2.5%)

(144).

58

Figure 3: Jamie’s Ministry of Food Centre, Ipswich, Queensland, Australia.

59

2.5 Summary

This chapter has provided an overview of the importance of cooking skills for

healthy diets and the barriers around preparing home-cooked meals. The chapter

demonstrates that a number of factors influence the healthiness of the people’s

diets and cooking skills and home-cooked meals are but several pieces of the

puzzle to improving the population’s diets. The chapter has highlighted that there

are a number of influences on the preparation of home-cooked meals via various

socio-ecological factors pertaining to an individual's personal capabilities,

demographics, beliefs and the environment. The chapter critically reviewed

cooking skills interventions in the community that aimed to improve the

population’s cooking skills; however, these interventions are generally poorly

evaluated, meaning more rigorous research is required in this field. The chapter

concluded by describing JMoF Australia, and highlighted the programme’s lack

of evaluation to date. It should be noted that there is limited evidence around

cooking practices and interventions within the Australian context as most of the

research has been conducted in the UK, US and Canada. The next three chapters

highlight the methods used in this evaluation of JMoF Australia.

60

Chapter 3. Mixed methods evaluation of Jamie’s Ministry of Food Australia

programme 3.1 Chapter overview

In Chapter 2, the literature around cooking was identified and the background to

Jamie’s Ministry of Food (JMoF) Australia discussed. Chapter 3 provides a

rationale for the evaluation of JMoF and positions the research in social theory.

This chapter outlines the overarching research questions used to guide the

research and the mixed methods study design. Chapter 3 is the first of three

chapters to describe the methodology for this evaluation.

3.2 Evaluation and rationale

In 2011, TGF and Queensland Health commissioned Deakin University, in

collaboration with colleagues at The University of Melbourne, to conduct an

evaluation of the JMoF Ipswich programme as operating in Ipswich, Queensland,

Australia. The purpose of the JMoF evaluation was to inform the practice of

programme developers, implementers, evaluators and the wider research

community interested in cooking skills programmes, and to inform policy around

investment in the programme. Given the limited quantity and quality of evidence

on cooking skills (as outlined in Chapter 2) this research offered an opportunity to

build the evidence on the effectiveness of practical cooking skills programmes.

3.2.1 Jamie’s’ Ministry of Food (JMoF) programme objectives

The programme initially did not have predefined programme objectives.

Consultation occurred between TGF, Queensland Health and the evaluation team

to determine clear programme objectives. The following three programme

objectives were identified:

61

1. To provide opportunities, to people of different ages and demographic

background, to experience and learn how to cook healthy meals quickly

and cheaply;

2. To increase programme participants’ cooking skills, knowledge and self-

efficacy;

3. To increase programme participants’ enjoyment of food and social

connectedness.

3.3 Theoretical framework to guide evaluation

In Chapter 2, a broad range of inter-related factors that influence an individual’s

cooking behaviours were described. This section describes the theoretical

framework, which is the foundation underpinning and guiding this research; it

consists of inter-related theories that allow for reflection on specific factors that

influence behaviours. It is important to ground research in theory because theories

provide a justification for an individual’s actions. Theories are used to explain and

predict events or situations in order to make findings meaningful and

generalisable (145). Theories are considered a set of inter-related concepts,

definitions and propositions which describe and identify why a problem may exist

(146). They also help us to discover various influences on behaviour, for example,

knowledge, attitudes, self-efficacy, social support and available resources (146).

–

62

participants’ behaviours.

63

a person’s environment . An individual’s environment includes both the

rnal to the person as well as the person’s social

individual’s perception of their environment or situation, for example, their time

“

”

belief in one’s

belief influences “

”

’

person’s self

shape an individual’s capacity through mastered skills enabling them to succeed

64

person’s capacity through and developing skills may influence one’s

mood. It is important to control one’s somatic reaction

’

that a behaviour will “ ”

65

’

3.4 Programme logic model

The purpose of the JMoF evaluation is to determine the immediate impacts of the

programme on participants as well as any sustained outcomes that may result over

a longer period. A programme logic model, Figure 3, was developed by the

candidate in collaboration with the evaluation team in order to focus the

evaluation inquiry and show potential causal pathways and influencing factors for

behaviour change. This model was used to help define the evaluation, the

objectives and research questions.

66

3.5 Evaluation research questions

As outlined in Chapter 1, this study aims to determine what were the impacts of

JMoF Ipswich Australia as a community-based cooking skills intervention?

More specifically, the evaluation aims to answer the following research questions

surrounding participation in the JMoF programme:

1. Did JMoF increase participants’ skills, knowledge, attitudes, enjoyment,

and satisfaction of cooking and cooking self-efficacy (confidence to

cook)?

2. Did JMoF result in broader positive outcomes for participants in terms of

behaviour change to a healthier diet, more affordable healthy meals, and

improve self-esteem and social connectedness?

3. What were participants’ expectations and experiences of the programme?

4. What were the moderators, barriers and facilitators related to participants’

cooking skills behaviour change?

5. Did participants experience any unanticipated outcomes after attending

JMoF?

understanding participants’ experience

Figure 4: Jamie’s Ministry of Food programme logic model

68

3.6 Mixed methods evaluation design

A mixed methods approach was adopted because the utilisation of both

quantitative and qualitative methods would yield a better understanding of the

JMoF programme compared to a single study design approach. Mixed methods

research acknowledges that there are multiple legitimate ways of making sense of

the social world (132). There are a number of different definitions of what

constitutes mixed methods research. Johnson et al (2007) collated the ideas and

definitions used by leading mixed methods researchers and concluded that mixed

methods research is defined by the following; “the type of research in which a

researcher or team of researchers combines elements of qualitative and

quantitative research approaches (e.g., use of qualitative and quantitative

viewpoints, data collection, inference techniques) for the broad purposes of

breadth and depth of understanding and corroboration” (154, p.123).

different methods to “

”

69

Figure 5: Quantitative and qualitative paradigms*

*Diagram adapted from Crotty (1998) (156)

Epistemology

Theoretical perspective

Methodology

Methods

Objectivism

Post-positivism

Deductive inquiry

Questionnaires

Subjective

Social-ecological

Inductive/ Abductive

Interviews

Study design Quantitative research Qualitative research

71

Figure 6: Mixed methods design

Mixed methods study What were the impacts of JMoF Ipswich Australia as a

community-based cooking skills intervention?

Quantitative evaluation methods (Chapter 4) and results

(Chapter 6)

Quantitative research questions

1. Did JMoF increase participants’ skills, knowledge, attitudes, enjoyment, and satisfaction of cooking and cooking self-efficacy (confidence to cook)?

2. Did JMoF result in broader positive outcomes for participants in terms of behaviour change to a healthier diet, more affordable healthy meals, and improve self-esteem and social connectedness?

Qualitative research questions

3. What were participants’ expectations and experiences of the programme? 4. What were the moderators, barriers and facilitators related to participants’ cooking skills behaviour change? 5. Did participants experience any unanticipated outcomes after attending JMoF?

Qualitative evaluation methods (Chapter 5) and results

(Chapter 7)

Mixed methods integration Interpretation of results

(Chapter 8)

d i t tiMi d h

72

3.7 Summary

Chapter 3 has described the rationale for this mixed methods evaluation and

positioned the research in social theory. Two theoretical frameworks –

experiential learning theory and Social Cognitive Theory – will guide this work.

A programme logic model was also developed to test causal pathways to

behaviour and to develop research questions. This chapter justifies reasons for a

mixed methods approach and explains how the quantitative and qualitative

methods were combined. The next two chapters describe the methods for the

quantitative and qualitative studies, separately.

73

Chapter 4. Quantitative methods

4.1 Chapter overview

In Chapter 3, the overarching mixed methodology of the JMoF evaluation was

discussed along with the rationale for using a mixed methods design. This

chapter, Chapter 4, details the quantitative methods. Quantitative studies are vital

for providing evidence to demonstrate programme effectiveness (159). The

methods described in the quantitative study have been published by Flego,

Herbert et al (2013); the candidate provided significant input to this paper in her

role as second author (8). A copy of this methods paper is provided in Appendix 3

This chapter goes into more detail than is outlined in the journal article and

provides justification for the methods used.

4.2 Quantitative paradigm

The approach taken to this quantitative study is a post-positivist approach, which

is a modified version of a positivist approach.

Positivism was popularised in the 19th century by philosopher Auguste Comte

and was founded on a "given" that reality is certain; "Objects in the world have

meaning prior to, and independently of, any consciousness of them." (156, p.27).

This means that reality can be understood by attempts to search for universal laws

through objective observation, measurement, recording and verification (156,

160). Positivism relies on an objective approach which puts aside bias and beliefs

creating distance between the researched and the researcher (156). A positivist

approach searches for and develops universal and scientific laws, which can be

deduced from hypothesis testing and standardised statistical analyses (160).

74

This version of positivism has evolved over time and its limitations have been

recognised. One limitation of such an approach is the view that anything can be

objectively measured and that all findings are certain and constitute an accurate,

unambiguous account of the world (156, 161). Another limitation is that a

positivist believes in a scientific, systematic and organised world, which is

removed from the “lived world” or reality that people experience (156). This

focus on facts does not acknowledge underlying mechanisms of observations

(156). These restrictive limitations led to the evolution of post-positivist

approaches.

Post-positivism is a moderate version of positivism. It both entails the belief that

reality exists and values objectivity; but it recognises uncertainties and critiques

them (156). This approach acknowledges probability rather than certainties, while

reality exists it is not unchangeable and absolute, thereby recognising the

possibilities of bias (156). It also accepts that observation can alter those being

observed, and challenges the notion of absolute objectivity (156). With these

uncertainties in mind, this quantitative research takes a post-positivist approach.

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This study adopts a deductive approach to the research. Quantitative studies

commonly denote from an objective view of knowledge and often use deductive

methods to test a general theory (159). Deductive research aims to test hypotheses

by collecting data through measurement and observation (162). Deductive inquiry

is driven by the research question and involves the use of questions that have

predetermined responses seeking specific answers based on theoretical concepts

(161). Deductive approaches must have a hypothesis to test; this bring us to the

next section that sets out the research aims and objectives.

4.3 Research aims and objectives

The overarching research question for this mixed methods evaluation is

what were the impacts of JMoF Ipswich Australia as a community-based cooking

skills intervention?

In order to explore this overall research aim, the quantitative study specifically

aims to address the following two research questions:

1. Did JMoF increase participants’ skills, knowledge, attitudes, enjoyment, and

satisfaction of cooking and cooking self-efficacy (confidence to cook)?

2. Did JMoF result in broader positive outcomes for participants in terms of

behaviour change to a healthier diet, more affordable healthy meals, and

improve self-esteem and social connectedness?

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4.4 Quantitative study parameters

4.4.1 Study design

The quantitative study used a longitudinal quasi-experimental design with a wait-

list control group. “Quasi-experimental” refers to the use of non-randomised

methods of allocating participants, often in natural or real-world settings (163).

Random assignment of participants to an intervention or control group is

considered the gold standard of research methods and is an important feature in

experimental studies because it helps protect against threats to internal validity

(164). However, randomisation is often difficult to achieve in community-based

interventions. The use of a non-randomised design was an appropriate choice for

the JMoF programme as randomisation was neither suitable nor feasible. Many

participants attending JMoF wanted to go with family and friends; randomisation

would have made this impossible and may have potentially jeopardised their

recruitment to the programme.

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Figure 7: Quantitative study design

related to “ ”

ng and highlighted that if the “ ”

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4.4.2 Sample size

Sample size calculations were conducted to determine the likely numbers required

in each group to ensure that the study was able to detect a statistically significant

change. The available literature around cooking skill interventions is limited, and

there were no precise sample size calculations available related to measuring an

effect of cooking confidence. Therefore, the sample size calculations were based

on the second primary outcome of daily vegetable intake, for which there were

data available to predict an effect size. A cooking skills programme in the UK

found that an effect size of one serve of vegetables per day was unlikely to be

achieved by programmes of this nature (77).

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4.4.3 Recruitment

During the two-year data collection period participants were continuously

recruited to the evaluation. The programme was open to all members of the

general public. Once a participant registered for JMoF they were automatically

assigned to a control or intervention group based on their allocated programme

start date. The invitation to participate in the evaluation was controlled by the

programme implementers, who set up computer generated rules in the JMoF

participant database operating system Salesforce (170). Salesforce automatically

emailed members an invitation to be involved in the evaluation and a unique web

link to a Plain Language Statement and a questionnaire at pre-programmed times

based on their programme start date. For all non-responders or participants

without an email address, a paper version of the questionnaire was sent.

participant’s date of birth was manually checked against the date

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20 “ ” store charge card, redeemable at any

4.4.4 Data collection

At each time point, participants completed a 15-minute self-report questionnaire

consisting of 40 multiple-choice questions (Appendix 4). The questionnaire was

designed in collaboration with the evaluation team and key stakeholders to elicit

data to cover all four research domains as described in the programme logic

model (Figure 4).

’

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Cooking and food knowledge questions were based on content taught within the

JMoF programme. The specific nutrition knowledge questions, which aimed to

align with the nutrition messages embedded within the programme and to

individually test knowledge around salt, fat and sugar, were sourced from a

nutrient knowledge questionnaire (171). Questions about cooking and eating

attitudes and beliefs were adapted from questions used in a food choice

questionnaire administered to French and English populations (174).

Cooking confidence (a primary outcome) was used as a proxy to measure cooking

self-efficacy. Cooking confidence questions were adapted from a two-page

questionnaire developed to assess cooking skills interventions (131), which also

incorporated a question on the willingness to try new foods. One additional

question was added – confidence that what they cooked would turn out well; this

addressed self-efficacy and was taken from the questionnaire used in the

evaluation of the Men Can Cook! Programme in Ontario, Canada (111). The

cooking confidence questions were adapted to a five-point Likert scale ranging

from “not at all confident” to “extremely confident”.

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Questions about shared enjoyment of cooking and meal satisfaction were adapted

from questions used in the evaluations of The Stephanie Alexander Kitchen

Garden (71) and Men Can Cook!, a men’s cooking group (111).

Measures to investigate cooking behaviours were adapted from the cooking skills

questions developed by Barton et al (2011) (131). Items included measuring

changes in weekly frequency of cooking the main meal from basic ingredients and

the inclusion of vegetables with the main meal.

The primary outcome used to underpin the sample size calculations was self-

reported daily vegetable intake. Questions about daily and weekly consumption of

vegetables, fruit and take-away food were sourced from the Queensland Health

self-report health status survey (169).

Questions about household food expenditure and food affordability and budgeting

were also asked. Household expenditure questions were adapted from The

Household, Income and Labour Dynamics in Australia (HILDA) Survey (173).

Questions about weekly social eating and normative eating behaviours, such as

whom the participant ate with and where they ate their dinner meal, were adapted

from The Stephanie Alexander Kitchen Garden Evaluation questionnaire (71).

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Rosenberg’s self-esteem scale was used to test global self-esteem (175). The

Rosenberg self-esteem scale is a well validated and reliable measure of self-

esteem based on 10 questions on a Likert scale; the scores are combined to

produce an overall self-esteem score. Scores ranged from 0-30, for ease of

interpretation scores were were categorised as low self-esteem (less than 15)

normal self-esteem (15-25) and high self-esteem (over 25). The measure of

perceived general health status was taken from the Queensland Health self-report

health status survey (169). Self-reported height and weight were used to calculate

participants’ BMI using the BMI formula: kg/m2 (176).

Demographic questions were taken from a range of sources to facilitate

comparisons with the Australian and Queensland populations, where possible.

The demographic questions related to education level, employment and income

levels, cultural ethnicity (18, 169, 173, 177) as well as household characteristics

(131).

The first stage of questionnaire development involved discussion on whether the

questionnaire content matched the domains that it aimed to measure (163). The

first phase of the content validity process involved a workshop with the JMoF

evaluation reference group, in July 2011, to determine the evaluation direction

and design and to agree on the key domains to be tested. Present at this workshop

were two programme implementers, a government representative, five chief

investigators of the evaluation study, the evaluation co-ordinator (a research

fellow) and the PhD candidate. The chief investigators, academics with expertise

in research, shared their thoughts about different questions to be used. The

programme implementers were able to comment on the content relating to the

programme and relevance to programme participants. The government

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representative provided insight into other programmes and areas of research in

Queensland and questions of particular relevance to government as an investor in

the programme.

informal focus group discussion at the end of the participants’ class.

There were two modes of data collection; a web-based questionnaire was the

primary method of data collection, supplemented by a paper-based mailed version

sent to non-responders. The data collection occurred over approximately two

years, between 25 November 2011 and 6 December 2013. Due to the rolling

nature of the programme, questionnaire distribution occurred weekly. During the

piloting of the questionnaire it became apparent that in-class survey completion

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was not an appropriate delivery method because this period was too rushed and

took time away from the class and clean-up time. Therefore, it was decided that a

web-based version would be the most appropriate method of survey distribution.

implementer’s participant database system ‘Salesforce’, web

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4.4.5 Data management

All data were entered and stored in Microsoft Excel, checked for errors then

imported into STATA (version 12.0) (181) for analysis preparation. The web-

based questionnaires were downloaded weekly from Qualtrics into an Excel

format. Online data were combined into a master Excel file and checked for

duplicates and computer errors to ensure the online survey system was

functioning properly. Paper-based questionnaires responses were entered

manually into Excel by the researcher and two casual research assistants. Data

from the web-based questionnaires and paper-based questionnaires were initially

stored separately because the paper-based questionnaires required rigorous

checking for errors.

’

“ ” category were checked to see if the “ ” responses fitted one of the

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=INDEX(A2:A30,RAND()*100+1)

The sample determined was double entered and compared to the original data for

any discrepancies. The overall number of errors found was 0.8%.

4.4.6 Data analysis

All analysis was conducted using STATA (version 12.0) (181). The purpose of

the analysis was to explore changes both within and between the intervention and

control groups and over time (T1, T2 and T3). Statistical analyses were based on

the set of individuals who registered for the programme, responded to an

invitation to participate in the evaluation, and subsequently completed the

baseline questionnaire. Significance testing was performed for all outcome

variables to generate a P-value which shows the probability of observing a

difference between the intervention and the control group; the smaller this P-value

the stronger the difference between groups is (183). Results were deemed

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significant if P<0.05. Follow-up T2 or T3 data were only used if the participant’s

T1 baseline data were available.

Demographic and baseline characteristics of the participant sample were

summarised using standard summary statistics (means and standard deviations)

and non-parametric statistics (medians and inter-quartile ranges). Demographic

variables included: gender, age, Aboriginal or Torre Strait Islander status,

language spoken at home, postcode, employment status, education level,

household yearly income, household characteristics, and who the participant

attended the programme with. Descriptive statistics were compiled and chi-square

analysis was performed to test for any differences between the intervention and

control groups at baseline.

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‘ ’

‘ ’

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Food expenditure data were collected in AUD using seven multiple choice

categories to indicate a weekly price range. Total food and drink ranged from $0

to $200 or more, and fruit and vegetable and take-away food expenditure ranged

from $0 to $100 or more. The data were then re-coded by the mid-points and

analysed on a continuous scale.

Rosenberg's global self-esteem consisted of a series of 10 questions, which were

combined to generate an overall self-esteem score (175). Scores ranged from 0-

30: low self-esteem (less than 15), normal self-esteem (15-<25) and high self-

esteem (25 and over) (187). This variable was analysed as a continuous variable.

Perceived general health was measured on a 5-point scale with poor = 1, fair = 2,

good = 3, very good = 4, excellent = 5. General health was analysed as a

continuous variable.

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Two analyses of each outcome variable were conducted: (I) comparisons between

groups of their changes over time from T1 to T2 (equivalent to testing for a group

by time interaction), and (II) comparisons of the three time points (T1, T2 and T3)

within the intervention group. The latter tested for the sustainability of any

programme effect at six-month follow-up.

Each model-based analysis was re-run adjusting for covariates (age, gender,

employment status and a combination of the three) when the covariates exhibited

baseline differences (that is., differences at T1) between the control and

intervention groups.

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Cohen’s d statistical test

4.5 Ethical considerations

Ethics approval was obtained from Deakin University Human Research Ethics

Committee (reference number: HEAG-H 117_11) in October 2011. Consent was

required for all participants in the evaluation. Each participant with an email

address was sent an email inviting them to complete the web-based questionnaire.

The email indicated that consent was granted by completion of the web-based

questionnaire. Once participants had clicked on the link to the questionnaire,

information about the evaluation was included in a Plain Language Statement.

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Postal questionnaires were sent with a paper copy of the Plain Language

Statement, consent form and an invitation letter, which was adapted from the

initial email content. The invitation email, Plain Language Statements and consent

forms are found in Appendix 5. All data were de-identified. The data collected

were initially in an identified form, however each participant was assigned a

unique identifier to facilitate the linking of data collected at different time points.

All identifiable data (excluding their ID codes) were removed once entered into

the database. Identifiable data were stored separately to the central database.

4.6 Summary

This chapter has described the methods used in this quantitative study. In

summary, the evaluation was open to all persons registered for the JMoF

programme who were 18 years old or over. The design was a longitudinal quasi-

experimental design with a wait-list control. Intervention participants were

measured at three time points; before programme commencement, after the

completion of their programme, and at six months follow-up. The wait-list control

group were measured twice; 10 weeks prior to commencing their JMoF class and

at the commencement of the programme. There was no six-month follow-up

control; instead, results were compared to Queensland state-wide data. An online

questionnaire was used followed by a paper postal questionnaire to maximise

recruitment. All repeated measures were analysed using multilevel mixed model

analysis or generalised estimating equations (GEE). The next chapter reports the

methods for the qualitative study.

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Chapter 5. Qualitative methods


In Chapter 4, the quantitative methods were presented. This chapter presents the

qualitative methods. The qualitative study aims to provide a deeper understanding

of participants’ experiences of the programme and to explore the barriers and

facilitators to cooking. In Chapters 2 and 3, relevant literature and theoretical

concepts were reviewed to seek explanations to explore factors that may impact

on cooking behaviours. The same literature has been taken into account in the

development of this qualitative evaluation. This chapter outlines the qualitative

methods used in this evaluation including the qualitative paradigm, research aims

and objectives, study design parameters related to participant sampling and

recruitment, and data collection and analysis.

5.2 Qualitative paradigm

Qualitative methods are useful for understanding human behaviour. They provide

opportunities to explore the reasoning behind particular behaviours, their

interpretation, and the meaning that they give to the person’s own and other

people’s actions (190). In other words, they facilitate understanding of the ‘why’

and ‘how’ people do the things they do (191). The use of a qualitative component

in the evaluation of the JMoF programme provides for an exploration of

individual experiences of the programme. It provides a voice for participants and

offers the capacity to explain both significant and insignificant quantitative

findings, thereby providing the ‘why’ to differences that may be of consequence

(191). A qualitative approach is an appropriate fit to explore the perspectives of

JMoF participants around food and cooking in order to understand the broader

socio-cultural and environmental factors influencing their choices and actions.

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Table 6: Introduction of the researcher

Reflectivity – about the researcher I, Jessica Herbert the researcher and writer of this thesis, grew up in a way that was somewhat different to many other children. I am the daughter of a retired Australian Army Officer and my family and I moved from place to place, sometimes internationally, throughout most of my childhood and adolescence. This constant moving made me appreciate new people, with interest and curiosity. I believe this childhood has also made me resilient, adaptable and flexible. My middle-income family upbringing gave me a fortunate start in life. I lived in a stable family home where I was always fed; family holidays were a regular experience and education and new experiences were highly valued.

equity for all and my beliefs in people’s rights of safety and good health. I am

5.2.1 A social constructionist approach to the research

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The social world plays key roles in influencing people in different ways. With this

in mind, the approach to the qualitative evaluation assumes a social

constructionist approach. This implies that people construct meaning in various

ways, as people engage with the world they begin to interpret it differently (156,

161, 193). Reality can be constructed differently by others and it is ultimately

influenced by a number of everyday factors. Through language, the construction

of reality is created and transmitted to others (194). Crotty (1998) uses an analogy

of a tree to explain the concept of social constructionism; “What the

‘commonsense’ view commends to us is that the tree standing before us is a tree,

it has all the meaning we ascribe to a tree. It would be a tree with that same

meaning whether anybody knew of its existence or not. We need to remind

ourselves here that it is human beings who have constructed it is as a tree, given it

the name, and attribute to it the association we make with trees. It may help if we

recall the extent to which those associations differ even within the same overall

culture. “Tree” is likely to bear quite different connotations in a logging town, an

artists’ settlement and a treeless slum” (156, p.43).

factors will influence participants’ personal values, beliefs and cultural influence

5.2.2 An abductive approach to the research process

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The aim of conducting a qualitative study was to provide insight into and

understanding of JMoF participants’ attitudes, beliefs and practices around

domestic cooking. In order to do this, an abductive approach to the research was

taken. Abductive research uses a combination of both inductive and deductive

techniques informed by theoretical and empirical literature (161). Deductive

inquiry, as the method of inquiry described in Chapter 4, aims to test hypotheses

(162) through the use of methods such as multiple choice questions (161).

Inductive inquiry, on the other hand, aims to understand and establish patterns

from the data collected; it is more of an open, creative and exploratory process

collected through an accumulative process to confirm patterns, themes and

interactions as they emerge in order to produce generalisations (157, 161). Patton

(2002) argues that “the strategy of inductive designs allow the important analysis

dimensions to emerge from patterns found in the cases under study without

presupposing in advance what the important dimensions will be” (161, p.56).

There is an element of deduction used within the qualitative study design, drawn

from pre-existing literature and theoretical concepts that have been used to guide

the methods and data collection. The exploratory nature of the qualitative work

also allows for new ideas and patterns to emerge and to not be restricted by pre-

existing ideas found in the literature. Morse and Mitcham (2002) believe that

research must have a focus of inquiry and make use of some inductive techniques.

They suggest considering the literature to make the analysis smarter and to

develop a skeleton which is guided by the literature and can be used to focus and

facilitate the inquiry (195). The inductive component of the research facilitates the

filling out of the skeleton. An abductive approach moves back and forth between

inductive and deductive inquiry and facilitates the discovery and understanding of

the motives underpinning the behaviour of different people.

5.2.3 Conceptual frameworks

The conceptual frameworks that guide this qualitative study are taken from a

social-ecological model, with constructs of Social Cognitive Theory and

experiential learning theory applied at the interpersonal and intrapersonal level to

understand behaviour. An ecological theory recognises that multiple factors can

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influence health behaviours, as described in Chapter 2. To complement this

perspective, constructs of Social Cognitive Theory (45, 196) and experiential

learning theory can be applied to the conceptual framework of the qualitative

study, as described in Chapter 3. Constructs of Social Cognitive Theory were used

to guide the analysis of the qualitative data obtained. The next section outlines

how the data were obtained before describing how the data were then analysed.

5.3 Research aims and objectives

The overarching research question for this thesis was to investigate what were the

benefits of community-based cooking skills programme using Jamie’s Ministry of

Food Australia programme as a case study? As pointed out previously, healthy

eating is complicated and individuals place complex meanings around this topic,

which warrants further investigation as to why people eat what they eat. Cooking

skills impact at one level of this complex issue, and it is important to understand

what drives people to act in ways that are healthy or unhealthy in terms of the

food that they prepare and eat. As part of the broader mixed methods study, the

qualitative study specifically aims to address the following three research

question:

participants’ expectations and experiences of the programme?

What were the moderators, barriers and facilitators related to participants’

5.4 Qualitative study parameters

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5.4.1 Study design

A longitudinal qualitative design was selected to follow programme participants

over the course of their JMoF journey. Programme participants were interviewed

three times over a period of approximately eight months. Repeated semi-

structured interviews were used to build an understanding of programme

participants’ food behaviours and cooking habits over time and their expectations

and experiences of the programme.

prospective and retrospective accounts of participants’ experience

nature allowed the researcher to use the participants’ responses from previous

if any reported changes in participants’ described behaviour had been mainta

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Figure 8: Qualitative evaluation time frame and study design

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5.4.2 Sampling

Participants were selected using purposive sampling, utilising maximum variation

(161, 204) to ensure that a diverse group of participants was recruited. Specific

factors considered when sampling included: socio-economic status, age, gender,

family structure and cooking confidence level. By including these different

elements, the selected sample would allow for the opportunity to capture different

expectations and experiences of the programme.

Qualitative studies typically have a smaller sample size compared to quantitative

studies. The emphasis in qualitative studies is to select participants who provide

in-depth, meaningful data, rather than relying on a large sample size to make

statistical comparisons (161, 205). An important factor with a qualitative sample

is whether the data can answer the research questions posed, and if the sampling

processes were flexible enough in order to do so (205). It was believed that the

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sampling methods used in this study met these requirements because a diverse and

purposively selected sample was used.

5.4.3 Recruitment

Recruitment of participants for the qualitative evaluation occurred in two ways.

Firstly, the quantitative baseline survey included a question asking if the

participant was willing to be contacted for a future interview. One hundred and

ninety-nine people indicated they were happy to be contacted and provided

contact information. Initial recruitment was potentially confined to those

participants who were beginning the JMoF programme during the data collection

period, timetabled for August to September 2012. This was the period the

researcher was in Ipswich, because funding was limited for the researcher to

travel and stay in Ipswich. This meant only 24 people were eligible. All 24

participants were contacted via phone to schedule an interview time; however

only 12 were recruited. The remaining 12 were unable to participate due to time

commitments or interview scheduling constraints, such as not being available

during the researcher’s scheduled time in Ipswich.

during the researcher’s class observations of gro

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5.4.4 Data collection

Semi-structured interviews were deemed the most appropriate method of data

collection to answer the research questions and gain insight into participants’

perspectives, such as their thoughts, feelings and intentions (161). The interviews

used a conversational style, with the researcher remaining neutral and non-

judgemental, to allow participants to share their perceptions. Interviews were kept

focused with the use of an interview guide. The interview guide was used as just

that, a guide, which allowed the interview to have some focus specifically relating

to the study’s objectives and, at the same time, was flexible enough to not restrict

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the freedom of the participants to raise issues and the researcher to probe and

explore issues as they emerged in the interview (161). Questions were framed to

be open-ended, which allowed participants the chance to respond in their own

words (161). Patton (2002) suggests that one weakness in using an interview

guide may be that topics are unknowingly omitted. However, this was not thought

to be a concern because the researcher remained flexible and allowed enough time

during each interview to explore new topics if they arose. The full guides for each

interview are found in Appendix 6. Brief versions of the topics for each interview

are listed below.

Interview one

Participant motivations for joining the programme

Expectations about participating in the programme

Current cooking and food behaviours and attitudes

Interview two

Feedback about the programme and programme environment

Current food and cooking behaviours and attitudes

Perceived changes made after the programme

Unexpected outcomes

Reflections from interview one

Interview three

Current food and cooking behaviours and attitudes

Perceived changes made after the programme, and if change was or was not

sustained

Unexpected outcomes

Reflections from interview two, and over the last six months

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The first few interviews were conducted with the researcher and a senior

researcher present. During this time, the interview structure was discussed by the

two researchers and refined.

interview during the researcher’s time in Ipswich.

the researcher’s

’

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5.4.5 Data analysis

Qualitative data analysis was a challenge. While the methodological literature

offered guidance and direction, there is no formula of exactly how to transform

qualitative data into insightful findings (161). There were instances when the

researcher felt completely out of her depth with the challenge of: (I) managing the

vast amount of data presented, and (II) trying to creatively explore the data and to

synthesise a story which both met the research questions and provided an accurate

and conceptual account of participants’ experiences of the programme and the

motives, intentions and reasons behind their behaviours. Due to the longitudinal

nature of the study, data analysis occurred concurrently with data collection.

Essentially data analysis began with the first instance of data collected.

Figure 9: Qualitative data analysis process*

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*adapted figure from Green et al (2007) (208)

The data immersion process first began during conduct of the interviews. The

second process of immersion occurred during the transcription phase. All

interviews and memos were transcribed verbatim. The researcher transcribed 34

of the 42 transcripts. Nine transcripts obtained during the third round of

interviews were transcribed by a professional transcription agency (A1

Transcriptions, http://www.a1transcriptions.com.au/). This service was utilised

due to the availability of funding from a small internal grant. The process of

immersion for these nine interviews began from the error checking stage. The

next process of immersion was to check each transcript for errors by listening to

the interview and reading the transcript. The transcript was then printed and re-

read to begin the coding process. This process of immersion started to stimulate

ideas and provide a clearer picture of the issues being researched (208).

The coding process involved applying descriptive labels to the transcripts by way

of examining and organising the data (208). Coding was first conducted via

printouts of each transcript; highlighting and making notes in the margins as the

transcripts were read and re-read, linking back to the immersion process. Notes

were made on topics and issues present, and any other points of interest. The

second stage of coding was done electronically. All interview transcripts and

memos were uploaded into a qualitative software package, NVivo (NVivo 9

[programme]: QSR International Pty Ltd 2011), to assist with data management.

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The linking of codes was the next step in the analysis process, to create coherent

categories (208). Codes that related to one another were grouped together,

keeping in mind codes that did not fit or link with other codes. This process began

the generation of categories and starting to form explanations of the data,

providing descriptive details of what was found (208). The longitudinal nature of

this study added another element to the analysis process. Firstly, interviews at

each time point underwent the immersion and coding process to create categories.

Once all three interview points had undergone this process, the categories were

compared over time and looked at as the whole dataset. This process was

essentially to understand “what happened first, next and last to the participants”

(202, p.51). The categorised data were then reviewed to explore similarities and

differences as well as any over time comparisons and differences, to identify

patterns and determine specific relationships between categories. This provided an

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overall conceptual picture of the impact of the JMOF programme within the

context of its unique setting and population.

The final stage of analysis was the identification of themes. Green et al (2007)

explains, “the generation of themes requires moving beyond a description of a

range of categories; it involves shifting to an explanation or even better an

interpretation of the issue under investigation” (208, p.349). Essentially this phase

was about recognising patterns and meanings within the data to conceptualise

findings. Comparisons were made with relevant theoretical concepts and the

literature base to determine if findings resonated with existing knowledge or made

new contributions to the evidence.

’

5.5 Ethical considerations

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Ethics approval was received from Deakin University Human Research Ethics

Committee (HEAG-H 117_11) in October 2011. Written consent was gained from

participants prior to the interviews for both participation and digital recording of

the interview. Each participant was given an opportunity to read the Plain

Language Statement (Appendix 5) and to ask any questions. All written consent

forms were kept in secure locked storage.

A number of steps were employed to maintain participants’ privacy and

all information containing participants’ names and contact

5.6 Summary

This study has described the methods used for the qualitative study. In summary,

repeated 30-minute semi-structured interviews were used. Participants were

interviewed three times, before their programme, after completion of their

programme, and at six-month follow-up. Participants were purposively selected to

ensure that a broad range of participant characteristics were met. All data were

analysed thematically. The results of this research are presented in the next two

chapters: Chapter 6, Quantitative results and Chapter 7, Qualitative results.

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Chapter 6. Quantitative results


This chapter presents the results from the quantitative evaluation of the JMoF

programme. Chapter 4 outlined the quantitative methods, whilst this chapter

reports the findings from the statistical analysis of the JMoF questionnaire

repeated at different time points. More specifically, this chapter explores a range

of effects on participants associated with from their attendance at the programme.

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6.2 Participants: quantitative study

6.2.1 Participant response rates

Over the course of data collection, from November 2011 to December 2013, a

total of 1,690 people registered to participate in the programme and were invited

to participate in the quantitative evaluation. Based on the study design, 1,526 were

allocated to the intervention group and 434 were allocated to the wait-list control

group. Figure 10 provides details of participant response rates. After allowing for

exclusions and dropouts, a total of 694 intervention participants completed

questionnaires at T1, 383 at T2, and 259 at T3. In the intervention group, 55.2%

of participants who completed T1 questionnaires also completed T2

questionnaires; and a total of 30.8% of all participants completed the

questionnaire three times, at baseline T1, T2 and T3. An additional 45 participants

completed T3 but did not complete T2 questionnaires; these participants were

included in the analysis given their baseline information and the employment of

multilevel mixed model statistical methods which allowed for all data to be used

in the analysis. The wait-list control group had a 62.9% response rate, with 237

participants completing the questionnaire at T1 and 149 at T2.

6.2.2 Baseline demographics

Table 7 shows the demographic characteristics of participants, in both the control

and interventions groups, at baseline. Overall, the two groups were largely

similar, however because the study was not randomised there were statistically

significant differences in terms of gender, age and employment.

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Figure 10: Questionnaire response rates

Intervention T2 analysed (n =383)

Loss to six month follow-up, n=169


Whilst 45 participants failed to complete T2, they completed T1 and T3.

Loss to follow-up, n=311

Did not respond to invitation to participate in evaluation, n=691 Excluded n=141 Underage (n=120) Incomplete surveys (n=14) Incorrect timeframe (n=7)

Intervention Registered for the programme <10

weeks before programme commencement

(n= 1526)

Intervention T1 analysed (n = 694)

Wait-list control Registered for the programme >10

weeks before programme commencement (n=434)

Did not respond to invitation to participate in evaluation, n=154 Excluded, n=43 Underage (n=38) Incomplete surveys (n=2) Incorrect timeframe (n=3)

Loss to follow-up, n=88

Wait-list control T2 analysed (n =149)

Wait-list control T1 analysed (n = 237)

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Participants’ age and gender

The sample was not culturally diverse. Most participants at baseline spoke

English (92.2% in the intervention group and 94.7% in the control group) and

lived in the Ipswich district (82.0% in the intervention group and 78.8% in the

control group). There were relatively few indigenous Australians, with only 1.8%

of intervention group participants and less than 1% of the control group indicating

they were of Aboriginal and/or Torres Strait Islander descent.

Most participants were in full or part-time employment; however there were a

significantly higher proportion of control participants (34.7%) in full-time

employment compared to the intervention group (26.4%) (P=0.02). In addition,

23% of intervention participants were retired compared to 21% in the control

group. There was also a larger proportion of control participants in the home

duties or carer category compared to the intervention group (18.4% and 14.4%).

In terms of education levels, nearly half of all participants indicated that high

school (year 12 or less) was their highest level of education (intervention group

47.8% and control group 45.8%). Household yearly income was proportionally

higher in the control group compared to the intervention group. The intervention

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group had a higher proportion of participants in the lower income group with

50.3% earning AUD 50,000 or less compared to the control group (38.5%).

be slightly higher as the ‘other’ category sometimes incl

grandparent living in the household. Other examples in the ‘other’ category

Over half of all participants in both control and intervention groups, indicated that

they attended the programme with another person. Of those that shared their

programme experience, more intervention participants (24.4%) attended the

programme as a member of a community group compared to control participants

(7.3%).

For the most part, the demographic characteristics did not change dramatically

over the course of the evaluation. As previously shown, there were more

participants who completed the T1 questionnaires than T2 and T3. Over time, the

older participants (aged ≥ 50 years) were more likely to remain in the study and

complete the T2 and T3 questionnaires.

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6.3 Jamie’s Ministry of Food sample compared to the

Ipswich population

Over 500 participants contributed to this quantitative evaluation of JMoF

Australia. Participants were mostly female, spoke English at home, lived within

the Ipswich district and were in full or part-time employment. The JMoF

population reflected the Ipswich population in terms of ages of the age of persons

attending the programme. Whilst any direct comparisons with the Ipswich

population should be interpreted with care, it would appear that the JMoF

evaluation sample had a lower population of participants from Aboriginal and/or

Torres Strait Islander backgrounds than Ipswich (3.5% in Ipswich, and 0.9% to

1.8% at baseline in the JMoF sample). Also lower was the proportion who spoke a

language other than English at home (18.8% in Ipswich compared to 5.3% to

7.8% at baseline in the JMoF sample). Household composition was markedly

different in the JMoF sample compared to Ipswich. There was a lower population

of one parent families with children living at home in the JMoF sample (7% to

8.9% at baseline compared to 19.2% in the Ipswich population). There also

appeared to be a lower proportion of participants with children living at home in

the JMoF sample. Overall, at baseline the JMoF sample comprised approximately

37.2% to 42.2% of participants in households with two parent families and

children (aged 0 to 18) living at home. State-wide Ipswich population data show

that 45.2% of the population were couple families with children living at home

(143), which is higher than the JMoF sample.

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Table 7: Demographic characteristics of participants1 by time point

Intervention % (n) Control % (n) Demographic, time point T1

N=694 T2

N=383 T3

N=259 T1

N=237 T2

N=149

Gender2

Female 77.4 (525) 79.1 (299) 80.5 (207) 87.2 (198) 87.7(128) Male 22.6 (153) 20.9 (79) 19.5 (50) 12.8 (29) 12.3 (18) Age (years) Under 502 55.6 (375) 44.1(165) 43.5 (110) 64.3 (144) 60.3 (85) 50 and over2 44.4 (300) 55.9 (209) 56.5 (143) 35.7 (80) 39.7 (56) 18-24 7.4 (50) 2.7 (10) 3.2 (8) 5.8 (13) 4.3 (6) 25-34 17.5 (118) 14.2 (53) 14.6 (37) 22.8 (51) 20.6 (29) 35-44 23.0 (155) 19.8 (74) 19.0 (48) 26.3 (59) 24.1 (34) 45-54 16.0 (108) 15.5 (58) 15.8 (40) 16.5 (37) 18.4 (26) 55-64 15.0 (101) 18.5 (69) 18.6 (47) 12.5 (28) 13.5 (19) 65-74 17.5 (118) 24.6 (92) 24.1 (61) 13.4 (30) 15.6 (22) 75+ 3.70 (25) 4.8 (18) 4.7 (12) 2.7 (6) 3.5 (5) Mean age years (SD) 48.0(16.1) 52(15.7) 52.0(15.9) 46(15.1) 47(15.2) Aboriginal or Torres Strait Islander 1.8 (12) 1.8 (7) 2.7 (7) 0.9 (2) 1.4 (2) Speaks a language other than English at home 7.8 (53) 6.9 (26) 7.4 (19) 5.3 (12) 3.4 (5) Locality Ipswich 82.0 (555) 84.7(320) 83.3 (214) 78.8 (178) 79.4 (116) Other Queensland localities 17.7 (120) 15.3 (58) 16.3 (42) 21.2 (48) 20.5 (30) NSW 0.3 (2) 0.0 (0) 0.4 (1) 0.0 (0) 0.0 (0) Highest level of education attained

High school, year 12 or less 47.8 (321) 49.3(185) 49.4 (126) 45.8 (104) 47.3 (69) Technical and Further Education, apprenticeship, diploma or certificate 22.2 (149) 20.8 (78) 21.6 (55) 22.9 (52) 19.9 (29) Tertiary, bachelor degree or higher 28.0 (188) 28.5(107) 27.4 (70) 29.1 (66) 30.1 (44) Other 2.0 (13) 1.3 (5) 1.6 (4) 2.2 (5) 2.7 (4) Employment2 Full-time 26.4 (176) 23.6 (88) 26.2 (67) 34.7 (79) 31.3 (46) Part-time or casual 18.6 (124) 16.6 (62) 18.4 (47) 14.5 (33) 17.0 (25) Retired 23.8 (159) 31.6(118) 30.5 (78) 21.5 (49) 23.8 (35) Home duties/ carer 14.4 (96) 15.3 (57) 13.3 (34) 18.4 (42) 17.7 (26) Not working (permanently ill or unable to work, unemployed) 9.9 (66) 7.0 (26) 4.3 (11) 8.8 (20) 7.5 (11) Student (full-time and part-time) 3.1 (21) 1.9 (7) 1.9 (5) 1.3 (3) 2.0 (3) Other 3.9 (26) 4.0 (15) 5.47(14) 0.9 (2) 0.7 (1) Household yearly income

$1-$6,000 2.5 (15) 1.8 (6) 2.6 (6) 2.0 (4) 1.5 (2) $6,001-$13,000 5.7 (34) 5.7 (19) 5.3 (12) 5.0 (10) 5.3 (7) $13,001-$20,000 11.9(71) 12.9 (43) 14.1 (32) 9.5 (19) 9.9 (13) $20,001-$30,000 14.8(88) 17.7 (59) 17.2 (39) 9.5 (19) 9.9 (13) $30,001-$50,000 15.4(92) 14.7 (49) 14.5 (33) 12.5 (25) 12.2 (16) $50,001-$100,000 30.0(179) 29.7 (99) 26.9 (61) 35.5 (71) 36.6 (48) $100,001-$150,000 13.6(81) 11.1 (37) 12.3 (28) 18.5 (37) 16.8 (22) >$150,000 6.0(36) 6.3 (21) 7.0 (16) 7.5 (15) 7.6 (10)

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1 Sample size for different variables might vary from total sample size because of missing responses and the rounding of weighted frequencies. 2Significant difference between groups (P<0.05) at baseline as tested with chi-squared analysis. 3Excludes two participants living in institutional facilities. SD = standard deviation.

Intervention % (n) Control % (n) Demographic, time point T1

N=694 T2

N=383 T3

N=259 T1

N=237 T2

N=149 Household Characteristics Couple, with young children (0-17 years old) living at home 24.7 (169) 23.2 (88) 20.0(51) 32.1 (76) 30.2 (45) Couple, with adult children (18 years and over) living at home 12.5 (86) 10.8 (41) 11.0(28) 10.1 (24) 10.7 (16) Couple, without children living at home 32.9 (226) 35.3(134) 36.0(92) 24.5 (58) 27.5 (41) One parent family with children living at home 7.0 (48) 3.7 (14) 4.3(11) 8.9 (21) 6.7 (10) Live Alone 16.0 (110) 21.6 (82) 22.7(58) 17.7 (42) 20.1(30) Other 6.9 (47) 5.5 (21) 6.2(16) 6.8 (16) 4.7 (7) Mean household size (SD)3 2.8 (1.5) 2.6 (1.3) 2.5 (1.3) 3.0 (1.6) 2.9 (1.6) Median household size

(50% percentile)3 2 2 2 3 2 Shared programme experience Attending JMoF with others or group (Yes)

58.0 (393) 56.2(212) 53.5(137) 67.0 (152) 66.7 (98)

If yes, who they attending with….

Friends 32.2 (123) 31.0 (64) 25.0 (33) 45.7 (69) 49.5 (48) Family 40.3 (154) 36.9 (76) 40.1 (53) 39.1 (59) 34.0 (33) With a carer 1.6 (6) 1.0 (2) 1.5 (2) 3.3 (5) 3.1 (3) With a community group 24.4 (93) 28.7 (59) 33.3 (44) 7.3 (11) 8.3 (8) Other 1.6 (6) 2.4 (5) 0.0 (0) 4.6 (7) 5.2 (5)

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Table 8: Prevalence of health indicators, population 18 years and over

Health indicator Ipswich, population

prevalence1 % (95% CI)

JMoF baseline sample, population

prevalence % (95% CI)

Body Mass Index (BMI) 2 Underweight (BMI <18.5) 3.4 (1.8-6.3) 2.5 (1.4-3.5) Healthy weight (BMI 18.5 to <25) 37.4 (33.1-42.0) 28.5 (25.5-31.6) Overweight (BMI 25 to <30) 34.0 (30.1-38.2) 30.3 (27.2-33.4) Obese (BMI 25+) 25.2 (21.8-28.8) 38.7 (35.4-42.0) Overweight/obese 59.2 (54.6-63.6) 69.0 (65.9-72.1) Unhealthy weight 62.6 (58.0-66.9) 71.5 (68.4–74.5) Self-rated health (rated excellent, very good or good)

80.5 (75.4-84.7) 69.4 (67.2-71.6)

Fruit and vegetable consumption Mean daily vegetable intake (serves) 2.2 (2.1-2.3) 2.5 (2.4-2.6) Mean daily fruit intake (serves) 1.5 (1.4-1.6) 1.6 (1.6-1.7) Persons aged 18 years and older (n= 941 for Ipswich, n=931 for JMoF) 1Data take from 2011-2012 Queensland Health self-reported health status survey (212). 2BMI cut-off points sourced from World Health Organization (176).

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6.4 Programme outcomes

6.4.1 Cooking confidence

Cooking confidence was a primary outcome of the evaluation and results have

been presented in Flego et al (2014) (of which the candidate was a major

contributor and second author) (10). Intervention participants overall showed

significant positive improvements between T1 and T2 in their confidence to cook

from basic ingredients (0.81, SD 0.05, P<0.001), follow a simple recipe (0.53, SD

0.04, P<0.001), prepare and cook new foods and recipes (0.77, SD 0.05,

P<0.001), cook something that will turn out well (0.72, SD 0.04, P<0.001) and to

taste new foods (0.54, SD 0.05, P<0.001) (Table 9). There was no significant

change between T1 and T2 in all confidence outcomes amongst control group

participants. All cooking confidence scores showed a statistically significant

group by time interaction effect (P<0.001) indicating that the intervention group

significantly increased their cooking confidence compared to the control group

(Table 9). The effect size between groups and overtime for all cooking confidence

measures ranged from medium to large (0.42-0.85).

6.4.2 Cooking and healthy eating knowledge attitudes, beliefs and skills

Intervention participants significantly improved their healthy eating skills,

knowledge, attitudes and beliefs between T1 and T2 (Table 9). There were no

significant changes reported in the same measures in the control group. While

effect size was small between groups there were statistically significant

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differences between the intervention and control groups and over time in terms of

preparing a meal from scratch in 30 minutes (P<0.001), beliefs around the ease of

changing eating habits (P=0.02), vegetables being tasty (P=0.01) and eating

enough fruit and vegetables (P<0.001). Participant attitudes around lifestyle

preventing a healthy diet did not show a significant difference between control

and interventions groups over time (P=0.07), however the mean score was high

for both groups both before and after the programme. In the intervention group,

analysis over the three time points showed that all attitudes and knowledge around

cooking and healthy eating were significantly sustained from baseline (T1) to six

months post-programme (T3) (Table 10).

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6.4.3 Cooking enjoyment and satisfaction

123

Figure 11: Correctly answered nutrition knowledge by group and over time

Table 9: Predicted mean scores in cooking confidence, knowledge, attitudes beliefs, skills, enjoyment and satisfaction outcomes by group (T1 and T2)¹

Intervention Control Interaction effect, group by time P-value

Outcome measure baseline (T1) mean (SE)

intervention completion (T2) mean (SE)

change from baseline(T2-T1) mean (SE) P-value

baseline (T1) mean (SE)

wait-list completion (T2) mean (SE)

change from baseline(T2-T1) mean (SE) P-value

Difference between group (effect size)7

Cooking confidence Confidence to cook from basic ingredients4 3.56 (0.04) 4.36 (0.05) 0.81 (0.05) P<0.001 3.69 (0.07) 3.72 (0.08) 0.03 (0.08) P=0.70 P<0.001 0.78 Confidence to follow a simple recipe4 4.00 (0.04) 4.53 (0.05) 0.53 (0.04) P<0.001 4.11 (0.06) 4.06 (0.07) -0.06 (0.07) P=0.40 P<0.001 0.67 Confidence in preparing and cook new foods and recipes4

3.35 (0.04) 4.13 (0.05) 0.77 (0.05) P<0.001 3.45 (0.07) 3.55 (0.08) 0.10 (0.08) P=0.22 P<0.001 0.65

Confidence that what one cooks will turn out well4

3.21 (0.04) 3.93 (0.05) 0.72 (0.04) P<0.001 3.28 (0.06) 3.35 (0.07) 0.07 (0.07) P=0.30 P<0.001 0.70

Confidence to taste new foods never eaten before4

3.47 (0.04) 4.01 (0.05) 0.54 (0.05) P<0.001 3.41 (0.07) 3.51 (0.09) 0.09 (0.08) P=0.25 P<0.001 0.42

Combined confidence score5 17.59 (0.02) 20.95 (0.2) 3.36 (0.18) P<0.001 17.94 (0.03) 18.17 (0.03) 0.23 (0.28) P=0.41 P<0.001 0.85 Cooking and healthy eating knowledge, attitudes, beliefs and skills

I can put together a healthy meal from scratch in 30 minutes6

2.85 (0.031) 3.30 (0.04) 0.45 (0.04) P<0.001 2.85 (0.05) 2.89 (0.06) 0.03 (0.06) P=0.61 P < 0.001 -0.49

I find it easy to change my eating habits6 2.52 (0.03) 2.71 (0.04) 0.19 (0.04) P<0.001 2.52 (0.05) 2.53 (0.06) 0.01 (0.06) P=0.82 P = 0.02 -0.18 Vegetables can be tasty foods6 3.54 (0.02) 3.69 (0.03) 0.15 (0.03) P<0.001 3.53 (0.04) 3.51 (0.05) -0.02 (0.05) P=0.74 P = 0.01 -0.26 I eat enough fruit and vegetables6 2.66 (0.03) 3.00 (0.04) 0.34 (0.04) P<0.001 2.66 (0.06) 2.68 (0.07) 0.02 (0.06) P=0.71 P < 0.001 -0.37 My lifestyle does not prevent me eating a healthy diet6a 3.11 (0.03) 3.33 (0.04) 0.22 (0.04) P<0.001 3.04 (0.05) 3.12 (0.06) 0.08 (0.06) P=0.17 P = 0.07 -0.19 Cooking enjoyment and satisfaction I enjoy cooking6 3.05 (0.03) 3.33 (0.04) 0.28 (0.03) P<0.001 3.12 (0.05) 3.17 (0.06) 0.06 (0.05) P=0.28 P = 0.001 -0.31 I get a lot of satisfaction from cooking my meals6 2.96 (0.03) 3.31 (0.04) 0.35 (0.03) P<0.001 3.02 (0.05) 3.05 (0.06) 0.03 (0.05) P=0.60 P < 0.001 -0.44 I enjoy cooking for others6 3.01 (0.03) 3.27 (0.04) 0.26 (0.03) P<0.001 3.09 (0.06) 3.16 (0.07) 0.07 (0.06) P=0.22 P = 0.004 -0.27 I enjoy eating a meal with others6 3.51 (0.02) 3.60 (0.03) 0.09 (0.03) P = 0.01 3.47 (0.39) 3.55 (0.05) 0.07 (0.05) P=0.16 P = 0.81 -0.03 Outcomes within each group and over time were determined by a mixed linear model for repeated measures using all available data at each time point. All means and Standard Errors (SE) have been rounded to 2 decimal points. Baseline values were not significantly different between groups (independent t tests P<0.05). A significant group by time interaction effect denotes that the response over time differed between groups. 4Scale values are 1-5 (where 1= not at all confident and 5 = extremely confident). 5 The combined confidence score is equal to the sum total of all other confidence scores (scores ≥20 = confident). 6Mean predicted score indicating level of agreement with statements from a Likert Scale (1=strongly disagree, 2=somewhat disagree, 3=some agree, 4=strongly agree), a Score assignment was reversed. 7Cohen's d effect size, general guideline: small (0.2), medium (0.5) and large (0.8).

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Table 10: Predicted mean scores in cooking confidence, knowledge, attitudes beliefs, skills, enjoyment and satisfaction outcomes for the intervention group (T1, T2, T3)¹

Outcome measure Intervention group Interaction effect over time2 P-value

Baseline

(T1) Mean (SE)

Intervention completion (T2) mean SE)

6 months follow-up (T3) mean (SE)

Change from T2-T1 mean (SE) P-value



Effect size (T2-T1)6

Effect size (T3-T1) 6

Cooking confidence Confidence to cook from basic ingredients3 3.56 (0.04) 4.37 (0.05) 4.43 (0.06) 0.81 (0.05) P<0.001 0.87(0.06) P<0.001 0.07(0.06) P=0.28 P<0.001 0.83 1.15 Confidence to follow a simple recipe3 4.00 (0.04) 4.53 (0.04) 4.61 (0.05) 0.53 (0.04) P<0.001 0.61(0.05) P<0.001 0.08(0.05) P=0.13 P<0.001 0.83 0.95 Confidence in preparing and cook new foods and recipes3

3.35 (0.04) 4.13 (0.05) 4.17 (0.06) 0.78 (0.05) P<0.001 0.82(0.06) P<0.001 0.05(0.06) P=0.44 P<0.001 1.09 1.16

Confidence that what one cooks will turn out well3 3.21 (0.04) 3.93 (0.05) 3.94 (0.05) 0.72 (0.04) P<0.001 0.73(0.05) P<0.001 0.01(0.06) P=0.80 P<0.001 1.07 1.12 Confidence to taste new foods never eaten before3 3.47 (0.04) 4.01 (0.05) 3.99 (0.06) 0.53 (0.05) P<0.001 0.52(0.06) P<0.001 -0.02(0.06) P=0.75 P<0.001 0.74 0.74 Combined confidence score4 17.59 (0.16) 20.95 (0.19) 21.15 (0.22) 3.36 (0.18) P<0.001 3.56(0.21) P<0.001 0.20(0.22) P=0.36 P<0.001 1.24 1.32 Cooking and healthy eating knowledge, attitudes, beliefs and skills


2.85 (0.03) 3.29 (0.04) 3.31 (0.05) 0.44 (0.04) P<0.001 0.46 (0.05) P<0.001 0.02 (0.06) P=0.67 P < 0.001 0.75 0.72

I find it easy to change my eating habits5 2.52 (0.03) 2.71 (0.04) 2.70 (0.04) 0.17 (0.04) P<0.001 0.18 (0.05) P<0.001 0.00 (0.05) P=0.94 P < 0.001 0.29 0.37 Vegetables can be tasty foods5 3.54 (0.02) 3.69 (0.03) 3.69 (0.04) 0.15 (0.03) P=0.001 0.15 (0.04) P<0.001 0.00 (0.04) P=0.97 P < 0.001 0.28 0.33 I eat enough fruit and vegetables5 2.66 (0.03) 3.00 (0.04) 3.05 (0.05) 0.34 (0.04) P<0.001 0.39 (0.05) P=0.001 0.06 (0.05) P=0.26 P < 0.001 0.55 0.61 My lifestyle does not Prevent me eating a healthy diet5a

3.11 (0.03) 3.32 (0.04) 3.29 (0.05) 0.21 (0.04) P<0.001 0.18 (0.05) P<0.001 -0.03 (0.05) P=0.55 P < 0.001 0.38 0.35

Cooking enjoyment and satisfaction I enjoy cooking5 3.05 (0.03) 3.32 (0.04) 3.28 (0.04) 0.27 (0.03) P<0.001 0.23 (0.04) P<0.001 -0.04 (0.04) P=0.31 P < 0.001 0.58 0.46 I get a lot of satisfaction from cooking my meals5 2.96 (0.03) 3.31 (0.04) 3.29 (0.04) 0.35 (0.04) P<0.001 0.33 (0.04) P<0.001 -0.02 (0.04) P=0.72 P < 0.001 0.71 0.58 I enjoy cooking for others5 3.01 (0.03) 3.26 (0.04) 3.18 (0.05) 0.25 (0.04) P<0.001 0.18 (0.04) P<0.001 -0.08 (0.05) P=0.11 P < 0.001 0.53 0.29 I enjoy eating a meal with others5 3.51 (0.02) 3.60 (0.03) 3.61 (0.03) 0.09 (0.03) P = 0.01 0.10 (0.04) P = 0.01 0.01 (0.04) P=0.77 P = 0.003 0.18 0.15 Outcomes at each time point were determined by a mixed linear model for repeated measures using all available data at each time point. All means and Standard Errors (SE) have been rounded to 2 decimal points. 2A significant over time interaction effect denotes that the response over time differed between groups. 3Scale values are 1-5 (where 1= not at all confident and 5 = extremely confident).4 The combined confidence score is equal to the sum total of all other confidence scores (scores ≥ 20 = confident).5 Mean predicted score indicating level of agreement with statement from a Likert Scale (1=strongly disagree, 2=somewhat disagree, 3=some agree, 4=strongly agree), a Score assignment was reversed. 6 Cohen's d effect size, general guideline: small (0.2), medium (0.5) and large (0.8).

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6.4.4 Healthy diets

127

Figure 12: Mean daily fruit and vegetable consumption - comparison of JMoF intervention participants and Queensland (QLD) state-wide 2012 data*

serves of fruit per day compared to the JMoF population’s mean intake at T1 of

128

Figure 13: Take-away food consumption comparison between intervention participants and Queensland*

129

Table 11 indicates that cooking behaviours positively increased after programme

attendance. Intervention participants significantly increased their frequency of

cooking the main meal from basic ingredients, from 4.05 times per week at T1 to

4.66 at T2 (P<0.001), whereas the control group did not significantly change over

time (P=0.95). The overall group by time interaction effect for cooking the main

meal from basic ingredients was statistically significant (P<0.001). The

consumption of ready-made meals (such as frozen dinners or pre-prepared pizzas)

did not show a significant difference between groups and over time (P=0.06). The

frequency of consuming a salad or vegetables with the main meal significantly

increased in the intervention group over time, but not in the control group. The

intervention group consumed an average of 0.39 more salads or vegetables per

week as part of their main meal, with total weekly serves increasing from 4.67 at

T1 to 5.06 at T2. The overall group by time interaction effect of consuming a

salad or vegetables with the main meal was significant (P=0.01).

6.4.5 Affordability of a healthy diet

Three food purchasing behaviours were measured (table 11). Total food and drink

expenditure did not significantly differ between groups or over time. On the other

hand, total fruit and vegetable expenditure did significantly increase in the

intervention group by a mean AUD 2.50 per week between T1 and T2 (P<0.001),

but not in the control group. The overall group by time interaction effect was not

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significantly different for fruit and vegetable expenditure (P=0.10). There was a

statistically significant decrease in total weekly take-away food spending in the

intervention group (P<0.001), but not in the control group, between T1 and T2

(P=0.07). Weekly take-away food expenditure showed a significant difference

between intervention and control groups and over time (P=0.004) (Table 11).

6.4.6 Social connectedness

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6.4.7 Health and emotional well-being

The last component of the programme logic model measured quantitatively was

self-esteem. In addition to this, perceived general health and BMI were analysed.

The JMoF programme did not impact on participants' BMI; there were no overall

significant interactions between groups and over time (Table 11). There was a

statistically significant increase in global self-esteem in the intervention group

(P<0.001) but not in the control group. Overall, there was however a significant

group by time interaction for general health (P<0.001) and self-esteem (P=0.002).

‘ ’ ‘ ’

6.5 Adjusted analyses of outcomes

Each outcome analysed was adjusted to account for any differences between the

intervention and control groups at baseline due to the non-randomised nature of

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the evaluation design. Each variable was adjusted for age, gender and

employment, with each covariant analysed separately and then all together. These

results are presented in Appendix 9. There were small differences in the predicted

group by time mean values; however, pairwise comparisons remained similar to

the unadjusted analysis. Appendix 9 shows similar patterns of change over time in

the pairwise comparisons. Similar patterns mean that inferences between the

adjusted and unadjusted result models remain the same, therefore the results have

not been presented in this chapter.

Table 11: Predicted mean scores in behaviours and health and well-being by group (T1 and T2)¹

Intervention Control Interaction effect, group by time P-value

Difference between group (effect size)10

Outcome measure Baseline (T1) mean (SE)

Intervention completion (T2) mean (SE)

Change from T2-T1 mean (S.E) P-value

Baseline (T1) mean (SE)

Wait-list completion (T2) mean (SE)


Consumption behaviours Daily vegetable consumption (serves per day) 2.46 (0.51) 2.97 (0.06) 0.52 (0.06) P<0.001 2.49 (0.09) 2.59 (0.10) 0.10 (0.10) P=0.30 P<0.001 0.29 Daily fruit consumption (serves per day) 1.65 (0.04) 1.93 (0.05) 0.28 (0.05) P<0.001 1.61 (0.07) 1.71 (0.08) 0.10 (0.08) P=0.20 P=0.06 0.16 Take-away consumption4 0.98 (0.04) 0.77 (0.04) -0.21(0.04) P<0.001 0.94 (0.06) 0.96 (0.07) 0.03 (0.06) P=0.62 P=0.001 -0.26 Cooking behaviours Cooking the main meal from basic ingredients4 4.05 (0.08) 4.66 (0.09) 0.61 (0.09) P<0.001 4.16 (0.14) 4.17 (0.16) 0.01 (0.15) P= 0.95 P<0.001 0.29 Consumption of ready- made meals at home4 1.06 (0.05) 0.95 (0.06) -0.11 (0.06) P=0.06 1.11 (0.08) 1.21 (0.10) 0.10 (0.10) P=0.30 P=0.06 -0.09 Consumption of vegetables with the main meal4 4.67(0.07) 5.06 (0.09) 0.39 (0.08) P<0.001 4.76 (0.12) 4.75 (0.14) 0.01 (0.14) P=0.94 P=0.01 0.25 Food purchasing behaviours and attitudes Total weekly food and drink expenditure (AUD)5 137.16 (2.72) 135.60 (3.15) -1.56 (2.46) P = 0.53 147.34 (4.68) 151.68 (5.20) 4.33 (3.96) P=0.27 P = 0.21 -0.10 Total weekly fruit and veg expenditure (AUD)5 20.77 (0.61) 23.28 (0.73) 2.50 (0.63) P<0.001 21.70 (1.06) 22.24 (1.20) 0.53 (1.01) P=0.60 P = 0.10 0.18 Total weekly take away expenditure (AUD)5 13.17 (0.59) 9.86 (0.69) -3.31 (0.55) P<0.001 12.395 (1.01) 12.05 (1.13) -0.34 (0.87) P=0.70 P = 0.004 -0.24 I can prepare a meal from basics that is low in Price6 2.99 (0.03) 3.41 (0.04) 0.41 (0.04) P<0.001 3.00 (0.05) 2.97 (0.06) -0.02 (0.06) P=0.71 P < 0.001 -0.55 Buying more fruit/vegetables would not be difficult on my budget6a

2.85 (0.03) 2.93 (0.04) 0.08 (0.04) P = 0.06 2.85 (0.06) 2.89 (0.07) 0.04 (0.07) P=0.59 P = 0.60 -0.03

Fruit and vegetables are cheaper when they are in season6

3.42 (0.02) 3.62 (0.03) 0.21 (0.03) P<0.001 3.43 (0.04) 3.50 (0.05) 0.07 (0.06) P=0.21 P = 0.04 -0.20

Social eating Frequency of eating together at home with others7 3.94 (0.07) 4.20 (0.08) 0.24 (0.07) P<0.001 3.97 (0.11) 4.02 (0.13) 0.06 (0.11) P=0.61 P = 0.13 0.15 Frequency of eating dinner in front of the television7 2.69 (0.08) 2.50 (0.09) -0.19 (0.07) P = 0.01 2.51 (0.14) 2.52 (0.15) 0.00 (0.11) P=0.99 P = 0.17 -0.12 Frequency of eating dinner at a dinner table7 3.12 (0.08) 3.40 (0.09) 0.29 (0.06) P<0.001 3.11 (0.13) 3.09 (0.14) -0.02(0.10) P=0.86 P = 0.01 0.23 Health and emotional well-being Global self-esteem score8 20.88 (0.22) 22.60 (0.25) 1.73 (0.20) P <0.001 20.46 (0.37) 21.02 (0.42) 0.56 (0.32) P=0.09 P = 0.002 0.26 General health9 2.77 (0.04) 3.11 (0.04) 0.34 (0.04) P <0.001 2.80 (0.06) 2.86 (0.07) 0.06 (0.06) P=0.34 P < 0.001 0.37 Body Mass Index (BMI) 28.86 (0.27) 28.78 (0.28) -0.09 (0.13) P = 0.49 29.71 (0.46) 29.70 (0.47) -0.02 (0.20) P=0.94 P = 0.76 -0.03 ¹Outcomes at each time point were determined by a mixed linear model for repeated measures using all available data at each time point. All means and Standard Errors (SE) have been rounded to 2 decimal points. ²Baseline values were not significantly different between groups (independent t tests P<0.05). ³A significant group x time interaction effect denotes that the response over time differed between groups 4times per week 5Expenditure data was collected in Australian dollars (AUD) on a 7-Point scale which was analysed by its midpoints. 6Mean predicted score indicating level of agreement with statement from a Likert Scale (1=strongly disagree, 2=somewhat disagree, 3=some agree, 4=strongly agree), aScore assignment was reversed. 7Mean frequency for a typical week was collected on a 6 or 7-Point scale which was analysed by its midpoint, with the maximum category being five or more times Per week. 8Rosenberg's global self-esteem score (Low self-esteem= 0-14, Normal self-esteem=15-25 and High self-esteem =16-30). 9Perceived general health (Poor=1, fair=2, good=3, very good=4, excellent=5). 10 Cohen's d effect size, general guideline: small (0.2), medium (0.5) and large (0.8)..

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Table 12: Predicted mean scores in behaviours and health and well-being for the intervention group (T1, T2, T3)¹

Intervention group Interaction effect over time2 P value

Difference over time T2-T1 (effect size)9

Difference over time T3-T1 (effect size)9

Outcome measure

Baseline (T1) mean (SE)

Intervention completion (T2) mean SE)

6 months follow-up (T3) mean (SE)




Consumption behaviours Daily vegetable consumption (serves per day) 2.46 (0.05) 2.97 (0.06) 3.05 (0.07) 0.51(0.06) P<0.001 0.60(0.07) P<0.001 0.08(0.08) P=0.27 P<0.001 0.54 0.53 Daily fruit consumption (serves per day) 1.65 (0.04) 1.93 (0.05) 2.05 (0.06) 0.27(0.05) P<0.001 0.40(0.06) P<0.001 0.12(0.06) P=0.06 P<0.001 0.38 0.50 Take-away consumption3 0.98 (0.04) 0.76 (0.04) 0.73 (0.05) -0.23(0.04) P<0.001 -0.25(0.04) P<0.001 -0.02(0.05) P=0.61 P<0.001 -0.30 -0.35 Cooking behaviours Cooking the main meal from basic ingredients3 4.05 (0.08) 4.65 (0.10) 4.88 (0.11) 0.60(0.09) P<0.001 0.84 (0.10) P<0.001 0.24(0.11) P=0.03 P<0.001 0.39 0.64 Consumption of ready- made meals at home3 1.06 (0.05) 0.93 (0.06) 0.80 (0.07) -0.13(0.06) P=0.04 -0.26(0.07) P<0.001 -0.13(0.08) P=0.09 P<0.001 -0.02 -0.30 Consumption of vegetables with the main meal3 4.67 (0.07) 5.05 (0.09) 5.31 (0.10) 0.38(0.09) P<0.0011 0.64(0.09) P<0.001 0.25(0.10) P=0.02 P<0.001 0.29 0.51 Food purchasing behaviours and attitudes Total weekly food and drink expenditure (AUD)4 137.13 (2.65) 135.21 (3.08) 137.28 (3.42) -1.93(2.48) P = 0.44 0.15 (2.90) P = 0.96 2.08 (3.08) P=0.50 P = 0.70 -0.01 0.02 Total weekly fruit and veg expenditure (AUD)4 20.77 (0.62) 23.25 (0.74) 23.64 (0.83) 2.48 (0.65) P<0.001 2.86 (0.76) P<0.001 0.39 (0.81) P=0.63 P < 0.001 0.31 0.37 Total weekly take away expenditure (AUD)4 13.19 (0.59) 9.85 (0.68) 9.14 (0.76) -3.34 (0.54) P<0.001 -4.05 (0.63) P<0.001 -0.71 (0.68) P=0.29 P < 0.001 -0.35 -0.44 I can prepare a meal from basics that is low in Price5

2.99 (0.03) 3.41 (0.04) 3.42 (0.04) 0.42 (0.04) P<0.001 0.43 (0.05) P<0.001 0.01 (0.05) P=0.79 P < 0.001 0.68 0.69

Buying more fruit/vegetables would not be difficult on my budget5a

2.85 (0.03) 2.93 (0.04) 2.97 (0.05) 0.08 (0.05) P = 0.09 0.11 (0.05) P = 0.03 0.04 (0.06) P=0.52 P = 0.06 0.11 0.18


3.42 (0.02) 3.62 (0.03) 3.66 (0.04) 0.21 (0.04) P<0.001 0.24 (0.04) P<0.001 0.04 (0.04) P=0.41 P < 0.001 0.35 0.42

Social eating Frequency of eating together at home with others6

3.92 (0.07) 4.17 (0.08) 4.20 (0.09) 0.25 (0.07) P<0.001 0.28 (0.09) P<0.001 0.04 (0.09) P=0.69 P < 0.001 0.26 0.38

Frequency of eating dinner in front of the television6

2.69 (0.08) 2.50 (0.09) 2.46 (0.10) -0.19 (0.07) P = 0.01 -0.23 (0.08) P = 0.01 -0.04 (0.09) P=0.66 P = 0.01 -0.19 -0.18

Frequency of eating dinner at a dinner table6 3.12 (0.08) 3.40 (0.09) 3.37 (0.10) 0.28 (0.65) P<0.001 0.25 (0.08) P=0.001 -0.02 (0.08) P=0.76 P < 0.001 0.33 0.25 Health and emotional well-being Global self-esteem score7 20.88 (0.22) 22.61 (0.25) 22.92 (0.28) 1.73 (0.21) P<0.001 2.04 (0.25) P<0.001 0.31 (0.26) P=0.24 P < 0.001 0.59 0.62 General Health8 2.77 (0.04) 3.11 (0.05) 3.24 (0.05) 0.34 (0.04) P<0.001 0.47 (0.05) P<0.001 0.13 (0.05) P=0.01 P < 0.001 0.59 0.75 Body Mass Index (BMI) 28.86 (0.27) 28.79 (0.28) 28.94 (0.29) -0.07 (0.14) P = 0.61 0.08 (0.16) P = 0.65 0.15 (0.17) P=0.39 P = 0.68 -0.05 0.00 ¹Outcomes at each time point were determined by a mixed linear model for repeated measures using all available data at each time point. All means and Standard Errors (SE) have been rounded to 2 decimal points. 2A significant over time interaction effect denotes that the response over time differed between groups, 3times per week. 4Expenditure data was collected in Australian dollars (AUD) on a 7-Point scale which was analyse by its midpoints. 5Mean Predicted score indicating level of agreement with statement from a Likert Scale (1=strongly disagree, 2=somewhat disagree, 3=some agree, 4=strongly agree), aScore assignment was reversed. 6Mean frequency for a typical week was collected on a 6 or 7-Point scale which was analyse by its midpoint, with the maximum category being five or more times per week. 7Rosenberg's global self-esteem score (Low self-esteem= 0-14, Normal self-esteem=15-25 and High self-esteem =16-30). 8Perceived general health (Poor=1, fair=2, good=3, very good=4, excellent=5) .9Cohen's d effect size, general guideline: small (0.2), medium (0.5) and large (0.8).

6.6 Supplementary analysis

In addition to the primary analysis, a supplementary analysis was run for individual

variables as a precautionary check to see if differences in the statistical approaches

impacted on results. Ordinal variables measured on a 4 or 5-point Likert scale were

analysed using ordinal logistic regressions to produce an odds ratio. The ordinal

logistic regression was compared to the predicted mean results from the primary

multilevel mixed model analysis (Table 13). Comparison of P-values for each

analysis showed that there were no differences in the overall group by time

interaction effect between the different analysis techniques used.

analysed as a ‘confident’ or ‘not confident’

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Table 13: Supplementary analysis: ordinal logistic regression and multilevel mixed model analysis

Ordinal variables Ordinal logistic regression1

Multilevel mixed model analysis3

OLR odds ratio (SE)

Confidence intervals

Z score P-value Interaction effect group by time P-value2

Cooking and healthy eating knowledge, attitudes, beliefs and skills


2.68 (0.49) 1.87 - 3.82 5.41 P< 0.001 P< 0.001

I find it easy to change my eating habits4

1.62 (0.31) 1.12 - 2.37 2.53 P= 0.010 P= 0.020

Vegetables can be tasty foods4 1.93 (0.38) 1.31 - 2.85 3.34 P= 0.001 P= 0.010 I eat enough fruit and vegetables4 2.06 (0.34) 1.48 - 2.86 4.31 P< 0.001 P< 0.001 My lifestyle does not prevent me eating a healthy diet4a

1.33 (0.24) 0.93 - 1.89 1.57 P= 0.120 P= 0.07

Cooking enjoyment and satisfaction I enjoy cooking4 1.75 (0.26) 1.31 - 2.34 3.80 P< 0.001 P= 0.001 I get a lot of satisfaction from cooking my meals4

2.29 (0.35) 1.69 - 3.10 5.36 P< 0.001 P< 0.001

I enjoy cooking for others4 1.56 (0.23) 1.16 - 2.01 2.98 P= 0.003 P= 0.004 I enjoy eating a meal with others4 1.05 (0.21) 0.70 - 1.56 0.22 P= 0.830 P= 0.810 Food purchasing behaviours and attitudes

I can prepare a meal from basics that is low in price4

3.01 (0.53) 2.12 - 4.26 6.20 P< 0.001 P<0.001

Buying more fruit/vegetables would not be difficult on my budget4a

1.13 (0.21) 0.79 - 1.62 0.66 P= 0.512 P=0.600


1.54 (0.30) 1.04 - 2.26 2.18 P= 0.030 P=0.040

Cooking confidence Confidence to cook from basic ingredients5

3.73 (0.59) 2.74 - 5.08 8.37 P< 0.001 P<0.001

Confidence to follow a simple recipe5

3.21(0.55) 2.29 - 4.51 6.76 P< 0.001 P<0.001

Confidence in preparing and cooking new foods and recipes5

3.61(0.6) 2.60 - 5.01 7.67 P< 0.001 P<0.001

Confidence that what one cooks will turn out well5

3.9(0.65) 2.82 - 5.41 8.19 P< 0.001 P<0.001

Confidence to taste new foods never eaten before5

2.16(0.35) 1.57 - 2.95 4.79 P< 0.001 P<0.001

OLR = Ordinal Logistic Regression. SE = Standard error. 1 Ordinal logistic regression is the supplementary analysis. Odds of a positive change occurring between T1 and T2 in the intervention group and control group for all ordinal variables (control =0 and intervention = 1). 2A significant over time interaction effect denotes that the response over time differed between groups. 3 Multilevel mixed model analysis was the original analysis technique used. P-values are presented to compare. 4Four-point Likert scale used to measure level of agreement with statement (1=strongly disagree, 2=somewhat disagree, 3=some agree, 4=strongly agree). a Score assignment was reversed.5Five point Likert scale used to measure confidence level (1= not at all confident through to 5 = extremely confident. ≥4 = confident).

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Table 14: Supplementary analysis: secondary logistic model (generalised estimated equation) for cooking confidence1

Ordinal variables Generalised estimated equation Multilevel mixed model analysis

OLR odds ratio (SE)

Confidence intervals

Z score P-value1 Interaction effect group by time P-value1

Confidence variables Confidence to cook from basic ingredients 3.75 (0.84) 2.41 – 5.81 5.90 P<0.001 P<0.001

Confidence to follow a simple recipe 3.66 (0.92) 2.24 – 5.98 5.18 P<0.001 P<0.001

Confidence in preparing and cooking new foods and recipes 3.56 (0.74) 2.37 – 5.36 6.09 P<0.001 P<0.001

Confidence that what one cooks will turn out well 4.31 (0.89) 2.87 – 6.46 7.06 P<0.001 P<0.001

Confidence to taste new foods never eaten before 2.21 (0.44) 1.50 – 3.27 3.99 P<0.001 P<0.001

Combined confidence score 4.71 (1.23) 2.82 - 7.876 5.92 P<0.001 P<0.001

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6.7 Summary

In the quantitative study, the targeted sample size was achieved with over 500

participants contributing to the study. There were a number of positive statistically

significant results indicating that a diversity of benefits accrued to the intervention

group. Both primary outcomes, cooking confidence and vegetable intake, were

significantly increased and the benefits were sustained after the programme.

Intervention participants self-reported vegetable intake increased by more than 0.5

serves per day after completing the programme. The magnitude of change for self-

reported mean vegetable consumption, while significant, was smaller compared to

the medium-large effect differences found in participants’ cooking confidence. A

number of secondary outcomes also significantly improved and were maintained

over time. The programme positively influenced participants’ cooking knowledge,

attitudes and beliefs around cooking easy and quick healthy meals prepared from

“scratch”. Participants were increasingly preparing more meals at home, and

consuming and incorporating more vegetables into their meals. Participants were

also consuming significantly less take-away food, which corresponded to a reduction

in their take-away food spending.

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Chapter 7. Qualitative results


This chapter discusses the qualitative results of the evaluation. The presentation of

the qualitative results differs to that of the quantitative results because qualitative

research stems from a different paradigm of inquiry (161). The key themes emerging

from the thematic data analysis are outlined in this chapter. The motivations for

attending the programme and influences on participants’ intentions to change are

investigated. Ideas around cooking and healthy eating, social standards, identity and

individual responsibility are explored, specifically looking at the role of social norms

and personal responsibility in influencing food and cooking choices. Further themes

to emerge from the data included the celebrity influence of Jamie Oliver on

participants’ food choice, the social benefits stemming from the programme, food

affordability and food purchasing changes as a consequence of the programme; and

barriers and facilitators to cooking.

Table 15: Summary of interview themes and domains

Participants’ motivations and intentions

The celebrity factor, Jamie Oliver’s influence Social benefits of the programme Socialisation and social support in class The value of eating with others and social interactions in the home

“ ” Feelings of accomplishment and achievement

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and to illustrate participants’ experience

the reader, utterances such as ‘umm’, ‘yeah’ and ‘you know’

the use of “…” indicate

7.2 Participants: qualitative study

Fifteen participants participated in the qualitative study. All completed round one

and two interviews, whilst 13 completed a third interview (with two participants lost

to follow-up). Figure 14 shows this in more detail. After initial reflection and

analysis of the first round of interviews, it was decided that all participants who

participated in the first interview would be invited to participate in repeated

interviews. All participants provided rich and unique insights or differing

perspectives, hence the decision to invite them back for subsequent interviews.

Another participant, who had an intellectual disability, was interviewed with a

carer present. There were no instances of the carer interrupting or preventing a

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response during the interview, therefore it was decided that the attendance of another

person did not appear to influence the responses provided by the participant.

However, it is possible that subtle influences arising from their relationship could

have influenced the response of the other person present, this was perceived to be the

case by the researcher.

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Figure 14: Jamie’s Ministry of Food evaluation - qualitative participation, August 2012 to July 2013*

* This diagram is published in Herbert et al (2014) (9)

Six-month T3 Interview, n=13 Face-to-face (n=8) or phone interview (n=5) Interview with another person present (n=2)

Loss to six-month follow-up, (n=2) Reasons unknown (n=1) Could not be contacted (n=1)

Before programme, Interview one, n=15 Face-to-face interview, n=15. Interview with another person present (n=3)

After programme, Interview two, n=15 Face-to-face (n=11) or phone interview (n=4) Interview with another person present (n=3)

Recruitment via telephone number provided, n=12

A total of 199 participants agreed to be contacted for an interview on their completed baseline quantitative questionnaire and provided a contact telephone number. Based on data collection dates and the participant’s programme commencement date only 24/199 participants were eligible for an interview.

12 were scheduled for an interview. 12 were unavailable for an interview due to time commitments and interview scheduling constraints.

Recruitment via class observation (n=3) 4 participants were approached only 3 agreed to an interview.

Qualitative participants

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attempted with the individual’s carer to understand the participant’s

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Table 16: Qualitative participant profile at time of first interview

n Total participants interviewed 15 Gender

Female 13 Male 3 Age range in years

18-29 2 30-39 2 40-49 2 50-59 5 60 + 4 Household characteristics

Couple, with young children (0-17 years old) living at home 4 Couple, with adult children (18 years and over) living at home 3 Couple, without children living at home 6 Live Alone 1 Semi-independent living in care facility 1 Main cook in the home

No 4 Yes 9 Yes, shared responsibility 2

7.3 Participants’ motivations and intentions

7.3.1 Programme participants’ motivations for programme attendance

The decision to enrol in the JMoF programme occurred at a time of significant

change in life circumstances for many participants. These included health issues,

family changes or financial difficulties. Many participants were seeking an

opportunity for either self-improvement or respite from daily realities by enrolling in

the programme. Some were looking for a positive change in their life and saw the

programme as a first step in this process. Others saw it as an avenue for help and

assistance, something they were “needing” or an “outlet… to not think about what

was going on at home”. For some participants, life was particularly tough at the time

of the initial interview and they saw the programme as an opportunity to do

something positive and as an outlet from their hardship. Participant circumstances

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evolved and changed during the evaluation period, which often led to changes in

their cooking roles. For example, retirement, moving house, being made redundant

or working different or longer hours changed people’s schedules and routines, which

in turn impacted on their domestic cooking practices.

7.3.2 Influences on intention to change

The recruitment and sampling process previously outlined in Chapter 5 aimed to

capture critical factors that may impact on the participants’ home cooking, their

willingness to learn and ability to make changes. Some factors appeared to influence

participants’ intention to change cooking and food practices more than others.

Participant life stage impacted on domestic food practices and willingness to change.

There were differences between participants living in a household with children at

home (or adult children) compared to those without children at home or those living

alone. As participants aged they appeared to cook less, which is reflective of their

life stage. Most participants whose children had grown up and left home talked

about what they “used” to do in terms of family cooking. Some participants

considered that making a big meal from scratch, which entailed lots of ingredients,

would be a waste of time and effort unless they had a big family to cook for. For

those participants the effort involved in preparing a big meal was saved for when

their children or grandchildren visited. Cooking and meal sharing were recognised as

having a social element which influenced food choices and practices. For participants

who lived alone, cooking behaviours differed between when cooking for others and

cooking for themselves.

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7.4 Cooking social norms and cooking identity

This section discusses the ideas around social norms, responsibility and identity

towards cooking and healthy eating. Firstly, normative themes around identity and

the responsibility of being a good mother or wife are presented; this includes, for

example, feeling the need to be responsible for food provisioning and knowledge

sharing. In addition, the influence of age and life stage is explored as well as the role

that health and well-being plays in individual food choices.

7.4.1 Provisioning and being a good mother and wife

There are complex meanings placed on decision-making when it comes to food

choices and cooking practices (44). Social influences and pressures play an

influential role in decision-making. There is a normative moral notion of the identity

of being a good wife and mother and what this means in terms of food provisioning;

it is not only about providing a “proper” meal but also about the transference of

knowledge (38, 214). For JMoF participants, the concept of being a good wife was

about providing meals that their partner will enjoy and eat. The notion of

motherhood appears to be even a stronger influence on cooking changes in the JMoF

sample than being a good wife. Therefore, this concept of motherhood will be further

explored.

“ ”

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“I would like to be able to [show my daughter], because she says ‘can I cook tea’

and I go ‘well I don’t even know what is planned, let alone what to have…”

~ Leah, mother in her 40s.

“I’m thinking it is important to be able to move forward with yourself [referring to

her children] and later on you are going to want to cook. If nobody has taught you

by the time you move out of home you get a little bit behind. Even if in the end she

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[daughter] conquers three or four things that she is a whip at [its] still good…”


“It has actually been quite good, my girls have been a bit more encouraged I

suppose. They [say], ‘mum can we help cook dinner tonight?’ And so they are

learning the knife skills and stuff like that”

~ Wanda, mother in her 40s.

7.4.2 Influence of age and life stage

Age and life stage appeared to affect cooking responsibilities and motivations to

cook. The motivational role of having children living at home was discussed

previously in Section 7.3.2. Retired or semi-retired participants, without children or

whose children had grown up and moved away, indicated different cooking

responsibilities. In these instances the responsibility to make changes rested on the

individual. Without a motivational prompt or some subjective norm to change, there

was often no adequate trigger to bring about change.

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7.4.3 Individual responsibility towards personal health and well-being

Health is often a motivating factor that influences life changes and transitions. In the

previous section, the social pressures associated with the preparation of a proper

meal, with being a good mother, and the influences of life stage were discussed. An

additional motivation appeared to be personal responsibility for one’s own health.

For a few participants their health and well-being were motivating factors towards

changing their cooking practices.

“ ”

“I cook most days….it’s not a burden it’s pleasant.”

~ Dolly, semi-retired grandmother in her 50s.

“I have noticed that my skin feels healthier… I seem to have more energy and I

thought maybe that is because we have cut out all the extra crap or all the added

preservatives and stuff like [that] since now we are going healthy, like the healthy

option with the fresh food… Since we have cut out all the bottle jars and stuff we

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have noticed, both of us seem to have more energy and even the kids have more

energy…”

~ Kaye, mother in her 30s.

messages within class had a role in influencing participants’

“I think it is a little bit combined with Jamie’s health approach [which] is put

through how you cook. You go away going I have cooked with so much bad stuff for

your body and for yourself and you watch his shows, and well I have only seen a

couple of episodes of the 15 Minutes Meals, you just see his exuberance and how he

explains healthy food doesn’t have to taste like crap… You can do all these things

and it was just a by-product of that. I started to think well he says so much about

obesity and all that but if we keep eating this way, we are just going to get worse and

worse and have more health issues and things like that… Do I want to be eating

these nasty foods forever and it just kind of sparked something in my head. I started

thinking about being healthier and getting active and ways to do that [is] eating

healthier. But I would never have thought about that before”

~ Katie, student in her 20s.

The programme had an influence on participants’ attitudes towards their health

ys they could improve it. These factors resonate with Jamie Oliver’s

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7.5 The celebrity factor, Jamie Oliver’s influence

Powerful people such as Jamie Oliver, a successful celebrity chef seen by many as an

authority on cooking as well as an obesity prevention advocate, can influence how

knowledge is viewed. It was not unusual that the topic of Jamie Oliver came up

during the interviews given that his name is a key factor that sets this programme

apart from other non-celebrity promoted cooking programmes. Jamie Oliver is well

loved within Australian popular culture, as demonstrated by his outstanding book

sales in Australia (215) and the popularity of his television shows. Within the

Australian policy context, he has the backing of state governments who support and

fund the JMoF programme. In addition to his celebrity status being a political draw

card, it also helped with programme recruitment.

Jamie’s

healthy as distinct from the “ ”

s. Jamie’s philosophy of a healthy meal is

Jamie’s

“Now that I have seen him I’m a bit impressed. Not to be horrible but I hadn’t seen

much of him and thought he was a bit of a British ponce. But now I kind of [think] he

is an honest guy, he just wants to cook good stuff...”


and Jamie Oliver’s cooking style and

Jamie says “

”

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to be healthy “ ”

. One person’s perception o

“You [know] how Jamie Oliver’s [cooking] is oil, all oil... I thought it’s meant to be

healthy? Is it [that] olive oil is ok or what? I’m not sure?”

~ Sally, carer in her 50s.

“ ” “ ” “ ”

enthusiasm. Perhaps Jamie’s level

’s content

increase people’s level of food interest

“ ”

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“My wish list is to have some of Jamie’s beautiful knives and his pots and pans.

Going home to use my daggy knives that was a little bit hard...”

~ Diana, living alone in her 50s.

“I actually saw him on TV the other night for the first time ever and he was cooking

the 15 minute meals and I went out and bought the book. So he has got me

motivated…”

~ Barbara, semi-retired in her 50s.

There was discussion about the programme in the context of the Ipswich community.

The programme has been “embraced” by the community members, which was

recognised as largely due to the efforts of the Ipswich City Council and the current

mayor of Ipswich. Participants felt special that Ipswich had been chosen for the site

and appreciated using new and lovely cooking utensils and equipment and good-

quality cuts of meat.

“Ipswich is a smaller country town and it’s nice to have some of these things

available to people outside the capital city areas…”

~ Jenny, retired in her 60s.

Participants had an understanding of where other JMoF sites were, both in Australia

and internationally. Some participants still felt a connection to the JMoF staff and

programme six months after completing the programme. Some participants felt

connected to and a part of something bigger than their programme in Ipswich, by the

realisation that they were connected to others sites in Australia and around the world.

The qualitative findings included examples of Jamie’s influence on programme

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authority that is Jamie Oliver. Oliver’s celebrity effect was viewed as providing

e participants’

7.6 Social benefits of the programme

7.6.1 Socialisation and social support in class

The social benefits of the programme were explored. There were obvious and

expected social links within the class setting. At programme onset, strong motivating

factors to attend the programme included a desire to make new social contacts. In

class there were opportunities to interact and learn from others, through class

discussion, in an encouraging and positive way. Participants were able to share, learn

and discuss food and their cooking knowledge with other class members as well as

with the JMoF volunteers and food trainers.

participants’ experiences and feelings of inclusion. Bonds were built with others that

influenced class enjoyment. As each course progressed, participants’ interactions and

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“You expected to go in, cook, bring home a meal, whoop-di-do, but you came out,

[and] you were friends with these people for an hour and a half every week, you got

to know your leader and learn different skills and things that you can kind of take

home. So it’s more than just a meal in a box…”


“

take a picture and put it on…”

7.6.2 The value of eating with others and social interactions in the home

The JMoF programme encouraged commensality and valued the social significance

of eating with others. The significance of commensality was also felt within the

broader environment as these messages are engrained in many facets of society. The

JMoF programme emphasised these societal messages with embedded context

around the value of eating with others; for example, the meal cooked within class

could be taken home and was enough to feed four. Participants’ beliefs and attitudes

about the importance of eating meals together with other people, and particularly

around the value of eating as a family, were expressed by many. Before commencing

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the programme, most participants had similar perceptions on eating socially, with

opinions and actions dependent on their life stage and everyday scheduling of

activities. Participants with children living at home noted the importance of eating

dinner together at the table, and this only changed for special occasions or when a

family member was not home. There was a consistent belief amongst participants

about the importance of eating meals together with other people.

“The kids get to tell us what they are up [to] and we don’t always get that together

time, because I’m working, so eating at the dinner table is really good because we sit

down and we go “what did you do today?'…”

~ Wanda, mother in her 40s.

For a few older participants, it was their children’s visits to the family home

circumstances commented, “ the kids are at home…”

“ ” “ ”

in front of the television was reported by a number of respondents as being “ ”

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participants acted in ways to prepare “ ” meals with others, whether this was

home, many describing “ ”

“We've made a bit more space and… we sort of moved some things around, so now

when I'm cooking, the kids can sit up on the kitchen bench and we can still do

reading or some of the homework so there's still that interaction, whereas before we

didn't have it set up like that… I think it's changed the dynamics, which we wouldn't

have bothered to change at all if we hadn't come along [to the programme]… It was

like, well if the kids needed help I had to go and help them out. I couldn't be

cooking. The risotto needs to be stirred continuously. You can't do that if every

minute "can you help me with…" but now it's like "yeah, I'm doing this". Yeah but

putting those changes into place…”


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7.7 Food purchasing behaviours

A number of the results in this section have been reported by the candidate in a peer-

reviewed journal article, Herbert et al (2014) (9). After completing the programme,

there was an attitude shift amongst some participants who began to recognise the

importance of preparing meals from fresh ingredients compared to using prepared

foods. As a result of this attitude change, some participants indicated changes in their

food purchasing practices. Participants reported purchasing a wider variety of fresh

foods, such as fruit and vegetables, and less ‘packet’ and processed or prepared

foods; many viewed this as a direct consequence of preparing more meals from

scratch. Six months after the programme, there were examples of participants

shopping smarter, “buying more to our list” and growing vegetables and herbs.

“I was stuffing the fatty things [in the trolley], and I wouldn’t change and try new

stuff, which was costing me more money and now I’m trying all these new things, I

might spend a bit more on fresh fruit and vegetables than what I used to but…. It’s a

good thing [it] means we are not buying crap…”


home were more likely to invest energy in providing a “ ” meal made from

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7.8 Barriers and facilitators to cooking

Cooking and eating attitudes, beliefs, knowledge and behaviours were explored to

understand the factors that hindered or helped participants’ food experiences at

home.

7.8.1 Cooking enjoyment

Enjoyment or lack of enjoyment played a significant role in participants’ attitudes

around cooking. For many, cooking was an enjoyable process which allowed

opportunities to be creative by "creating something from nothing". However, this

creative process was only enjoyable under the right circumstances. Some people did

not enjoy cooking and yet it was described as an essential task, “a necessary evil”.

Lack of cooking enjoyment stemmed from feelings of failure and was linked heavily

to other barriers such as lack of skills, confidence and time. Whilst both male and

female participants indicated a lack of enjoyment from cooking, there were gender

differences. The men commented they did not have the skills or confidence to do it

and therefore did not like it or felt they were bad at it. When women discussed their

dislike of cooking, it often related to a lack of time, feeling unappreciated, and that it

was a chore. In contrast, there were some participants that expressed a genuine love

of and satisfaction with cooking. However, these comments were often followed by

examples of barriers around cooking. In the beginning, the programme was seen as

an opportunity to convert cooking into a positive experience through increased skills

and efficiency and a broadening of their meals repertoire. Post-programme, these

expectations were met for many.

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7.8.2 Time to cook, the “battle between this and that”

Lack of time was considered a barrier to cooking because limited cooking skills and

knowledge prevented quick meal preparation. Between work, family and social

commitments, time was typically seen as a precious commodity not to be wasted.

Many participants begrudged time spent cooking as it took them away from other

activities they preferred to do. In the past, to save time, some participants prepared

fewer meals from scratch. One participant described how in the past cooking was a

battle and she had to choose between cooking and helping with children’s homework

“which was why some of the quick foods or the instants or takeaway were easier”.

For this participant, as well as for others, the programme offered some time-saving

tips such as planning ahead and being prepared in advance. After the programme

busy schedules were still a common problem and participants’ daily commitments

did not change. Family, work and social lives continued to be demanding. The

programme did however offer solutions and ways to save time, so that cooking was

not as burdensome.

“Some nights we still don't but a lot of the times we're making extra now to freeze

into little bits which we weren't doing before. All of a sudden we're going "hey,

there's these quick meals."


and Jamie Oliver’s television shows and

7.8.3 Cooking confidence, skills and knowledge

Cooking confidence is an important aspect of the cooking process, affecting skills,

meal planning and food attitudes (61). Participants described a lack of trust in their

161

ability to cook, read recipes, prepare new foods, prepare food for others and prepare

a healthy meal. Whilst participants had the ability to prepare a simple meal from

scratch at home, they were limited by their lack of confidence to go beyond that

basic level. Thus this restricted their ability to prepare certain types of foods, extend

their cooking repertoire and their willingness to cook for others beyond their

immediate family.

“I’m confident in the meals that I do on a regular basis, if it’s something new I take

hours…. ”


“ ”

participants’ domestic

“I am going to make some stock on the weekend and make the pizza sauce, so it’s

there in the freezer ready to go…”

~ Rochelle, mother with no children living at home in 50s.

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In contrast, one retired male participant felt that learning new knowledge at his age

and in his situation was “probably a little bit too late".

"I would say if you were a health fanatic you wouldn't find it healthy enough, but if

you eat in moderation, yeah [it was] good"

~ Jackie, retired in her 60s.

"It is there in practice but there wasn't a discussion about it, you know ‘hey you are

better off cooking homemade spaghetti than buying something else’. There weren't

nutrition lessons I guess but maybe that is enough, maybe that is enough to change

people's minds..."


".... I thought going into the whole idea of trying to make people healthier would

have been useful but not "I will teach you how to cook". That is lovely but tell me

how much to cook and why I should be eating it and what are the benefits. Maybe

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look at the courses more from a weekly menu plan. Over the ten weeks look at it like

a weekly menu plan if you cook these dishes throughout the week you are getting this

amount of serves and it’s this many calories..."

~ Danni, mother in her 30s.

Some participants thought Jamie Oliver’s recipes that use

“[I] used to throw so much away that you didn’t think you could use. Just different

aspect of how to put it together and what is in certain things that maybe you

shouldn’t eat - like don’t choose this type of meat, it’s very fatty, choose this type of

beef or steak. I think what they said was ‘get the best quality for what you can

afford’… If you can get the good quality steak or rump steak get that one, if you can

afford it, and a bit more different fruit and veggies add them into your diet you know

for all the good things that we need, like the fibres and everything I think that was

very much a kind of a point over all classes”


7.8.4 Cooking and food attitudes

As previously mentioned, cooking confidence played a crucial role in participants’

cooking attitudes and food choices. The opportunity to prepare a successful meal in

class and take it home built participants confidence. The process of cooking in class

allowed participants the chance to experiment with personal and family food

preferences. The programme provided an opportunity for participants to try and

prepare new foods in a safe environment. There were changes in some participants’

preparedness to try and have a go at making something new without fear of failure.

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“[In class] everything you cook turned out. It was never a failure for anybody. And

there were some people who had skills and some people who didn't have skills and

they all seemed to manage a good outcome”


“He doesn’t cook every day and I don’t use the computer everyday so I can’t use a

computer.”

~ Sally, carer in her 50s.

“It’s just a big of a waste of time. If I was by myself I would eat sandwiches all day

long…”

~ Ron, retired in his 50s.

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7.8.5 Feelings of accomplishment and achievement

Another facilitator to cooking, gained after programme attendance by many

participants, was feelings of accomplishment and achievement. Firstly, participants

experienced a sense of accomplishment within class after completing the programme

and having tangible evidence each week of what they had prepared. Long after

completing the programme, participants reported continued feelings of happiness and

increased levels of support from others in their home. Feelings of resentment towards

the task of cooking had subsided; for many, the cooking and eating process became

more inclusive of other family members, and therefore became more enjoyable.

“You find it's a little lonely task and everybody else is watching the news or doing

something… and I'm stuck in the kitchen. How did that happen? Whereas now it's

more interactive and people are sort of appreciating it and wanting to be part of it”


7.9 Summary

In summary, qualitative findings revealed many of the positive experiences

stemming from programme attendance. The course facilitated ways to make cooking

easier and simpler, thereby reducing the time taken to prepare meals and improving

participants’ self-efficacy around cooking. Cooking no longer felt like a chore and it

was considered a more enjoyable process and was inclusive of other family

members, which in turn further enhanced their enjoyment. There were social benefits

from the programme, both within the class and at home, through changed

environments and attitudes to cooking. Jamie Oliver was exemplified as an expert

role model empowering participants to cook from scratch. These results are further

discussed in the next chapter, Chapter 8, where these qualitative findings are

compared and contrasted to the findings of the quantitative study presented in

Chapter 6.

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Chapter 8. Discussion of findings


8.2 Research questions and programme logic model

The overarching research question for this research was to determine the impact of

JMoF Ipswich Australia as a community-based cooking skills intervention using a

mixed methods approach.

rticipants’ skills, knowledge, attitudes,

interviewed participants’ expectations were met, and a number of motivators for

167

Figure 15: Improved programme logic model

The next section discusses the major findings in line with the major domains in the

programme logic model, namely personal development, social connectedness,

healthy eating and affordability of a healthy diet.

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8.3 Major findings

The evaluation results showed multiple significant, positive and sustained outcomes

of the JMoF programme in terms of the personal development of participants, such

as improvements in cooking skills, cooking knowledge, cooking confidence, cooking

enjoyment and attitudes, and perceived health. There were positive social benefits

gained as a result of attending the programme, both in terms of family home life and

commensality (the social significance placed on eating with others). Positive dietary

behaviours changed in terms of improved cooking behaviours, increased

consumption of vegetables and decreased take-away food consumption. As well,

changes in food spending patterns reflected the changes in participants' diets. The

qualitative findings accorded closely with the quantitative findings and served to

strengthen the findings by providing an understanding as to why the identified

changes may have occurred, a summary of quantitative and qualitative findings are

shown in Table 17 to identify complementary findings. Findings consistently

expressed a story of improved cooking skills, confidence and behaviours amongst

participants after attending the JMoF programme were sustained six months post

programme.

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Table 17: Summary of complementary quantitative and qualitative findings

Improved and sustained cooking confidence, belief they find it easy to change eating habits, nutrition food knowledge are salt and sugar

Improved and sustained belief and attitude that vegetables can be tasty foods

Ability to put together a healthy meal from scratch in 30 minutes Increased and sustained belief in consuming enough fruit and vegetables

Small reduction in total weekly take away expenditure

8.3.1 Increase personal capacity for successful behaviour change

The JMoF programme placed great emphasis on building participants’ confidence,

skills and knowledge to cook simple food in a supportive and non-judgemental fun

environment. For example the programme teaches participants how to cut an onion

in a unique way, how to read recipes and encourages the tasting of new foods.

During this process, participants gained the experience of producing successful

healthy and cheap meals. Results indicated that participants experienced many

changes described in Social Cognitive Theory as essential to behavioural change,

including positive reinforcement, increased capacity, and positive meal expectations

and expectancies, given the emphasis placed on cooking meals from scratch and food

appreciation (150, 151, 196).

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relating to one’s belief in

change in participants’ cooking confidence as indicated

indicated improvements in participants’ confidence to cook and

one’s

The confidence questions in the JMoF questionnaire related to participants’

improve participants’ confidence to follow a recipe. The JMoF intervention provides

171

improvements in the JMoF participants’ cooking skills, attitudes

The quantitative questionnaire included three questions on nutrition knowledge.

Before responses to these questions are discussed, it is important to note that the

JMoF programme did not directly teach nutrition education; this was not considered

172

a primary objective of the programme. However, whilst health and nutrition were not

key components of the JMoF curriculum, the notions of good nutrition and a healthy

diet are strongly embedded in all facets of the programme.

173

Like nutrition outcomes, health outcomes were not a stated principal objective of the

JMoF programme. Nevertheless, whilst they are not specifically articulated, the word

“health” features strongly in the rhetoric around and marketing of the programme.

Furthermore, potential improvements in population health and well-being are the key

factors underpinning investment in the programme by state health departments.

participants’

participants’

JMoF participants’ i

edium improvements in participants’ general

174

Another study with a control group reported on children’s BMI after

human body’s response to weight loss is slow

175

8.3.2 Positive behaviour changes after the JMoF programme

Social connectedness was measured in the quantitative study via a series of questions

relating to where and with whom people ate their evening meals. Results showed that

the JMoF programme over time, led to small significant increases in eating at the

table (9). On the other hand, programme attendance did not appear to significantly

impact on the frequency of eating dinner together with other people or eating dinner

in front of the television. In Australia, in 2008, a national study (n=1000 parents)

found that 77% of families ate together at mealtimes five or more times per week

(36). JMoF showed that six months after the intervention, approximately 72% of

those participants who had children living at home reported eating together five

times per week; this had increased from 66% at baseline. The JMoF population is

representative of only one socially disadvantaged area in Australia. Therefore, direct

comparison with a national sample must be treated with caution. The fact remains

that there is opportunity for improvements for the JMoF population to reach this

national comparison.

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The JMoF qualitative evaluation showed that positive social interactions in the home

environment increased through both domestic cooking and social eating. These

benefits were particularly evident in mothers with children living at home, who

reported changing their food and cooking behaviours for the benefit of their

household (Chapter 7, section 7.4.1). These changes also influenced their level of

cooking enjoyment, which in turn contributed to a further reduction in cooking

barriers (Chapter 7, section 7.8.5). The social effects in the home environment

following a cooking skills programme do not appear to be well established in the

literature.

participant who attended the JMoF programme but also on their family’s experience

d meals and less on family members’ attitudes and cooking

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shows that increased family meal frequency and children’s involvement in cooking

s’

There were small sustained improvements in the frequency of cooking a main meal

from basic ingredients, consuming more vegetables and incorporating more

vegetables into the main meal, as well as reducing take-away food purchasing and

consumption (Chapter 6, sections 6.4.4 and 6.4.5). Most of the outcomes that

improved significantly (compared to controls and over time) remained relatively

stable and were sustained between baseline and the six-month follow-up. The

preparation of a meal from basic ingredients and the consumption of more vegetables

with the meal were the two outcomes that continued to show increases after

programme completion, with significant improvements between post-intervention

and six-month follow-up. This is also highlighted by a small to medium increase in

effect size between T1 and T3. These elements are not surprising as a key message in

the programme is to about cooking from “scratch” and teaches ways of

incorporating vegetables within the main meal, for example with the addition of a

salad.

178

and eating. Results also showed that increases in participants’ cooking skills,

in participants’ cooking, consumption and shopping behaviours, whilst the

one’s family can be a motivating factor

The act of providing a “ ” meal made from scratch and containing vegetables

179

part of the programme’s

effect differences found in participants’ cooking confidence.

180

in JMoF participants’ take

equates to less than the price of a McDonalds ‘ ’

181

’

–

8.3.3 Additional emergent findings

In addition to the alignment between the results and the domains set down in the

original programme logic model, the evaluation gave rise to several key findings that

fell outside the originally identified domains. Two emergent findings in Chapter 7

were cooking role modelling as an element of parental provisioning (section 7.4.1)

and the celebrity impact of Jamie Oliver (section 7.5).

The notion of being a “good mother” by making meals from scratch and preparing

healthy meals was strong amongst participants attending the JMoF programme.

These ideas link to the provisioning of healthy foods and the normative view that, as

a mother, one should provide children with healthy nutritious meals (214). For some

JMoF participants, a mother’s role was to foster healthy behaviours in their children.

182

After attending the programme, participants gained new knowledge and cooking

skills, which enabled them to fulfil their perceived responsibility to provide healthy

meals to their families. The programme was instrumental in shifting the attitudes of

some participants and redirecting them away from the frequent use of convenience

foods.

“ ”

compromise on their perceptions of being a “ ” and negotiate between

183

This is consistent with a shift in the population’s attit

shifted the norms and attitudes around what is satisfactory to serve to one’s family;

provide for their children’s future knowledge base. This expectation can be

“ ” their children’s

184

The qualitative evaluation findings provided examples of Jamie’s influence on

programme participants. Jamie Oliver’s track record shows that he has created his

own discourse on cooking skills and what “proper cooking” involves in order to help

people achieve quick and delicious meal outcomes (231, 232). Participants sought to

acquire cooking knowledge and skills from Jamie Oliver by their attendance.

However, those who were not attuned to his discourse before starting the programme

were more aware after the programme of his “non-fancy” cooking and basic

messages. These messages encouraged an attitudinal shift in many participants

towards cooking enjoyment. Participant Katie, for example, did not think much of

Jamie before completing the programme; however, after the programme her attitude

had changed and she actively sought healthy behaviours around cooking and food.

Jamie’s “expert” advice created individual self-surveillance and self-governance

(76), and this was evident in the sustained behaviours of JMoF participants six

months after the programme in terms of both the quantitative and qualitative results.

There was an interplay occurring between Jamie’s role as an expert and his simple

approach to cooking which was accessible to participants.

Cooking skills and what is considered “ ”, or what constitutes

“ ”,

. Jamie Oliver is one such “ ” . Jamie Oliver’s altruism has been

a presence in participants’ lives after

185

’

programme were reinforced in the participants’ broader environment. This factor

me the face of one of Australia’s

branded itself the “ ”, there was controversy; the chain used

186

in 2012, Jamie Oliver participated in the Victorian government’s launch of

’s

mething “ ”

187

8.4 Evaluation strengths and limitations

The use of a mixed methods evaluation is a major strength of this PhD because the

results not only measure changes in outcomes to demonstrate programme

effectiveness but also provide insights into participant experiences in order to

understand why changes occurred. Findings showed clear and consistent results from

both methods, painting a picture of what was going on in terms of participants'

attitudes, knowledge, cooking skills, confidence and behaviours. Furthermore, the

breadth of the outcome variables measured is a key strength, which facilitated the

building of a more comprehensive picture of impacts of the programme. Two

previous interventions have used a mixed methods design with a control group and a

follow-up period (77, 94); however, this JMoF evaluation extends their findings by

the provision of a larger sample size and the broader breadth of the outcome

variables measured. The findings relate only to the 35-45% of enrolled programme

participants, as these are the participants who participated in the evaluation. Whilst

inferences and generalisations can be made, it must be acknowledged that more than

half of the programme participants were not represented in the evaluation

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population may be “ ”. On the other hand, the use of a

inferences about the programme’s effectiveness.

189

measure such as dietary patterns, nutrition knowledge, food security and participants’

Questions testing participants’ nutrition knowledge were considered for the

available on participants’ ability to pay for food or to take time out to attend cooking

190

to obtain true accounts of participants’ weight, height and waist, however they were

researcher’s inexperience was accounted for by training conducted with her

critical and useful feedback on the researcher’s style and techniques. This

A major strength of the qualitative study methods was the effort taken to

ensure methodological rigour, reliability and validity of the data collection and data

analysis processes used. The detailed description of the data collection methods and

systematic analysis process, presented in Chapter 5 (Qualitative methods), is a point

of rigour in its own right (248) and provides credibility to the researcher (161). The

191

level of detail specified in Chapter 5 means that others could easily replicate the

methods employed.

A number of strategies are discussed in the academic literature to help establish

reliability and validity in the qualitative research process (161, 207, 249). Morse et al

(2002) recommend the building of five verification strategies into the methods (249).

The first verification approach, methodological coherence, refers to the research

questions and the methods. As the process of data collection and analysis proceeds,

the research question and methods may need to be changed (249). In this study, this

occurred with the development of the interview structure and was built into the

research objectives. The study aimed to explain any unanticipated programme

outcomes, allowing the methods and questions to be open to exploration of any new,

unexpected outcomes. The second verification strategy was the use of a sample that

was appropriate to answer the research question (249). This was achieved by using

purposive sampling. The third recommendation was that data collection and analysis

occurred concurrently (249). As previously described in Chapter 5, data analysis

began at the very first instance of data collection, with data immersion and initial

coding beginning directly after each interview via transcription memos compiled by

the researcher. This allowed opportunities to clarify any uncertainties and follow up

prevalent issues and ideas with each participant in their follow-up interviews or over

the phone. A key strength in using a longitudinal design was that participants’

journeys throughout their programme were recorded; the researcher established a

relationship with participants and built rapport over time. The fourth strategy was to

take social theory into consideration, as outlined in the data analysis section of

Chapter 5. The use of social theory allowed opportunities to verify and compare new

ideas to the initial theoretical concepts as well as to search for other concepts that

may explain results (161, 207). The fifth aspect was to contribute to theory (249) by

results extending and enhancing the knowledge base around a cooking skills

theoretical framework.

presented as being representative of the participants’ perspectives and not limited to

the researcher’s perspective

192

In addition, during the researcher’s visits to Ipswich,

help differentiate between descriptions of what occurred in class and participants’

8.5 Summary

This chapter discusses both the quantitative and qualitative findings. This study is

one of the first evaluations of any cooking programme to include a longitudinal

mixed methods evaluation with a control group and six-month follow-up. Findings

provide strong comprehensive evidence to confidently strengthen the programme

logic pathway outlined prior to the evaluation. The use of a mixed methods approach

further strengthens this programme logic model as results align with each other to

confirm the logic pathway to behaviour change after attending the JMoF programme.

Results are grounded in the literature and social theory so that findings may be

translated and applied elsewhere. Findings also accord with the literature. Findings

offer further insights into the evidence around the effectiveness of cooking skills

intervention; few other studies have contained the range of variables that the JMoF

evaluation has. Major findings highlight that JMoF has had an influence on

participants’ capabilities for behaviour change, such as cooking confidence, skills,

attitudes and enjoyment. These capabilities have led to small behavioural changes

that were sustained six months after the programme was completed. Behaviours

included changes towards positive social connectedness, improved social

environments and positive changes in eating and food purchasing for a healthy diet,

with participants prioritising and valuing health and cooking after attending the

programme. In addition, new ideas to emerge from the qualitative data related to

participant motivations for change. These were discussed, namely cooking role

modelling as an element of parental provisioning and the celebrity impact of Jamie

Oliver. The celebrity factor may have contributed to the dose of the programme and

added to the sustained effect of the programme outcomes.

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Chapter 9. Implications and conclusions

The research that is presented in this PhD represents a robust study and is the first

evaluation of JMoF in Australia. It is also the first evaluation of a cooking skills

intervention using a longitudinal mixed methods design encompassing both a control

group and a six-month follow-up period with a large sample size. Given that the

JMoF programme has been in operation since 2008 in the UK, findings will impact

on implementation of the programme both in Australia and internationally. Using

mixed methods, the change over time was measured through quantitative methods

and qualitative methods that explored participants’ experiences over the course of

their programme journey. This research adds to the limited evidence available

internationally on the effectiveness of cooking skills programmes, and offers new

insights into the factors underpinning behaviour change.

9.1 Research implications

9.1.1 Considerations for policy

To date, governments have implemented JMoF without available evidence of the

programme’s effectiveness or cost-effectiveness. As a result of this research, the

programme’s effectiveness has now been addressed but not the programme’s cost-

effectiveness. Results demonstrate the effectiveness and impacts of JMoF Australia.

Any other Australian states or territories considering the JMoF programme

intervention can reasonably assume there will be multiple benefits to arise from the

implementation of the programme. The JMoF programme has been shown to

improve vegetable consumption within the community. This is highly important as

only 8.2% of the Australian population currently meet the daily recommended five to

seven serves of vegetables per day (250).

195

–

196

ry mode and the programme’s

sufficient indicators of the programme’s effectiveness. The sustainability of the 10

the Heart Foundation’s Heart moves

197

and its ‘value money’ as a public

9.1.2 Programme considerations

Practitioners implementing JMoF can confidently claim effectiveness of the

programme via the evaluation presented. Findings are supported by transparent and

robust methods. However, there are a few standout areas where practitioners may

consider an adjustment of the programme for improvement.

responsibility within this “ ” space if its auspices wish to accept funding from

198

9.1.3 Considerations for future research

The JMoF programme has been shown to result in significant and sustained gains in

cooking skills, knowledge, confidence, attitudes and behaviours, yet questions

remain for which further research is needed.

199

analyses. Supplementary sampling of participants’ families may provide data to

investigate whether there were any ripple effects on participants’ family members

wer has been discussed and it is hypothesised that Jamie’s

200

the costs and benefits of Jamie’s

health benefits associated with Jamie Oliver’s connection to the programme include:

participant recruitment to the JMOF programme,

political engagement and funding,

public awareness and engagement,

advertising and media for health promotion messages,

policy and programme enhancement.

’

9.1.4 Implications for the theoretical framework

Finally, this research has implications for theory. The findings from this mixed

method study show a breadth of outcomes which extend our knowledge around

201

cooking skills interventions. Results paint a broader picture measuring and

conveying important findings on a number of integrated outcomes that help to

present a logical pathway to behaviour change. Both the quantitative and qualitative

longitudinal results reinforce each other, and this increases confidence that the

programme logic model framework, shown in Chapter 8, Figure 14, is a valuable

representation of what is likely to occur following programme completion. At the

beginning of this study, there were a number of unknown elements inferred from the

limited and emerging data available. Findings have shown that there is a clear

pathway for confidence and skills acquisition via experiential learning and improved

self-efficacy, which translate into a number of positive cooking-related outcomes and

behaviours. The findings demonstrate that the links between the elements have been

established in a clear pathway towards behaviour change. Results have demonstrated

that the JMoF programme logic model framework is a sound process and it may be

useful for others in understanding cooking skills intervention pathways.

202

9.2 Significance of this PhD

This PhD makes an important contribution to new understandings and extends the

evidence base in the area of cooking classes as a public health nutrition intervention.

The research presented is robust and its findings both build on the existing evidence

and make new contributions to the field. It is the first evaluation of JMoF and is the

first longitudinal mixed method evaluation of any cooking skills intervention in the

literature encompassing a control group, a six-month follow-up period and a large

sample size. The comprehensiveness and concordance of the findings from both the

quantitative and qualitative studies (and their alignment with the literature) are

meaningful and offer a strong platform for robust conclusions on the impacts of

cooking skills interventions. They expand the theoretical concepts around cooking

skills programs and the logical pathway to behaviour change. The programme logic

pathway that was developed offers a new framework that is useful for understanding

cooking skills interventions. This research has discovered new findings that offer

insights into motivations for attending JMoF, and potentially other cooking skills

interventions, which may be applied for future recruitment and targeting of

programme participants. Firstly, the motivator of being a good mother may offer an

avenue of engagement of potential food providers and provide solutions for

knowledge and skills translation in the home for future generations. Secondly, the

celebrity factor may have empowered participants and contributed to sustained

effects on behaviours. These findings contribute to the understanding of why people

engage in programmes such as JMoF, and offer a valuable direction for future

research. Lastly, findings have uncovered new questions for future research, and

directions and considerations for policy makers and programme implementers going

forward.

203

9.3 Conclusions

This study has investigated the impacts of the 10-week cooking skills intervention,

JMoF Australia, in Ipswich, Queensland. It demonstrated the programme’s

effectiveness to provide sustained positive impacts on participants’ cooking and

food-related behaviours and attitudes, as well as enhanced understanding as to the

reasons for changes. Specifically, programme effectiveness was proven given that

the primary outcomes, vegetable intake and cooking confidence, significantly

improved and were sustained after the programme. There were also gains in personal

development around cooking self-efficacy, cooking skills, knowledge, attitudes and

enjoyment, as well as potential improvements in health outcomes. All results are

based on self-reported outcomes; it is important to state that in addition to the use of

more objective measures, there are other areas which should be explored such as the

programme‘s cost-effectiveness, and the effects of the celebrity factor on

participants.

impact on the population’s diet.

204

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Appendices

Appendix 1. Quality Assessment Tool for Quantitative Studies

Appendix 1 presents the “Quality Assessment Tool for Quantitative Studies” (78) use to score each study.

226

QUALITY ASSESSMENT TOOL FOR QUANTITATIVE STUDIES

COMPONENT RATINGS

A) SELECTION BIAS

(Q1) Are the individuals selected to participate in the study likely to be representative of the target population? 1 Very likely

2 Somewhat likely

3 Not likely

4 Can’t tell

(Q2) What percentage of selected individuals agreed to participate? 1 80 - 100% agreement

2 60 – 79% agreement

3 less than 60% agreement

4 Not applicable

5 Can’t tell

RATE THIS SECTION STRONG MODERATE WEAK

See dictionary 1 2 3

B) STUDY DESIGN

Indicate the study design 1 Randomized controlled trial

2 Controlled clinical trial

3 Cohort analytic (two group pre + post)

4 Case-control

5 Cohort (one group pre + post (before and after))

6 Interrupted time series

7 Other specify ____________________________

8 Can’t tell

Was the study described as randomized? If NO, go to Component C. No Yes

If Yes, was the method of randomization described? (See dictionary) No Yes

If Yes, was the method appropriate? (See dictionary) No Yes



1

C) CONFOUNDERS

(Q1) Were there important differences between groups prior to the intervention? 1 Yes

2 No

3 Can’t tell

The following are examples of confounders: 1 Race

2 Sex

3 Marital status/family

4 Age

5 SES (income or class)

6 Education

7 Health status

8 Pre-intervention score on outcome measure

(Q2) If yes, indicate the percentage of relevant confounders that were controlled (either in the design (e.g. stratification, matching) or analysis)?

1 80 – 100% (most)

2 60 – 79% (some)

3 Less than 60% (few or none)

4 Can’t Tell



D) BLINDING

(Q1) Was (were) the outcome assessor(s) aware of the intervention or exposure status of participants? 1 Yes

2 No

3 Can’t tell

(Q2) Were the study participants aware of the research question? 1 Yes

2 No

3 Can’t tell



E) DATA COLLECTION METHODS

(Q1) Were data collection tools shown to be valid? 1 Yes

2 No

3 Can’t tell

(Q2) Were data collection tools shown to be reliable? 1 Yes

2 No

3 Can’t tell



2

F) WITHDRAWALS AND DROP-OUTS

(Q1) Were withdrawals and drop-outs reported in terms of numbers and/or reasons per group? 1 Yes

2 No

3 Can’t tell

4 Not Applicable (i.e. one time surveys or interviews)

(Q2) Indicate the percentage of participants completing the study. (If the percentage differs by groups, record the lowest).

1 80 -100%

2 60 - 79%

3 less than 60%

4 Can’t tell

5 Not Applicable (i.e. Retrospective case-control)


See dictionary 1 2 3 Not Applicable

G) INTERVENTION INTEGRITY

(Q1) What percentage of participants received the allocated intervention or exposure of interest? 1 80 -100%

2 60 - 79%

3 less than 60%

4 Can’t tell

(Q2) Was the consistency of the intervention measured? 1 Yes

2 No

3 Can’t tell

(Q3) Is it likely that subjects received an unintended intervention (contamination or co-intervention) that may influence the results?

4 Yes

5 No

6 Can’t tell

H) ANALYSES

(Q1) Indicate the unit of allocation (circle one) community organization/institution practice/office individual

(Q2) Indicate the unit of analysis (circle one) community organization/institution practice/office individual

(Q3) Are the statistical methods appropriate for the study design? 1 Yes

2 No

3 Can’t tell

(Q4) Is the analysis performed by intervention allocation status (i.e. intention to treat) rather than the actual intervention received?

1 Yes

2 No

3 Can’t tell

3

GLOBAL RATING COMPONENT RATINGS Please transcribe the information from the gray boxes on pages 1-4 onto this page. See dictionary on how to rate this section.

A SELECTION BIAS STRONG MODERATE WEAK

1 2 3

B STUDY DESIGN STRONG MODERATE WEAK

1 2 3

C CONFOUNDERS STRONG MODERATE WEAK

1 2 3

D BLINDING STRONG MODERATE WEAK

1 2 3

E DATA COLLECTION METHOD

STRONG MODERATE WEAK

1 2 3

F WITHDRAWALS AND DROPOUTS STRONG MODERATE WEAK

1 2 3 Not Applicable

GLOBAL RATING FOR THIS PAPER (circle one):

1 STRONG (no WEAK ratings)

2 MODERATE (one WEAK rating)

3 WEAK (two or more WEAK ratings)

With both reviewers discussing the ratings:

Is there a discrepancy between the two reviewers with respect to the component (A-F) ratings?

No Yes

If yes, indicate the reason for the discrepancy

1 Oversight

2 Differences in interpretation of criteria

3 Differences in interpretation of study

Final decision of both reviewers (circle one): 1 STRONG 2 MODERATE 3 WEAK

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Appendix 2. Jamie’s Ministry of Food Australia manifesto

Appendix 2 presents Jamie’s Ministry of Food Australia manifesto sourced from: http://www.jamieoliver.com/jamies-ministry-of-food-australia/

This manifesto explains a really effective way to empower the public to make short and long-term changes. I believe it will radically improve the health prospects and social welfare of the public, regardless of age and class. When I set out to establish the Ministry of Food campaign, I wanted to dig into some issues which have been nagging at me since I filmed my School Dinners television series in the UK, the biggest ones being: why aren’t people cooking at home anymore and why don’t kids recognise everyday vegetables? I wanted to find out more about how people eat at home and why our diet is leading to a huge increase in obesity in so many countries around the world. I wanted to see if I could find a way to get people cooking again, to give them the tools to help themselves by learning some basic food skills, to feel confident in the kitchen and enjoy eating their own meals. I then wanted to take it a step further by asking them to take this knowledge and Pass It On; sharing their newfound skills with other people. Diet and health are massive social issues. In the UK, obesity already costs the National Health Service more than smoking: £4.2 billion vs. £2.7 billion per year. Over 9,000 people in Britain die prematurely each year due to health conditions caused by being overweight; cancer, heart disease, stroke and diabetes are the most common. This will be the first generation in which children are predicted to die at a younger age than their parents. In Australia the figures are equally shocking. Figures given by the National Preventative Health Taskforce show that being overweight or obese affects over 60% of Australian adults and 25% of Australian children. Nearly one in three Indigenous Australian adults is obese. The total financial cost in Australia of obesity alone, not including overweight people, was estimated at $8.3 billion in 2008. The most recent projections indicate that there will be an extra 6.7 million obese Australians by 2025. This frightening statistic clearly demonstrates an urgent need for action! Recent UK government research into obesity found that “lack of knowledge, confidence and skil ls is the main barrier which stops parents cooking from scratch”.

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But, despite this, obesity strategies rarely contain any measures specifically designed to address the root problem of obesity: a complete lack of cooking knowledge. Cooking skills used to be passed down through the generations but now that chain has been broken. More women go out to work, fewer countries have compulsory cooking lessons at school, and we’ve now got about two generations of people who have not been taught the basics. In my Ministry of Food television series, and throughout the campaign, my goal was to help people tackle the obvious problems of lack of money and time. But I found I had to start by addressing the more fundamental issues like a lack of cooking ability and food knowledge. But my team and I found that, armed with a little bit of knowledge and confidence, people very quickly started to change the way they were eating. On the Ministry of Food pages on my website (www.jamieoliver.com/jamies-ministry-of-food), we have provided what I think are some of the basic recipes, videos and kitchen advice to help get people on the first rung of the ladder. One thing is for sure; if a better diet is one of the keys to sorting out our health and obesity problems, then governments worldwide urgently need to put cooking at the top of their agendas. The original Ministry of Food, set up in the UK during the Second World War, was a great model. Set up to manage wartime rationing and food shortages, it is to me, a great example of how a government can quickly and successfully educate its people in times of crisis. It bombarded the population with help and advice, ensuring that people knew how to feed themselves properly and as well as possible until things were back to normal. They even went as far as sending cooks and advisors out into the community to give practical demonstrations and advice on how best to use the available resources. Australia also had a wartime government department dedicated to food issues; the Commonwealth Rationing Commission. Limited rationing was introduced in 1942 and wartime recipes were circulated in magazines, pamphlets and on government-sponsored radio programmes alongside really down-to-earth, sensible advice on how to use the available ingredients. The Australian Government reportedly feared that rationing would result in deterioration in health on the home front but the outcome was positive. As in the UK, the period saw a dip in the numbers of people suffering from diet related problems. These days the food crisis isn’t about rationing, it’s about people not understanding food, or cooking. It’s time we got back to this idea of teaching the public by getting professional cookery teachers around the world trained up to teach their communities. They need to reach the people who don’t cook, don’t watch cookery programmes, don’t buy cookbooks, and simply don’t know about food. If they give it a try and people start to feel inspired about cooking, it could make a massive difference, and quickly. All it needs is proper funding and support from Federal, State or Local Governments, specifically the departments of health, skills or education.

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So I’m asking governments across the world to help make this happen through a few simple steps: 1. SET UP A FOOD CENTRE IN EVERY TOWN: These should be friendly, local walk-in centres, kitted out with the sort of equipment you’d find in homes, offering basic cooking courses for the local community. These centres can then be places where local people can meet professional cookery teachers face-to-face, get hands on experience with food, and take a course in basic cooking. They can also provide practical hubs from which public health trainers and other community workers can offer advice on healthcare or local government services. For these “Ministry of Food Centres”, we’ve put together a set of simple set of recipes that cover the basic food skills: chopping, frying, roasting and baking. These recipes are inspiring and affordable. After a course of lessons, most people will know how to follow a recipe and be able to transfer what they’ve learned to other dishes and ingredients. And they’ll have those skills for the rest of their lives. Here in the UK, we estimate a food centre costs approximately £150,000 to set up. If a government were to set up150 across the nation, this would cost approximately £22.5 million. A small price to pay when you consider the rising cost of obesity. Running costs could come from local government and public health budgets. There should also be a commitment to support any new centre for a minimum of 3 years to allow it to “bed into” its community and for the scheme to have a sustained and sustainable long-term effect on the health and well-being of the population. 2. MAKE SURE THE CENTRES ARE STAFFED BY TRAINED FOOD TEACHERS: These individuals – who will ideally be from the local community – will be trained in my Ministry of Food cookery course. They’ll teach basic food skills like how to shop for ingredients, how to use kitchen equipment, how to make the most of local and seasonal food, and how to make good simple meals on a tight budget. 3. PUT COOKS OUT IN THE COMMUNITY: If we look back at the original Ministry of Food’s wartime model, it is clear that we’ve got to get cooks out into the community to spread the message by working with charitable bodies, community groups, local services, and businesses. Sending people out to teach in the community or to Pass It On, requires only a set of cooking equipment, some mobile gas burners, ingredients and wheels to get there. Governments should therefore encourage, and seek to fund, the training of a new wave of home economists to work within communities. Properly qualified teachers working in schools and the community will deliver rapid change. 4. SUPPORT BUSINESSES TO SPREAD THE CAMPAIGN: Our Ministry of Food Centres are often contacted by businesses who want to initiate cooking lessons for their workforce and their families. They see it as a great way to promote employee health, team building, community relations, and also as a tool to break down the barriers separating departments in big businesses. Offering tax incentives to businesses that are prepared to invest in the health of their staff through cookery would encourage many more to take part and could make a significant contribution to the long-term health of the nation’s workforce and economy.

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5. INVEST IN MOBILE FOOD CENTRES FOR DEPRIVED NEIGHBOURHOODS AND REGIONS: In the UK a group called Focus on Food runs a small fleet of cooking buses. These buses visit schools and introduce cooking to kids, parents, and teachers. This is a fantastic scheme for communities in the remote parts of the country, or those in very deprived inner-city neighbourhoods with little access to facilities. The visits inspire people to keep cooking long after the bus has left and are a fantastic marketing tool for cooking. Operating flat out, a bus could run over 11,500 sessions a year. They’ve got great reach and are so popular that I strongly believe mobile cooking classrooms should be introduced in other countries. This sort of scheme would be hugely beneficial to larger countries, like Australia or the US, where people are often spread out across great distances. 6. FUND ADULT COOKERY CLASSES: Over the last few years, I have consistently called for better food education for young adults and parents because it’s this group of people who have been left behind. Sure, there are cookery courses out there, but the majority of them are for people who already know quite a bit about cooking and want to take it further. If you don’t know how to boil an egg, roast a chicken or chop vegetables, it’s pretty difficult to find a course for adults at that level. This is especially true for people on low incomes or in areas of high deprivation. Our governments need to recognise cooking as an essential life skill and a key part of adult learning, and start funding courses at Food Centres, and further education colleges. People working in the community on health and obesity need this training too. Knowing how to make food fun and cooking appealing would help them get better results. Without a doubt, investing in food skills now would save millions in healthcare down the road. 7. GET KIDS COOKING PROPERLY Government research in the UK already acknowledges that kids who get a chance to cook at school often end up changing the way their family eats at home (for the better). So it makes sense to put proper cooking lessons on the school curriculum to ensure kids are learning about food and how to cook as early as possible. Teacher training courses also urgently need to include cooking. Like a lot of young adults, young teachers are unlikely to know how to cook themselves. How can we expect them to teach cooking lessons if they don’t know anything about food themselves? Getting food education into schools does cost money, but if supermarkets were encouraged to adopt their local school they could then provide ingredients for free or, at least, at cost. Not only would they be doing something wonderful, they’d be educating potential future customers. There’s a serious lack of knowledge about food and cooking, and the result is the modern-day epidemic of obesity and bad health we are currently facing. I believe if the actions I’ve mentioned above are carried through they will represent a major step towards tackling these problems once and for all. We simply can’t wait any longer. Jamie Oliver February 2010

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Appendix 3. JMoF protocol journal article The protocol paper for Jamie’s Ministry of Food Australian can be found at: http://www.biomedcentral.com/1471-2458/13/411

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STUDY PROTOCOL Open Access

Methods for the evaluation of the Jamie OliverMinistry of Food program, AustraliaAnna Flego1*, Jessica Herbert1, Lisa Gibbs2, Boyd Swinburn3,4, Catherine Keating1, Elizabeth Waters2

and Marj Moodie1

Abstract

Background: Community-based programs aimed at improving cooking skills, cooking confidence and individualeating behaviours have grown in number over the past two decades. Whilst some evidence exists to support theireffectiveness, only small behavioural changes have been reported and limitations in study design may haveimpacted on results.This paper describes the first evaluation of the Jamie Oliver Ministry of Food Program (JMoF) Australia, in Ipswich,Queensland. JMoF Australia is a community-based cooking skills program open to the general public consisting of1.5 hour classes weekly over a 10 week period, based on the program of the same name originating in the UnitedKingdom.

Methods/Design: A mixed methods study design is proposed. Given the programmatic implementation of JMoF inIpswich, the quantitative study is a non-randomised, pre-post design comparing participants undergoing theprogram with a wait-list control group. There will be two primary outcome measures: (i) change in cookingconfidence (self-efficacy) and (ii) change in self-reported mean vegetable intake (serves per day). Secondaryoutcome measures will include change in individual cooking and eating behaviours and psycho-social measuressuch as social connectedness and self-esteem. Repeated measures will be collected at baseline, programcompletion (10 weeks) and 6 months follow up from program completion. A sample of 250 participants per groupwill be recruited for the evaluation to detect a mean change of 0.5 serves a day of vegetables at 80% power (0.5%significance level). Data analysis will assess the magnitude of change of these variables both within and betweengroups and use sub group analysis to explore the relationships between socio-demographic characteristics andoutcomes.The qualitative study will be a longitudinal design consisting of semi-structured interviews with approximately 10-15 participants conducted at successive time points. An inductive thematic analysis will be conducted to exploresocial, attitudinal and behavioural changes experienced by program participants.

Discussion: This evaluation will contribute to the evidence of whether cooking programs work in terms ofimproving health and wellbeing and the underlying mechanisms which may lead to positive behaviour change.

Trial registration: Australian and New Zealand Trial registration number: ACTRN12611001209987.

* Correspondence: [email protected] Health Economics, Faculty of Health, Deakin University,Melbourne, AustraliaFull list of author information is available at the end of the article

© 2013 Flego et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

Flego et al. BMC Public Health 2013, 13:411http://www.biomedcentral.com/1471-2458/13/411

BackgroundCooking skills programs have been described as a prac-tical illustration of how to simultaneously change know-ledge, attitudes and behaviours around healthy eatingpractices [1]. Interest in cooking has been stimulated bymedia attention afforded to celebrity chefs and popularprime time television cooking programs. However, theneed to promote cooking skills to individuals has in partstemmed from a decline in the traditional pathways bywhich individuals learn to cook [2], and from the hy-pothesis that a decline in cooking skills may have con-tributed to the growth in nutrition-related disease incertain sub-sections of western populations [3]. InAustralia, Winkler investigated the relationship betweena lack of confidence to cook and the purchasing of fruitand vegetables. The author concluded that cooking skillsmay contribute to socio economic differences in dietaryintake and that promotion of such could be a usefulstrategy to improve fruit and vegetable intake [4].In the past two decades, there has been an increase in

the number of not-for-profit community-based cookingskills programs both in Australia and internationally[5-8]. Such programs have been conducted in a varietyof community and institutional settings, targeting differ-ent sub-populations and varying in purpose; however,they are predominantly aimed at increasing confidenceto cook, promoting healthy eating, addressing health in-equalities and increasing access to healthy food [9].Whilst there is emerging evidence of the effectiveness

of these adult programs in terms of increasing confi-dence to cook and creating positive dietary change, thisevidence, to date, has been based on small scale evalua-tions that are subject to methodological limitations [9].In a recent systematic review of the effectiveness of adultcommunity cooking programs conducted in the UnitedKingdom, only one evaluation was identified as suitablyrobust to provide reliable findings with respect to pro-gram effectiveness [10]. This highlights the need formore rigorous, larger scale studies to examine the rangeof impacts and outcomes of cooking skills programs andthe underlying potential mechanisms for change in indi-vidual behaviour. At the same time, study designs musttake account of the challenges associated with evaluationin community settings and be practical, feasible and sen-sitive to all stakeholders involved.

The Jamie Oliver Ministry of Food program, AustraliaThis methods paper describes the evaluation frameworkand design for the Jamie Oliver Ministry of Food program(JMoF) Australia, Ipswich site. The JMoF program wasoriginally developed by Jamie Oliver, a renowned celebritychef and food author based in the United Kingdom (UK).JMoF Australia has been specifically adapted for theAustralian setting. It is a community focused program that

teaches basic cooking skills and good nutrition to non-cooks. It consists of 10, weekly, 1.5 hour cooking skillsclasses aimed at getting people of all ages and back-grounds cooking simple, fresh, healthy food quickly andeasily [11]. Participants pay AUD10 per class and, wherethis may pose a barrier to entry, subsidies are madeavailable.JMoF was pioneered as a community-based cooking

skills program in Rotherham, UK in 2008 and since then,other centres have opened in Bradford and Leeds and amobile centre in the North West of the UK. These cen-tres were reliant on funding mostly from local councilsand to a lesser extent, charities and the private sector.The first Australian site opened in Ipswich in the stateof Queensland in April 2011 co-funded by a local phil-anthropic non-government organisation (NGO), TheGood Foundation (TGF), and the Queensland Depart-ment of Health. Ipswich was intentionally chosen givenits significant low socio-economic status population [12]and increasing levels of overweight and obesity [13].

Objectives of the JMoF program AustraliaConsultation occurred between TGF, Queensland Health(as program co-founder) and the program evaluationteam to describe program objectives of the JMoF pro-gram Australia in sufficient detail to be tested in an ap-plied evaluation. The following program objectivesresulted:

1. To provide opportunities, to people of different ageand demographic background, to experience andlearn how to cook healthy meals quickly andcheaply.

2. To increase program participants’ cooking skills,knowledge and self-efficacy.

3. To increase program participants’ enjoyment of foodand social connectedness.

Theoretical perspectivesA program logic model was developed as a frameworkto describe the potential pathways to behaviour change,and in turn to guide evaluative enquiry (Figure 1).Whilst some steps along the logic pathway weregrounded by emerging or convincing evidence, otherareas were backed by limited evidence, thereby requiringfurther hypothesis testing.Theoretical frameworks were not explicitly stated for

the JMoF Program. However, Carahar and Lang, 1999[2] have identified theoretical perspectives specific tocooking skills that are in keeping with the objectives ofthe JMoF program and its evaluation - cooking skillsempower individuals in preparation for healthy eating,encourage self-esteem and provide opportunities for leis-ure and enjoyment.

Flego et al. BMC Public Health 2013, 13:411 Page 2 of 8http://www.biomedcentral.com/1471-2458/13/411

Other theories that resonate with the program includeKolb’s concept of experiential learning [14] which identi-fies the importance of empowering participants withpractical “get your hands dirty” experience in learning tocook from scratch as a basis for skill acquisition, andBandura’s Social Cognitive Theory [15] which states thatchanges in attitudes and beliefs and the development ofself- efficacy (i.e. confidence in cooking) are central toinfluencing behaviour change. Bandura’s Social LearningTheory [16] also states that modelling is an importantcomponent of the learning process and that opportun-ities for practising learned behaviours and positivereinforcement are needed for learning to take place. Animportant element in the learning process is role modelcredibility [17].

Methods/DesignThe evaluation will be conducted over a 2.5 year periodfrom late 2011 to early 2014. The evaluation was ap-proved by the Deakin University Human Research EthicsCommittee (HEAG-H 117_11) in October 2011. Evalu-ation project governance will be provided by a referencegroup (comprising personnel from the TGF team andthe research team members) which will meet twice

yearly to oversee the project. A representative fromQueensland Health will be invited to attend ReferenceGroup meetings, when appropriate.The evaluation will use a questions-oriented approach

[18] derived primarily from the JMoF Program objec-tives. It will also incorporate additional economic ques-tions of relevance to potential government funders andprogram stakeholders. A longitudinal mixed methodsevaluation design will be employed. The quantitative andqualitative components will be conducted sequentially,with baseline quantitative data informing sampling forthe initial qualitative interviews. Each component willthen be analysed independently, with merging of dataoccurring at the interpretation stage [19].

Quantitative study

Research questionsThe quantitative component of the evaluation will an-swer the following research questions:

1. Does the JMoF program increase participants’ skills,knowledge, attitudes, enjoyment and satisfaction ofcooking and cooking confidence (self-efficacy)?

JMOF Program Australia

IncreaseCooking skills and Knowledge

Increase Cooking Self -Efficacy (confidence to cook)

Increase Enjoyment & Satisfaction of Cooking and Eating

Increase Global Self Esteem

Increase Social Connectedness around Cooking and Eating

Increase Frequency of Cooking meals

IncreaseAffordability of Meals

Improve Attitude to Cooking/ Willingness to try new food

Increase HealthyEating

Decrease risk factors for ill health

Key

Emerging/ convincing evidence

Limited evidence

Figure 1 JMOF Australia program logic model.


2. Does the JMoF program result in broader positiveoutcomes for participants in terms of behaviourchange to a healthier diet, more affordable healthymeals, improved self-esteem and socialconnectedness?

Outcome measuresThere will be two primary outcome measures: a change incooking confidence (self-efficacy) and a change in self-reported mean vegetable intake (serves per day). Second-ary outcome measures will include change in self-reportedmeasures of: (i) mean daily fruit intake, (ii) mean weeklytakeaway/fast food intake, (iii) frequency of cooking themain meal from basic ingredients, (iv) nutrition know-ledge, (v) attitudes towards cooking, (vi) willingness to trynew foods and (vii) enjoyment and satisfaction of cooking.Change in psycho-social measures such as (viii) globalself-esteem and (ix) social connectedness in relation tocooking and eating will be measured as will (x) a changein participant’s total expenditure on food.

Study designA quasi-experimental pre-post design will consist of anintervention group of participants undergoing the JMoFprogram and a control group comprising of participantsfrom the program waitlist who are waiting for at least 10weeks until program entry. Recruitment to each group willbe based on program start date and will not be subject torandomisation. Randomisation was not possible as itwould not allow participants any choice as to when andwith whom they participated in the program – which areimportant aspects of the JMoF program design [20].Intervention participants will be surveyed at three

time-points: program commencement, program comple-tion (10 weeks) and at six months post program comple-tion. Controls drawn from the waitlist will be surveyedat two time-points: 10 weeks prior to program com-mencement and on completion of their 10 weeks on thewaitlist (which will correspond to their program entry).A time-three measurement will not be obtained fromcontrols as it was considered neither feasible nor accept-able for the waitlist controls to have to wait a further sixmonths before entering the program (equivalent to theintervention follow-up period); this potentially wouldlead to a high drop-out rate both from the evaluationand the program itself. However, for one of the primaryoutcome measures, vegetable intake, Queensland state-wide monitoring data will be used as a proxy time-threemeasure for the control group.

Survey instrumentIn collaboration with key stakeholders, a quantitativemeasurement tool was developed. The self- adminis-tered questionnaire was designed to be completed in

approximately 15 minutes. Given the lack of validatedand reliable survey tools which can accurately measurethe impacts and outcomes of cooking skills programs invarying population groups [21], a prototype question-naire was designed to address the unique objectives ofthe evaluation. Where suitable, specific questions wereincorporated that have been previously used to measurethe impact of cooking skills programs, particularly oncooking confidence and cooking behaviours such asthose used by Barton et al, 2011 [21].To measure the primary outcome of cooking confidence

as a proxy for cooking self-efficacy, questions were devel-oped addressing confidence in relation to specific cookingskills based on Short’s work [22] and Barton et al. 2011work [21]. These items are presented on a 5 point Likertconfidence scale ranging from ‘not at all confident’ to‘extremely confident’.The other primary outcome measure of change in vege-

table intake will be captured through self-report questionsof vegetable intake (serves per day) and aligned with base-line measurement questions of the same nature used byQueensland Health in its population-based self-reportedhealth surveys [23]. Survey items addressing specific sec-ondary outcome measures such as self- reported meandaily fruit intake and mean daily takeaway/fast food intakewere also aligned with corresponding questions from thesame baseline population health survey [23].Other secondary outcome items include measuring

change in the self-reported frequency of cooking themain meal from basic ingredients and the inclusion ofsalad or vegetables with the main meal. Nutrition know-ledge questions, aligned with the nutrition messages em-bedded within the program, will test knowledge aroundsalt, fat and sugar intake and have been adapted fromParmenter et al’s work [24].Participant attitudes towards cooking and eating

healthy foods, willingness to try new foods, enjoymentand satisfaction in cooking and eating healthy foods willbe tested, using Likert scale based questions. Questionsabout shared enjoyment of cooking, eating and norma-tive eating behaviours were adapted from questions fromThe Stephanie Alexander Kitchen Garden Evaluation(SAKG) [25]. The Rosenberg Self-Esteem Scale (RES), awidely validated and reliable measure of self-esteem, willalso be administered [26]Participants will be asked to report their total house-

hold food and drink (excluding alcohol) expenditure andexpenditure specifically on take-away food and fruit andvegetables. Height and weight will be self-reported to en-able the calculation of Body Mass Index (BMI).

PilotingThe questionnaire was piloted in a 3 step process to testthe design, content and potential delivery methods.


Following comment by the reference group and aca-demic colleagues on content and layout/design, a paper-based version of the questionnaire was piloted with asample (N = 30) of the current JMoF population. Feed-back was invited through informal focus group sessions,facilitating the identification of any questions that wereambiguous, sensitive or required further development.The final stage of piloting involved testing the ques-

tionnaire in an online format whilst simultaneously test-ing the online survey distribution system and the likelyresponse rate. As the survey distribution required inte-gration between the JMoF participant database and thesurvey platform, Qualtrics™ [27], the piloting tested thatthese two components were effectively integrated andcapable of providing the necessary information needs.

RecruitmentAll participants registered on the JMoF Australia waitlistdatabase, aged 18 years or over, and who had received aconfirmed start date for the program, will be eligible toparticipate in the quantitative component of the evalu-ation. Whilst the program is open to all members of theIpswich community over the age of 12 years, the evalu-ation will target the adult population only as othercooking skills programs exist within the Greater Ipswichregion that are specifically targeting children and adoles-cents in educational settings.All participants will be required to consent prior to

participation in the evaluation. A link to the question-naire will be embedded within an email generated by theJMoF program database, inviting program participantsto participate in the evaluation questionnaire.Recruitment to both groups will be based on con-

firmed program start dates. As control participants arerequired to be on the program waitlist for 10 weeks andbecause the JMoF waitlist is sufficiently large to enablethis to occur naturally, participants that are allocated astart date longer than 10 weeks ahead, will be automatic-ally made a control, whilst persons commencing theprogram within 10 weeks will be assigned to the inter-vention group. Computer programmed “rules” in theJMoF participant database have been created to auto-mate this process.To show appreciation for participation, those interven-

tion participants who complete the third and final ques-tionnaire at six months post completion of the programwill be sent a $20 “Good Guys” store charge card re-deemable at any Good Guys store (white goods retailer)across Australia.

Data collectionData collection commenced in February 2012 followingcompletion of piloting. Whilst the challenges of deliver-ing online surveys are well documented [28], it was

decided to be the most feasible and practical firstmethod of delivery with subsequent delivery of a postalversion to non-respondents and persons who do nothave a working email address or access to a computer.

Sample sizeGiven that the specific questions developed for thisstudy to measure confidence to cook (cooking self-efficacy) have not been previously employed, a precisesample size calculation for this primary outcome couldnot be calculated given the absence of a priori baselinemeasures, measures of effect size and measures of vari-ance (standard deviation).Sample size calculations around the second primary

outcome of a change in vegetable intake between thetwo groups assumed the use of a split-plot anova and Ftest for interaction given the wait list design. The litera-ture does not provide clear guidance with regards to anexpected effect size for a program of this nature [29,30].However, as there is some evidence from Wrieden et althat an effect size of one serve per day may be too largefor a program of this nature [20], sample size calcula-tions are based on an effect size range likely to beachieved [29,30]. For an effect size of 0.5 serves a day,starting from a mean daily consumption at baseline of2.5 serves per day [13,23], 250 subjects per group will berequired at 80% power (0.05 significance). In the eventthat accrual is slower than expected, recruiting at least140 participants will give 80% power for an effect size of0.7 serves a day. There will be no analysis of the data be-fore accrual has closed.

Data analysisDemographic and baseline characteristics will besummarised for both intervention and control groupsusing standard summary statistics (mean and standarddeviation) and non-parametric statistics (medians andinter-quartile ranges) where applicable. Frequencies andpercentages will be reported for categorical variables.The magnitude of change both within and betweenintervention and control groups for T1, T2 and T3 time-points will be assessed. For continuous data, such asfruit and vegetable intake, two sample t tests will beemployed to compare means between intervention andcontrol groups at each time point and paired t tests forwithin group comparisons. A split-plot in time Anovawill be used as the basis for these t-tests. For categoricaldata, frequencies will be reported for intervention andcontrol groups and chi squared analysis will provide be-tween group comparison results. Regression analysis willbe conducted to determine the potential contribution ofspecific demographic factors on the outcome variablesof interest. All data analysis will be performed usingSTATA S.E. 12.0 statistical software.


Qualitative study

Research questionsTo further understand how and why the JMoF programimpacts on participants, the qualitative investigation willexplore the following:

1. What are the expectations and experiences ofparticipants?

2. What are the moderators, facilitators and barriers tobehaviour change?

3. Were there any unanticipated outcomes?

Study designA longitudinal design will be employed for the qualita-tive study to follow program participants over the courseof their JMoF journey. This will allow for prospective ac-counts of a participant’s experience and change overtime [31,32]. Repeated semi-structured interviews will beconducted with participants. Up to three interviews willbe conducted - prior to program commencement, onprogram completion and six months after completion.

Participant interviewsThe interview structure was generated to capture participantperspectives, to explore moderators, facilitators and barriersto behaviour change, and to capture any unanticipated out-comes from program involvement. As indicated in Table 1,the purpose of the sequential interviews is to understandparticipant expectations and experiences at different stagesof program involvement. The interviews will be unstruc-tured; however questions and prompts will be used to guidethe discussion where appropriate. Table 1 lists the general

discussion points used for each participant (interviews threeand four will be based on previous discussions).Interviews of approximately 30-40 minutes duration will

take place in a public location that provides a comfortableenvironment for both interviewer and the participant. All in-terviews will be conducted by the same researcher and par-ticipants will be required to consent to both participationand recording of the interview. To show appreciation forparticipation in an interview, participants will be thankedwith a $15 Coles supermarket gift voucher at eachinterview.

Participant samplingPurposive sampling will be employed initially to capturemaximum variation [33] in factors considered likely toinfluence expectations and experiences of the JMoF pro-gram. These factors were captured in the participantquestionnaire and included socio-economic status, age,gender, family structure, and cooking confidence level.Further sampling will be informed by themes emergingfrom the initial interviews and instructor observationsabout characteristics that seem to influence participantmotivations and experience. Interview one will subse-quently be conducted with approximately 10-15 partici-pants. Participants who provide rich data in terms ofinsights and unique perspectives, and who are willing tocontinue, will be invited to progress to interviews twoand three. In the event that there are insufficient num-bers to progress (less than 6), new participants will berecruited from new enrolments.

Participant recruitmentParticipants who have completed the baseline quantitativestudy survey and have agreed to be contacted for an inter-view, will be eligible to participate as well as all partici-pants who are within the first three weeks of commencingthe program. The baseline survey data will assist in pur-posive selection for the qualitative interviews, using thecriteria based on demographic and personal circumstancesas previously described. Opportunistic purposive samplingwill also be carried out during the researcher’s time inIpswich during class observations. Selected participantswill be contacted by phone or in person (in class context)and provided with information about the qualitativecomponent of the study and invited to participate in theinterviews. Written consent will be required prior to par-ticipation in the interview process.

Data analysisThe interviews will be transcribed verbatim. The datawill be managed with the assistance of qualitative soft-ware package NVivo 9 (NVivo 9 [program]: QSR Inter-national Pty Ltd 2011). Concurrent data collection andanalysis will be conducted to allow for confirmation of

Table 1 Interview structure

Interview timing Discussion topics

Interview 1: Prior tocommencement of theprogram

Motivations for registering for theprogram, expectations of the program.Discussion of previous and current foodand cooking experiences.

Contact: During program Phone conversation to recruitparticipants to repeat interviews and toenquire how the course is going.

Interview 2: After programcompleted

Discussion around their programexperience and whether programexpectations were met. If participantsexperienced any changes in food andcooking behaviour and anyunanticipated changes as a result of theprogram.

Interview 3: Six months afterprogram completion

Discussion around whether any changesas a result of the program have beensustained in terms of food and cookingbehaviour. Any unanticipated changesas a result of the program. Reflection onwhat was talked about in the lastinterview.


emerging themes and clarification of any contradictoryfindings [34]. To contribute to the analytical process, theinterviewer will record post-interview memos as reflec-tions including contextual information, non-verbal fac-tors of note, reflections on the interview process, andthoughts about emerging patterns or contradictions inthe data [33,35].The analysis of interview transcripts and interview

memos will be conducted by the interviewer using in-ductive thematic analysis. The data will first be codedand then categorised to allow themes and patterns toemerge [34,36]. A second researcher will independentlygenerate codes on a sub-sample of transcripts [37].Comparisons will then be conducted and any differenceswill be discussed to achieve consensus in the final codes.The categorised data will then be reviewed to exploresimilarities and differences, to identify patterns and todetermine whether there are specific relationships occur-ring between categories that together provide an overallconceptual picture of the impact of the JMOF programwithin the context of its unique setting and population.The resultant conceptual analysis will then be comparedboth to relevant theoretical frameworks and to the lit-erature base to determine if it resonates with existingknowledge or makes a new contribution to the evidence.

Integrated analysisIn addition to the separate analysis of the quantitative andqualitative results, integration of the respective findingswill be conducted. This will involve examining consisten-cies and inconsistencies in the findings from each method[19,38] to build a more nuanced and comprehensive un-derstanding of the JMoF program impacts and outcomes.This added depth and breadth will inform the conclusionsdrawn from the evaluation.

DiscussionThe evaluation of the JMoF program will contribute to thegrowing body of literature on the effectiveness ofcommunity-based cooking skills programs. It will employ amixed methodology to draw on the strengths of bothquantitative and qualitative study design to best captureand measure experiences, impacts and outcomes ofcooking skills programs. The methods described herein willinform the research community about program outcomesand facilitate comparisons of results with other cookingskills programs conducted in comparable populations.This study will also provide insights into practical consid-

erations required when designing program evaluations incommunity settings. These include factors such as recruit-ment of a comparison group, minimisation of participantdata collection burden, and the suitability and feasibility ofselected data collection modes, which must be consideredwithout compromising study design or program integrity.

There are both strengths and limitations to the evalu-ation design. Mixed methods studies as a paradigm canrisk compromising methodological rigour if integrationoccurs at point of data collection and/or analysis andpotentially undermines paradigm and process consider-ations [18,19]. This is not an issue in the current evalu-ation with integration only occurring in relation tosample identification and final integration of findings.Whilst it is acknowledged that the use of a non-

randomised quasi-experimental design makes the quantita-tive study vulnerable to sampling bias, practical limitationsprevented the application of a randomised design. Despitethis potential bias, the use of a waitlist control and pre andpost measures support attribution of any changes to theprogram.Potential selection bias associated with choice to par-

ticipate or not in the quantitative study may also occur.However various methods were employed in an attemptto address this issue: providing participants with mul-tiple options for survey completion, follow up of non-responders and the use of incentives.In the quantitative study, there is no direct measure of

cooking skills despite the JMoF program being a cookingskills program per se. However, there is currently no goldstandard for the measurement of cooking skills in an adultpopulation nor consensus on the definition of cookingskills or whether changes in it alone will predict the likeli-hood of changes in cooking behaviour [3]. Therefore con-fidence to cook which reflects self-efficacy, a relativelystrong predictor of behaviour change, was the chosenmeasure for the evaluation as suggested by Winkler,Wrieden and Barton et al [3,20,21]. It is noted that evenBarton et al’s confidence questions upon which some ofthe current survey questions are based, whilst consideredreliable, have yet to be formally tested in the communitysetting [21]. Another limitation of the quantitative study isthe reliance on self-reported measures. Yet lessons learntfrom previous evaluations [20,21] suggest that the use ofmore intensive methods would likely overburden partici-pants and lead to low participation rates.In summary, the use, in this evaluation, of a mixed

method, pre-post design with a waitlist control group willprovide sufficient strength of evidence to assess the im-pact of the JMoF program on participants’ attitudes andbehaviours. It will also make a contribution to the limitedevidence base about the effectiveness of community-basedcooking programs.

Competing interestsThe authors wish to declare that the evaluation has been commissioned byThe Good Foundation.

Authors’ contributionsAll authors have contributed to project design and development, whilst AFand JH are responsible for project management and data collection. AFdrafted the manuscript with JH and LG contributing to the qualitative


sections. All listed authors reviewed the draft manuscript, then read andapproved the final manuscript.

AcknowledgmentsThe authors would like to acknowledge Alicia Peardon and all the staff ofThe Good Foundation as well as Christina Stubbs of the QueenslandDepartment of Health for their contributions in relation to evaluation designand implementation. The authors also thank Associate Professor JohnReynolds, Deakin University for his contribution to the quantitative dataanalysis design. Moodie and Swinburn are researchers within an NHMRCCentre for Research Excellence in Obesity Policy and Food Systems(APP1041020).

Author details1Deakin Health Economics, Faculty of Health, Deakin University,Melbourne, Australia. 2Jack Brockhoff Child Health and WellbeingProgram, The McCaughey Centre, Melbourne School of PopulationHealth, The University of Melbourne, Melbourne, Australia. 3WHOCollaborating Centre for Obesity Prevention, Faculty of Health, DeakinUniversity, Melbourne, Australia. 4School of Population Health, Faculty ofMedical and Health Sciences, University of Auckland, Auckland, NewZealand.

Received: 9 January 2013 Accepted: 15 April 2013Published: 30 April 2013

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21. Barton KL, Anderson AS, Wrieden WL: Validity and realiability of a shortquestionnaire for assessing impact of cooking skills interventions. J HumNutr Diet 2011, 24:588–595.

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2009 Survey Report. Edited by Pollard G, White D, Harper C. Brisbane:Queensland Health; 2009.

24. Parmenter K, Wardle J: Development of a general nutrition knowledgequestionnaire for adults. Eur J Clin Nutr 1999, 53(4):298–308.

25. Block K, Johnson B, Gibbs L, et al: In Final Report to: The Stephanie AlexanderKitchen Garden Foundation. Edited by Wellbeing TMCVCftPoMHaC. Australia:Melbnourne University of Melbourne and Deakin University; 2009.

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27. Qualtrics online survey software. http://www.qualtrics.com.28. Lefever S, Dal M, Matthíasdóttir A: Online data collection in academic

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doi:10.1186/1471-2458-13-411Cite this article as: Flego et al.: Methods for the evaluation of the JamieOliver Ministry of Food program, Australia. BMC Public Health 201313:411.


Appendix 4. Jamie’s Ministry of Food Australia questionnaire

IDT1 _________________________

We appreciate and thank you for your time in completing this survey. All the information you provide us will be completely confidential. Only the survey team will have access to this form. Your full name and address will never be linked with any of the information you provide. When completed, please seal in the envelope provided and post to Deakin University. Today’s Date (Day /Month /Year) / / Q1. Are you 18 years old or over? 1 Yes 2 No, if no you do not need to complete this survey. Q2. In a typical week….? How often do you prepare and cook a main meal from basic ingredients? For example starting with meat and vegetables (Please select one answer) 1 Never 2 Less than once 3 Once 4 2-3 times 5 4-6 times 6 Daily

Q3. In a typical week….? How often do you eat ready-made meals at home? For example a frozen roast dinner, lasagne or pizza that was purchased (Please select one answer) 1 Never 2 Less than once 3 Once 4 2-3 times 5 4-6 times 6 Daily

Q4. In a typical week….? How often do you include salad or vegetables with the main meal? For example, chicken with vegetables or pasta with a salad. (Please select one answer) 1 Never 2 Less than once 3 Once 4 2-3 times 5 4-6 times 6 Daily

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Q5. How many serves of vegetables including fresh, dried, frozen and tinned vegetables do you usually eat each day, where a serve is half a cup of cooked vegetables or 1 cup of salad? (Please select one answer) 1 None 2 Less than 1 serve a day 3 1 serve

4 2 serves 5 3 serves 6 4 serves

7 5 serves 8 6 or more serves 9 Don’t know

Q6. How many serves of fruit including fresh, dried, frozen and tinned fruit do you usually eat each day, where a serve is a medium piece or two small pieces of fruit, or a cup of diced pieces? (Please select one answer) 1 None 2 Less than 1 serve a day 3 1 serve

4 2 serves 5 3 serves 6 4 serves

7 5 serves 8 6 or more serves 9 Don’t know

Q7. How many times do you eat take-away or ‘fast foods’ from places such as McDonalds, Red-rooster, fish and chips shop, Asian take-away or local take-away pizza places? (Please select one answer) 1 Never 2 Less than once a month 3 Once a week

4 2 times a week 5 3- 4 times a week 6 5 or more times a week

7 Don’t know

Q8. Which of the following choices do you think is not high in salt and could be used to enhance the flavours in food? (Please select one answer) 1 Bacon 2 Tomato Sauce

3 Herbs and Spices 4 Cheese

5 Not Sure

Q9. Out of the items listed below, which foods do you think health experts recommend eating the least? (Please select one answer) 1 Olive Oil 2 Nuts & Seeds

3 Avocados 4 Butter

5 Vegetable Oil 6 Not sure

Q10. If a person felt like something sweet, but was trying to cut down on sugar, which would be the best choice? (Please select one answer) 1 Glass of fruit juice 2 A cereal snack bar

3 A plain biscuit 4 A piece of fruit

5 Not sure

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Q11. How confident do you feel ….? (Please circle one response for each question)

The next section asks about your household Q12. What is your current household characteristic? (Please select one answer) 1 Couple, with young children (0-17 years old) living at home 2 Couple, with adult children (18 years and over) living at home 3 Couple, without children living at home 4 One parent family with children living at home 5 Live Alone 6 Other, please specify ………………………………………… Q13. How many persons (including yourself) live in your household?

Q14. How many adults (18 years and over) do you usually prepare food for on a daily basis?

Q15. How many children (0-17 years old), living at home, do you usually prepare food for on a daily basis?

Q16. Do you have access to a kitchen to prepare your own meals? 1 Yes 2 No Q17. Do you do the food shopping in your household? 1 Yes 2 No Q18. In a typical week how much does your household spend in total on food and drink? Including take away food, eating out, food and drinks for cooking and eating at home (excluding alcohol). (Please select one answer) 1 $0 2 $1 - $29 3 $30 - $59

4 $60 - $99 5 $100 - $149 6 $150 - $199

7 $200 or more

Not at all Confident Extremely Confident

a) About being able to cook from basic ingredients? 1 2 3 4 5

b) About following a simple recipe? 1 2 3 4 5 c) About preparing and cooking new foods

and recipes? 1 2 3 4 5

d) That what you cook will ‘turn out’ well? 1 2 3 4 5 e) About tasting foods that you have not

eaten before? 1 2 3 4 5

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Q19. In a typical week, how much does your household spend on fruit and vegetables? (Please select one answer) 1 $0 2 $1- $9 3 $10 - $19

4 $20 - $39 5 $40 - $49 6 $50 - $99

7 $100 or more

Q20. In a typical week, how much does your household spend on take away/fast foods? (Please select one answer) 1 $0 2 $1- $9 3 $10 - $19

4 $20 - $39 5 $40 - $49 6 $50 - $99

7 $100 or more

The next section asks about preparing and eating food Q21. In a typical week, how often do you eat together at home, with the other people in your household in the evenings? (Please select one answer) 1 Never 2 Less than once a month 3 Once a week


7 Don’t know 8 I live alone

Q22. In a typical week, how often do you eat your dinner in front of the TV? (Please select one answer) 1 Never 2 Less than once a month 3 Once a week


7 Don’t know

Q23. In a typical week, how often do you eat your dinner sitting at a dinner table, or equivalent? (Please select one answer) 1 Never 2 Less than once a month 3 Once a week


7 Don’t know

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Q24. Please choose the answer which best indicates how much you agree or disagree with each of the following statements. (Please select one answer for each question) Strongly

disagree Somewhat disagree

Somewhat agree

Strongly agree

a) I find it easy to change my eating habits 1 2 3 4

b) My lifestyle prevents me eating a healthy diet 1 2 3 4

c) Vegetables can be tasty foods 1 2 3 4 d) I eat enough fruit and vegetables 1 2 3 4

e) I can put together a healthy meal from scratch in 30 minutes 1 2 3 4

f) I enjoy cooking 1 2 3 4 g) I enjoy cooking for others 1 2 3 4

h) I get a lot of satisfaction from cooking my meals 1 2 3 4

i) I enjoy eating a meal with others 1 2 3 4

j) I can prepare a meal from basic ingredients that is low in price 1 2 3 4

k) Fruit and vegetables are cheaper when they are in season 1 2 3 4

l) Buying more fruit/vegetables would be difficult on my budget 1 2 3 4

The next section ask about how you feel about your health Q25. In general how do you feel about your health? (Please select one answer) 1 Excellent 2 Very good 3 Good 4 Fair 5 Poor

Q26. What is your current weight? Please answer in either kilogrammes (kg) or stone and pounds.

kg OR

stone and pounds (Note there are 14 pounds in a stone)

Q27. How tall are you (without shoes)? Please answer in either centimetres or feet and inches

cm OR

feet and inches (note there are 12 inches in a foot)

248

Q28. Below is a list of statements dealing with your general feelings about yourself. Please choose the answer which best indicates how much you agree or disagree with each of the following statements. (Please select one answer for each question)

Strongly disagree

Somewhat disagree

Somewhat agree

Strongly agree

a) I feel that I am a person of worth, at least on an equal plane with others

1 2 3 4

b) I feel that I have a number of good qualities 1 2 3 4

c) All in all, I am inclined to feel that I am a failure 1 2 3 4

d) I am able to do things as well as most other people 1 2 3 4

e) I feel I do not have much to be proud of 1 2 3 4

f) I take a positive attitude toward myself 1 2 3 4

g) On the whole, I am satisfied with myself 1 2 3 4

h) I wish I could have more respect for myself 1 2 3 4

i) I certainly feel useless at times 1 2 3 4

j) At times I think I am no good at all 1 2 3 4

The next section ask for some details about you Q29. What is your postcode? Q30. What is your date of birth? (Day /Month /Year) / / Q31. What is your sex? Male1 Female 2 Q32. Are you of Aboriginal or Torres Strait Islander origin? (Please select one answer) 1 No 2 Yes, Aboriginal 3 Yes, Torres Strait Islander 4 Yes, both Aboriginal and Torres Strait Islander

249

Q33. Do you speak a language other than English at home? (Please select one answer) 1 No 2 Yes, Italian

3 Yes, Greek 4 Yes, Cantonese

5 Yes, Arabic 6 Yes, Vietnamese 7 Yes, Mandarin 8 Yes, Other please specify …………………………

Q34. Please select which one of the following best describes your current employment? (Please select one answer) 1 Employed full-time 2 Employed part-time / casual 3 Home duties / carer 4 Unemployed 5 Full-time student

6 Part-time student 7 Retired 8 Permanently ill / unable to work 9 Other

Q35. What is the highest level of education you have completed? (Please select one answer) 1 Year 10 or less 2 Year 11 3 Year 12 4 Technical apprenticeship

5 Technical diploma 6 Tertiary degree 7 Post graduate degree 8 Other (please specify) ………………

Q36. Before tax is taken out, which of the following ranges best describes your household income, from all sources over the last 12 months? This includes wages/salaries, government benefits, pensions, allowances and other income usually received. (Please select one answer) 0 Nil Income 1 $1 - $6,000 per year 2 $6,001 - $13,000 per year 3 $13,001 - $20,000 per year 4 $20,001 - $30,000 per year

5 $30,001 - $50,000 per year 6 $50,001 - $100,000 per year 7 $100,001 - $150,000 per year 8 More than $150,000 per year 9 Don’t Know

Q37. Are you attending Jamie's Ministry of Food programme with someone else or as part of a group or organisation? 1 No, please continue to question 39 2 Yes, please answer question 38 Q38. Who are you attending the programme with? 1 Friend 2 Family 3 With a Carer 4 As part of a community group, please specify …………………………………………. 5 Other, please specify ………………………………………….

250

Q39. Are you happy to be contacted in the future for an interview about your experiences with the Ministry of Food Programme? 1 No 2 Yes, if yes please provide a contact number Thank you for your time When completed, please seal this survey in the envelope provided and post to Deakin University

251

sfol

Retracted Stamp

TO: Programme Participants [questionnaire] Plain Language Statement Date: 25/11/2011 Full Project Title: The Jamie Oliver Ministry of Food (JMoF) Programme Evaluation Principal Researcher: Associate Professor Marj Moodie, Catherine Keating, Professor Boyd Swinburn, Professor Elizabeth Waters, Dr. Lisa Gibbs Researchers: Anna Flego, Jessica Herbert This document includes Plain Language Statement and consent forms. Please make sure you have all the pages. You are invited to take part in the evaluation of Jamie’s Ministry of Food programme in Ipswich, Queensland. Programme participants under the age of 18 do not need to complete this questionnaire. Deakin University with the University of Melbourne, in Melbourne Victoria, have been funded by The Good Foundation to conduct the programme evaluation. Some aspects of this study are being completed as part of the requirements for a Doctor of Philosophy by Jessica Herbert. This evaluation will help us to understand if the programme makes a difference for people who participate. What we learn from this evaluation will help to support the extension of Jamie’s Ministry of Food Programme and guide any future improvements in Australia and internationally. This Plain Language Statement contains detailed information about the evaluation. Its purpose is to explain to you as openly and clearly as possible all the procedures involved in this evaluation so that you can decide whether you are going to participate. Please read it carefully. Feel free to ask questions about any information in the document. You do not have to participate if you don’t want to. You can end your involvement in the research at any time without explanation. If you decide not to be part of the evaluation it will not affect your involvement in Jamie’s Ministry of Food Programme in any way and any information you have previously provided will not be used. Once you understand what the evaluation is about and if you agree to take part in it, you will be asked to sign and return the Consent Form provided on page 3. By signing the Consent Form, you indicate that you understand the information and that you give your consent to participate in the research project.

253

If you agree to participate in the evaluation, you will be asked to complete a short questionnaire on two to three occasions about your cooking and eating behaviours. It should take less than 15 minutes to complete. All of the information you provide will be grouped and reported together with other responses. It will not be possible to identify anyone in any of the research reports or publications. All data will be kept secure at Deakin University and only the research team will be able to access it. When the evaluation is finished, the data will be kept on a computer CD and stored for six years. After that it will be destroyed. We will send you a link to an online summary of the research findings when available if you are interested. The research results will also be reported through conference presentations and academic publications. If you have any complaints about any aspect of the project, the way it is being conducted or any questions about your rights as a research participant, then you may contact The Manager, Office of Research Integrity, Deakin University, 221 Burwood Highway, Burwood Victoria 3125, Telephone: 9251 7129, Facsimile: 9244 6581; [email protected]. Please quote project number [HEG-H117_2011]. If you require further information, wish to withdraw your participation or if you have any problems concerning this evaluation please feel free to contact a member of the two evaluation team members listed below: Associate Professor Marj Moodie Deakin University Phone: (03) 9251 7367 Email: [email protected]

Anna Flego, Project Coordinator Deakin University Phone: (03) 9251 7138, Email: [email protected]

254

TO: Programme Participants [questionnaire] Consent Form Date: 25/11/2011 Full Project Title: The Evaluation of Jamie Oliver’s Ministry of Food programme Reference Number: HEAG-H117_2011 I have read, and I understand the attached Plain Language Statement. I freely agree to participate in this evaluation according to the conditions in the Plain Language Statement, and understand I may be contacted more than once to participate in this evaluation. I have been given a copy of the Plain Language Statement and Consent Form to keep. The researcher has agreed not to reveal my identity and personal details, including where information about this project is published, or presented in any public form. Participant’s Name (printed) …………………………………………………………………… Signature ……………………………………………………… Date ………………………… Associate Professor Marj Moodie Deakin University, 221 Burwood Road, Burwood, VIC 3121, Australia Tel: 613 9251 7367, email: [email protected]

255

TO: Participants [questionnaire]

Revocation of Consent Form [questionnaire] (To be used for participants who wish to withdraw from the project) Date: 25/11/2011 Full Project Title: The Ministry of Food Evaluation Reference Number: HEAG-H117_2011 I hereby wish to WITHDRAW my consent to participate in the above evaluation and understand that such withdrawal WILL NOT jeopardise my relationship with Deakin University or Jamie’s Ministry of Food. Participant’s Name (printed) ……………………………………………………. Signature …………………………………………………. Date …………………… Please mail, fax or scan and email a signed copy of this form to: Jessica Herbert Population Health Strategic Research Centre Deakin University 221 Burwood Highway Burwood, VIC, 3125 Phone: (03) 9244 6258 Fax: (03) 9244 6624

256

Qualitative Study

TO: Programme Participants [interview] Plain Language Statement Date: 30/08/2011 Full Project Title: The Jamie Oliver Ministry of Food (JMoF) Programme Evaluation Principal Researcher: Associate Professor Marj Moodie, Catherine Keating, Professor Boyd Swinburn, Professor Elizabeth Waters, Dr. Lisa Gibbs Researchers: Anna Flego, Jessica Herbert You are invited to take part in the evaluation of Jamie’s Ministry of Food programme in Ipswich, Queensland. Deakin University with the University of Melbourne, in Melbourne Victoria, have been funded by The Good Foundation to conduct the programme evaluation. Some aspects of this study are being completed as part of the requirements for a Doctor of Philosophy by Jessica Herbert. This evaluation will help us to understand if the programme makes a difference for people who participate. Please read this Plain Language Statement carefully as it contains detailed information about this stage of the evaluation. Feel free to ask questions about any information in the document. With your consent, you will be interviewed for approximately 30-45 minutes. You can stop the interview at any point and any information you have previously provided will not be used. If you agree to participate you will be asked to sign the consent form provided on page 2. By signing the Consent Form, you indicate that you understand the information and that you give your consent to participate in the evaluation. The interviewer will ask you about your expectation and experiences with JMoF programme. You may be contacted again to clarify information or to participate in a repeat interview (after your programme and six months after your programme). They will also ask to voice record the interview. If you do not wish this to occur we will take handwritten notes of the interview. All of the information you provide will be kept secure at Deakin University and only the research team will be able to access it. When the evaluation is finished, the data will be securely stored for six years. After that it will be destroyed. We will send you a link to an online summary of the research findings when available if you are interested. The research results will also be reported through conference presentations and academic publications. If you have any complaints about any aspect of the project, the way it is being conducted or any questions about your rights as a research participant, then you may

257

contact The Manager, Office of Research Integrity, Deakin University, 221 Burwood Highway, Burwood Victoria 3125, Telephone: 9251 7129, Facsimile: 9244 6581; [email protected]. Please quote project number [HEAG-H117_2011]. If you require further information, wish to withdraw your participation or if you have any problems concerning this evaluation please feel free to contact a member of the two evaluation team members listed below: Associate Professor Marj Moodie Deakin University Phone: (03) 9251 7367 Email: [email protected]

Anna Flego, Project Coordinator Deakin University Phone: (03) 9251 7138, Email: [email protected]

258

TO: Programme Participants [interviews] Consent Form Date: 30/08/2011 Full Project Title: The Evaluation of Jamie Oliver’s Ministry of Food programme Reference Number: HEAG-H117_2011 I have read, and I understand the attached Plain Language Statement. I freely agree to participate in this interview according to the conditions in the Plain Language Statement and understand I may be contacted more than once to participate in this evaluation I have been given a copy of the Plain Language Statement and Consent Form to keep. The researcher has agreed not to reveal my identity and personal details, including where information about this project is published, or presented in any public form. Participant’s Name (printed) …………………………………………………………………… Signature ……………………………………………………… Date ………………………… Associate Professor Marj Moodie Deakin University, 221 Burwood Road, Burwood, VIC 3121, Australia Tel: 613 9251 7367, email: [email protected]

259

TO: Participants [interviews] Revocation of Consent Form (To be used for participants who wish to withdraw from the project) Date: 30/08/2011 Full Project Title: The Ministry of Food Evaluation Reference Number: HEAG-H117_2011 I hereby wish to WITHDRAW my consent to participate in the interview for the above evaluation and understand that such withdrawal WILL NOT jeopardize my relationship with Deakin University or Jamie’s Ministry of Food. Participant’s Name (printed) ……………………………………………………. Signature ………………………………………………………………. Date …………………… Please mail, fax or scan and email a signed copy of this form to: Jessica Herbert Population Health Strategic Research Centre Deakin University 221 Burwood Highway Burwood, VIC, 3125 Phone: (03) 9244 6258 Fax: (03) 9244 6624

260

Appendix 6. Interview guide Interview 1 Why they registered for the programme? Main motivations. How they found out about the programme? Jamie Oliver’s influence? ~ What is it about him? ~ What does he represent to them? Role at home? In terms of food, cooking, shopping and growing food. How they feel about cooking? ~ Prompts: confidence, trying new foods. How they eat their meal? ~ Who they eat with? ~ Do they ever eat together? How they feel about mealtime? Who they prepare food for? Socially? Do they have people over for a meal? Interview 2 Programme experience How was their experience of the programme? – encourage detail. What was their experience like in class? How did they feel when they were there? Did feelings change over the weeks? What was good/what was difficult? What kept them going and wanting to finish or why didn’t they complete (if applicable)? Programme Learning’s (if any). Did they learn anything or get anything from the programme? Was this what was talked about in the previous interview (reflection of programme expectations). Expectations. Were expectations met? Are there any other unexpected outcomes? Behaviours (cooking and food). What is happening at home now? Has anything changed since the last interview? ~ Last time we talked about your cooking preferences and mealtimes. Description of their food and cooking experience. Who they cook for, thoughts on healthy eating? (Has this changed as a result of the programme?) Reflection from last interview. Has anything changed as a result of the programme? (Reflection on key themes discussed in the previous interview). Changes: when and how changes occurred (if any). Were there any other changes not specific to food and cooking?

261

Interview 3 Food and cooking discussion. What is happening at home now? Description of their food and cooking experience. ~ Prompts: what they cook, who they cook for, healthy eating, shopping, cost of food? Did they feel there has been changed since we last talked? How? Why? How do they feel about food and cooking? Has food spending’s changed at all? Tell me about that? Confidence. What makes them feel confident as a cook? ~If they don’t, what would it take to make you feel confident as a cook? Social connections. Have they made any connections with others from your class? Have they joined any other programmes? Has the programme changed the way they socialise with family and friends? Willingness to pay for the course. What would they pay for the course and how much? Barriers/enablers to cooking. Explore what influences their “readiness to cook” – i.e. daily barriers and enablers. What have they indicted make it easy/hard to cook at home… Changes from the programme. Did they see any changes in themselves? When and how changes happened (if any). Other changes not specific to food and cooking. Has anything changed or is different as a result of the programme? (Reflection on key themes discussed in the previous interview). Unanticipated outcomes. Were there any unanticipated outcomes? * Talk about the last six months – reflect on what was said in the last interview with each participant

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Appendix 7. JMoF Australia primary outcomes journal article

The primary outcomes paper for Jamie’s Ministry of Food Australia evaluation can be found at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0114673

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RESEARCH ARTICLE

Jamie’s Ministry of Food:Quasi-Experimental Evaluation ofImmediate and Sustained Impacts of aCooking Skills Program in AustraliaAnna Flego1*, Jessica Herbert1, Elizabeth Waters2, Lisa Gibbs2,Boyd Swinburn3,4, John Reynolds5, Marj Moodie1

1. Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Australia, 2. Jack BrockhoffChild Health and Wellbeing Program, Melbourne School of Population and Global Health, The University ofMelbourne, Melbourne, Australia, 3. World Health Organisation Collaborating Centre for Obesity Prevention,Faculty of Health, Deakin University, Melbourne, Australia, 4. School of Population Health, Faculty of Medicaland Health Sciences, University of Auckland, Auckland, New Zealand, 5. Biostatistics Unit, Faculty of Health,Deakin University, Melbourne, Australia

*[email protected]

Abstract

Objective: To evaluate the immediate and sustained effectiveness of the first

Jamie’s Ministry of Food Program in Australia on individuals’ cooking confidence

and positive cooking/eating behaviours.

Methods: A quasi- experimental repeated measures design was used

incorporating a wait-list control group. A questionnaire was developed and

administered at baseline (T1), immediately post program (T2) and 6 months post

completion (T3) for participants allocated to the intervention group, while wait -list

controls completed it 10 weeks prior to program commencement (T1) and just

before program commencement (T2). The questionnaire measured: participants’

confidence to cook, the frequency of cooking from basic ingredients, and

consumption of vegetables, vegetables with the main meal, fruit, ready-made meals

and takeaway. Analysis used a linear mixed model approach for repeated

measures using all available data to determine mean differences within and

between groups over time.

Subjects: All adult participants ($18 years) who registered and subsequently

participated in the program in Ipswich, Queensland, between late November 2011-

December 2013, were invited to participate.

Results: In the intervention group: 694 completed T1, 383 completed T1 and T2

and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237

completed T1 and 149 completed T1 and T2 assessments. Statistically significant

increases within the intervention group (P,0.001) and significant group*time

OPEN ACCESS

Citation: Flego A, Herbert J, Waters E, Gibbs L,Swinburn B, et al. (2014) Jamie’s Ministry of Food:Quasi-Experimental Evaluation of Immediate andSustained Impacts of a Cooking Skills Program inAustralia. PLoS ONE 9(12): e114673. doi:10.1371/journal.pone.0114673

Editor: Martyn Kirk, The Australian NationalUniversity, Australia

Received: June 26, 2014

Accepted: November 12, 2014

Published: December 16, 2014

Copyright: � 2014 Flego et al. This is an open-access article distributed under the terms of theCreative Commons Attribution License, whichpermits unrestricted use, distribution, and repro-duction in any medium, provided the original authorand source are credited.

Data Availability: The authors confirm that all dataunderlying the findings are fully available withoutrestriction. All relevant data are within the paperand its Supporting Information files.

Funding: This evaluation was jointly commis-sioned by the Queensland Government and TheGood Foundation, co-funders of the JMOFprogram, Ipswich. Whilst the project funders wereinvolved in initial discussions around study design,they had no role in data collection and analysis,decision to publish or preparation of the manu-script.

Competing Interests: The authors have declaredthat no competing interests exist.

PLOS ONE | DOI:10.1371/journal.pone.0114673 December 16, 2014 1 / 18

interaction effects (P,0.001) were found in all cooking confidence measures

between T1 and T2 as well as cooking from basic ingredients, frequency of eating

vegetables with the main meal and daily vegetable intake (0.52 serves/day

increase). Statistically significant increases at T2 were sustained at 6 months post

program in the intervention group.

Conclusions: Jamie’s Ministry of Food Program, Australia improved individuals’

cooking confidence and cooking/eating behaviours contributing to a healthier diet

and is a promising community-based strategy to influence diet quality.

Introduction

Healthy food choices and eating patterns are essential for promoting good health

and well-being and preventing a wide range of chronic diseases [1] such as type

two diabetes [2], cardiovascular disease(CVD) [3], stroke [4]some cancers [5, 6]

and obesity [7, 8]. Yet it is increasingly more difficult for westernized societies to

achieve population adherence to recommended nutrition guidelines for healthy

eating [9]. As such, nutrition-related chronic disease and obesity is on the rise

[10], and, in addition to placing considerable burden on healthcare budgets, is

also having far wider impacts within societies [11, 12]. Poor diet has been

identified as a leading contributing risk factor for global disease burden, with

obesity, in part a product of unhealthy eating, being the leading risk factor in

Australasia [13].

One concerning trend is the increasing consumption of energy dense foods of

lower nutritional value prepared outside of the home [14] rather than the

preparation and consumption of home cooked meals that are associated with

higher vegetable intake [15] and overall higher diet quality [16]. This shift towards

outsourcing of meal preparation [14] is likely to be the product of a multitude of

varying, competing and inter-related factors [17, 18] including social, economic,

cultural, environmental and technological influences, that serve to potentially

constrain home cooking practices [14]. One hypothesis is that a decline in

cooking skills in adults is contributing to the problem [19]. Caraher and Lang

[19], in their review of the state of cooking skills in England, identified many

possible reasons for declining cooking skills including a reduction in

opportunities to learn to cook. In Australia, cooking is not always taught in

schools and fundamental changes in the ways in which individuals and families

function, on a day-to-day basis, in a modern society have reduced the traditional

opportunities for learning to cook from family members. Furthermore there is

growing evidence of a relationship between a lack of cooking skills, low cooking

confidence and poor food choices [20], including the likelihood of higher ready

prepared meal consumption [21]; inversely, higher levels of cooking skills and

confidence are associated with higher vegetable purchasing [22] and healthier

eating [15].

Jamie’s Ministry of Food, Australia: Quasi-Experimental Evaluation


This evidence underpins the proliferation of community-based cooking skills

education programs which are being used as a strategy, both by government and

non -government organisations, to promote cooking skills and cooking

confidence as a vehicle to healthy eating. For example, the recent World Cancer

Research Fund’s (WCRF) ‘‘NOURISHING’’ food policy framework specifically

identifies cooking skills education within its nutrition education policy area,

which is one of the ten key policy areas of action to foster healthy eating and

prevent obesity [23]. The Cooking Matters program in the United States (US) and

the Jamie Ministry of Food programs in the United Kingdom (UK) and now

Australia are recognisable community-based cooking skills programs. The latter,

in particular, has attracted attention, in part due to their development by Jamie

Oliver, a UK based celebrity chef. However, the evidence to support the efficacy of

these and other community-based cooking programs, in adult populations, is still

emerging [24, 25]; the Jamie Ministry of Food program itself is yet to be formally

evaluated. Individual programs have reported positive findings in relation to

improved cooking confidence [26, 27], healthy cooking and food consumption

patterns [27, 28, 29] with some sustained effects up to one year post intervention

[27]. A recent systematic review concluded that interventions involving home

food preparation and/or cooking may result in improved food choices, dietary

behaviours and other health related outcomes [25]. Still the authors were cautious

in their interpretation of the results given the dearth of suitably robust evaluations

from which to make definitive statements about program effectiveness [25]. Given

growing pressure for evidence-based public health investment [30], evaluations of

program effectiveness should be both robust and practicable.

This study aims to evaluate the immediate impacts and longer term outcomes

of Jamie’s Ministry of Food program, in Ipswich, Australia using a quasi-

experimental, repeated measures design. This paper reports the impacts of the

program in terms of cooking confidence and cooking and eating behaviours. This

quantitative component is embedded within a larger mixed methods evaluation

[31]; other secondary outcomes (including a range of attitudinal, knowledge,

affordability metrics and broader psychosocial impacts) and qualitative study

findings are reported elsewhere [32].

Methods

The intervention

Jamie’s Ministry of Food programs have been running since 2008 in the UK

funded by a mixture of private and public sources. In 2010, Jamie’s Ministry of

Food was brought to Australia by The Good Foundation (TGF), a not-for-profit,

health promotion organisation funded by The Good Guys, a major Australian

electrical goods retailer, in partnership with Jamie Oliver. In April 2011, the first

Australian Jamie’s Ministry of Food Centre opened in Ipswich, Queensland

(QLD). The Ipswich Centre is predominantly funded by philanthropist Mr

Andrew Muir (owner of The Good Guys) and QLD State Government, as well as



local partners. Whilst the program is all inclusive and not targeted towards a

specific demographic group, Ipswich was deliberately chosen as the location due

to its population’s lower socioeconomic status [33] and higher prevalence of

overweight and obesity than the QLD state average [34]. Given the socioeconomic

gradient apparent in obesity prevalence within Australia [35], wherein health

inequalities related to obesity and its risk factors such as unhealthy eating [36] are

more evident in lower income groups, Ipswich was considered a suitable setting

for the program.

Jamie Oliver’s manifesto is to inspire individuals to cook simple basic meals

from scratch both for themselves and their families [37].The 10 week program,

consisting of weekly 1.5 hour classes, runs from a fixed site located in the main

Ipswich shopping precinct. Participants are taught recipes from 50 ‘‘Jamie Oliver’’

recipes which have been adapted to the Australian context from the UK program

so that over the 10 week course they learn to prepare and cook a variety of dishes

while learning specific cooking techniques such as chopping, frying, roasting and

baking. Messages about good nutrition, meal planning and budgeting are

embedded in the program and are discussed in an informal manner during the

skills sessions. There is an emphasis on cooking from scratch using fresh

ingredients such as fish, meat and seasonal vegetables and fruit. Further details of

the program, its specific objectives, and the full evaluation protocol are reported

elsewhere [31].

Evaluation Objectives

To provide a basis for evaluation enquiry, a program logic model was developed

to determine the potential pathways to behaviour change [31]. Whilst some

pathways such as the effect of cooking skills programs on individuals’ cooking

confidence/self -efficacy and cooking and eating behaviours were based on an

emerging evidence base, and were directly aligned with program objectives, others

around psychosocial, social connectedness, attitudinal and other broader impacts

were viewed as more exploratory [31]. This paper draws on the quantitative

evaluation to explore the former pathways and determine the impact of Jamie’s

Ministry of Food on participants’ cooking confidence (self-efficacy), and cooking

and eating behaviours.

Evaluation design

The evaluation used a quasi-experimental design with a wait-list control group.

All program participants aged 18 years and over were invited to participate in the

evaluation. Participants who signed up to the program .10 weeks before their

course start date, due to the length of the wait-list at the time, were allocated to

the control group whilst participants who signed up to the program ,10 weeks

before their course start date, were allocated to the intervention group.

Intervention participants were surveyed at three time points (before the program

start (T1), on program completion (T2) and six months after program



completion (T3), whilst control participants were surveyed 10 weeks before

program start date (T1) and just prior to beginning their first class (T2). An

online questionnaire was used followed by a postal version sent to all non-

respondents or to anyone who did not have access to a computer or the internet.

Data collection ran from December 2011 to December 2013. Six month follow up

data were not collected from controls; instead, data from Queensland State-wide

monitoring of vegetable intake [38] collected and reported during the evaluation

data collection period was used as a proxy T3 control measurement to enable

comparison with the self- reported vegetable intake measured in the intervention

group at 6 months post intervention (T3). Further details of the methods are

provided in Flego et al 2013 [31]. The evaluation was approved by the Deakin

University Human Research Ethics Committee (HEAG-H 117_11) in October

2011 and was registered with the Australian and New Zealand Clinical Trials

Registry (registration number: ACTRN12611001209987).

Questionnaire and outcome measures

A self -administered quantitative measurement tool was developed [31]. The

primary outcome measures for the quantitative evaluation were a change in self-

reported cooking confidence and daily vegetable intake. Cooking confidence (self-

efficacy) was measured by five questions assessing confidence in a number of

generalised skills required to do basic cooking at home on a scale from 1-5

anchored from ‘‘not at all confident’’51 to ‘‘extremely confident’’55. Four of the

confidence questions were adapted from a validated cooking skills questionnaire

by Barton et al, 2011 [39] and the fifth adapted from Keller et al, 2004 [40]. In

addition to the separate confidence items, all item scores were combined to create

an overall confidence score. Self-reported daily vegetable intake was measured as

serves per day (a serve was equal to half a cup of cooked vegetables or 1 cup of

salad where cup 5250 ml) anchored from 05 no serves per day to 6 or more

serves per day 56. This question used the same wording as that used in the

Queensland Self-Reported Health Status Survey question to enable comparison

[41].

Secondary outcomes included changes in self-reported cooking and eating

measures including: (i) frequency of cooking the main meal from basic

ingredients; (ii) frequency of eating ready-made meals at home; (ii) frequency of

eating vegetables with the main meal, all measured on a scale from 05 never to

75 daily; (iv)serves of fruit per day measured as per daily vegetable intake and (v)

frequency of eating takeaway per week measured from 05 never to 555 or more

times per week.

Sample size

Sample size calculations were based on the primary outcome of a change in self-

reported vegetable intake. The study was powered to detect a mean change in self-

reported vegetable intake of 0.5 serves per day, at 80% power (0.05 significance)



starting from a baseline measure of 2.5 serves a day [41]. This assumed the use of a

nested anova or mixed model analysis with an F test for the group by time

interaction. Additional sample size calculations suggested at least 140 participants

would be required in each group to detect a mean difference of 0.5–0.7 serves per

day. For further details of sample size calculations, see Flego et al, 2013 [31].

Statistical Analysis

All continuous outcomes were analysed using linear mixed models for repeated

measures to determine mean differences between groups over time. This type of

analysis copes with unbalanced groups, missing (at random) follow up data and

enables all available data to be utilised to determine the estimated changes in

mean outcomes. Predicted means from the mixed model analyses are reported in

all tables in the results section. Each analysis was also subsequently run with

separate adjustments for gender, age (dichotomised at below 50 or 50 years and

above) and categories of employment status then with all three covariates

together, to account for the potential effect of baseline differences (assessed by

chi-squared tests between groups, refer to Table 1) on the estimated effect of the

intervention.

Ratings on the cooking confidence score from ‘‘not at all confident’’ (1) to

‘‘extremely confident’’ (5) were regarded as a continuous variable in the primary

analysis - an acceptable technique for larger data sets [42]. However,

supplementary analyses using ordinal logistic and logistic models, to account for

the ordered response categories, and the dichotomization of the categories (‘‘not

confident’’ and ‘‘confident’’), were also conducted to determine if results from the

differing statistical approaches would provide similar inferences with respect to

differences between groups in their changes over time (see S3 and S4 Tables).

To explore the sustainability of the intervention group effect over time, a

repeated measures analysis was performed using the intervention group data

collected at all three time points. For the primary outcome measure of self-

reported vegetable intake, a two-sample t-test comparison between the 6-month

post-program intervention group mean and the reported state-wide mean was

performed.

All analyses were performed using STATA software (version 12.0). Results were

deemed significant at the P,0.05 level.

Results

Participant recruitment and retention

Over the two-year data collection period, approximately 1960 participants

registered for the program and were invited to participate in the evaluation; 1526

were allocated to the intervention group and 434 to the control group. Fig. 1

provides a summary of group allocation and response numbers including

specification of exclusions and loss to follow up at each time point.



Table 1. Demographic characteristics of evaluation participants by time point a.

Group, Time-point Intervention T1 Intervention T2 Intervention T3 Control T1 Control T2

% (n) % (n)

Gender b

Female 77.4 (525) 79.1(299) 80.5(207) 87.2 (198) 87.7(128)

Male 22.6 (153) 20.9(79) 19.5(50) 12.8 (29) 12.3(18)

Age (years)

Under 50b 55.6 (375) 44.1(165) 43.5(110) 64.3 (144) 60.3(85)

50 and over b 44.4 (300) 55.9 (209) 56.5(143) 35.7 (80) 39.7(56)

18–24 7.4 (50) 2.7(10) 3.2(8) 5.8 (13) 4.3(6)

25–34 17.5 (118) 14.2(53) 14.6(37) 22.8 (51) 20.6(29)

35–44 23.0 (155) 19.8(74) 19.0(48) 26.3 (59) 24.1(34)

45–54 16.0 (108) 15.5(58) 15.8(40) 16.5 (37) 18.4(26)

55–64 15.0 (101) 18.45(69) 18.6(47) 12.5 (28) 13.5(19)

65–74 17.5 (118) 24.6(92) 24.1(61) 13.4 (30) 15.6(22)

75+ 3.70 (25) 4.8(18) 4.7(12) 2.70 (6) 3.5(5)

Mean age years (SD) 48(16.1) 52(15.7) 52(15.9) 46(15.1) 47(15.2)

Aboriginal and/or Torre Strait Islander 1.8 (12) 1.8(7) 2.7(7) 0.9 (2) 1.4(2)

Speaks a language other than English at home 7.8 (53) 6.9(26) 7.4(19) 5.3 (12) 3.4(5)

Locality

Ipswich 82.0 (555) 84.7(320) 83.3(214) 78.8 (178) 79.4(116)

Other Queensland localities 17.7 (120) 15.3 (58) 16.3(42) 21.2 (48) 20.5 (30)

NSW 0.3 (2) 0.0(0) .4(1) 0.0 (0) 0.0

Highest Level of education attained

High school, year 12 or less 47.8 (321) 49.3(185) 49.4(126) 45.8 (104) 47.3(69)

TAFE, apprenticeship, diploma or certificate 22.2 (149) 20.8(78) 21.6(55) 22.9 (52) 19.9(29)

Tertiary, bachelor degree or higher 28.0 (188) 28.5(107) 27.4(70) 29.1 (66) 30.1(44)

Other 2.0 (13) 1.3(5) 1.6(4) 2.2 (5) 2.7(4)

Employment b

Full-time 26.4 (176) 23.6(88) 26.2(67) 34.7 (79) 31.3(46)

Part-time/casual 18.6 (124) 16.6(62) 18.4(47) 14.5 (33) 17.0(25)

Retired 23.8 (159) 31.6(118) 30.5(78) 21.5 (49) 23.8(35)

Home duties/carer 14.4 (96) 15.3(57) 13.3(34) 18.4 (42) 17.7(26)

Not working (Permanently ill/unable to work, unem-ployed)

9.9 (66) 7.0(26) 4.3(11) 8.8 (20) 7.5(11)

Student (full-time and part-time) 3.1 (21) 1.9(7) 1.9(5) 1.3 (3) 2.0(3)

Other 3.9 (26) 4.0(15) 5.47(14) 0.9 (2) .70(1)

Household yearly income

1– 6,000 2.5(15) 1.8(6) 2.6(6) 2.0(4) 1.5(2)

6,001– 13,000 5.7(34) 5.7(19) 5.3(12) 5.0(10) 5.3(7)

13,001– 20,000 11.9(71) 12.9(43) 14.1(32) 9.5(19) 9.9(13)

20,001– 30,000 14.8(88) 17.7(59) 17.2(39) 9.5(19) 9.9(13)

30,001– 50,000 15.4(92) 14.7(49) 14.5(33) 12.5(25) 12.2(16)

50,001– 100,000 30.0(179) 29.7(99) 26.9(61) 35.5(71) 36.6(48)

100,001– 150,000 13.6(81) 11.1(37) 12.3(28) 18.5(37) 16.8(22)

.150,000 6.0(36) 6.3(21) 7.0(16) 7.5(15) 7.6(10)



Some 45% of intervention and 55% of control participants invited to

participate in the evaluation completed the baseline assessment (T1). Of those

participants who completed baseline, 55% of intervention and 63% of control

participants completed the T2 assessment. In the intervention group, 31% of

those participants who completed baseline, also completed both T2 and T3

assessments.

Baseline demographic profile

At baseline (Table 1), the majority of participants (,80%) were female, with a

statistically significant higher proportion of females in the control group (87.2%)

than the intervention group (77.4%) (P,0.05). Both groups had more

participants aged under 50 years than over, with the controls having significantly

more in the younger category than the intervention group (64% and 55%

respectively P,0.05). Employment status differed between groups (P,0.05) with

the intervention group less likely to be in full time employment (26%) and more

likely to be retired (24%) compared to the control group (35% and 21%

respectively). Losses to follow-up in each group over time significantly differed by

age (P,0.05) but not for gender (P.0.05) (Table 1).

Change in cooking confidence (self-efficacy)

In the intervention group but not the control group, there was a statistically

significant increase between T1 and T2 in all cooking confidence measures

(P,0.001) both individually and when combined into a cooking confidence score

(Table 2). Statistically significant group by time interactions for all confidence

measures (P,0.001) demonstrate that the change over time differed between

Table 1. Cont.

Group, Time-point Intervention T1 Intervention T2 Intervention T3 Control T1 Control T2

Household Characteristics

Couple, with young children (0–17 years old) living athome

24.7 (169) 23.2(88) 20.0(51) 32.1 (76) 30.2(45)

Couple, with adult children (18 years and over) living athome

12.5 (86) 10.8(41) 11.0(28) 10.1 (24) 10.7(16)

Couple, without children living at home 32.9 (226) 35.3(134) 36.0(92) 24.5 (58) 27.5(41)

One parent family with children living at home 7.0 (48) 3.7(14) 4.3(11) 8.9 (21) 6.7(10)

Live Alone 16.0 (110) 21.6(82) 22.7(58) 17.7 (42) 20.1(30)

Other 6.9 (47) 5.5(21) 6.2(16) 6.8 (16) 4.7(7)

Mean household size (SD) c 2.8 (1.5) 2.6(1.3) 2.5(1.3) 3.0(1.6) 2.9(1.6)

Median household size c (50%centile) 2 2 2 3 2

aSample size for different variables might vary from total sample size because of missing responses and rounding of weighted frequencies.bsignificant difference between groups (p,0.05) at baseline as tested with chi squared analysis.cexcludes 2 participants living in institutional facilities.SD 5 standard deviation.

doi:10.1371/journal.pone.0114673.t001



Fig. 1. Evaluation participation over time.

doi:10.1371/journal.pone.0114673.g001



groups. These results remained significant at the P,0.001 level for all covariate-

adjusted analyses performed for each confidence variable (see S1 Table). The

supplementary ordinal logistic and logistic analyses (S3 and S4 Tables) also

Table 2. Cooking and eating measures at baseline and immediately post program1.

Intervention group Control group

Differencebetween groupsin changes frombaseline(interactioneffect)3 P value

Outcome measure

Baselinevalue(T1)mean (S.E)2

Follow upvalue(T2)mean (S.E)

Change frombaseline(T2-T1)mean (S.E) P value

Baselinevalue(T1)mean (S.E)2


Change frombaseline(T2-T1)mean (S.E) P value P value

Cooking confidence

Confidence to cookfrom basic ingredients4

3.56(0.04) 4.36(0.05) 0.81(0.05) p,0.001 3.69(0.07) 3.72(0.08) 0.03(0.08) p50.70 p,0.001

Confidence to follow asimple recipe4

4.00(0.04) 4.53(0.05) 0.53(0.04) p,0.001 4.11(0.06) 4.06(0.07) 20.06(0.07)p50.40

p,0.001

Confidence in prepar-ing and cooking newfoods and recipes4

3.35(0.04) 4.13(0.05) 0.77(0.05) p,0.001 3.45(0.07) 3.55 (0.08) 0.10(0.08) p50.22 p,0.001

Confidence that whatone cooks will turn outwell4

3.21(0.04) 3.93(0.05) 0.72(0.04) p,0.001 3.28(0.06) 3.35(0.07) 0.07(0.07) p50.30 p,0.001

Confidence to tastenew foods never eatenbefore4

3.47(0.04) 4.01(0.05) 0.54(0.05) p,0.001 3.41(0.07) 3.51(0.09) 0.09(0.08) p50.25 p,0.001

Combined confidencescore5

17.6(0.02) 21.0(0.2) 3.36(0.18) p,0.001 17.9(0.03) 18.2(0.03) 0.23(0.28) p50.41 p,0.001

Cooking and eatingmeasures

Cooking the main mealfrom basic ingredients6

4.05 (0.08) 4.66 (0.09) 0.61 (0.09) p,0.001 4.16 (0.14) 4.17(0.16) 0.01(0.15) p5 0.95 p,0.001

Consumption of ready-made meals at home6

1.06 (0.05) 0.95 (0.06) 20.11 (0.06)p50.06 1.11(0.08) 1.21(0.10) 0.10(0.10) p50.30 p50.06

Consumption of vege-tables with the mainmeal6

4.67(0.07) 5.06(0.09) 0.39 (0.08) p,0.001 4.76(0.12) 4.75(0.14) 0.01(0.14) p50.94 p50.01

Daily vegetable con-sumption (serves perday)

2.46 (0.51) 2.97(0.06) 0.52 (0.06) p,0.001 2.49(0.09) 2.59(0.10) 0.10(0.10) p50.30 p,0.001

Daily fruit consumption(serves per day)

1.65(0.04) 1.93(0.05) 0.28 (0.05) p,0.001 1.61(0.07) 1.71(0.08) 0.10(0.08) p50.20 p50.06

Take-away consump-tion6

0.98(0.04) 0.77(0.04) 20.21(0.04)p,0.001

0.94(0.06) 0.96(0.07) 0.03(0.06) p50.62 p50.001

1Outcomes within each group and over time were determined by a mixed linear model for repeated measures using all available data at each time point. Allmeans and Standard Errors (S.E) have been rounded to 2 decimal points.2Baseline values were not significantly different between groups (independent t tests P,0.05).3A significant group x time interaction effect denotes that the response over time differed between groups.4Scale values are 1–5 (where 15 not at all confident and 55 extremely confident and 4 or. 5 confident).5The combined confidence score is equal to the sum total of all other confidence scores (scores 20 or. 5 confident).6Times per week.




resulted in similar findings regarding the differences between the groups for all

cooking confidence measures (P,0.001).

When analysis was restricted to the intervention group only to test the

sustained effect of the program (i.e. to T3), statistically significant increases in all

cooking confidence measures (P,0.001) were reported for pairwise comparisons

between T1 and T2 (P,0.001) and T1 and T3 (6 months post intervention)

(P,0.001) but not between T2 and T3 (Table 3). Statistically significant results

were also noted (P,0.001) for the overall or main effects of time.

Self -reported Vegetable intake

Self-reported daily vegetable intake increased significantly between T1 and T2 in

the intervention group by just over a half serve (0.52 serves, SD 0.06, P,0.001)

but not in the control group (0.10 serves, SD 0.1, P50.30). A statistically

significant group by time interaction (P,0.001) was found (Table 2). All adjusted

analyses found very similar results (see S2 Table).

For the intervention group only, daily vegetable consumption increased

significantly from T1 (2.46, SD 0.05) to T2 (2.97, SD 0.06, P,0.001) and T3 (3.05,

SD 0.07), although the change between T2 and T3 was not significant (P50.273).

The change between T1 and T3 was significant (0.60 serves, SD 0.07, P,0.001) as

was the overall effect of change over time (P,0.001) (Table 3).

Results of the t-test comparison between the self-reported mean vegetable

intake at T3 for the intervention group (mean53.13, SD51.39) and state-wide

monitoring data from the 2012 Queensland Self-Reported Health Status Survey

(mean52.39, SD 5 2.39) [38] showed a statistically significant mean difference of

0.74 serves (SD 0.09, P,0.001).

Changes in other cooking and eating measures

Cooking the main meal from basic ingredients increased significantly from T1 to

T2 in the intervention group (0.61, SD 0.09, P,0.001) and the overall group by

time interaction effect was statistically significant (P,0.001) (Table 2). Both the

consumption of takeaway food and of ready -made meals reduced in the

intervention group although only the reduction in takeaway consumption was

statistically significant (-0.21, SD 0.04, P,0.001) and showed a significant

interaction effect (P,0.001). Consumption of vegetables with the main meal and

daily fruit intake also increased significantly in the intervention group (P,0.001)

but daily fruit intake did not demonstrate a significant group by time interaction

effect (P50.06). No significant differences in any of the cooking and eating

measures were found in the control group between T1 and T2. All adjusted

analyses performed found very similar results (see S2 Table).

Analysis of data from the intervention group only (Table 3) showed an overall

statistically significant positive effect over time for the aforementioned cooking

and eating measures (P,0.001) and between T1 and T2 (P,0.05), however

change between T2 and T3 did not remain significant for reductions in



Table 3. Cooking and eating measures for the intervention group only at baseline, post intervention and 6 months follow up1.

intervention group

overalleffect ofchangeover timeP value

Outcomemeasure

Baselinevalue(T1)mean (S.E)


6 months postinterventionfollow up (T3)mean (S.E)

Change frombaseline(T2-T1) mean(S.E) P value

Change frombaseline(T3-T1) mean(S.E) P value

Change betweenfollow up (T3-T2)mean (S.E) P value P value

Cooking confi-dence

Confidence tocook from basicingredients2

3.56(0.04) 4.37(0.05) 4.43(0.06) 0.81(0.05)p,0.001 0.87(0.06)p,0.001 0.07(0.06)p50.280 p,0.001

Confidence to fol-low a simplerecipe2

4.00(0.04) 4.53(0.04) 4.61(0.05) 0.53(0.04)p,0.001 0.61(0.05)p,0.001 0.08(0.05)p50.133 p,0.001

Confidence inpreparing andcooking new foodsand recipes2

3.35(0.04) 4.13(0.05) 4.17(0.06) 0.78(0.05)p,0.001 0.82(0.06)p,0.001 0.05(0.06)p50.439 p,0.001

Confidence thatwhat one cookswill turn out well2

3.21(0.04) 3.93(0.05) 3.94(0.05) 0.72(0.04)p,0.001 0.73(0.05)p,0.001 0.01(0.06)p50.803 p,0.001

Confidence totaste new foodsnever eatenbefore2

3.47(0.04) 4.01(0.05) 3.99(0.06) 0.53(0.05)p,0.001 0.52(0.06)p,0.001 20.02(0.06)p50.746 p,0.001

Combined confi-dence score3

17.59(0.16) 20.95(0.19) 21.15(0.22) 3.36(0.18)p,0.001 3.56(0.21)p,0.001 0.20(0.22)p50.363 p,0.001

Cooking and eat-ing measures

Cooking the mainmeal from basicingredients4

4.05(0.08) 4.65(0.10) 4.88(0.11) 0.60(0.09) p,0.001 0.84 (0.10) p,0.001 0.24(0.11) p50.03 p,0.001

Consumption ofready- mademeals at home4

1.06(0.05) 0.93(0.06) 0.80(0.07) 20.13(0.06)p50.04 20.26(0.07)p,0.001 20.13(0.08) p50.09 p,0.001

Consumption ofvegetables withthe main meal4

4.67(0.07) 5.05(0.09) 5.31(0.10) 0.38(0.09) p,0.001 0.64(0.09) p,0.001 0.25(0.10) p,0.018 p,0.001

Daily vegetableconsumption(serves per day)

2.46(0.05) 2.97(0.06) 3.05(0.07) 0.51(0.06)p,0.001 0.60(0.07)p,0.001 0.08(0.08)p50.273 p,0.001

Daily fruit con-sumption (servesper day)

1.65(0.04) 1.93(0.05) 2.05(0.06) 0.27(0.05) p,0.001 0.40(0.06) p,0.001 0.12(0.06) p50.055 p,0.001

Take-away con-sumption4

0.98(0.04) 0.76(0.04) 0.73(0.05) 20.23(0.04)p,0.001 20.25(0.04)p,0.001 20.02(0.05)p50.607 p,0.001

1Outcomes at each time point were determined by a mixed linear model for repeated measures using all available data at each time point. All means andStandard Errors (S.E) have been rounded to 2 decimal points.2Scale values are 1–5 (where 15 not at all confident and 55 extremely confident).3The combined confidence score is equal to the sum total of all other confidence scores (scores 20 or. 5 confident).4Times per week.




consumption of ready-made meals or takeaway, or for increases in daily fruit

intake.

Discussion

This is the first published quantitative evaluation of Jamie’s Ministry of Food

Program providing evidence of the program’s impact on participants’ cooking

and eating behaviours. While evaluation recruitment was relatively modest at

baseline (,47% response rate), the retention rates were similar to other recent

studies in this area [27]. Results showed that the program significantly increased

participants’ cooking confidence in all generalised cooking skill areas tested from

baseline (T1) to program completion (T2) and the increase in the intervention

group was also sustained six months later which is indicative of an enduring

program effect. These findings resonate with those from Garcia et al, 2012 who

also found sustained positive effects of a cooking skills program on participants’

cooking confidence at one year post intervention [27]. Statistically significant

increases between T1 and T2 were also found in the weekly frequency of cooking

the main meal from basic ingredients and in the consumption of vegetables with

the main meal together with a reduction in weekly take-away consumption,

although effect sizes were modest. Whilst daily fruit consumption increased in the

intervention group between baseline and both T2 and T3, there was no significant

difference between groups at T2. Daily vegetable intake however increased

significantly by just over a half a serve per day within the intervention group from

baseline to T2, but not in the control group, and continued to increase (but not

significantly), between T2 to T3. The T3 intervention mean vegetable intake was

significantly higher, by 0.74 serves per day, than the reported Queensland State-

wide monitoring result [38].

These findings are encouraging and align with evaluation of other cooking skills

programs that have found positive results with respect to improved cooking

confidence [26, 27] and/or healthy eating results [25]. In particular, the 0.5 serve

increase in vegetable intake, which was maintained at 6 months follow up in the

intervention group, is comparable to outcomes achieved by other nutrition

education programs exclusively targeting healthy eating in community settings

[43] or low income communities [43]. In light of published relative risk

reductions for coronary heart disease of 7% associated with a one serve per day

increase in vegetable consumption [44] as well as reported risk reductions for

stroke [45] with increased vegetable consumption, an increase of 0.5 serves of

vegetables is likely to have small but positive protective benefits for individuals

and arguably be of public health benefit if achieved across whole populations. It

has been estimated that inadequate fruit and vegetable consumption alone, cost

the Australian health sector AUD 206 million in 2008 [46]; therefore small shifts

in the right direction are a constructive first step.

Additionally, the apparent agreement between results around daily vegetable

intake, consumption of vegetables with the main meal, cooking confidence and



cooking from basic ingredients, all of which reported statistically significant

increases, suggests that the program influences many aspects of cooking and

eating behaviours simultaneously and the parallel increases in these variables are

consistent with the causal logic model proposed for the program [31]. The results

of the intervention only analysis over time also implies a sustaining of program

effect 6 months post program for most variables reported. However, there was

very little change from completion (T2) to 6 months post program (T3), therefore

in agreement with Garcia et al [27], a refresher or booster class around this time

may be warranted to enhance program effect in the long run.

Furthermore, acknowledging that self-reported daily fruit intake did not result

in a statistically significant difference between groups at T2 (P50.06), a 0.40

serves per day increase was still found between T1 and T3 in the intervention

group only analysis (P,0.001). Nevertheless the statistically significant results

between groups for self-reported vegetable intake and not for self-reported fruit

intake possibly reflect the emphasis within the Jamie’s Ministry of Food program

to promote and teach inclusion of vegetables or salad with the main meal.

The results of this study offer the strongest quantitative evidence at this point in

time to specifically support the premise that Jamie’s Ministry Food program

improves cooking confidence and leads to healthier cooking and eating

behaviours. The evaluation also adds to the literature more generally around the

effectiveness of cooking skills programs per se, particularly given the relatively

large sample size, use of a control group and six month follow up measures, all

design elements which have been lacking in many other studies of community

cooking skills interventions [24]. It is acknowledged that there is a reliance on self-

reported data which is not as valid as other more objective measurement tools

used in traditional nutrition evaluation [47]. Yet the self-administered

questionnaire, with a focus on simple English, was well completed, which was an

important consideration, given the program was based in an area of social

disadvantage. The use of objective measurement tools would have been difficult in

this context because of the participant burden, as shown in previous studies [26].

Efforts were also made to increase data validity: guidance was provided to

respondents on portion size, plus a question was included on vegetable intake

within the main meal which is considered good practice [48]; also, importantly,

questions used in Government preventive health surveillance surveys were

included for comparison. As an aside, baseline mean daily vegetable intake

reported in both groups was similar (2.46, 2.49 for each group) to that reported by

the Queensland surveillance survey (2.4) [38] suggesting that our sample was a

valid representation of the population. A wait-list, non-randomised study design

was selected as the most suitable for this context and ensured participants were

able to participate with family and friends at a convenient time. This led to some

disparity between groups in terms of numbers and demographic characteristics at

baseline including gender, age and employment status. However by adjusting for

these covariates, the sensitivity of the group comparison to between- group

differences at baseline, was able to be tested and proven to have little impact on

results. The inclusion of 6 month follow up results in this study demonstrates the



sustainability of effects on intervention participants. While it would have been

ideal to extend the control comparison to this point, it was not feasible to expect

wait-list participants to wait a further 6 months before starting the program. It has

been recommended that studies into community cooking skills interventions

ideally use a community control group [24] to avoid this issue all together, but

this was not considered a feasible option for this evaluation.

Jamie’s Ministry of Food Program in Australia, has succeeded in recruiting

large numbers in the communities in which it is operating and has attracted both

private and public investment even when it precedes evidence of program

effectiveness. This may speak to the influence of Jamie Oliver himself as program

ambassador and his capacity to mobilise various players within communities.

Whether or not this celebrity endorsement augments program effectiveness and

what role such programs should play in the promotion of public health nutrition,

remain questions for future research as does determination of the efficiency of the

program measured against known alternatives through cost-effectiveness analysis.

However the results suggest that the Jamie’s Ministry of Food Program holds

promise as a community-based strategy and should certainly be considered as part

of a comprehensive approach to improving diet quality.

Conclusion

This evaluation has, for the first time, demonstrated that the Jamie’s Ministry of

Food Program has positive personal, dietary and likely health impacts for

participants through improvements in cooking confidence, cooking and eating

behaviours towards a healthier diet. These benefits were sustained at 6 months

post program suggesting the program does have an enduring effect on program

participants and should be considered as a component in any suite of

interventions targeting healthy eating.

Supporting Information

S1 Table. Cooking confidence measures at baseline and follow up adjusted by age,

gender and levels of employment independently and all together.

doi:10.1371/journal.pone.0114673.s001 (DOCX)

S2 Table. Cooking and eating measures at baseline and follow up adjusted by age

gender and levels of employment independently and all together.


S3 Table. Results of ordinal logistic regression for confidence to cook questions.


S4 Table. Results of the logistic models for dichotomised confidence questions

(‘‘not confident’’ and ‘‘confident’’).




Acknowledgments

The authors acknowledge Alicia Peardon and staff of The Good Foundation

(including staff at the Ipswich site) for facilitating implementation of the

evaluation, and all participants who generously offered their time to complete the

evaluation surveys. Moodie and Swinburn are researchers within an NHMRC

Centre for Research Excellence in Obesity Policy and Food Systems

(APP1041020).

Author ContributionsConceived and designed the experiments: AF JH EW LG BS MM JR. Performed

the experiments: JH AF. Analyzed the data: AF JH JR. Wrote the paper: AF JH EW

LG BS JR MM.

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Appendix 8. JMoF Australia secondary

outcomes journal article The secondary outcomes paper for Jamie’s Ministry of Food Australia evaluation can be found at: http://www.biomedcentral.com/1471-2458/14/1161

282

RESEARCH ARTICLE Open Access

Wider impacts of a 10-week community cookingskills program - Jamie’s Ministry of Food, AustraliaJessica Herbert1*, Anna Flego1, Lisa Gibbs2, Elizabeth Waters2, Boyd Swinburn3,4, John Reynolds5 and Marj Moodie1

Abstract

Background: Jamie’s Ministry of Food (JMoF) Australia is a 10-week community-based cooking skills program whichis primarily aimed at increasing cooking skills and confidence and the promotion of eating a more nutritious diet.However, it is likely that the program influences many pathways to behaviour change. This paper explores whetherJMoF impacted on known precursors to healthy cooking and eating (such as attitudes, knowledge, beliefs, cookingenjoyment and satisfaction and food purchasing behaviour) and whether there are additional social and healthbenefits which arise from program participation.

Methods: A mixed method, quasi-experimental longitudinal evaluation with a wait-list control was conducted.Intervention participants were measured using repeated questionnaires at three time points; before and after theprogram and at six-month follow-up. Control participants completed the questionnaire 10 weeks before theirprogram and at program commencement. Quantitative analysis used a linear mixed model approach and generalisedlinear models for repeated measures using all available data. Qualitative methods involved 30-minute repeatedsemi-structured interviews with a purposively selected sample, analysed thematically.

Results: Statistically significant differences between groups and over time were found for a reduction of take away/fastfood weekly purchasing (P = 0.004), and increases in eating meals at the dinner table (P = 0.01), cooking satisfaction(P = 0.01), and the ability to prepare a meal in 30 minutes (P < 0.001) and from basics that was low in cost (P < 0.001).The qualitative findings supported the quantitative results. Repeat qualitative interviews with fifteen participantsindicated increased confidence and skills gained from the program to prepare meals from scratch as well as increasesin family involvement in cooking and meal times at home.

Conclusions: Jamie’s Ministry of Food, Australia resulted in improvements in participants’ food and cooking attitudesand knowledge, food purchasing behaviours and social interactions within the home environment, which weresustained six months after the program.

Trial registration: Australian and New Zealand Trial registration number: ACTRN12611001209987.

Keywords: Cooking skills, Healthy eating, Health promotion, Evaluation, Nutrition education

BackgroundThere is a common discourse about a lack of homecooking and food skills in westernized societies today.Factors contributing to this lack of cooking and declinein skills include competing time demands, busy sche-dules, daily stressors, lack of cooking knowledge andconfidence and an increased reliance on prepared food[1-3]. This problem has raised interest from both the

media and health promotion sectors, resulting in anincreased number of not-for-profit community-basedcooking skills programs, both in Australia and inter-nationally [4-9].There are many factors that influence whether indivi-

duals and families will cook and eat healthy meals. Theseinclude cooking and eating knowledge, attitudes and be-liefs, and enjoyment and satisfaction with the cookingexperience. The perceived cost of healthy food can be abarrier to a healthy diet [5,10]. Healthy food choices areinfluenced by food purchasing behaviours, particularlyaround vegetable purchasing. Results from a Brisbane

* Correspondence: [email protected] Health Economics, Faculty of Health, Deakin University, Melbourne,Victoria, AustraliaFull list of author information is available at the end of the article

© 2014 Herbert et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly credited. The Creative Commons Public DomainDedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,unless otherwise stated.

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food study in Australia found that low socio-economic po-sitioned (SEP) groups purchased fewer types of fruit andvegetables, fewer foods high in fibre and low in fat com-pared to high SEP groups [11]. Those with low educationand income levels were less likely to comply with dietaryguidelines in terms of fruit and vegetable consumption asreflected by their fruit and vegetable purchasing [11]. Inaddition, increased confidence to prepare vegetables hasbeen found to be related to purchasing a greater variety ofvegetables and more often [12]. One could assume that byimproving cooking confidence around fruit and vegetablepreparation this may impact on food purchasing attitudesand behaviours.Changes to traditional family meal patterns have been

reported. Busy schedules and competing priorities im-pact on the frequency of family meals [13,14]. The tra-ditional family meal around the dinner table with foodprepared from fresh ingredients or ‘from scratch’ is nolonger a cultural norm [15]. These factors are cause forconcern because the frequency of family meals has beenfound to have a protective health factor through im-proved dietary outcomes [16]. There is evidence to sug-gest that children of families who always eat dinnertogether at the table consume more fruit and vegetablescompared to children of families who never eat together[17]. Eating meals in front of the television is associatedwith negative health impacts such as higher body massindex, particularly in older children [18]. In a nationwidesurvey of 1,011 Australians in 2008, 60% of respondentsreported that the television was always or often on du-ring meal time [19].Jamie’s Ministry of Food (JMoF) was originally developed

by celebrity chef Jamie Oliver in the United Kingdom (UK)[20], and in recent years brought to Australia and adaptedto an Australian setting. The program is a community-based cooking skills program consisting of ten weekly90-minute classes, aimed at getting people of all ages andbackgrounds cooking simple, fresh, healthy food quicklyand easily [21]. The JMoF program focuses on buildingpositive attitudes and increasing knowledge, skills andself-efficacy related to healthy eating, food and cooking.It was brought to Australia by a not-for-profit, healthpromotion organisation, The Good Foundation (TGF),and The Good Guys, a major Australian electrical goodsretailer, in partnership with Jamie Oliver. Ipswich inQueensland was the first Australian centre to open andcommenced operation in April 2011. The Ipswich Centreis primarily funded by philanthropist Mr Andrew Muir(owner of The Good Guys) and Queensland State Govern-ment, as well as local partners. Ipswich was intentionallyselected as a target site given its low SEP [22] and increa-sing levels of overweight and obesity [23] within the popu-lation. This program has been evaluated both in terms ofthe primary aims of increasing cooking confidence and

vegetable consumption (reported elsewhere [24]) and itswider dietary, health and psychosocial impacts.A program logic model was developed to explore the

pathways that might impact on behaviour change interms of cooking and food behaviours [25]. It is under-stood that changes in attitude, beliefs and self-efficacyare important pre-cursors to behaviour change [26].There is evidence to suggest that improved cooking con-fidence may impact on cooking behaviours [9] as well ashealthy diets [12], however the evidence around othereffects on cooking behaviours is less strong and warrantsmore research [27]. This paper explores the 10-weekprogram’s impacts on the other influences on cookingand eating (specifically, cooking and healthy eating atti-tudes, beliefs and knowledge, food purchasing beha-viours, cooking enjoyment and satisfaction, and socialand health benefits).

MethodsThe evaluation methods are detailed in Flego et al. [25],but are briefly summarised here. A longitudinal mixedmethods design was adopted for the evaluation. Thequantitative component measured changes in participantskills, knowledge, attitudes, and food purchasing beha-viours, cooking enjoyment and satisfaction, social con-nectedness around food and health effects as a result ofthe JMoF program. The qualitative component aimed toprovide a deeper understanding of participant expe-riences of the program and to explore the barriers andfacilitators to cooking. The qualitative and quantitativestudies ran concurrently and results were analysed sepa-rately before being combined.

Quantitative studyThe quantitative component used a quasi-experimentaldesign with a wait-list control group. Intervention partici-pants were measured at program commencement (T1), atprogram completion (T2) approximately 10 weeks aftercommencement, and six months later (T3) approximatelysix months after program completion. The control group(participants who registered for the program ten weeks inadvance) were measured ten weeks prior to (T1) and atprogram commencement (T2). Controls were not mea-sured at six month follow-up (T3) because it was deemedimpractical to make participants wait six months to attendthe program. At each time point, participants completeda 15-minute self-administered questionnaire designedto elicit self-reported information around key programdomains.Recruitment to the evaluation was restricted to par-

ticipants over the age of 18 years. The study was designedto detect a change in mean daily vegetable intake (primaryoutcome) of 0.5 serves per day, from a baseline of 2.5serves per day, with 80% power using a two-sided test at

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the 5% significance level – this required a minimum of140 participants in each group [25]. Recruitment to thestudy continued until the sample reached the target of 140participants in each group at T2. Statistical analyses werebased on the set of individuals who registered for theprogram, responded to an invitation to participate inthe evaluation and subsequently completed the baselinequestionnaire.Multilevel mixed linear models were used to analyse all

continuous-scale, repeated measures data [28,29]. Resultsfrom these analyses are presented in the form of predictedmeans, recovered from the fitted mixed linear model, andtheir associated standard errors (SE). Differences in thesepredicted means over time and within each participantgroup are also presented. Responses to questions on nutri-tional knowledge were dichotomised into correct or incor-rect responses. The proportions of correct responses insubgroups are presented and comparisons of subgroupswere based on generalized linear models, fitted using themethod of generalized estimating equations (GEE) whichallows for longitudinal binary data [29].Two analyses of each outcome variable were con-

ducted: (i) comparisons between groups of their changesover time from T1 to T2 (equivalent to testing for a timeby group interaction), and, (ii) comparisons of the threetime points (T1, T2 and T3) within the interventiongroup. Each model-based analysis was also re-run ad-justing for covariates (such as age, gender, and employ-ment status) when the covariates exhibited baselinedifferences (i.e. differences at T1) between the controland intervention groups. Analyses was performed usingSTATA (version 12.0) [30]. Results were considered sig-nificant if P < 0.05.

Qualitative studyA selected number of JMoF program participants wereapproached to be involved in the qualitative study. Pur-posive sampling was employed, utilising maximum vari-ation [31] to ensure a diverse group of participants interms of socio-demographic characteristics such as socio-economic status, age, gender, family structure, and coo-king confidence level.Recruitment of participants occurred via two ways

[25]. Firstly, in the quantitative questionnaire, partici-pants were asked about their willingness to be contactedfor a future interview. Secondly, purposive sampling wasundertaken by the researcher whilst observing groups intheir first week of the program.The interviews were conducted face-to-face or by phone

by a trained researcher, Figure 1. The first interview wasconducted before the program had commenced or nogreater than two weeks into the program. Repeat inter-views with the same people were conducted at programcompletion, and at six months post completion.

The three repeat semi-structured interviews were ap-proximately 30–40 minutes long and were conducted in apublic location in Ipswich. The interviews explored par-ticipant expectations and experiences of the program andreflections on the impact of the program on their attitudesand behaviours, described in more detail elsewhere [25].Participants were given a $15 supermarket gift voucher atthe end of each interview in appreciation of their time.All interviews were recorded and transcribed verbatim,

with participant consent. The data was managed with theassistance of a qualitative software package NVivo 9 (NVivo9 [program]: QSR International Pty Ltd 2011). Transcriptsand data memos were coded, then categorised to identifythemes and emerging patterns. A second researcher inde-pendently generated codes on a sub-sample of transcriptsand any differences between codes were discussed [32,33].Analysis was conducted concurrently with data collectionallowing for ongoing clarification of emerging findings [32].Further analysis of the themes was conducted in compari-son with relevant literature to determine alignment withexisting evidence [32,33].

EthicsEthics approval was received from Deakin UniversityHuman Research Ethics Committee (HEAG-H 117_11).Informed consent was received for both quantitative andqualitative components of the study [25].

ResultsQuantitative resultsParticipantsFigure 1 provides a summary of the participants involvedin both the quantitative and qualitative components of theevaluation. In the quantitative analysis, a total of 694 inter-vention participants completed T1 measurements, 383 atT2 and 259 at T3. In the wait-list control group, 237 par-ticipants completed the survey at T1and 149 at T2. Furtherdetails of participant dropout rates are presented elsewhere,as is a detailed description of the demographic profile [24].At baseline, most participants spoke English at home, werefemale, resided within the Ipswich district, and were in fullor part-time employment. There were three significant dif-ferences between the control and intervention groups - thecontrol group was younger (64.3% aged below 50 yearscompared to 55.6% in the intervention group and medianages of 48 and 46 years in the control and interventiongroups respectively); was comprised of fewer males (12.8%compared to 22.6% males in the intervention group) andwas more likely to have participants in full employment(34.7% compared to 26.4% in the intervention group).

Food purchasing behaviours and attitudesThere was a statistically significant decrease in totalweekly take away/fast food expenditure in the intervention


group (P < 0.001) but not in the control group betweenT1 and T2. This was the only food purchasing behaviourto show a statistically significant group by time interaction(P = 0.004) (Table 1). However total fruit and vegetable ex-penditure did significantly increase by a mean AUD2.50over time in intervention group between T1 and T2(P < 0.001). There was a statistically significant increase inthe numbers believing that they could prepare a mealfrom basics that was low in price between T1 and T2 inthe intervention group (P < 0.001) but not the control.There was also a small significant increase in knowledgearound cost of fruit and vegetables being cheaper when in

season in the intervention group (P < 0.001) but not in thecontrol.When the analysis was restricted to the intervention

group across the three time points (Table 2), overall ex-penditure on food and drink did not change, but therewere significant increases between T1 and T3 in fruitand vegetable expenditure, preparing low cost meal fromscratch, attitudes around buying more fruit and vegeta-bles and the knowledge that fruit and vegetables arecheaper when in season. There was also a significant de-crease in take away/fast food expenditure between T1and T3 (P < 0.001).

Recruitment via telephone number provided, n=12

•A total of 199 participants agreed to be contacted for an interview on their completed baseline quantitative questionnaire and provided a contact telephone number.

•Based on data collection dates and the participant’s program commencement date only 24/199 participants were eligible for an interview. o 12 were scheduled for an interview. o 12 were unavailable for an interview due to time

commitments and interview scheduling constraints.

Recruitment via class observation (n=3) • 4 participants were approached only 3 agreed to

Intervention, n= 1526

<10 weeks before program commencement

Wait-list control, n=434

>10 weeks before program commencement

Quantitative participants, n=1,960 Qualitative participants, n=15

Six-month T3 Interview, n=13

• Face-to-face (n=8) or phone interview (n=5) • Interview with another person present (n=2)


An additional 45 participants failed to

complete T2 but completed T1 and

T3 (n=259)

Loss to six-month follow-up, (n=2)

• Reasons unknown (n=1) • Could not be contacted (n=1)

T1 Interview, n=15

• Face-to-face interview (n=15) • Interview with another person present (n=3)

T2 Interview, n=15

• Face-to-face (n=11) or phone interview (n=4) • Interview with another person present (n=3)

Wait-list control T2 analysed (n=149)

Intervention T2 analysed

(n=383)

Wait-list control T1 analysed (n = 237)

Intervention T1 analysed

(n= 694)

Figure 1 Jamie’s ministry of food mixed methods evaluation, quantitative and qualitative participation. The quantitative componentbegan in November 2011 – December 2013, the qualitative evaluation began in August 2012 – July 2013.


Table 1 Secondary outcome measures by group at baseline and follow up1

Outcome measure Intervention Control Difference betweengroups in changes

over time (interactioneffect)3 P value

Baseline (T1)mean (S.E)2

Follow up(T2) mean (S.E)

Change frombaseline (T2-T1)

mean (S.E) P value

Baseline (T1)mean (S.E)2

Follow up (T2)mean (S.E)

Change frombaseline(T2-T1) mean

(S.E) P value

Food purchasing behaviours and attitudes

Total weekly food and drinkexpenditure (AUD)4

137.16 (2.72) 135.60 (3.15) −1.56 (2.46) P = 0.53 147.34 (4.68) 151.68 (5.20) 4.33 (3.96) P = 0.27 P = 0.21

Total weekly fruit and vegexpenditure (AUD)4

20.77 (0.61) 23.28 (0.73) 2.50 (0.63) P < 0.001 21.70 (1.06) 22.24 (1.20) 0.53 (1.01) P = 0.60 P = 0.10

Total weekly take away/fast food expenditure (AUD)4

13.17 (0.59) 9.86 (0.69) −3.31 (0.55) P < 0.001 12.395 (1.01) 12.05 (1.13) −0.34 (0.87) P = 0.70 P = 0.004

I can prepare a meal frombasics that is low in price5

2.99 (0.03) 3.41 (0.04) 0.41 (0.04) P < 0.001 3.00 (0.05) 2.97 (0.06) −0.02 (0.06) P = 0.71 P <0.001

Buying more fruit/vegetableswould not be difficult on mybudget5a

2.85 (0.03) 2.93 (0.04) 0.08 (0.04) P = 0.06 2.85 (0.06) 2.89 (0.07) 0.04 (0.07) P = 0.59 P = 0.60

Fruit and vegetables arecheaper when they are inseason5

3.42 (0.02) 3.62 (0.03) 0.21 (0.03) P < 0.001 3.43 (0.04) 3.50 (0.05) 0.07 (0.06) P = 0.21 P = 0.04

Cooking and healthy eating knowledge, attitudes beliefs and behaviours

I can put together a healthymeal from scratch in30 minutes5

2.85 (0.031) 3.30 (0.04) 0.45 (0.04) P < 0.001 2.85 (0.05) 2.89 (0.06) 0.03 (0.06) P = 0.61 P <0.001

I find it easy to change myeating habits5

2.52 (0.03) 2.71 (0.04) 0.19 (0.04) P < 0.001 2.52 (0.05) 2.53 (0.06) 0.01 (0.06) P = 0.82 P = 0.02

Vegetables can be tastyfoods5

3.54 (0.02) 3.69 (0.03) 0.15 (0.03) P < 0.001 3.53 (0.04) 3.51 (0.05) −0.02 (0.05) P = 0.74 P = 0.01

I eat enough fruit andvegetables5

2.66 (0.03) 3.00 (0.04) 0.34 (0.04) P < 0.001 2.66 (0.06) 2.68 (0.07) 0.02 (0.06) P = 0.71 P <0.001

My lifestyle does not Preventme eating a healthy diet5a

3.11 (0.03) 3.33 (0.04) 0.22 (0.04) P < 0.001 3.04 (0.05) 3.12 (0.06) 0.08 (0.06) P = 0.17 P = 0.07

Cooking enjoyment and satisfaction

I enjoy cooking5 3.05 (0.03) 3.33 (0.04) 0.28 (0.03) P < 0.001 3.12 (0.05) 3.17 (0.06) 0.06 (0.05) P = 0.28 P = 0.001

I get a lot of satisfactionfrom cooking my meals5

2.96 (0.03) 3.31 (0.04) 0.35 (0.03) P < 0.001 3.02 (0.05) 3.05 (0.06) 0.03 (0.05) P = 0.60 P <0.001

I enjoy cooking for others5 3.01 (0.03) 3.27 (0.04) 0.26 (0.03) P < 0.001 3.09 (0.06) 3.16 (0.07) 0.07 (0.06) P = 0.22 P = 0.004

I enjoy eating a meal withothers5

3.51 (0.02) 3.60 (0.03) 0.09 (0.03) P = 0.01 3.47 (0.39) 3.55 (0.05) 0.07 (0.05) P = 0.16 P = 0.81

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Table 1 Secondary outcome measures by group at baseline and follow up1 (Continued)

Social eating

Frequency of eating togetherat home with others6

3.94 (0.07) 4.20 (0.08) 0.24 (0.07) P < 0.001 3.97 (0.11) 4.02 (0.13) 0.06 (0.11) P = 0.61 P = 0.13

Frequency of eating dinner infront of the television6

2.69 (0.08) 2.50 (0.09) −0.19 (0.07) P = 0.01 2.51 (0.14) 2.52 (0.15) 0.00 (0.11) P = 0.99 P = 0.17

Frequency of eating dinnerat a dinner table6

3.12 (0.08) 3.40 (0.09) 0.29 (0.06) P < 0.001 3.11 (0.13) 3.09 (0.14) −0.02(0.10) P = 0.86 P = 0.01

Health and emotional well-being

Global self-esteem score7 20.88 (0.22) 22.60 (0.25) 1.73 (0.20) P <0.001 20.46 (0.37) 21.02 (0.42) 0.56 (0.32) P = 0.09 P = 0.002

General Health8 2.77 (0.04) 3.11 (0.04) 0.34 (0.04) P <0.001 2.80 (0.06) 2.86 (0.07) 0.06 (0.06) P = 0.34 P <0.001

Body Mass Index (BMI) 28.86 (0.27) 28.78 (0.28) −0.09 (0.13) P = 0.49 29.71 (0.46) 29.70 (0.47) −0.02 (0.20) P = 0.94 P = 0.761Outcomes within each group and over time were determined by a mixed linear model for repeated measures using all available data at each time point using STATA (version 12.0).2Baseline values were not significantly different between groups (independent t tests). 3A significant group and time interaction effect denotes that the response over time differed between groups (P = 0.05).4Expenditure data was collected in Australian dollars (AUD) on a 7-point scale which was analyse by its midpoints. 5Mean predicted score indicating level of agreement with statement from a Likert Scale (1 = stronglydisagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = strongly agree), aScore assignment was reversed. 6Mean frequency for a typical week was collected on a 6 or 7-point scale which was analyse by its midpoint,with the maximum category being five or more times per week. 7Rosenberg’s global self-esteem score (Low self-esteem = 0-14, Normal self-esteem = 15-25, High self-esteem = 16-30). 8Perceived general health (poor = 1,fair = 2, good = 3, very good = 4, excellent = 5).

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Table 2 Secondary outcome measures for the intervention group only at baseline (T1), post intervention (T2) and 6 months follow up (T3)1

Outcome measure Baseline(T1) mean

(S.E)

Follow up(T2) mean

(S.E)

6 months postintervention followup (T3) mean (S.E)

Change frombaseline (T2-T1) mean

(S.E) P value


(S.E) P value


(S.E) P value

Overall effectof change overtime P value2

Food purchasing behaviours and attitudes

Total weekly food and drinkexpenditure (AUD)3

137.13 (2.65) 135.21 (3.08) 137.28 (3.42) −1.93(2.48) P = 0.44 0.15 (2.90) P = 0.96 2.08 (3.08) P = 0.50 P = 0.70

Total weekly fruit and vegexpenditure (AUD)3

20.77 (0.62) 23.25 (0.74) 23.64 (0.83) 2.48 (0.65) P < 0.001 2.86 (0.76) P < 0.001 0.39 (0.81) P = 0.63 P <0.001

Total weekly take away/fast foodexpenditure (AUD)3

13.19 (0.59) 9.85 (0.68) 9.14 (0.76) −3.34 (0.54) P < 0.001 −4.05 (0.63) P < 0.001 −0.71 (0.68) P = 0.29 P <0.001

I can Prepare a meal from basicsthat is low in Price4

2.99 (0.03) 3.41 (0.04) 3.42 (0.04) 0.42 (0.04) P < 0.001 0.43 (0.05) P < 0.001 0.01 (0.05) P = 0.79 P <0.001

Buying more fruit/vegetableswould not be difficult on mybudget4a

2.85 (0.03) 2.93 (0.04) 2.97 (0.05) 0.08 (0.05) P = 0.09 0.11 (0.05) P = 0.03 0.04 (0.06) P = 0.52 P = 0.06

Fruit and vegetables are cheaperwhen they are in season4

3.42 (0.02) 3.62 (0.03) 3.66 (0.04) 0.21 (0.04) P < 0.001 0.24 (0.04) P < 0.001 0.04 (0.04) P = 0.41 P <0.001

Cooking and healthy eating knowledge, attitudes beliefs and behaviours

I can Put together a healthymeal from scratch in30 minutes4

2.85 (0.03) 3.29 (0.04) 3.31 (0.05) 0.44 (0.04) P < 0.001 0.46 (0.05) P < 0.001 0.02 (0.06) P = 0.67 P <0.001

I find it easy to change myeating habits4

2.52 (0.03) 2.71 (0.04) 2.70 (0.04) 0.17 (0.04) P < 0.001 0.18 (0.05) P < 0.001 0.00 (0.05) P = 0.94 P <0.001

Vegetables can be tasty foods4 3.54 (0.02) 3.69 (0.03) 3.69 (0.04) 0.15 (0.03) P = 0.001 0.15 (0.04) P < 0.001 0.00 (0.04) P = 0.97 P <0.001

I eat enough fruit andvegetables4

2.66 (0.03) 3.00 (0.04) 3.05 (0.05) 0.34 (0.04) P < 0.001 0.39 (0.05) P = 0.001 0.06 (0.05) P = 0.26 P <0.001

My lifestyle does not Prevent meeating a healthy diet4a

3.11 (0.03) 3.32 (0.04) 3.29 (0.05) 0.21 (0.04) P < 0.001 0.18 (0.05) P < 0.001 −0.03 (0.05) P = 0.55 P <0.001

Cooking enjoyment and satisfaction

I enjoy cooking4 3.05 (0.03) 3.32 (0.04) 3.28 (0.04) 0.27 (0.03) P < 0.001 0.23 (0.04) P < 0.001 −0.04 (0.04) P = 0.31 P <0.001

I get a lot of satisfaction fromcooking my meals4

2.96 (0.03) 3.31 (0.04) 3.29 (0.04) 0.35 (0.04) P < 0.001 0.33 (0.04) P < 0.001 −0.02 (0.04) P = 0.72 P <0.001

I enjoy cooking for others4 3.01 (0.03) 3.26 (0.04) 3.18 (0.05) 0.25 (0.04) P < 0.001 0.18 (0.04) P < 0.001 −0.08 (0.05) P = 0.11 P <0.001

I enjoy eating a meal withothers4

3.51 (0.02) 3.60 (0.03) 3.61 (0.03) 0.09 (0.03) P = 0.01 0.10 (0.04) P = 0.01 0.01 (0.04) P = 0.77 P = 0.003

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Table 2 Secondary outcome measures for the intervention group only at baseline (T1), post intervention (T2) and 6 months follow up (T3)1 (Continued)

Social eating

Frequency of eating together athome with others5

3.92 (0.07) 4.17 (0.08) 4.20 (0.09) 0.25 (0.07) P < 0.001 0.28 (0.09) P < 0.001 0.04 (0.09) P = 0.69 P <0.001

Frequency of eating dinner infront of the television5

2.69 (0.08) 2.50 (0.09) 2.46 (0.10) −0.19 (0.07) P = 0.01 −0.23 (0.08) P = 0.01 −0.04 (0.09) P = 0.66 P = 0.01

Frequency of eating dinnerat a dinner table5

3.12 (0.08) 3.40 (0.09) 3.37 (0.10) 0.28 (0.65) P < 0.001 0.25 (0.08) P = 0.001 −0.02 (0.08) P = 0.76 P <0.001

Health and emotional well-being

Global self-esteem score6 20.88 (0.22) 22.61 (0.25) 22.92 (0.28) 1.73 (0.21) P < 0.001 2.04 (0.25) P < 0.001 0.31 (0.26) P = 0.24 P <0.001

General Health7 2.77 (0.04) 3.11 (0.05) 3.24 (0.05) 0.34 (0.04) P < 0.001 0.47 (0.05) P < 0.001 0.13 (0.05) P = 0.01 P <0.001

Body Mass Index (BMI) 28.86 (0.27) 28.79 (0.28) 28.94 (0.29) −0.07 (0.14) P = 0.61 0.08 (0.16) P = 0.65 0.15 (0.17) P = 0.39 P = 0.681Outcomes within each group and over time were determined by a mixed linear model for repeated measures using all available data at each time Point using STATA (version 12.0).2A significant group and time interaction effect denotes that the response over time differed between groups (P < 0.05). 3Expenditure data was collected in Australian dollars (AUD) on a 7-Point scale which wasanalyse by its midpoints. 4Mean Predicted score indicating level of agreement with statement from a Likert Scale (1 = strongly disagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = strongly agree), aScore assignmentwas reversed. 5Mean frequency for a typical week was collected on a 6 or 7-Point scale which was analyse by its midpoint, with the maximum category being five or more times Per week. 6Rosenberg’s globalself-esteem score (Low self-esteem = 0–14, Normal self-esteem = 15-25 and High self-esteem = 16-30). 7Perceived general health (Poor = 1, fair = 2, good = 3, very good = 4, excellent = 5).

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Cooking and healthy eating knowledge, attitudes, beliefsThe belief that participants could prepare a healthy mealfrom scratch in 30 minutes increased significantly in theintervention group but not in the control group betweenT1 and T2. A statistically significant group by time in-teraction (P < 0.001) also indicated a difference betweengroups in their changes and over time (Table 1). Table 1also indicates statistically significant group by time inter-actions in beliefs around ease of changing eating habits(P = 0.02), vegetables being tasty (P = 0.01), and eatingenough fruit and vegetables (P < 0.001). In the inter-vention group only analyses of the three time points, allattitudes and knowledge around cooking and healthyeating were significantly sustained from baseline (T1) to6 months post program (T3) (Table 2).Participants were asked to select the healthiest option

from a range of food choices to test their knowledgearound salt, sugar and fat content (results presented intext and not shown in a table). Based on the test for agroup by time interaction in the GEE analysis, there wasa significant increase in salt knowledge in the interven-tion group with 89.2% of participants indicating the cor-rect answer at baseline and 94.75% at T2 and no changein the control group between T1 and T2 (91.45% and90.41%; P = 0.04. Sugar knowledge increased in the inter-vention group between T1 (87.1%) and T2 (92.2%), andthis was significantly different (P = 0.02) from the changeover time in the control group between T1 and T2(88.94% and 86.49% respectively). Changes in fat know-ledge over time were also significantly different betweenthe control and intervention groups (P = 0.03), with alarger increase in the control group (67.7% at T1, 79.9%at T2) compared to the intervention group (71.0% at T1,74.5% at T2). When the analysis was restricted to partici-pants in the intervention group, between T2 and T3, therewas a significant increase (P = 0.02) in salt knowledge(93.4% at T3). But there was a significant (P = 0.001) de-crease in sugar knowledge (90.3% at T3). Lastly, know-ledge around fat appeared to decrease at T3 (69.4%) butnot significantly (P = 0.42).

Cooking enjoyment and satisfactionThere were small but statistically significant differences inthe increases over time and between groups in cookingenjoyment (P = 0.001), cooking satisfaction (P < 0.001) andcooking for others (P = 0.004) (Table 1). In the inter-vention group, all improvements in the level of cookingenjoyment and satisfaction were sustained at T3 (Table 2).

Social eatingWeekly frequency of eating dinner at the dinner table in-creased significantly in the intervention group (P < 0.001)but not in the control group. The overall group by timeinteraction was statistically significant (P = 0.01) (Table 1).

The improvements in the intervention group in terms ofbehaviours around meal location and eating with otherswere statistically significant over time (Table 2). Betweenbaseline (T1) and six months after the program (T3) therewere significant increases in frequency of eating withothers (P < 0.001) and decreased eating in front of thetelevision (P = 0.01).

Health and emotional well-beingThe JMoF program did not impact on participants’ self-reported BMI between groups and over time (Table 1).There was however a significant group by time inter-action in both self-reported general health (P < 0.001)and self-esteem (P = 0.002). There was a statistically sig-nificant increase in global self-esteem in the interventiongroup (P < 0.001) but not in the control group. Therewas also a significant increase in general health in theintervention group (P < 0.001), but not in the controlgroup. The improvement in general health continued toT3 and the improvement in self-esteem was maintainedat T3 (Table 2).

Adjusted analyses of outcomesAnalyses of each outcome adjusted for age, gender andemployment separately, then all together, to account fordifferences in composition between the non-randomizedintervention and control groups, showed small diffe-rences in the predicted group by time means howeverpairwise comparisons remained similar to those in theresults of the unadjusted analyses (results not shown,see [Additional file 1]).

Qualitative resultsParticipantsFifteen participants participated in the qualitative study.All completed T1 and T2 interviews, whilst 13 competedT3 interviews (with 2 lost to follow up) (Figure 1). Theinterviewees represented a heterogeneous cross-sectionof people from various stages of life. They varied in age(from 21–69 years old), household characteristics andlevels of food preparation, responsibility and confidence,i.e. key factors which impacted on their home cookingand their willingness to learn and ability to makechanges. There were more females interviewed thanmales, which reflects overall program enrolment. Twoparticipants were interviewed together and one partici-pant was interviewed with a carer present. There wereno instances of one person interrupting, correcting orotherwise changing the response of another. However, itis possible that subtle influences arising from the rela-tionship could have influenced participants’ responseswhen another was present. The qualitative sample in-cluded a young adult living at home, both working andstay-at-home mothers, a young adult with an intellectual


disability and retired or semi-retired males and females,whose children had left home.

Qualitative findingsThe qualitative findings facilitate a deeper understandingof the quantitative results from the program participants’perspectives. Two key themes to emerge from the datawere changes in food shopping behaviours and in socialinteractions at home through domestic cookingpractices.Participants reported purchasing a wider variety of

fresh foods, such as fruit and vegetables, and less ‘packet’and processed/prepared foods; many viewed this as aconsequence of preparing more meals from scratch. Sixmonths after the program, there were examples of par-ticipants shopping smarter, “buying more to our list” andgrowing their own vegetables and herbs.

“I was stuffing the fatty things [in the trolley] and Iwouldn’t change and try new stuff, which was costingme more money and now I’m trying all these newthings, I might spend a bit more on fresh fruit andvegetables than what I used to but…. It’s a good thing[it] means we are not buying crap…”

However, for a number of participants, shopping be-haviour did not appear to change. Several retired olderparticipants claimed they were “set in their ways” andhad not made many changes to their food purchasing,nor noticed many distinct changes in their food prefer-ences. Some older participants indicated that the effortinvolved and the cost of ingredients, prevented themfrom making, for example a curry paste from scratch,when they could either go out for a meal or purchasethe prepared version. Premixed sauces, for example,were seen as “getting close to authentic” compared towhat they were like in the past. For older participants,prepared meals continued to be an easy option for easeand convenience. However this attitude did not persistamongst younger participants, particularly those withchildren living at home. The decision to make a mealfrom scratch appeared to be more influenced by whomthey were cooking for. Those with children or youngadults residing at home were more likely to invest en-ergy in providing a “proper” meal made from scratchand containing vegetables. There was limited discussionaround the consumption of takeaway food. Howeverthere was discussion around the role that time playswhen cooking at home and how increases in their cook-ing confidence and skills to prepare meals quickly fromscratch may have contributed to a decrease in take-awayexpenditure.As participants gained confidence in their cooking

abilities and found enjoyment in attending the program,

the benefits gained in the class were taken home andshared with others. Firstly, they described sharing theirprogram experience with others, through sharing theknowledge they had acquired and the food they had pre-pared with friends, family and colleagues. For many, thisbrought about feelings of accomplishment and encour-agement and interest from others that did not attend theprogram. Secondly, a small number of participants de-scribed changes after the program in their ability andconfidence to prepare a meal for others. Some partici-pants endeavoured to prepare “fun” meals with others,whether this was sharing the food they made in class, orpreparing and serving a new meal like Jamie would onshared platters, or moving away from eating in front ofthe television to eating at the table. For many, sharingtheir program experience provided a positive experiencethat added to their cooking enjoyment and satisfaction.All interview participants were unanimous about the

importance of eating meals together with other people.There were reports of more social interactions in thehome environment after attending the JMoF program,with many describing “an opportunity to have familytime cooking”. Social cooking and eating as a family re-sulted in shared food enjoyment and special memoriesfor some. There were reported changes to the family en-vironment and in family interactions. It was commonlymentioned, that working as a household team to preparemeals was still occurring six months after finishing theprogram. Some participants reported talking more aboutfood and cooking practices and meal planning than be-fore doing the program. Some reported physical changesto the home environment.

“We've made a bit more space and… we sort of movedsome things around, so now when I’m cooking, the kidscan sit up on the kitchen bench and we can still doreading or some of the homework so there’s still thatinteraction, whereas before we didn’t have it set uplike that… I think it’s changed the dynamics, which wewouldn’t have bothered to change at all if we hadn’tcome along [to the program]… It was like, well if thekids needed help I had to go and help them out. Icouldn’t be cooking. The risotto needs to be stirredcontinuously. You can’t do that if every minute “canyou help me with…” but now it’s like “yeah, I’m doingthis”. Yeah but putting those changes into place…”

DiscussionThis study which uses a longitudinal mixed method de-sign including a wait-list control group, is the first toevaluate a JMoF program. The evaluation adds to thebody of literature around cooking skills interventionswhich to date has been limited in showing effectivenessof impacts [34]. This study has demonstrated that the


10-week JMoF program has provided small but positivesustained effect on intervention participants’ attitudes,beliefs, knowledge and enjoyment around cooking andhealthy eating. The strongest changes in attitudes con-cerned being able to prepare a meal in 30 minutes andable to prepare a meal from basics that was low in cost.This was also reflected in participants’ pride in beingable to discuss and demonstrate their program expe-riences to others. There were also small improvementsin eating at the dinner table, expenditure on take-awayor fast foods, as well as self-perceived health and self-esteem. Attitudes and beliefs are understood to be goodpredictors of behaviour [35], so improved attitudes asso-ciated with participation in the program is a positiveoutcome. The confidence and skills gained by partici-pants from attending the JMoF program gave them afresh attitude to cooking, which in turn enabled them toreview and change cooking and meal practices at home.The baseline values suggest that the evaluation partici-pants started in the mid-range of cooking skills, attitudesand knowledge. So there is a possibility that the programcaptured people who may not have needed it and mayattract people with at least some cooking skills whichthey wanted to improve. While each individually mea-sured change was small, together they represent a movetowards positive behaviour change.Six months after finishing the program, JMoF partici-

pants were spending on average 4.15AUD less on takeaway/fast foods per week, which is consistent with thefinding that participants were consuming less take away/fast food [24]. To put this into context the cost of a “BigMac” in Australia according to the Big Mac index is ap-proximately AUD5.15 [36]. Whilst participants’ overallweekly food and drink expenditure did not change, theywere spending more on fruit and vegetables. This alignswith qualitative findings which indicated that there was achange in attitude around food spending with some par-ticipants favouring cooking from scratch using fresh in-gredients rather than packaged convenience foods. Thisappeared to be a direct consequence of their improvedcooking confidence and knowledge. This attitude shift wasaligned with life stage, with younger participants and thosewho had children living at home more motivated tochange. In summary, food expenditure changes appearedto be driven from a prioritisation of cooking from scratchin the act of providing a ‘proper’ meal to those living athome.Another cooking skills intervention program con-

ducted in Australia, The Food Cent$ program, aimed toimprove diets and change food purchasing behavioursthrough developing budgeting, cooking and shoppingskills and knowledge [5]. Through the provision of bud-geting skills the program led to significant dietary beha-viour changes - more vegetables consumed, decreased

consumption of confectionary items and fewer purchasesof cakes. The Can Cook Family programme in the UK[37] showed that participants increased their mean per-centage weekly spend on fruit and vegetable expenditureby 2.55% after the program, which is similar to the esti-mated increase in the percentage (2.07% = 100 × ( (23.64/137.28) – (20.77/137.13)) six months after participation inthe JMoF program. The Can Cook Family Programme alsoled to a reduction of takeaway meals purchased and indi-cated this was due to improvements in participants’ coo-king confidence [37]. These two programs (Food Cent$and Can Cook programs) however had small sample sizesand no control group. The JMoF program has a largersample size and a control group and therefore makes astronger case that cooking skills interventions have an im-pact on food purchasing behaviours and this can lead tohealthier diets.Results showed that over time the JMoF program led

to an increase in eating at the table and an associateddecrease in eating in front of the TV. These changeswere also reflected in the qualitative findings. Partici-pants, particularly those with children living at home,found more enjoyment from cooking and involvingothers in planning, cooking and sharing meals. Thereare a number of consequences arising from changes insocial and mealtime behaviours. Firstly, social connec-tedness can be fostered through positive family relation-ships [38]. Cooking and eating together at home resultsin families spending more quality time together, therebyproviding an opportunity for social support and im-proved family relationships. Increased family meal fre-quency and children’s involvement in cooking is alsolikely to improve the nutritional quality of a meal [6,17].Children’s involvement in the cooking process has beenfound to increase consumption of fruit and vegetables[17]. Participants’ greater confidence and enjoyment ofcooking translated to more positive shared experiencesof both preparing meals and eating together as a family.An Australia wide study conducted in 2008 looking at

family dinners found 77% of families ate together at meal-time five or more times per week [19]. To make a com-parison to the JMoF program proportions showed that, atT3, approximately 72% of JMoF participants who had chil-dren living at home reported eating together 5 times perweek. This had increased from approximately 66% atbaseline. Direct comparison must be treated with cautionbecause the JMOF sample represents greater social dis-advantage, and geographical differences than the Huntley(2008) sample. However, it does indicate scope for furtherimprovements.Typically, evaluations of cooking skills interventions

report on social outcomes in terms of social connectionsand support experienced through attendance of the pro-gram such as social support, friendship building and


information sharing [8,39,40]. Keller et al. reported fin-dings from a men’s cooking skills intervention in whichqualitative findings suggested the program had a positiveeffect on participants’ sense of self-worth and connectionwith others [8]. Engler-Stringer and Berenbaum [40] ex-plored social support developed through participation incollective kitchens through qualitative participant ob-servations and interviews. Findings suggested that therewere improvements in social isolation, increased socialsupport, participation and sharing resources in theircommunity as well as knowledge of where to find help[40]. There is limited evidence available on the social ef-fect beyond the program. The JMoF evaluation offersnew findings that highlight improved social interactionsthrough domestic cooking within the home.BMI did not show an overall effect either between

groups or over time and this was not unexpected giventhat the program did not focus on weight reduction dur-ing its 10-week intervention. BMI is rarely reported ormeasured in evaluations of cooking skills interventions.One study that did report on children’s BMI after a five90-minute parent/child cooking intervention addressingobesity revealed that BMI did not significantly changeafter program attendance [6]. Another intervention calledRaising the Bar on Nutrition, aimed at food pantry clients,did show a significant reduction in BMI after a six weekcooking program, however this study had low participantnumbers (n = 54) and did not have a control group [41].Hall et al. (2011) states that weight loss response is slow[42] and therefore it would not be expected in a programof this nature and duration. If the study had a T3 control,there is a possibility that results may have shown a differ-ence between control and intervention groups, howeverspeculating this is not possible within the current studydesign and beyond the data presented.While this study has strengths, it is not without its limi-

tations. Qualitative findings are based on a purposive sub-sample of JMoF participants willing to be interviewed. Itsuccessfully captured a range of perspectives but the find-ings, shaped by their personal insights and experiences,may not be translatable to all JMoF participants. Bothquantitative and qualitative findings may possess an ele-ment of social desirability bias which is often common inself-report measures and interview data [43]. On the otherhand such measures are commonly used, until alternativesare devised. Another issue is the possibility of biases re-lated to “Readiness to change” that may impact on thecomparison of wait-list control groups with interventiongroups, a recent paper [44] has attempted to investigatethis (in the context of problem drinking). If the highlyready are forced to wait they might start changing and theeffect of the intervention is underestimated. Accidentalconfounding of readiness-to-change with the controlgroup is then a problem. Randomization would reduce

confounding however randomisation within real life set-tings often poses barriers to the intervention [45]. A ran-domised control would have also been unsuitable forparticipation in the JMoF program because participantsoften attend at a convenient time with family and friends.The low literacy level of some participants may also haveimpacted on results, however literacy of participants werenot measured in this evaluation, which may be required infuture studies. While the questionnaire used clear simplelanguage and was piloted within Ipswich, there may bemisinterpretations of questions within the population.Results presented in this paper suggest there were

sustained improvements in attitudes, knowledge and pur-chasing behaviours around the consumption and prepa-ration of vegetables after the program. The program had asustained impact on participants’ cooking enjoyment andsatisfaction, which linked heavily to improved social inter-action around cooking and meal consumption within thefamily home. Many changes resulting from the programwere statistically significant but small and sustained. Theprogram implementers need to explore ways in which theparticipant benefits gained as a consequence of the pro-gram can be sustained over time.

ConclusionsThis study is the first rigorous evaluation of the JMoFprogram that incorporates a control group, a mixedmethods design, and a follow-up period. Results showedmultiple improvements in participants’ food and cookingattitudes and knowledge, food purchasing behavioursand social interactions within the home environment,which were sustained six months after the program, ad-ding to the limited evidence of the wider impacts ofcooking skills interventions.

Additional file

Additional file 1: Secondary outcome measures betweenintervention and control group at baseline and follow up adjustedfor age, gender, employment and combined. Additional analysesto show adjusted results for intervention and control at baseline andfollow up.

Competing interestsThe evaluation has been commissioned by The Good Foundation.

Authors’ contributionsJH drafted the manuscript, performed the analysis and interpretation ofresults, with AF and LG contributing to the analysis and interpretation ofquantitative and qualitative sections respectively. Authors LG, MM, EW andBS substantially contributed to conception and design of the research,critically reviewed the draft manuscript and provided intellectual content.JH and AF were responsible for project management and data collection.JR provided statistical guidance and performed secondary statistical analysisto validate all data presented and critically reviewed the draft manuscript toprovide intellectual content. All authors read and approved the finalmanuscript.


AcknowledgementsThe authors acknowledge Alicia Peardon and staff of The Good Foundation(including staff at the Ipswich site) for facilitating implementation of theevaluation, and all participants who generously offered their time tocomplete the evaluation surveys. Thanks are extended to Ipswich CityCouncil for providing interview space We also thank Catherine Keating, ChristinaStubbs for early contributions to the study design and Dr. MohammadrezaMohebbi for providing additional statistical advice. Authors Moodie andSwinburn are researchers within an NHMRC Centre for Research Excellence inObesity Policy and Food Systems (APP1041020).

Author details1Deakin Health Economics, Faculty of Health, Deakin University, Melbourne,Victoria, Australia. 2Jack Brockhoff Child Health and Wellbeing Program,Centre for Health Equity, Melbourne School of Population Health, TheUniversity of Melbourne, Melbourne, Victoria, Australia. 3WHO CollaboratingCentre for Obesity Prevention, Faculty of Health, Deakin University,Melbourne, Victoria, Australia. 4School of Population Health, Faculty ofMedical and Health Sciences, University of Auckland, Auckland, New Zealand.5Deakin Biostatistics Unit, Faculty of Health, Deakin University, Melbourne,Victoria, Australia.

Received: 1 August 2014 Accepted: 3 November 2014Published: 12 December 2014

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doi:10.1186/1471-2458-14-1161Cite this article as: Herbert et al.: Wider impacts of a 10-week communitycooking skills program - Jamie’s Ministry of Food, Australia. BMC PublicHealth 2014 14:1161.

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Appendix 9. Adjusted results for age, gender, employment and combined

297

Adjusted results for age, gender, employment and combined

Intervention Control Interaction effect, group by time P value Outcome measure

Baseline (T1) mean (S.E)

Intervention completion (T2) mean (S.E)

Change from T2-T1 mean (S.E) P value


Wait-list completion (T2) mean (S.E)


Cooking confidence Confidence to cook from basic ingredients4 3.56 (0.04) 4.36 (0.05) 0.81 (0.05) P<0.001 3.69 (0.07) 3.72 (0.08) 0.03 (0.08) P=0.70 P<0.001 Age 3.56 (0.04) 4.37 (0.04) 0.81 (0.05) P<0.001 3.72 (0.08) 3.76 (0.07) 0.04 (0.08) P= 0.61 P<0.001 Gender 3.56 (0.04) 4.38 (0.04) 0.81 (0.05) P<0.001 3.70 (0.08) 3.74 (0.07) 0.05 (0.08) P=0.53 P<0.001 Employment 3.56 (0.04) 4.38 (0.04) 0.81 (0.05) P<0.001 3.70 (0.08) 3.74 (0.07) 0.04 (0.08) P= 0.62 P<0.001 Age, gender, employment 3.57 (0.04) 4.38 (0.04) 0.81 (0.05) P<0.001 3.70 (0.08) 3.75 (0.07) 0.05 (0.08) P= 0.54 P<0.001 Confidence to follow a simple recipe4 4.00 (0.04) 4.53 (0.05) 0.53 (0.04) P<0.001 4.11 (0.06) 4.06 (0.07) -0.06 (0.07) P=0.40 P<0.001 Age 4.00 (0.04) 4.53 (0.04) 0.54 (0.04) P<0.001 4.15 (0.07) 4.07 (0.06) -0.08 (0.07) P=0.21 P<0.001 Gender 4.00 (0.04) 4.54 (0.04) 0.54 (0.04) P<0.001 4.12 (0.07) 4.07 (0.06) -0.05 (0.07) P=0.48 P<0.001 Employment 4.00 (0.04) 4.54 (0.04) 0.53 (0.04) P<0.001 4.13 (0.07) 4.07 (0.06) -0.06 (0.07) P=0.35 P<0.001

Age, gender, employment 4.01 (0.04) 4.55 (0.04) 0.53 (0.04) P<0.001 4.12 (0.07) 4.05 (0.06) -0.07 (0.07) P=0.276 P<0.001

Confidence in preparing and cooking new foods and recipes4 3.35 (0.04) 4.13 (0.05) 0.77 (0.05) P<0.001 3.45 (0.07) 3.55 (0.08) 0.10 (0.08) P=0.22 P<0.001 Age 3.35 (0.04) 4.13 (0.04) 0.77 (0.05) P<0.001 0.07 3.55 (0.07) 0.10 (0.08) P=0.19 P<0.001 Gender 3.36 (0.04) 4.13 (0.04) 0.77 (0.05) P<0.001 3.45 (0.07) 3.54 (0.07) 0.10 (0.08) P=0.22 P<0.001 Employment 3.36 (0.04) 4.14 (0.04) 0.78 (0.05) P<0.001 3.44 (0.07) 3.54 (0.07) 0.10 (0.08) P=0.21 P<0.001 Age, gender, employment 3.37 (0.04) 4.12 (0.04) 0.77 (0.05) P<0.001 3.44 (0.08) 3.53 (0.07) 0.10 (0.08) P=0.22 P<0.001 Confidence that what one cooks will turn out well4 3.21 (0.04) 3.93 (0.05) 0.72 (0.04) P<0.001 3.28 (0.06) 3.35 (0.07) 0.07 (0.07) P=0.30 P<0.001 Age 3.21 (0.04) 3.93 (0.04) 0.72 (0.04) P<0.001 3.30 (0.07) 3.37 (0.06) 0.08 (0.07) P=0.26 P<0.001 Gender 3.21 (0.04) 3.93 (0.04) 0.72 (0.04) P<0.001 3.30 (0.07) 3.36 (0.07) 0.06 (0.07) P=0.35 P<0.001 Employment 3.22 (0.04) 3.94 (0.04) 0.72 (0.04) P<0.001 3.28 (0.07) 3.35 (0.07) 0.07 (0.07) P=0.33 P<0.001 Age, gender, employment 3.22 (0.04) 3.94 (0.04) 0.72 (0.04) P<0.001 3.30 (0.07) 3.38 (0.07) 0.08 (0.07) P=0.28 P<0.001 Confidence to taste new foods never eaten before4 3.47 (0.04) 4.01 (0.05) 0.54 (0.05) P<0.001 3.41 (0.07) 3.51 (0.09) 0.09 (0.08) P=0.25 P<0.001 Age 3.46 (0.05) 4.01 (0.05) 0.55 (0.05) P<0.001 3.43 (0.08) 3.52 (0.08) 0.09 (0.08) P=0.27 P<0.001 Gender 3.46 (0.05) 4.01 (0.05) 0.54 (0.05) P<0.001 3.46 (0.08) 3.56 (0.08) 0.10 (0.08) P=0.18 P<0.001 Employment 3.47 (0.05) 4.02 (0.05) 0.55 (0.05) P<0.001 3.44 (0.08) 3.54 (0.08) 0.10 (0.08) P=0.22 P<0.001 Age, gender, employment 3.46 (0.05) 4.02 (0.05) 0.55 (0.05) P<0.001 3.44 (0.08) 3.54 (0.08) 0.10 (0.08) P=0.22 P<0.001

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Combined confidence score5 17.59(0.02) 20.95 (0.2) 3.36 (0.18) P<0.001 17.94 (0.03) 18.17 (0.03) 0.23 (0.28) P=0.41 P<0.001 Age 17.59 (0.17) 20.98 (0.17) 3.39 (0.17) P<0.001 18.05 (0.30) 18.27 (0.28) 0.23 (0.28) P=0.42 P<0.001 Gender 17.60 (0.17) 20.99 (0.17) 3.39 (0.17) P<0.001 18.01 (0.30) 18.27 (0.28) 0.26 (0.28) P=0.34 P<0.001 Employment 17.63 (0.17) 21.02 (0.17) 3.39 (0.17) P<0.001 17.99 (0.30) 18.23 (0.28) 0.24 (0.27) P=0.39 P<0.001 Age, gender, employment 17.64 (0.17) 21.04 (0.17) 3.39 (0.17) P<0.001 17.99 (0.30) 18.24 (0.28) 0.24 (0.28) P=0.387 P<0.001 Cooking and healthy eating knowledge, attitudes and beliefs


2.85 (0.031) 3.30 (0.04) 0.45 (0.04) P<0.001 2.85 (0.05) 2.89 (0.06) 0.03 (0.06) P=0.61 P < 0.001

Age 2.86 (0.03) 3.30 (0.03) 0.44 (0.04) P<0.001 2.87 (0.06) 2.89 (0.06) 0.02 (0.06) P=0.76 P < 0.001 Gender 2.86 (0.03) 3.30 (0.03) 0.44 (0.04) P<0.001 2.85 (0.06) 2.87 (0.06) 0.02 (0.06) P=0.75 P < 0.001 Employment 2.86 (0.03) 3.29 (0.03) 0.43 (0.04) P<0.001 2.86 (0.06) 2.88 (0.06) 0.02 (0.06) P=0.72 P < 0.001 Age, gender, employment 2.87 (0.03) 3.30 (0.03) 0.44 (0.04) P<0.001 2.86 (0.06) 2.88 (0.06) 0.01 (0.06) P=0.82 P < 0.001 I find it easy to change my eating habits6 2.52 (0.03) 2.71 (0.04) 0.19 (0.04) P<0.001 2.52 (0.05) 2.53 (0.06) 0.01 (0.06) P=0.82 P = 0.02 Age 2.52 (0.03) 2.71 (0.04) 0.19 (0.04) P<0.001 2.53 (0.05) 2.54 (0.06) 0.01 (0.07) P=0.89 P = 0.02 Gender 2.51 (0.03) 2.70 (0.04) 0.19 (0.04) P<0.001 2.53 (0.05) 2.55 (0.06) 0.02 (0.06) P=0.71 P = 0.03 Employment 2.51 (0.03) 2.70 (0.04) 0.19 (0.04) P<0.001 2.53 (0.05) 2.55 (0.06) 0.01 (0.06) P=0.82 P = 0.02 Age, gender, employment 2.51 (0.03) 2.71 (0.04) 0.20 (0.04) P<0.001 2.54 (0.05) 2.56 (0.06) 0.02 (0.07) P=0.78 P = 0.02 Vegetables can be tasty foods6 3.54 (0.02) 3.69 (0.03) 0.15 (0.03) P<0.001 3.53 (0.04) 3.51 (0.05) -0.02 (0.05) P=0.74 P = 0.01 Age 3.54 (0.02) 3.68 (0.03) 0.14 (0.03) P<0.001 3.54 (0.04) 3.51 (0.05) -0.03 (0.05) P=0.52 P = 0.003 Gender 3.54 (0.02) 3.69 (0.03) 0.15 (0.03) P<0.001 3.53 (0.04) 3.51 (0.04) -0.02 (0.05) P=0.75 P = 0.01 Employment 3.54 (0.02) 3.69 (0.03) 0.15 (0.03) P<0.001 3.53 (0.04) 3.51 (0.05) -0.01 (0.05) P=0.77 P = 0.01 Age, gender, employment 3.54 (0.02) 3.69 (0.03) 0.14 (0.03) P<0.001 3.54 (0.04) 3.51 (0.05) -0.03 (0.05) P=0.57 P = 0.003 I eat enough fruit and vegetables6 2.66 (0.03) 3.00 (0.04) 0.34 (0.04) P<0.001 2.66 (0.06) 2.68 (0.07) 0.02 (0.06) P=0.71 P < 0.001 Age 2.66 (0.03) 2.98 (0.04) 0.32 (0.04) P<0.001 2.70 (0.06) 2.70 (0.06) 0.00 (0.06) P=0.96 P < 0.001 Gender 2.65 (0.03) 2.99 (0.04) 0.34 (0.04) P<0.001 2.68 (0.06) 2.69 (0.06) 0.01 (0.06) P=0.83 P < 0.001 Employment 2.67 (0.03) 3.00 (0.04) 0.33 (0.04) P<0.001 2.68 (0.06) 2.69 (0.06) 0.01 (0.06) P=0.89 P < 0.001 Age, gender, employment 2.67 (0.03) 2.99 (0.04) 0.32 (0.04) P<0.001 2.70 (0.06) 2.70 (0.06) 0.01 (0.06) P=0.93 P < 0.001 My lifestyle does not prevent me eating a healthy diet6a 3.11 (0.03) 3.33 (0.04) 0.22 (0.04) P<0.001 3.04 (0.05) 3.12 (0.06) 0.08 (0.06) P=0.17 P = 0.07

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Age 3.11 (0.03) 3.32 (0.04) 0.21 (0.04) P<0.001 3.06 (0.05) 3.14 (0.06) 0.07 (0.06) P=0.17 P = 0.10 Gender 3.11 (0.03) 3.33 (0.04) 0.21 (0.04) P<0.001 3.04 (0.05) 3.12 (0.06) 0.08 (0.06) P=0.19 P = 0.07 Employment 3.12 (0.03) 3.32 (0.04) 0.20 (0.04) P<0.001 3.05 (0.05) 3.13 (0.06) 0.08 (0.06) P=0.18 P = 0.09 Age, gender, employment 3.17 (0.03) 3.32 (0.04) 0.21 (0.04) P<0.001 3.06 (0.05) 3.14 (0.06) 0.08 (0.06) P=0.21 P = 0.08 Cooking enjoyment and satisfaction I enjoy cooking6 3.05 (0.03) 3.33 (0.04) 0.28 (0.03) P<0.001 3.12 (0.05) 3.17 (0.06) 0.06 (0.05) P=0.28 P = 0.001 Age 3.05 (0.03) 3.34 (0.03) 0.29 (0.03) P<0.001 3.08 (0.06) 3.15 (0.06) 0.06 (0.05) P= 0.24 P<0.001

Gender 3.06 (0.03) 3.33 (0.03) 0 .27 (0.03) P<0.001 3.12 (0.06) 3.16 (0.06) 0.04 (0.05) P=0.41 P<0.001

Employment 3.06 (0.03) 3.34 (0.03) 0.28 (0.03) P<0.001 3.10 (0.06) 3.16 (0.06) 0.06 (0.05) P=0.27 P<0.001 Age, gender, employment 3.06 (0.03) 3.35 (0.03) 0.30 (0.03) P<0.001 3.09 (0.06) 3.14 (0.06) 0.05 (0.05) P=0.32 P<0.001 I get a lot of satisfaction from cooking my meals6 2.96 (0.03) 3.31 (0.04) 0.35 (0.03) P<0.001 3.02 (0.05) 3.05 (0.06) 0.03 (0.05) P=0.60 P < 0.001 Age 2.97 (0.03) 3.33 (0.03) 0.36 (0.03) P<0.001 3.00 (0.06) 3.02 (0.06) 0.02 (0.05) P=0.70 P<0.001 Gender 2.97 (0.03) 3.32 (0.04) 0.35 (0.03) P<0.001 3.03 (0.06) 3.03 (0.06) 0.01 (0.05) P=0.89 P<0.001 Employment 2.97 (0.03) 3.32 (0.04) 0.35 (0.03) P<0.001 3.00 (0.06) 3.03 (0.06) 0.02 (0.05) P=0.68 P<0.001 Age, gender, employment 2.97 (0.03) 3.33 (0.03) 0.36 (0.03) P<0.001 3.01 (0.06) 3.02 (0.06) 0.01 (0.05) P=0.83 P<0.001 I enjoy cooking for others6 3.01 (0.03) 3.27 (0.04) 0.26 (0.03) P<0.001 3.09 (0.06) 3.16 (0.07) 0.07 (0.06) P=0.22 P = 0.004 Age 3.01 (0.03) 3.28 (0.04) 0.27 (0.03) P<0.001 3.06 (0.06) 3.13 (0.06) 0.07 (0.06) P=0.19 P = 0.003 Gender 3.02 (0.03) 3.27 (0.04) 0.25 (0.03) P<0.001 3.09 (0.06) 3.14 (0.06) 0 .06 (0.05) P=0.31 P = 0.003 Employment 3.01 (0.03) 3.27 (0.04) 0.26 (0.03) P<0.001 3.07 (0.06) 3.14 (0.06) 0.07 (0.05) P=0.20 P = 0.004 Age, gender, employment 3.02 (0.03) 3.28 (0.04) 0.27 (0.03) P<0.001 3.06 (0.06) 3.12 (0.06) 0.06 (0.06) P=0.26 P = 0.002 I enjoy eating a meal with others6 3.51 (0.02) 3.60 (0.03) 0.09 (0.03) P = 0.01 3.47 (0.39) 3.55 (0.05) 0.07 (0.05) P=0.16 P = 0.81 Age 3.51 (0.02) 3.60 (0.03) 0.09 (0.03) P=0.004 3.47 (0.04) 3.54 (0.04) 0.07 (0.05) P=0.17 P = 0.75 Gender 3.52 (0.02) 3.60 (0.03) 0.08 (0.03) P = 0.01 3.47 (0.04) 3.54 (0.04) 0.07 (0.05) P=0.16 P = 0.83 Employment 3.51 (0.02) 3.60 (0.02) 0.09 (0.03) P=0.004 3.47 (0.04) 3.54 (0.04) 0.07 (0.05) P=0.16 P = 0.76 Age, gender, employment 3.52 (0.02) 3.61 (0.03) 0.09 (0.03) P = 0.01 3.47 (0.04) 3.53 (0.05) 0.07 (0.05) P=0.17 P = 0.75 Consumption behaviours Daily vegetable consumption (serves per day) 2.46 (0.51) 2.97 (0.06) 0.52 (0.06) P<0.001 2.49 (0.09) 2.59 (0.10) 0.10 (0.10) P=0.30 P<0.001 Age 2.46 (0.05) 2.98 (0.06) 0.52 (0.06) P<0.000 2.55 (0.09) 2.60 (0.10) 0.06 (0.10) P= 0.51 P<0.001

300








Gender 2.47 (0.05) 2.99 (0.06) 0.52 (0.06) P< 0.000 2.48 (0.09) 2.57 (0.10) 0.09 (0.10) P=0.36 P<0.001

Employment 2.48 (0.05) 2.99 (0.06) 0.51 (0.06) P<0.001 2.50 (0.09) 2.59 (0.10) 0.08 (0.10) P=0.39 P<0.001 Age, gender, employment 2.49 (0.05) 3.00 (0.06) 0.51 (0.05) P<0.001 2.51 (0.09) 2.58 (0.10) 0.07 (0.10) P=0.48 P<0.001 Daily fruit consumption (serves per day) 1.65 (0.04) 1.93 (0.05) 0.28 (0.05) P<0.001 1.61 (0.07) 1.71 (0.08) 0.10 (0.08) P=0.20 P=0.06 Age 1.64 (0.04) 1.92 (0.0) 0.28 (0.05) p<0.001 1.65 (0.07) 1.75 (0.09) 0.10 (0.08) P=0.24 P=0.07 Gender 1.64 (0.04) 1.92 (0.05) 0.28 (0.05) p<0.001 1.61 (0.07) 1.72 (0.09) 0.10 (0.08) P=0.21 P=0.06 Employment 1.64 (0.04) 1.91 (0.05) 0.27 (0.05) p<0.001 1.63 (0.07) 1.73 (0.09) 0.10 (0.08) P=0.23 P=0.07 Age, gender, employment 1.64 (0.04) 1.91 (0.05) 0.27 (0.05) P<0.001 1.65 (0.07) 1.75) (0.09) 0.10 (0.08) P=0.25 P=0.07

Take-away consumption7 0.98 (0.04) 0.77 (0.04) -0.21 (0.04) P<0.001 0.94 (0.06) 0.96 (0.07) 0.03 (0.06) P=0.62 P=0.001

Age 0.98 (0.04) 0.74 (0.04) -0.23 (0.04) P<0.001 0.87 (0.07) 0.92 (0.06) 0.04 (0.06) P=0.48 P<0.001

Gender 0.98 (0.04) 0.73 (0.04) -0.25 (0.04) P<0.001 0.94 (0.07) 0.95 (0.06) 0.02 (0.06) P=0.80 P<0.001

Employment 0.97 (0.04) 0.73 (0.04) -0.24 (0.04) P<0.001 0.90 (0.07) 0.92 (0.06) 0.02 (0.06) P=0.72 P<0.001

Age, gender, employment 0.96 (0.04) 0.73 (0.04) -0.25 (0.04) P<0.001 0.89 (0.06) 0.93 (0.06) 0.04 (0.06) P=0.50 P<0.001

Cooking behaviours Cooking the main meal from basic ingredients7 4.05 (0.08) 4.66 (0.09) 0.61 (0.09) p<0.001 4.16 (0.14) 4.17 (0.16) 0.01 (0.15) P= 0.95 P=0.001

Age 4.05 (0.06) 4.68 (0.09) 0.63 (0.09) P<0.001 4.21 (0.15) 4.23 (0.15) 0.02 (0.15) P=0.89 P<0.001

Gender 4.08 (0.08) 4.71 (0.09) 0.63 (0.09) P<0.001 4.11 (0.14) 4.11 (0.15) 0.00 (0.15) P=1.0 P<0.001

Employment 4.07 (0.09) 4.70 (0.09) 0.63 (0.09) P<0.001 4.16 (0.14) 4.17 (0.15) 0.00 (0.15) P=0.99 P<0.001

Age, gender, employment 4.11 (0.08) 4.72 (0.09) 0.62 (0.09) P<0.001 4.13 (0.14) 4.15 (0.15) 0.02 (0.15) P=0.91 P=0.001

Consumption of ready-made meals at home7 1.06 (0.05) 0.95 (0.06) -0.11 (0.06) P=0.06 1.11 (0.08) 1.21 (0.10) 0.10 (0.10) P0.30 P=0.06

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Age 1.06 (0.05) 0.96 (0.06) -0.10 (0.06) P=0.10 1.05 (0.08) 1.19 (0.10) 0.14 (0.10) P=0.18 P=0.05 Gender 1.06 (0.05) 0.94 (0.06) -0.12 (0.06) P=0.05 1.09 (0.08) 1.17 (0.10) 0.08 (0.10) P=0.41 P=0.08 Employment 1.04 (0.05) 0.93 (0.06) -0.10 (0.06) P=0.09 1.09 (0.08) 1.20 (0.10) 0.11 (0.10) P=0.26 P=0.06 Age, gender, employment 1.04 (0.05) 0.94 (0.06) -0.09 (0.06) P=0.12 1.06 (0.08) 1.17 (0.10) 0.11 (0.10) P=0.28 P=0.08 Consumption of vegetables with the main meal7 4.67 (0.07) 5.06 (0.09) 0.39 (0.08) P<0.001 4.76 (0.12) 4.75 (0.14) -0.01 (0.14) P=0.94 P=0.01 Age 4.67 (0.07) 5.06 (0.08) 0.39 (0.08) P<0.001 4.87 (0.13) 4.82 (0.14) -0.04 (0.14) P=0.75 P=0.01 Gender 4.67 (0.07) 5.07 (0.08) 0.40 (0.08) P<0.001 4.83 (0.13) 4.81 (0.13) -0.02 (0.14) P=0.86 P=0.01 Employment 4.69 (0.07) 5.08 (0.08) 0.39 (0.08) P<0.001 4.84 (0.13) 4.81 (0.13) -0.03 (0.14) P=0.80 P=0.01 Age, gender, employment 4.70 (0.07) 5.08 (0.08) 0.38 (0.08) P<0.001 4.85 (0.13) 4.82 (0.14) -0.03 (0.14) P=0.86 P=0.01 Food Purchasing behaviours and attitudes Total weekly food and drink expenditure (AUD) 8 137.16

(2.72) 135.60 (3.15) -1.56 (2.46) P =

0.53 147.34 (4.68)

151.68 (5.20)

4.33 (3.96) P=0.27 P = 0.21

Age 136.98 (2.63) 136.42 (2.99)

-0.56 (2.44) P = 0.82

144.15 (4.61)

148.26 (5.01) 4.11 (4.00) P=0.30 P = 0.32

Gender 137.25 (2.75) 135.40 (3.14)

-1.85 (2.46 ) P = 0.45

149.03 (4.79)

151.97 (5.22) 2.94 (3.99) P=0.46 P = 0.31

Employment 137.61 (2.63) 136.46 (2.98)

-1.14 (2.45) P = 0.64

144.82 (4.54)

148.52 (4.89) 3.70 (3.94) P=0.35 P = 0.30

Age, gender, employment 136.84 (2.60) 136.31 (2.95)

-0.53 (2.44) P = 0.83

144.96 (4.56)

148.81 (4.95) 3.85 (4.00) P=0.34 P = 0.35

Total weekly fruit and veg expenditure (AUD) 8 20.77 (0.61) 23.28 (0.73) 2.50 (0.63) P<0.001 21.70 (1.06) 22.24 (1.20) 0.53 (1.01) P=0.60 P = 0.10

Age 20.77 (0.60) 23.53 (9.73) 2.76 (0.63) P<0.001

21.28 (1.06) 21.44 (1.21) 0.16 (1.04) P=0.88 P = 0.03

Gender 20.73 (0.61) 23.31 (0.74) 2.58 (0.63) P<0.001 21.92 (1.07) 22.20 (1.23) 0.28 (1.02) P=0.79 P = 0.06 Employment 20.75 (0.61) 23.56 (0.73) 2.81 (0.63) P<0.001 21.33 (1.05) 21.63 (1.20) 0.29 (1.01) P=0.77 P = 0.04 Age, gender, employment 20.66 (0.60) 23.53 (0.73) 2.87 (0.64) P<0.001 21.37 (1.06) 21.66 (1.22) 0.28 (1.04) P=0.79 P = 0.03 Total weekly take away expenditure (AUD) 8 13.17 (0.59) 9.86 (0.69) -3.31 (0.55)

P<0.001 12.395 (1.01)

12.05 (1.13) -0.34 (0.87) P=0.70 P = 0.004

Age 13.17 (0.58) 9.99 (0.60) -3.19 (0.54) P<0.001 11.50 (1.01) 11.26 (1.0) -0.24 (0.88) P=0.78 P = 0.005

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Gender 13.28 (0.62) 9.65 (0.62) -3.63 (0.53) P<0.001 12.47 (1.07) 11.73 ( 1.03) -0.73 (0.86) P=0.40 P = 0.004

Employment 13.22 (0.58) 9.79 (0.59) -3.43 (0.54)P<0.001 11.78 ( 1.01) 11.33 (0.97) -0.45 (0.87) P=0.60 P = 0.004

Age, gender, employment 13.15 (0.57) 9.93 (0.59) -3.22 (0.54) P<0.001 11.56 ( 1.01) 11.07 (0.98) -0.48 (0.88) P=0.57 P = 0.01

I can Prepare a meal from basics that is low in price6 2.99 (0.03) 3.41 (0.04) 0.41 (0.04) P<0.001 3.00 (0.05) 2.97 (0.06) -0.02 (0.06) P=0.71 P < 0.001 Age 3.00 (0.03) 3.40 (0.03) 0.40 (0.04) P<0.001 3.01 (0.05) 2.98 (0.05) -0.02 (0.06) P=0.70 P < 0.001 Gender 3.00 (0.03) 3.41 (0.03) 0.41 (0.04) P<0.001 2.99 (0.05) 2.97 (0.05) -0.03 (0.06) P=0.67 P < 0.001 Employment 3.00 (0.03) 3.40 (0.03) 0.40 (0.04) P<0.001 3.01 (0.05) 2.98 (0.05) -0.03 (0.06) P=0.63 P < 0.001 Age, gender, employment 3.00 (0.03) 3.40 (0.03) 0.40 (0.04) P<0.001 3.00 (0.05) 2.97 (0.05) -0.03 (0.06) P=0.68 P < 0.001 Buying more fruit/vegetables would not be difficult on my budget6a

2.85 (0.03) 2.93 (0.04) 0.08 (0.04) P = 0.06 2.85 (0.06) 2.89 (0.07) 0.04 (0.07) P=0.59 P = 0.60

Age 2.86 (0.03) 2.93 (0.04) 0.07 (0.04) P = 0.10 2.86 (0.06) 2.87 (0.07) 0.01 (0.07) P=0.94 P = 0.43 Gender 2.86 (0.03) 2.93 (0.04) 0.06 (0.04) P = 0.15 2.87 (0.06) 2.90 (0.07) 0.04 (0.07) P=0.60 P = 0.75 Employment 2.87 (0.03) 2.93 (0.04) 0.06 (0.04) P = 0.17 2.85 (0.06) 2.89 (0.07) 0.03 (0.07) P=0.65 P = 0.74

Age, gender, employment 2.87 (0.03) 2.93 (0.04) 0 .06 (0.05) P = 0.16 2.85 (0.06) 2.86 (0.07) 0.01 (0.07) P=0.84 P = 0.58


3.42 (0.02) 3.62 (0.03) 0.21 (0.03) P<0.001 3.43 (0.04) 3.50 (0.05) 0.07 (0.06) P=0.21 P = 0.04

Age 3.41 (0.03) 3.62 (0.03) 0.21 (0.03) P<0.001 3.44 (0.05) 3.51 (0.05) 0.07 (0.06) P=0.23 P = 0.03 Gender 3.41 (0.03) 3.62 (0.03) 0.21 (0.03) P<0.001 3.43 (0.05) 3.50 (0.05) 0.07 (0.06) P=0.19 P = 0.03 Employment 3.41 (0.03) 3.62 (0.03) 0.21 (0.03) P<0.001 3.44 (0.05) 3.50 (0.05) 0.07 (0.06) P=0.24 P = 0.03

Age, gender, employment 3.41 (0.03) 3.62 (0.03) 0.21 (0.03) P<0.001 3.42 (0.05) 3.50 (0.05) 0.07 (0.06) P=0.19 P = 0.05

Social eating Frequency of eating together at home with others9 3.94 (0.07) 4.20 (0.08) 0.24 (0.07) P<0.001 3.97 (0.11) 4.02 (0.13) 0.06 (0.11) P=0.61 P = 0.13 Age 3.93 (0.07) 4.20 (0.08) 0.27 (0.07) P<0.001 3.97 (0.12) 4.08 (0.12) 0.11 (0.11) P=0.31 P = 0.23 Gender 3.93 (0.07) 4.19 (0.08) 0.27 (0.07) P<0.001 4.00 (0.12) 4.07 (0.12) 0.07 (0.12) P=0.51 P = 0.13 Employment 3.95 (0.07) 4.21 (0.08) 0.27 (0.07) P<0.001 3.98 (0.12) 4.08 (0.12) 0.11 (0.11) P=0.33 P = 0.20 Age, gender, employment 3.95 (0.07) 4.21 (0.08) 0.27 (0.07) P<0.001 3.98 (0.12) 4.06 (0.12) 0.08 (0.11) P=0.45 P = 0.15

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Frequency of eating dinner in front of the television9 2.69 (0.08) 2.50 (0.09) -0.19 (0.07) P = 0.01

2.51 (0.14) 2.52 (0.15) 0.00 (0.11) P=0.99 P = 0.17

Age 2.69 (0.08) 2.49 (0.09) -0.19 (0.07) P = 0.01 2.49 (0.14) 2.45 (0.15) 0.01 (0.12) P=0.92 P = 0.14

Gender 2.69 (0.08) 2.52 (0.09) -0.18 (0.07) P = 0.01 2.48 (0.14) 2.48 (0.15) 0.00 (0.12) P=0.98 P = 0.18

Employment 2.69 (0.08) 2.52 (0.09) -0.17 (0.07) P = 0.02 2.46 (0.14) 2.48 (0.15) 0.01 (0.12) P=0.90 P = 0.17

Age, gender, employment 2.70 (0.08) 2.51 (0.09) -0.19 (0.07) P = 0.01 2.44 (0.14) 2.44 (0.15) 0.00 (0.12) P=0.97 P = 0.16

Frequency of eating dinner at a dinner table9 3.12 (0.08) 3.40 (0.09) 0.29 (0.06) P<0.001 3.11 (0.13) 3.09 (0.14) -0.02 (0.10) P=0.86 P = 0.01 Age 3.12 (0.08) 3.40 (0.08) 0.28 (0.06) P<0.001 3.14 (0.14) 3.17 (0.14) 0.03 (0.10) P=0.76 P = 0.03 Gender 3.12 (0.08) 3.40 (0.08) 0.28 (0.06) P<0.001 3.13 (0.14) 3.12 (0.14) -0.01 (0.10) P=0.89 P = 0.01 Employment 3.13 (0.08) 3.41 (0.08) 0.28 (0.06) P<0.001 3.15 (0.13) 3.14 (0.14) -0.01 (0.10) P=0.89 P = 0.01 Age, gender, employment 3.13 (0.08) 3.41 (0.08) 0.28 (0.06) P<0.001 3.17 (0.14) 3.20 (0.14) 0.02 (0.10) P=0.82 P = 0.03 Health and emotional well-being Global self-esteem score10 20.88 (0.22) 22.60 (0.25) 1.73 (0.20) P<0.001 20.46 (0.37) 21.02 (0.42) 0.56 (0.32) P=0.09 P = 0.002 Age 20.90 (0.22) 22.58 (0.25) 1.68 (0.20) P<0.001 20.53 (0.38) 21.07 (0.42) 0.54 (0.33) P=0.10 P = 0.003 Gender 20.85 (0.22) 22.58 (0.25) 1.73 (0.20) P<0.001 20.50 (0.38) 21.12 (0.42) 0.62 (0.32) P=0.06 P = 0.003 Employment 20.94 (0.22) 22.65 (0.25) 1.71 (0.20) P<0.001 20.47 (0.37) 21.05 (0.41) 0.58 (0.32) P=0.07 P = 0.003 Age, gender, employment 20.91 (0.21) 22.62 (0.25) 1.71 (0.20) P<0.001 20.60 (0.37) 21.17 (0.42) 0.58 (0.33) P=0.08 P = 0.004 General health11 2.77 (0.04) 3.11 (0.04) 0.34 (0.04) P<0.001 2.80 (0.06) 2.86 (0.07) 0.06 (0.06) P=0.34 P < 0.001 Age 2.77 (0.04) 3.11 (0.04) 0.34 (0.04) P<0.001 2.83 (0.06) 2.90 (0.07) 0.07 (0.06) P=0.26 P < 0.001 Gender 2.76 (0.04) 3.10 (0.04) 0.34 (0.04) P<0.001 2.82 (0.07) 2.89 (0.07) 0.07 (0.06) P=0.24 P < 0.001 Employment 2.77 (0.04) 3.12 (0.04) 0.34 (0.04) P<0.001 2.83 (0.06) 2.89 (0.07) 0.06 (0.06) P=0.33 P < 0.001 Age, gender, employment 2.77 (0.04) 3.11 (0.04) 0.34 (0.04) P<0.001 2.84 (0.07) 2.92 (0.07) 0.07 (0.06) P=0.22 P < 0.001 Body Mass Index (BMI) 28.86 (0.27) 28.78 (0.28) -0.09 (0.13) P =

0.49 29.71 (0.46) 29.70 (0.47) -0.02 (0.20) P=0.94 P = 0.76

Age 28.86 (0.27) 28.77 (0.29) -0.09 (0.13) P = 0.49 29.50 (0.47) 29.47 (0.49) -0.04 (0.21) P=0.86 P = 0.83

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Gender 28.83 (0.27) 28.74 (0.28) -0.09 (0.13) P = 0.49 29.66 (0.46) 29.63 (0.48) -0.03 (0.20) P=0.90 P = 0.80

Employment 28.90 (0.27) 28.80 (0.29) -0.10 (0.13) P = 0.42 29.56 (0.46) 29.53 (0.48) -0.03 (0.20) P=0.90 P = 0.75

Age, gender, employment 28.85 (0.28) 28.75 (0.29) -0.10 (0.13) P = 0.43 29.54 (0.47) 29.50 (0.49) -0.03 (0.21) P=0.87 P = 0.79

Outcomes within each group and over time were determined by a mixed linear model for repeated measures using all available data at each time point. All means and Standard Errors (S.E) have been rounded to 2 decimal points. Baseline values were not significantly different between groups (independent t tests P<0.05). A significant group x time interaction effect denotes that the response over time differed between groups. 4Scale values are 1-5 (where 1= not at all confident and 5 = extremely confident) 5 6Mean Predicted score indicating level of agreement with statement from a Likert Scale (1=strongly disagree, 2=somewhat disagree, 3=some agree, 4=strongly agree), a Score assignment was reversed. 7times per week. 8Expenditure data was collected in Australian dollars (AUD) on a 7-point scale which was analysed by its midpoints. 9Mean frequency for a typical week was collected on a 6 or 7-point scale which was analysed by its midpoint, with the maximum category being five or more times per week. 10Rosenberg's global self-esteem score (Low self-esteem= 0-14, Normal self-esteem=15-25 and High self-esteem =16-30). 11Perceived general health (Poor=1, fair=2, good=3, very good=4, excellent=5).

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the impacts of jamie™s ministry of food...

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