Back to the drawing board: broadening health & nutrition measurement approaches in school-based programmes
Minh Phuong La with Cox Bogaards and colleagues working on the School-Based Programme Impact Evaluation Window*
School feeding programmes have long been celebrated for their role in addressing hunger and malnutrition among school-aged children.
However, it is often argued that the benefits extend beyond the provision of meals. Recognizing this, the School-Based Programmes Impact Evaluation Window of the World Food Programme’s impact evaluation unit, sets out to explore the multifaceted outcomes of school feeding initiatives, aiming to shed light on the lesser-studied effects of these programmes.
This blog summarizes our measurement approach across three areas of focus of nutrition and health: nutritional behaviours, physical health, and psychosocial wellbeing. By measuring outcomes beyond food security and diet, we hope to uncover valuable insights and establish a connection between the provision of more diverse meals and children’s overall health and education outcomes.
Measuring nutritional behaviours: A path to healthier choices
School meals can introduce healthier meal options to children, leading to not only direct changes in overall meal composition but also broader shifts in nutritional behaviours, including improvements in children’s eating habits and physical activity levels, particularly when combined with social and behaviour change campaigns.
Surveys can be designed to investigate the types of foods children consume and the frequency of unhealthy choices for their breakfast and snacks. For example, in the impact evaluation in Jordan, we compare children’s outcomes from schools where a new, healthy meal model is implemented against schools with the status quo, where a high-energy biscuit model is distributed.
To measure nutritional behaviours, children are asked whether they brought snacks from home, or plan to purchase snacks from the school cafeteria and whether children opt for healthier snack choices. In addition, we measure children’s average food allowances, consumption habits, and diversity of their food choices. When appropriate, we also capture the time children spent on physical activity, such as walking, cycling, playing and doing sport by using a self-reported child questionnaire or a time-use questionnaire module.
These measurements not only help us document the changes in behaviours following school feeding, but also provides insights into children’s nutritional landscape, allowing programmes to tailor interventions promoting healthier habits among children.
Measuring physical health: Linkage to classroom attendance
School meals may have an impact on a child’s physical health, particularly in areas grappling with food insecurity.
To explore this, we employ two approaches. One approach involves incorporating questions in high-frequency child surveys or household surveys to determine the number of illness-related days experienced by children in a given week. Alternatively, we examine digitized school attendance records to identify sick days and reasons for absences. For example, in an ongoing impact evaluation in the Gambia, we capture attendance of students by days they were present for the full day, present before the break, present after the break, absent, or sick each month.
These measurements can help provide insights into the linkages between school feeding, enhanced physical health, and educational outcomes which may improve if children spend more time in the classroom.
Measuring psychosocial well-being: Connection to holistic development
School feeding programmes may also impact children’s psychosocial well-being. While some evidence hints at positive impacts, rigorous studies are scarce, especially in low-income country settings. To shed light on this aspect, we tap into a set of indicators on children’s well-being including life satisfaction, stress levels, depression, and sense of agency.
To measure life satisfaction, children are asked to rate their well-being on a scale from 0 to 10 using the Cantril ladder and to answer a set of questions from an adapted version of the Diener’s “Satisfaction with Life Scale”. We employ White’s Perceived Stress Scale for children to gauge stress levels. To uncover potential signs of depression, an adapted eight-question version of the depression scale of the Patient Health Questionnaire for adolescents (PHQ-A) is used. Additionally, we measure a child’s sense of agency through adaptations of the Nowicki-Strickland’s Locus of Control scale. These indicators, collected through surveys with children, enable us to document the potential influence of school feeding programs on children’s mental well-being, alongside physical health, and development.
Interested in learning more about our School-based Programming Window? Find our full concept note here.
*Colleagues working on the School-Based Programme Impact Evaluation Window include Astrid Zwager, Benedetta Lerva, Dahyeon Jeong, Florence Kondylis, Erin Kelley, Gregory Lane, Hannah Irmela Uckat, Jonas Heirman, Paul Christian, Roshni Khincha, Simone Lombardini, Thiago De Gouvea Scot de Arruda, research analysts and field coordinators from World Bank DIME, and all the colleagues from WFP Country Offices, Regional Bureaus, and HQ’s School-Based Programmes.
