Increasing Intake of an Unfamiliar Vegetable in Preschool Children Through Learning Using Storybooks and Sensory Play: A Cluster Randomized Trial

Abstract

Background: Most children eat fewer vegetables than recommended. Storybooks and sensory play may increase vegetable intake.

Objective: This study tested the effects on intake of learning about an unfamiliar vegetable (celeriac) through storybooks and sensory play. It was predicted that an illustrated, congruent storybook would increase intake of celeriac compared to an incongruent storybook (carrot); and that adding congruent sensory play with celeriac to the storybook would produce a synergistic effect on intake of celeriac.

Design: Children from 12 UK preschools were randomly assigned by clusters to four intervention conditions using a 2×2 factorial design. The factors were vegetable congruency (sensory play and/or storybook were congruent, or incongruent [carrot] with celeriac) and intervention type (storybook only or storybook combined with sensory play).

Participants/setting: Three hundred and thirty-seven children aged 2 to 5 years were recruited to take part in November 2017.

Intervention: Over a 2-week period, children in all four conditions were read a vegetable storybook featuring celeriac or carrot. In addition, two conditions received sensory play with either carrot or celeriac added to the storybook method.

Main outcome measures: Intake of the unfamiliar vegetable (celeriac) was measured at baseline and after the 2-week intervention.

Statistical analysis performed: Complex samples logistic regression and general linear modeling were performed to examine group differences at post-intervention.

Results: Children receiving the congruent (celeriac) storybook had higher odds of eating celeriac compared to children who received the incongruent (carrot) storybook. Receiving congruent sensory play increased the odds of eating celeriac, whereas receiving incongruent sensory play did not. From the 267 children who completed both baseline and post-intervention assessments, 85 ate no celeriac at baseline and were classed as non-eaters. Sensory play (congruent or incongruent) increased the odds of eating some celeriac in non-eaters compared to storybook only conditions.

Conclusions: Congruency between storybook and vegetable increased intake; sensory play with celeriac increased the likelihood of eating celeriac. Storybooks and sensory play are simple interventions to increase willingness to try an unfamiliar vegetable.

Trial registration: ClinicalTrials.gov NCT03400566.

Keywords: Health promotion; Healthy eating intervention; Nutrition education; Sensory learning; Vegetable intake.