Table 2 Effects of interventions strategies synthesised by included systematic reviews on measures of fruit and vegetable intake or purchase

    Micha et al., 2018 [55]

Providing (for free or at reduced cost) or increasing the availability (e.g. in cafeterias) of F&V

Domain: Food environment (FE)

Policy area: Economic tools to address affordability and purchase incentives

Five studies had an overall quality score of five; five studies had a score of four; five studies had a score of three; and four studies had a score of two. ^a

Fruit: Increased intake by 0.27 servings/day (95%CI 0.17, 0.36; p = 0.000; I² 78.3%; n = 15 primary studies)

Vegetables: Increased intake (marginally) by 0.04 servings/day (95%CI 0.01, 0.08; p = 0.221; I² 23.4%; n = 11 primary studies)

Combined: Increased F&V intake by 0.28 servings/day (95%CI: 0.17, 0.4; p = <.001; I² 90.2%; n = 16 primary studies)

Y

    Micha et al., 2018 [55]

Food standard policies

Domain: FE

Policy area: Offer healthy food and set standards in public institutions and other specific settings

Three studies had an overall quality score of two; one study had a score of three; and one study had a score of four.^a

Fruit: increased by 0.76 servings/day (95%CI: 0.37, 1.16; p = NR; I² NR; n = 2 primary studies)

Vegetable: Non-significant trend toward increased intake of 0.30 servings/day (95%CI: −0.001, 0.59; p = NR; I² NR; n = 2 primary studies)

Combined: nonsignificant trends toward increased intake of F&V intake of 0.12 servings/day (95%CI: − 0.08, 0.31; p = NR; I² NR; n = 5 primary studies)

Y

    Rochira et al., 2020 [57]

School Gardens

Domain: Behaviour Change Communication (BCC)

Policy area: Give nutrition education and skills

Of the 15 studies assessed using the Cochrane Tool for Quality Assessment 3 were assessed as good quality while 12 scored fair quality. ^b,o

Of the 17 observational studies rated using the STROBE tool, 4 scored intermediate quality and 13 scored good quality. ^{b, o}

“The selected articles demonstrate that children increased F&V daily/weekly intake” (n = 20 primary studies)

Y

    Silveria et al., 2011 [58]

Circular/ nutrition education

Domain: BCC

Policy area: Give nutrition education and skills

Of the 16 primary studies that measured fruit and/or vegetable consumption, four were rated as “quality level A”, nine were “quality level B”, and three were “quality level C”. ^c

“Of the 12 studies that adopted at least two of the three most common components (activities in the classroom, parental development and school feeding policy), 10 presented results that confirm the effectiveness of nutritional education intervention strategies in schools for increased consumption of F&V among children and adolescents.”

Y

    Champion et al., 2019 [46]

School eHealth

Domain: BCC

Policy area: Give nutrition education and skills

The quality of evidence for screen time and fruit and vegetable outcomes immediately after the intervention was deemed to be moderate. ^c

eHealth school-based multiple health behaviour change intervention strategies led to a small but significant increase in fruit and vegetable intake immediately after the intervention (Standardised mean difference (SMD) = 0.11; 95%CI: 0.03, 0.19; p = 0.007; I² 42% n = 7 primary studies). Effects on F&V intake were not sustained at follow-up (SMD 0.07; 95%CI: − 0.01, 0.15; p = 0.07; I² 52% n = 6 primary studies)

?

    Langford et al., 2014 [54]

Health Promoting schools

Domain: FE, BCC

Policy area:

FE: Offer healthy food and set standards in public institutions and other specific settings

BCC: Give nutrition education and skills

GRADE assessment for 23 nutrition trials was ‘Low’. ^{d, o}

Nutrition only intervention strategies were effective on average at increasing reported F&V intake among students (SMD 0.15; 95%CI: 0.02, 0.29; p = NR; I² = 83%; n = 9 primary studies).

Y

    DeCosta et al., 2017 [22]

Cooking lessons/classes (i.e. not solely school-based)

Domain: BCC

Policy area: Give nutrition education and skills

No formal quality assessment.

“Evidence suggests that cooking classes may positively change intake and preference for vegetables and that the effect might be mediated by tasting new F&V. However, based on the little evidence currently available, no conclusions regarding best practise can be made. Additionally, long-term effects have not been investigated.” (n = 6 primary studies)

?

    Hodder et al., 2020 [23]

Child feeding intervention strategies delivered by childcare providers

Domain: BCC

Policy area: Give nutrition education and skills

GRADE for child feeding intervention strategies was ‘Low’.^d, ^o

Child feeding intervention strategies for childcare providers improved fruit and/or vegetable intake of children:

SMD 0.63 (95%CI 0.23, 1.03; p = 0.002; I² 81%; n = 8 primary studies)

Y

    Hodder et al., 2020 [23]

Parent nutrition education intervention strategies delivered in childcare

Domain: BCC

Policy area: Give nutrition education and skills

GRADE for parent nutrition education intervention strategies was ‘Very Low’.^{d, o}

Parent nutrition education did not significantly improve child fruit and/or vegetable intake: SMD 0.43 (95%CI −0.27, 1.13; p = 0.23; I² 84%; n = 2 primary studies)

?

    Hodder et al., 2020 [23]

Multicomponent interventions

Policy domain: BCC

Policy area: Give nutrition education and skills

GRADE for multi-component interventions was ‘Moderate’.^{d, o}

Multi-component interventions delivered in childcare did not significantly improve child fruit and/or vegetable intake: SMD 0.21 (95%CI − 0.07, 0.49; p = 0.15; I² 78%; n = 5 primary studies)

?

    Hodder et al., 2020 [23]

Nutrition education

Domain: BCC

Policy area: Give nutrition education and skills

GRADE for parent nutrition education interventions was ‘Very Low’.^{d, o}

Parent nutrition education interventions delivered at home did not improve child F&V intake: SMD = 0.07 (95%CI −0.14, 0.27; p = 0.52; I² 68%; n = 5 primary studies)

?

    Hodder et al., 2020 [23]

Child feeding intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

GRADE for child feeding intervention strategies was ‘Low’.^{d, o}

Child feeding intervention strategies targeting parents significantly improved child F&V intake: SMD = 0.46 (95%CI: 0.13, 0.79; p = 0.007; I² 68%; n = 4 primary studies)

Y

    Hendren et al., 2017 [50]

Cafeteria intervention strategies

Domain: FE, BCC

Policy area:

FE: Standards in other specific locations; Nutrition label standards and regulations on the use of claims and implied claims on food; Use economic tools to address food affordability and purchase incentives BCC: Inform people about food and nutrition through public awareness

Of the 14 primary studies reporting significant results, five were rated as high-quality, six as moderate-quality, and three as low-quality.^k

“There appears to be a moderately strong association toward a positive impact of cafeteria intervention strategies to increase fruit and/or vegetable consumption. Of the 18 studies in the review, 13 reported a statistically significant increase, one reported a significant decrease, three reported mixed results, and one did not assess a change in consumption.”

Six studies assessed long-term follow-up and reported mixed results

Y

    Feltner et al., 2016 [48]

Total Worker Health (TWH) program (“target e protection from work-related safety and health hazards with prevention efforts)

Domain: BCC, FE

Policy area:

BCC: Give nutrition education and skills FE: Offer healthy food and set standards in public institutions and other specific settings

All three RCTs that measured changes in fruit and vegetable intake, were rated as have a low strength of evidence.ⁿ

“Three RCTs (all from the same research team) … measured changes in fruit and vegetable intake among US manufacturing or construction workers who were randomly assigned to a multicomponent integrated intervention or no intervention. Evidence from these three RCTs supported the effectiveness of TWH intervention strategies compared with no intervention for improving fruit and vegetable consumption over 26 to 104 weeks.”

Y

    Patnode et al., 2017 [56]

Counselling - individual or group; via in-person, telephone, web-based, text message, and/or print mailing

Domain: BCC

Policy area: Nutrition advice and counselling in healthcare settings

Of the 26 primary studies reporting fruit and vegetable intake, three were rated as ‘good’ quality and the remaining 23 were rated as ‘fair’ quality.^e

“… Between-group differences in the mean change of fruit and vegetable intake ranged from −0.2 servings/day (favouring the control group) to 2.2 servings/day (favouring the intervention group) at 6 months to 1 year of follow up. All six trials that focused dietary messages exclusively on increased fruit and vegetable intake found statistically significantly greater benefit among intervention versus control participants” (n = 26 primary studies)

Y

    Hendrie et al., 2017 [51]

After school community-based nutrition education and skill based programs for children and/or families

Domain: BCC

Policy area: Give nutrition education and skills

Three studies were rated as weak quality and one was rated as moderate quality.^{i, o}

Of the four primary studies assessing children’s vegetable intake, two studies assessed longer-term effectiveness (6 months) on children’s vegetable intake. One of two trials of after school programs were effective in the longer-term (6 months)

?

    Rodriguez et al., 2019 [26]

Any eHealth intervention (i.e. includes the use technology to deliver and enhance health services and information)

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

Overall e-Health intervention strategies improved fruit and/or vegetable intake: SMD/Hedge’s g = 0.26 (SE 0.05; 95%CI 0.17, 0.35; p < 0.001; I² NR; n = 19 primary studies)

Y

    Rodriguez et al., 2019 [26]

Computer-based intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

Computer-based intervention strategies improved fruit and/or vegetable intake: SMD = 0. 44 (SE 0.08; 95%CI NR; p < 0.001; I² NR; n = 3 primary studies)

Y

    Rodriguez et al., 2019 [26]

SMS intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

SMS intervention strategies improved fruit and/or vegetable intake: SMD/Hedge’s g = 0.41 (SE 0.10; 95%CI 0.21, 0.61; p < 0.01; I² NR; n = 3 primary studies)

Y

    Rodriguez et al., 2019 [26]

Internet-based intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

Internet-based intervention strategies improved fruit and/or vegetable intake: SMD/Hedge’s g 0.19 (SE 0.05; 95%CI 0.09, 0.29; p < .001; I² 42; n = 9 primary studies)

Y

    Rodriguez et al., 2019 [26]

CD-ROM, intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

CD-ROM intervention strategies did not significantly improve F&V intake: SMD/Hedge’s g 0.09 (SE 0.10; 95%CI NR; p > .05; I² NR; n = 2 primary studies)

?

    Rodriguez et al., 2019 [26]

Mobile apps, intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

Mobile-based (app) intervention strategies did not significantly improve F&V intake: SMD/Hedge’s g 0.13 (SE 0.15; 95%CI NR; p > .05; I² NR; n = 1 primary study)

?

    Rodriguez et al., 2019 [26]

Video game intervention strategies

Domain: BCC

Policy area: Give nutrition education and skills

Most primary studies were assessed as being fair quality (n = 12), five as good quality, and two as poor quality.^f

Video game intervention strategies did not significantly improve F&V intake: SMD/Hedge’s g 0.08 (SE 0.23; 95%CI NR; p > .05; I² NR; n = 1 primary studies)

?

    Afshin et al., 2015 [43]

Media

Domain: BCC

Policy area:

Inform people about food and nutrition through public awareness

No formal quality assessment.

“Several studies suggest potential effectiveness of mass media campaigns as a stand-alone intervention. These have shown temporal improvements in consumption of specific dietary factors, especially increased F&V …” (n = 5 primary studies)

Y

    DeCosta et al., 2017 [22]

Choice Architecture strategies in school food service, tuck shops and vending machines

Domain: BCC

Policy area: Public awareness, mass media and informational campaigns and social marketing on healthy eating

No formal quality assessment.

“In school settings, choice architecture and nudging have been shown to positively increase selection and overall consumption of fruits and vegetables in the short term. However, evidence for long-term benefits is sparse.” (n = 7 primary studies)

?

    Carter et al., 2018 [45]

Information based cues

Domain: BCC

Policy area: Inform people about food and nutrition through public awareness

Of the three primary studies undertaken in supermarkets, two were assessed as high risk of bias and the remaining study at unclear risk.^{c, o}

“In relation to supermarkets, two of the three included studies observed significant increase in sales of fruit and vegetables.” (n = 3 primary studies)

?

    Hsiao et al., 2019 [53]

Mobile Produce markets (MPM)

Domain: Food system

Policy area: Harness supply chain and actions across sectors to ensure coherence with health

All four primary studies assessing fruit and/or vegetable intake received a quality score of two. ^j

Positive associations were observed for all five studies that assessed the relationship between Mobile Produce Markets (MPM) use and fruit and/or vegetable intake. “Overall, intervention primary studies (n = 4) found consistent increases in reported vegetable intake and in combined reported fruit and vegetable intakes during the study periods among MPM users, with greater changes observed in vegetable intake.”

Y

    Hollis-Hansen et al., 2019 [52]

Farmers markets

Domain: Food System (FS)

Policy area: Harness supply chain and actions across sectors to ensure coherence with health

No formal quality assessment.

“Two of five primary studies of new farmers markets reported improvements in F&V intake ranging from −0.70 to + 0.70 cups/day and Cohen’s d effect sizes ranging from 0.15 to 0.38. “

“The remaining three primary studies report findings graphically or with frequencies, and these suggest improvements in F&V consumption although insufficient data are available to draw a conclusion.”

?

    Hollis-Hansen et al., 2019 [52]

Retail supermarkets

Domain: FS

Policy area: Harness supply chain and actions across sectors to ensure coherence with health

No formal quality assessment.

“None of the four retail supermarket primary studies reported a positive impact on F&V consumption. Two of the primary studies reported statistically significant inverse findings that suggest the introduction of a new retail supermarket may have decreased F&V consumption, with a third study also reporting an inverse finding that was not statistically significant.”

X

    Girard et al., 2012 [49]

Household food production

Policy domain: Food system

Policy area: Community food production (directly mapped to home-based gardening strategies)

GRADE for the five primary studies assessing fruit and vegetable intake was low to very low.^d

“In general home gardening strategies both with and without animal production improved … the consumption of vitamin A (VA)-rich fruits and vegetables. Findings for VA-rich foods were consistent regardless of whether the home gardening strategy included an animal production component.” (n = 5 primary studies)

Y

    Afshin et al., 2017 [44]

Subsidy

Domain: FE

Policy area: Use economic tools to address food affordability and purchase incentives

Used CDC Community Guide grading system: ‘Strong Evidence, Strongly Recommended grade’.^g, ^P

A 10% price decrease increased consumption of fruits and vegetables by 14% (95%CI: 11 to 17%). (n = 9 primary studies)

Y

    Cornelson et al., 2015 [47]

Tax/price increase

Domain: FE

Policy area: Use economic tools to address food affordability and purchase incentives

Of the 24 primary studies with fruit and vegetable outcomes, 41.2% were classified as ‘replicable’.^h

Low income countries

−10% increase in the price of F&V = decrease in F&V 7.2%; p < .001

− 10% increase in the price of meat = increase in F&V 0.05%; p = not significant (NS)

− 10% increase in the price of Fish = decrease in F&V 0.14%; p = NS

− 10% increase in the price of Dairy = decrease in F&V 0.01%; p = NS

− 10% increase in the price of Cereals = increase in F&V.65%; p < .10

− 10% increase in the price of Fats & oils = decrease in FV 0.14%; p = NS

− 10% increase in the price of sweets = increase in F&V 1.12%; p < .001

Middle income countries

− 10% increase in the price of F&V = decrease in F&V 6.5%; p < .001

− 10% increase in the price of meat = decrease in F&V 0.26%; p = NS

− 10% increase in the price of Fish = decrease in F&V 0.79%; p < 0.05

− 10% increase in the price of dairy = decrease in F&V 0.58%; p < 0.05

− 10% increase in the price of cereals = increase in F&V 0.07%; p = NS

− 10% increase in the price of fats & oils = decrease in F&V 0.39%; p = NS

− 10% increase in the price of sweets = increase in F&V 0.34%; p = NS

High income countries

− 10% increase in the price of F&V = decrease in F&V 5.3%; p < .001

− 10% increase in the price of meat = increase in F&V 0.02%; p = NS

− 10% increase in the price of Fish = increase in F&V 0.10%; p = NS

− 10% increase in the price of dairy = decrease in F&V 0.30%; p < .001

− 10% increase in the price of cereals = increase in F&V 0.48%; p = NS

− 10% increase in the price of fats & oils = decrease in F&V 0.33%; p = NS

− 10% increase in the price of sweets = increase in F&V 0.60; p < .001

Y/X