Megan Harrison – Medical Student, Brighton and Sussex Medical School
Joe Tan – Medical Student, Brighton and Sussex Medical School
Harriet Sharp – Medical Student, Brighton and Sussex Medical School
Keziah Kemp – Brighton and Sussex Medical School
Katie Clark – Brighton and Sussex Medical School
James Willans – Brighton and Sussex Medical School
Amaran Cumarasamy – Brighton and Sussex Medical School
Elaine Macaninch – Nutrition Medical Educator and Dietitian, Brighton & Sussex Medical School and Brighton & Sussex University Hospitals NHS Trust
Dr Kathy Martin – Principle Lecturer, University of Brighton School of Health Sciences
Adolescents in the UK face numerous health challenges at a crucial time in their development. Evolving consumer technologies and changing contemporary norms have a significant impact on physical, mental and social development. Evidence suggests that development is particularly precarious for adolescents from lower socio-economic backgrounds. This creates inequalities in their educational attainment, employability, financial security, quality of life and increases their vulnerability to serious health conditions such as heart disease, obesity and mental illness. As an example, in the UK, children in the most deprived areas are twice as likely to be obese than children in least deprived areas .
This set of inequalities challenge how we envisage a just and fair society. With health professionals at the forefront of the patient and community interface, they can play an important role in the prevention of this asymmetric disease burden, working in solidarity with communities to bring about meaningful change, and fostering the evolution of an NHS fit for the health challenges of today and tomorrow.
‘An Apple A Day’ is an interactive, discussion-based, community initiative led by student health professionals to enhance knowledge and health behaviours among adolescents in deprived areas of Brighton. It provides opportunities to improve understanding of nutrition, health and wellbeing whilst developing practical skills, as well as opportunities for mentors to develop their leadership and communication skills.
The programme takes the form of 6 weekly, one-hour sessions, delivered to Year 7 students at Brighton Aldridge Community Academy (BACA) across one school term. The focus is placed on interactive learning, small-group discussion and translating knowledge into practical skills and positive health behaviours.  It has been developed in partnership with the University of Brighton Active Student volunteering platform, members of faculty at Brighton and Sussex Medical School, Brighton and Aldridge Community Academy (BACA), with support from Brighton & Hove City Council, Public Health Team. The sessions cover; what it can mean to be ‘healthy’, the basics of nutrition and a balanced diet, eating smart and positive health behaviours. The final session takes place in the kitchen, consolidating foundation knowledge and developing practical skills in cooking and food preparation. 
So far, the programme has received positive feedback from participants, teachers and mentors alike, and overall the project shows much promise. However, there is a need to review and understand its impact on both the participants and student mentors, and we now plan to carry out a formal programme evaluation in 2019-2020. This would allow us to understand how the programme affects the knowledge, attitudes and practices of the pupils – essentially if it has an impact, and in what way, highlighting areas for improvement and new opportunities for further development.
Measuring the knowledge, practices and attitudes (KAPs) of secondary school children before and after the medical student-led nutrition and health teaching programme ‘An Apple A Day’ as a measure of its implications and efficacy. There are two components to this enquiry:
- a) To assess its efficacy
- b) To explore ways of improving and expanding the programme, and apply this to nutrition teaching in schools.
We will use one of these cycles to do a KAP (knowledge, attitudes and practice) survey on the pupils’ knowledge, attitudes and practice based around the learning objectives of An Apple A Day to measure what kind of effect, if any, the programme has had on the pupils. The surveys will be administered before and after one cycle of the lessons, and will be adapted for the age group. It will be based on a questionnaire, however may take the form of a quiz to keep the children engaged and more likely to fill it out truthfully. A pilot of the questionnaire is likely to be used on the cycle prior to the research.
This service evaluation will be undertaken as part of a student research project, supervised by the AAAD faculty advisors, with support from key contacts including teaching staff at the secondary school.
This evaluation is designed to be minimally resource intensive. The 9-month window for completion will allow ample time for data collection and analysis. We have secured the support of students and faculty at Brighton and Sussex Medical School, the University of Brighton and staff at Brighton Aldridge Community Academy to ensure a robust evaluation within the time available.
With the ‘An Apple A Day’ infrastructure already in place for 2 years, the set up of this evaluation has been straight forward. The organising team have prior experience in conducting focus groups with young people as part of the setting up of AAAD. Resources are in place and we await the approval of the project proposal for commencement of the evaluation in August 2019.
This evaluation will take place between August 2019 to May 2020. Resources have been put in place to ensure progress in line with the project milestones, including data collection and analysis.
Progress made: What have you learned from doing this?
From the delivery of two iterations of project so far, participants have benefitted from tailored and youth-specific small-group discussion and skills development on health and health behaviours. Feedback shows improved awareness and understanding of basic nutrition and health issues and greater enthusiasm for engagement in the issues discussed. Participants have reported greater self-efficacy for more positive health behaviours in the community and at home, including greater input on food shopping and meal preparation.
It has also provided a wealth of opportunities for our medical students including; teaching on health and lifestyle topics, developing youth-specific communication skills, organising and planning the content of the sessions, taking leadership decisions, contextualising child health alongside the Year 4 paediatric placement, and an opportunity to connect with and understand the needs of the local community.
What’s your take home message?
Widening social and economic inequalities are having profound impacts on the health of our population, disproportionately shifting a growing disease burden onto low income groups, limiting opportunities and prospects for a life in good health. With adolescence being such a formative stage for health behaviours, this presents a powerful opportunity for healthcare professionals to work in solidarity to address the impacts of social, economic inequality in deprived communities.
‘An Apple A Day’ recognises a significant role for student health professionals to promote discussion and learning on nutrition, health and wellbeing with youth from deprived communities, reaping numerous possible benefits for both participants and mentors.
A robust service evaluation will help cast a critical and valuable lens on this community-led approach, providing opportunities to understand the efficacy of the project, areas for improvement and other possible avenues of development. 
 NHS Digital: Statistics on Obesity, Physical Activity and Diet – England, 2016. Available from:
 (Giles, E) Disaggregating Young Adults’ Knowledge of Healthy Lifestyle Practices, Centre for Rural Economy, Discussion Paper, Series No. 30, March 2011. University of Newcastle. Available from:
 (Linsday, AC) The Role of Parents in Preventing Childhood Obesity. Future Child, 2006, Spring 16(1): 169-86.