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Abstract

Non-communicable diseases represent a significant global challenge for public health, and efforts to combat these diseases are therefore constantly increasing. Schools are one of the key settings for the delivery of nutrition and other health interventions, and considerable evidence supports the potential impact of school-based interventions on children’s nutrition and health outcomes. However, studies on the broader effects of these interventions on the parents and other family members are limited. The status of non-communicable diseases in Saudi Arabia is comparable to the global picture in that they account for approximately 73% of all deaths and constitute a great burden on the country’s health system and economy. The first objective of the thesis was to systematically review the available literature on the potential influence of school-based nutrition interventions targeted at school children on the nutrition knowledge, dietary intake, and health outcomes of their parents and other family members. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. The second part of the thesis shifts the focus to Saudi Arabia in particular. As there is currently no instrument available to evaluate the state of nutrition knowledge in Saudi Arabia, the second objective was therefore to develop and determine the validity and reliability of a nutrition knowledge questionnaire for primary school children in the country. The third objective was to assess the current state of nutrition knowledge among female students of the upper primary schools in Jeddah, the second largest city in Saudi Arabia, by employing the validated questionnaire. This information serves as a cornerstone for designing and evaluating school- based nutrition interventions. The findings of the systematic review support the positive impact of school-based nutrition interventions on parental nutrition knowledge. It also found promising but limited evidence suggesting a positive impact on parental health outcomes, and evidence on outcomes relating 75 to dietary intake was equivocal. Furthermore, the findings highlighted the lack of studies evaluating the impact of school-based interventions on family members other than parents and pointed to the need for more systematic assessment to identify intervention characteristics that may strengthen their impact. For the Saudi Arabian context, the questionnaire developed and used for this thesis demonstrated acceptable validity and reliability. The results show that nearly 46% of the participating students have poor levels of nutrition knowledge (scoring below the mean), and three areas were found specifically lacking among the study participants: i. daily recommended intake of fruits and vegetables; ii. sources of fiber; and iii. carbohydrates. The level of nutrition knowledge was higher among sixth graders, followed by the fifth and fourth graders. Additionally, students attending private schools had significantly higher levels of nutrition knowledge than their peers attending public schools. After controlling for school type and grade of participants, school’s educational region and nationality appeared to influence the nutrition knowledge of school children. To conclude, this thesis provides the first steps for developing and assessing school-based nutrition interventions for female upper primary school children in Saudi Arabia. These interventions are found to have positive effects beyond the children themselves (i.e., among their parents) and could help deliver health promotion efforts to a large segment of the population.