First Step – Cooking, Food and Health

Direct work with parents and carers in First Step has been going on since Sept 2011 in each of the four agreed goals of the social marketing group.

The main focus of work since January has been to support and build confidence with cooking and basic skills. Nine people attended food hygiene training in January which enabled staff and parents to take forward cooking demonstration sessions. To date sixteen people have participated in these sessions, getting involved in menu suggestions, sharing the preparation work and the sample the dishes.

At the last steering group meeting staff commented on the changes with some of the young mums.  For example, they noticed during Yummy Mummies group time that some of the mums were looking at recipe books and discussing the meals – something staff said they had never witnessed with this group before. Other examples included the story of a young mum who previous didn’t cook at all and predominately ate take-away food. Since participating in the cooking sessions she has had friends/family over for dinner – which she cooked.

Recently the parents had a Bring a Dish day to celebrate their newly acquired skills and progress. They have also offered to cook a lunch meal for the Social Marketing Steering Group, which the group warmly welcomed.

Work has recently begun with graphics company Creative Link to develop a “Healthy Eating Keepsake”.  This will be a printed folder, with recipes from parents and “Top Ten Tips” suggested by parents and carers designed onto the front of the folder.  Focus groups to generate the Top Ten Tips will be conducted with First Step users and staff.  The idea with the tips is that they are short pieces of advice around healthy eating – breakfasts, snacks, cooking or general parenting, mealtime and other eating issues, but very much in the parents and carers own words.  The aim is to have the product completed and available by June so they can be given to First Step users at an end-of-term event.

The Steering group is now identifying ways to share the learning from the pilot project.  One of the ideas is to present at the local Health Bites seminar.

A final report will be produced and disseminated widely including a link to it on this blog.

Breakfast & Snacks at First Step

First Step Social Marketing Survey June 2011


The Survey

In June 2011, an informal survey which gathered information on people’s current breakfast and snacking habits took place at First Step community project. Fifty-nine people took part in the survey of which 53 people were previous or current users of First Step Services

  • 38 people were survey at the First Step 21st Birthday Gala on 4th June 2011
  • A further 21 First Step users were surveyed when they attended First Step groups in the 3 weeks following the Gala



The findings showed some differences in eating habits between children and adults, particularly in relation to breakfast.

It revealed that 52% of adults had breakfast seven days a week compared to 88% of children.

27% of the adults surveyed ate breakfast three times a week or less with 3% not eating breakfast at all. Only 2% of children had breakfast less than three times a week and there were no reports of children missing a breakfast.

The survey findings taken at the First Step Gala suggested that the frequency and type of food consumed appeared to vary at weekends compared to week days. This was more noticeable with adults. On the day of the Gala, which was a Saturday,   people were asked if they had had breakfast that day. 71% of adults and 100% of children reported eating breakfast.  Anecdotal evidence from the researchers, reported a change in type of food described by people when asked about a typical breakfast meal. Pancakes, Croissants and fry-ups were described as weekend treats for breakfast.

Findings from those surveyed on a weekday revealed that frequency of adults consuming breakfast was slightly higher at 76% and remained the same for children (100%).

The most popular breakfast food for both adults and children was cereal, followed by porridge and then toast. Fourteen different types of cereal were named by parents with slightly less for children although the popular brands for children were typically sweeter varieties such as Coco Pops, Shreddies, Frosties, Cheerios and Cocowheels.

Croissants, pancakes, eggs, fruit, yogurt and cereal bars were other food items that featured on both parents and children’s typical breakfast foods. A cooked breakfast of some variety was more common in the adults’ responses.


In relation to snacking, there were also some small differences. 15% of adults reported not snacking on the previous day compared to 3% of children. The children not having a snack were not old enough to eat solid foods. Adults described slightly less snacks in a day than the responses for children.

The range of snack consumed by adults and children was relatively similar for example, crisps, chocolate, biscuits and fruit. Fruit appeared to be a popular snack choice with children but was often described alongside other snacks, such as, “apple and crisps” or “chocolate and fruit”. Cereal bars were also a frequent snack choice for children.

The survey provided a useful insight into the breakfast and snacking habits of First Step users. Caution should be taken in interpreting or applying this data out with this context.


Report produced by

Morag Nicholson, Senior Health Promotion Specialist

July 2010

(Revised November 2011)


Want to know about the difficulties faced by some people in eating healthily?  Then read the attached report on Food Practices among Mothers of Young Children by Dr Jeni Harden, Dr Adele Dickson, Ms Naomi Mason

Food practices among mothers of young children – a preliminary report

This report sought to develop an understanding of food practices in socio-economically disadvantaged families.  There is a complex interplay between social constraints and individual lives which shapes food practices in the home.  This study identified multiple, interlinking social factors which shape parents’ food practices and so which shape young children’s eating behaviour.  At a societal level, effective policy and practice should therefore seek to address the wider contexts within which food practices are experienced by those living near to or below the poverty line.  It is recognised that this is both a very long term goal and one that has proved challenging for successive governments therefore more focussed recommendations can also be offered from the main findings.

Parents have knowledge of healthy eating practices, but are restricted by their financial and social circumstances

All the mothers in the study had a sound knowledge of what food they ‘should’ be providing for their children.  The limitations to practising this ideal were both financial and social.  To address the issue of cost and time, more advice on preparing quick meals on a budget could be offered.

Children are not the passive recipients of food

The mothers described ways in which children, from a very young age, were are able to influence and sometimes dictate what food they were eating.  Policy relating to healthy eating needs to recognise the role that children play, both in terms of children’s rights within the family, but also as part of the challenges faced by parents.  More support around parenting strategies in relation to food may prove useful to parents.  This could be addressed in the context of pre-school provision, working with both parents and children together.

Food practices are transmitted through generations

Most of the mothers described the ways in which their own childhood experiences with food had shaped their own practices as parents.  However this awareness of the links to their own past, did not seem to alert them to the potential difficulties in maintaining a ‘do as I say not as I do’ practice in relation to food.  Advice and services could be targeted to parents on the issue of their own diet in relation to the longer term implications for themselves and for their children.

The significance of age

There were little differences found in the study between the younger mums and the older mums.  Most of the issues were shared across both groups and the age of the mother did not appear to be significant in shaping food practices.

Delivering on Early Years

A conference at the National Museum of Scotland on the 7th March organised by Holyrood saw a range of speakers from across theUK and panel discussions on a wide range of topics of interest to professionals with an interest on improving and promoting early years care.

Human Connections

The day was ably chaired by Tam Baillie, Scotland’s Commissioner for Children and Young People and was started off with a look at human interconnections and the connected baby with a moving and heartfelt presentation by Dr. Suzanne Zeedyck who used and promoted her new video “The Connected Baby” (

This was followed by illustrative case studies on the importance of attachment from Paul Gilroy of Crossreach (Paul Gilroy Crossreach) and on working with communities by Mary Glasgow of Barnardos Scotland (Mary Glasgow Barnardos)

The Policy Context

The second part of the morning focused on the wider policy context and was kicked off by Councillor Isabel Hutton, COSLA Spokesperson for Education, Children and Young People.  Cllr Hutton emphasised the importance and centrality of the early years acrossScotlandin order to make a long term positive difference toScotland’s future.  This was followed by an interesting panel discussion and Q&A session with a range of participants form Health, Education, Local Government and the Third Sector.

Funding Opportunities and Challenges

The afternoon began with a session focused on funding with input form and a panel discussion with representatives from the Scottish Community Foundation, Inspiring Scotland and the Big Lottery Fund.  Much useful information was shared on the mechanisms, procedures, priorities and thinking behind some of the more substantial grant funders inScotland.

Making it Happen in Nottingham

Katy Ball Nottingham

The final session of the day looked at howNottinghamhas succeeded in rebranding itself as an earlyInterventionCitywith a full and interesting presentation from Katy Ball the Head of Early Intervention and Market Development with Nottingham City Council.  She illustrated how Nottingham had turned around a series of negative aspects of a city with high levels of deprivation and associated problems to one where an Ofsted Inspection recently said that Nottingham has…”an extensive and outstanding range of early intervention services, making a marked shift with vulnerable children and families”.  This was achieved with an extensive basket of early intervention programmes starting from:

  • universal services offered to all (Healthy Child Programme);
  • moving on up to proportionate universal services offered widely but pushed towards certain groups (Baby Massage);
  • then on to targeted work with specific groups (Family Nurse Partnership);
  • and on finally up to highly specialised programmes working with high end/high cost groups to reduce costs and intergenerational impact (Family Intervention Project)

Making it Happen in Nottingham in Northumberland

Jane Casson Northumberland

Katy was followed by a very inspirational speaker, Jane Casson MBE, a Locality manger for Sure Start Northumberland.  She detailed how a range of rather unexpected partnerships developed across her patch with shared services and often co-location of services such as:

  • Sure Start family centres
  • Ambulance Service
  • Community Transport
  • Environment Agency
  • GP Support Services
  • Midwifery Services
  • Probation Services
  • Local Community Charities

This wide range of close partnership working and facilities sharing has led to very significant cost savings as well as a range of concert positive outcomes for individuals, families and communities including:

  • Reduction in smoking.
  • Reduction in 0-3 admitted to A&E.
  • Safety information available for all families.
  • Training in health and safety and basic first aid available to all families.
  • Reduction in house fires.
  • Reduction in casualty / fatality figures.
  • Home Fire Safety message to hard to reach groups.
  • Address the community safety agenda.

John Boyce / Ann Hume

Public Health Practitioner / Manager

East Lothian Community Health Partnership / Olivebank Children & Families Centre, Musselburgh


Children and young people’s mental health indicator set

A set of national mental health indicator for children and young people in Scotland has been established.  This complements the mental health indicator set for adults.

Launched at an event at the Glasgow Royal Concert Hall on 25 November 2011, the children and young people’s mental health indicators cover both the state of mental health (mental wellbeing and mental health problems) and the associated contextual factors. They are structured under two constructs (categories):

  • High level constructs of mental health status – outcome measures
  • Contextual constructs – covering the risk and protective factors and the consequences of mental health. These are structured within five domains: individual, family, learning environment, community and structural.

The indicators provide for the first time a means of assessing and monitoring the mental health of Scotland’s children and young people over time and will enable the development of the first national mental health profile for children and young people (aged from pre-birth to 17 years). Updated every four years, the profile will result in a greater understanding of the current and changing picture of mental health within this population and the factors that influence it.

The final briefing paper (2011) provides a summary of the output from the work including the indicators, their measures and associated data sources and recommendations.

The final report on the indicators, which describes in detail the background to the work, the process undertaken in creating the indicators, the rationale and an overview of the evidence-base for the indicators as well as the indicators themselves and their data sources and the recommendations in full, will be available here shortly.

A next step is reporting on the indicators to create a national mental health profile. NHS Health Scotland is currently producing an update of the adult mental health profile. When this is completed in spring 2012, work on the children and young people’s mental health profile will follow.

Launch Presentations

The children and young people’s mental health indicator set for Scotland was launched on 25 November 2011. The programme for the event included presentations by:

Future steps


If you have comments on the indicators project or require further information please contact Jane Parkinson –

First Step Social Marketing Project


First Step Community Project with backing from Support from the Start are piloting a practical example of using a social marketing approach within a community based early years organisation. The aim is to develop capacity within a group of parents and grandparents to identify and respond to their community health needs in the early years. The project will utilise the expert knowledge of the parents and grandparents to develop appropriate intervention for health improvement.  At an early stage the food and health was chosen as a focus.

Who’s involved?

We have worked with service user from various groups who attend First Step which has included our Young Mums Group (yummy mummies) grans group, me time group (mums from all the areas of the project), Wednesday Group (families affected by substance misuse), Dad’s Work, parents who use the playrooms and staff to try to identify and respond to community health needs in early years.

After an attempt to get a “voices” or champions core group together, we realised that at the early stage both staff and those in the community were uncertain and unclear about what social marketing meant.

Health Survey

To raise the profile of the project and to try to enter into meaningful debate with the all service users we then carried out a health survey. This was collated using Survey Monkey. In the introduction to this survey we brought together the gran’s group and the “me time “group for a discussion to give us an intergenerational insight into their thoughts about health. We also had a discussion with the young mum’s group. There were 55 respondents in total to the survey.

Once this was collated we brought the Me-time and Grans Group together again to discuss the findings from the survey. The discussions and feedback of this focus group was videoed.

Social Marketing

Around this time two members of the steering group attended a three day training course, delivered by NHS Tayside and the National Social Marketing Centre as part of the Scottish Government Social Marketing pilot. This training was helpful in understanding the principles and processes of the Social Marketing approach. The learning from this was shared by providing training to First Step staff during an in-service day.

Scrapbook Project

As part of a wider project Support from the Start were asking groups to complete a Scrapbook and take photographs in response to the question “Does the physical space of our communities contribute to creating good health in the early years and support parents in raising healthy children”? First Step participated in this activity with input from five families.  A session was arranged with Jane, Tina and Morag from the Steering Group and parents who had taken part in this project. Various insights were gleaned from this process and the discussions that took place reflected common themes. The group successfully put together a scrapbook which was then presented at a wider community event.

Nutrition in Young Mums

Around the same time and independent of the Social Marketing project, Dr Jeni Hardin, Senior Lecturer at Napier University approached First Step to interview young mums as part of her research into nutrition. The findings from this preliminary research were presented to the steering group and copies of the report made available


Focus on Food

Information from the survey, focus groups, the Scrapbook and Dr Hardin’s research provided insight into local health concerns and informed the priority issue for the social marketing approach. The evidence from these scoping activities identified food and health as the focus for the social marketing project.


A New Concept

One of the difficulties about this project was that social marketing was a relatively new concept for staff, steering group members and First Step parents and grandparents. It has taken time to develop an understanding and agree how best to proceed. Additionally there have been changes and transition of staff within our organisation so it felt that we were always on catch up.

The initial proposal for a small group of First Step users to take this forward did not work because it was difficult to communicate what they were required to do. However in working this through in other ways we now have a core of parents who are interested in taking this forward.

Family Engagement

Unique to our approach was the involvement of the First Step families to identify the health concern in the first instance. Most other social marketing projects are set a health challenge from policy or research e.g. a “top-down” issue. It has been time consuming to reach this point however the steering group was comfortable with the “bottom-up” approach that we had to adopt from the start as it was in keeping with the underpinning social marketing principle of “customer orientation “.

Wider Involvement

The local community have been involved in all aspects as described above and based on the insight gained through this involvement it has been agreed that “food and health “ will be the issue to take forward and work with.

Next steps

Drawing from all the information we will be setting behavioural goals around food and health. We are finalising the statements to make them more user friendly, but the overarching goal will be to maintain and improve healthy food practices amongst First Step users.  The draft sub goals are:

  • To start the day with a healthy breakfast
  • To replace one unhealthy snack a day with a healthy snack
  • To be able to cook more healthier meals on a budget
  • To be able to cook more meals from scratch
  • To learn to share parenting strategies around food and children
  • To understand the relationship between adult (parent) food practices and their children’s food practices

We plan to use participatory appraisal techniques to test the phrasing and interest in these behavioural goals. We are also considering what baseline information we need to gather. We hope to tie some of this work into the First Step 21st birthday celebrations.  Following this the identification, development and implementation of “interventions” to achieve the behavioural goals will go ahead.  The Steering group is considering appropriate means to map existing food and health activity, services and information.

Fact & figures

55 respondents to survey
20 Me time and grans focus groups X 2 sessions
9 yummie mummies focus group
8 young mums in research
5 Scrapbooks
Training for staff
5 young mums at Cooking Bus
12 staff attended in-service training on Social Marketing Approach

Financial report

The funds were allocated to:

  • Part of salary cost
  • Additional hours for other key members of staff.
  • Crèche facilities for focus groups.
  • Staff training

Dental Health in Wallyford & Whitecraig

Early year’s dental health is one focus for Support from the Start in Whitecraig and Wallyford.  Part of this focus is to examine the current and ongoing dental health status of all three year olds in these areas.

Following detailed dental inspections carried out earlier this year on 3-year-old children seen at Whitecraig and Wallyford 33% of children were found to be affected by tooth decay.  

These findings confirm that, although the majority of children have as yet no experience of caries, for some children the presence of dental caries is already well-established by the time they reach three years of age.

What is being done locally to address this issue?

  • Local nurseries are getting an extra morning each for dental health promotion with new materials (see example above) and information packs for children and parents available.
  • Tooth varnishing has been rolled out in the targeted areas allied with encouragement to enrol with a dental practice.
  • There is additional dental health promotion work underway in playgroups and toddler groups and tooth brushing schemes in P1&P2
  • Local dental practices are being encouraged to become Childsmile practices.

Changexchange – Evaluating the Impact of Support from the Start

Changexchange is a collaborative research project consisting of practitioners from NHS Lothian and East Lothian Council working alongside academics from Queen Margaret University. Those involved are John Boyce, NHS Lothian, Ann Hume, East Lothian Council, Prof Kirsty Forsyth and Donald Maciver, both Queen Margaret University.

The overall aim of Changexchange is to understand how communities deliver sustainable change to reduce health inequalities in early years.

Many initiatives have developed under the auspices of Support from the Start, each with a focus on addressing the health and well-being of some of our youngest children and their families. The main aim has been to facilitate and enable mainstream services to deliver support in a different way and share the learning from this.

The key to ensuring long term change in service delivery is to establish what has made a difference both to practitioners and to those who are in receipt of the service.

The Changexchange project will seek to evaluate the impact of these initiatives by identifying changes which have taken place both within families, practice and service delivery. Information will be gathered by a variety of research methods including questionnaires, focus groups and individual interviews.

The output from this research will highlight changes which have taken place within families, staff, communities and organisations, detailing examples of good practice where appropriate, and will be used to inform future service delivery.

The methodolgy used to gather this qualitative data will involve questionnaires issued to all our champions, individual interviews with a selection of champions, and focus groups involving participants in some of the change initiatives.

The first stage in this process has involved gathering information on “Good News Stories” which are initiatives that are already having an impact. These are attached below in one document.

We are about to launch into our data gathering phase so will be kept very busy over the coming 3 months.