Effectiveness evaluation of a health promotion programme in primary schools: a cluster randomised controlled trial

Abstract

BackgroundProgrammes based on the World Health Organization’s Health Promoting Schools framework (HPS) have been implemented in several countries but for evidence-based policy-making more research is required to determine the effectiveness of the HPS approach.MethodsWe conducted a cluster randomised controlled trial. The units of randomisation were primary school classes recruited in May 2010. Eligible participants were Year 3 primary school classes in Lower Austria that had not participated in a similar programme during the last two years. After baseline assessment in September 2010, 53 classes from 45 primary schools in Lower Austria were randomly assigned to an intervention (n = 26 classes, 432 children) or waiting control arm (n = 27 classes, 493 children aged 8.7 years +/- 4 months). Over the course of 1.5 academic years, participating teachers received on-the-job training (20 h) and two workshops (8 h) to promote health related behaviour in students such as physical activity during the school day and to improve the quality of regular physical education classes. We assessed 15 outcomes grouped into five categories: Emotional and Social Experience in School, Physical Activity, Well-being, and Attention Performance measured by validated and standardised questionnaire and Motor Skills measured by validated and standardised motoric and coordination tests in the school gym. The primary outcome was Classroom Climate and part of the outcomecategory Emotional and Social Experience in School. The final assessment took place in April 2012. All assessors were blinded to the allocation of classes. Multilevel growth modelling was used to investigate programme effectiveness.ResultsWe could not detect any statistically significant differences between groups for the outcomecategories Emotional and Social Experience in school (p = 0.22 to 0.78), Physical Activity, Well-being, and Attention Performance. Significant differences between groups were limited to the outcomecategory Motor Skills (Complex Reaction Ability, Spatial Orientation Skills, Coordination with Precision) which were higher in the intervention group (P < .05).ConclusionsDespite small statistically significant differences in Motor Skills, our study could not detect any clinically relevant improvements in the Emotional and Social Experience at School (including the primary outcome ClassroomClimate), Physical Activity, Well-being, Motor Skills and Attention Performance of students.Trial registrationGerman register of clinical studies: DRKS00000622. Retrospectively registered: 03.12.2010. Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107-2010).

Pathways leading to success and non-success: a process evaluation of a cluster randomized physical activity health promotion program applying fuzzy-set qualitative comparative analysis

“…In addition, we assessed 14 other outcomes grouped into the categories: emotional and social school-experience, self-reported physical activity, well-being, and attention performance. Overall, the cRCT showed small statistically significant differences in three different motor skills, but could not detect any relevant changes in the primary outcome or the other twelve outcomes [32].…”

“…All classes were selected for the analysis process. Details on design and the results of the evaluation of the program's effectiveness can be found elsewhere [32]. The flow of the school classes and participants through the study are depicted in Fig.…”

“…We embedded our process evaluation in a cluster randomized controlled trial (cRCT) assessing an integrated school-based health promotion program for physical activity, called Classes in Motion [32]. The Swiss Model for Outcome Classification [33] assisted in developing clear goals of the intervention and clarifying the primary outcome.…”

“…The process evaluation focused on multiple influencing factors based on a theoretical model and explored which combinations of contextual factors and characteristics of the implementation process affected the participating primary school children's emotional and social school experience including the primary outcome, the classroom climate. As the program did not lead to a statistically significant improvement of the primary outcome [32], a detailed analysis process should reveal which influencing factors led to an intervention and/or an implementation failure.…”

SALTO - Study Protocol and Rationale of a Community-Oriented Obesity Prevention Program in the Kindergarten

“…Evidence has shown that obesity prevention programs in schools have minimal effects on a few obesity inducing components, but no impact on the prevalence of obesity [10,11,12]. In contrast, prevention strategies targeting the community seem to be beneficial in reducing the prevalence of obesity over time, as shown in obesity prevention programs using the EPODE methodology [13,14,15].…”