Impact of a one-year school-based teacher-implemented nutrition and physical activity intervention: main findings and future recommendations

Abstract

Background: The aim of the current study is to describe the effectiveness of a school-based intervention when delivered by a non-nutrition specialist (trained schoolteachers) as compared to an expert in nutrition. Methods: Two trials of the same school-based intervention using the same intervention package were delivered, one by nutritionists and another by trained schoolteachers. The intervention focused mainly on dietary behaviours, as well as physical activity. In both trials, purposively selected schools were randomized to intervention or control groups; students (aged 9-11 years) in both groups were compared at post-test on knowledge and self-efficacy scores, as well as dietary and physical activity behaviours, controlling for their baseline status on the various measures. All analyses accounted for clustering at the school level. Results: In both trials, a statistically significantly greater improvement was observed for both the knowledge and self-efficacy scores in intervention vs. school students. When the programme was delivered by trained schoolteachers, frequency of breakfast intake was increased, crisps consumption was reduced, but no change in fruit and vegetable consumption was observed (latter increased when delivered by nutrition professionals only). Physical activity did not improve in both trials. Conclusion: Trained schoolteachers can have a positive impact on students' dietary behaviours with the appropriate training to ensure they are equipped with the right information, skills, and resources to deliver the programme with the highest fidelity. Trial registration: ClinicalTrial.gov Identifier: NCT03040271. Retrospectively registered on 2 February 2017.

The Effectiveness of School-Based Interventions on Obesity-Related Behaviours in Primary School Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…Seven different methods were used to measure PA and SB. Both PA and SB were objectively measured via accelerometer in 13 studies [65][66][67][68][69][70][71][72][73][74] and subjectively measured through self-report questionnaires in 12 studies [58,60,69,[75][76][77][78][79]. One study used a combination of self-report and accelerometers to measure PA and SB [80], and three studies used questionnaires to measure both PA and SB [63,64,81].…”

“…A variety of dietary assessments were employed throughout the 30 articles. Food frequency questionnaires were the most commonly used [57,58,65,66,69,76,77,81,[93][94][95][96]. One study used the digital photography method on three consecutive days to measure food selections and food intake [79].…”

“…There were 35 (71%) multi-component interventions, while others adopted single component and 21 (48%) multi-component interventions targeted a change in PA, SB and nutrition behaviour [56,58,60,[63][64][65][68][69][70]76,[79][80][81][82]91,95,100,101]. Eight (17%) interventions targeted a change in PA and SB [62,67,[71][72][73][74][75]81], and five (9%) interventions targeted a change in PA and nutrition behaviour [57,77,86,87,90]. Intervention strategies included school environment adaptions, interactive drama activities, modified PE lessons, extracurricular PA sessions, gardening, cooking workshops, educational sessions, counselling sessions and provision of further opportunities to be physically active (e.g., active homework, lunch and break time, PA clubs).…”

“…One study used several intervention activities including: classroom lessons, 19 takehome activities, cooking demonstrations, school gardens, family newsletters, health fairs, salad bars, procurement of regional produce and school-site wellness committees [93]. Four interventions did not measure BMI at any time point [72,77,81,82]. One study used a self-reported measurement for height and weight [103]; the remainder of the interventions measured the participants' body weight and height objectively by a member of the research team.…”

“…Twenty-one (44%) studies explicitly reported that the interventions incorporated one or more behaviour change theories (Table 1). These included Social Cognitive Theory [63,64,66,68,77,88,93,99,100], Social Identity Theory [78], the Theory of Planned Behaviour [87,91], Socio-Ecological Model [71,73,93], RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) Theoretical Framework [72,86], the Theory of Triadic Influence and the Comprehensive School Health Program Model [79], Bronfenbrenner's Ecological Model [77] and the analysis grid for environments linked to obesity (AN-GELO) [101]; two studies used a theoretical pathway that was informed by a previous mixed-method study [58,62,65,69]. The remaining studies (n = 27, 56%) did not specify the use of a behaviour change model or theory.…”