Long-term process evaluation of a school-based programme for overweight prevention

Background The epidemic increase in childhood overweight demands effective and also feasible prevention programmes. A school‐based environmental and educational intervention focusing on the promotion of water consumption was found to be effective for overweight prevention in children. Process evaluation and long‐term surveillance are necessary to evaluate the feasibility and sustainability of the intervention programme in a school setting. Methods Process evaluation was conducted during the intervention period (one school year) and a 19‐month follow‐up after the intervention trial on the prevention of overweight in 17 elementary schools. Data were collected through measuring the water flow of water fountains installed in schools, and questionnaires and interviews were administered to teachers and headmasters of intervention schools. Main outcomes were implementation of the intervention components, behavioural modification of the children concerning water consumption, and teacher and headmaster attitudes towards the intervention. Results Eleven out of 17 intervention schools maintained the water fountains until 19‐month follow‐up. The mean water flow of the fountains decreased initially, but remained stable after the during the follow‐up period. The implementation rate of the educational units by teachers varied between the units from 13% to 84%. Teachers graded the overall concept of the intervention as good, continuously during the intervention and follow‐up period. The majority of teachers organized the water supply of the fountains on the class level during the intervention period but not during the follow‐up. Conclusions The long‐term process evaluation showed that the combined educational and environmental intervention has potential for sustained modifications in the beverage consumption habits of children. It also identified barriers and promoting factors of a sustainable and feasible implementation of the preventive programme in a school setting.     

Effectiveness of lifestyle intervention in overweight children

Therapy of choice in obese children and adolescents is lifestyle intervention based on nutrition education, behavioural treatment and exercise treatment. Its efficacy even after the end of intervention has been proven by several randomised-controlled trials and meta-analyses including a recent Cochrane review. However, randomised-controlled trials are likely to overestimate the effectiveness. Studies under normal day-to-day circumstances demonstrated only a very moderate effect on weight loss (<10% success rate 2 years after the onset of intervention). A reduction of >0·5 SDS-BMI (which means a stable weight over 1 year in growing children) is associated with an improvement of cardiovascular risk factors, while improvements of quality of life seem independent of the degree of weight loss. Younger children and less overweight children particularly profit from lifestyle interventions in contrast to extremely obese adolescents. Recent studies demonstrated that involving parents is crucial for success, suggesting that parents and children and not children alone should be the primary target of interventions. Failures in weight reduction are attributed not only to a lack of motivation but also to other aspects particular to the genetic background. The techniques, more than the contents, of an intervention influence the treatment outcome. Besides behavioural therapy, systemic and solution-focused treatments are important. Future longitudinal research should focus on the identification of which children and adolescents profit from which kind of intervention, in order to be able to tailor specific treatment approaches. Studies under normal day-to-day circumstances are necessary to prove the benefit of this kind of intervention.     

Follow-up study of a school-based scalds prevention programme

This paper describes the follow-up evaluation of a school-based scalds prevention programme designed to teach children about scalds hazards and encourage safe family practices. It involved two classroom sessions and a homework exercise that targeted five safety practices. The programme was taught to 28 classes in 14 schools in Waitakere City, New Zealand by Public Health Nurses (PHNs). Children (n = 116) aged 10-11 years from three of the schools in ethnically diverse, low/middle-income areas were assessed for their knowledge of scalds hazards 1 year after the programme. They recalled a mean of 7.46 out of 10 hazards, which was almost equivalent to children in an earlier evaluation who recalled 7.62 hazards immediately after the teaching. Altogether, 65-79% of children reported that each of the four safety items provided were at least temporarily used as intended, with 29-55% reporting that they were still in use 1 year later. Interviews with children's parents (n = 18) indicated that the majority of their hot water practices were not optimally safe prior to the programme and that many had adopted the suggested practices. While the PHNs were positive about the programme, they suggested teachers could deliver it as part of the school curriculum.     

A process evaluation of an injury prevention school-based programme for adolescents

A process evaluation provides critical information that can inform the design and implementation of a programme. This study sought to provide examples of how to operationalize a process evaluation of an effective programme (Skills for Preventing Injury in Youth). A comprehensive definition of process evaluation was used which included assessing dose, adherence, quality of process, participant responsiveness and programme differentiation. Dose was assessed through teacher and student ratings as well as independent observations. Reports from an observer were used to assess adherence to programme objectives, the quality of process including interactive delivery and programme differentiation. Participant responsiveness was assessed quantitatively and qualitatively with students providing greater depth to the findings. Findings regarding dose varied and suggested different sources of reports provided supplementary information. The findings also suggested that independent observations are an important tool for process evaluation and identified challenges for programme designers regarding interactive material. Overall, the research indicated that a comprehensive definition of process evaluation could be operationalized and provided an understanding of an application of a process evaluation to an injury prevention programme. Continued development of process evaluations will enable a better understanding of the conduct of interventions and maximize the likely effect of such interventions.     

A cluster randomised school-based lifestyle intervention programme for the prevention of childhood obesity and related early cardiovascular disease (JuvenTUM 3)

Background  

Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease. The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear, as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function. In this study a comprehensive school-based randomized intervention programme will be investigated in 10-14-year old children addressing the influence of lifestyle intervention on inactivity, cardiometabolic risk factors and early signs of vascular disease.     

Prevalence of hyperinsulinemia and clinical correlates in overweight children referred for lifestyle intervention

Although not well documented in the literature, there is growing evidence that overweight children may develop hyperinsulinemia. Children (n=171) with a body mass index greater than the 85th percentile for age using the Centers for Disease Control and Prevention growth charts for children were recruited through primary care physician offices for a lifestyle change intervention. Laboratory measurements were obtained. About 30% of these children were identified as hyperinsulinemic, using an insulin-to-glucose ratio of > or =33% or a serum insulin > or =25 microU/mL. When compared with non-hyperinsulinemic children, there were significant differences in cardiovascular risk factors. Dietetics professionals providing medical nutrition therapy to overweight children need to be aware of dietary and physical activity recommendations for individuals with marked hyperinsulinemia.     

Economic evaluation of a multi-disciplinary community-based intervention programme for New Zealand children and adolescents with obesity

ObjectiveTo determine whether Whānau Pakari, a home-based, 12-month multi-disciplinary child obesity intervention programme was cost-effective when compared with the prior conventional hospital-based model of care.MethodsWhānau Pakari trial participants were recruited January 2012–August 2014, and randomised to either a high-intensity intervention (weekly sessions for 12 months with home-based assessments and advice, n = 100) or low-intensity control (home-based assessments and advice only, n = 99). Trial participants were aged 5–16 years, resided in Taranaki, Aotearoa/New Zealand (NZ), with a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities. Conventional group participants (receiving paediatrician assessment with dietitian input and physical activity/nutrition support, n = 44) were aged 4–15 years, and resided in the same or another NZ centre. The change in BMI standard deviation score (SDS) at 12 months from baseline and programme intervention costs, both at the participant level, were used for the economic evaluation. A limited health funder perspective with costs in 2016 NZ$ was taken.ResultsThe per child 12-month Whānau Pakari programme costs were significantly lower than in the conventional group. In the low-intensity group, costs were NZ$939 (95% CI: 872, 1007) (US$648) lower than the conventional group. In the high-intensity intervention group, costs were NZ$155 (95% CI: 89, 219) (US$107) lower than in the conventional group. BMI SDS reductions were similar in the three groups.ConclusionsA home-based, multi-disciplinary child obesity intervention had lower programme costs per child, greater reach, with similar BMI SDS outcomes at 12 months when compared with the previous hospital-based conventional model.     

Economic evaluation of a community based exercise programme to prevent falls

OBJECTIVE: To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women. DESIGN: An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were individually prescribed an exercise programme (exercise group, n=116) or received usual care and social visits (control group, n=117). SETTING: 17 general practices in Dunedin, New Zealand. PARTICIPANTS: Women aged 80 years and older living in the community and invited by their general practitioner to take part. MAIN OUTCOME MEASURES: Number of falls and injuries related to falls, costs of implementing the intervention, healthcare service costs resulting from falls and total healthcare service costs during the trial. Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented. MAIN RESULTS: 27% of total hospital costs during the trial were related to falls. However, there were no significant differences in health service costs between the two groups. Implementing the exercise programme for one and two years respectively cost $314 and $265 (1995 New Zealand dollars) per fall prevented, and $457 and $426 per fall resulting in a moderate or serious injury prevented. CONCLUSIONS: The costs resulting from falls make up a substantial proportion of the hospital costs for older people. Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs. However, the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies.     

Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults

OBJECTIVE: To evaluate the effects of a lifestyle intervention and a structured exercise intervention on physical activity in older adults. METHOD: Participants were randomly assigned to a lifestyle intervention (n=60), including an individualized home-based program supported by phone calls, or to a structured intervention (n=60) consisting of three weekly supervised sessions. Results were compared with a control group (n=66). Physical activity was measured with self-report questionnaires, pedometers, and accelerometers before the start (pretest), at the end (11 months, posttest), and after 23 months (follow-up). The study took place in Belgium from March 2004 until April 2006. RESULTS: At posttest, both intervention groups had significantly increased their total physical activity compared with the control group. At follow-up, the lifestyle group showed significantly larger increases in active transportation and total steps than the control and structured group respectively. There were no longer significant differences between the structured intervention and the control group. CONCLUSIONS: The structured and lifestyle interventions were equally effective at the end of the intervention. One year after the intervention the lifestyle group maintained a significant increase in physical activity, which highlights the potential of lifestyle programs in the battle against inactivity in older adults.     

Economic analysis of a school-based obesity prevention program

OBJECTIVE: To assess the cost-effectiveness and cost-benefit of Planet Health, a school-based intervention designed to reduce obesity in youth of middle-school age children. RESEARCH METHODS AND PROCEDURES: Standard cost-effectiveness analysis methods and a societal perspective were used in this study. Three categories of costs were measured: intervention costs, medical care costs associated with adulthood overweight, and costs of productivity loss associated with adulthood overweight. Health outcome was measured as cases of adulthood overweight prevented and quality-adjusted life years (QALYs) saved. Cost-effectiveness ratio was measured as the ratio of net intervention costs to the total number of QALYs saved, and net-benefit was measured as costs averted by the intervention minus program costs. RESULTS: Under base-case assumptions, at an intervention cost of $33,677 or $14 US dollars per student per year, the program would prevent an estimated 1.9% of the female students (5.8 of 310) from becoming overweight adults. As a result, an estimated 4.1 QALYs would be saved by the program, and society could expect to save an estimated $15,887 USD in medical care costs and $25,104 USD in loss of productivity costs. These findings translated to a cost of $4305 USD per QALY saved and a net saving of $7313 USD to society. Results remained cost-effective under all scenarios considered and remained cost-saving under most scenarios. DISCUSSION: The Planet Health program is cost-effective and cost-saving as implemented. School-based prevention programs of this type are likely to be cost-effective uses of public funds and warrant careful consideration by policy makers and program planners.     

Evaluation of a school-based teen obesity prevention minimal intervention

ObjectiveA school-based nutrition education minimal intervention (MI) was evaluated.DesignThe design was experimental, with random assignment at the school level.SettingSeven schools were randomly assigned as experimental, and 7 as delayed-treatment.ParticipantsThe experimental group included 551 teens, and the delayed treatment group included 329 teens.InterventionThe minimal intervention was Present and Prevent, a commercially available PowerPoint program presented in two 30-minute time slots over 1 week.Main Outcome MeasuresThe dependent variables were nutrition knowledge, attitudes, peer and family influences, behavioral intentions, and program satisfaction. The independent variable was group assignment.AnalysesA matched-pairs and 2-sample t test were used respectively to assess within-group and between-group changes.ResultsSignificant experimental posttest improvements occurred in the following: knowledge (P < .001); intention to maintain a healthy body weight because of importance to friends (P < .001); and intention to eat fewer fried foods, eat fewer sweets, look more at food labels, and limit TV watching (all P < .001). Program satisfaction measures were significantly associated with each of the healthy weight maintenance behavioral intentions.Conclusions and ImplicationsThe MI teen obesity prevention program made an impact on nutrition knowledge and positive behavioral intentions in only 2 classroom sessions and was well received by participants.     

Healthwise South Africa: cultural adaptation of a school-based risk prevention programme

There is a need for effective prevention programmes aimed at reducing risk behaviour among South African adolescents. HealthWise South Africa is a school-based programme designed to reduce sexual and substance use risk behaviour, and promote positive use of leisure time among high-school learners (students). Based on successful programmes in the United States of America, HealthWise was developed for use in South Africa and pilot tested in four South African high schools. We carried out a process evaluation to establish the fidelity of implementation and make sure HealthWise was culturally relevant. Data sources comprised focus groups with educators and learners, lesson evaluations and observations, and interviews with school principals. Qualitative analysis of data highlighted pertinent cultural and contextual factors and identified areas for modifying HealthWise in order to promote better programme-consumer fit. These areas centred on time, language, and leisure. We noted a dynamic tension between the educators' desire to adhere to plan, and to make adaptations in accordance with learners' needs and the context. Ultimately, researchers need to find a balance between fidelity of implementation and programme adaptation to obtain effective programmes that are culturally acceptable to local consumers.     

Russian-American partners for prevention. Adaptation of a school-based parent-child programme for alcohol use prevention

BACKGROUND: The Russian-American Partners for Prevention was an adaptation and evaluation of the Slick Tracy Home Team Program which was developed in Minnesota in order to delay the onset of drinking. The Slick Tracy Home Team Program was the first intervention of Project Northland, a large 3 year community trial of the efficacy of a public health intervention for under age drinking. METHODS: The programme was administered through schools, but involved parents using engaging and fun homework activities. The Russian version was implemented in fifth-grade classrooms in 20 Moscow schools with 1,212 students surveyed at baseline. Students were surveyed again after programme implementation (n = 1,182), of whom 980 were present at baseline. Parents of 1,078 students were surveyed by telephone after programme implementation. RESULTS: The results demonstrated the successful recruitment and retention of 20 Moscow schools in a research project, acceptability of programme materials in Russia, high participation rates, changes in students' knowledge about problems associated with under age drinking and some evidence about increases in parent-child communication about alcohol use. As in the USA, no changes in students' alcohol use rates were observed at the end of the first year of the 3 year programme. CONCLUSION: Russian youth, as compared to Americans, began drinking at earlier ages, received fewer prevention messages from their parents, and had fewer prevention programmes in school. The results suggested that carefully implemented and evaluated replications of the US Project Northland interventions might provide effective and appropriate school-based programmes for Russia.     

代谢综合征的早期预防和生活方式干预

代谢综合征(MS)是一种心血管病的多重危险因素在个体集结的状态.其病理基础是胰岛素抵抗,临床表现为:肥胖、高血压、糖调节受损或糖尿病、脂代谢紊乱、高尿酸血症及微量白蛋白尿、持续低度炎症反应及血液凝溶异常等.其中以超重、肥胖、高血压、高血糖和血脂异常4项更为突出而被称之为"死亡四重奏".     

运动干预12周对超重/肥胖儿童内皮细胞功能的影响

探讨12周运动处方干预对超重/肥胖儿童内皮细胞功能的影响,为促进超重/肥胖儿童心血管健康水平提供有效方法.方法 将郑州市某小学69名超重/肥胖儿童随机分为对照组(35名)和运动组(34名),对照组仅参加学校组织的体育活动,运动组在对照组的基础上进行60 min/次、3次/周共12周的运动处方干预(有氧运动+抗阻训练).分别于实验前后利用流式细胞仪测定外周血CD34+(造血干细胞表面标志物)、CD133+(造血祖细胞表面标志物)以及CD34+CD133+(内皮祖细胞)表达量(用阳性细胞率表示),B超检测颈总动脉内膜中层厚度(cIMT),内皮功能—外周动脉张力测试仪测定反应性充血指数(RHI)作为血管内皮功能参数.结果 实验后,运动组CD34+(0.087%±0.044%),CD133+ (0.192%±0.076%)以及CD34+CD133+ (0.110%±0.034%)表达量均较实验前(0.043%±0.011%,0.077%±0.030%,0.062%±0.011%)升高(t值分别为-6.05,-8.72,-7.75,P值均<0.01),RHI升高[实验前(1.86±0.27),实验后(2.13±0.32),t=-3.70,P<0.05],cIMT下降[实验前(0.41±0.09) mm,实验后(0.34±0.11) mm,t=2.49,P<0.05];对照组各参数均无显著性变化(P值均>0.05).结论 12周运动干预可通过动员内皮祖细胞改善超重/肥胖儿童血管内皮细胞功能.     

基于学校环境的重庆市中小学生超重肥胖干预效果评价

目的 探讨基于学校环境的学生超重肥胖综合干预效果,为预防和控制中小学生超重肥胖提供依据。方法 采用多阶段分层整群抽样方法抽取重庆市主城区12所中小学9 933名学生,随机分为6所干预校和6所对照校,对干预校采取学校环境政策干预、健康教育、体育活动指导结合的综合干预,干预前后进行体格检查和问卷调查。结果 干预后干预校超重率在原有基础上(12.9%)上升了0.2%,肥胖率(7.4%)未变化;对照校超重率、肥胖率分别在原有基础上(11.5%、7.7%)上升了0.5%、0.1%。干预前两组学校正常体重的学生在干预后BMI、腰围、臀围均升高(P<0.05),干预校超重肥胖的学生在干预后BMI、腰围均下降(P<0.05),对照校超重肥胖的学生在干预后臀围升高、腰围降低(P<0.05);干预校学生在干预后肥胖相关饮食问题正确率上升,不健康饮食行为报告率下降(P<0.05)。结论 基于学校环境的学生超重肥胖综合干预能控制肥胖相关指标的增长速度,改善中小学生的饮食行为。     

Development of a school-based prevention program for children in alcoholic families

The systematic development of a preventive intervention for elementary-aged children of alcoholics (COAs) is described. First, the risk status of children of untreated alcoholics was established. Second, risk and protective factors that appeared to be mediators of mental health status for COAs were identified. Third, a preventive intervention was designed to teach coping skills and enhance self-esteem. Fourth, the intervention was pilot tested to assess its feasibility and potential. Finally, plans for a large scale experimental field trial of the revised curriculum are outlined. The advantages of following a systematic intervention development plan are demonstrated.Work on this study was funded in part by the National Institute of Mental Health Grant P50-MH39246 to Support a Preventive Intervention Research Center and T32-MH18387-02 Postdoctoral Prevention Training Grant. The authors wish to recognize the significant contributions of our Community Advisory Board, composed of Laurel Cappo, Frank Diaz, Julie Edmonson, and Joyce Heddleson, to the development and implementation of this prevention program.