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Pushpa BS, Abdul Latif SN, Sharbini S, Murang ZR, Ahmad SR. Nutrition education and its relationship to body image and food intake in Asian young and adolescents: a systematic review. Front Nutr 2024; 11:1287237. [PMID: 38585614 PMCID: PMC10995287 DOI: 10.3389/fnut.2024.1287237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/21/2024] [Indexed: 04/09/2024] Open
Abstract
Background The literature brings to light the unhealthy nutritional habits prevalent among Asian adolescents and their high level of body image dissatisfaction. This study aims to conduct a systematic review of the literature on the effect of nutritional education interventions on their nutritional knowledge and food intake behavior, attitude, practice, and body image. Methods We searched relevant published studies in PubMed, Web of Science, Scopus, Science Direct, and Springer using the PICO framework and performed a quality assessment using the 10-point checklist adapted from the National Institutes for Health tool. Results The majority of the nutritional education interventions improve unhealthy food intake and body image misperception, particularly on nutritional knowledge/self-efficacy, healthy dietary habits, physical activities, and fruit and vegetable intake. We also found a negative association with excess weight gain, obesity, and unethical weight reduction practices, leading to dissatisfaction with body image. Conclusion These interventions can help address dietary problems and body image perception and support the development of future interventions.
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Affiliation(s)
| | | | - Sharimawati Sharbini
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
| | | | - Siti Rohaiza Ahmad
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
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2
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Craig DW, Walker TJ, Cuccaro P, Sharma SV, Heredia NI, Robertson MC, Fernandez ME. Using the R = MC 2 heuristic to understand barriers to and facilitators of implementing school-based physical activity opportunities: a qualitative study. BMC Public Health 2024; 24:207. [PMID: 38233842 PMCID: PMC10792959 DOI: 10.1186/s12889-024-17744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Schools are a key setting for supporting youth physical activity, given their broad reach and diverse student populations. Organizational readiness is a precursor to the successful implementation of school-based physical activity opportunities. The R = MC2 heuristic (Readiness = Motivation x Innovation-Specific Capacity x General Capacity) describes readiness as a function of an organization's motivation and capacity to implement an innovation and can be applied to better understand the implementation process. The purpose of this study was to explore the barriers to and facilitators of implementing school-based physical activity opportunities in the context of organizational readiness. METHODS We analyzed interview data from 15 elementary school staff (principals, assistant principals, physical education teachers, and classroom teachers) from a school district in Texas. We focused on factors related to adopting, implementing, and sustaining a variety of school-based physical activity opportunities. We used the Framework Method to guide the analysis and coded data using deductive (informed by the R = MC2 heuristic) and inductive approaches. Themes were generated using the frequency, depth, and richness of participant responses. RESULTS Four themes emerged from the data: (1) implementation is aided by the presence of internal and external relationships; (2) physical activity opportunities compete with other school priorities; (3) seeing the benefits of physical activity opportunities motivates school staff toward implementation; and (4) staff buy-in is critical to the implementation process. Themes 1-3 aligned with subcomponents of the R = MC2 heuristic (intra- and inter-organizational relationships, priority, and observability), whereas Theme 4 (staff buy-in) related to multiple subcomponents within the Motivation component but was ultimately viewed as a distinct construct. CONCLUSION Our results highlight and explain how key readiness constructs impact the implementation of school-based physical activity opportunities. They also highlight the importance of obtaining staff buy-in when implementing in the school setting. This information is critical to developing readiness-building strategies that help schools improve their capacity to deliver physical activity opportunities effectively. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Derek W Craig
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
| | - Timothy J Walker
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Paula Cuccaro
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, & Environmental Sciences, Center for Health Equity, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Natalia I Heredia
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michael C Robertson
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Maria E Fernandez
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Abstract
Physical inactivity is a global challenge that necessitates early intervention during childhood. Schools are positioned to make a significant impact on children's current and future physical activity behavior, but numerous barriers hinder the implementation and sustainability of school-based physical activity opportunities. The purpose of this invited article is to provide an overview of the comprehensive school physical activity program (CSPAP) as a concept, framework, and promising approach to institutionalizing physical activity within the school environment. Despite the availability of numerous published reviews on the topic, a broad, up-to-date panorama of the CSPAP literature that encompasses and consolidates historical, conceptual, empirical, and practical perspectives is currently lacking. Contained within this article is an explanation of the public health context that undergirds the CSPAP concept, a historical perspective of the concept's origins and evolution, examples of CSPAP research, recommendations for advancing the knowledge base, and evidence-informed frameworks and principles for professional practice.
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4
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Imad N, Pearson N, Hall A, Shoesmith A, Nathan N, Giles L, Grady A, Yoong S. A Pilot Randomised Controlled Trial to Increase the Sustainment of an Indoor-Outdoor-Free-Play Program in Early Childhood Education and Care Services: A Study Protocol for the Sustaining Play, Sustaining Health (SPSH) Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5043. [PMID: 36981955 PMCID: PMC10048850 DOI: 10.3390/ijerph20065043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Early Childhood Education and Care (ECEC) settings are important environments to support children's physical activity (PA). In 2021, COVID-19 regulations recommended the provision of indoor-outdoor free-play programs in ECEC settings to reduce the transmission of COVID-19, resulting in an increased uptake of this practice. As the context has since changed, research suggests that ECEC services could cease the implementation of these practices. Therefore, this pilot randomised controlled trial (RCT) aims to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure the ongoing implementation (sustainment) of ECEC-delivered indoor-outdoor free-play programs. Twenty ECEC services located in New South Wales, Australia that have implemented indoor-outdoor free-play programs since the release of COVID-19 guidelines will be recruited. The services will be randomly allocated either the sustainment strategy or usual care. The "Sustaining Play, Sustaining Health" program consists of eight strategies, developed to address key barriers against and facilitators of sustainment informed by the Integrated Sustainability Framework. The outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of free play. This study will provide important data to support the performance of a fully powered trial within Australian ECEC settings and to inform the development of future sustainment strategies.
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Affiliation(s)
- Noor Imad
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Luke Giles
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
| | - Alice Grady
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Serene Yoong
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
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Merica CB, Egan CA, Webster CA, Mindrila D, Karp GG, Paul DR, Orendorff KL. Association of Physical Educators' Socialization Experiences and Confidence with Respect to Comprehensive School Physical Activity Program Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12005. [PMID: 36231304 PMCID: PMC9566013 DOI: 10.3390/ijerph191912005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Comprehensive school physical activity programs (CSPAPs) are recommended to support physical education (PE) and increase the amount of physical activity (PA) youth receive each day. However, adoption of CSPAPs in the United States is low. PE teachers are well positioned to lead the implementation of CSPAPs, but research is needed to better understand (a) PE teachers' confidence to assume the multiple roles involved with CSPAP implementation and (b) the factors that are associated with such confidence. This study examined PE teachers' role breadth self-efficacy (RBSE) as a measure of PE teachers' CSPAP-related confidence and its association with seminal life experiences as framed within teacher socialization theory. A survey was emailed to a stratified-random sample of 2976 PE teachers and distributed on social media, garnering a total of 259 responses. Exploratory structural equation modeling supported a three-factor solution for teacher socialization variables (acculturation, professional socialization and organizational socialization), in line with the theoretical framework, and a single factor solution for RBSE. Professional socialization and organizational socialization were significant predictors of RBSE, and qualitative data from open-ended survey questions supported these relationships. The results highlight the importance of preservice teacher education and current employment contexts in PE teachers' CSPAP-related confidence.
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Affiliation(s)
- Christopher Barton Merica
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Campus Box 5956, Wilmington, NC 28401, USA
| | - Cate A. Egan
- Department of Movement Sciences, University of Idaho, 875 Perimeter Drive MS 2401, Moscow, ID 83844, USA
| | - Collin A. Webster
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham Dubai, Dubai P.O. Box 341799, United Arab Emirates
| | - Diana Mindrila
- Department of Leadership, Research, and School Improvement, University of West Georgia, 1601 Maple Street, Carrollton, GA 75006, USA
| | - Grace Goc Karp
- Department of Movement Sciences, University of Idaho, 875 Perimeter Drive MS 2401, Moscow, ID 83844, USA
| | - David R. Paul
- Department of Movement Sciences, University of Idaho, 875 Perimeter Drive MS 2401, Moscow, ID 83844, USA
| | - Karie Lee Orendorff
- Department of Health and Human Development, Montana State University, Culbertson Hall 100, Bozeman, MT 59717, USA
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Grimes A, Lightner JS, Eighmy K, Wray BD, Valleroy E, Baughn M. Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study. JMIR Res Protoc 2022; 11:e37126. [PMID: 35507392 PMCID: PMC9118081 DOI: 10.2196/37126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. OBJECTIVE Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. METHODS This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. RESULTS The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. CONCLUSIONS An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37126.
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Affiliation(s)
- Amanda Grimes
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
| | - Katlyn Eighmy
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Bridget D Wray
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States.,School of Urban Planning, University of Kansas, Lawrence, KS, United States
| | - Ella Valleroy
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Maya Baughn
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
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7
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Marttinen R, Wilson K, Fisher K, Beitzel M, Fredrick RN. Process evaluation and challenges in collecting data from an after-school sports and literacy program in a diverse, low-income community. EVALUATION AND PROGRAM PLANNING 2022; 91:102052. [PMID: 35180551 DOI: 10.1016/j.evalprogplan.2022.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/04/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To understand how programs succeed we must evaluate them. The purpose of this paper was to examine the intervention and evaluation processes and identify areas of success and challenges in delivering and evaluating the Reflective Educational Approach to Character and Health (REACH) after-school program in a low SES community. METHODS Sixty-six fifth and sixth graders from two schools participated. Data were collected at the intervention and control schools at four time points over the year. Data collected at baseline (Aug/Sep 2016), and Time 4 (May, 2017) were used for the analysis. Reach and fidelity to the intervention were assessed along with information on the process of data collection for variables of interest (e.g., accelerometer-measured physical activity level, FITNESSGRAM tests, vertical jump, and literacy). Missing data were imputed and a 2(School) by 2(Time) mixed factorial ANOVA was performed to examine the efficacy of the intervention. RESULTS There were no significant time by school interactions for any of the outcomes assessed. There were several challenges in evaluating the program such as low compliance to wearing the accelerometer, lack of effort during literacy tests, peers affecting effort on physical tests, and missing data. CONCLUSIONS We posit that research implementation be re-examined in community-based research that is conducted with students at the elementary level in low-income communities. Future research should engage with youth in the data collection process to make it a meaningful experience for them and to possibly reduce attrition from the program.
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Affiliation(s)
- Risto Marttinen
- George Mason University, Recreation and Athletic Complex, rm 2109, 4350 Bannister Creek Ct, Fairfax, VA 22030, USA.
| | - Kathleen Wilson
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831, USA.
| | - Koren Fisher
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831, USA.
| | - Maria Beitzel
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831, USA.
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Bin X. A Method for Recommending Sports Network Course Resources Based on Collaborative Filtering Technology. SECURITY AND COMMUNICATION NETWORKS 2021; 2021:1-9. [DOI: 10.1155/2021/1082697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In the process of online course resource recommendation, the output of recommendation results is often unstable. Therefore, a physical education online course resource recommendation method based on collaborative filtering technology is proposed. Firstly, the learning preference of e-learners is calculated, the frequency index of the word frequency-inverse document is defined, the correlation between courses is reflected, and the specific needs of students for PE online course resource recommendation are understood. Then, the collaborative filtering recommendation algorithm is used to generate the similarity matrix and correlation matrix, update the edge characteristics of sports online curriculum resources, collect and refine the hidden index of sports online curriculum resources, optimize the prediction rules of the neighborhood of the most similar teaching unit, and complete the recommendation of sports online curriculum resources. Experimental results show that, for 1000 keywords, the method has the highest single average matching degree, the recommendation process is stable, and the F1 value is more than 0.9, and the practical application is ensured.
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Affiliation(s)
- Xu Bin
- Hunan University of Humanities, Science and Technology, 417000 Hunan Loudi, China
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9
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Shoesmith A, Hall A, Wolfenden L, Shelton RC, Powell BJ, Brown H, McCrabb S, Sutherland R, Yoong S, Lane C, Booth D, Nathan N. Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review. Implement Sci 2021; 16:62. [PMID: 34118955 PMCID: PMC8199827 DOI: 10.1186/s13012-021-01134-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Sustainment has been defined as the sustained use or delivery of an intervention in practice following cessation of external implementation support. This review aimed to identify and synthesise factors (barriers and facilitators) that influence the sustainment of interventions (policies, practices, or programmes) in schools and childcare services that address the leading risk factors of chronic disease. Methods Seven electronic databases and relevant reference lists were searched for articles, of any design, published in English, from inception to March 2020. Articles were included if they qualitatively and/or quantitatively reported on school or childcare stakeholders’ (including teachers, principals, administrators, or managers) perceived barriers or facilitators to the sustainment of interventions addressing poor diet/nutrition, physical inactivity, obesity, tobacco smoking, or harmful alcohol use. Two independent reviewers screened texts, and extracted and coded data guided by the Integrated Sustainability Framework, an existing multi-level sustainability-specific framework that assesses factors of sustainment. Results Of the 13,158 articles identified, 31 articles met the inclusion criteria (8 quantitative, 12 qualitative, 10 mixed-methods, and 1 summary article). Overall, 29 articles were undertaken in schools (elementary n=17, middle n=3, secondary n=4, or a combination n=5) and two in childcare settings. The main health behaviours targeted included physical activity (n=9), diet (n=3), both diet and physical activity (n=15), and smoking (n=4), either independently (n=1) or combined with other health behaviours (n=3). Findings suggest that the majority of the 59 barriers and 74 facilitators identified to impact on intervention sustainment were similar across school and childcare settings. Factors predominantly relating to the ‘inner contextual factors’ of the organisation including: availability of facilities or equipment, continued executive or leadership support present, and team cohesion, support, or teamwork were perceived by stakeholders as influential to intervention sustainment. Conclusions Identifying strategies to improve the sustainment of health behaviour interventions in these settings requires a comprehensive understanding of factors that may impede or promote their ongoing delivery. This review identified multi-level factors that can be addressed by strategies to improve the sustainment of such interventions, and suggests how future research might address gaps in the evidence base. Trial registration This review was prospectively registered on PROSPERO: CRD42020127869, Jan. 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01134-y.
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Affiliation(s)
- Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. .,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Hannah Brown
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Serene Yoong
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
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10
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Herlitz L, MacIntyre H, Osborn T, Bonell C. The sustainability of public health interventions in schools: a systematic review. Implement Sci 2020; 15:4. [PMID: 31906983 PMCID: PMC6945701 DOI: 10.1186/s13012-019-0961-8] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sustainability of school-based health interventions after external funds and/or other resources end has been relatively unexplored in comparison to health care. If effective interventions discontinue, new practices cannot reach wider student populations and investment in implementation is wasted. This review asked: What evidence exists about the sustainability of school-based public health interventions? Do schools sustain public health interventions once start-up funds end? What are the barriers and facilitators affecting the sustainability of public health interventions in schools in high-income countries? METHODS Seven bibliographic databases and 15 websites were searched. References and citations of included studies were searched, and experts and authors were contacted to identify relevant studies. We included reports published from 1996 onwards. References were screened on title/abstract, and those included were screened on full report. We conducted data extraction and appraisal using an existing tool. Extracted data were qualitatively synthesised for common themes, using May's General Theory of Implementation (2013) as a conceptual framework. RESULTS Of the 9677 unique references identified through database searching and other search strategies, 24 studies of 18 interventions were included in the review. No interventions were sustained in their entirety; all had some components that were sustained by some schools or staff, bar one that was completely discontinued. No discernible relationship was found between evidence of effectiveness and sustainability. Key facilitators included commitment/support from senior leaders, staff observing a positive impact on students' engagement and wellbeing, and staff confidence in delivering health promotion and belief in its value. Important contextual barriers emerged: the norm of prioritising educational outcomes under time and resource constraints, insufficient funding/resources, staff turnover and a lack of ongoing training. Adaptation of the intervention to existing routines and changing contexts appeared to be part of the sustainability process. CONCLUSIONS Existing evidence suggests that sustainability depends upon schools developing and retaining senior leaders and staff that are knowledgeable, skilled and motivated to continue delivering health promotion through ever-changing circumstances. Evidence of effectiveness did not appear to be an influential factor. However, methodologically stronger primary research, informed by theory, is needed. TRIAL REGISTRATION The review was registered on PROSPERO: CRD42017076320, Sep. 2017.
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Affiliation(s)
- Lauren Herlitz
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
- Institute for Health and Human Development, University of East London, Water Lane, London, E15 4LZ, UK.
| | - Helen MacIntyre
- Department of Psychology and Human Development, UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK
| | - Tom Osborn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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