Collaborative school-based obesity interventions: lessons learned from 6 southern districts

Domains of Capacity Building in Whole-Systems Approaches to Prevent Obesity-A "Systematized" Review

Despite increased awareness of its risks, for the most part, contemporary efforts for obesity prevention have been patchy at best. As such, the burgeoning interest in whole-systems approaches (WSAs) that acknowledge the complex, dynamic nature of overweight and obesity and operate across multiple levels of society is particularly timely. Many components of "community capacity building" (CB), an essential but often neglected aspect of obesity prevention, overlap with "best practice principles" in effective/optimal community-based obesity-prevention initiatives. Rhetoric urging WSAs and community CB in public health abounds although operative and efficacious contemporary examples of these approaches to reducing obesity levels are scarce. The aim of this investigation was to undertake a systematized review of the level of capacity building incorporated in published literature on WSAs targeting obesity to better understand how domains of CB have been incorporated. A PubMed search and a recently published systematic review were utilized to identify WSAs to obesity prevention between 1995-2020. A team-based approach to qualitative thematic data analysis was used to systematically assess and describe each intervention regarding explicit capacity-building practice. Despite not being specifically designed for building capacity, a significant proportion of the WSAs studied in the current report had implemented several CB domains.

Lessons Learned in Conducting Community Participatory School-Based Health Research on an American Indian Reservation

BACKGROUND

Describing lessons learned from using a community-based participatory research (CBPR) approach to conduct school-based child health research in a tribal community is an important contribution to the literature.

OBJECTIVES

To identify how CBPR principles shaped the process of conducting a school-based child health intervention, and to describe lessons learned.

METHODS

The study evaluates how CBPR principles guided a mixed-methods, school-based child health intervention to increase physical activity (PA).

RESULTS

Nine key lessons are identified, associated with CBPR principles.

CONCLUSIONS

This information can help researchers understand how to successfully navigate the challenges and opportunities of conducting CBPR-guided research in the context of a small, short-term project, including leadership turnover, multiple Institutional Review Board (IRB)s, and study design approaches amidst schools policy changes. Collectively, understanding the lessons learned through the perspective of CBPR principles may help others conduct meaningful research with schools and children in tribal communities.

A review of the sustainability and impact of a healthy lifestyles programme in primary schools 2-5 years after the intervention phase

There has been an emphasis on schools to promote healthy lifestyles and many intervention programmes have attempted this. Most programmes are evaluated at the time and/or shortly afterwards. This is a review of the impact and sustainability of the Health for Life programme 2-5 years after the initial phase. It captures the experiences of the senior school staff who delivered the programme through semi-structured interviews. Senior teachers recognized the importance of promoting healthy lifestyles in primary schools. They reported positively on aspects of the programme, in particular its flexibility and how it enabled schools to develop a new relationship with parents and how schools have sustained the initial programme. They discussed the main barriers to intervention and how they could be mitigated. Delivering a sustainable healthy lifestyle primary schools programme which has an impact is feasible but challenging for school staff. To maximize the likelihood of delivery, interventions must be championed by a member of the Senior Leadership Team, embedded in the curriculum, hands-on, easy to manage, and flexible to the needs of individual schools but requires support (financial, training and advisory). With these conditions the sustainability and impact of the programme was significant.

Sustaining obesity prevention in communities: a systematic narrative synthesis review

Obesity is a global problem for which sustainable solutions are yet to be realized. Community-based interventions have improved obesity-related behaviours and obesity in the short term. Few papers have explored how to make the interventions and their intended outcomes sustainable. The aim of this paper is to identify factors that contribute to the sustainability of community-based obesity prevention interventions and their intended outcomes. A systematic narrative synthesis review was conducted of published community-based obesity prevention interventions to identify factors contributing to intervention sustainability. Data extracted were included study authors' perspectives of intervention success and sustainability. Eighty-one papers met the inclusion criteria, and from these we identified ten factors that contribute to sustainability: resourcing, leadership, workforce development, community engagement, partnerships, policy, communications, adaptability, evaluation and governance. This review of community-based obesity prevention interventions gives rise to optimism that sustainable change is possible. We propose a framework to help practitioners build sustainability into their interventions and report on them so that others can also benefit.

The Influence of Organizational Culture on School-Based Obesity Prevention Interventions: A Systematic Review of the Literature

BACKGROUND

Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school-based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school-based obesity prevention interventions.

METHODS

Fourteen studies examining the impact of organizational-level characteristics on school-based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus.

RESULTS

Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school-based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate.

CONCLUSIONS

Organizational culture can greatly influence the success of school-based obesity interventions. The collection of data related to organizational-level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.

Addressing childhood obesity at school entry: Qualitative experiences of school health professionals

School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This multi-method qualitative study explored the experiences of 26 school health professionals in addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n = 3); focus groups with school nurses (n = 12) and child health practitioners (n = 6); and open-ended questionnaires with school nurses (n = 4) and child health practitioners (n = 1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policymakers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development and ensure clear pathways are established to ensure consistency of care.

Healthy Lifestyle Fitness Camp: A Summer Approach to Prevent Obesity in Low-Income Youth

OBJECTIVE

To examine the effect of participation in a summer camp focused on nutrition and fitness among low-income youth.

METHODS

In 2011-2012, overweight and obese youth (n = 126) from Fresno, CA participated in a free 6-week summer program, Healthy Lifestyle Fitness Camp (HLFC), which included 3 h/wk of nutrition education provided by University of California CalFresh and 3 hours of daily physical activity through Fresno Parks and Recreation. The researchers used repeated-measures ANOVA to examine changes in weight, waist circumference, and waist-to-height ratio (WHtR) between HLFC and the comparison group (n = 29).

RESULTS

Significant pre-post WHtR reductions were observed in HLFC: 0.64 to 0.61 (P < .001). In addition, WHtR reductions were maintained in HLFC 2 months afterward whereas an increase occurred in the comparison group (P < .007).

CONCLUSIONS AND IMPLICATIONS

Understanding the impact of nutrition- and fitness-themed summer camps during unstructured months of summer is integral to obesity prevention among low-income youth.

Improved Body Mass Index Measures Following a Middle School-Based Obesity Intervention-The MATCH Program

BACKGROUND

Motivating Adolescents with Technology to CHOOSE Health™ (MATCH) is an educational and behavioral intervention in seventh grade.

METHODS

Teachers in 2 schools delivered the MATCH curriculum, with 1 control school. Using a quasi-experimental design, outcome measures included lessons completed, body mass index (BMI), BMI z-score (zBMI), BMI percentile, weight category, and self-reported lifestyle behaviors. We used multiple regression models to compare group results.

RESULTS

For the MATCH group (N = 189), teachers provided lessons over 14 weeks; the control group (N = 173) received usual curriculum. Postintervention, the MATCH group had significant decreases in BMI measures compared with the control. In combined overweight and obese participants, the mean (95% confidence interval) zBMI change was -0.05 (-0.07, -0.03) in MATCH and -0.01 (-0.04, 0.02) in control, p = .034 between groups. After 1 year, improvements are sustained: for the overweight subgroup, the mean zBMI decreased from 1.34 to 1.26 post-MATCH, then to 1.26 after 1 year; for the obese subgroup, mean zBMI = 2.16, to 2.13 post-MATCH to 2.08 after 1 year. Self-reported lifestyle behaviors showed no differences.

CONCLUSIONS

MATCH integrates theory-based strategies into standard curriculum delivered by teachers. No prior middle-school intervention has shown sustained change in BMI measures. MATCH warrants further study as a strategy to address obesity.

Implementing a multicomponent school-based obesity prevention intervention: a qualitative study

OBJECTIVE

To explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts.

METHODS

Using purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses.

RESULTS

State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance.

CONCLUSIONS AND IMPLICATIONS

Results confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.

The researchers have left the building: what contributes to sustaining school-based interventions following the conclusion of formal research support?

BACKGROUND

This study examined the sustainability of New Moves, a school-based program aimed at decreasing weight-related problems in adolescent girls. The National Cancer Institute recognizes New Moves as a research-tested intervention program that produced positive behavioral and psychosocial outcomes.

METHODS

Ten schools participated in the sustainability study. Teachers completed a survey and interview, and research staff observed 1 physical education (PE) class within 2 years of the study's completion. Qualitative data were grouped by themes. Frequencies were calculated using quantitative data.

RESULTS

All schools continued all-girls PE classes using New Moves components following the study period. Fewer schools continued the nutrition and social support classroom modules and individual coaching sessions while no schools continued lunch get-togethers. Program components were sustained in both New Moves intervention schools and control schools.

CONCLUSIONS

Programs are most likely to be sustained if they (1) fit into the current school structure, (2) receive buy-in by teachers, and (3) require minimal additional funds or staff time. Providing control schools with minimal training and intervention resources was sufficient to continue program components if staff perceived the program was important for students' health and compatible within the school's existing infrastructure.

Preliminary assessment of a school-based healthy lifestyle intervention among rural elementary school children

BACKGROUND

Childhood obesity has become a national public health crisis in America. Physical inactivity and unhealthy eating behaviors may contribute to the childhood obesity epidemic. School-based healthy lifestyle interventions play a promising role in preventing and controlling childhood obesity. A comprehensive school-based healthy lifestyle intervention was implemented in 4 rural elementary schools in Kentucky.

METHODS

The intervention included 4 goals: improving physical education, health education, family/community involvement, and school wellness policies. Children's physical activity was assessed by pedometer, and nutrition was assessed by a previous day recall survey in January (baseline), February (t1), March (t2), April (t3), and May (t4) of 2011.

RESULTS

The intervention had significant effects on increasing the percentages of children meeting physical activity (1% vs 5%, p < .01) and nutrition (15% vs 26%, p < .01) recommendations. The effects of the intervention on physical activity and nutrition depended on school, grade, and age of the children. There was an increasing linear trend of physical activity and an increasing quadratic trend of nutrition over time among children.

CONCLUSIONS

The intervention had beneficial effects in improving healthy behaviors among children. Further studies are needed to assess its long-term effects and cost-effectiveness.

Nursing: promoting the health of overweight children and adolescents in the school context

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

Evaluating school wellness policy in curbing childhood obesity in Anchorage, Alaska

In 2006, the Anchorage School District implemented a school wellness policy to address the problem of obesity among its elementary-aged students. We assessed whether the addition of this policy is effective in protecting or preventing students from becoming overweight/obese over time. The methods involved following two cohorts of students for 5 years, a cohort not exposed and a cohort exposed to the policy. The results show that exposure to the policy does not significantly protect or prevent students from becoming overweight/obese. However, we found that regardless of being exposed to the policy, boys (odds ratio [OR] = 1.12), ethnic minorities, (OR = 1.18), and students from low socioeconomic backgrounds (OR = 1.44) were more likely to remain or become overweight/obese. Our findings suggest that factors outside the school may be impacting students' overweight/obese status. Efforts to curb the problem of childhood obesity should extend to the children's communities and homes.