School-based behaviour change intervention to increase physical activity levels among children: a feasibility cluster non-randomised controlled trial in Yangzhou, China

Pivoting school health and nutrition programmes during COVID-19 in low- and middle-income countries: A scoping review

Background

Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions.

Methods

We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible.

Results

We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition.

Conclusions

We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.

School Health Education Program in Pakistan (SHEPP): findings from a feasibility trial in pre-adolescent school children from a lower middle-income country

BACKGROUND

The school environment plays an essential role in promoting health education and physical activity for children and adolescents. We aim to assess the feasibility of threefold health education program in children and its potential efficacy on physical activity and diet and cardiometabolic risk factors including blood pressure, body mass index (BMI), and waist circumference.

METHODS

The SHEPP was a parallel group feasibility intervention trial conducted in two schools over 23 months. All children aged 9-11 years enrolled in the schools were included. The SHEPP intervention comprised of health education on healthy lifestyle and physical activity sessions for children, training of teachers, and awareness sessions for parents conducted over 10 months. One school received the intervention of SHEPP while the other school continued routine activity. The primary outcome was the feasibility of SHEPP in terms of recruitment, retention, and treatment fidelity. Secondary outcomes were physical activity levels, dietary intake (of fruits and vegetables), and cardiometabolic risk factors (blood pressure, BMI, and waist circumference (WC)).

RESULTS

A total of 1280 preadolescent children were assessed for eligibility and 1191 were found eligible. The overall recruitment n (%) was 982/1191(82.5%) with 505(51.4) from SHEPP intervention school and 477(48.6) in routine activity school. The overall retention rate n (%) at 10-month follow-up was 912/982(92.8), with 465/505(92) in SHEPP intervention school and 447/477(93.7) in routine activity school. In treatment fidelity, 132/144(92) %). Physical activity sessions and all (100%) health education sessions were conducted for each of the twelve classes. Mean (SD) Seven-day Physical activity increased by 134 (196) min in the SHEPP intervention school v 29.8(177) in the routine activity school (P value < 0.001) from baseline to follow-up. Overall, there was an increase in vegetable intake (> 3 serving /day) in SHEPP intervention school of 5.5 to 21.4% from baseline to follow-up compared to 7.5 to 14.9% in routine activity school. The mean change (SD) in systolic blood pressure was 1.3(12) mmHg, 2.2(19.0) mm Hg in in diastolic blood pressure, - 0.09(5.4) kg/m² in BMI and 6.2 cm in waist circumference in the intervention arm versus - 3.4(11.1) mm Hg in SBP, - 4.3(9.9) mm Hg in DBP, - 0.04((4.6) kg/m² in BMI, and 3.8 cm in WC in the control arm.

CONCLUSION

We found that intervention using SHEPP is feasible in schools and may help children to adopt a healthy lifestyle as they age by increasing physical activity. However, the potentially beneficial effect on diet, MI, and BP needs further exploration and a longer follow-up, more specifically at the juncture of teenage and adulthood.

TRIAL REGISTRATION

NCT03303287.

School-Based Physical Activity Intervention: A Qualitative Process Evaluation of a Feasibility Trial in Yangzhou, China

Background: There is an urgent need for children in China to increase their physical activity levels. We first developed a 16-week school-based behavior change intervention based on the Behavior Change Wheel and Theoretical Domains Framework. We then conducted a cluster feasibility non-randomized controlled trial (RCT) among children in Yangzhou, China. Aim: This qualitative process evaluation was embedded within the cluster feasibility non-RCT and aimed to: (1) explore the experiences and perceptions of participants and providers in the intervention and trial; and (2) generate recommendations to inform a future intervention and full-scale cluster RCT. Methods: A qualitative study, using semi-structured interviews with trial participants (n = 20 children: 10 intervention, 10 control), parents (n = 20), and health education providers (n = 2), was conducted in two public schools in Yangzhou, China. Interviews were audio-recorded, transcribed, and translated verbatim from Mandarin to English. Data were analyzed using thematic analysis. Results: Findings believed to reflect experiences and perceptions of participants in the intervention and the trial are presented as eight major themes: (1) perceived high efficacy of the intervention components to help children become more active, (2) appreciation of the intervention features, (3) factors that facilitated or impeded intervention attendance and delivery, (4) positive experiences and feelings gained through the data collection process, (5) satisfaction regarding the organization and implementation of the trial, (6) influences of personal beliefs and emotional responses to the trial, (7) social influences on participatory decision-making, and (8) key barriers to consider regarding the recruitment of participants. Conclusions: The intervention and trial methods were acceptable to children, parents, and health education providers. School-based behavior change intervention was perceived to be a useful approach to increase physical activity in children aged 10–12 years in China. However, there were barriers to intervention delivery and engagement that should be considered when designing a future cluster RCT to assess the intervention efficacy.