More insight into the health effects of scaled-up school-based interventions in real-world settings is vital to sustainably integrate health in all schools. This study investigated the effectiveness ...of the scaled-up Healthy Primary School of the Future (HPSF) initiative in real-world school contexts on children's health (behaviours). From 2019 to 2022, eleven Dutch primary schools implemented HPSF-related activities. In 315 children from study years four to six (aged 7-11 years) from these schools, anthropometric measurements were performed, and questionnaires assessing the children's dietary behaviours and physical activity were administered. COVID-19 greatly limited the implementation of HPSF-related activities. Therefore, the results were compared between schools categorised as medium implementers and schools categorised as low implementers. After correction for baseline, waist circumference in the medium implementer group was significantly higher at one-year follow-up (B = 1.089,
= 0.003) and two-year follow-up (B = 1.665,
< 0.001) compared with waist circumference in the low implementer group. No significant effects were observed for other outcomes. This study showed hardly any effects of the scaled-up HPSF initiative, mainly due to the limited implementation caused by COVID-19. More research investigating the real-world effectiveness of HPSF and comparable programmes is greatly encouraged to advance the field of school-based health promotion.
Evidence suggests that multi-component school-based health-promoting interventions have great potential to improve children’s fruit and vegetable intake. However, interventions that combine ...classroom-based curricula with experiential learning strategies (e.g., cooking) are relatively seldom described. This study investigates the short-term and longer-term effects of a multi-component school-based nutrition education intervention combining classroom-based and experiential learning strategies on children’s determinants of their fruit and vegetable intake (knowledge, taste preferences, attitudes, and intention). Using a comparative quasi-experimental study design, data were collected, via child-reported questionnaires, at the baseline, directly after the intervention, and three months after the intervention from 4 control and 15 intervention classes from Dutch primary schools. A total of 192 children in grades three and four (aged 8–10 years) constituted the participants. After correction for the baseline, sex, age, and the fruit or vegetable product assessed in the questionnaire; the intervention group showed a significant increase in knowledge (p = 0.001; standardized effect size (ES = 0.60), taste preference (p = 0.002; ES = 0.52), attitude towards the assessed fruit or vegetable product (p = 0.004; ES = 0.48), and general attitude towards healthy products (p = 0.01; ES = 0.39) over the short term, when compared to the control group. The effects of the intervention did not continue to be significant over the longer term. The findings implicate short-term intervention success, although more research and intervention adaptations are recommended to increase the impact of such programs, especially over the long term.
Mere exposure is an often-described strategy to increase children’s food familiarity, preferences, and intake. Research investigating this method in less controlled settings is scarce. This study ...investigates the effects of repeated fruit and vegetable (FV) exposure through the Healthy Primary School of the Future (HPSF) on children’s FV familiarity, preferences, and intake. The study had a longitudinal quasi-experimental design comparing two full HPSFs (focus: nutrition and physical activity) with two partial HPSFs (focus: physical activity) in the Netherlands. Annual measurements (child-reported questionnaires) were conducted during 2015–2019 in 833 7–12-year-old children. The study was registered on ClinicalTrials.gov (NCT02800616). After correction for baseline, full HPSFs had, on average, a lower number of unfamiliar vegetable items after one (effect size (ES) = −0.28) and three years (ES = −0.35) and a higher number of disliked vegetable items after one year (ES = 0.24) than partial HPSFs. Unfavorable intervention effects were observed for fruit intake after one (odds ratio (OR) = 0.609) and four years (OR = 0.451). Repeated FV exposure had limited effects on children’s FV familiarity, preferences, and intake, likely due to insufficient taste exposure. Considering the widespread implementation of school-based mere exposure efforts, it is highly relevant to further investigate under which circumstances mere exposure effectively contributes to improvements in (determinants of) FV intake.
PurposeTo gain insight into factors enhancing or obstructing implementation in various school-settings, which is vital for widespread dissemination and sustainable integration of school-based ...health-promoting interventions.Design/methodology/approachA mixed methods multisite comparative case study to investigate (factors influencing) the implementation of health-promoting activities in twelve Dutch primary schools. Data were collected during three school years (2019–2022) through observations, questionnaires and interviews.FindingsThe project resulted in the implementation of small, incidental activities. Important reasons for the limited implementation were lack of commitment and bottom-up involvement. School directors and teachers were not involved early on in the project, which limited project support and commitment. On school level, directors largely carried project responsibility themselves, hindering project sustainability and integration. Coronavirus disease 2019 (COVID-19) made that schools had difficulties forming long-term visions and plans. Other observed barriers included limited perceived necessity to change, high workload and high staff turnover. Important facilitators were the presence of a process coordinator and sharing experiences from other schools.Originality/valueThis research provided valuable insights into (factors influencing) the implementation of health-promoting initiatives in diverse, real-world school contexts. More extensive support is needed to create commitment, bottom-up involvement and a project vision. Furthermore, empowering in-school champions and/or school-wide project groups is desirable to decrease schools' dependence on long-term external support. The findings can be used by various stakeholders throughout development, adoption and implementation and can facilitate widespread dissemination and sustainable integration of school-based health-promoting interventions.
There are various research designs and approaches to investigate how health-promoting activities are implemented in complex, real-world systems, and to identify potential health effects that might ...occur following implementation. Although literature describes guidelines to perform and report about implementation research and effect evaluations, no specific guidelines exist on analysing and reporting about the combination of effectiveness data and implementation data collected as part of intervention evaluation in complex and diverse settings. This paper describes the evaluation of primary school-based health-promoting activities in complex systems. Furthermore, an approach for data categorization inspired by Rogers' Diffusion of Innovations theory is presented that can facilitate structuring the study's results and relating the degree of implementation to any impact on effectiveness outcomes that might be observed. Researchers interested in using this approach for data categorization have to ensure that the following three conditions are met: (i) data on an intervention's efficacy in a controlled setting with optimal implementation is available; (ii) key points that define an intervention's optimal implementation are available and (iii) an evaluation study is performed, collecting both effectiveness data and implementation data in a real-world context. This data categorization approach can be useful to generate more insight into an intervention's effectiveness under varying circumstances, and optimal support and advice can be provided to stakeholders to achieve maximum impact of population-based health-promoting interventions in complex, real-world systems. However, the proposed approach is a first suggestion and further testing and adaptation is necessary to increase its usefulness. Knowledge and experience sharing among researchers performing comparable research can increase the knowledge base regarding this subject.
As health literacy (HL) is hypothesized to develop throughout life, enhancement during childhood will improve HL and health during life. There are few valid, age-appropriate tools to assess ...children’s HL. The German-language European Health Literacy Survey Questionnaire Adapted for Children (HLS-Child-Q15-DE) is a self-report questionnaire adapted from the adult European Health Literacy Survey Questionnaire. This study aims to translate the HLS-Child-Q15 to Dutch and explore the sample’s HL distribution. The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample’s HL distribution was explored by demographic characteristics. The HLS-Child-Q15-NL had high internal consistency (α = 0.860) and moderate to strong item-total correlations (mean = 0.499). For 6 of the 15 items, >10% of participants answered “do not know”, indicating comprehension problems. Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nine-year-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). This supports the idea that HL evolves throughout life and the importance of schools in this process. With the HLS-Child-Q15-NL, a Dutch measurement instrument of children’s HL is available, although it needs further tailoring to the target group. More research is needed to decrease comprehension problems and to investigate retest reliability and construct validity.
Overweight and obesity in children are an increasing public health problem. Health literacy (HL) is a determinant of obesity and body mass index (BMI) rates in adults, but few studies have addressed ...the impact of children’s own HL on their weight and lifestyle. In this study, we aim to assess the impact of Dutch children’s HL on (1) their BMI z-score, (2) dietary behaviour, and (3) the amount of physical activity (PA) they engage in. A sample of 139 children (age 8–11 years) filled out a digital questionnaire, including an HL measurement instrument and questions regarding their food intake and PA. Furthermore, the height and weight of the children were measured, and background information was collected using a parental questionnaire. Multiple regression revealed a significant positive relation between children’s HL and their PA. No significant association between children’s HL and their BMI z-score or dietary behaviour was found. HL of children in primary school thus has an impact on some aspects of children’s lifestyle, although more research in a larger, more diverse sample is needed to further investigate this.
Information regarding school-based health-promoting interventions' potential effects in the home environment is scarce. Gaining more insight into this is vital to optimise interventions' potential. ...The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children's health and well-being by providing daily physical activity sessions and healthy school lunches. This qualitative study examines if and how HPSF influenced children's and parents' physical activity and dietary behaviours at home. In 2018-2019, 27 semi-structured interviews were conducted with parents from two HPSFs. Interviews were recorded and transcribed, and data were coded and interpreted through thematic analysis. HPSF resulted in various behavioural changes at home, initiated by both children and parents. Parents reported improvements in healthy behaviours, as well as compensatory, unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints. Both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home and are therefore key mechanisms to maximise school-based health-promoting interventions' impact.
SuperFIT aims to improve the dietary and physical activity behaviour of children (2-4 years) in the Dutch childcare and home setting. Healthy parenting practices, policies, and availability of ...materials, fruits, and vegetables were promoted over the course of a year. This pilot study, with a quasi-experimental design, examined the effectiveness of children's intake of fruits, vegetables, water, and sweet beverages. Families attending intervention preschools could participate in the partial (preschool) or full (preschool + home) intervention. Parental 24-hour recalls assessed the child's diet at baseline and two follow-ups. Data from 81 control and 88 intervention children was included in a three-level hierarchical logistic regression. The full intervention showed significantly favourable effects for sweet beverages (B = −1.85, P < 0.05) and unfavourable effects for vegetables (B = −1.94, P < 0.05), compared to the control between the second follow-up and baseline. No significant effects were found for fruit or water, nor for the partial intervention. More research in a larger sample is needed to confirm current findings.
Trial registration: ClinicalTrials.gov identifier: NCT03021980.
Information regarding school-based health-promoting interventions' potential effects in the home environment is scarce. Gaining more insight into this is vital to optimise interventions' potential. ...The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children's health and well-being by providing daily physical activity sessions and healthy school lunches. This qualitative study examines if and how HPSF influenced children's and parents' physical activity and dietary behaviours at home.
In 2018-2019, 27 semi-structured interviews were conducted with parents from two HPSF schools. Interviews were recorded and transcribed, and data were coded and interpreted through thematic analysis.
HPSF resulted in various behavioural changes at home, initiated by both children and parents. Parents reported improvements in healthy behaviours, as well as compensatory, unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints.
Both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home and are therefore key mechanisms to maximise school-based health-promoting interventions' impact.
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