Making healthy eating and physical activity policy practice: The design and overview of a group randomized controlled trial in afterschool programs

Abstract

National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1,800 children (6-12yrs) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs’ daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children’s accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness.

Intervention leads to improvements in the nutrient profile of snacks served in afterschool programs: a group randomized controlled trial

“…A complete description and overview of the study can be found elsewhere [12]. For this study, ASPs were defined as child care programs operating immediately after the school day, every day of the school year for a minimum of 2 h. Programs had to serve a minimum of 30 children of elementary age (6-12 years) and could operate in a school, community, or faith setting.…”

“…All children enrolled, staff, and ASP leaders in the programs were eligible to participate in the study. A total of 20 ASPs, representing 13 different organizations were randomly selected from an existing registry of 535 ASPs in South Carolina and invited to participate in an intervention targeting healthy eating and physical activity -Making Healthy Eating and Physical Activity Policy Practice [12]. Of the 535 programs, 376 met the eligibility criteria-76 did not operate Mon-Fri, 53 enrolled fewer than 30 children, and 30 did not have sufficient information to evaluate eligibility.…”

“…Intervention A detailed description of the Strategies To Enhance Practice for Healthy Eating (STEPs-HE) conceptual framework can be found elsewhere [16]. In brief, the STEPs-HE conceptual framework involves a multistep, adaptive approach to incorporating healthy eating strategies into daily routine practice.…”

“…Recently, an intervention focused on capacity building with ASPs to develop menus that met the HE Standards and identifying low-cost outlets to purchase snacks reported that programs can make substantial changes in the types of foods and beverages served [11,12]. Although the HE Standards do not specify the energy value or micronutrients or macronutrients of snacks, understanding how changes in the foods and beverages served relate to improvements in the overall caloric value, as well as the macronutrient and micronutrient content of snacks is necessary.…”

“…Such information is valuable as programs across the nation look toward achieving nutrition-focused policies in ASPs to help contribute to solutions for childhood obesity [13,14]. The purpose of this study was to evaluate the changes in total calories and macronutrient content of the foods and beverages served to children attending ASPs that were part of a group randomized controlled trial focused on achieving the HE Standards [12]. A secondary goal was to evaluate changes in the micronutrients of snacks served.…”