Parental involvement and association with adolescents’ fruit and vegetable intake at follow-up: Process evaluation results from the multi-component school-based Boost intervention

Jørgensen, Sanne Ellegaard; Jørgensen, Terese Sara Høj; Aarestrup, Anne Kristine; Due, Pernille; Krølner, Rikke

doi:10.1186/s12966-016-0435-1

Cited by 10 publications

(9 citation statements)

References 47 publications

(53 reference statements)

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“…The comprehensiveness of our process evaluation is a strength but also a limitation, as it is not possible to perform an in-depth analysis of all the data collected regarding all features and all informant groups. Another option would have been to cut the process evaluation results into slices for each component and informant, such as presenting the evaluation of the curriculum component via teacher interviews in one paper [35] and the parental component via parent surveys in another paper [36]. Our choice provides an overview of the complexity, but the presentation of each aspect is brief.…”

Section: Discussionmentioning

confidence: 99%

Process evaluation of implementation fidelity in a Danish health-promoting school intervention

et al. 2018

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Background“We Act” is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils’ dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5–6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools.MethodsThe Medical Research Council’s new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation.ResultsA total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils’ presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the school-year plan and weak management support.ConclusionsAlthough ‘We Act’ was designed to comply with evidence- and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools’ preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.Trial registration ISRCTN85203017 Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6289-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Process evaluation of implementation fidelity in a Danish health-promoting school intervention

et al. 2018

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“…The remaining studies (n 37) were not included in the meta-analysis because of various factors: necessary information could not be obtained (i.e. no control group (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56) ; control is another intervention (57,58) ; unstandardised effect size (49,59,60) ; not an actual consumption (15,(61)(62)(63)(64)(65)(66)(67)(68) and no sample size) (69) ; tracking studies (i.e. dietary intervention initiated in childhood and tracked/followed up into adulthood) (34,70) and studies were rated as weak (71)(72)(73)(74)(75)(76)(77) .…”

Section: Literature Searchmentioning

confidence: 99%

“…The majority of the studies distributed solely FV as a snack (i.e. stand-alone intervention), whereas some studies in addition to providing FV, integrated other supplementary/reinforcement components such as nutrition education (34,38,60,67,78) , parental involvement (33,44,49,56,68,79) , peer modelling and rewards (46,50,57,58) . Most of the study interventions were guided by the constructs of social cognitive theory (SCT) (n 13) (80) , Intervention Mapping Protocol (IMP) (n 7) (81) and utilisation-focused Participatory Approach (82) .…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Twenty-six out of forty-seven studies measured FV consumption among children, reported an increase in consumption at post-intervention (15,39,40,43,(45)(46)(47)(48)(49)(50)53,54,56,57,(60)(61)(62)(63)(66)(67)(68)(69)72,74,83,84) , while only three studies reported an increase in FV consumption at follow-up (44,64,65) . The remaining sixteen studies reported an increase in FV consumption at post-intervention, with a loss of effectiveness at follow-up (i.e.…”

Section: Intervention Sustainabilitymentioning

confidence: 99%

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Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

Ismail

Seabrook

Gilliland

2021

Public Health Nutr.

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Objective: Fruit and vegetables (FVs) distribution interventions have been implemented as a public health strategy to increase children’s intake of FVs at school settings. The purpose of this review was to examine whether snack-based FVs distribution interventions can improve school-aged children’s consumption of FVs. Design: Systematic Review and meta-analysis of articles published in English, in a peer-review journals were identified by searching six databases up to August 2020. Standardized Mean Differences (SMDs) and 95% Confidence Interval (CI) were calculated using a random effects model. Heterogeneity was quantified using I2 statistics. Setting: Population-based studies of interventions where the main focus was the effectiveness of distributed FVs as snacks to schoolchildren in North America, Europe and Pacific were included. Results: Forty-seven studies, reporting on 15 different interventions, were identified; 10 studies were included in the meta-analysis. All interventions were effective in increasing children’s consumption of FVs, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children’s consumption of FVs, particularly for multi-component interventions at post-intervention (SMD 0.20, CI 0.13, 0.27) and free distribution interventions at follow-up (SMD 0.19, CI 0.12, 0.27). Conclusions: Findings suggest that utilizing FV distribution interventions provide a promising avenue by which children’s consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration, and follow-up evaluation are needed to improve comparability across studies.

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“…Baltimore Healthy Eating Zones (BHEZ), a childhood obesity prevention trial conducted at multiple levels in the low-income urban area of Baltimore City, used different components of the intervention to create an exposure score to inform a secondary evaluation analysis [ 15 ]. The Boost program, a Danish multi-component school-based trial, used measures of exposure as the extent of parental involvement in the intervention, and found that students with a high exposure level consumed more fruits and vegetables daily than those with a low exposure score [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: patterns, determinants, and implications

Trude

Kharmats

Jones-Smith

et al. 2018

Trials

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BackgroundFor community interventions to be effective in real-world conditions, participants need to have sufficient exposure to the intervention. It is unclear how the dose and intensity of the intervention differ among study participants in low-income areas. We aimed to understand patterns of exposure to different components of a multi-level multi-component obesity prevention program to inform our future impact analyses.MethodsB’more Healthy Communities for Kids (BHCK) was a community-randomized controlled trial implemented in 28 low-income zones in Baltimore in two rounds (waves). Exposure to three different intervention components (corner store/carryout restaurants, social media/text messaging, and youth-led nutrition education) was assessed via post-intervention interviews with 385 low-income urban youths and their caregivers. Exposure scores were generated based on self-reported viewing of BHCK materials (posters, handouts, educational displays, and social media posts) and participating in activities, including taste tests during the intervention. For each intervention component, points were assigned for exposure to study materials and activities, then scaled (0–1 range), yielding an overall BHCK exposure score [youths: mean 1.1 (range 0–7.6 points); caregivers: 1.1 (0–6.7), possible highest score: 13]. Ordered logit regression analyses were used to investigate correlates of youths’ and caregivers’ exposure level (quartile of exposure).ResultsMean intervention exposure scores were significantly higher for intervention than comparison youths (mean 1.6 vs 0.5, p < 0.001) and caregivers (mean 1.6 vs 0.6, p < 0.001). However, exposure scores were low in both groups and 10% of the comparison group was moderately exposed to the intervention. For each 1-year increase in age, there was a 33% lower odds of being highly exposed to the intervention (odds ratio 0.77, 95% confidence interval 0.69; 0.88) in the unadjusted and adjusted model controlling for youths’ sex and household income.ConclusionTreatment effects may be attenuated in community-based trials, as participants may be differentially exposed to intervention components and the comparison group may also be exposed. Exposure should be measured to provide context to impact evaluations in multi-level trials. Future analyses linking exposure scores to the outcome should control for potential confounders in the treatment-on-the-treated approach, while recognizing that confounding and selection bias may exist affecting causal inference.Trial RegistrationClinicalTrials.gov, NCT02181010. Retrospectively registered on 2 July 2014.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2663-y) contains supplementary material, which is available to authorized users.

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Parental involvement and association with adolescents’ fruit and vegetable intake at follow-up: Process evaluation results from the multi-component school-based Boost intervention

Cited by 10 publications

References 47 publications

Process evaluation of implementation fidelity in a Danish health-promoting school intervention

Process evaluation of implementation fidelity in a Danish health-promoting school intervention

Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: patterns, determinants, and implications

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