Promoting water consumption among children: a three-arm cluster randomised controlled trial testing a social network intervention

Abstract

Objective: To test the effectiveness of a social network intervention (SNI) to improve children’s healthy drinking behaviours. Design: A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as ‘influence agents’ to promote water consumption–as an alternative to sugar-sweetened beverages (SSB)–among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention. Setting: Eleven schools in the Netherlands. Participants: Four hundred and fifty-one children (Mage = 10·74, SDage = 0·97; 50·8 % girls). Results: Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (β = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (β = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (β = –0·12, P = 0·028) and injunctive norms (β = 0·11–0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions. Conclusions: These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI.

Promoting water consumption among Dutch children: an evaluation of the social network intervention Share H2O

“…Given the age of the participants (< 16 years), written informed consent was obtained from a parent or legal guardian as well as the children themselves. Subsequently, the participating schools were randomly assigned to one of the five conditions of the MyMovez project (see [27,31] for a detailed description of the conditions). The current study sample included the five (sub) urban primary schools (i.e., eight classes from grades 4-6) assigned to the condition exposed to the Share H 2 O SNI.…”

“…This study was integrated into the Share H 2 O intervention effectiveness study [31], which was part of the second data collection phase of the MyMovez research program (see [40] for a detailed description of the MyMovez program). The study reported on data collected from both the selected influence agents and their peers.…”

“…The required sample size for the Share H 2 O effectiveness study was based on the previous pilot study [25], in which a small effect on water and SSB consumption was found with 210 children in the intervention and control condition. To calculate the sample for the effectiveness study [31], this number was multiplied by 1.5 to add the third group (i.e., the active control), resulting in a minimum number of 315 children across the three groups. Ethical approval was obtained from the Ethics Committee of the Faculty of Social Sciences at Radboud University (ECSW2014-100614-222) and the ethical review board from the European Research Council (617253).…”

“…Based on this premise, interventionists select a subset of individuals as influence agents to initiate the diffusion of the target health behaviors in their social network [29]. Accordingly, in the SNI called Share H 2 O, children were selected as influence agents and trained to promote water consumption-as an alternative to sugarsweetened beverages (SSBs)-among their peers [25,30,31]. As reported elsewhere [31], the Share H 2 O intervention was effective in increasing water drinking and reducing SSBs, with the effectiveness on water drinking depending on the prevailing social norms in the classrooms.…”

“…Accordingly, in the SNI called Share H 2 O, children were selected as influence agents and trained to promote water consumption-as an alternative to sugarsweetened beverages (SSBs)-among their peers [25,30,31]. As reported elsewhere [31], the Share H 2 O intervention was effective in increasing water drinking and reducing SSBs, with the effectiveness on water drinking depending on the prevailing social norms in the classrooms. In particular, children with higher perceived descriptive norms and lower perceived injunctive norms reported an increase in their water drinking.…”