School Health Education Program in Pakistan (Shepp)-Findings From a Feasibility Trial in School Children From a Lower Middle-Income Country

Abstract

Objective:The school environment plays an essential role in promoting health education and physical activity for children and adolescence, which they adapt into their adulthood. We aim to test feasibility of threefold health education program in children and its potential efficacy on physical activity and diet and cardio metabolic risk factors by including BP, BMI, and waist circumference.Design and method:The SHEPP was a parallel group feasibility intervention trial conducted in 2 schools over a 23 month period. All children aged 9–11 years enrolled from the above-mentioned 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. Primary outcome was feasibility of SHEPP in terms of recruitment, retention, and treatment fidelity. Secondary outcomes were physical activity levels, dietary intake (of fruits, vegetable), and cardio metabolic risk factors (blood pressure, BMI, and waist circumference (WC)Results: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 12 classes. There was increase by134(196) minutes in the SHEPP intervention school v 29.8(177) in the routine activity school (P value < 0.001).The increase in out of school physical activity component of physical activity was more compared to in In school Physical activity from baseline to follow-up (101.0(187) v 33(27)). Overall, there was increase in vegetable intake n (%) (>3 serving /day) in SHEPP intervention school (28(5.5) to 108(21.4)) from baseline to follow-up compared to routine activity school (36(7.5) to 71(14.9)).Conclusions:We found that intervention using SHEPP is feasible in schools and may help children to carry healthy lifestyle in adulthood by increasing physical activity.