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A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial.
BMC Public Health. 2018 04 06; 18(1):459.BP

Abstract

BACKGROUND

Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children's health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through parental support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study.

METHODS

Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context.

DISCUSSION

The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health.

TRIAL REGISTRATION

The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .

Authors+Show Affiliations

Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. liselotte.schafer-elinder@ki.se. Centre for Epidemiology and Community Medicine, Solnavägen 1E, 113 65, Stockholm, Sweden. liselotte.schafer-elinder@ki.se.Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. Centre for Epidemiology and Community Medicine, Solnavägen 1E, 113 65, Stockholm, Sweden.Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. Centre for Epidemiology and Community Medicine, Solnavägen 1E, 113 65, Stockholm, Sweden.Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29625599

Citation

Elinder, Liselotte Schäfer, et al. "A Healthy School Start Plus for Prevention of Childhood Overweight and Obesity in Disadvantaged Areas Through Parental Support in the School Setting - Study Protocol for a Parallel Group Cluster Randomised Trial." BMC Public Health, vol. 18, no. 1, 2018, p. 459.
Elinder LS, Patterson E, Nyberg G, et al. A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial. BMC Public Health. 2018;18(1):459.
Elinder, L. S., Patterson, E., Nyberg, G., & Norman, Å. (2018). A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial. BMC Public Health, 18(1), 459. https://doi.org/10.1186/s12889-018-5354-4
Elinder LS, et al. A Healthy School Start Plus for Prevention of Childhood Overweight and Obesity in Disadvantaged Areas Through Parental Support in the School Setting - Study Protocol for a Parallel Group Cluster Randomised Trial. BMC Public Health. 2018 04 6;18(1):459. PubMed PMID: 29625599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial. AU - Elinder,Liselotte Schäfer, AU - Patterson,Emma, AU - Nyberg,Gisela, AU - Norman,Åsa, Y1 - 2018/04/06/ PY - 2018/01/05/received PY - 2018/03/21/accepted PY - 2018/4/8/entrez PY - 2018/4/8/pubmed PY - 2019/2/23/medline KW - Children KW - Diet KW - Low education KW - Parents KW - Physical activity KW - School health services KW - Type 2 diabetes SP - 459 EP - 459 JF - BMC public health JO - BMC Public Health VL - 18 IS - 1 N2 - BACKGROUND: Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children's health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through parental support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. METHODS: Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. DISCUSSION: The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. TRIAL REGISTRATION: The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 . SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/29625599/A_Healthy_School_Start_Plus_for_prevention_of_childhood_overweight_and_obesity_in_disadvantaged_areas_through_parental_support_in_the_school_setting___study_protocol_for_a_parallel_group_cluster_randomised_trial_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5354-4 DB - PRIME DP - Unbound Medicine ER -