SWITCH Implementation Effectiveness Trial
Condition: Sedentary Behavior; Health Promotion; Overweight and Obesity; Healthy Lifestyle; Diet, Healthy
MeSH terms: Overweight
Study type: Interventional

Summary: 
      The SWITCH (School Wellness Integration Targeting Child Health) project is a multi-component
      intervention designed to support school wellness programming and contribute to youth obesity
      prevention. Consistent with social-ecological models, SWITCH is designed to reach multiple
      settings within schools while also facilitating engagement with families and community
      partners. The program focuses on three distinct behaviors known to impact obesity (i.e.,
      physical activity (PA), sedentary behavior (SB) and fruit and vegetable consumption (FV)) in
      a creative way by challenging children to "switch what they do, view and chew".
    

Detailed description: 
      Schools provide an ideal setting for coordinated youth obesity prevention but it has proven
      difficult to widely disseminate evidence-based programs in a cost-effective way.
      Multi-component programs that target multiple behaviors and reach multiple settings have been
      widely recommended in both scientific literature and in public health guidelines documents,
      but there are few examples of integrated social-ecological approaches that offer promise for
      broad dissemination.

      SWITCH initially began as a controlled childhood obesity intervention trial. A limitation of
      the original SWITCH program is that the print-based materials made it cost-prohibitive to
      promote broader dissemination, or to engage other schools. Therefore, the focus of subsequent
      work focused on developing and testing implementation strategies that would enable SWITCH to
      be more widely disseminated. In a controlled effectiveness study, we demonstrated that a
      web-based version had similar utility and outcomes as the print-based program, but effects
      were directly related to the degree of engagement within the school. Through a USDA-funded
      project, we developed a novel training method designed to facilitate greater adoption and
      more effective implementation of SWITCH in schools. The focus in this revised SWITCH model
      was on helping schools to independently manage the implementation of the evidence-based
      SWITCH program as part of overall school wellness programming. Thus, we have gradually
      evolved SWITCH from a school-based intervention conducted through schools to a school
      wellness training method provided for schools. Schools received

      Before moving to broader dissemination efforts it was important to determine the dose of
      training and support needed to assist schools with implementation. Therefore, the focus of
      this study was on comparing two different implementation approaches. An enhanced capacity
      building model that included personalized webinars with school leaders (Enhanced) was
      compared to a streamlined model based on email communication (Standard). Thus, a key goal is
      to determine the additive benefit of the enhanced school support relative to the standard
      implementation. Past work has demonstrated that there is considerable variability in the
      capacity of schools to take on and lead school wellness programming. Therefore, the analyses
      also directly examined the moderating influence of school capacity on implementation as well
      as the impact of implementation on outcomes.
    

Intervention name(s): Standard Implementation; Enhanced Implementation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Schools in the Standard implementation model received web-based training, access to on online education / tracking system and programming resources (modules, posters, trinkets) to facilitate wellness programming in their school. They completed audit tools at the beginning to facilitate goal setting and received weekly emails during the 12-week implementation process.; Schools in the Enhanced implementation model received the same training, web-access, and programming resources as those in the Standard implementation, but also received enhanced monthly support during implementation from the project team. The supplemental web calls (completed jointly by Extension leaders and SWITCH staff) utilized motivational interviewing to help schools build capacity and to enhance motivation for wellness programming.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Pragmatic Cluster Randomized Controlled Superiority Trial.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: School Wellness Policy; Professional Development; Comprehensive School Physical Activity Programs; Whole-of-School Intervention; Screen Time; Physical Activity