The Healthy Elementary School of the Future
Condition: Overweight; Physical Activity; Malnutrition; Child Development; Lifestyle-related Condition; Socioeconomic Difficulty
MeSH terms: Overweight; Malnutrition
Study type: Interventional

Summary: 
      Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles
      often persist from generation to generation and contribute to a vicious cycle of
      health-related and social problems. We present a study protocol that examines the
      effectiveness of two novel, integrated healthy school interventions. One is a full
      intervention called 'The Healthy Primary School of the Future', the other is a partial
      intervention called 'The Physical Activity School'. These intervention approaches will be
      compared with the regular school approach that is currently common practice in the
      Netherlands. The main outcome measure will be changes in children's body mass index (BMI). In
      addition, lifestyle behaviours, academic achievement, child well-being, socio-economic
      differences, and societal costs will be examined.
    

Detailed description: 
      In close collaboration with various stakeholders, a quasi-experimental study was developed,
      for which children of four intervention schools (n = 1200) in the southern part of the
      Netherlands are compared with children of four control schools (n = 1200) in the same region.
      The interventions started in November 2015. In two of the four intervention schools, a
      whole-school approach named 'The Healthy Primary School of the Future', is implemented with
      the aim of improving physical activity and dietary behaviour. For this intervention, pupils
      are offered an extended curriculum, including a healthy lunch, more physical exercises, and
      social and educational activities, next to the regular school curriculum. In the two other
      intervention schools, a physical-activity school approach called 'The Physical Activity
      School', is implemented, which is essentially similar to the other intervention, except that
      no lunch is provided.

      We hypothesize that these healthy school interventions will result in normalized BMI
      distributions that are more in line with national and international standards (smaller
      standard deviations) among primary school children, with a more pronounced effect in the full
      intervention schools (due to the expected synergy between exercise and diet) than in the
      partial intervention schools. Also, our multi-disciplinary research group will study a wide
      range of outcome measures, including lifestyle behaviours, academic achievement, child
      well-being, socio-economic differences, and societal costs. Moreover, an evaluation will be
      performed of the legal consequences of a healthy school approach in the Netherlands, as well
      as the conflicting interests of the stakeholders. Data collection is conducted within the
      school system. The interventions proceed during a period of four years. The baseline
      measurements started in September 2015 and yearly follow-up measurements are taking place
      until 2019.

      Our primary research question is: What is the effect of the full intervention ('The Healthy
      Primary School of the Future') on the BMI of primary school children compared to no
      intervention (control schools)? Our secondary research question is: What is the effect of the
      full intervention on the BMI of primary school children compared to the partial intervention
      ('The Physical Activity School')? Our tertiary research questions are: (1) What is the effect
      of the full intervention in comparison with the partial intervention and the regular school
      approach (control schools) on: (a) children's levels of physical activity and sedentary
      behaviour, nutritional knowledge, healthy food preferences and behaviour, cognitive and
      non-cognitive performance, Health related-QoL, socio-emotional development, and sick leave?
      (b) parenting and teacher practices regarding physical activity and nutrition? (c) parental
      HR-QoL, well-being, labour participation and sick leave? (d) benefits across different
      socio-economic backgrounds? (e) long and short term cost-effectiveness? (f) satisfaction
      among the involved stakeholders (children, parents, teachers, and child care partners)? (2)
      Which determinants influence the quality of the implementation of the intervention? (3) What
      is the scope of children's human rights to health, what is the legal role of primary schools
      in realizing these rights (e.g., obligations and responsibilities of state and non-state
      actors, conflicts of interests and legal solutions to these conflicts), and is the
      intervention feasible within Dutch educational law?

      A whole-school approach is a new concept in the Netherlands. Due to its innovative,
      multifaceted nature and sound scientific foundation, these integrated programmes have the
      potential to form a template for primary schools worldwide. The effects of this approach may
      extend further than the outcomes associated with well-being and academic achievement,
      potentially impacting legal and cultural aspects in our society.
    

Intervention name(s): The Healthy Primary School of the Future; The Physical Activity School
Intervention type(s): Other; Behavioral
Intervention description(s): In two out of four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum.; In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided.
Allocation: Non-Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Academic Achievement; Accelerometry; Children; Primary school Intervention; Nutrition; Obesity; Physical Activity; Prevention; School Health