Wellness Champions for Change
Condition: Obesity, Childhood
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      The Wellness Champions for Change (WCC) study aims to reduce pediatric obesity among students
      who attend schools in Maryland by training teacher and student-led wellness teams to increase
      opportunities for physical activity and healthy eating at school.

      The study uses a cluster randomized design to allocate 6 schools (3 elementary, 3 middle) in
      5 school systems to one of 3 arms: "A" (teacher and student training), "B" (teacher training
      only), and "C") (delayed teacher training/control). Approximately 36 3rd/6th graders and
      their caregivers ("evaluation cohort"), 15 4th/7th graders ("student leaders"), and 20
      teachers from each school will be recruited in the spring before the intervention. All
      schools will identify a teacher "Wellness Champion" who will coordinate intervention
      activities. In "A" and "B" schools, wellness champions will attend a training to learn how to
      build a wellness team and create more opportunities for students to make healthy choices. In
      "A" schools, student leaders ("Student Wellness Champions") will meet weekly during lunch
      with a health educator to receive training as peer leaders and help the Wellness Champion
      with wellness initiatives. Student leaders in "B" and "C" schools will receive a monthly
      general Adolescent Health Curriculum. To assess the impact of the teacher and student-led
      interventions, the evaluation cohort will be followed for 2.5 years, with measures including:
      anthropometry (height/weight), 7-day accelerometry (physical activity), and validated
      questionnaires to assess healthy eating. Student leaders will be followed for 1.5 years to
      assess the impact of their participation, with measures including: anthropometry, 7-day
      accelerometry, validated questionnaires to assess healthy eating, and validated
      questionnaires and focus groups to assess leadership/advocacy skills. Teachers will complete
      validated questionnaires to investigate their perceptions of the school environment,
      classroom practices, and role modeling skills. Prior to data collection and analysis,
      participants will be assigned an identification number, and all documents linking participant
      information to identification numbers will be locked/ password-protected.
    

Detailed description: 
      The long-term goal of this project is to create health promoting school environments that
      support healthy growth and development of children in order to prevent obesity. The approach
      for creating health promoting school environments involves the school-level implementation of
      existing Local Wellness Policies (LWPs). Implementation science suggests that policy
      implementation may occur through diffusion ("letting it happen"), dissemination ("helping it
      happen"), or implementation ("making it happen"). Since LWPs were initially mandated in 2006,
      most school systems have relied on a diffusion or dissemination approach to LWP
      implementation, leading to limited implementation on the school-level. We propose a
      school-level LWP implementation strategy ("making it happen") that relies on
      educating/training teachers and students to be wellness champions. Through this proposed
      study, the impact of a school-level intervention to enhance LWP implementation (WCC) and the
      added benefit of training students to be wellness champions (WCC-students, "WCC-S") on
      student-level outcomes [diet, physical activity (PA), and obesity] will be examined through a
      randomized controlled trial.

      Objectives are presented at the student and student wellness champion level:

      Student Objectives:

      Aim 1: To determine the impact of a school-based intervention ("Wellness Champions for
      Change" (WCC)) to enhance implementation of LWPs, on health behaviors (diet and PA) and
      weight status of elementary and middle school students through a randomized controlled trial.

      Hypothesis 1: WCC will have a positive impact on health behaviors of students, compared to
      control.

      Aim 2: To examine the added impact of a student-led school-based intervention ("Wellness
      Champions for Change-Students" (WCC-S) on health behaviors (diet and PA) and weight status of
      elementary and middle school students through a randomized controlled trial.

      Hypothesis 2: WCC+WCC-S will have a greater impact on health behaviors of students, compared
      to WCC and control.

      Aim 3: To examine factors in the home and school-neighborhood environments that moderate the
      impact of WCC/WCC-S on health behavior (diet and PA) and weight status change of
      elementary/middle school students.

      Hypothesis 3: Students living in a moderately health-promoting home and school-neighborhood
      environment will experience a greater change in health behaviors when exposed to WCC or
      WCC+WCC-S compared to students in high or low health-promoting environments.

      Aim 4: To examine the reach and fidelity of WCC and WCC-S when disseminated via eXtension
      through an online continuing education credit model for teachers and a toolkit for students.

      Hypothesis 4: WCC and WCC-S dissemination schools will experience positive changes in LWP
      implementation.

      Student Wellness Champion Objectives:

      One part of our study involves developing a Student Wellness Champions curriculum (WCC-S
      group) to train 5th and 8th graders in diverse schools across Maryland to make policy and
      environmental changes that create a "health-promoting environment" in their schools. We plan
      to evaluate individual and organizational outcomes for the 5th and 8th grade student wellness
      champions:

      Aim 1: To assess the individual effectiveness of WCC-S to improve student wellness champions
      youth advocacy, health literacy and public health literacy constructs, and changes in diet
      and physical activity behaviors and/or weight status compared to control students.

      Aim 2: To asses organizational effectiveness of WCC-S to improve school level LWP
      implementation and environmental change compared to control or WCC-only schools.

      Aim 3: To describe reach, adoption, implementation, and maintenance factors including- reach
      and representativeness of student champions, extent to which the intervention reaches other
      students in WCC-S schools, representativeness of adopting schools compared to non-adopting
      schools, implementation fidelity, barriers and challenges of implementation of training and
      goal achievement, which intervention aspects (if any) are institutionalized.

      A portion of participating schools will receive a Student Wellness Champion curriculum,
      training for their wellness team, as well as technical assistance provided by a Wellness
      Specialist (WCC-S Group). Other participating schools will only receive the training and
      technical assistance (WCC Group) and some will solely receive resources (Control Group). The
      process to determine which school receives which intervention is completely random, and will
      not be decided until after baseline data collection.

      In the spring prior to the intervention, all participating schools will be asked to select a
      group of about 15 students (4th graders in elementary schools, 7th graders in middle schools)
      to be a part of a Health Leader group that begins the following year (when the same students
      are 5th graders in elementary, 8th graders in middle school). Students can either be
      nominated by teachers or write a few sentences on why the student thinks it is important to
      make his/her school a healthier place. At the beginning of the next school year, the health
      leaders that attend schools randomized to WCC-S will become Student Wellness Champions. These
      students will meet with a Wellness Specialist (member of our project team) once a week during
      lunch to receive a health education/ health literacy curriculum in order to be well-versed on
      the importance of being active and eating healthy foods, and how to communicate health
      information to key stakeholders (administration and teachers) to enact policy change and to
      fellow students to enact behavior change. These students will work with the Wellness
      Specialist and staff members from their school to implement wellness policies and practices.
      Health leaders that attend schools randomized to the WCC or control schools will remain
      Health Leaders, and will have the opportunity to participate in an Adolescent Health
      Curriculum, taught by the Wellness Specialist, during their 5th or 8th grade year. These
      students will meet once a month, during lunch, and the curriculum will focus on general
      public health topics including dental health, stress management and hygiene. At the end of
      the year, participants will also have the opportunity to participate in a public health
      leadership workshop.

      Schools randomized to WCC-S and WCC will select a teacher to become the Wellness Champion
      (WC). This person may be a teacher or other school leader (nurse, counselor, etc.) who is
      passionate about creating a healthy school environment. The wellness champions will attend a
      Wellness Champions for Change training prior to the start of the intervention. During the
      training, the Wellness Champion will work with a Wellness Specialist to set achievable LWP
      implementation goals and design a plan for implementing those goals over the academic year.
      Furthermore, this training will equip the Wellness Champion to build a school-level wellness
      team, assess the school's wellness environment, develop, monitor, and report a school LWP
      action plan, and conduct wellness activities that align with the LWP.

      Following the training, the Wellness Champion will work with the school's wellness team to
      develop and implement a school LWP action plan. All Wellness Champions in a given school
      system will meet monthly, as a group, with the Wellness Specialist to discuss progress,
      pitfalls, and successes (bi-monthly in-person and/or bi-monthly by phone). In addition, all
      Wellness Champions will receive year-long technical assistance from the Wellness Specialist
      that focuses on implementing and monitoring LWP's at the school-level. The WCC intervention
      will formally last for one school year, with schools continually followed for an additional
      year to assess sustainability.

      In order to measure the success of the intervention, evaluations on a group of 36 students
      from all participating schools will be conducted (recruited as 3rd grade students in
      elementary school and 6th grade students in middle schools). These students will become
      members of the Evaluation Cohort, and will be asked to be followed for 2.5 years.
    

Intervention name(s): Student Wellness Champions; Teacher Wellness Champions
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Student Wellness Champions participate in a training to, develop a rapport, and build trust with the wellness specialist. SWCs will meet once/week during lunch. The SWC's will receive a health education/ health literacy curriculum in order to be well-versed on the importance of being active and eating healthy foods and how to communicate health information to key stakeholders to enact policy change and to fellow students to enact behavior change. These students will work with the Wellness Specialist and Wellness Champion to implement wellness policies and practices.
Target policies/practices will be presented as a menu of options. The mechanisms used to enact change are based in the tenets of health literacy anchored in nutrition and PA promotion. Components of the curriculum include raising awareness of school system's local wellness policies and improving student skills surrounding the five standards of health literacy, using examples/activities linked to the local wellness policy.; Schools will be asked to identify a Wellness Champion (WC), someone at the school who is passionate about creating a healthy school environment. All WC's will be asked to attend a Wellness Champions for Change (WCC) training, led by a Wellness Specialist (health educator part of our study team). The WC's will learn about the skills necessary to make health promoting changes to the School Environment.
Following the WCC training, the Wellness Champion will receive technical assistance from the Wellness Specialist. The Wellness Specialist will work with the Wellness Champion and the school's Wellness Team to conduct a needs assessment, and develop and implement a school action plan. The Wellness Specialist will provide support and resources to the Wellness Champion and the school to help them work towards their goals. All Wellness Champions in a given school system will meet monthly, as a group, with their Wellness Specialist to discuss progress, pitfalls, and successes.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: A portion of participating schools will receive a Student Wellness Champion curriculum, training for their wellness team, as well as technical assistance provided by a Wellness Specialist (WCC-S Group). Other participating schools will only receive the training and technical assistance (WCC Group) and some will solely receive resources (Control Group). The process to determine which school receives which intervention is completely random, and will not be decided until after baseline data collection.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: School; Policy; Nutrition; Physical Activity; Local Wellness Policy