Effects of a School-based Intervention to Increase the Water Consumption in Elementary School Children

Study Overview
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Brief Summary
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The purpose of this controlled intervention study is to evaluate the effectiveness of a school-based intervention aiming at increasing the water consumption in elementary school children. The intervention schools received refillable water bottles and drying racks for all school children as well as educational material. The focus of the intervention is the promotion of drinking tap water.

Detailed Description
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This pilot project, called H2NOE-Wasserschulen (Water Schools in Lower Austria), aims to increase the water consumption of school children in elementary schools, to raise awareness of water drinking in children, parents and school teachers and to promote water drinking in Lower Austria in general. By increasing the consumption of water, the consumption of sugar-sweetened beverages may decrease and in the long run may have a positive impact on children's body weight and tooth status. All intervention schools receive refillable water bottles for each school child and drying racks for each classroom. Furthermore, in each school an information session for all school teachers is held and the teachers receive prepared educational material. The control schools do not receive the water bottles nor the educational material. For the study, the investigators recruited 22 intervention schools and 32 control schools. Outcomes will be measured by paper and pencil questionnaires of school children at third grade of participating elementary schools in Lower Austria and with online questionnaires of teachers at baseline, at the end of the intervention (after one school year/June 2019) and at the one-year follow-up (after two school years/June 2020). For process evaluation outcomes, the investigators will carry out focus group discussions with a subsample of school children and teachers and include questions in the respective questionnaires for school children, teachers and school headmasters. Parents will have the possibility to give feedback online.

Official Title
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Process and Outcome Evaluation of an Intervention to Increase the Water Consumption of Elementary School Children in Lower Austria - a Pilot Study

Conditions
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Water Consumption, Drinking Behavior

Intervention / Treatment
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* Behavioral: Wasserschulen


Participation Criteria
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Eligibility Criteria
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For the intervention schools: Inclusion criteria: elementary school in Niederösterreich (Upper Austria, a province of Austria) no juice provided with the school milk programme For the school children taking part in the survey: Inclusion criteria: school children in third class of elementary school (at baseline) written declaration of consent by a parent/guardian
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention versus no intervention
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group Wasserschulen<br>Schools receive refillable drinking bottles for all school children and drying racks for each classroom. Schools receive special project educational material and informational material and one training session for teachers. The intervention will be implemented during one school year (2018/2019), but schools can use the material and bottles also after ending of the intervention period. | Behavioral: Wasserschulen<br>* Schools receive following materials and trainings: one training sessions for teachers (at the beginning of the intervention) refillable water bottles for each school student drying rack for water bottles for each classroom educational material for each class and for school events informational material for parents<br>|
| No Intervention: Control group<br>No intervention (usual education). Schools do not receive any project material. Schools got the information that they are part of a study on drinking and eating habits of third grade elementary school children. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in water consumption of school children (from baseline to post-intervention and follow-up) | consumption of tap water, in number of glasses (with 1 glass defined as 200 mL) per day/ during school time (self-report) | baseline, end of intervention (after one school year, 9 months), follow-up (after two school years, 21 months) | 
| Change of attitude of school children towards drinking water (from baseline to post-intervention and follow-up) | preference for water and sugar-sweetened beverages (measured as agreement to various statements regarding water and sugar-sweetened beverage consumption with 5 likert-scale answer categories: yes, that's right; yes, mostly; no, mostly not; no, not true; I don't know) | baseline, end of intervention (after one school year, 9 months), follow-up (after two school years, 21 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in beverage consumption of school children (from baseline to post-intervention and follow-up) | consumption of tap water, mineral water, fruit- and herbal tea, milk and cacao, soft drinks (lemonade, cola and iced tea), juice and juice with water; in number of glasses (with 1 glass defined as 200 mL) for the last 24h | baseline, end of intervention (after one school year, 9 months), follow-up (after two school years, 21 months) | 
| Change in food consumption of school children (from baseline to post-intervention and follow-up) | consumption of fruit and berries; vegetables (raw or cooked); sweets, chocolate or ice-cream; soft drinks (lemonade, cola and iced tea); fast food (french fries, chicken nuggets, pizza, McDonald's, sausages); salty snacks (crisps, popcorn, salted pretzel sticks); frequency of consumption during a normal week, when thinking of the last weeks | baseline, end of intervention (after one school year, 9 months), follow-up (after two school years, 21 months) | 
| Change in breakfast consumption of school children (from baseline to post-intervention and follow-up) | frequency of eating breakfast during school days and on the weekend | baseline, end of intervention (after one school year, 9 months), follow-up (after two school years, 21 months) | 
| Parameters of process evaluation (implementation dose) | frequency of addressing the topic water during regular lessons, implementation of classroom rules for water drinking, extent of water bottle use of school children; by online questionnaire (all teachers from intervention schools); extent of water bottle use, by paper and pencil questionnaire (all school children from intervention schools); number of interventional material distributed in school; by online questionnaire (all headmasters from intervention schools) | end of intervention (after one school year, 9 months) | 
| Parameters of process evaluation (implementation fidelity) | implementation of classroom rules for water drinking; extent of information for parents; by online questionnaire (all teachers from intervention schools) | end of intervention (after one school year, 9 months) | 
| Parameters of process evaluation (implementation reach) | proportion of classes that implemented the intervention, information about intervention on the school homepage, number of interventional material distributed in school; by online questionnaire (all headmasters from intervention schools); extent of information for parents; by online questionnaire (all teachers from intervention schools) | end of intervention (after one school year, 9 months) | 
| Parameters of process evaluation (acceptance) | focus group discussions with a subset of school children, teachers and school headmasters | end of intervention (after one school year, 9 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Child, Health promotion, longitudinal studies, Surveys and Questionnaires, beverages, Water/administration & dosage, Austria, Program evaluation, Students/statistics & numerical data, Food Preferences, Follow-Up Studies, school setting, behavioural change