The Healthy Primary School of the Future: study protocol of a quasi-experimental study

M Willeboordse, M W Jansen, S N van den Heijkant, A Simons, B Winkens, R H M de Groot, N Bartelink, S P Kremers, P van Assema, H H Savelberg, E de Neubourg, L Borghans, T Schils, K M Coppens, R Dietvorst, R Ten Hoopen, F Coomans, S Klosse, M H J Conjaerts, M Oosterhoff, M A Joore, I Ferreira, P Muris, H Bosma, H L Toppenberg, C P van Schayck, M Willeboordse, M W Jansen, S N van den Heijkant, A Simons, B Winkens, R H M de Groot, N Bartelink, S P Kremers, P van Assema, H H Savelberg, E de Neubourg, L Borghans, T Schils, K M Coppens, R Dietvorst, R Ten Hoopen, F Coomans, S Klosse, M H J Conjaerts, M Oosterhoff, M A Joore, I Ferreira, P Muris, H Bosma, H L Toppenberg, C P van Schayck

Abstract

Background: 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. This design article presents a study evaluating the effects of two novel healthy school interventions. 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.

Methods: 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. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019.

Discussion: 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.

Trial registration: The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 .

Keywords: Academic Achievement; Accelerometer; Children; Nutrition; Obesity; Physical activity; Prevention; Primary school Intervention; School health.

Figures

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Fig. 1
Study design

References

    1. Mendis S. Global status report on noncommunicable diseases 2014. Geneva: WHO Press; 2014.
    1. Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC. Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas. 2011;70(3):266–284. doi: 10.1016/j.maturitas.2011.08.005.
    1. Puder JJ, Munsch S. Psychological correlates of childhood obesity. Int J Obes. 2010;34(Suppl 2):S37–S43. doi: 10.1038/ijo.2010.238.
    1. Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ. Age-related consequences of childhood obesity. Gerontology. 2014;60(3):222–228. doi: 10.1159/000356023.
    1. Stein D, Weinberger-Litman SL, Latzer Y. Psychosocial perspectives and the issue of prevention in childhood obesity. Frontiers Public Health. 2014;2:104. doi: 10.3389/fpubh.2014.00104.
    1. Han E, Norton EC, Powell LM. Direct and indirect effects of body weight on adult wages. Econ Hum Biol. 2011;9(4):381–392. doi: 10.1016/j.ehb.2011.07.002.
    1. Green LW, Kreuter MW. Health promotion planning: an educational and ecological approach. 3. Mountain View: Mayfield Publishing Company; 1999.
    1. Katz DL. School-based interventions for health promotion and weight control: not just waiting on the world to change. Annu Rev Public Health. 2009;30:253–272. doi: 10.1146/annurev.publhealth.031308.100307.
    1. Pate RR, Davis MG, Robinson TN, Stone EJ, McKenzie TL, Young JC. Promoting physical activity in children and youth a leadership role for schools: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in collaboration with the councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation. 2006;114(11):1214–1224. doi: 10.1161/CIRCULATIONAHA.106.177052.
    1. van Stralen MM, Yildirim M, Wulp A, te Velde SJ, Verloigne M, Doessegger A, Androutsos O, Kovacs E, Brug J, Chinapaw MJ. Measured sedentary time and physical activity during the school day of European 10- to 12-year-old children: the ENERGY project. J Sci Med Sport/Sports Med Aust. 2014;17(2):201–206. doi: 10.1016/j.jsams.2013.04.019.
    1. Hollar D, Lombardo M, Lopez-Mitnik G, Hollar TL, Almon M, Agatston AS, Messiah SE. Effective multi-level, multi-sector, school-based obesity prevention programming improves weight, blood pressure, and academic performance, especially among low-income, minority children. J Health Care Poor Underserved. 2010;21(2 Suppl):93–108.
    1. Nansel TR, Huang TT, Rovner AJ, Sanders-Butler Y. Association of school performance indicators with implementation of the healthy kids, smart kids programme: case study. Public Health Nutr. 2010;13(1):116–122. doi: 10.1017/S1368980009005898.
    1. Carson V, Hunter S, Kuzik N, Wiebe SA, Spence JC, Friedman A, Tremblay MS, Slater L, Hinkley T. Systematic review of physical activity and cognitive development in early childhood. J Sci Med Sport. 2015;19(7):573–8.
    1. Khambalia A, Dickinson S, Hardy L, Gill T, Baur L. A synthesis of existing systematic reviews and meta‐analyses of school‐based behavioural interventions for controlling and preventing obesity. Obes Rev. 2012;13(3):214–233. doi: 10.1111/j.1467-789X.2011.00947.x.
    1. Saraf DS, Nongkynrih B, Pandav CS, Gupta SK, Shah B, Kapoor SK, Krishnan A. A systematic review of school-based interventions to prevent risk factors associated with noncommunicable diseases. Asia Pac J Public Health. 2012;24(5):733–752. doi: 10.1177/1010539512445053.
    1. Meng L, Xu H, Liu A, van Raaij J, Bemelmans W, Hu X, Zhang Q, Du S, Fang H, Ma J. The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China. PLoS One. 2013;8(10):e77971. doi: 10.1371/journal.pone.0077971.
    1. Rush E, Obolonkin V, McLennan S, Graham D, Harris JD, Mernagh P, Weston AR. Lifetime cost effectiveness of a through-school nutrition and physical programme: Project Energize. Obesity Res Clin Practice. 2014;8(2):e115–e122. doi: 10.1016/j.orcp.2013.03.005.
    1. Sobol-Goldberg S, Rabinowitz J, Gross R. School-based obesity prevention programs: a meta-analysis of randomized controlled trials. Obesity (Silver Spring) 2013;21(12):2422–2428. doi: 10.1002/oby.20515.
    1. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12:00.
    1. Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health (Oxford, England) 2012;34(3):360–369. doi: 10.1093/pubmed/fdr116.
    1. Leurs M. A collaborative approach to tailored whole-school health promotion; the schoolBeat study. Maastricht: Maastricht University; 2008.
    1. McCreary LL, Park CG, Gomez L, Peterson S, Pino D, McElmurry BJ. A mixed-methods evaluation of school-based active living programs. Am J Prev Med. 2012;43(5 Suppl 4):S395–S398. doi: 10.1016/j.amepre.2012.06.030.
    1. Steenbakkers M, Vermeer AJM, Janssen-Goffin MJH, Hajema KJ. Een nieuwe kijk op gezondheid in Zuid-Limburg [A new vision on health in South-Limburg]. In: GGD Zuid-Limburg: Regionaal rapport Volksgezondheid Toekomst Verkenning 2014. Geleen: GGD Zuid Limburg; 2014. p.103.
    1. Jansen M, Kuppens E. Op zoek naar de Limburg-factor [seeking the Limburg-factor] Geleen: GGD Zuid Limburg; 2015.
    1. Vermeer AJM, Boot NMWM, Hesdahl MH, Janssen-Goffin MJH, Linssen ECAJ, Rutten N, Hajema KJ. Lokale rapporten Volksgezondheid Toekomst Verkenning: Een nieuwe kijk op gezondheid in Heerlen, Kerkrade, Landgraaf en Brunssum; [Local reports on Public Health Development: A new perspective on health in Heerlen, Kerkrade, Landgraaf and Brunssum] Geleen: GGD Zuid Limburg; 2014.
    1. Borghans L, Golsteyn B, Zölitz U. Parental Preferences for Primary School Characteristics. J Econ Anal Policy. 2015;15(1):85–117.
    1. Golsteyn B, Schils T. Gender Gaps in Primary School Achievement – A Decomposition into Endowments and Returns to IQ and Non-Cognitive Factors. Econ Educ Rev. 2014;41:176–187. doi: 10.1016/j.econedurev.2014.04.001.
    1. Driessen G, Claassen A, Smit F. Variatie in schooltijden; Een internationale literatuurstudie naar de effecten van verschillende invullingen van de schooldag, de schoolweek en het schooljaar. Nijmegen: Radboud Universiteit Nijmegen; 2010. p. 108.
    1. Kremers S, Schaalma H, Meertens R, Van Mechelen W, Kok G. Paediatric Exercise Science and Medicine. New York: Oxford University Press; 2008. Systematic promotion of physical activity; pp. 409–417.
    1. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME. Planning health promotion programs: an intervention mapping approach, 3rd edition. San Francisco: Jossey-Bass; 2011.
    1. [] (last checked April 1th 2016)
    1. Schonbeck Y, Talma H, van Dommelen P, Bakker B, Buitendijk SE, Hirasing RA, van Buuren S. Increase in prevalence of overweight in Dutch children and adolescents: a comparison of nationwide growth studies in 1980, 1997 and 2009. PLoS One. 2011;6(11):e27608. doi: 10.1371/journal.pone.0027608.
    1. WHO. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation. Geneva: World Health Organisation Press; 2008. p.47.
    1. Molenaar HM, Zuidam JM, Selles RW, Stam HJ, Hovius SE. Age-specific reliability of two grip-strength dynamometers when used by children. J Bone Joint Surg Am. 2008;90(5):1053–9.
    1. Theunissen MJ, Griensven Van I, Verdonk P, Feron F, Bosma H. The early identification of risk factors on the pathway to school dropout in the SIODO study: a sequential mixed-methods study. BMC Public Health. 2012;12:1033. doi: 10.1186/1471-2458-12-1033.
    1. Ravens-Sieberer U, Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, Devlin N, Egmar AC, Gusi N, Herdman M. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2010;19(6):887–897. doi: 10.1007/s11136-010-9649-x.
    1. Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800–812. doi: 10.1097/00005650-200108000-00006.
    1. Engelen V, Haentjens MM, Detmar SB, Koopman HM, Grootenhuis MA. Health related quality of life of Dutch children: psychometric properties of the PedsQL in the Netherlands. BMC Pediatr. 2009;9:68. doi: 10.1186/1471-2431-9-68.
    1. Muris P, Meesters C, van den Berg F. The Strengths and Difficulties Questionnaire (SDQ)--further evidence for its reliability and validity in a community sample of Dutch children and adolescents. Eur Child Adolesce Psychiatry. 2003;12(1):1–8. doi: 10.1007/s00787-003-0298-2.
    1. Silva TB, Osorio FL, Loureiro SR. SDQ: discriminative validity and diagnostic potential. Front Psychol. 2015;6:811.
    1. Bradley MM, Lang PJ. Measuring emotion: the Self-Assessment Manikin and the Semantic Differential. J Behav Ther Exp Psychiatry. 1994;25(1):49–59. doi: 10.1016/0005-7916(94)90063-9.
    1. Muris P. A brief questionnaire for measuring self-efficacy in youths. J Psychopathol Behav Assess. 2001;23(3):145–149. doi: 10.1023/A:1010961119608.
    1. van Nassau F, Chau JY, Lakerveld J, Bauman AE, van der Ploeg HP. Validity and responsiveness of four measures of occupational sitting and standing. Int J Behav Nutr Physical Activity. 2015;12:144. doi: 10.1186/s12966-015-0306-1.
    1. Mahar MT, Guerieri AM, Hanna MS, Kemble CD. Estimation of aerobic fitness from 20-m multistage shuttle run test performance. Am J Prev Med. 2011;41(4 Suppl 2):S117–S123. doi: 10.1016/j.amepre.2011.07.008.
    1. van Assema P, Brug J, Ronda G, Steenhuis I. The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake. J Hum Nutr Diet. 2001;14(5):377–390. doi: 10.1046/j.1365-277X.2001.00310.x.
    1. Van Assema P, Brug J, Ronda G, Steenhuis I, Oenema A. A short dutch questionnaire to measure fruit and vegetable intake: relative validity among adults and adolescents. Nutr Health. 2002;16(2):85–106. doi: 10.1177/026010600201600203.
    1. Rodenburg G, Oenema A, Pasma M, Kremers SP, van de Mheen D. Clustering of food and activity preferences in primary school children. Appetite. 2013;60(1):123–132. doi: 10.1016/j.appet.2012.10.007.
    1. Gevers DW, Kremers SP, de Vries NK, van Assema P. Clarifying concepts of food parenting practices. A Delphi study with an application to snacking behavior. Appetite. 2014;79:51–57. doi: 10.1016/j.appet.2014.04.002.
    1. Pavot W, Diener E, Colvin CR, Sandvik E. Further validation of the Satisfaction with Life Scale: evidence for the cross-method convergence of well-being measures. J Pers Assess. 1991;57(1):149–161. doi: 10.1207/s15327752jpa5701_17.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–343. doi: 10.3109/07853890109002087.
    1. Mackenbach JP, van de Mheen H, Stronks K. A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands. Soc Sci Med. 1994;38(2):299–308. doi: 10.1016/0277-9536(94)90399-9.
    1. Schram MT, Sep SJ, van der Kallen CJ, Dagnelie PC, Koster A, Schaper N, Henry RM, Stehouwer CD. The Maastricht Study: an extensive phenotyping study on determinants of type 2 diabetes, its complications and its comorbidities. Eur J Epidemiol. 2014;29(6):439–451. doi: 10.1007/s10654-014-9889-0.
    1. van den Akker M, Spigt MG, De Raeve L, van Steenkiste B, Metsemakers JF, van Voorst EJ, de Vries H. The SMILE study: a study of medical information and lifestyles in Eindhoven, the rationale and contents of a large prospective dynamic cohort study. BMC Public Health. 2008;8:19. doi: 10.1186/1471-2458-8-19.
    1. Hoff S. Replicatie van het meetinstrument voor sociale uitsluiting [Replication of the measurement instrument for social seclusion]. Den Haag: Sociaal en Cultureel Planbureau; 2014. p.65
    1. Taylor RW, McAuley KA, Barbezat W, Strong A, Williams SM, Mann JI. APPLE Project: 2-y findings of a community-based obesity prevention program in primary school age children. Am J Clin Nutr. 2007;86(3):735–742.
    1. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12:CD001871.
    1. Lamers LM, Stalmeier PFM, McDonnell J, Krabbe PFM, Van Busschbach JJ. Kwaliteit van leven meten in economische evaluaties: het Nederlands EQ-5D-tarief. [Measuring quality of life in economic evaluations: The Dutch EQ-5D rate.] Ned Tijdschr Geneeskd. 2005;149:1574–1578.
    1. Green LW, Glasgow RE. Evaluating the relevance, generalization, and applicability of research: issues in external validation and translation methodology. Eval Health Professions. 2006;29(1):126–153. doi: 10.1177/0163278705284445.
    1. Vermaire JH, van Loveren C, Poorterman JH, Hoogstraten J. Non-participation in a randomized controlled trial: the effect on clinical and non-clinical variables. Caries Res. 2011;45(3):269–274. doi: 10.1159/000325742.
    1. Jansen W, Borsboom G, Meima A, Zwanenburg EJ, Mackenbach JP, Raat H, Brug J. Effectiveness of a primary school-based intervention to reduce overweight. Int J Pediatr Obes. 2011;6(2-2):e70–77. doi: 10.3109/17477166.2011.575151.
    1. Slingerland M. Bij modern bewegingsonderwijs wordt…… bewogen!: een praktijkartikel over het intensiveren van de les LO [In modern physical education lessons pupils……move!: a practice-based article about intensivating the physical education lessons] Lichamelijke opvoeding. 2011;5:28–30.
    1. Battjes-Fries MCE, van Dongen EJI, Haveman-Nies A. Evaluatie van smaaklessen: heeft smaaklessen effect op determinanten van gezond en bewust eetgedrag? [Evaluation of taste lessons: do taste lessons influence determinants of healthy and conscious eating behaviour?] Wageningen: Wageningen University; 2013.
    1. van Lier PA, Muthen BO, van der Sar RM, Crijnen AA. Preventing disruptive behavior in elementary schoolchildren: impact of a universal classroom-based intervention. J Consult Clin Psychol. 2004;72(3):467–478. doi: 10.1037/0022-006X.72.3.467.
    1. Amorim LD, Bangdiwala SI, McMurray RG, Creighton D, Harrell J. Intraclass correlations among physiologic measures in children and adolescents. Nurs Res. 2007;56(5):355–360. doi: 10.1097/01.NNR.0000289497.91918.94.
    1. van Breukelen GJ, Candel MJ, Berger MP. Relative efficiency of unequal cluster sizes for variance component estimation in cluster randomized and multicentre trials. Stat Methods Med Res. 2008;17(4):439–458. doi: 10.1177/0962280206079018.

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