The Short-Term Value of the "Healthy Primary School of the Future" Initiative: A Social Return on Investment Analysis
Marije Oosterhoff, Onno C P van Schayck, Nina H M Bartelink, Hans Bosma, Maartje Willeboordse, Bjorn Winkens, Manuela A Joore, Marije Oosterhoff, Onno C P van Schayck, Nina H M Bartelink, Hans Bosma, Maartje Willeboordse, Bjorn Winkens, Manuela A Joore
Abstract
Background: This study examines the social return on investment (SROI) of the "Healthy Primary School of the Future" initiative after 2 years. Methods: Healthy Primary Schools of the Future (HPSF) provide a healthy lunch and daily structured physical activity sessions, whereas Physical Activity Schools (PAS) focus on physical activity only. We evaluated the 2-years investments and effects (N = 1,676 children) of both school environments (four schools) compared to control schools (four schools). Investments and outcomes were grouped within the healthcare, education, household & leisure, and labor & social security sector. Outcomes that could be expressed in monetary terms were used for the calculation of social return on investment. Results: HPSF and PAS created outcomes for the healthcare sector by favorable changes in health behaviors, body mass index [both significant], and medical resource use [not significant]. Outcomes for the education sector included a favorable impact on perceived social behaviors and school satisfaction, and absenteeism from school [latter not significant], and more engagement with the community was experienced. The per child investments, €859 (HPSF) and €1017 (PAS), generated a benefit of €8 (HPSF) and €49 (PAS) due to reduced school absenteeism and medical resource use. Conclusions: Within 2 years of intervention implementation, the HPSF initiative created outcomes in several sectors, but the benefits did not outweigh the investments. Follow-up assessments as well as modeling long-term outcomes are needed to assess the total value of the interventions. Until then, the SROI framework can inform strategies for obtaining stakeholder support and intervention implementation. Trial registration: The study was registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616).
Keywords: child; economic evaluation; health promoting schools; health promotion/economics; social return on investment.
Copyright © 2020 Oosterhoff, van Schayck, Bartelink, Bosma, Willeboordse, Winkens and Joore.
Figures
References
- Lake A, Townshend T. Obesogenic environments: exploring the built and food environments. J R Soc Promot Health. (2006) 126:262–7. 10.1177/1466424006070487
- Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet. (2018) 6:e1077–86. 10.1016/S2214-109X(18)30357-7
- Schönbeck Y, Talma H, van Dommelen P, Bakker B, Buitendijk SE, Hirasing RA, et al. . 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:e27608. 10.1371/journal.pone.0027608
- Willeboordse M, Jansen MW, van den Heijkant SN, Simons A, Winkens B, de Groot RH, et al. . The Healthy Primary School of the Future: study protocol of a quasi-experimental study. BMC Public Health. (2016) 16:639. 10.1186/s12889-016-3301-9
- Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HH, Oosterhoff M, Willeboordse M, et al. . One- and two-year effects of the Healthy Primary School of the Future on children's dietary and physical activity behaviours: a quasi-experimental study. Nutrients. (2019) 11:689. 10.3390/nu11030689
- Bartelink N, Van Assema P, Kremers SPJ, Savelberg HH, Oosterhoff M, Willeboordse M, et al. . Can the Healthy Primary School of the Future offer perspective in the on-going obesity epidemic in young children?—A quasi-experimental study. BMJ Open. (2019) 9:e030676. 10.1136/bmjopen-2019-030676
- Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health. (2017) 71:827–34. 10.1136/jech-2016-208141
- Finkelstein EA, Trogdon JG. Public health interventions for addressing childhood overweight: analysis of the business case. Am J Public Health. (2008) 98:411–5. 10.2105/AJPH.2007.114991
- Laing CM, Moules NJ. Social return on investment: a new approach to understanding and advocating for value in healthcare. J Nurs Adm. (2017) 47:623–8. 10.1097/NNA.0000000000000557
- Banke-Thomas AO, Madaj B, Charles A, van den Broek N. Social return on investment (SROI) methodology to account for value for money of public health interventions: a systematic review. BMC Public Health. (2015) 15:582. 10.1186/s12889-015-1935-7
- Bartelink NHM, van Assema P, Jansen MWJ, Savelberg HH, Willeboordse M, Kremers SPJ. The Healthy Primary School of the Future: a contextual action-oriented research approach. Int J Environ Res Public Health. (2018) 15:2243. 10.3390/ijerph15102243
- Nicholls J, Lawlor E, Neitzert E, Goodspeed T. A Guide to Social Return on Investment. (2012). Available online at: (accessed March 1, 2019).
- Oosterhoff M, Bosma H, van Schayck OCP, Joore MA. A cost analysis of school-based lifestyle interventions. Prev Sci. (2018) 19:716–27. 10.1007/s11121-018-0918-1
- Bartelink NHM, van Assema P, Jansen MWJ, Savelberg HH, Moore GF, Hawkins J, et al. . Process evaluation of the Healthy Primary School of the Future: the key learning points. BMC Public Health. (2019) 19:698. 10.1186/s12889-019-6947-2
- Zorginstituut Nederland. Kostenhandleiding: Methodologie van Kostenonderzoek en Referentieprijzen voor Economische Evaluaties in de Gezondheidszorg [Methodology of Cost Research and Cost Prices for Heal Economic Evaluations]. (2015). Available online at: (accessed November 14, 2019).
- Pomp M, Schoemaker CG, Polder JJ. Op weg naar Maatschappelijke Kosten-Batenanalyses voor Preventie en zorg [Social Cost-Benefit Analysis for Prevention and Care]. Ministerie van Volksgezondheid (2014). Available online at: (accessed March 1, 2019).
- Drost R, Paulus A, Ruwaard D, Evers S. Handleiding Intersectorale Kosten en baten van (Preventieve) Interventies [Guideline for Intersectoral Costs and Benefits of Preventive Interventions]. (2014). Available online at: (accessed November 25, 2019).
- Walker S, Griffin S, Asaria M, Tsuchiya A, Sculpher M. Striving for a societal perspective: a framework for economic evaluations when costs and effects fall on multiple sectors and decision makers. Appl Health Econ Health Policy. (2019) 17:577–90. 10.1007/s40258-019-00481-8
- Oosterhoff M, Bosma H, van Schayck OCP, Joore MA. Correction to: cost analysis of school-based lifestyle interventions. Prev Sci. (2019) 20:970–4. 10.1007/s11121-019-01030-4
- Oosterhoff M, Bosma H, van Schayck OCP, Evers S, Dirksen CD, Joore MA. A systematic review on economic evaluations of school-based lifestyle interventions targeting weight-related behaviours among 4–12 year olds: issues and ways forward. Prev Med. (2018) 114:115–22. 10.1016/j.ypmed.2018.06.015
- Goebbels AF, Lakerveld J, Ament AJ, Bot SD, Severens JL. Exploring non-health outcomes of health promotion: the perspective of participants in a lifestyle behaviour change intervention. Health Policy. (2012) 106:177–86. 10.1016/j.healthpol.2012.04.005
- van Mastrigt GA, Paulus AT, Aarts MJ, Evers SM, Alayli-Goebbels AF. A qualitative study on the views of experts regarding the incorporation of non-health outcomes into the economic evaluations of public health interventions. BMC Public Health. (2015) 15:954. 10.1186/s12889-015-2247-7
- Jones RA, Sinn N, Campbell KJ, Hesketh K, Denney-Wilson E, Morgan PJ, et al. . The importance of long-term follow-up in child and adolescent obesity prevention interventions. Int J Pediatr Obes. (2011) 6:178–81. 10.3109/17477166.2011.575155
- Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. . Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. (2016) 316:1093–103. 10.1001/jama.2016.12195
- Hutchinson CL, Berndt A, Gilbert-Hunt S, George S, Ratcliffe J. Valuing the impact of health and social care programmes using social return on investment analysis: how have academics advanced the methodology? A protocol for a systematic review of peer-reviewed literate. BMJ Open. (2018) 8:e022534 10.1136/bmjopen-2018-022534
Source: PubMed