Evaluating the Implementation and Effectiveness of the SWITCH-MS: An Ecological, Multi-Component Adolescent Obesity Prevention Intervention.

Senlin Chen,David A Dzewaltowski,Spyridoula Vazou,Douglas A Gentile,Gabriella M Mcloughlin,Richard R Rosenkranz,Lorraine Lanningham-Foster

doi:10.3390/ijerph17155401

Abstract

Background: The purpose of this study was to evaluate the implementation and effectiveness of an ecological, multi-component adolescent obesity prevention intervention called School Wellness Integration Targeting Child Health–Middle School (SWITCH–MS). Methods: Following the effectiveness-implementation hybrid type 3 quasi-experimental design, seven middle schools (377 students) in Iowa, United States, were stratified into “experienced” (n = 3; 110 students) or “inexperienced” (n = 4; 267 students) groups to receive the 12-week SWITCH–MS intervention. To evaluate implementation, school informants (n = 10) responded to a survey and students completed behavioral tracking in the classroom on a website. For effectiveness evaluation, students in 6th, 7th, and 8th grades completed a validated questionnaire before and after intervention, to measure behaviors of physical activity (PA; “Do”), screen-based activity (“View”), and fruits and vegetable consumption (“Chew”). Results: The two groups of schools showed similar levels of implementation for best practices, awareness, and engagement. Behavioral tracking rate favored the experienced schools early on (47.5% vs. 11.7%), but differences leveled off in weeks 3–12 (sustained at 30.1–44.3%). Linear mixed models demonstrated significant time effects for “Do” (at school and out of school; p < 0.01) and “View” behaviors (p = 0.02), after controlling for student- and school-level covariates. Conclusions: This study demonstrates that prior experience with SWITCH–MS may not be a prominent factor for implementation and effectiveness, although greater experience is associated with favorable behavioral tracking when the intervention is first launched.

Highlights

Childhood obesity remains a major global public health concern with over 340 million children and adolescents being classified overweight or obese in 2016 [1]
More youth obesity prevention interventions that allow for adaptations in implementation in rural areas are warranted to reduce health disparity [3]
The average scores for these implementation indicators were commensurate between the two groups of schools, experienced schools showed higher levels of engagement and inexperienced schools showed higher implementation in the lunchroom

Summary

Introduction

Childhood obesity remains a major global public health concern with over 340 million children and adolescents being classified overweight or obese in 2016 [1]. More youth obesity prevention interventions that allow for adaptations in implementation in rural areas are warranted to reduce health disparity [3]. The purpose of this study was to evaluate the implementation and effectiveness of an ecological, multi-component adolescent obesity prevention intervention called School. Methods: Following the effectiveness-implementation hybrid type 3 quasi-experimental design, seven middle schools (377 students) in Iowa, United States, were stratified into “experienced” (n = 3; 110 students) or “inexperienced” (n = 4; 267 students) groups to receive the 12-week SWITCH–MS intervention. School informants (n = 10) responded to a survey and students completed behavioral tracking in the classroom on a website. Students in 6th, 7th, and 8th grades completed a validated questionnaire before and after intervention, to measure behaviors of physical activity (PA; “Do”), screen-based activity (“View”), and fruits and vegetable consumption (“Chew”). Behavioral tracking rate favored the experienced schools early on (47.5% vs. 11.7%), but differences leveled off in weeks 3–12 (sustained at 30.1–44.3%)

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Discussion

Conclusion