How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research.

Manou Anselma,Teatske M Altenburg,Xinhui Wang,Jos W R Twisk,Mai J M Chinapaw

doi:10.1177/10901981211046533

Manou Anselma, Teatske M Altenburg + Show 3 more

Open Access

https://doi.org/10.1177/10901981211046533

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Abstract

Most actions targeting children's health behaviors have limited involvement of children in the development, potentially contributing to disappointing effectiveness. Therefore, in the 3-year "Kids in Action" study, 9- to 12-year-old children from a lower-socioeconomic neighborhood were involved as coresearchers in the development, implementation, and evaluation of actions targeting health behaviors. The current study describes the controlled trial that evaluated the effects on children's energy balance-related behaviors, physical fitness, and self-rated health, as well as experienced challenges and recommendations for future evaluations. Primary school children from the three highest grades of four intervention and four control schools were eligible for participation. Outcome measures assessed at baseline, and at 1- and 2-year follow-up were as follows: motor fitness by the MOPER test (N = 656, N = 485, N = 608, respectively), physical activity and sedentary behavior by accelerometry (N = 223, N = 149, N = 164, respectively), and consumption of sugar sweetened beverages and snacks and self-rated health by a questionnaire (N = 322, N = 281, N = 275, respectively). Mixed-model analyses were performed adjusted for clustering within schools and relevant confounders. Significant beneficial intervention effects were found on self-reported consumption of energy/sports drinks at T2 versus T0, and on total time and ≥5-minute bouts of moderate-to-vigorous physical activity at T1 versus T0. Significant adverse effects were found on "speed and agility" and "coordination and upper-limb speed." No other significant effects were found. The inconsistent intervention effects may be explained by the dynamic cohort and suboptimal outcome measures. We advise future studies with a similar approach to apply alternative evaluation designs, such as the delayed baseline design.

Highlights

In the Netherlands, the number of children with overweight and obesity gradually declined in the past decade (Dutch Bureau for Statistics [Centraal Bureau voor de Statistiek–Dutch], 2019), in the city of Amsterdam (City of Amsterdam, 2017)
energy balance-related behaviors (EBRBs)—that is, behaviors that effect energy intake or expenditure, such as physical activity, dietary behavior, and screen time—have been associated with overweight and obesity in children (Romieu et al, 2017; te Velde et al, 2012), with children from lower educated parents being more likely to engage in unhealthy EBRBs (Fernandez-Alvira et al, 2013)
Supplemental 2 provides the characteristics of children participating in the Motor Performance (MOPER) fitness test

Summary

Introduction

In the Netherlands, the number of children with overweight and obesity gradually declined in the past decade (Dutch Bureau for Statistics [Centraal Bureau voor de Statistiek–Dutch], 2019), in the city of Amsterdam (City of Amsterdam, 2017) Despite this promising development, the number of children with overweight or obesity with a low-socioeconomic position (SEP; based on family income, household conditions, parental education, and occupation) or from a non-Western background remains high (City of Amsterdam, 2017; Franssen et al, 2015). The number of children with overweight or obesity with a low-socioeconomic position (SEP; based on family income, household conditions, parental education, and occupation) or from a non-Western background remains high (City of Amsterdam, 2017; Franssen et al, 2015) These children are disproportionally affected by unhealthy behaviors and related health effects, for example, because healthy foods are not/cannot be prioritized, cultural habits, and limited finances (Anselma et al, 2018). Interventions that are designed for, or even together with, children from these communities may better fit their needs and interests and thereby may be more effective (Anselma et al, 2020)

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