Abstract
BackgroundThe Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9–10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods. This paper reports on both the quantitative and qualitative data regarding the implementation of the HeLP intervention in the definitive cluster randomised controlled trial, which was part of the wider process evaluation.MethodsMixed methods were used to collect data on intervention uptake, fidelity of delivery in terms of content and quality of delivery of the intervention, as well as school and child engagement with the programme. Data were collected using registers of attendance, observations and checklists, field notes, focus groups with children and semi-structured interviews with teachers. Qualitative data were analysed thematically and quantitative data were summarized using descriptive statistics.ResultsAll 16 intervention schools received a complete or near complete programme (94–100%), which was delivered in the spirit in which it had been designed. Of the 676 children in the intervention schools, over 90% of children participated in each phase of HeLP; 92% of children across the socio-economic spectrum were deemed to be engaged with HeLP and qualitative data revealed a high level of enjoyment by all children, particularly to the interactive drama workshops. Further evidence of child engagment with the programme was demonstrated by children’s clear understanding of programme messages around marketing, moderation and food labelling. Thirteen of the intervention schools were deemed to be fully engaged with HeLP and qualitative data revealed a high level of teacher ‘buy in’, due to the programme’s compatability with the National Curriculum, level of teacher support and use of innovative and creative delivery methods by external drama practitioners.ConclusionOur trial shows that it is possible to successfully scale up complex school-based interventions, engage schools and children across the socio-economic spectrum and deliver an intervention as designed. As programme integrity was maintained throughout the HeLP trial, across all intervention schools, we can be confident that the trial findings are a true reflection of the effectiveness of the intervention, enabling policy recommendations to be made.Trial registrationISRCTN15811706.
Highlights
The Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9–10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods
This paper reports on the quantitative and qualitative data collected to assess the implementation of the HeLP intervention in the sixteen intervention schools
Intervention uptake Over 90% of children participated in each phase of HeLP and 93% of children received the four drama sessions in phase 2 and the 1–1 goal setting in phase 3 delivered in the ‘spirit’ of HeLP
Summary
The Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9–10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods. Childhood obesity is strongly associated with socioeconomic status, with children from the least affluent decile being twice as likely to be obese as children from the most affluent decile [2]. School-based obesity preventative interventions have the potential to reach a large number of children and families across the socioeconomic spectrum and schools provide the organisational, social and communication structures to educate children and parents about healthy lifestyles. Systematic reviews of school-based interventions to prevent obesity and/or increase physical activity and reduce sedentary behaviours show, at best, moderate evidence of effectiveness, with the majority of studies being conducted in the United States [4]. Programme integrity is rarely reported in primary and early secondary prevention programmes in general [7] and those trials which do report on the fidelity of delivery, often reveal a lack of intervention integrity, calling into question the validity of their findings [8, 9]
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