Abstract
To test the effectiveness of a social network intervention (SNI) to improve children's healthy drinking behaviours. A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as 'influence agents' to promote water consumption-as an alternative to sugar-sweetened beverages (SSB)-among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention. Eleven schools in the Netherlands. Four hundred and fifty-one children (Mage = 10·74, SDage = 0·97; 50·8 % girls). Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (β = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (β = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (β = -0·12, P = 0·028) and injunctive norms (β = 0·11-0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions. These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI.
Highlights
The required sample size was based on the previous pilot study(23) where a small effect of the social network intervention (SNI) was found with 210 children with a SNI condition and control condition
The analyses yielded statistically significant differences at baseline (T1) between conditions for sugar-sweetened beverages (SSB), F (2435) = 3·57, P = 0·029, but not for water consumption, F (2435) = 1·38, P = 0·252. This indicated that the randomisation was not successful for SSB consumption; it is essential to account for these initial differences between conditions to avoid interpreting regression to the mean effects(46)
Condition differences on changes in water and sugar-sweetened beverage consumption The first structural path model examined whether children exposed to the SNI increased their water and decreased SSB consumption compared to those in the active control condition (H1a and H2a) and control condition (H1b and H2b)
Summary
Design The study involved a three-arm cluster randomised controlled trial with schools as the unit of randomisation. The active control condition was based on the principles of mass media campaigns and, consisted of exposing all children simultaneously to a presentation on the benefits of water consumption. The required sample size was based on the previous pilot study(23) where a small effect of the SNI was found with 210 children with a SNI condition and control condition. This number was multiplied with 1·5 to add the third condition (i.e. active control) in the current study, resulting in a minimum number of 315 children across the 3 groups. In order to take non-response in the active consent procedure into account, a larger number of children were recruited
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