The Healthy Elementary School of the Future

Brief Summary

Detailed Description

In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. We hypothesize that these healthy school interventions will result in normalized BMI distributions that are more in line with national and international standards (smaller standard deviations) among primary school children, with a more pronounced effect in the full intervention schools (due to the expected synergy between exercise and diet) than in the partial intervention schools. Also, our multi-disciplinary research group will study a wide range of outcome measures, including lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs. Moreover, an evaluation will be performed of the legal consequences of a healthy school approach in the Netherlands, as well as the conflicting interests of the stakeholders. Data collection is conducted within the school system. The interventions proceed during a period of four years. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019. Our primary research question is: What is the effect of the full intervention ('The Healthy Primary School of the Future') on the BMI of primary school children compared to no intervention (control schools)? Our secondary research question is: What is the effect of the full intervention on the BMI of primary school children compared to the partial intervention ('The Physical Activity School')? Our tertiary research questions are: (1) What is the effect of the full intervention in comparison with the partial intervention and the regular school approach (control schools) on: (a) children's levels of physical activity and sedentary behaviour, nutritional knowledge, healthy food preferences and behaviour, cognitive and non-cognitive performance, Health related-QoL, socio-emotional development, and sick leave? (b) parenting and teacher practices regarding physical activity and nutrition? (c) parental HR-QoL, well-being, labour participation and sick leave? (d) benefits across different socio-economic backgrounds? (e) long and short term cost-effectiveness? (f) satisfaction among the involved stakeholders (children, parents, teachers, and child care partners)? (2) Which determinants influence the quality of the implementation of the intervention? (3) What is the scope of children's human rights to health, what is the legal role of primary schools in realizing these rights (e.g., obligations and responsibilities of state and non-state actors, conflicts of interests and legal solutions to these conflicts), and is the intervention feasible within Dutch educational law? A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society.

Primary Outcomes

Secondary Outcomes

• Teacher's self-reported height, weight and transport forms to work(Four years)
• Parental practices regarding nutrition and physical activity(Four years)
• Parents' ethnicity and level of (material) deprivation(Four years)
• School advice and the actual level of secondary school opted for (Dutch secondary education is hierarchically ordered).(Four years)
• Child disease status(Four years)
• Parental BMI(Four years)
• Parental practices regarding physical activity(Four Years)
• Sports club membership, active forms of transport to school, and leisure time physical activities assessed in both children and parents.(Four years)
• Child academic achievements(Four years)
• Parental practices regarding nutrition(Four years)
• Labour participation of parents(Four years)
• Parental sick leave and absence from work or education because of illness of their child.(Four years)
• Child health-related quality of life(Four years)
• Child food intake(Four years)
• Parental wellbeing(Four years)
• Socioeconomic status(Four years)
• Juridical evaluation through literature study and interviews(Four years)
• Child hip and waist circumferences(Four years)
• Child pre-school blood pressure, birth weight, and information on disease history.(Obtained once)
• Child psychological attributes(Four years)
• Child social, emotional, and academic self-efficacy.(Four years)
• Parental health-related quality of life(Four years)
• School/ teacher practices regarding nutrition and physical activity(Four years)
• School absenteeism and repeating classes(Four years)
• Child handgrip strength(Four years)
• Child self-confidence, social skills, self-efficacy, school well-being, and social support(Four years)
• Child physical activity and sedentary behavior (Actigraph accelerometer)(Four years)
• Child food preferences and familiarity with healthy food products.(Four years)
• Process evaluation using a school satisfaction questionnaire(Four years)