Alongside learning about mathematics, history, languages and many other things, schools are a recommended setting for interventions to improve health. However, it can be difficult to implement these interventions and, in November 2017, Luke Wolfenden of the University of Newcastle in Callaghan, Australia and colleagues published their new Cochrane Review looking into how this might be done. Luke tells us what they found in this podcast.
Although there are a variety of school-based interventions that improve the diet, physical activity and weight status of school students or reduce their risk of harmful alcohol or tobacco use, their implementation in schools is not routine. Broadly, therefore, our objective was to review strategies that might be used to improve the implementation of school-based interventions which target student diet, activity, obesity, tobacco or alcohol use. Unfortunately, we’ve found that the current evidence base is weak for such an important topic.
The sorts of thing that might be done when a health promoting intervention is introduced into a school include training, audit and feedback or incentives. We looked for randomized and non-randomized trials that had assessed the impact of these and other strategies on how well the health promoting intervention was implemented. The strategies could target policies and practices in the school environment such as changes to cafeteria offerings, or the school curriculum itself, such as the introduction of physical education lessons.
We included 27 trials, most of which were from the USA. Nineteen of the trials were randomised and all reported multi-component implementation strategies. The most common of which were educational meetings, educational outreach visits, and educational materials. The main focus was on policies or programs targeting healthy eating or physical activity interventions, and none of the included trials sought to improve the implementation of interventions to influence alcohol consumption.
Among 13 trials reporting change in the proportion of schools or school staff implementing a targeted policy or practice, the average improvements achieved by the strategies ranged just under 10% to nearly 70%. Whereas, among the seven trials that reported the percentage of a practice, program or policy that had been implemented, we found a drop of 8% for one up to an increase of 43% for another.
Turning to the actual effect on health outcomes, we found only very low certainty evidence. The impact on student health behaviour or weight status were mixed and there was also mixed, low certainty evidence for their effects on health behaviours of the school staff.
In summary, there’s no clear evidence at the moment on the impact of implementation strategies on getting health-promoting policy and practice initiatives into schools or on the health behaviours or weight status of the students. This leaves an important gap and further research is required to develop the implementation evidence base, so that policies, practices and programs designed to improve student health can be applied and can yield their intended benefits.