Thirsty? Choose Water! Behavioural interventions and water stations in secondary schools a two-by-two factorial randomised controlled trial

Abstract Background Childhood overweight and obesity is a significant public health issue. A key contributing factor is sugar sweetened beverages (SSBs) consumption. Evidence suggests that secondary school students are frequent consumers of SSBs, with high daily consumption. The promotion of water consumption and provision of chilled water stations can reduce SSBs consumption. The Thirsty Choose Water! study will evaluate the effectiveness of two interventions, a behavioural intervention, Thirsty? Choose Water! behavioural intervention (TCW-BI), that target students through the domains of the health promoting high schools framework, and the second intervention is the installation and promotion of chilled water stations. Methods/design This community trial will recruit 60 secondary schools from across three Local Health Districts (LHDs) within New South Wales (NSW). A two-by-two factorial study design will be used to determine the effect of the Thirsty? Choose Water! behavioural intervention (TCW-BI), and the installation of chilled water stations. The recruited secondary schools will be randomised and non-blinded to one of four study arms receiving either the TCW-BI or chilled water stations, both interventions, or neither (control group). Baseline measures will be collected including student self-report surveys which will gather data regarding knowledge, attitudes and consumption of water and SSBs, a school profile and an environmental scan. Student surveys will be repeated post the intervention and at follow-up. Regular water meter readings will determine the water flow from the chilled water stations across the study period. Discussion There is an increasing body of evidence which suggests that decreasing consumption of SSBs can impact positively on childhood overweight and obesity. However, in the Australian context there are limited studies on how this may occur in the secondary school setting. This study will add to this evidence base and establish the effectiveness of TCW-BI and chilled water stations, either alone or combination on increasing water consumption in adolescents. Information about barriers and facilitators to implementation will be documented. Packages to support the implementation of the TCW-BI as a state-wide initiative will be developed. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12618000526279 April 2018

Additional file 1: of Thirsty? Choose Water! Behavioural interventions and water stations in secondary schools a two-by-two factorial randomised controlled trial

Thirsty Choose Water and the Health Promoting Schools Framework. (PDF 207 kb

Additional file 2: of Thirsty? Choose Water! Behavioural interventions and water stations in secondary schools a two-by-two factorial randomised controlled trial

Spouts and Straws game. (PDF 320 kb

Evaluating the scaling up of an effective implementation intervention (PACE) to increase the delivery of a mandatory physical activity policy in primary schools

Abstract Background Physically Active Children in Education (PACE) is an effective implementation intervention for increasing the number of minutes classroom teachers schedule physical activity each week. To date, evaluations of PACE have included a smaller number of schools from only one region in New South Wales Australia. If PACE is to have population-wide benefits we must be able to deliver this support to a larger number of schools across multiple regions. This study aimed to evaluate the scale-up of PACE. Methods An uncontrolled before and after study, with 100 schools from three regions was conducted. Participating schools received PACE for approximately 12 months. We assessed the following outcomes: delivery of the evidence-based intervention (EBI) (i.e. minutes of physical activity scheduled by classroom teachers per week); delivery of the implementation strategies (i.e. reach, dose delivered, adherence and indicators of sustainability); and key determinants of implementation (i.e. acceptability of strategies and cost). Data were collected via project officer records, and principal and teacher surveys. Linear mixed models were used to assess EBI delivery by evaluating the difference in the mean minutes teachers scheduled physical activity per week from baseline to follow-up. Descriptive data were used to assess delivery of the implementation strategies and their perceived acceptability (i.e. PACE). A prospective, trial-based economic evaluation was used to assess cost. Results Delivery of the EBI was successful: teachers increas their average minutes of total physical activity scheduled across the school week by 26.8 min (95% CI: 21.2, 32.4, p 50% of schools adhered to the majority of strategies (11 of the 14 components); and acceptability was > 50% agreement for all strategies. The incremental cost per additional minute of physical activity scheduled per week was $27 per school (Uncertainty Interval$24, $31). Conclusions PACE can be successfully delivered across multiple regions and to a large number of schools. Given the ongoing and scalable benefits of PACE, it is important that we continue to extend and improve this program while considering ways to reduce the associated cost