Data_Sheet_3_Building community capacity to stimulate physical activity and dietary behavior in Dutch secondary schools: Evaluation of the FLASH intervention using the REAIM framework.docx

BackgroundBuilding community capacity in secondary schools is a promising strategy for the sustainable implementation of school-based health promotion. The Fit Lifestyle at School and at Home (FLASH) intervention explored how building community capacity works for the prevention of overweight following four strategies: leadership, participatory school culture, tailored health-promotion activities, and local networks. This study evaluates the intervention's impact on community capacity and capacity-building processes over a period of 3 years, as well as its effects on adolescents' BMI and waist circumference.
MethodsA mixed-methods design guided by the RE-AIM framework was used. Impact on community capacity was evaluated with semi-structured interviews at the start and end of the intervention and analyzed using an anchored coding scale. Capacity-building processes were evaluated using interviews, journals, questionnaires, and the minutes of meetings. The effects on BMI z-scores and waist circumference were evaluated using a quasi-experimental design comparing an intervention (IG) and reference group (RG), based on multi-level analyses.
ResultsCommunity capacity improved across all intervention schools but varied between capacity-building strategies. Leadership recorded the greatest improvements, aided by the appointment of Healthy School Coordinators, who increasingly focused on coordinating processes and fostering collaborations. Participatory school culture also improved through the adoption and implementation of participatory methods and a general increase in awareness concerning the importance of the Healthy School approach. Although additional health-promotion activities were implemented, stakeholders struggled with tailoring these to the specific dynamics of their schools. Limited improvements were observed in setting-up local networks that could help schools encourage healthy behavior among pupils. Differences in BMI z-scores between IG and RG over the total sample were negligible whereas waist circumference increased slightly more in IG (0.99 cm, 95% CI [.04; 1.93]). However, differences were inconsistent over time and between cohorts.
ConclusionsThis study highlights the potential of building community capacity. It emphasizes that this is a process in which stakeholders must become acquainted with new leadership roles and responsibilities. To navigate this process, schools need support in improving communication, establishing local networks, and sustaining capacity-building efforts in school policy.
Trial registrationISRCTN67201841; date registered: 09/05/2019, retrospectively registered.

背景 在中学阶段构建社区能力，是实现校本健康促进可持续落地的极具前景的策略。本研究所关注的「校园与居家健康生活方式（Fit Lifestyle at School and at Home, FLASH）」干预项目，围绕领导力、参与式校园文化、定制化健康促进活动及本地网络四大策略，探究了社区能力建设在超重预防中的应用路径。本研究对该干预实施3年间对社区能力及能力建设过程的影响，以及对青少年身体质量指数（BMI）和腰围的干预效果进行了评估。
方法 本研究采用基于RE-AIM框架（RE-AIM Framework）指导的混合研究设计。通过干预开始与结束阶段的半结构化访谈，结合锚定编码量表进行分析，以评估社区能力所受的干预影响。针对能力建设过程，则通过访谈、研究日志、调查问卷及会议纪要进行评估。对于青少年BMI及腰围的干预效果，本研究采用准实验设计，设置干预组（Intervention Group, IG）与对照组（Reference Group, RG），并通过多层分析方法开展比较评估。
结果 所有参与干预的学校，其社区能力均得到提升，但不同能力建设策略的提升效果存在差异。其中，随着健康学校协调员的任命，领导力维度的提升最为显著，该职位人员也愈发专注于协调各项流程并推动多方协作。通过采用并落实参与式方法，以及对健康学校理念重要性的整体认知提升，参与式校园文化维度也得到改善。尽管研究团队落实了多项额外的健康促进活动，但利益相关方仍难以根据各校的具体情况对活动进行定制化调整。在搭建可助力学校引导学生健康行为的本地网络方面，仅取得了有限的提升。干预组与对照组整体样本的BMI z得分差异可忽略不计，但干预组的腰围平均增长略高于对照组（0.99 cm，95%置信区间[0.04; 1.93]）。不过，该差异随时间推移及不同队列间存在不一致性。
结论 本研究证实了构建社区能力的潜在价值，并强调这是一个需要利益相关方熟悉全新领导角色与职责的过程。为顺利推进该建设过程，学校需获得相关支持，以改善沟通、搭建本地网络，并在校园政策中持续推进能力建设工作。
试验注册 ISRCTN67201841；注册日期：2019年5月9日，为回顾性注册。