Overweight and Obesity Clinical Trial
Official title:
SWITCH Implementation Effectiveness Trial
The SWITCH (School Wellness Integration Targeting Child Health) project is a multi-component intervention designed to support school wellness programming and contribute to youth obesity prevention. Consistent with social-ecological models, SWITCH is designed to reach multiple settings within schools while also facilitating engagement with families and community partners. The program focuses on three distinct behaviors known to impact obesity (i.e., physical activity (PA), sedentary behavior (SB) and fruit and vegetable consumption (FV)) in a creative way by challenging children to "switch what they do, view and chew".
Schools provide an ideal setting for coordinated youth obesity prevention but it has proven
difficult to widely disseminate evidence-based programs in a cost-effective way.
Multi-component programs that target multiple behaviors and reach multiple settings have been
widely recommended in both scientific literature and in public health guidelines documents,
but there are few examples of integrated social-ecological approaches that offer promise for
broad dissemination.
SWITCH initially began as a controlled childhood obesity intervention trial. A limitation of
the original SWITCH program is that the print-based materials made it cost-prohibitive to
promote broader dissemination, or to engage other schools. Therefore, the focus of subsequent
work focused on developing and testing implementation strategies that would enable SWITCH to
be more widely disseminated. In a controlled effectiveness study, we demonstrated that a
web-based version had similar utility and outcomes as the print-based program, but effects
were directly related to the degree of engagement within the school. Through a USDA-funded
project, we developed a novel training method designed to facilitate greater adoption and
more effective implementation of SWITCH in schools. The focus in this revised SWITCH model
was on helping schools to independently manage the implementation of the evidence-based
SWITCH program as part of overall school wellness programming. Thus, we have gradually
evolved SWITCH from a school-based intervention conducted through schools to a school
wellness training method provided for schools. Schools received
Before moving to broader dissemination efforts it was important to determine the dose of
training and support needed to assist schools with implementation. Therefore, the focus of
this study was on comparing two different implementation approaches. An enhanced capacity
building model that included personalized webinars with school leaders (Enhanced) was
compared to a streamlined model based on email communication (Standard). Thus, a key goal is
to determine the additive benefit of the enhanced school support relative to the standard
implementation. Past work has demonstrated that there is considerable variability in the
capacity of schools to take on and lead school wellness programming. Therefore, the analyses
also directly examined the moderating influence of school capacity on implementation as well
as the impact of implementation on outcomes.
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