Background
Methods
Working definitions
Intervention
Prevention interventions in schools
Collaboration between school and local community
Stakeholders
Active involvement of stakeholders
Outcomes
A scoping review
Search approach
Database search
Inclusion criteria
Screening process
Stakeholder consultation
Data analysis
Children’s involvement
School-community collaboration
Intervention outcomes
Results
Overview of included studies
Authors | Children and youth involvement | School/community collaboration | |||
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Representative | Consensus | Shared activities | Collaboration | Joint intervention | |
Birnbaum et al. (2002) [38] | Collecting children’s opinion: participation in health committees; School Nutrition Advisory Council (SNAC). Children are involved in the implementation of predefined interventions: peer leaders “help deliver the intervention”, i.e., a predefined curriculum. | Take-home activities and information: Parent Packs with a newsletter, tip sheets on healthy eating, and family assignments and activities. | Parents and staff take part in SNACs to develop policy practices. | ||
Carlsson & Simovska (2012) [47] | The intervention follows the Investigation-Vision-Action-Change (IVAC) approach and involves pupils in all its stages. | Local communities were involved in the health-promoting changes made in the school, e.g. through collaboration with community stakeholder consultants that take part in development and implementation. | |||
Dzewaltowski et al. (2009) [40] | Children take part in school advocacy groups, “change teams”, led by adult site coordinators. Change teams create awareness of PA and healthy eating among peers. A curriculum supporting environmental change skills reached all involved classes. 14.9 % of intervention pupils take part in a change team. Children and youth take part in implementing change, but adults initiate and lead the intervention. | Shared activities between schools: school staff members receive training and are linked between schools in a “performance community hub” to facilitate sharing and problem-solving. | |||
Gådin et al. (2009) [44] | All pupils are involved in developing suggestions for school change in a participatory process using the “It’s your decision” model. A few pupils participate in an HPS committee and take part in the decision-making process. Students make up half the committee, which has the purpose of prioritising pupils’ proposals for environmental change and developing strategies for implementation. | Whole-school approach with involvement of parents in the school health committee. The amount of influence of the two parent representatives is unclear. | |||
Haapala et al. (2014) [41] | Involving children in implementation of predefined interventions: pupils take part in designing and executing recess activities as peer instructors and activators. | Schools and municipalities implement the plan that they have designed for themselves, backed by the national project framework. | |||
Hannay et al. (2013) [49] | Teens are involved as co-researchers, taking part in defining framing questions, identifying problem areas and developing and implementing an action plan for advocacy for environmental and policy change in their community. | Presentation of the project by students to policy-makers and community stakeholders. Partnership between community members. | |||
Linton et al. (2014) [45] | Youth participating in the action groups perform community assessment and subsequently advocate for environmental and policy change with policy-makers. Genuine participation, including conducting surveys, assessing and prioritizing issues. Leadership and development and implementation of an action plan for advocacy for change in their community. | Adult mentors form youth action groups in schools and community centres. Mentors attend train-the-trainer seminars delivered by the programme. | |||
Orme et al. (2013) [39] | Participation in School Nutrition Action Groups (SNAGs); policy groups located at school. Pupil representatives collect the opinions of all pupils. Different levels of involvement in different schools. Pupils provide input through the SNAG, but decisions are made by school staff. | Whole-school approach including curriculum, school ethos and community involvement. Parents, teachers and school management participate in SNAGs. | |||
Ríos-Cortázar et al. (2014) [42] | Involving children in research: children as co-researchers. Children take part in leadership and advocacy: leadership and development and implementation of an action plan for advocacy for change in their community. | Partnerships: participatory approach involving students and the community. Three phases (exploratory, diagnostic, strategy definition). | |||
Rowe et al. (2010) [43] | A group of students conduct a survey among the other pupils, staff, parents and community stakeholders (the “ideal” school). Staff and senior students work together to address problem areas. Students take part in the visioning, advocacy, implementation and running of a “Kids Café”. Children contribute to Kids Café activities (recipes) and workshops. | Students, school staff, parents and community stakeholders take part in the launch of the initiative, a “Kids Café”, and the formation of a health committee. Parents and community stakeholders use the Kids Café and attend performances and educational activities. The area is established permanently through support from the community and local businesses. | |||
Simovska & Carlsson (2012) [48] | Involving children in decision-making and project management: participation as a learning-through-success strategy. Participation is used as an influence strategy that enhances confidence and competence. | Local communities are involved in the health-promoting changes made in the school. Changes to the local environment related to healthy eating in one school and PA in four schools. A “walking school bus” is established in collaboration with parents at two schools. Several schools collaborate with local authorities to improve local PA opportunities. | |||
Toussaint et al. (2011) [46] | Youth Health Advocates (YHAs); high school youth enrolled in the programme receive training on health, leadership and more, to empower them to perform peer outreach. Youth are involved in implementation of activities. Power-sharing activities. | Community-generated programme including a community advisory board. The initiative includes a campaign and policy change efforts at local schools, and runs an after-school club. |
Children’s involvement
School-community collaboration
Intervention outcomes
Authors | Outcomes for children | Outcomes for stakeholders | Outcomes for schools and communities |
---|---|---|---|
Birnbaum et al. (2002) [38] | Impact on fruit and vegetable consumption (from 4.88 + -0.06 servings to 5.80 + -0.05) and food choice (from a score of 5.90 + -0.16 to 6.54 + -0.16) for those exposed to environment changes, curriculum intervention and being peer leaders. | ||
Carlsson & Simovska (2012) [47] | Changes in pupils’ action competence through increased knowledge (related to healthy behaviours and health determinants), self-confidence, communication skills and critical thinking. | Changes in school meal provision and PA-promoting environments, e.g., bicycle parking lot, road safety on the school and community levels. | |
Dzewaltowski et al. (2009) [40] | Intervention schools increased in PA while controls decreased from years 7 to 8. 3.7 % increase in physical activity after school, corresponding to an increase of 7.5 min per day. FV intake did not change over time compared to controls. | Self-efficacy of adult leaders was high before the intervention and remained high at all measurements. | |
Gådin et al. (2009) [44] | The outcomes reported are not the result of an evaluation, but rather the expected outcomes based on the changes made. These include empowerment and increased influence on their school life, leading to mental health benefits. | Change in school and community policy: adaptation of existing policies, rules and action plans, e.g., action plan against bullying. Physical changes to the school playground to increase PA and improve social relations between pupils. | |
Haapala et al. (2014) [41] | Increase in recess physically active play (from 30 to 49 %) and ball games (from 33 to 42 %) during the project, mainly due to males’ participation. However, PA decreased in the follow-up period. Pupils who spent recess outdoors increased from 17 to 33 % in the project period. | Change in the organisation of the school day, including more opportunities for PA. Development of facilities and equipment for PA during the project. At one school, networks with parents and municipality office-holders were established for PA promotion. | |
Hannay et al. (2013) [49] | Development of advocacy skills, enhanced self-esteem and confidence, and motivation to engage in further advocacy. | Parents reaped personal benefit from contributing to overcoming negative stereotypes. | Advocacy by participants led to changes in policies for credit towards physical education in an alternative setting and changes to a school bus route. |
Linton et al. (2014) [45] | Implementation of environmental changes in schools and communities following advocacy activities e.g., extra lighting, salad bar, female-only swim time. | ||
Orme et al. (2013) [39] | Improvements to school meals and dining environment reported by pupils. | ||
Ríos-Cortázar et al. (2014) [42] | Changed behaviour, attitudes and norms: the programme had an impact on children’s cognitive, social and emotional levels, nutrition and physical activity. | ||
Rowe et al. (2010) [43] | The learning process developed pupils’ advocacy skills. | Stronger relationship between school and community. The intervention ensured the availability of healthy, affordable meals through the establishment of the Kids Café and supported an environment that promotes healthy eating behaviours. | |
Simovska & Carlsson (2012) [48] | Skills and competence: leadership increased the sense of responsibility and motivation in pupils, development of learning and competency. Development of social responsibility, e.g., considering younger peers. | Provision of healthy eating and PA opportunities and improved environment e.g., bicycle parking lot, road safety initiatives on the school and community levels. | |
Toussaint et al. (2011) [46] | Change in eating habits, e.g., less sugar intake, and increase in PA. Development of critical thinking, leadership and advocacy skills, enhancement of self-esteem and confidence, motivation to engage in higher education. | Change in family members: healthier eating habits, weight loss, increased PA. |
Impact of involvement of stakeholders on the outcomes of the intervention
Discussion
Results and limitations of the included studies
Implications for practice, policy and research
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A community-based approach to mobilise the diverse and valuable resources available in local community settings, and to draw on the strengths of social interactions and local ownership as drivers of change processes [12].
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A whole-school approach [55] that includes coherence between school policy and practice to improve social inclusion and commitment to education, to facilitate the improvement of learning outcomes and to increase emotional well-being and reduce health risk behaviours [11]. This approach is most effective when the school uses its full organisational potential to enhance health among students, staff, families and community members [56].
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A participatory approach addressing health and actively involving children as well as various other groups of stakeholders in the processes of influencing decision-making regarding the design, planning, implementation and/or evaluation of interventions [57]. This approach means that the emphasis is not on implementing interventions “targeting children” but rather on creating the necessary conditions to reduce risk factors and enhance children’s health. The mobilisation, active involvement and empowerment of stakeholders are not only intermediate outcomes but also critical preconditions for the effectiveness of prevention efforts and are therefore goals in and of themselves [58, 59].
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A relevant evaluation framework that has proven useful in assessing the quality of implementation processes while determining the effects of interventions. Many frameworks and approaches have attempted to identify the components of effects of complex interventions (e.g. the RE-AIM framework [60], cost-effectiveness models, and multiplier assessments [61] and the most relevant level to evaluate them (e.g., individual, group, setting, and/or institutional level [62]. To provide a dynamic account of the inherent complexity of interventions, theory-based realistic evaluations have been identified as a relevant framework of choice to evaluate interventions implemented in complex school- and/or community-based settings.
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In addition to these gaps, it would be interesting and highly relevant to investigate and compare the effectiveness of “outcomes” between studies that involve children and young people in interventions and those that do not. Related to this, future research should explore methodological issues related to how one measures the effectiveness of the active involvement of children and stakeholders.