Background
Rationale
Why investigate adolescents?
Why investigate full-time schools in Brazil?
Why is the program called Fortaleça sua Saúde?
Methods
Aim and study design
Setting and population
Recruitment of schools and students
Intervention
Pilot study
Theoretical basis of the Fortaleça sua Saúde program
Component descriptions and strategies | Specific focus on PA or screen time use mediatorsa | Executor agent |
---|---|---|
Training and activities in general curriculum (Aim: to train and encourage teachers to discuss health topics in the classroom) | ||
➢Training with certification focused on health topics and dynamics in the curriculum | √ Primary: EP (teacher support and modeling) and ENV (school) | √ Program members |
➢Supplemental manual with proposed activities on health topics to be applied in the classroom | √ Primary: IP (knowledge, risks/benefits, types) and ENV (school) | √ Teachers |
√ Secondary: EP (teacher support and modeling) | ||
➢Interactive media for teachers to disseminate ideas and implementation of activities in classroom | √ Primary: EP (teacher support and modeling) and ENV (school) | √ Teachers/Program members |
➢Exposition of materials (posters, murals) to disseminate health messages in school (integrated with health education) | √ Primary: ENV (school) | √ Teachers |
√ Secondary: IP (knowledge, risks/benefits, types, self-efficacy) and EP (peer and teacher support and modeling) | ||
Training and activities in PE classes (Aim: to train and encourage teachers to discuss topics on PA and health in PE classes) | ||
➢Training with certification focused on health and active dynamics in PE classes | √ Primary: EP (teachers support and modeling) and ENV (school) | √ Program members |
➢Supplemental manual with proposed activities on active and health topics to be applied in the classroom | √ Primary: IP (knowledge, risks/benefits, types) | √ Teachers/Program members |
√ Secondary: EP (peer and teacher support, modeling) and ENV (school opportunities, school and neighborhood perceptions) | ||
➢Production of material by students (e.g., posters, photos) to be exhibited at school, and health events (integrated with Health Education) | √ Primary: IP (attitude, risks/benefits, types, self-efficacy) | √ Teachers/Program members |
√ Secondary: EP (peer and teacher support) and ENV (school environment opportunities, school and neighborhood perceptions) | ||
➢Staff support during PE classes | √ Primary: EP (teacher support and norms) and ENV (school) | √ Program members |
Active opportunities in the school environment (Aim: to promote structural spaces and materials in school for PA practice, reducing sedentary time and health information). | ||
➢Two 10–15 min supervised sessions per week of dynamic activities during free-time in school | √ Primary: IP (types), EP (peers support, norms and modeling) and ENV (school opportunities, school perception) | √ Program members |
√ Secondary: IP (knowledge, risk/benefices, self-efficacy) | ||
➢Equipment for games (e.g., mini-courts, “Squash in Health”) with active opportunities and health messages during free-time | √ Primary: ENV (school opportunities, school perception) and EP (peers support and modeling) | √ School manager/students |
√ Secondary: IP (risk/benefices, types, self-efficacy) | ||
➢School equipment (balls, rackets, etc.) available to students during free-time in school | √ Primary: ENV (school opportunities, school perceptions) and EP (peer and teacher support and modeling) | √ School manager/students |
➢Banners with games rules, material use guidelines and motivational and health messages (integrated with Health Education) | √ Primary: ENV (school opportunities, school perceptions) | √ School manager/Program members |
√ Secondary: IP (knowledge, risks/benefits) and EP (social support and norms) | ||
Health education in school community (Aim: to promote health knowledge to the school community, especially students and their families) | ||
➢Pamphlets to students in the classroom or schoolyard: 1) PA and health; 2) screen time use and health; 3) eating behaviors | √ Primary: IP (knowledge, attitude, types and health recommendations) | √ School manager/Teachers |
√ Secondary: EP (social and family support) and ENV (opportunities in school and home) | ||
➢Pamphlets to parents in meetings or visits to schools: 1) PA and family; 2) screen time use and family | √ Primary: EP (social and family support, norms and modeling) and ENV (opportunities in school and home) | √ School manager/Teachers |
√ Secondary: IP (risks/benefits, types and health recommendations) |
Dimension | Variables (reliability)b | |
---|---|---|
Primary Variablesa | ||
PA | √ Weekly volume in moderate to vigorous PA and PA levels (ICC = 0.71) | |
√ PA-related behavior change (ICC = 0.76) | ||
√ Preference for PA in leisure-time (ICC = 0.75) | ||
√ Active commuting (walking/cycling) to school (ICC = 0.89) | ||
Potential PA mediators | √ Intrapersonal: Attitudes, self-efficacy and expectations (risks/benefits) (α range = 0.77–0.81) | |
√ Interpersonal: family, friend and teacher support (α range = 0.84–0.90) | ||
√ Environmental: Neighborhood and school perception (α range = 0.61–0.78) | ||
Screen time | √ Daily time watching TV on weekdays and weekends days (ICC = 0.72 and 0.56) | |
√ Daily time using computer/video games on weekdays and weekends days (ICC = 0.80 and 0.75) | ||
√ Reducing TV watching-related behavior change stage (ICC = 0.80) | ||
√ Reducing computer/videogames using-related behavior change stage (ICC = 0.78) | ||
Potential reducing screen time mediators | √ Intrapersonal: attitude, self-efficacy and expectations (risks/benefits) (α range = 0.64–0.85) | |
√ Interpersonal: family modelling, support and norms (α range = 0.56–0.78) | ||
√ Environmental: family and school environment, house and bedroom characteristics (α range = 0.73–0.85) | ||
Secondary variablesa | √ Body mass index | √ Self-rated health (ICC = 0.90) |
√ Waist circumference | √ Stress perception (ICC = 0.79) | |
√ Eating habits (ICC range = 0.71-0.89) | √ Body image (ICC = 0.85) | |
√ Alcohol use (ICC = 0.71) | √ Sleep quality and duration (ICC range = 0.59-0.75) | |
√ Tobacco use (ICC = 0.99) | √ Sleepiness (α = 0.62) | |
√ Condom use (ICC = 0.98) | √ Academic performance | |
√ Quality of life (ICC = 0.78) | √ School attendance | |
Descriptive variablesa | √ Age (ICC = 0.99) | √ Mother’s schooling (ICC = 0.92) |
√ Gender (Kappa = 1.00) | √ Student’s occupational status (Kappa = 0.90) | |
√ Father’s schooling (ICC = 0.86) | √ Family’s economy class (ICC = 0.93) | |
Subsample (obese) Variablesa | √ Depressive symptoms (α = 0.90) | √ Objectively-measured PA |
√ Eating disorders (α = 0.80) | √ Objectively-measured sedentary time | |
√ Sleep quality (α = 0.83) | ||
Evaluation variables | √ Interest of the school community for the program proposal (before baseline) | |
√ Visibility of the program during implementation (during the program) | ||
√ Execution process of the strategies (during the program) | ||
√ Interest in keeping the strategies in the future (immediately after the end of the program) | ||
√ Maintenance of the program strategies (six months after the end of the program) | ||
√ Start-up and operational costs (economic evaluation) |