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Rationale: In 2015-2020, the Dutch 'Healthy Primary School of the Future' intervention took place. Two schools became 'Healthy Primary Schools of the Future'; providing a healthy lunch and structured physical activity (PA) sessions. Two other 'Physical Activity Schools' only implemented the PA sessions. The intervention showed promising effects on children's BMI z-score and dietary and PA behaviours. Following these promising results, childcare centres of educational board Prisma have expressed their interest in implementing changes fitting the 'Healthy Primary School of the Future'. However, this is more complex than it seems to be, as budget to implement changes is lower and all childcare centres have a unique context. Therefore, there is a need to investigate how 'Healthy Primary School of the Future' can successfully be implemented in various, real-life school-settings. It is hypothesised that to maximise implementation and sustainability, each childcare centre will need to put together a set of changes and interventions which fit the context and needs of all stakeholders involved. No intervention is allocated in this study other than activities planned by childcare centres in accordance with wishes and needs of stakeholders.
Objective: To study the implementation of 'Healthy Childcare Centre of the Future' in different school-contexts and develop guidelines that can be used to facilitate widespread dissemination of the initiative. Secondary objectives include evaluating the initiative's effects on children's BMI z-score, general health, dietary and PA behaviours and school well-being. To reach these objectives, a process evaluation, effect evaluation and cost-effectiveness evaluation will be executed. Data will be collected using questionnaires (parents, children, teachers, directors), anthropometric measures (children), interviews (teachers, directors), observations and analyses of minutes of meetings.
Rationale: From 2015-2020, the 'Healthy Primary School of the Future' intervention took place in Limburg, the Netherlands. The school environment of four primary schools changed. Two schools became 'Healthy Primary Schools of the Future'; providing their students with a healthy lunch and structured physical activity (PA) sessions during lunch time breaks. Two other 'Physical Activity Schools' only implemented the structured PA sessions. Interim analyses showed promising effects of the intervention; at two-year-follow-up, the study showed a significant decrease in BMI z-score of children in the 'Healthy Primary Schools of the Future' as compared with children in control schools. Also, positive intervention effects on dietary and PA behaviours were observed. Following these promising results, childcare centres of educational board Prisma have expressed their interest in implementing changes fitting the 'Healthy Primary School of the Future' initiative. However, this is more complex than it seems to be, as budget to implement changes is lower than in the original trial, and all childcare centres have a unique context. Therefore, there is a need to investigate how 'Healthy Primary School of the Future' can successfully be implemented in various, real-life school-settings. It is hypothesised that to maximise implementation and sustainability, each childcare centre will need to put together a set of changes and interventions which fit the context and needs of all stakeholders involved (e.g., the school board, teachers, parents and children).
Objective: The main objective is to study the implementation process of 'Healthy Childcare Centre of the Future' in different school-contexts and develop guidelines that can be used to facilitate widespread dissemination of the initiative. Secondary objectives include evaluating the effects of the 'Healthy Childcare Centre of the Future' on children's BMI z-score, general health, dietary and PA behaviours and school well-being. To reach these objectives, a process evaluation, effect evaluation and cost-effectiveness evaluation will be executed.
Study design: A non-randomised, non-controlled, observational study design. Study population: Children in study years four to six (at baseline) of twelve childcare centres located in Limburg, the Netherlands.
Main parameters/endpoints: The main study parameter of the effect evaluation is the change in absolute BMI z-score, which will be compared between the childcare centres categorised based on their degree of implementation (using categories based on the Diffusion of Innovations Theory).
Methods: Data will be collected in the form of questionnaires (parents, children, teachers/pedagogical employees, directors), anthropometric measurements (children), interviews (teachers/pedagogical employees, directors), observations and analyses of minutes of meetings.
Nature and extend of the burden and risks associated with participation: No intervention is allocated in this study other than activities planned by childcare centres in accordance with wishes and needs of childcare centre staff and parents. All outcome measures are non-invasive. The measurement protocol was designed while taking into account both a minimal burden for participants and a relevant scientific output for stakeholders (e.g., school board, teachers, parents/caregivers and children). Burden of participants is minimalised by incorporating most measurements in the regular school day.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Various health-promoting initiatives | Behavioral | No intervention is allocated in this study other than activities planned by childcare centres in accordance with wishes and needs of childcare centre staff and parents. |
| Measure | Description | Time Frame |
|---|---|---|
| BMI Z-score | Children's Body Mass Index (BMI) was assessed by height and weight; age- and sex-specific BMI cut-off points were used to define overweight and obesity. BMI z-scores were calculated using Dutch reference values. A z-score of 0 represents the population mean. A z-score > 0 means a BMI higher than the population mean, a z-score of < 0 means a BMI lower than the population mean, both can pose specific health-related risks. | Two years |
| Measure | Description | Time Frame |
|---|---|---|
| Mean Number of Days Per Week of Healthy Dietary Behaviours | A composite score for healthy dietary behaviours was computed from four separate questions. This score was calculated by averaging the weekly consumption (ranging from never (0) to every day (7)) of breakfast consumption and intake of fruit, warm and raw vegetables, and water throughout the day, as reported in the parental questionnaire. |
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Inclusion Criteria:
Exclusion Criteria:
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A closed design will be used, meaning that at baseline (T0), all children in study year four to six of the childcare centres will be invited to participate in the study. At T1, these children will be students in study year five to seven, and at T2 they will be in study year six to eight. Based on the amount of children enrolled in school year 2019/2020, approximately 685 children are eligible to participate in the study.
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| Name | Affiliation | Role |
|---|---|---|
| Marla Hahnraths, MSc | PhD candidate | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Stichting Prisma | Panningen | 5981 CG | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30720796 | Background | Bartelink NHM, Van Assema P, Jansen MWJ, Savelberg HHCM, Willeboordse M, Kremers SPJ. The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach. Int J Environ Res Public Health. 2018 Oct 12;15(10):2243. doi: 10.3390/ijerph15102243. | |
| 27456845 | Background | Willeboordse M, Jansen MW, van den Heijkant SN, Simons A, Winkens B, de Groot RH, Bartelink N, Kremers SP, van Assema P, Savelberg HH, de Neubourg E, Borghans L, Schils T, Coppens KM, Dietvorst R, Ten Hoopen R, Coomans F, Klosse S, Conjaerts MH, Oosterhoff M, Joore MA, Ferreira I, Muris P, Bosma H, Toppenberg HL, van Schayck CP. The Healthy Primary School of the Future: study protocol of a quasi-experimental study. BMC Public Health. 2016 Jul 26;16:639. doi: 10.1186/s12889-016-3301-9. |
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It is not our intention to share individual participant data with other researchers
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| ID | Title | Description |
|---|---|---|
| FG000 | Medium implementers | As the present study investigated the effectiveness of health-promoting activities under real-world conditions and all participating schools were free to implement activities of their choice, there were no intervention or control groups. Instead, schools were categorised on the basis of the implemented activities' intensity. This resulted in the formation of two groups: medium implementers (six schools) and low implementers (five schools). The project's effectiveness on various health outcomes was compared between these two groups. |
| FG001 | Low implementers | As the present study investigated the effectiveness of health-promoting activities under real-world conditions and all participating schools were free to implement activities of their choice, there were no intervention or control groups. Instead, schools were categorised on the basis of the implemented activities' intensity. This resulted in the formation of two groups: medium implementers (six schools) and low implementers (five schools). The project's effectiveness on various health outcomes was compared between these two groups. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Medium Implementers | As the present study investigated the effectiveness of health-promoting activities under real-world conditions and all participating schools were free to implement activities of their choice, there were no intervention or control groups. Instead, schools were categorised on the basis of the implemented activities' intensity. This resulted in the formation of two groups: medium implementers (six schools) and low implementers (five schools). The project's effectiveness on various health outcomes was compared between these two groups. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | BMI Z-score | Children's Body Mass Index (BMI) was assessed by height and weight; age- and sex-specific BMI cut-off points were used to define overweight and obesity. BMI z-scores were calculated using Dutch reference values. A z-score of 0 represents the population mean. A z-score > 0 means a BMI higher than the population mean, a z-score of < 0 means a BMI lower than the population mean, both can pose specific health-related risks. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Mean | Standard Deviation | Z-score | Two years |
|
One year after baseline and two years after baseline.
As there was no intervention administered as part of the study, there was no risk for all-cause mortality or (serious) adverse effects as part of the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | All participants | As there were no intervention and control groups included in the present study, participants were not categorised in different arms/groups. This arm/group therefore includes all participants in the study. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Marla Hahnraths, MSc | Maastricht University | 3882184 | 0031 | mth.hahnraths@maastrichtuniversity.nl |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Feb 4, 2020 | Feb 4, 2020 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| Two years |
| Child Physical Activity Behaviour (Child-reported) | Assessed using the validated Physical Activity Questionnaire for Children (PAQ-C).The PAQ-C is a self-administered,7-day recall instrument, which provides a summary physical activity score derived from eight items, each scored on a 5-point scale. Item 1 (spare time activity) from no activity = 1; 7 times or more = 5. Items 2 to 7 (PE, lunch, right after school, evening, weekends) from lowest activity response = 1 or highest activity response = 5. Item 8 (mean of all days of the week) from none = 1; very often = 5. Item 9 (identifies students who are unusual active during the previous week). By adding up all means of the first eight items in PAQ-C, a summative score of physical activity is obtained. A score of 1 indicates low physical activity level, whereas a score of 5 indicates high physical activity level. | Two years |
| Child Waist Circumference | Waist circumference is measured with a measuring tape to the nearest 0.1 cm, following the World Health Organisation's assessment protocol. | Two years |
| Mean Number of Days Per Week of Soft Drink Consumption | Soft drink consumption during the past week was derived from the parental questionnaire ranging from never (0) to every day (7). | Two years |
| Water Consumption During School Hours | Water consumption during school hours was derived from the child questionnaire ranging from never (0) to every day (3). | Two years |
| Fruit Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Two years |
| Vegetable Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Two years |
| Grain Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Two years |
| Dairy Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Two years |
| Water Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Two years |
| Butter Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Two years |
| Consumption of at Least Two Healthy Food Groups During Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. To shed more light on the nutritional value of the children's lunches, the different food types consumed were summed, and a dichotomous variable was created indicating whether children consumed at least two of the food types during lunch. | Two years |
| 31676651 | Background | Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HHCM, Oosterhoff M, Willeboordse M, van Schayck OCP, Winkens B, Jansen MWJ. Can the Healthy Primary School of the Future offer perspective in the ongoing obesity epidemic in young children? A Dutch quasi-experimental study. BMJ Open. 2019 Oct 31;9(10):e030676. doi: 10.1136/bmjopen-2019-030676. |
| 30909515 | Background | Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HHCM, Oosterhoff M, Willeboordse M, van Schayck OCP, Winkens B, Jansen MWJ. One- and Two-Year Effects of the Healthy Primary School of the Future on Children's Dietary and Physical Activity Behaviours: A Quasi-Experimental Study. Nutrients. 2019 Mar 22;11(3):689. doi: 10.3390/nu11030689. |
| BG001 | Low Implementers | As the present study investigated the effectiveness of health-promoting activities under real-world conditions and all participating schools were free to implement activities of their choice, there were no intervention or control groups. Instead, schools were categorised on the basis of the implemented activities' intensity. This resulted in the formation of two groups: medium implementers (six schools) and low implementers (five schools). The project's effectiveness on various health outcomes was compared between these two groups. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | The number analysed in this row differs from the overall number of participants, as we could not collect baseline data in all participants for this variable. | Count of Participants | Participants | No |
|
| Study year | Count of Participants | Participants |
|
| Socioeconomic status | The number analysed in this row differs from the overall number of participants, as we could not collect baseline data in all participants for this variable. | Count of Participants | Participants |
|
| BMI z-score | Children's Body Mass Index (BMI) was assessed by height and weight; age- and sex-specific BMI cut-off points were used to define overweight and obesity. BMI z-scores were calculated using Dutch reference values. A z-score of 0 represents the population mean. A z-score > 0 means a BMI higher than the population mean, a z-score of < 0 means a BMI lower than the population mean, both can pose specific health-related risks. | Mean | Standard Deviation | Z-score |
|
| Overweight/obese | Children's Body mass index (BMI) was assessed by height and weight; age- and sex-specific BMI cut-off points were used to define overweight and obesity. | Count of Participants | Participants |
|
| Waist circumference | Mean | Standard Deviation | centimeters |
|
| Physical activity summary score | The child questionnaire was used to gain insight into children's PA behaviour. The questionnaire contained ten items derived from the International Physical Activity Questionnaire for Children (IPAQ-C), which has acceptable validity. Activity scores between 1 and 5 were obtained for each item, after which the mean of these scores was calculated to obtain the total activity summary score (ranging from 1 (low PA) to 5 (high PA)). | Mean | Standard Deviation | units on a scale |
|
| Healthy dietary behaviours | A composite score for healthy dietary behaviours was computed from four separate questions. This score was calculated by averaging the weekly consumption (ranging from never (0) to every day (7)) of breakfast consumption and intake of fruit, warm and raw vegetables, and water throughout the day, as reported in the parental questionnaire. | Mean | Standard Deviation | mean days/week |
|
| Soft drink consumption | Soft drink consumption during the past week was derived from the parental questionnaire ranging from never (0) to every day (7). | Mean | Standard Deviation | mean days/week |
|
| School water consumption | Water consumption during school hours was derived from the child questionnaire ranging from never (0) to every day (3). | Mean | Standard Deviation | units on a scale |
|
| Fruit at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Count of Participants | Participants |
|
| Vegetables at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Count of Participants | Participants |
|
| Grains at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Count of Participants | Participants |
|
| Dairy at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Count of Participants | Participants |
|
| Water at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Count of Participants | Participants |
|
| Butter at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | Count of Participants | Participants |
|
| At least two healthy food groups at lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. To shed more light on the nutritional value of the children's lunches, the different food types consumed were summed, and a dichotomous variable was created indicating whether children consumed at least two of the food types during lunch. | Count of Participants | Participants |
|
Participants defined as low implementers |
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| Secondary | Mean Number of Days Per Week of Healthy Dietary Behaviours | A composite score for healthy dietary behaviours was computed from four separate questions. This score was calculated by averaging the weekly consumption (ranging from never (0) to every day (7)) of breakfast consumption and intake of fruit, warm and raw vegetables, and water throughout the day, as reported in the parental questionnaire. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Mean | Standard Deviation | mean days/week | Two years |
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| Secondary | Child Physical Activity Behaviour (Child-reported) | Assessed using the validated Physical Activity Questionnaire for Children (PAQ-C).The PAQ-C is a self-administered,7-day recall instrument, which provides a summary physical activity score derived from eight items, each scored on a 5-point scale. Item 1 (spare time activity) from no activity = 1; 7 times or more = 5. Items 2 to 7 (PE, lunch, right after school, evening, weekends) from lowest activity response = 1 or highest activity response = 5. Item 8 (mean of all days of the week) from none = 1; very often = 5. Item 9 (identifies students who are unusual active during the previous week). By adding up all means of the first eight items in PAQ-C, a summative score of physical activity is obtained. A score of 1 indicates low physical activity level, whereas a score of 5 indicates high physical activity level. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Mean | Standard Deviation | score on a scale | Two years |
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| Secondary | Child Waist Circumference | Waist circumference is measured with a measuring tape to the nearest 0.1 cm, following the World Health Organisation's assessment protocol. | Number analysed at T1 and T2 corresponds to number of participants that were not LOF at T1 and T2. | Posted | Mean | Standard Deviation | centimeters | Two years |
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| Secondary | Mean Number of Days Per Week of Soft Drink Consumption | Soft drink consumption during the past week was derived from the parental questionnaire ranging from never (0) to every day (7). | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Mean | Standard Deviation | mean days/week | Two years |
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| Secondary | Water Consumption During School Hours | Water consumption during school hours was derived from the child questionnaire ranging from never (0) to every day (3). | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Mean | Standard Deviation | mean days/week | Two years |
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| Secondary | Fruit Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| Secondary | Vegetable Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| Secondary | Grain Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| Secondary | Dairy Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| Secondary | Water Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| Secondary | Butter Consumption at Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| Secondary | Consumption of at Least Two Healthy Food Groups During Lunch | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. To shed more light on the nutritional value of the children's lunches, the different food types consumed were summed, and a dichotomous variable was created indicating whether children consumed at least two of the food types during lunch. | The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2. | Posted | Number | percentage of yes | Two years |
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| 0 |
| 315 |
| 0 |
| 315 |
| 0 |
| 315 |
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| Six |
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| Highest tertile |
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| T1 (after one year) |
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| T2 (after two years) |
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| Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0. | Mixed Models Analysis | 0.863 | Other |
| T1 (after one year) |
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| T2 (after two years) |
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| Linear mixed model analyses were used to assess longitudinal intervention effects on children's PA score. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0. | Mixed Models Analysis | 0.209 | Other |
| T1 (after one year) |
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| T2 (after two years) |
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| Linear mixed model analyses were used to assess longitudinal intervention effects on children's waist circumference. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0. | Mixed Models Analysis | <0.001 | Other |
| T1 (after one year) |
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| T2 (after two years) |
|
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| Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0. | Mixed Models Analysis | 0.418 | Other |
| T1 (after one year) |
|
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| T2 (after two years) |
|
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| Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0. | Mixed Models Analysis | 0.263 | Other |
| T1 (after one year) |
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| T2 (after two years) |
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| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0. | Mixed Models Analysis | 0.803 | Other |
| T1 (after one year) |
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| T2 (after two years) |
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| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0. | Mixed Models Analysis | 0.658 | Other |
| T1 (after one year) |
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|
| T2 (after two years) |
|
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| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0. | Mixed Models Analysis | 0.370 | Other |
| T1 (after one year) |
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|
| T2 (after two years) |
|
|
| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0. | Mixed Models Analysis | 0.626 | Other |
| T1 (after one year) |
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|
| T2 (after two years) |
|
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| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0. | Mixed Models Analysis | 0.861 | Other |
| T1 (after one year) |
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|
| T2 (after two years) |
|
|
| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0. | Mixed Models Analysis | 0.995 | Other |
| T1 (after one year) |
|
|
| T2 (after two years) |
|
|
| Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0. | Mixed Models Analysis | 0.798 | Other |