Publicação
Evaluation of the effectiveness and costs of a health promotion program in primary schools and children in socially vulnerable conditions - cluster-randomized study (BeE-school)
| Resumo: | Obesity is a complex and multifactorial disease whose prevalence has been increasing in Portugal and worldwide. It causes a negative impact on health, quality of life, and on healthcare systems. There are significant associations between overweight and lower socioeconomic status so, it is even more pertinent to implement obesity prevention programs in schools facing vulnerability. This study aims to evaluate the effectiveness and costs of the health promotion program concerning the body composition in children attending primary schools facing vulnerable conditions. The BeE-school study involved 735 children (51.7% boys, average age 7.7 years old) from 10 primary schools in the Northern region of Portugal. These schools were part of two school groups identified as Educational Territories for Priority Intervention. After the initial assessment, the schools were randomized into two groups: one receiving the intervention (4 schools, n=353) and the other not (6 schools, n=382). The intervention included educating and training teachers for 16 weeks, their implementation in the classroom, and giving families challenges every two weeks. To assess the program’s effectiveness, we measured the children's weight, height and waist circumference using standardized methods. Then we calculated their BMI and used the World Health Organization LMS to compute their BMI z-score (BMIz). The waist-to-weight ratio, an indicator of central adiposity was calculated as waist circumference/weight0.5. We used Generalized Linear Model considering the outcomes as the difference in BMIz and waist-to-weight ratio from baseline to post-intervention and the predictor as group allocation (control/intervention). We also adjusted for school groups, school level, length of time from baseline to post-intervention assessment, sex, age, and mothers’ and fathers’ education. The costs of the intervention, reported in 2023 euros price, included the design of the intervention, implementation, and evaluation. Subsequently, we calculated the Incremental Cost Effectiveness Ratio (ICER). Intervened children had a significant reduction in BMIz and waist-to-weight ratio, even after adjusting for confounders (b= -0.112, CI 95% -0.193 to -0.032) and (b= -0.133, CI 95%: -0.235 to -0.031), respectively. We obtain a cost per capita of €17.31 and an ICER of €154.55 per unit decrease in BMIz. The school-based intervention, focusing on teacher training in health promotion and involving families, proved to be effective in improving body composition in socially vulnerable children. Further studies are needed to assess the long-term effects of the intervention. |
|---|---|
| Autores principais: | Martins, Juliana Catarina Mendes |
| Assunto: | Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| Ano: | 2024 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade do Minho |
| Idioma: | inglês |
| Origem: | RepositóriUM - Universidade do Minho |
| Resumo: | Obesity is a complex and multifactorial disease whose prevalence has been increasing in Portugal and worldwide. It causes a negative impact on health, quality of life, and on healthcare systems. There are significant associations between overweight and lower socioeconomic status so, it is even more pertinent to implement obesity prevention programs in schools facing vulnerability. This study aims to evaluate the effectiveness and costs of the health promotion program concerning the body composition in children attending primary schools facing vulnerable conditions. The BeE-school study involved 735 children (51.7% boys, average age 7.7 years old) from 10 primary schools in the Northern region of Portugal. These schools were part of two school groups identified as Educational Territories for Priority Intervention. After the initial assessment, the schools were randomized into two groups: one receiving the intervention (4 schools, n=353) and the other not (6 schools, n=382). The intervention included educating and training teachers for 16 weeks, their implementation in the classroom, and giving families challenges every two weeks. To assess the program’s effectiveness, we measured the children's weight, height and waist circumference using standardized methods. Then we calculated their BMI and used the World Health Organization LMS to compute their BMI z-score (BMIz). The waist-to-weight ratio, an indicator of central adiposity was calculated as waist circumference/weight0.5. We used Generalized Linear Model considering the outcomes as the difference in BMIz and waist-to-weight ratio from baseline to post-intervention and the predictor as group allocation (control/intervention). We also adjusted for school groups, school level, length of time from baseline to post-intervention assessment, sex, age, and mothers’ and fathers’ education. The costs of the intervention, reported in 2023 euros price, included the design of the intervention, implementation, and evaluation. Subsequently, we calculated the Incremental Cost Effectiveness Ratio (ICER). Intervened children had a significant reduction in BMIz and waist-to-weight ratio, even after adjusting for confounders (b= -0.112, CI 95% -0.193 to -0.032) and (b= -0.133, CI 95%: -0.235 to -0.031), respectively. We obtain a cost per capita of €17.31 and an ICER of €154.55 per unit decrease in BMIz. The school-based intervention, focusing on teacher training in health promotion and involving families, proved to be effective in improving body composition in socially vulnerable children. Further studies are needed to assess the long-term effects of the intervention. |
|---|