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 |
| _version_ | 1866875729486020608 |
|---|---|
| author | Martins, Juliana Catarina Mendes |
| author_facet | Martins, Juliana Catarina Mendes |
| author_role | author |
| contributor_name_str_mv | Rosário, Rafaela Veiga, Paula Universidade do Minho |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Martins, Juliana Catarina Mendes\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Rosário, Rafaela Veiga, Paula Universidade do Minho |
| datacite.creators.creator.creatorName.fl_str_mv | Martins, Juliana Catarina Mendes |
| datacite.date.Accepted.fl_str_mv | 2024-03-14T00:00:00Z |
| datacite.date.available.fl_str_mv | 2025-03-14T07:00:14Z |
| datacite.date.embargoed.fl_str_mv | 2025-03-14T07:00:14Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| datacite.titles.title.fl_str_mv | 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) Avaliação da efetividade e custos de um programa de promoção da saúde em escolas primárias e crianças em condições de vulnerabilidade social - estudo-randomizado por clusters (BeE-school) |
| dc.contributor.none.fl_str_mv | Rosário, Rafaela Veiga, Paula Universidade do Minho |
| dc.creator.none.fl_str_mv | Martins, Juliana Catarina Mendes |
| dc.date.Accepted.fl_str_mv | 2024-03-14T00:00:00Z |
| dc.date.available.fl_str_mv | 2025-03-14T07:00:14Z |
| dc.date.embargoed.fl_str_mv | 2025-03-14T07:00:14Z |
| dc.description.none.fl_str_mv | A obesidade é uma doença complexa e multifatorial, que tem impacto negativo na saúde, na qualidade de vida e nos sistemas de saúde, cuja prevalência tem vindo a aumentar em Portugal e no mundo. Tem sido associada a um estatuto socioeconómico mais baixo, por isso torna-se pertinente implementar programas de prevenção da obesidade em escolas em contextos de maior vulnerabilidade. O objetivo deste estudo é avaliar a efetividade e os custos de um programa de promoção da saúde na composição corporal de crianças de escolas primárias em situação de vulnerabilidade. Participaram no Projeto BeE school 735 crianças (51,7% rapazes, idade média de 7,7 anos), de 10 escolas primárias de 2 Agrupamentos identificados como Territórios Educativos de Intervenção Prioritária, no Norte de Portugal. Após a avaliação inicial, as escolas foram randomizadas em grupo controlo (6 escolas, n=382) e intervenção (4 escolas, n=353). A intervenção incluiu a formação de professores sobre estilos de vida saudáveis durante 16 semanas, a sua intervenção junto das crianças e o envolvimento das famílias através de desafios quinzenais. A massa corporal, a estatura e o perímetro da cintura foram medidos à criança, seguindo procedimentos internacionalmente aceites. Foi calculado o IMC e o respetivo z-score (IMCz), segundo as normas da Organização Mundial de Saúde, bem como o rácio perímetro da cintura/massa corporal0,5 , como indicador de gordura central. Realizou-se um modelo linear generalizado, tendo como resultado a diferença (pós intervenção – avaliação inicial) no IMCz e no rácio perímetro da cintura-massa corporal, e como preditor o grupo controlo/intervenção, ajustado para o agrupamento de escolas, ano de escolaridade, tempo decorrido entre as duas avaliações, sexo, idade e a escolaridade da mãe e do pai. Os custos do programa de intervenção, reportados em euros de 2023, incluíram: planeamento da intervenção, implementação e avaliação. De seguida foi calculado o Rácio Incremental de Custo-Efetividade (ICER). O grupo de intervenção apresentou uma redução significativa no IMCz e no rácio perímetro da cintura-massa corporal, mesmo após o ajuste para variáveis de confusão (b= -0,112, IC 95% -0,193 a -0,032) e (b= -0,133, IC 95%: -0,235 a -0,031), respetivamente. Obteve-se um custo per capita de 17,31€ e um ICER de 154,55€ por unidade de IMCz reduzida. Esta intervenção de base escolar com envolvimento das famílias foi efetiva na melhoria da composição corporal em crianças em contexto de vulnerabilidade. São necessários mais estudos para avaliar os efeitos da intervenção a longo prazo. |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | https://hdl.handle.net/1822/91207 |
| dc.language.none.fl_str_mv | eng |
| dc.rights.cclincense.fl_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.rights.rights.copyright.fl_str_mv | openAccess |
| dc.subject.none.fl_str_mv | Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| dc.title.fl_str_mv | 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) Avaliação da efetividade e custos de um programa de promoção da saúde em escolas primárias e crianças em condições de vulnerabilidade social - estudo-randomizado por clusters (BeE-school) |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_bdcc |
| description | 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. |
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| format | masterThesis |
| fulltext.url.fl_str_mv | https://prod-dspace.uminho.pt/bitstreams/5d998d72-5e98-447f-b80c-ab830ed5a686/download |
| id | rum_366f551ff13b1b310327b0bd2e99e6ef |
| identifier.url.fl_str_mv | https://hdl.handle.net/1822/91207 |
| instacron_str | repositorium |
| institution | Universidade do Minho |
| instname_str | Universidade do Minho |
| language | eng |
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| oai_identifier_str | oai:repositorium.uminho.pt:1822/91207 |
| organization_str_mv | urn:organizationAcronym:repositorium |
| person_str_mv | Martins, Juliana Catarina Mendes |
| publishDate | 2024 |
| reponame_str | RepositóriUM - Universidade do Minho |
| repository_id_str | urn:repositoryAcronym:rum |
| service_str_mv | urn:repositoryAcronym:rum |
| spelling | engengObesity 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.porA obesidade é uma doença complexa e multifatorial, que tem impacto negativo na saúde, na qualidade de vida e nos sistemas de saúde, cuja prevalência tem vindo a aumentar em Portugal e no mundo. Tem sido associada a um estatuto socioeconómico mais baixo, por isso torna-se pertinente implementar programas de prevenção da obesidade em escolas em contextos de maior vulnerabilidade. O objetivo deste estudo é avaliar a efetividade e os custos de um programa de promoção da saúde na composição corporal de crianças de escolas primárias em situação de vulnerabilidade. Participaram no Projeto BeE school 735 crianças (51,7% rapazes, idade média de 7,7 anos), de 10 escolas primárias de 2 Agrupamentos identificados como Territórios Educativos de Intervenção Prioritária, no Norte de Portugal. Após a avaliação inicial, as escolas foram randomizadas em grupo controlo (6 escolas, n=382) e intervenção (4 escolas, n=353). A intervenção incluiu a formação de professores sobre estilos de vida saudáveis durante 16 semanas, a sua intervenção junto das crianças e o envolvimento das famílias através de desafios quinzenais. A massa corporal, a estatura e o perímetro da cintura foram medidos à criança, seguindo procedimentos internacionalmente aceites. Foi calculado o IMC e o respetivo z-score (IMCz), segundo as normas da Organização Mundial de Saúde, bem como o rácio perímetro da cintura/massa corporal0,5 , como indicador de gordura central. Realizou-se um modelo linear generalizado, tendo como resultado a diferença (pós intervenção – avaliação inicial) no IMCz e no rácio perímetro da cintura-massa corporal, e como preditor o grupo controlo/intervenção, ajustado para o agrupamento de escolas, ano de escolaridade, tempo decorrido entre as duas avaliações, sexo, idade e a escolaridade da mãe e do pai. Os custos do programa de intervenção, reportados em euros de 2023, incluíram: planeamento da intervenção, implementação e avaliação. De seguida foi calculado o Rácio Incremental de Custo-Efetividade (ICER). O grupo de intervenção apresentou uma redução significativa no IMCz e no rácio perímetro da cintura-massa corporal, mesmo após o ajuste para variáveis de confusão (b= -0,112, IC 95% -0,193 a -0,032) e (b= -0,133, IC 95%: -0,235 a -0,031), respetivamente. Obteve-se um custo per capita de 17,31€ e um ICER de 154,55€ por unidade de IMCz reduzida. Esta intervenção de base escolar com envolvimento das famílias foi efetiva na melhoria da composição corporal em crianças em contexto de vulnerabilidade. São necessários mais estudos para avaliar os efeitos da intervenção a longo prazo.application/pdfporEvaluation of the effectiveness and costs of a health promotion program in primary schools and children in socially vulnerable conditions - cluster-randomized study (BeE-school)AlternativeTitleporAvaliação da efetividade e custos de um programa de promoção da saúde em escolas primárias e crianças em condições de vulnerabilidade social - estudo-randomizado por clusters (BeE-school)Martins, Juliana Catarina MendesRosário, RafaelaVeiga, PaulaHostingInstitutionOrganizationalUniversidade do Minhoe-mailmailto:repositorium@usdb.uminho.ptrepositorium@usdb.uminho.ptURNurn:tid:2035615202025-03-14T07:00:14Z2024-03-1420242024-03-14T00:00:00ZHandlehttps://hdl.handle.net/1822/91207http://purl.org/coar/access_right/c_abf2open accessChildrenCostsEffectivenessHealth promotionObesityCriançasCustosEfetividadeObesidadePromoção da saúde1435078 bytesliteraturehttp://purl.org/coar/resource_type/c_bdccmaster thesis2024-03-14http://creativecommons.org/licenses/by-nc-nd/4.0/openAccesshttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://prod-dspace.uminho.pt/bitstreams/5d998d72-5e98-447f-b80c-ab830ed5a686/download |
| spellingShingle | 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) Martins, Juliana Catarina Mendes Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| status | SINGLETON |
| subject.fl_str_mv | Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| title | 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) |
| title_full | 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) |
| title_fullStr | 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) |
| title_full_unstemmed | 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) |
| title_short | 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) |
| title_sort | 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) |
| topic | Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| topic_facet | Children Costs Effectiveness Health promotion Obesity Crianças Custos Efetividade Obesidade Promoção da saúde |
| url | https://hdl.handle.net/1822/91207 |
| visible | 1 |