PROCESS EVALUATION OF THE CLUSTER RANDOMIZED CONTROLLED TRIAL ACTIVITAL- A SCHOOL-BASED HEALTH PROMOTION INTERVENTION

Background and objectives: Process evaluations (PE) of behavioral interventions can help to understand pathways of change and assess the opportunities to implement the intervention in real practice. In Ecuador, the school-based health intervention ACTIVITAL was effective in decreasing adolescents intake of added sugar and unhealthy competitive food items as well as in decreasing waist circumference. We report the PE of the ACTIVITAL. Methods: The trial involved 10 intervention and 10 control schools and was conducted among 1430 adolescents (12-14 years old). Interventions strategies involved the implementation of interactive healthy eating classes with adolescents, healthy eating workshops with parents and canteen staff, and social events A full pre-specified PE was performed to document the implementation of the ACTIVITAL intervention. Reach, dose, fidelity and barriers of the intervention were evaluated. Data collection comprised observations, face-to-face interviews and questionnaires, applied to adolescents, parents, teachers and school staff. Results: ACTIVITAL was implemented in all the schools, 46% of the school teachers delivered the classes themselves (the remaining classes were implemented by external teachers). Students received 94% of the planned classes, and, teachers were motivated in 89% of them. The teachers demonstrated sufficient knowledge in 88% of the classes and their students enjoyed 93% of the delivered classes. All the parental workshops were implemented and all but one school participated in the school canteens workshops. All the parental and canteen workshops were delivered by experienced staff and the attendants showed a positive attitude, but parental reach was low (15%). Most of the adolescents enjoyed the social events. The main barriers were the difficulty to include the program in the school curriculum, the voluntary participation of the school teachers, lack of time to perform the classes, poor parental reach, difficulties to change the food and portion sizes served by the canteens staff and persistence of an adverse nutritional environment outside the school. Conclusions: In general, the ACTIVITAL intervention was well implemented and its content was well received by the included audiences. Future programs should: incorporate the activities in the school curriculum, deal with poor parental participation and promote changes in the canteens by means of new formative research.