School-based intervention to promote healthy nutrition and physical activity in palestinian girls-process evaluation

Aim: School-based interventions have the potential to intervene with the students and teachers, and to reach their families. A controlled program trial was designed to promote healthy eating and physical activity among Palestinian females, while the process evaluation aimed to monitor the program’s implementation and identify factors that led to its success. Methods: A randomized controlled program trial was conducted in 14-Palestinian schools under 4-different jurisdictions, divided into 7-control and 7-intervention schools chosen randomly after applying a sample size calculation. A monitoring system, elucidated factors which contributed to improved outcomes, was applied in the intervention schools only, while the control schools continued with their regular curriculum. The process evaluation tracked the timing and implementation of interventions including changes in the school strategy, policy and structure, teachers’ capacity building, mothers’ education and involvement, the school’s supportive health environment, and integration food consumption records and physical activity into the daily class routine. Results: The intervention included 3,805 schoolchildren and their mothers’ as-well-as 147 teachers. At the completion of the 18-month intervention the schools had successfully participated in the various intervention activities. Only the private school did not sustain some of the interventions, which put it at 55% completion of the school supportive environment activities compared to the other schools which all reached the 100% completion of planned activities. Conclusion: This process evaluation approach enabled a more comprehensive understanding of the intervention implementation and outcomes and identified factors that contribute to the sustainability of the intervention. Each school required a different amount of time for understanding, applying and implementing the program depending on its needs.