After-school obesity prevention program is a planned intervention. The foundation of the intervention is educating both children and their parents on the significance of healthy diet and physical exercises as well as sharing the most effective nutrition and exercise patterns in order to prevent the problem of childhood obesity. The rationale for the intervention selection is its high efficiency in decreasing obesity risks in the short run and improvement of the quality of life and health outcomes in the long run (Nabors, Burbage, Woodson, & Swoboda, 2015).
Cai et al. (2014)
This study is a systematic review and meta-analysis of both qualitative and quantitative research. Therefore, it addresses both perceptions of different interventions and their efficiency. Because the authors include 23 intervention studies (21 based in school settings) with almost 19 thousand students affected, the provided evidence is significant. Nevertheless, the quality of evidence is questionable because no experiments or interventions were conducted by the authors themselves. Instead, the study is level I – a review of previous research – that is connected to significant evidence quality risks. At the same time, it investigates the influence of obesity prevention programs on blood pressure among young children (Cai et al., 2014).
In this way, the study is related to both the planned intervention and nursing practice. It can be explained by the fact that elevated blood pressure is a common problem caused by obesity, and the instance of childhood obesity is not an exception. From this perspective, the research is valuable for gaining a better understanding of the connection between obesity prevention and addressing blood pressure issues. It means that it can both improve practice and make the planned intervention more comprehensive in case if young children with elevated blood pressure will be treated or included in the intervention group. That said, the potential contribution of this study is the improvement of nursing practice due to becoming aware of specific needs of those with high blood pressure.
Gomez et al. (2014)
The focus of this study is the assessment of a community-based intervention. Even though it is not related to schools, it still addresses the needs of young children. It means that the research is closely connected to the objectives of the proposed paper because it may be helpful for understanding the frameworks of the intervention and potential changes in lifestyle related to it. The study is Level II – randomized control trial. It is planned that the intervention group will consist of around 2200 young children. Regardless of the level of evidence, it is still significant because the authors will conduct the experiment by themselves instead of analyzing the information collected from the previous research.
Moreover, the sample size is large enough in order to guarantee relevance of findings, as they can be generalized. However, the selected article is the outline of the planned intervention. It means that it is impossible to estimate the quality of evidence. At the same time, this research is valuable for improving nursing practice because it addresses not only health issues but also socioeconomic burden related to obesity. From this perspective, the after-school intervention may become more detailed and comprehensive because pointing to obesity-based socioeconomic issues may not only enhance parent involvement but also make children more interested in getting engaged in the proposed activities. It can be explained by the fact that obesity is a common factor affecting the social image of an individual so that preventing it is connected to improved social bonds (Gomez et al., 2014).
Kothandan (2014) focuses on comparing the effectiveness of family-based and school-based interventions. This research is Level I – systematic review and meta-analysis of 1231 articles. The author determines several inclusion criteria, such as intervention type, study design, and age of children included in intervention groups. Based on correspondence with the inclusion criteria, only 13 articles were analyzed. It means that regardless of valuable conclusions, the evidence is less significant compared to other studies. However, because all articles meet the inclusion criteria, the quality of evidence is satisfying because it is focused so that findings are detailed. Nevertheless, it was chosen due to the fact that both family- and school-based interventions were addressed. It means that the research is of special value for improving nursing practice because it reviews common specificities of the two types of interventions and their effectiveness for preventing obesity in young children. It means that the decision was affected by personal clinical expertise and being familiar with common challenges related to obesity prevention, such as the choice of relevant intervention.
O’Brien, McDonald, & Haynes (2013)
O’Brien et al. (2013) pay special attention to one of the most challenging practical issues related to childhood obesity prevention – the involvement of parents. The study is level IV – descriptive case study. Regardless of the small sample size (16 parents), the proposed evidence is significant because parents are ethnically diverse. It means that their opinions on obesity vary due to cultural specificities of the perception of this health issue. Nevertheless, the quality of evidence is questionable because the findings cannot be generalized due to the small sample size. Still, this article is relevant to changing policy and improving nursing practice because it reveals parents’ attitudes to becoming involved in programs aimed at obesity prevention. From this perspective, it may be helpful for making both nursing practice (and policies) and the planned intervention socially significant due to parents’ support. In general, taking into consideration research findings may be valuable for improving health of community population because the lack of parent support and involvement are the common factors that undermine the efficiency of obesity prevention programs and preclude from achieving positive trends in combatting obesity in young children.
Sbruzzi et al. (2013)
The authors focus on studying the effectiveness of educational programs that address changes in behavior, eating habits, and physical activities. The study is level I – systematic review and meta-analysis. In this way, regardless of the evidence significance, its quality is questionable because the authors analyzed the findings of previous research. The significance of evidence is explained by the sample size – around 23 thousand articles were included in the analysis. Nevertheless, because the authors have not conducted their own experiments, quality risks are substantial. This article is useful for improving nursing practice and policies as well as making the planned intervention more comprehensive. This belief is related to the very fact that intervention is planned as an educational program. At the same time, it is applicable to practice because of mentioning some valuable knowledge (the criticality of combining healthy dieting with physical exercises) that can be used for educating parents in a clinical setting after the intervention or those who were not included in the intervention group. Regardless of criticizing the effectiveness of educational programs for preventing childhood obesity, the article is still valuable because it may help to obtain a better understanding of the specificities of these programs (Sbruzzi et al., 2013).
Tarro et al. (2014)
Tarro et al. (2014) made up two intervention groups covering 24 schools and 1222 students. From this perspective, the evidence is significant because it involves children with different socioeconomic, educational, and ethnic background. The study is Level II – randomized control trial. At the same time, the authors conduct the experiment by themselves. It means that the quality of evidence is satisfying. Due to the significance and quality of evidence, the article findings are beneficial for improving policy and nursing practice because the authors promote school-based obesity prevention programs. At the same time, the article can be used as a guideline for developing the planned intervention because it mentions the elements of an efficient intervention program: classroom practices, teaching activities, and parent activities. Therefore, the study was included due to the provided evidence as well as personal expertise, i.e. the understanding that detailed frameworks of the intervention are critical for guaranteeing the success of the planned program.
Table 1. Quality and level of evidence.
|Level I: Systematic review or meta-analysis||Sbruzzi et al. (2013)||Cai et al. (2014)|
|Level II: Randomized controlled trial||Tarro et al. (2014)||Gomez et al. (2014)|
|Level III: Controlled trial without randomization|
|Level IV: Case-control or cohort study|
|Level V: Systematic review of qualitative or descriptive studies||Kothandan (2014)|
|Level VI: Qualitative or descriptive study (includes evidence implementation projects)||O’Brien et al. (2013)|
|Level VII: Expert opinion or consensus|
Table 2. Assessed interventions.
|In-s||Cai et al. (2014)||Gomez et al. (2014)||Kothandan (2014)||O’Brien et al. (2013)||Sbruzzi et al. (2013)||Tarro et al. (2014)|
|1||Diet||Community-based parallel intervention||Family-based||Interactive obesity prevention program||Educational programs||Educational intervention with three elements:|
|2||Physical activity||Diet||School-based||Behavioral modification||Classroom practices|
|3||Combined||Physical activities||Physical activities||Teaching practice|
|4||Parent activities||Nutrition||Parent activities|
|Note. “In-s” stands for “interventions”|
Table 3. Study details.
|Cai et al. (2014)||Meta-analysis and systematic review of randomized and controlled trials, natural experiments, and quasi-experimental studies||23 intervention studies (18925 participants), 21 in school settings||The impact of obesity prevention intervention on reducing blood pressure is moderate. Still, in case of addressing both dieting and physical activities, the effects are more significant.|
|Gomez et al. (2014)||Parallel intervention study||2249 children aged between 8 and 10 in 4 Spanish towns (2 intervention; 2 control)||Interventions are expected to improve children’s health status and reduce obesity-related socioeconomic burden.|
|Kothandan (2014)||Systematic review||1231 articles (participants of interventions aged between 12 and 17)||Both family- and school-based obesity prevention programs are effective. However, their efficiency depends on age, long- and short-term outcomes, and methodological framework of interventional program.|
|O’Brien et al. (2013)||Uncontrolled trial; qualitative survey||16 parents (14 mothers and 2 fathers)||Interactive children obesity prevention programs are beneficial for improving parent involvement in combating the challenge of obesity in young children.|
|Sbruzzi et al. (2013)||Meta-analysis and systematic review of randomized trials||22852 articles retrieved; 26 trials included||Educational interventions are not efficient in preventing obesity. Nevertheless, they are productive for treating it.|
|Tarro et al. (2014)||Quantitative; randomized control trial||Intervention (24 schools; 1222 students); control (14 schools, 717 students)||School-based obesity prevention programs helped to reduce overall obesity prevalence among school students.|
Cai, L., Wu, Y., Wilson, R. F., Segal, J. B., Kim, M. T., & Wang, Y. (2014). Effect of childhood obesity prevention programs on blood pressure: A systematic review and meta-analysis. Circulation, 129(18), 1832-1839. Web.
Gomez, S. F., Casas, R., Palomo, V. T., Pujol, A. M., Fíto, M., Schröder, H. (2014). Study protocol: Effects of the THAO-child health intervention program on the prevention of childhood obesity – the POIBC study. BMC Pediatrics, 14(1), 215-220. Web.
Kothandan, S. K. (2014). School-based interventions versus family-based interventions in the treatment of childhood obesity – a systematic review. Archives of Public Health, 72(1), 3-19. Web.
Nabors, L., Burbage, M., Woodson, K. D., & Swoboda, C. (2015). Implementation of an after-school obesity prevention program: Helping young children toward improved health. Issues in Comprehensive Pediatric Nursing, 38(1), 22-38. Web.
O’Brien, A., McDonald, J., & Haynes, J. (2013). An approach to improve patient participation in a childhood prevention program. Canadian Journal of Dietetic Practice and Research, 74(3), 143-145. Web.
Sbruzzi, G., Eibel, B., Barbiero, S. M., Petkowicz, R. O., Ribeiro, R. A., Cesa, C. C., … Pellanda, L. C. (2013). Educational interventions in childhood obesity: A systematic review with meta-analysis of randomized clinical trials. Preventive Medicine, 56(5), 254-264. Web.
Tarro, L., Llaurado, E., Albaladejo, R., Moriña, D., Arija, V., Solà, R., & Giralt, M. (2014). A primary-school-based study to reduce the prevalence of childhood obesity – the EdAl (Educació en Alimentació) study: A randomized controlled trial. Trials, 15(1), 58-70. Web.