Target Behavior: Healthy Eating, Physical Activity
Intervention Type: PSE Change
Intervention Reach and Adoption
Setting: Child Care, Community, School
Target Audience: Elementary School
- Complete assessment of current afterschool program practices. Programs assessed their policies and practices related to healthy eating, beverages, and physical activity. This included collecting data on beverages currently being served to children at afterschool snack.
- Hold learning communities, including training of afterschool program coordinators and writing afterschool wellness policies. Afterschool program directors and staff were invited to participate in a series of three learning community sessions. The meetings were hosted at participating sites and held at various times of the day to ensure participation. As part of the sessions, staff set actionable goals to improve program practices, wrote relevant policies, and communicated changes to parents, students, the school nutrition service, and school administrators.
- Review and revise district snack menus and beverage serving plans. The OSNAP team partnered with the Boston Public Schools Food and Nutrition Service to review snack menus and provide nutritional and price analyses to support modifications to menus and beverage serving plans. Modified menus promoted water as the primary beverage.
- Establish water-delivery systems to ensure children are served water during snack time. Water-serving plans were determined based on infrastructure issues, program size, and applicable costs. Each plan had to be tailored to the needs of the school or organization operating the afterschool program. Options for providing water ranged from tap water in pitchers or jugs to bottled water in coolers.
- Engage stakeholders through parent newsletters, and get buy-in from food and nutrition services and school administrators. Understanding and acceptance of the program by parents and school staff were essential to its success. To achieve the goal of providing water at snack every day, the learning communities decided on action steps that included: creating policies in family handbooks, announcing new practices at staff meetings and assemblies, and communicating with families via newsletters and during program events. OSNAP provides sample language and templates for parent communications (www.osnap.org).
- Implement hydration units from Food & Fun Afterschool Curriculum in afterschool programs. Afterschool staff received the Food & Fun curriculum during learning communities and had the option to receive training on implementation of the curriculum. Part of the curriculum includes involving children in art activities and weekly water-helper duties.
The intervention has been developed into a CEU-eligible on-demand module via Better Kid Care.
Primary and secondary outcomes of the OSNAP intervention related to drinking water access included average changes in: 1) ounces of water served at snack per day (primary); 2) beverage calories served at snack per day (secondary); 3) ounces of juice and milk served at snack per day (secondary); and 4), number of times each beverage was served at snack per day (secondary). Trained observers (blinded to the study group assignment) observed snack serving on 5 consecutive days at both baseline and follow-up. All sites completed the study.
Of the planned observation days (100 total), 97 were completed (3 sites were observed for 4 days instead of 5 because of holiday schedules). After 6 months, the comparison of afterschool programs in the study intervention vs. control sites showed:
- increased volume of water served by a mean of 3.6 oz. per day per child;
- decreased calories from beverages served by a mean of 60.9 kcal per day; and
- increased frequency of water being served to children by a mean of 0.6 times (or 3 additional times over a 5-day school week)
All of these outcomes were statistically significant. Milk servings decreased by a mean of 0.3 servings per day, but this change achieved only borderline statistical significance. Servings of juice were not significantly reduced with a mean change of 0.2 servings per day.
In a 3-arm group-randomized trial conducted to compare effectiveness of in-person and online training models for scaling up the intervention compared to controls, on average, sites in the in-person arm achieved 0.44 additional OSNAP goals compared to controls (95%CI 0.02, 0.86, p = 0.04). Increases in the number of additional goals achieved in sites in the online arm were not significantly greater than control sites (+ 0.28, 95% CI -0.18, 0.73, p = 0.24). Goal-specific improvements were observed for increasing water offered in the in-person arm and fruits and vegetables offered in the online arm.
This pilot trial presents promising findings on implementation strategies for scale-up. It validated the in-person training model as an effective approach. The less expensive online training may be a useful option for geographically disbursed sites where in-person training is challenging.
|Readiness and Capacity – Short Term (ST)||Changes – Medium Term (MT)||Effectiveness and Maintenance – Long Term (LT)||Population Results (R)|
|Individual||ST1, ST3||MT1, MT3||LT1, LT3|
|Environmental Settings||ST5||MT5, MT6||LT5, LT6|
|Sectors of Influence||MT9|
- Action Planning Tool Document– Designed to help practitioners set goals and identify action steps for creating healthier nutrition, physical activity and screen time practices at an afterschool program. Available as a PDF.
- Policy Assessment Tool– Tool for assessing an afterschool program’s policies. Available as a PDF.
- Daily Practice Assessment Tool– Observation tool for assessing afterschool practices: Available as a PDF.
- Food & Fun Afterschool Planning Tool– A tool designed to help plan the use of the Food & Fun afterschool curriculum. Staff can make note of which activities children enjoy the most and how they communicate each unit’s healthy goal to families. On website here.
- Food & Fun Afterschool Family Engagement Planning Tool– A tool designed to record and plan the strategies that programs will use to promote nutrition and physical activity with families. On website here.
Center TRT developed an evaluation logic model and evaluation plan for the Out of School Nutrition and Physical Activity (OSNAP) Strategies to Increase Drinking Water Access, an intervention to increase access to drinking water for children in afterschool programs. The logic model is intended to guide the evaluation process (as opposed to the planning process); the evaluation plan focuses on the implementation and effectiveness of an approach like the OSNAP program in increasing access to drinking water. The evaluation plan addresses the reach, adoption, extent of implementation and effectiveness of the OSNAP program in changing policies and practices related to drinking water in afterschool programs. The evaluation is a pre-post design with no comparison group. This evaluation plan provides guidance on evaluation questions and types and sources of data for both process and outcome evaluation. If you are interested in answering evaluation questions not listed in the evaluation plan, please refer to the list of additional evaluation questions here.
Lecturer, Harvard T.H. Chan School of Public Health
*Updated as of August 4, 2023