Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Social Network/Peer, Consultation (Parent/Family),

Intervention Description: Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC.

Intervention Results: Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, P < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care.

Conclusion: As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.

Study Design: Randomized controlled trial

Setting: Group well-child care at Yale University in New Haven, CT

Population of Focus: English-speaking mother-infant dyads whose babies were born in the Yale New Haven Hospital's well newborn nursery

Sample Size: 97 mother-infant dyads

Age Range: Infants birth to 12 months old and their mothers

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: Thirty-seven elementary school students participated in a 4-week randomized controlled study (1-week baseline; 2-week intervention [with only the Game group receiving MKMM]; and 1-week follow-up). All participants wore a Tractivity® accelerometer throughout. Linear mixed models were applied to assess sustainability; a second 42-children-based dataset and age-/sex-adjusted linear regression models were used to compare effect across socioeconomic environments.

Intervention Results: In the first week of intervention, the Game group compared to the Control group showed a greater increase in physical activity (of 1,758 steps/day [95% confidence interval, CI = 133-3,385] and 31 active minutes/day [95% CI = 4-59]), relative to baseline (13,986 steps/day; 231 active minutes/day). However, this was not sustained in the second intervention week or follow-up. The school within a lower socioeconomic status environment showed lower baseline activity and the 1-week intervention resulted in a greater increase relative to baseline (3,633 steps/day more [95% CI = 1,281-5,985]).

Conclusion: MKMM could be a useful short-term physical activity promotion tool; however, effectiveness may decrease as novelty diminishes.

Study Design: RCT

Setting: 2 elementary schools with different socioeconomic environments

Population of Focus: Elementary school students (9-13-year-olds)

Data Source: Accelerometer

Sample Size: 79 students in two interventions

Age Range: Ages 9-13

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: Girls Active involves teachers reviewing PA, sport and physical education provision, culture and practices in their school; attending training; creating action plans; and effectively working with girls as peer leaders to influence decision-making and to promote PA to their peers. Support from a hub school and the YST is offered.

Intervention Results: Twenty schools and 1752 pupils were recruited; 1211 participants provided complete primary outcome data at 14 months. No difference was found in mean MVPA level between groups at 14 months [1.7 minutes/day, 95% confidence interval (CI) –0.8 to 4.3 minutes/day], but there was a small difference in mean MVPA level at 7 months (2.4 minutes/day, 95% CI 0.1 to 4.7 minutes/day). Significant differences between groups were found at 7 months, but not at 14 months, in some of the objective secondary outcomes: overall PA level represented by average acceleration (1.39 mg, 95% CI 0.1 to 2.2 mg), after-school sedentary time (–4.7 minutes/day, 95% CI –8.9 to –0.6 minutes/day), overall light PA level (5.7 minutes/day, 95% CI 1.0 to 10.5 minutes/day) and light PA level on school days (4.5 minutes/day, 95% CI 0.25 to 8.75 minutes/day). Minor, yet statistically significant, differences in psychosocial measures at 7 months were found in favour of control schools. Significant differences in self-esteem and identified motivation in favour of intervention schools were found at 7 and 14 months, respectively. Subgroup analyses showed a significant effect of the intervention for those schools with higher numbers of pupils at 14 months. Girls Active was well received by teachers, and they reported that implemented strategies and activities were having a positive impact in schools. Barriers to implementation progress included lack of time, competing priorities and the programme flexibility. Implementation costs ranged from £2054 (£23/pupil) to £8545 (£95/pupil) per school. No differences were found between groups for health-related quality-of-life scores or frequencies, or for costs associated with general practitioner, school nurse and school counsellor use.

Conclusion: Girls Active may not have had an effect on the random 90 girls per school included in the evaluation. Although we included a diverse sample of schools, the results may not be generalisable to all schools. Girls Active was viewed positively but teachers did not implement as many aspects of the programme as they wanted. The intervention was unlikely to have a wide impact and did not have an impact on MVPA level at 14 months. Capitalising on the opportunities of a flexible programme like this, while also learning from the stated barriers to and challenges of long-term implementation that teachers face, is a priority for research and practice.

Study Design: Two-arm cluster RCT

Setting: 20 secondary schools

Population of Focus: Girls aged 11-14

Data Source: Wrist-worn accelerometers

Sample Size: 1,752 pupils (Girls)

Age Range: Ages 11-14

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: A cluster-randomized controlled trial with preassessment in 2014 and follow-up assessment in 2015 included 29 schools with 1020 students (47.6% girls, mean age = 13.69 years). Intervention students received pedometers and monitored their steps for 12 weeks. Classes with the most steps were awarded. Primary outcomes included moderate-to-vigorous PA, out-of-school sports activities, active transport assessed through questionnaires, as well as cardiorespiratory fitness measured using the 20-m shuttle-run test and anthropometric data (weight, height, body fat, and waist circumference) assessed by study staff.

Intervention Results: Significant interaction terms between group and time were found for all 3 indicators of PA; intervention students showed a higher increase of PA than control students. The same pattern was shown for cardiorespiratory fitness, but the effect missed significance. A more favorable development for the intervention students was shown for body fat and waist-to-height ratio, while there was no effect on body mass index percentile.

Conclusion: An easy way to administer school-based PA program may enhance students' leisure-time PA even 1 year after the intervention has ended.

Study Design: Cluster RCT

Setting: Secondary schools in 6 districts in SchleswigHolstein, Germany

Population of Focus: 8th grade adolescents

Data Source: Pedometers (only used as motivator during the intervention), questionnaires (usual level of activity, out of school sports, active transport), 20-minute shuttle test, anthropometric measures

Sample Size: 29 schools (18 schools, 36 classes in intervention), 1,020 students

Age Range: Ages 12-16

Intervention Components (click on component to see a list of all articles that use that intervention): Social Network/Peer, CLASSROOM_SCHOOL

Intervention Description: The investigation aimed to evaluate the feasibility of a novel school three-tier peer-led mentoring model designed to improve PA levels and reduce sedentary time (ST) of adolescent girls. Two-hundred and forty-nine Year 9 adolescent girls (13⁻15 years old) from three UK secondary schools were invited to participate in a peer-led mentoring intervention (Girls Peer Activity (G-PACT) project). The peer-led mentoring model was delivered in all three schools. Two of the schools received an additional after-school PA component. PA and ST were assessed through wrist-worn accelerometry.

Intervention Results: Girls who received an exercise class after-school component significantly increased their whole day moderate-to-vigorous PA (MVPA) (3.2 min, p = 0.009, d = 0.33). Girls who received no after-school component significantly decreased their MVPA (3.5 min, p = 0.016, d = 0.36) and increased their ST (17.2 min, p = 0.006, d = 0.43). The G-PACT intervention demonstrated feasibility of recruitment and data collection procedures for adolescent girls.

Conclusion: The peer-led mentoring model shows promise for impacting girls' MVPA levels when combined with an after-school club PA opportunity.

Study Design: Three-arm, parallel group, non-randomized feasibility trial

Setting: Three secondary schools in West Lancashire, England

Population of Focus: Year 9 adolescent girls in 3 secondary schools

Data Source: Accelerometers, anthropometrics, questionnaires

Sample Size: 249 adolescent girls

Age Range: Ages 13-15

Intervention Components (click on component to see a list of all articles that use that intervention): Peer-led Mentoring/Support Counseling, Group Education, Social Network/Peer,

Intervention Description: Participants were randomly assigned to either six sessions Mein Weg (n = 50; Mage = 17.00, 94% male) or UC (n = 49; Mage = 16.92, 92% male).

Intervention Results: Intention-to-treat analyses showed that Mein Weg was significantly superior to UC regarding symptom improvement of self-reported PTSS (Mein Weg: d = .61, UC: d = .15) and depression (Mein Weg: d = .63, UC: d = −.06), but not regarding caregiver-reported symptoms and self-reported dysfunctional posttraumatic cognitions.

Conclusion: In summary, this trial provides evidence of the feasibility and effectiveness of the trauma-focused group intervention Mein Weg as a community-based lowlevel cognitive-behavioral intervention for traumatized UYRs. Furthermore, the inconsistency between self-reports and caregiver reports on stress symptoms indicates the need to train social workers to be more sensitive to trauma-related issues and symptoms, as this is usually not included in their education. The benefits from implementing this intervention are twofold. The UYRs report on average improvements in their PTSS and depression and the social workers receive specific trauma-focused training and are thus empowered in their daily work with the refugee population. The intervention could be a valuable lowthreshold component in a stepped care approach.

Study Design: Randomized controlled trial

Setting: Child and adolescent welfare agencies in Germany

Population of Focus: Young refugees with posttraumatic stress symptoms

Sample Size: 50 in the intervention group, 49 in the control group

Age Range: Mean age 17 years old (range not provided)

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL, Social Network/Peer

Intervention Description: A total of 190 adolescents (46.32% boys; M age = 12.17, age range: 11-14 years) were randomly allocated to either the intervention or control condition. In the intervention condition, the most influential adolescents (based on peer nominations of classmates) in each classroom were trained to promote physical activity among their classmates. Participants received a research smartphone to complete questionnaires and an accelerometer to measure physical activity (steps per day) at baseline, and during the intervention one month later.

Intervention Results: A multilevel model tested the effectiveness of the intervention, controlling for clustering of data within participants and days. No intervention effect was observed, b = .04, SE = .10, p = .66.

Conclusion: This was one of the first studies to test whether physical activity in adolescents could be promoted via influence agents, and the first social network intervention to use smartphones to do so. Important lessons and implications are discussed concerning the selection criterion of the influence agents, the use of smartphones in social network intervention, and the rigorous analyses used to control for confounding factors.

Study Design: Cluster RCT

Setting: First year students from 15 secondary school classes in Venlo region, Netherlands

Population of Focus: First year secondary school students

Data Source: Accelerometers

Sample Size: 190 adolescents

Age Range: Ages 11-14