RE-AIM analysis of a randomized school-based nutrition intervention among fourth-grade classrooms in California

Abstract

Childhood overweight and obesity are major health problems. School-based programs enable intervening with large groups of children, but program overall health impact is rarely completely assessed. A RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) analysis tested the overall public health impact of the fourth-grade "Nutrition Pathfinders" school-based nutrition-education program. A randomized controlled trial in 47 fourth-grade California classrooms (1713 students) tested program efficacy, and a secondary analysis of archival data tested program dissemination. Desired effects were seen in child nutrition knowledge, attitudes, consumption of low-nutrient high-density foods, sugar-sweetened beverages, proteins, grains, and parent willingness to serve new foods. The program was disseminated to ∼25 % of public school fourth-grade classrooms in California and cost about $1.00 per student to implement. The Nutrition Pathfinders program demonstrates potential for moderate to high public health impact due to its wide dissemination, effectiveness in altering attitudes and behaviors, and its relatively inexpensive cost of implementation.

Keywords: Child nutrition; Nutrition knowledge; Obesity RE-AIM; Self-efficacy.

Fig 1

Flow diagram of classrooms and students through the recruitment, screening, and assessment phases of the evaluation study

Fig 2

Average daily intakes of proteins (meat, eggs, peanut butter, fish, and beans) reported at pre- and post-survey by study group and gender in the evaluation of the “Nutrition Pathfinders” program among fourth-grade children in California. Intervention group boys (gray broken line); intervention group girls (black broken line); control group boys (gray solid line); control group girls (black solid line)