Re: Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)
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Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)
Re: Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)
The outcomes of WAVES [1] disappointed us. Despite its ‘null’ outcomes, we remain optimistic about the potential of school-based approaches. In considering WAVES, we would like to point out easily overlooked issues. Fundamentally, our experience of delivering community and evidence-based interventions continues to rely on optimising the combined effects of (i) effective interventions drawing on the best research evidence, (ii) effective implementation and fidelity to effective interventions, and (iii) contexts and systems that support these features. Did WAVES meet this combination of criteria?
WAVES certainly met the first of these 'essentials'; it drew on the best available research evidence. Funding from the NIHR Health Technology Assessment Programme, initial buy-in from 56 schools, and a local delivery partner (the Villa Vitality programme) seemed to amplify – but clearly didn’t - guarantee an enabling context. Evidently, hardly any children experienced either a prolonged or a widespread exposure.
Whatever the causes of erratic exposure, the problems that prevented uniform systematic exposure were ubiquitous and, probably, recurrent. This undermines our second and third 'conditions'. Our major observation is that no school delivered the programme as intended. Instead, each school arguably contributed weaker and unique versions of WAVES. Fewer than half complied with even three quarters of programme content; physical activity was a particular problem. Indeed, for physical activity, most schools (83%) failed to achieve high implementation fidelity and more than half were in the low implementation bracket [1]. Simply put, the planned version of WAVES was almost never delivered.
Given these shortcomings, perhaps it is wisest to use these findings to suggest that this, rather than any, school-based interventions did/will not work? Without careful attention to implementation, even the most well intended interventions will fail.
1. Adab P, Pallan M, Lancashire E, et al. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). British Medical Journal 2018;18(360):k211 doi: 10.1136/bmj.k211[published Online First: 07 February 2018].
Rapid Response:
Re: Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study)
The outcomes of WAVES [1] disappointed us. Despite its ‘null’ outcomes, we remain optimistic about the potential of school-based approaches. In considering WAVES, we would like to point out easily overlooked issues. Fundamentally, our experience of delivering community and evidence-based interventions continues to rely on optimising the combined effects of (i) effective interventions drawing on the best research evidence, (ii) effective implementation and fidelity to effective interventions, and (iii) contexts and systems that support these features. Did WAVES meet this combination of criteria?
WAVES certainly met the first of these 'essentials'; it drew on the best available research evidence. Funding from the NIHR Health Technology Assessment Programme, initial buy-in from 56 schools, and a local delivery partner (the Villa Vitality programme) seemed to amplify – but clearly didn’t - guarantee an enabling context. Evidently, hardly any children experienced either a prolonged or a widespread exposure.
Whatever the causes of erratic exposure, the problems that prevented uniform systematic exposure were ubiquitous and, probably, recurrent. This undermines our second and third 'conditions'. Our major observation is that no school delivered the programme as intended. Instead, each school arguably contributed weaker and unique versions of WAVES. Fewer than half complied with even three quarters of programme content; physical activity was a particular problem. Indeed, for physical activity, most schools (83%) failed to achieve high implementation fidelity and more than half were in the low implementation bracket [1]. Simply put, the planned version of WAVES was almost never delivered.
Given these shortcomings, perhaps it is wisest to use these findings to suggest that this, rather than any, school-based interventions did/will not work? Without careful attention to implementation, even the most well intended interventions will fail.
1. Adab P, Pallan M, Lancashire E, et al. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). British Medical Journal 2018;18(360):k211 doi: 10.1136/bmj.k211[published Online First: 07 February 2018].
Competing interests: No competing interests