Nutrition Goes to School: a School-based Nutrition Intervention to Promote Healthy Eating Behaviour Among Adolescents

NCT ID: NCT06515288

Last Updated: 2024-07-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-09

Study Completion Date

2024-08-31

Brief Summary

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The goal of this cluster randomized controlled pilot trial is to assess the feasibility and effect of a school-based nutrition intervention program called "Nutrition Goes to School" (NGTS) in improving a healthy diet and physical activities as part of the prevention and management of obesity among adolescents in urban Indonesia. The main questions it aims to answer concern the feasibility of the NGTS multi-component school-based nutrition intervention model in selected secondary schools in an urban setting to inform the design of the future effectiveness study. Additionally, it aims to evaluate the effect of the school-based nutrition intervention in the healthy eating knowledge and behavior (fruit and vegetable consumption, energy-dense nutrient poor food, and sugary beverages consumption, as measured by food frequency questionnaire) and physical activities as well as its effect on nutrition status (body mass index, mid-upper arm circumference \[MUAC\] and waist circumference). The intervention components consist of nutrition education to school communities (teachers, management, students and parents), healthy school canteen, school garden, hygiene and sanitation promotion of the school environment and obesogenic environment control, and promotion of physical activities among students. Five secondary schools in Jakarta will be randomly assigned to receive the intervention for 6 months, and five other schools will serve as the control group.

Detailed Description

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A program which is called "Nutrition Goes to School" (NGTS) has been initiated by the Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) in 2016 to improve the health of the children through implementation of nutrition good practices at schools.The program was started by providing training to school teachers about nutrition and continuously improved until it currently includes multiple components consisting of school readiness survey, healthy school canteen, school garden for nutrition literacy, nutrition education, school hygiene and sanitation promotion and promotion of physical activities at school.

Since its initiation in mid-2016, some schools from primary to secondary level in several provinces in Indonesia have been trained in the implementation of some components of the program. However, since the program was developed gradually and schools' participation is on voluntary basis, no schools participated in the training currently implement the whole components, no standard protocol for the activities was implemented and an impact assessment is yet to been conducted. SEAMEO RECFON is one of the regional organizations under the Ministry of Education in Association of South-east Asian Nations (ASEAN) member countries which effort focused on the human resources development through education, research and community development activities in food and nutrition area. Evidence on the effectiveness of the NGTS as the flagship program of the institution is needed to advocate the implementation of the program nationally and even regionally among the ASEAN member countries.

A cluster randomized controlled pilot trial among secondary school in Jakarta, Indonesia. The school-based nutrition intervention which consisted of multi-components could be regarded as a complex health intervention. Therefore, evaluation of its effectiveness follows the steps suggested by the UK Medical Research Council (MRC) whom devised a four-phase framework for developing and evaluating RCT's of complex interventions. This pilot trial is the 2nd phase of the framework, which will be guided by the result of the program evaluation, and aimed to assess the adherence to the whole NGTS package, determine intra-cluster correlation coefficients and effect estimates. This stage is important to inform sample size calculations for future definitive trials designed to assess the effectiveness and cost-effectiveness of a full-scale intervention as currently high-quality controlled trial on school-based health intervention in Indonesia is still lacking.

Study population is adolescents (grade 10-11; 15-17 years old) in Jakarta from ten schools (five intervention and five control);each school consisted of at least 100 students. To accommodate the Indonesian school system in urban areas, we will intentionally select schools from Jakarta Provinces, which cover 5 different municipalities, North Jakarta, East Jakarta, South Jakarta, Central Jakarta, and West Jakarta. First, recruitment will be based on the discussion with the local education office at the provincial level and ask for a list of schools considering eligibility criteria, such as having a school canteen, implementing the School Health Program (Usaha Kesehatan Sekolah/UKS), and having potential land to be utilized as a school garden. Two schools in each municipality with comparable characteristics will be selected, and then each pair will be randomized to become either the intervention or the control group. Second, selected schools will be invited to participate in the study. The intervention group will receive baseline educational intervention (Nutrition Education Capacity Building for Teachers and Management) and all components of the NGTS program. While the control group will receive only the baseline educational intervention. The baseline educational intervention will be conducted in 5 days through face-to-face delivery training mode.

The sample size for this study was determined using the formula from Hayes R and Bennett S (1999). Determination of the calculation of the main parameter assessed was based on a prior study in Ecuador of a school-based intervention to improve dietary intake outcomes, the proportion of breakfast intake. Randomization was based on the number of clusters with a total of 10 schools, considering the significant level (α) of 0.05, the coefficient of variation between groups (Intra Class Correlation/ICC) of 0.15, the power of study (β) of 80%, the ratio of cases and controls (k = 1), and the anticipated dropout of 10%. Based on the sample calculation, the number of samples per intervention group and control group was 486 people each, which was increased to 500 people. So that the total sample needed is 1,000 people, with each school consisting of 100 students.

Conditions

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Obesity, Adolescent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Five intervention schools and five control schools will be selected from five different municipalities in Jakarta, with each school having a minimum of 100 students (grade 10-11; 15-17 years old). First, recruitment will be based on the discussion with the local education office at the provincial level and ask for a list of schools considering eligibility criteria. Two schools in each municipality with comparable characteristics will be selected, and then each pair will be randomized to become either the intervention or the control group. Second, selected schools will be invited to participate in the study. The intervention group will receive baseline educational intervention (Nutrition Education Capacity Building for Teachers and Management) and all components of the NGTS program. While the control group will receive only the baseline educational intervention. The baseline educational intervention will be conducted in 5 days through face-to-face delivery training mode.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Intervention schools

The intervention group will receive baseline educational intervention (Nutrition Education Capacity Building for Teachers and Management) and all components of the Nutrition Goes to School (NGTS) program.

Group Type EXPERIMENTAL

Nutrition Goes To School (NGTS) Program Intervention Package

Intervention Type BEHAVIORAL

The NGTS Program intervention package in this project consists of four components:

1. A comprehensive Nutrition Education to improve healthy eating, physical activity, and hygiene-sanitation practices.

This is a weekly interactive and fun nutrition and health promotion with different kinds of activities.
2. Healthy School Canteen to improve the availability of healthy food in school. This is an effort to strengthen the school canteen referring to the 4 Pillars of a Healthy School Canteen, including School Commitment and Management, Human Resources, Facilities and Infrastructure, and Food Quality.
3. School Garden. This is a gardening activity as a form of school garden as a media for nutrition education, character building, and contribute to supply vegetables during cooking class sessions in school.
4. Entrepreneurship nutrition. Entrepreneurship nutrition aims to foster entrepreneurial potential and skills among school members in providing healthy food at school.

Nutrition Education Capacity Building for Teachers and Management

Intervention Type BEHAVIORAL

The intervention schools will receive Nutrition Education Capacity Building for Teachers and School Management, before the above four NGTS components is implemented in the respective school. Three representatives from each school will be invited to attend a 5-day training that include knowledge on adolescent nutrition and health issues, as well as skills in implementing the NGTS Program.

Control schools

The control group receive no specific intervention other than current school health program conducted by the local public health centers (puskesmas).

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Nutrition Goes To School (NGTS) Program Intervention Package

The NGTS Program intervention package in this project consists of four components:

1. A comprehensive Nutrition Education to improve healthy eating, physical activity, and hygiene-sanitation practices.

This is a weekly interactive and fun nutrition and health promotion with different kinds of activities.
2. Healthy School Canteen to improve the availability of healthy food in school. This is an effort to strengthen the school canteen referring to the 4 Pillars of a Healthy School Canteen, including School Commitment and Management, Human Resources, Facilities and Infrastructure, and Food Quality.
3. School Garden. This is a gardening activity as a form of school garden as a media for nutrition education, character building, and contribute to supply vegetables during cooking class sessions in school.
4. Entrepreneurship nutrition. Entrepreneurship nutrition aims to foster entrepreneurial potential and skills among school members in providing healthy food at school.

Intervention Type BEHAVIORAL

Nutrition Education Capacity Building for Teachers and Management

The intervention schools will receive Nutrition Education Capacity Building for Teachers and School Management, before the above four NGTS components is implemented in the respective school. Three representatives from each school will be invited to attend a 5-day training that include knowledge on adolescent nutrition and health issues, as well as skills in implementing the NGTS Program.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* High school students in grades 10-11
* Aged 15-17 years
* Attending school in Jakarta

Exclusion Criteria

* unwilling and/or unable to complete the questionnaire thoroughly
Minimum Eligible Age

15 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Fakultas Kedokteran Universitas Indonesia

OTHER

Sponsor Role collaborator

SEAMEO Regional Centre for Food and Nutrition

OTHER

Sponsor Role lead

Responsible Party

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Indah Widyahening

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Indah S Widyahening, Professor

Role: PRINCIPAL_INVESTIGATOR

SEAMEO RECFON

Locations

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Seameo Recfon

Jakarta, The Special Capital Region of Jakarta, Indonesia

Site Status RECRUITING

Countries

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Indonesia

Central Contacts

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Indah S Widyahening, Professor

Role: CONTACT

+622122116225

Facility Contacts

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Indah S Widyahening, Professor

Role: primary

Ratna Wulanti

Role: backup

References

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National Institute of Health Research and Development. Basic Health Research 2013. Jakarta: Ministry of Health of the Republic of Indonesia, National Institute of Health Research and Development; 2013.

Reference Type BACKGROUND

National Institute of Health Research and Development. Basic Health Research 2018. Jakarta: Ministry of Health of the Republic of Indonesia, National Institute of Health Research and Development; 2018.

Reference Type BACKGROUND

Glanz K, Lankenau B, Foerster S, Temple S, Mullis R, Schmid T. Environmental and policy approaches to cardiovascular disease prevention through nutrition: opportunities for state and local action. Health Educ Q. 1995 Nov;22(4):512-27. doi: 10.1177/109019819502200408.

Reference Type BACKGROUND
PMID: 8550374 (View on PubMed)

World Health Organization. School Policy Framework: implementation of the WHO global strategy on diet, physical activity and health. Geneva: World Health Organization; 2008.

Reference Type BACKGROUND

World Health Organization. Global status report of noncommunicable diseases 2014. Geneva, Switzerland: World Health Organization; 2014.

Reference Type BACKGROUND

Parcel GS, Simons-Morton B, O'Hara NM, Baranowski T, Wilson B. School promotion of healthful diet and physical activity: impact on learning outcomes and self-reported behavior. Health Educ Q. 1989 Summer;16(2):181-99. doi: 10.1177/109019818901600204.

Reference Type BACKGROUND
PMID: 2732062 (View on PubMed)

Silveira JA, Taddei JA, Guerra PH, Nobre MR. Effectiveness of school-based nutrition education interventions to prevent and reduce excessive weight gain in children and adolescents: a systematic review. J Pediatr (Rio J). 2011 Sep-Oct;87(5):382-92. doi: 10.2223/JPED.2123. English, Portuguese.

Reference Type BACKGROUND
PMID: 22012577 (View on PubMed)

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Reference Type BACKGROUND
PMID: 25200996 (View on PubMed)

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Reference Type BACKGROUND
PMID: 29041899 (View on PubMed)

Aloia CR, Shockey TA, Nahar VK, Knight KB. Pertinence of the recent school-based nutrition interventions targeting fruit and vegetable consumption in the United States:a systematic review. Health Promot Perspect. 2016 Mar 31;6(1):1-9. doi: 10.15171/hpp.2016.01. eCollection 2016.

Reference Type BACKGROUND
PMID: 27123430 (View on PubMed)

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Kong K, Liu J, Tao Y. Limitations of studies on school-based nutrition education interventions for obesity in China: a systematic review and meta-analysis. Asia Pac J Clin Nutr. 2016;25(3):589-601. doi: 10.6133/apjcn.092015.19.

Reference Type BACKGROUND
PMID: 27440695 (View on PubMed)

Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000 Sep 16;321(7262):694-6. doi: 10.1136/bmj.321.7262.694. No abstract available.

Reference Type BACKGROUND
PMID: 10987780 (View on PubMed)

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Reference Type BACKGROUND
PMID: 31678935 (View on PubMed)

Octaria Y, Apriningsih A, Dwiriani CM, Februhartanty J. School readiness to adopt a school-based adolescent nutrition intervention in urban Indonesia. Public Health Nutr. 2021 Jun;24(S2):s72-s83. doi: 10.1017/S1368980020001299. Epub 2020 May 7.

Reference Type BACKGROUND
PMID: 32375906 (View on PubMed)

Maehara M, Rah JH, Roshita A, Suryantan J, Rachmadewi A, Izwardy D. Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia. PLoS One. 2019 Aug 20;14(8):e0221273. doi: 10.1371/journal.pone.0221273. eCollection 2019.

Reference Type BACKGROUND
PMID: 31430324 (View on PubMed)

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Reference Type BACKGROUND
PMID: 16978493 (View on PubMed)

Related Links

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http://www.seameo-recfon.org/nutrition-goes-to-school/

South-east Asian Ministers of Education Organization - Regional Center for Food and Nutrition. Nutrition Goes to School Jakarta2020

Other Identifiers

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ESTEEM NGTS

Identifier Type: -

Identifier Source: org_study_id

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