Jarrib Baleha--a pilot nutrition intervention to increase water intake and decrease soft drink consumption among...

The Global School-based Student Health Survey (2005) indicated that in Lebanon, 33% of students in grades 7-9 drink carbonated soft drinks two or more times per day. Observational evidence suggests that students do not drink enough water.

A pilot project called Jarrib Baleha ['try without it'] was implemented with 110 students in grades 3 and 4 in two schools in Lebanon to promote drinking water instead of soft drinks. Specific objectives included increasing knowledge about the benefits of water and the harms of soft drinks, increasing confidence in choosing water over soft drinks, and increasing actual water drinking behavior while decreasing soft drink consumption.

Four 50-minute theory-informed, interactive and participatory sessions were implemented --by a graduate student in partial fulfillment of requirements for a MPH degree--over a period of two weeks. The intervention sessions--based on the Health Belief Model--took place during a class period. Process evaluation measured satisfaction of the students with the sessions. Impact evaluation measured changes in knowledge, attitudes including self-efficacy, and behavior, using a self-administered questionnaire completed prior to and after the intervention. Bivariate analysis using crosstabs was carried out to compare pretest and posttest scores on knowledge, attitudes, and behavior.

Comparison of the knowledge index between pretest and posttest indicated that, overall, knowledge increased from 6.0769 to 9.1500 (p = 0.000). Compared to pretest, students at posttest also felt more confident to drink less soft drinks and more water (p < 0.05), to drink water when thirsty (p < 0.05), and to choose water over soft drinks when going to a restaurant (p < 0.05). The percentage of students drinking 6 or more cups of water increased from 27.7% to 59.1% (p = 0.000); and those drinking less than one can of soft drink/day increased from 25.5% to 57.6% (p = 0.000).

These results are encouraging and suggest the Jarrib Baleha intervention could be implemented on a wider scale with students from both public and private schools. A more robust evaluation design is recommended. A comprehensive approach to school-based nutrition is also suggested.