Systems thinking with active implementation research (STAIR): Protocol for a school-based randomised control trial...

Area of Science:

• Public Health and Preventive Medicine
• Implementation Science
• Systems Dynamics in Health

Background:

• Childhood obesity is a significant public health concern requiring effective prevention strategies in schools.
• Sustaining healthy school environments necessitates robust implementation strategies and community engagement.
• The Systems Thinking with Active Implementation Research (STAIR) protocol addresses these needs through a hybrid trial design.

Purpose of the Study:

• To evaluate the effectiveness of the STAIR intervention in preventing childhood obesity among primary school students in Victoria, Australia.
• To test and assess the implementation strategies for sustaining healthy school environments.
• To determine the cost-effectiveness and feasibility of the STAIR intervention and its support mechanisms.

Main Methods:

• A 3-year cluster-randomised controlled trial with a type-1 hybrid effectiveness-implementation design.
• Recruitment of 28 government primary schools in Southwest Victoria, Australia, with 3000-6000 students (grades 1-6) participating.
• Intervention involves co-designed, multi-step group model building and action formulation using community-based systems dynamics; implementation guided by an active implementation framework.

Main Results:

• Primary outcomes include changes in standardized body mass index (z-BMI) and adoption of STAIR interventions.
• Secondary outcomes assess differences in obesity prevalence, health behaviors, and health-related quality of life (HRQoL).
• Implementation outcomes focus on strategy effectiveness, acceptability, and utilization, with an economic evaluation of cost-effectiveness.

Conclusions:

• The STAIR trial aims to establish lasting changes in schools to combat childhood obesity.
• Findings will provide insights into the cost-effectiveness and feasibility of sustainable health promotion strategies.
• Results will inform policymakers and educational institutions on adopting effective and sustainable health promotion initiatives.