Building community capacity to stimulate physical activity and dietary behavior in Dutch secondary schools: Evaluation of the FLASH intervention using the REAIM framework.

Background: Building community capacity in secondary schools is a promising strategy for the sustainable implementation of school-based health promotion. The Fit Lifestyle at School and at Home (FLASH) intervention explored how building community capacity works for the prevention of overweight following four strategies: leadership, participatory school culture, tailored health-promotion activities, and local networks. This study evaluates the intervention's impact on community capacity and capacity-building processes over a period of 3 years, as well as its effects on adolescents' BMI and waist circumference. Methods: A mixed-methods design guided by the RE-AIM framework was used. Impact on community capacity was evaluated with semi-structured interviews at the start and end of the intervention and analyzed using an anchored coding scale. Capacity-building processes were evaluated using interviews, journals, questionnaires, and the minutes of meetings. The effects on BMI z-scores and waist circumference were evaluated using a quasi-experimental design comparing an intervention (IG) and reference group (RG), based on multi-level analyses. Results: Community capacity improved across all intervention schools but varied between capacity-building strategies. Leadership recorded the greatest improvements, aided by the appointment of Healthy School Coordinators, who increasingly focused on coordinating processes and fostering collaborations. Participatory school culture also improved through the adoption and implementation of participatory methods and a general increase in awareness concerning the importance of the Healthy School approach. Although additional health-promotion activities were implemented, stakeholders struggled with tailoring these to the specific dynamics of their schools. Limited improvements were observed in setting-up local networks that could help schools encourage healthy behavior among pupils. Differences in BMI z-scores between IG and RG over the total sample were negligible whereas waist circumference increased slightly more in IG (0.99 cm, 95% CI [.04; 1.93]). However, differences were inconsistent over time and between cohorts. Conclusions: This study highlights the potential of building community capacity. It emphasizes that this is a process in which stakeholders must become acquainted with new leadership roles and responsibilities. To navigate this process, schools need support in improving communication, establishing local networks, and sustaining capacity-building efforts in school policy. Trial registration: ISRCTN67201841; date registered: 09/05/2019, retrospectively registered.

Opportunities for Capacity Building to Create Healthy School Communities in the Netherlands: Focus Group Discussions With Dutch Pupils.

Background: To sustainably implement a healthy school community in which stakeholders, including pupils, feel ownership over health-promotion activities, building community capacity is important. Pupils have experiential knowledge that is complementary to professional knowledge, but their perspectives on capacity-building processes are underexposed. This study aims to explore secondary-school pupils' perceptions about key influencers on physical activity and dietary choices and starting points for building community capacity. Methods: Seven focus groups with forty one pupils were held in four secondary schools engaged in a capacity-building intervention. Transcripts were analysed thematically regarding key influencers about choices in the home and school setting and capacity-building strategies (leadership, participation, tailored health-promotion activities and local networks). Results: Parents remained important influencers for making healthy choices, but snacking choices were increasingly made independently from parents based on attractiveness, availability and cost. Choices to engage in physical activity depended on social aspects and opportunities in the physical environment. Pupils considered their influence over the healthy school community limited, desired more involvement, but require this to be facilitated. They identified leaders mainly within formal structures, for example, student councils. They believed health-promotion activities related to the physical environment and project-based activities within the curriculum have the maximum potential to stimulate healthy behaviours in school communities. Conclusion: This study shows that pupils can reflect critically on their physical activity and dietary choices, and on how this can contribute to processes in creating a healthy school community. In order to take an active role, they need to be considered as full partners and leadership roles should be facilitated in existing structures.

Research evaluation on diagnostic techniques to detect worm eggs and on the epidemiology and spread of schistosomiasis and ankylostomiasis among the Surinamese population: report

This report research conducted at the public health department of parasitology in Suriname. The aim of the research is an evaluation of a modified Kato-technique on diagnostic aspects and usability in the districts (methodology research). Secondly is to study the distribution and epidemiology of hookworm and schistosomiasis in Suriname, and in particular in the pilot area "Weg naar Zee" (epidemiological study). The modified Kato technique using physiological salt/eosin meets all the requirements for a good diagnostic technique, but is more complicated to perform than the Kato technique. When developing a health strategy, attention should be paid to information as well as to sanitation and (mass) treatment of the population