Community-engaged interventions on diet, activity, and weight outcomes in U.S. schools: a systematic review.

ABSTRACT

CONTEXT Community engagement literature suggests that capacity-building approaches and community partnership in health intervention design, delivery, and analysis improve outcomes. School communities influence childhood diet and activity patterns affecting lifelong obesity risk. This systematic review's purpose is to assess whether incorporating community engagement principles in school-based interventions influences weight-related outcomes. EVIDENCE ACQUISITION Obesity-prevention interventions (published January 2000-2011) in diverse U.S. schools, meeting a minimum threshold of community engagement and targeting weight-, diet- or activity-related outcomes were identified in MEDLINE, PsycINFO, and CINAHL (December 2010-March 2011). Two reviewers scored community engagement performance on 24 metrics of capacity building and partner involvement along four research stages. Outcome performance was calculated as percentage of targeted primary and/or secondary outcomes achieved. EVIDENCE SYNTHESIS: Sixteen studies were included, targeting anthropometric (n = 12); dietary (n = 13); and activity (n = 10) outcomes in schoolchildren (mean age=10.7 years). Studies averaged 46% of targeted outcomes (95% CI = 0.33, 0.60) and met 60% of community engagement metrics. Positive correlations existed between community engagement performance and all-outcome performance (r = 0.66, 95% CI = 0.25, 0.87) and secondary-outcome performance (r = 0.67, 95% CI = 0.22, 0.89), but not primary-outcome performance (r = 0.26, 95% CI = -0.27, 0.67). Number of outcomes met was not correlated with number of outcomes targeted, number of partners, or study size. Specific qualitative and quantitative trends suggested that capacity-building efforts, engagement in needs assessments and results dissemination, and durable partnerships positively influence outcomes. CONCLUSIONS: Results suggest that meaningful partnership of diverse school communities within obesity prevention interventions can improve health outcomes.