CUARTO MOMENTO: EVALUACION

Study Control condition Intervention condition Cultural tailoring

McEachan et al. delivered in a range of locations.

Twelve group sessions, six antenatal and six postnatal, consisting of verbal and written advice and promotion of positive parenting skills in recognition of healthy lifestyle behaviors that contribute to the prevention of childhood overweight/obesity (e.g., physical activity, healthy dietary behaviors).

Intervention duration: 1 year.

Intervention was tailored to both White British and South Asian groups:

- Use of community sources to develop and publicize the intervention.

- Identification and address of barriers to access and participation.

- Development of language sensitive communication strategies.

- Consideration of cultural/religious values that promote or hinder behavioral change.

- Recognition of degrees of ethnic identification.

- Intervention development is informed by local practitioners with experience in delivering community based interventions to a range of ethnic groups.

Children were given physical activity and nutrition activity cards, promoting specific exercises to be done at home. Preschool teachers participated in two workshops to learn about the content and the practical aspects of the interventions. Parents participated in three interactive information and discussion evenings, and were given brochures and information leaflets. School curriculum changes included four 45 minute physical activity lessons per week, health education sessions, promotion of healthy snacks during recess and treats for anniversaries, exclusive offering of water and healthy food to the children by the preschool classes, and a Ballabeina games event.

Adaption of the built environment in and around the preschool included the installation of fixed and mobile physical activity equipment.

Intervention duration: 10 months (1 school year).

Intervention was tailored to a culturally heterogenic group:

- Identification of norms and needs through pilot studies, focus groups, and expert meeting.

- Written information provided in ten languages.

- Recommendations on physical activity and nutrition were kept simple and short and contained many pictures.

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Study Control condition Intervention condition Cultural tailoring

Adab et al. (2014) physical activities during school hours, encouragement of physical activity outside of school hours, attendance at local sports club, cooking courses for family members, information on local leisure opportunities, taster sessions for families, and community walking programs.

Intervention duration: 1 year.

Intervention was tailored to South Asian communities:

- Involvement of key stake holders drawn from South Asian communities in intervention development and

At the beginning of the school year, there was a health promotion gathering for parents and local sports clubs. Children received three physical educational lessons per week, guided by a physical education teacher. Additional sports and play activities were organized outside school hours (attendance voluntary).

Children also received classroom education comprising of three main lessons on healthy nutrition, active living, and healthy lifestyle choices. Local sports clubs were involved in the intervention by providing some of the physical education lessons and sports activities outside school hours.

Intervention duration: 10 months (1 school year).

No information provided on cultural tailoring. Similarly, in design article no specific information provided.

Muckelbauer et al. (2010)

School curriculum as usual.

Installation of one or two water fountains with free access to cooled plain or carbonated water. School curriculum changes included four 45-minute lessons on water losses, water needs of the body, and on the water circuit in nature (led by classroom teachers). Lessons were not culture-specific adapted.

Intervention duration: 10 months (1 school year).

No information provided on cultural tailoring.

Children and their parents were provided with personal workbooks including assignments to perform in class and at home. Parents were offered information meetings, courses, and sports activities. School staff received instruction books. Accessible school sports activities were offered on a daily basis (“school sports clubs”). Children could join the club during out-of-school hours. Furthermore, children were offered recurrent breaks for physical activity, relaxation exercises, and posture exercise during regular lessons.

Intervention duration: 9 months (1 school year).

No information provided on cultural tailoring. According to the design article, parental information was provided in parents’ own language when necessary.

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Study Control condition Intervention condition Cultural tailoring

Van de Gaar et al.

(2014)

School curriculum as usual. This includes the regular health promotion programme

‘Enjoy Being Fit!’.

Use of promotion material and water promoting activities (e.g., pimp up your water bottle, pimp up your water jug). Free water was provided at school during the day and water breaks during physical education lessons offered. Children furthermore received special education water lessons and fun games. Parents were involved in the water promoting activities and received water education.

Intervention duration: 14 months.

Intervention was tailored to Moroccan and Turkish groups:

- Intervention Mapping.

- Social Marketing techniques.

Eyre et al. (2016) School curriculum as usual.

Children undertook a school-based pedometer challenge linked to the curriculum that required children to walk virtually form school to the coast (42 miles per week). Children were furthermore taught to skip and provided with a personal skipping rope. Children were also able to attend weekly afterschool activity sessions. Changes were made to the curriculum to include health education lessons.

Intervention duration: 6 weeks.

No information provided on cultural tailoring.

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Supplement 3.

Table S2: Quality assessment of randomized controlled trials (n=1)*

Criteria McEachan et al. (2016)

Selection bias

1. Random sequence generation 2. Allocation concealment

Low risk

1. Minimization algorithm incorporating a random element

2. Randomization occurred immediately after baseline assessment using a secure centralized telephone based service

Performance bias

1. Blinding of participants and personnel

Unclear risk

1. No, not possible to blind participants or those delivering the intervention

Detection bias

1. Blinding of outcome assessment

Low risk

1. Yes, but only partially successful Attrition bias

Similar number and reasons for loss to follow-up between treatment arms 2. Adjustment for potential confounders

Unclear risk 1. Yes 2. Partly Other bias: Outcome assessment

1. Self-reported or objectively measured data 2. Validity and reliability of assessment tools reported

Unclear risk

1. Combination of objectively measured data and self-report data

2. Validated objective measures where used when appropriate and available. When no validated tools were available, study specific measures were used

* Quality assessment based on Cochrane criteria.

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Table S3: Quality assessment of cluster randomized controlled trials (n=3)*

Criteria Puder et al. (2011) Burgi et al. (2012)

1. Blinding of participants and personnel

Unclear risk

1. No, not possible to blind participants or those

1. Blinding of outcome assessment

Low risk

Other bias: Outcome assessment 1. Self-reported or objectively measured data

2. Validity and reliability of assessment tools reported 1. Taking clustering into account

Low risk

* Quality assessment based on Cochrane criteria.