El conocimiento constructivo de González de Medina Barba

The findings of this feasibility study provide a number of contributions to the body of public health knowledge; the key contributions are listed below, other contributions are described subsequently.

- This study is the first to create and implement a school-based intervention programme within the context of girls’ school in the city of Al-Madinah, in Saudi Arabia. Designing a new programme which takes into consideration sociocultural factors which accommodate for the immediate contextual case, enhanced the effectiveness of the programme.

- Most consulted school-based interventions studies, focused on two factors: dietary habits and physical activity; whereas this study adopted multi-component intervention factors: sedentary activities, dietary habits and physical activity. The study goes as far as arguing that secondary activities are the most important risk factor, yet, it seems that only handful of previous studies covered it albeit the fact that it’s a modern day problem (Al-Naqeeb, 2012)

- This study contributes to existing knowledge by providing an insight for KSA’s public health practitioners, policy makers and nursing students, regarding the context of childhood obesity prevention both at home and in the school environment.

It was clear that KSA’s definitive national statistics for childhood obesity, control and prevention were lacking. Those that existed showed that child obesity was an epidemic and

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the prevalence was increasing (Abalkhail, 2002; Al-Hazzaa, 2007b), and that childhood obesity is associated with eating behaviours and lifestyle choices such as inactivity (Warren et al., 2003; Boddy et al., 2012; Al Dhaifallah et al., 2015). However, there were no readily accessible studies on which are specifically devoted to assessing the effectiveness of a school-based intervention that increases knowledge and awareness of healthy lifestyle behaviours among KSA children

Considering that children, who develop obesity face serious psychological, physiological, and social consequences including type 2 diabetes, risk of heart diseases, fatty liver diseases, musculosketal discomfort, depression and others (Wang et al., 2008), the key findings obtained from this study can be used as a reference point to KSA’s public health care and education, food and school regulation and practice and as a base for future childhood obesity evaluation. The findings indicate that a school-based education intervention had a positive impact on altering behaviour from unhealthy to healthy as a preventive measure of obesity in the future; also contributed to existing evidence that school-based obesity interventions have a successful impact on BMI.

This study also offers recommendations for developing and implementing a school-based intervention. As such, the study provides beneficial knowledge on how to conduct an intervention using a sequential explanatory mixed method design and SCT theory to elicit vital information that can be used in improving public health. With a small sample, this nutrition education school-based intervention’s short-term findings serve as an indicator that a study of a larger scale application of a similar intervention in similar settings may have considerable effect in combating childhood obesity.

This study’s use of a phased approach to completing the research activities (i.e. pre- intervention, intervention and post intervention) indicates that breaking the intervention into stages and then integrating the findings through triangulation minimises the challenges of using mixed methods. Additionally, the study contributed to the existing argument that a mixed methods approach offers a comprehensive analysis to the research problem, unlike using a single method in a study. The study also underscores the importance of planning resources, particularly time, in order to complete mixed methods research successfully. According to Ritchie and Lewis (2003) research studies that apply mixed methods are complex particularly with time and resource limitation.

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The results from this intervention study have also contributed to findings that there are existing cases of overweight and obese among children in KSA. The study has also revealed that despite children having prior knowledge of healthier practices, environmental factors like access to energy dense foods, the cost of healthier foods and taste preferences affect their food choice. Furthermore, with lack of physical activity classes and facilities coupled with gender equality issues, girls have limited physical exercise. The study therefore contributes evidence that these factors contribute to increasing childhood obesity in KSA. The study has offered an in-depth understanding of child obesity in KSA, significant analysis on how food and activity associate with child obesity and how awareness can be used to achieve behaviour change among KSA children, hence helping prevent childhood obesity. The observed short- term change in BMI after the intervention also adds to existing knowledge that physical exercises combined with nutrition component have an effect on BMI. It was observed that the intervention impacted on the sedentary activities of children in the short-term while an increase in hours of exercise, increased intake of health foods like vegetables and fruits was also observed. Overall, this feasibility study contributed to the existing literature that increasing knowledge and awareness about healthier lifestyle has beneficial effects in preventing and reducing child obesity.

The study confirms that the collaboration of parents and educators in helping children develop their own healthy habits and behaviours during the intervention is necessary. Importantly, it confirms the importance of obesity prevention strategies planning; to combine diet and physical activity as an effective way of preventing childhood obesity in the future. The study also showed that regular lessons that mirror components of this intervention are required to maintain the short-term impact, hence ensuring persistence in healthy living among KSA children.