Feasibility and acceptability of school-based intervention components to promote healthy weight and well-being among 6-11-year-olds in Denmark: mixed methods findings from the Generation Healthy Kids feasibility study

BACKGROUND: Overweight and obesity among children is a serious public health challenge worldwide which may lead to a range of negative physical, mental, and social consequences in childhood and later in life. There is a strong need for developing new innovative, integrated approaches and programs which can prevent overweight in children effectively and can be embedded into everyday practices. The Generation Healthy Kids intervention is a multi-component, multi-setting intervention aiming to promote healthy weight and well-being in children aged 6-11 years in Denmark. The present study investigates the feasibility and acceptability of 10 selected school-based intervention components and barriers and facilitators for implementation.

METHODS: A seven-week feasibility study was conducted in January to March 2023 among children in 1st and 2nd grade at a Danish public school, testing the multi-component intervention targeting children's meal-, physical activity-, sleep- and screen habits. Process evaluation data were collected using multiple methods (surveys, logbooks, evaluation sheets, registrations, counts, interviews, and observations) and data sources (parents, school staff, and school leader).

RESULTS: Most intervention components were feasible to deliver at the school, but only four components were fully delivered as intended, while the remaining components to some or low degree were delivered as intended. Some components were found acceptable by all/nearly all children (e.g., 40 min of high intensity training three times a week), and others by some or few children (e.g., reusable water bottles and midmorning snack). Intervention activities for the parents and families were found acceptable by all/nearly all participating parents. Parents' acceptability of the intervention activities delivered to their children at school could not be assessed, as only few parents participated in surveys and none in interviews. School staff's acceptability of the intervention tasks they were asked to deliver varied but was overall relatively high. Facilitators and barriers for implementation of intervention components were identified at both individual-, school class-, and school level.

CONCLUSIONS: The study underlines the importance of conducting feasibility studies as preparation for large trials. The findings will be used to refine intervention components, implementation strategies and data collection procedures before the Generation Healthy Kids main trial.