Scolaris Content Display Scolaris Content Display

Study flow diagram.

Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Forest plot of primary outcome (implementation).

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Figure 4

Forest plot of primary outcome (implementation).

Funnel plot for primary outcome (implementation).

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Figure 5

Funnel plot for primary outcome (implementation).

Sensitivity analysis – standardised mean difference between implementation and control groups in implementation trials, excluding trials with a high risk of bias.

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Figure 6

Sensitivity analysis – standardised mean difference between implementation and control groups in implementation trials, excluding trials with a high risk of bias.

Sensitivity analysis – standardised mean difference between implementation and control groups in implementation trials, with effective sample size calculated using an intracluster correlation coefficient of 0.01.
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Figure 7

Sensitivity analysis – standardised mean difference between implementation and control groups in implementation trials, with effective sample size calculated using an intracluster correlation coefficient of 0.01.

Sensitivity analysis – Standardised mean difference between implementation and control groups in implementation trials, with effective sample size calculated using an intracluster correlation coefficient of 0.05.

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Figure 8

Sensitivity analysis – Standardised mean difference between implementation and control groups in implementation trials, with effective sample size calculated using an intracluster correlation coefficient of 0.05.

Standardised mean difference between intervention and control groups in implementation trials.

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Figure 9

Standardised mean difference between intervention and control groups in implementation trials.

Funnel plot – Standardised mean difference between intervention and treatment groups in implementation trials by standard error.

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Figure 10

Funnel plot – Standardised mean difference between intervention and treatment groups in implementation trials by standard error.

Standardised mean difference between intervention and treatment groups in implementation trials, grouped by target behaviour.

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Figure 11

Standardised mean difference between intervention and treatment groups in implementation trials, grouped by target behaviour.

Funnel plot for secondary outcome (nutrition).

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Figure 12

Funnel plot for secondary outcome (nutrition).

Comparison 1: Primary outcome, Outcome 1: Implementation

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Analysis 1.1

Comparison 1: Primary outcome, Outcome 1: Implementation

Comparison 2: Secondary outcomes, Outcome 1: Nutrition

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Analysis 2.1

Comparison 2: Secondary outcomes, Outcome 1: Nutrition

Comparison 2: Secondary outcomes, Outcome 2: Physical activity

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Analysis 2.2

Comparison 2: Secondary outcomes, Outcome 2: Physical activity

Comparison 2: Secondary outcomes, Outcome 3: Obesity

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Analysis 2.3

Comparison 2: Secondary outcomes, Outcome 3: Obesity

Comparison 2: Secondary outcomes, Outcome 4: Tobacco

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Analysis 2.4

Comparison 2: Secondary outcomes, Outcome 4: Tobacco

Summary of findings 1. Comparison of strategies for enhancing the implementation of school‐based policies or practices targeting risk factors for chronic disease

Outcome

Anticipated absolute effects

Relative effect (95% CI)

№ of participants
(studies)

Certainty of the evidence

What happens

Risk with control

Risk with experimental

Implementation of policies, practices or programmes that promote student health in schools

Mean PA practices achieved 0.5 (SD 0.7)a

SMD of 1.04 is equivalent to an increase in the implementation of 0.73 of a school chronic disease prevention policy or practice

SMD 1.04 SD higher
(0.74 higher to 1.34 higher)

897 schoolsb

(22 RCTs)

⊕⊕⊖⊖
Lowc

Implementation strategies may result in a large increase in the implementation of interventions in schools.

Student diet

Dietary diversity score (range 0–9) mean 4.54 (SD 1.22)d

SMD of 0.08 is equivalent to an improvement in dietary diversity score of 0.10 units

SMD 0.08 SD higher
(0.02 higher to 0.15 higher)

16,649 participants
(11 RCTs)

⊕⊕⊖⊖
Lowe

Implementation strategies may result in slight improvements in student nutrition outcomes.

Student physical activity

Mean steps/day 2556.85 (SD 557.27)f

SMD of 0.09 is equivalent to an improvement of 50 steps/day more

SMD 0.09 SD higher
(0.02 lower to 0.19 higher)

16,389 participants
(9 RCTs)

⊕⊕⊖⊖
Lowg

Implementation strategies may result in slight improvements in student physical activity outcomes.

Student obesity

Mean BMI 19.1 (SD 3.7)h

SMD of −0.02 is equivalent to a reduction of

BMI by 0.074 points

SMD 0.02 SD lower
(0.05 lower to 0.02 higher)

18,618 participants
(8 RCTs)

⊕⊕⊕⊖
Moderatei

Implementation strategies probably result in little to no difference in measures of student obesity.

Student tobacco use

See comments

See comments

SMD 0.03 SD lower
(0.23 lower to 0.18 higher)

3635 participants
(3 RCTs)

⊕⊖⊖⊖
Very lowj

We are very uncertain about the effect of implementation strategies on tobacco use outcomes.

Adverse events

See comment

See comment

(3 RCTs)

⊕⊕⊖⊖
Lowk

Interventions had little to no impact of on adverse events.

Cost‐effectiveness

See comment

See comment

(4 RCTs)

⊕⊖⊖⊖
Very lowl

We are uncertain whether strategies to improve the implementation of school‐based policies, practices or programmes targeting risk factors for chronic disease are cost‐effective.

BMI: body mass index; PA: physical activity; RCT: randomised controlled trial; SD: standard deviation; SMD: standardised mean difference.

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aBaseline estimates and SDs used from Sutherland 2020.
bNumber of school reported rather than participants as implementation data were not reported at the participant level and may have included school, class, individual or some other level data.
cDowngraded one level for unclear/high risk of bias and one level for substantial heterogeneity (I2 = 81%; 50% to 90% considered substantial heterogeneity).
cBaseline estimates and SD used from de Villiers 2015.
dDowngraded one level for unclear/high risk of bias and one level for substantial heterogeneity (I2 = 63%; 50% to 90% considered substantial heterogeneity).
eBaseline estimates and SD used from Nathan 2020.
fDowngraded one level for substantial heterogeneity (I2 = 83%; 50% to 90% considered substantial heterogeneity) and one level for imprecision as 95% CI included both benefits and harms.
gBaseline estimates and SD used from Naylor 2006.
hDowngraded one level for imprecision as 95% CI included both benefits and harms.
iDowngraded one level for unclear/high risk of bias, one level for substantial heterogeneity (I2 = 81%; 50% to 90% considered high heterogeneity), and one level for imprecision as 95% CI include both benefits and harms.
jDowngraded one level for unclear/high risk of bias and one level for small number of studies reporting adverse outcomes.
kDowngraded one level for unclear/high risk of bias, one level for indirectness given the small number of studies providing assessment on cost‐effectiveness, and one level for imprecision given the small number of schools in total.

Figures and Tables -
Summary of findings 1. Comparison of strategies for enhancing the implementation of school‐based policies or practices targeting risk factors for chronic disease
Table 1. Interventions across studies

Trial

Audit and feedback

Clinical practice guidelines

Continuous quality improvements

External

funding

Education

games

Education

materials

Education

meeting

Education outreach visits

Inter‐

professional

education

Length of consultation

Local consensus

process

Local opinion

leader

Managerial supervision

Monitoring performance of delivery

Pay for performance

Procurement and distribution of supplies

Tailored intervention

The use of communication

technology

Other

Alaimo 2015

X

X

X

X

X

X

Bremer 2018

X

X

X

Cheung 2018

X

X

X

Cunningham‐Sabo 2003

X

X

X

X

de Villiers 2015

X

X

X

X

Delk 2014

X

X

X

X

X

X

Egan 2018

X

X

X

X

Evenhuis 2020

X

X

X

X

Farmer 2017

X

X

X

X

French 2004

X

X

X

X

Gingiss 2006

X

X

X

X

Hager 2018

X

X

X

X

X

Heath 2002

X

X

X

Hodder 2017

X

X

X

X

X

X

Hoelscher 2010

X

X

X

X

X

X

X

Lytle 2006

X

X

X

X

Mathur 2016

X

X

X

X

X

McCormick 1995

X

X

X

Mobley 2012

X

X

X

X

X

X

X

X

Nathan 2012

X

X

X

X

X

X

X

Nathan 2016

X

X

X

X

X

X

X

X

Nathan 2020

X

X

X

X

X

Naylor 2006

X

X

X

X

X

X

Perry 1997

X

X

X

X

Perry 2004

X

X

X

X

X

Sallis 1997

X

X

X

X

X

Saraf 2015

X

X

X

X

X

X

X

Saunders 2006

X

X

X

X

X

X

Simons‐Morton 1988

X

X

X

X

X

X

X

Story 2000

X

X

Sutherland 2017

X

X

X

X

X

X

Sutherland 2020

X

X

X

X

X

X

X

X

Taylor 2018

X

X

X

X

X

Waters 2017

X

Whatley Blum 2007

X

X

X

X

X

X

X

X

Wolfenden 2017

X

X

X

X

X

X

X

X

X

X

Yoong 2016

X

X

X

X

Young 2008

X

X

X

X

X

X

Figures and Tables -
Table 1. Interventions across studies
Table 2. Definition of Effective Practice and Organisation of Care (EPOC) subcategories utilised in the review

EPOC subcategory

Definition

Audit and feedback

A summary of health workers’ performance over a specified period of time, given to them in a written, electronic or verbal format. The summary may include recommendations for clinical action.

Clinical practice guidelines

Clinical guidelines are systematically developed statements to assist healthcare providers and patients to decide on appropriate health care for specific clinical circumstances'(US IOM).

Educational materials

Distribution to individuals, or groups, of educational materials to support clinical care, i.e. any intervention in which knowledge is distributed. For example this may be facilitated by the Internet, learning critical appraisal skills; skills for electronic retrieval of information, diagnostic formulation; question formulation.

Educational meetings

Courses, workshops, conferences or other educational meetings.

Educational outreach visits, or academic detailing

Personal visits by a trained person to health workers in their own settings, to provide information with the aim of changing practice.

External funding

Financial contributions such as donations, loans, etc. from public or private entities from outside the national or local health financing system.

Inter‐professional education

Continuing education for health professionals that involves > 1 profession in joint, interactive learning.

Length of consultation

Changes in the length of consultations.

Local consensus processes

Formal or informal local consensus processes, for example agreeing a clinical protocol to manage a patient group, adapting a guideline for a local health system or promoting the implementation of guidelines.

Local opinion leaders

The identification and use of identifiable local opinion leaders to promote good clinical practice.

Managerial supervision

Routine supervision visits by health staff.

Monitoring the performance of the delivery of healthcare

Monitoring of health services by individuals or healthcare organisations, for example by comparing with an external standard.

Other

Strategies were classified as other if they did not clearly fit within the standard subcategories.

Pay for performance – target payments

Transfer of money or material goods to healthcare providers conditional on taking a measurable action or achieving a predetermined performance target, for example incentives for lay health workers.

Procurement and distribution of supplies

Systems for procuring and distributing drugs or other supplies.

Tailored interventions

Interventions to change practice that are selected based on an assessment of barriers to change, for example through interviews or surveys.

The use of information and communication technology

Technology based methods to transfer healthcare information and support the delivery of care.

Figures and Tables -
Table 2. Definition of Effective Practice and Organisation of Care (EPOC) subcategories utilised in the review
Table 3. Summary of intervention, measures and absolute intervention effect size in included studies

Author, date Design

Targeted risk factors

Implementation strategy (according to the EPOC taxonomy)

Comparison

Measures, length of follow‐up, measurement type

Author reported effect size

Standardised effect size: SMD

Randomised and cluster randomised trials

Cunningham‐Sabo 2003

cRCTa

Nutrition

Clinical practice guidelines, educational materials, educational meetings, educational outreach visits or academic detailing

Usual practice

% calories total fat breakfast (less is better), 2 years, 5‐day menu and recipe data collection.

FU LS mean −3.3 (SE 1.50); P = 0.03

0.66 (95% CI 0.02 to 1.30)

de Villiers 2015

cRCTa

Nutrition

Local opinion leaders, educational materials, educational outreach visits, educational meetings

Minimal support control

% schools with nutrition related policy (more is better), 3 years, situational analysis (included a structured interview with the school principal and completion of an observation schedule).

No effect estimate between groups reported.

FU n/N: intervention 7/8; control 7/8

0 (95% CI −1.64 to 1.64)

French 2004

cRCT

Nutrition

Local consensus processes, tailored intervention, educational meetings, pay for performance

Usual practice or waitlist control

% low fat à la carte foods (more is better), 2 years, observation of lunchtime meals offered.

No effect estimate between groups reported.

FU mean: intervention 42.0 (range 28–58); control 27.7 (16–39)

0.85 (95% CI −0.07 to 1.76)

Hager 2018

cRCT

Nutrition, PA

Tailored interventions, educational meetings, external funding, educational materials, local opinion leaders

Usual practice or waitlist control

Implementation score (more is better), 1 year, online survey.

FU mean: 0.70; P = 0.501b

0.16 (95% CI −0.44 to 0.76)

Lytle 2006

cRCTa

Nutrition

Educational materials, educational meetings, local opinion leaders, local consensus processes

Usual practice or waitlist control

% of items in the foods to promote category (more is better), 3 years, 5‐day service observations.

P = 0.04 (1‐tailed test), no other data reported

NA

Mobley 2012

cRCTa

Nutrition

Educational games, educational meetings, external funding, tailored intervention, educational materials, educational outreach or academic detailing, other, the use of information and communication technology

Usual practice or waitlist control

% eliminate milk > 1% fat, all other added sugar beverages and 100% juice only served in < 150 g (more is better), about 3.5 years, data collection on all food/beverage product labels.

No effect estimate between groups reported.

FU %: intervention 94%; control 6%

2.17 (95% CI 0.64 to 3.70)

Nathan 2016

cRCTa

Nutrition

Audit and feedback, continuous quality improvement, education materials, education meeting, local consensus process, local opinion leader, tailored intervention, other

Usual practice

Healthy canteen items represent > 50% of products listed on the menu (more is better), 1 year, canteen menu audits.

FU RR (95% CI): 2.03 (95% CI 1.01 to 4.08); P = 0.03

0.70 (95% CI 0.05 to 1.34)

Perry 1997

cRCT

Nutrition, PA

Educational materials, educational meetings, educational outreach visits or academic detailing, other

Usual practice or waitlist control

Cholesterol in lunches provided (mean milligrams) (less is better), 3 years, menu analysis.

FU mean (SD): intervention 74.9 (SD 18.8); control 83.2 (SD 22.6), P = significant difference

0.40 (95% CI −0.01 to 0.81)

Perry 2004

cRCT

Nutrition

Educational meetings, educational outreach visits or academic detailing, educational materials, local consensus processes, other

Usual practice or waitlist control

Number of fruits and vegetables available at cafeteria (more is better), 2 years, canteen observations.

FU MD 0.48 (SE 0.11); P < 0.01

0.40 (95% CI 0.18 to 0.62)

Saraf 2015

cRCT

Nutrition, PA and tobacco

Educational games, educational materials, educational meetings, local consensus processes, local opinion leaders, tailored Interventions, other

Usual practice

Schools having a healthy food policy (more is better), 1 year, survey data.

FU n/N: intervention 16/19; control 3/21; P < 0.01

1.91 (95% CI 0.95 to 2.87)

Story 2000

cRCT

Nutrition

Educational meetings, other

Usual practice

Mean number of fruit and vegetable choices available at cafeteria (more is better), 1 year, observation of food service staff.

No effect estimate between groups reported.

Data for 4th and 5th year combined by review authors

FU mean: intervention 4.05 (SD 0.66), control 2.9 (SD 0.68)

1.60 (95% CI 0.59 to 2.60)

Taylor 2018

cRCTa

Nutrition

Incentives, educational materials, educational outreach visits or academic detailing

Usual practice or waitlist control

Number of fruit items offered daily at cafeteria (more is better), 9 months, based on produce expenditure.

FU mean: intervention 4.17 (SD 0.98); control 4.17 (SD 0.75); P = 1.00

0 (95% CI −1.13 to 1.13)

Waters 2017

cRCT

Nutrition, PA

Educational materials, educational outreach visits or academic detailing; local consensus approach, tailored interventions

Usual practice

Existence of Healthy Eating Policy (more is better), 3.5 years, principal survey.

No effect estimate between groups reported.

FU n (%): intervention 9 (75%); control 2 (20%)

1.52 (95% CI 0.31 to 2.73)

Wolfenden 2017

cRCTa

Nutrition

Audit and feedback, continuous quality improvement, external funding, education materials, education meeting, education outreach visits or academic detailing, local consensus process, local opinion leader, tailored intervention

Usual practice

Healthy items represented > 50% of canteen menu (more is better), 12–14 months, menu assessment.

FU RR 3.06 (95% CI 1.64 to 5.68); P < 0.01

1.37 (95% CI 0.68, 2.07)

Yoong 2016

cRCTa

Nutrition

Audit and feedback, continuous quality improvement, education materials, tailored intervention

Usual practice

Percentage of green (healthy) items on canteen menu (more is better), 12 months, menu audit.

FU estimate difference 10.55 (95% CI 2.06 to 19.05); P = 0.014

0.57 (95% CI 0.02 to 1.12)

Farmer 2017

cRCT

PA

Incentives, local consensus approach, tailored interventions

Usual practice

Play space evaluation score (total) (more is better), 1 year, principal survey.

FU MD 4.50 (95% CI 1.82 to 7.18); P = 0.005

1.20 (95% CI 0.13 to 2.26)

Nathan 2020

cRCT

PA

Educational outreach visits, centralised technical support, mandate change, identify and prepare champions, provide ongoing consultation, educational material

Usual practice

Teacher implementation (minutes) of a PA policy (structured physical activities) across the week (more is better), 9 months, teacher log book data.

FU MD 36.60 (95% CI 2.68 to 70.51); P = 0.04

0.65 (95% CI 0.21 to 1.10)

Naylor 2006

cRCT

PA

Educational materials, educational meetings, educational outreach meetings or academic detailing, local consensus process, other, tailored interventions

Usual practice or waitlist control

Minutes per week of planned PA (more is better), 11 months, teacher activity log.

No effect estimate between groups reported.

FU mean: usual practice schools: 91.4 (95% CI 70.7 to 112.2); champion schools: 137.8 (95% CI 117.0 to 158.6); liaison schools: 154.8 (95% CI 136.6 to 173.0)

2.39 (95% CI 0.29 to 4.48)

Saunders 2006

cRCTa

PA

Educational materials, educational meetings, educational outreach visits or academic detailing, local consensus processes, local opinion leaders, other

Usual practice or waitlist control

Implementation score (more is better), 12 months, survey.

Did not report aggregate results by group

NA

Sutherland 2017

cRCT

PA

Audit and feedback, education materials, education meeting, education outreach visits or academic detailing, local opinion leader, other

Usual practice or waitlist control

Overall lesson quality score (more is better), 6 months, observation checklist.

FU mean: intervention 57.5; control 36.0; P < 0.0b

2.31 (95% CI 1.87 to 2.75)

Sutherland 2020

cRCT

PA

Audit and feedback, educational materials, educational meetings, educational outreach visits or academic detailing, clinical practice guidelines, interprofessional education, local opinion leaders, other

Usual practice

Mean number of PA practices implemented (more is better), 12 months, survey.

FU MD 3.2 (95% CI 2.5 to 3.9); P < 0.001

2.48 (95% CI 1.74 to 3.23)

Young 2008

cRCT

PA

Education materials, education meetings, educational outreach visits or academic detailing, interprofessional education, local consensus processes, local opinion leaders

Usual practice

Mean number of PA programmes implemented semesters 1–4 (more is better), 2 years, survey.

FU mean: intervention 15.2 (SD 10.8); control 10.1 (SD 4.0); P = 0.8

0.61 (95% CI −0.06 to 1.28)

Hodder 2017

cRCT

Tobacco, alcohol

Educational outreach visits, educational meetings, local consensus processes, educational materials, external funding, audit and feedback

Usual practice

Number of programmes components used by teachers (more is better), 3 years, survey.

FU mean: intervention 3.1 (SD 1.83); control 1.2 (SD 0.87); P = 0.004

1.19 (95% CI 0.38 to 2.01)

Mathur 2016

cRCT

Tobacco

Local opinion leader, continuous quality improvement, education materials, education meeting, local consensus process

Usual practice or waitlist control

School policy or rule specifically prohibiting smokeless tobacco use inside school (more is better), 12 months, policy observation checklist.

FU OR 7.54 (95% CI 4.92, 11.60); P value not reported

1.11 (95% CI 0.88 to 1.34)

McCormick 1995

cRCT

Tobacco

Educational meetings, local consensus processes, educational materials

Minimal support control

Number of curriculum activities taught by each teacher, 1 year, implementation checklist.

FU mean: intervention 68.11; control 67.99; P = not significantb

NA

Non‐randomised controlled trials and cluster non‐randomised controlled trials

Alaimo 2015

Non‐randomised

Nutrition

Clinical practice guidelines, educational materials, educational outreach visits or academic detailing, external funding, local consensus processes, tailored interventions

Usual practice or waitlist control

Mean nutrition education and practice score (more is better), 2 years, survey.

FU mean: intervention 5.9 (SD 3.2); control 4.8 (SD 3.7); P = not significant

0.32 (95% CI −0.23 to 0.87)

Evenhuis 2020

Non‐randomised

Nutrition

Educational materials, educational meeting, audit with feedback, educational outreach visit or academic detailing

Waitlist control

Healthy products available in the cafeteria (more is better), 6 months, audit by canteen supervisor.

FU mean: intervention 77.20 (SD 13.41); control 60.10 (SD 15.67); P = not significant

1.12 (95% CI 0.18 to 2.07)

Heath 2002

Non‐randomised

Nutrition

Educational materials, educational meetings, educational outreach visits or academic detailing

Usual practice

% of fat in breakfast served (less is better), 12 months, menu and recipe audit.

FU %: intervention 20.0%; control 19.2%; P = not significantb

NA

Nathan 2012

Non‐randomised

Nutrition

Educational materials, educational meetings, local consensus processes, local opinion leaders, other, monitoring the performance of the delivery of the healthcare, tailored interventions

Minimal support control

Prevalence of fruit and vegetable break (more is better), 11–15 months, principal report.

FU OR 1.91 (95% CI 1.47 to 2.48); P < 0.1

0.59 (95% CI 0.32 to 0.86)

Simons‐Morton 1988

Non‐randomised

Nutrition

Educational materials, educational outreach visits or academic detailing, local consensus processes, local opinion leaders, managerial supervision, monitoring of performance, other

Usual practice

Fat content in grams per 100 g school cafeteria lunches served (less is better), 1 year, chemical analysis.

No effect estimate between groups reported.

FU mean: intervention school 1: −1.8; intervention school 2: −3.4; control school 1: −1.1; control school 2: 0.3

0.36 (95% CI 0.07 to 0.66)

Whatley Blum 2007

Non‐randomised

Nutrition

Clinical practice guidelines, educational materials, educational meetings, educational outreach visits or academic detailing, external funding, distribution of supplies, local consensus process, other

Usual practice or waitlist control

% meeting nutrient and proportion criteria – à la carte (more is better), 1 year, observations.

No effect estimate between groups reported.

FU mean: intervention 69.2 (SD 3.7); control 23.3 (SD 7.6)

6.90 (95% CI 2.99 to 10.81)

Bremer 2018

Non‐randomised

PA

Educational meetings, educational materials

Usual practice

Quantity of PE classes score (more is better), 20 weeks, teacher survey.

FU MD: t(27) = −0.23; P = 0.82

NA

Cheung 2018

Non‐randomised

PA

Educational meeting, educational materials

Usual practice

Total PA time (before school, after school, in class, recess and PE time) (more is better), 1 year, teacher survey.

FU MD 36.3 (95% CI 16.2 to 56.4); P < 0.01

NA

Egan 2018

Non‐randomised

PA

Educational materials; Educational outreach visit or academic detailing, tailored intervention, audit and feedback

Waitlist control

Implementation score (more is better), 12 months, coded interviews with teachers.

FU MD: Mann‐Whitney U analyses 5; P = 0.04

0.78 (95% CI −0.88 to 2.44)

Sallis 1997

Non‐randomised

PA

Educational materials, educational meetings, educational outreach visits or academic detailing, length of consultation, other

Usual practice or waitlist control

Amount of PE per week (minutes) (more is better), 2.5 years, direct observation.

FU mean: intervention 64.6 (95% CI 59.0, 70.2); control 38.0 (27.9, 48.1); P < 0.001

1.10 (95% CI 0.55 to 1.64)

Gingiss 2006

Non‐randomised

Tobacco

Educational meetings, educational outreach visits, external funding, local consensus processes

Usual practice

% of schools extremely or moderately active in providing faculty or staff cessation support (more is better), 2 years, survey

No effect estimate between groups reported.

FU %: intervention 37%; control 26%

0.30 (95% CI −0.32 to 0.91)

aData analysed at the school level. bMeasure of variance not reported.

CI: confidence interval, cRCT: cluster randomised controlled trial; EPOC: Effective Practice and Organisation of Care; FU: follow‐up; LS: least squares; MD: mean difference; NA: not applicable (estimate of SMD unable to be determined, results are described narratively); n/N: number of events/sample size; OR: odds ratio, PA: physical activity; PE: physical education; RCT: randomised controlled trial; RR: risk ratio; SD: standard deviation; SE: standard error; SMD: standardised mean difference.

Figures and Tables -
Table 3. Summary of intervention, measures and absolute intervention effect size in included studies
Comparison 1. Primary outcome

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Implementation Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

1.04 [0.74, 1.34]

Figures and Tables -
Comparison 1. Primary outcome
Comparison 2. Secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Nutrition Show forest plot

11

16649

Std. Mean Difference (IV, Random, 95% CI)

0.08 [0.02, 0.15]

2.2 Physical activity Show forest plot

9

16389

Std. Mean Difference (IV, Random, 95% CI)

0.09 [‐0.02, 0.19]

2.3 Obesity Show forest plot

8

18618

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.05, 0.02]

2.4 Tobacco Show forest plot

3

3635

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.23, 0.18]

Figures and Tables -
Comparison 2. Secondary outcomes