Thirsty? Choose Water! Behavioural Interventions and Water Stations in secondary schools

This study will assess the effect of two interventions designed to increase water consumption and effect changes in knowledge, attitudes or consumption of sugar sweetened beverages (SSBs) in year 7 secondary school students. Both interventions will take place in the secondary school setting. Schools recruited to the study will be randomised to one of four study arms: ARM 1 - the Thirsty Choose Water Behavioral Intervention ARM 2 - Chilled water stations, ARM 3 - the Thirsty Choose Water Behavioral Intervention and chilled water stations, or ARM 4 - Neither intervention (control arm). The first intervention is a behavioral intervention based on the Health Promoting Schools Framework. The health promoting schools framework has been well utilised in school settings to target a wide range of health issues. When using the health promoting schools framework to deliver health education all three domains of the framework must be addressed. These include promoting or delivering the health message or topic through the school curriculum, the school organisation, ethos and environment and the partnerships and service (formally families and/or communities) domain. There is good evidence that interventions utilising the Health Promoting Schools Framework have positive outcomes. A recent Cochrane systematic review demonstrated modest positive intervention effects on range of health indicators. The use of the Heath Promoting Schools framework adds strength to the Thirsty Choose Water behavioural intervention and aligns with an accepted way of working with schools. The behavioural intervention will occur over two school terms (term 3 and 4) targeting each domain of the health promoting schools framework, and will provide information about SSBs (eg SSBs sugar content, negative health effects of SSBs, physical activity required to burn off consumed SSBs etc) to increase student knowledge and awareness and promote water as a preferred drink. Within the curriculum, teaching and learning domain year students will receive the intervention in the classroom through the inclusion of messages in year 7 Personal Development, Health and Physical Activity (PDHPE) lessons. PDHPE teachers will deliver two 50 minute lessons. Project officers will liaise with teaching and immunisation staff to ensure that where possible the delivery of these lessons coincides with the delivery of the thirsty messages through the immunisation clinic (partnerships and services domain). PDHPE teachers will receive two PDHPE lesson plans and a resources pack, which were developed in consultation with PDHPE teachers. These lesson plans outline the key water messages as well as a goal based activity for students to decrease their consumption of SSBs and increase their water consumption. To support the implementation of these lesson plans within the PDHPE curriculum professional development opportunities for teaching staff will also be provided. This professional development will be face to face workshop, provided by the health promotion team, a number of who have teaching backgrounds. This professional development will be offered in term 2. The school organisation ethos and environment domain will be addressed by messaging through posters, school newsletters, school social media and other opportunities identified locally by schools to engage students and their families (potentially reaching students in other years)(term 3 and 4). The partnerships and services domain will be addressed through a partnership between schools and local immunisation teams. This provides an opportunistic avenue for the Thirsty Choose Water messages to be further targeted to year 7 students. When students attend the immunisation clinic the thirsty messages will be promoted through a number of avenues. Banners will display the thirsty messages, which include information about the sugar contents of sugar sweetened beverages, and a distractor card including the thirsty messages will be used as students receive their immunisation. Students will be given a guitar pick following their immunisation, which acts a playing marker for the “Spouts and Straws” (snakes and ladders) game. In the 10-15 minute post immunisation waiting period immunisation nurses direct students to participate in this game which introduces messages about the benefits of water consumption and the negative health effects of SSBs. This post immunisation waiting period provides an additional opportunity for students to receive the message. The guitar pick that students use as the playing marker also has the web address of the thirsty choose water website, where students can access further information http://www.healthpromotion.com.au/choosewater/More_Info.html. Whilst year 7 students attend 3 immunisation clinics over the course of the school year, the Thirsty intervention is only offered at the last immunisation clinic. Depending on the immunisation schedule for specified schools students will be provided the thirsty messages through the immunisation clinic in either term 3 or 4. Monitoring adherence to the behavioural intervention will be achieved via Project Officers regularly liaising with participating schools to gather feedback on the lesson implementation and the immunisation components, forming part of the process evaluation of the study. At the end of the study teachers and nurses will also complete feedback surveys. Web statistics can also be analysed to determine access to the website. The second intervention is the provision and installation of chilled water stations. Evidence suggests that providing water fountains and water bottles has been shown to increase water consumption in children and decrease the incidence of overweight in children. Project Officers will work closely will those schools who are receiving a chilled water station to determine the location and installation of the water station. The installation of chilled water stations will occur once baseline data has been collected. Where practical they will be installed within similar time frames. Local consultation with schools will determine the most appropriate location for the chilled water station, which has access to water, power and drainage. A remote water monitoring system will be added to record the flow of water from these chilled water stations. It is anticipated that chilled water stations will be installed in term 2 and water flow monitoring will commence at the time of installation. Each school in Arm 2 and 3 of the study will receive one chilled water station, regardless of student population, and this information will be accounted for in the analysis of the study finding. Schools will retain the chilled water station following the completion of the study, but the remote water monitoring system will be removed.