Mike: Hello, I’m Mike Clarke podcast editor for the Cochrane Library.Helping young people develop a healthy lifestyle could have long term implications for their health and wellbeing. In this podcast, Mia Parkinson, Cochrane Communications Officer, talks with Daniel Lee from the University of Newcastle in Callaghan, Australia, about the December 2024 update of the Cochrane review of ways to enhance the implementation of school-based policies or practices to improve diet and physical activity and reduce obesity, and the use of tobacco and alcohol.

Mia: Thanks Mike. Today, we’ll delve into what works - and what doesn’t - for increasing the implementation of those school-based policies and practices, based on the comprehensive review of 39 studies conducted by Daniel and his team. Welcome, Daniel!

Daniel: Hi Mia, and thank you for having me.

Mia: To begin, we know that childhood is a critical period for forming lifelong healthy habits and that these habits often persist into adulthood. So, Daniel, could you give us an overview of how school-based policies and practices might support this?

Daniel: Of course. There are a variety of ways in which schools can promote student health. These might focus on a singular practice, such as school canteen policies to ensure that the foods and drinks they provide are healthier, or on multiple practices. For instance, some programs aim to educate students about healthy behaviours while also creating opportunities to practice them. This might include incorporating active breaks into class time or ensuring recess activities encourage physical movement.

Mia: That’s a broad and promising aim but these policies and practices aren’t always implemented as intended, are they? Why is that?

Daniel: You’re absolutely correct that there is a problem with getting these things implemented. Research has consistently shown low compliance rates, with some studies finding that fewer than 10% of schools meet legislative or policy guidelines on healthy food promotion. It’s similar for physical activity and tobacco-use guidelines. Therefore, we wanted to identify and evaluate strategies that can bridge this gap and improve the implementation of these evidence-based practices.

Interviewer: That’s clearly important. Can you elaborate on these strategies and how they might help with implementation?

Daniel: Certainly. They can act as a link between research and what might be called real-world application. Some of the most commonly employed strategies in our review were disseminating educational materials, organising educational workshops, and conducting outreach visits to schools.

Mia: What impact was there on implementation?

Daniel: Overall, our findings suggest that these strategies probably do lead to a substantial increase in implementation rates. For instance, one measure indicated that the use of these strategies increased the implementation of one out of seven intervention components, when compared to no such strategy. While this may seem modest, it’s a meaningful advance when scaled to the population level, where such changes can yield significant public health benefits.

Mia: That’s encouraging. What about negative outcomes, though? Did your review identify any problems or assess the costs associated with implementing the strategies?

Daniel: Yes, we looked at both potential negative outcomes and costs. However, out of the 39 studies, only 11 examined negative outcomes, but none of these reported any negative effects. Regarding costs, the findings were inconclusive and we were only able to use data from nine studies.

Mia: It’s reassuring to hear that the positive impacts aren’t accompanied by clear drawbacks. Let’s move to the key takeaways.

Daniel: Certainly. Our findings provide important information to help policy makers use effective strategies to improve the adoption of evidence-based policies and practices in schools. However, there is also an important message for researchers in that our findings highlight gaps in the evidence. We need more studies that evaluate individual strategies, assess negative outcomes, and provide a better understanding of the costs involved. In the hope of those new studies getting done, we’re transitioning the review into a living systematic review. We’ll run monthly searches for new studies and conduct regular updates to incorporate new evidence that would significantly alter our conclusions or confidence in the evidence. This approach ensures that our review remains a dynamic and up-to-date resource for researchers and decision-makers.

Mia: That’s excellent! Finally, how can listeners access the review and stay updated on the latest evidence?

Daniel: The review is available on the Cochrane Library website and a simple search for “implementation of school-based strategies” will show a link to it.

Mia: Thank you, Daniel, for sharing these valuable insights and for your team’s ongoing contribution to this field.

Daniel: Thanks Mia and thanks to you for giving me this opportunity to talk about our review.