Summary of intervention, measures, and absolute intervention effect size in included studies
| Study | Targeted risk factor | Implementation strategies | Comparison | Primary implementation outcome and measures |
Effect size | Number of measures with significant result (p < .05) favoring the intervention |
|---|---|---|---|---|---|---|
| Alaimo et al. [43] | N | Clinical practice guidelines, educational materials, educational outreach visits or academic detailing, external funding, local consensus processes, tailored interventions | Usual practice or waitlist control |
Continuous: Nutrition policy score and nutrition education and/or practice score (two measures) |
Median (range): 0.65 (0.2 to 1.1) |
0/2 |
| Cunningham- Sabo et al. [44] |
N | Clinical practice guidelines, educational materials, educational meetings, educational outreach visits or academic detailing | Usual practice | Continuous: Nutrient content of school meals % of calories from fat breakfast/lunch (two measures) |
Median (range): −3% (−3.3% to −2.7%) |
1/2 |
| Delk et al. [46] | PA | Local consensus process, educational meetings, clinical practice guidelines, educational outreach visits or academic detailing, tailored interventions, other | Different implementation strategy |
Continuous: % of teachers that conducted activity breaks weekly (one measure, two comparisons) Dichotomous: % implementing a variety of policies and practices (two measures, four comparisons) |
Median (range): 13.3% (11.1% to 15.4%) Median (range): 26.5% (19.4% to 31.9%) |
6/6 |
| French et al. [47] | N | Local consensus processes, tailored intervention, educational meetings, pay for performance |
Usual practice or waitlist control |
Continuous % of program implementation (five measures) |
Median (range): 33% (11% to 41%) |
5/5 |
| Heath and Coleman [48] | N | Educational materials, educational meetings, educational outreach visits or academic detailing | Usual practice | Continuous: % fat in school meal (two measures) Sodium of school meals (two measures) |
Median (range): −1.7% (−4.4% to 1%) Median (range): −29.5 (−48 to −11) |
1/4 |
| Hoelscher et al. [49] |
N/PA | Educational materials, educational meetings, educational outreach visits or academic detailing, pay for performance, other, the use of information and communication technology, local consensus process | Different implementation strategy |
Continuous: Mean number of lessons/or activities (five measures) Dichotomous: % implementing a variety of policies and practices (two measures) |
Median (range): 0.8 (−0.4 to 1. 2) Median (range): 4.4% (3.6% to 5.2%) |
4/7 |
| Lytle et al. [50] | N | Educational materials, educational meetings, local opinion leaders, local consensus processes | Usual practice or waitlist control |
Dichotomous: % of schools offering or selling targeted foods (four measures) |
Median (range): 8.5% (4% to 12%) |
2/4 |
| Mobley et al. [51] | N | 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 |
Dichotomous: % schools meeting various nutrition goals (12 measures) |
Median (range): 15.5% (0% to 88%) |
NR |
| Nathan et al. [52] | N | 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 |
Dichotomous: % Schools implementing a vegetable and fruit break (one measure) |
Mean difference (95% CI): 16.2% (5.6% to 26.8%) |
1/1 |
| Nathan et al. [53] | N | Audit and feedback, continuous quality improvement, education materials, education meeting, local consensus process, local opinion leader, tailored intervention, other | Usual practice | Dichotomous: % implementing a variety of policies and practices (two measures) |
Median (range): 35.5% (30.0% to 41.1%) |
2/2 |
| Naylor et al. [54] | PA | Educational materials, educational meetings, educational outreach meetings or academic detailing, local consensus process, other, tailored interventions | Usual practice or waitlist control |
Continuous: Minutes per week of physical activity implemented in the classroom (one measure, two comparisons) |
Median (range): 54.9 min (46.4 to 63.4) |
2/2 |
| Perry et al. [56] | N/PA | Educational materials, educational meetings, educational outreach visits or academic detailing, other | Usual practice or waitlist control |
Continuous: % of kilocalories from fat in school lunch (one measure) Mean milligrams of sodium in lunches (one measure) Cholesterol milligrams in lunches (one measure) Quality of PE lesson % of seven activities observed (one measure) |
Mean difference (95%CI): −4.3% (−5.8% to −2.8%) Mean difference (95% CI): −100.5 (−167.6 to −33.4) Mean difference (95% CI): −8.3 (−16.7 to 0.1) Mean difference (95% CI): 14.3% (11.6% to 17.0%) |
3/4 |
| Perry et al. [55] | N | Educational meetings, educational outreach visits or academic detailing, educational materials, local consensus processes, other | Usual practice or waitlist control |
Continuous: % of program implementation (two measures) Mean number of fruit and vegetables available (two measures) |
Median (range): 14% (−2% to 30%) Median (range): 0.64 (0.48 to 0.80) |
2/4 |
| Sallis et al. [57] | PA | Educational materials, educational meetings, educational outreach visits or academic detailing, length of consultation, other | Usual practice or waitlist control |
Continuous: Duration (minutes) per week of physical education lessons (one measure) Frequency (per week) of physical education lessons (one measures) |
Mean difference (95% CI): 26.6 (15.3 to 37.9) Mean difference (95% CI): 0.8 (0.3 to 1.3) |
2/2 |
| Saunders et al. [66] | PA | Educational materials, educational meetings, educational outreach visits or academic detailing, local consensus processes, local opinion leaders, other | Usual practice or waitlist control |
Continuous: School level policy and practice related to physical activity (nine measures) |
N/A | NR |
| Simons- Morton et al. [59] |
N | Educational materials, educational outreach visits or academic detailing, local consensus processes, local opinion leaders, managerial supervision, monitoring of performance, other | Usual practice | Continuous: Macronutrient content of school meals (two measures) |
N/A | NR |
| Story et al. [58] | N | Educational meetings, other | Usual practice | Continuous: Mean number of fruit and vegetables available (two measures) % of guidelines implemented and % of promotions held (four measures) |
Median (range): 1.15 (1 to 1.3) Median (range): 38.4% (28.5% to 43.8%) |
6/6 |
| Sutherland et al. [60] | PA | Audit and feedback, education materials, education meeting, education outreach visits or academic detailing, local opinion leader, other | Usual practice or waitlist control |
Dichotomous: % implementing a variety of policies and practices (two measures) Continuous: Physical education lesson quality score (one measures) % of program implementation (four measures) |
Median (range): 19% (16% to 22%) Mean difference: 21.5 Median (range): −8% (−18% to 2%) |
0/2 1/1 0/4 |
| Whatley Blum et al. [61] | N | 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 |
Continuous: % of food and beverage items meeting guideline nutrient and portion criteria (six measures) |
Median (range): 42.95% (15.7% to 60.6%) |
5/6 |
| Wolfenden et al. [62] | N | 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 | Dichotomous: % implementing a variety of policies and practices (two measures) |
Median (range): 66.6% (60.5% to 72.6%) |
2/2 |
| Yoong et al. [63] | N | Audit and feedback, continuous quality improvement, education materials, tailored intervention | Usual practice | Dichotomous: % implementing a variety of policies and practices (two measures) |
Median (range): 21.6% (15.6% to 27.5%) |
0/2 |
| Young et al. [64] | PA | Education materials, education meetings, educational outreach visits or academic detailing, interprofessional education, local consensus processes, local opinion leaders | Usual practice | Dichotomous: % implementing a variety of policies and practices (seven measures) Continuous: Average number of physical activity programs taught (one measure) |
Median (range): 9.3% (−6.8% to 55.5%) Effect size (95% CI): 5.1 (−0.4 to 10.6) |
1/8 |
| New studies identified in this review | ||||||
| Bremer et al. [26] | PA | Educational meetings, educational materials | Usual practice | Continuous: Quantity of physical education lessons (one measure) |
Mean difference: t(27) = −0.23, |
0/1 |
| Cheung et al. [38] | PA | Educational meeting, educational materials | Usual practice | Continuous: Mean minutes of physical activity offered per week (three measures) |
Median (range): 5.7 (−2.4 to 13) |
NR |
| Egan et al. [39] |
PA | Educational materials; educational outreach visit or academic detailing, tailored intervention, audit, and feedback | Alternate intervention or usual practice | Continuous:Mean implementation score for components of movement integration (five measures) | Median (range): −2.79 (−4.92 to 3.66) |
NR |
| Evenhuis et al. [40] | N | Educational materials, educational meeting, audit with feedback, educational outreach visit or academic detailing | Educational materials | Continuous: Availability of healthier food products on display (one measure) Healthier product accessibility (one measure) |
Mean difference: 16.79 Mean difference: 9 |
NR |
| Farmer et al. [41] | PA | Incentives, local consensus approach, tailored interventions | Usual practice | Dichotomous: % implementing a variety of policies and practices (one measure) Continuous: Provision of play opportunities (one measure) |
Mean difference (95% CI): −0.20 (−11.46 to 11.06) Mean difference (95% CI): 4.50 (1.82 to 7.18) |
0/1 1/1 |
| Nathan, unpublished data | PA | Educational outreach visits, centralized technical support, mandate change, identify and prepare champions, provide ongoing consultation, educational material | Usual practice | Continuous: Mean minutes of teacher’s scheduled PA per day |
Mean difference (95% CI): 36.60 (2.68 to 70.51) | 1/1 |
| Taylor et al. [42] | N | Incentives, educational materials, educational outreach visits, or academic detailing | Usual practice or waitlist control |
Continuous: Quantity of fruit and vegetables available (two measures) |
Median (range): 1.23 (−0.79 to 3.26) |
NR |
| Waters et al. [27] | N/PA | Educational materials, educational outreach visits or academic detailing; local consensus approach, tailored interventions | Usual practice | Dichotomous: % implementing a variety of policies and practices (three measures) |
Median (range): 7% (−11.7% to 15%) |
NR |
CI confidence interval; N nutrition; NR not reported; PA physical activity.