Strong and Healthy in Primary School Klasse2000 Program, Germany: A Program Impact Pathways (PIP) Analysis

Abstract

Background Developing a Program Impact Pathways (PIP) diagram helps identify and clarify the key objectives, processes, activities, and evaluation indicators of school-based nutrition programs. The Mondelēz International Foundation has recently supported the development of PIP analyses for programs in seven countries around the world. The results were shared with other project organizers at a Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13–14 September 2013, under the auspices of the Mondelēz International Foundation. Objective The objectives were to develop the PIP assessment of the Strong and Healthy in Primary School Klasse2000 Program in order to refine the primary, secondary, and tertiary objectives of the program; identify Critical Quality Control Points (CCPs); and identify core indicators of the program's impact on healthy lifestyles. Methods The PIP report was developed based on detailed instructions provided prior to the workshop, taking into account the Klasse2000 Program evaluation reports. Results The following CCPs were identified: monitoring the qualifications and motivation of teaching staff (external health promoters and schoolteachers); assessing involvement of the students' environmental influences, including families, schools, and sponsors; and assessing the children's healthy lifestyle knowledge, attitudes, and behaviors before and after program exposure. The healthy lifestyle indicators identified were children's knowledge of healthy diets and health-enhancing physical activities; the availability of healthy breakfast and snacks; the frequency of consumption of fruits, vegetables, sweetened and unsweetened drinks, fast food, and sweets, as well as attitudes toward physical activity; and the frequency and extent of physical activity in school and during free time. Body mass index (BMI) was identified as the final outcome indicator. Conclusions Developing a PIP report helped to focus the objectives of the program. Identifying CCPs helped draw attention to the processes linking critical program activities. As a result, plans for the upcoming school year include conducting a PIP-informed survey of participating parents and children to gauge their satisfaction with the program.