[Do German nutrition interventions for children and adolescents meet quality criteria for program planning and evaluation? - Results of a survey of institutions at state and regional levels].
OBJECTIVE
The international literature describes comprehensive nutrition interventions for children and adolescents, and gives recommendations for successful program planning. For Germany, only few studies on these issues are available, and there is a particular scarcity of data on implementation, acceptance and effectiveness of nutrition interventions. Thus the aim of this study was to record nutrition interventions at state and regional levels in Germany, and to assess their project design and evaluation quality. On the basis of these data, conclusions about implementation, acceptance and effectiveness of interventions are made.


METHODS
Quality indicators for project design, process and outcome evaluation were developed according to international literature and related quality assurance models. State ministries, public health departments, non-governmental institutions for health at state level and "Healthy Cities" (n=105) were surveyed about their nutrition interventions for children and adolescents including evaluation with a standardised questionnaire. The interventions were assessed using the developed quality criteria.


RESULTS
The response rate was 70.5%. 42 primary preventive nutrition interventions were recorded. The quality criteria for program planning were only partly fulfilled. Encouraging results were, among others, that 54.8% of the projects combined behaviourally focused and environment focused criterions, 90.5% started in kindergarten or primary school, 88.1% involved parents, 85.7% cooperated with other institutions and 73.8% integrated nutrition specialists. 77.8% of the projects conducted a process evaluation (n=28), 60.7% of those had a good evaluation quality. Changing the environmental context proved to be the greatest challenge. The projects were well accepted by the target group. An outcome evaluation was conducted by 61.1% of the projects (n=22), 27.2% of those evaluations had a (very) good quality. Among these projects, 3 could improve nutrition knowledge, 3 environmental context and 3 nutrition behaviour. Improvements of medical parameters have not been recorded.


CONCLUSIONS
In Germany, a high number of nutrition interventions for children and adolescents is being conducted. However, only five quality indicators were fulfilled by more than 75% of the projects. Because of inadequate evaluation quality, only little evidence for implementation, acceptance, and effectiveness could be found. More evaluation studies are needed to more successfully plan, implement and assess future interventions.
Eichhorn
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C
Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth. christine.eichhorn@unibayreuth.de
Loss
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J
Nagel
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E
D000293:Adolescent; D001521:Behavior Therapy; D002648:Child; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000517:prevention & control*; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006287:Health Planning Guidelines; D006306:Health Surveys; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education; D010348:Patient Care Team / Q000592:standards; D011322:Primary Prevention / Q000458:organization & administration; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012931:Social Environment