title: The Healthy Primary School of the Future: study protocol of a quasi-experimental study.
abstract: Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined.
  
  
  
  In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019.
  
  
  
  A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society.
  
  
  
  The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 .
authors.affiliation: Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Willeboordse
authors.affiliation: Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands. maria.jansen@ggdzl.nl.|Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands. maria.jansen@ggdzl.nl.
authors.forename: M W
authors.initials: MW
authors.lastname: Jansen
authors.affiliation: Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: S N
authors.initials: SN
authors.lastname: van den Heijkant
authors.affiliation: MOVARE Educational board, Kerkrade, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Simons
authors.affiliation: Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Welten Institute - Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands.|School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
authors.forename: R H M
authors.initials: RH
authors.lastname: de Groot
authors.affiliation: Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands.|Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Bartelink
authors.affiliation: Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands.
authors.forename: S P
authors.initials: SP
authors.lastname: Kremers
authors.affiliation: Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: van Assema
authors.affiliation: Department of Human Movement Sciences, NUTRIM, Maastricht University, Maastricht, The Netherlands.
authors.forename: H H
authors.initials: HH
authors.lastname: Savelberg
authors.affiliation: School of Business and Economics, Maastricht University, Maastricht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: de Neubourg
authors.affiliation: School of Business and Economics, Maastricht University, Maastricht, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Borghans
authors.affiliation: School of Business and Economics, Maastricht University, Maastricht, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Schils
authors.affiliation: School of Business and Economics, Maastricht University, Maastricht, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Coppens
authors.affiliation: Department of Law, Maastricht University, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Dietvorst
authors.affiliation: Department of Law, Maastricht University, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Ten Hoopen
authors.affiliation: Department of Law, Maastricht University, Maastricht, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Coomans
authors.affiliation: Department of Law, Maastricht University, Maastricht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Klosse
authors.affiliation: Academic Hospital Maastricht, Treatment and Care Unit, Maastricht, The Netherlands.
authors.forename: M H J
authors.initials: MH
authors.lastname: Conjaerts
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Oosterhoff
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Joore
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands.|School of Public Health, The University of Queensland, Herston, Brisbane, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Ferreira
authors.affiliation: Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Muris
authors.affiliation: Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Bosma
authors.affiliation: Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: H L
authors.initials: HL
authors.lastname: Toppenberg
authors.affiliation: Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
mesh_terms: D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003479:Curriculum; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D008019:Life Style; D008297:Male; D009426:Netherlands; D065228:Non-Randomized Controlled Trials as Topic; D015397:Program Evaluation / Q000191:economics / Q000379:methods*; D012572:School Health Services; D012574:Schools
keywords: Academic Achievement; Accelerometer; Children; Nutrition; Obesity; Physical activity; Prevention; Primary school Intervention; School health