Promoting water consumption among children through a social network intervention: a cluster randomized controlled trial on a Caribbean island

Abstract Aim This study examined the effect of the evidence-based adapted social network intervention named Kies Awa (translation: Choose Water ) on children’s water and sugar-sweetened beverages (SSB) consumption. It also examined the moderating role of children’s descriptive and injunctive norms of water and SSB consumption on the intervention’s effect. Subject and methods We conducted a cluster randomized control trial (RCT) where schools were randomized to one of two clusters: the intervention group (IG; Kies Awa intervention; 156 participants; M = 11.08, SD = 1.00; 53.8% girls) or the control group (CG; no intervention; 144 participants; M = 11.32, SD = 0.96; 52.8% girls). The primary outcome measure was water consumption and the secondary outcome was SSB consumption. Results Linear mixed modeling analyses showed that water consumption increased significantly more among IG participants than in the CG ( β = 0.141; p = 0.015). The effect on SSB consumption was moderated by perceived injunctive norms, which refer to social disapproval of consuming SSBs. Specifically, the intervention reduced SSB consumption for participants reporting high levels of injunctive norms ( β = -0.052; p = 0.037). Conclusion These findings suggest that Kies Awa , an evidence-based adapted intervention, could be implemented in other Caribbean islands to improve children’s water consumption. This approach could be integrated into school health programs, contributing to public health. These findings may help achieve the United Nations’ goal of ensuring healthy lives for all children, even in under-researched world regions. Clinical Trial Registration: Main ID number: NL-OMON26157, preregistration date 2018-12-20. https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26157 .