Testing an adapted obesity prevention intervention in under resourced schools: a pilot clustered randomized controlled trial

The purpose of this pilot study was to test an adapted childhood obesity prevention intervention called Preventing Obesity Using Digital-Assisted Movement and Eating (ProudMe) in under-resourced schools. Six schools were cluster-randomized to ProudMe (n = 33; at three schools) or waitlist control (n = 46; at three schools) conditions. ProudMe aimed to improve participants' health behaviors and weight status through interventions in the school cafeteria (i.e., ProudMe Cafeteria), physical education (PE) (i.e., ProudMe PE), and through artificial-intelligence- (AI-) assisted behavioral counseling (i.e., ProudMe Tech), and staff professional development (i.e., ProudMe PD). Two implementation outcomes including penetration and fidelity were captured through mixed methods. We drew upon the Consolidated Framework for Implementation Research (CFIR) to identify facilitators and barriers underlying implementation. The intervention only resulted in highly positive implementation outcomes in the cafeterias, which subsequently resulted in improved cafeteria scores. Implementation outcomes were less desirable in ProudMe PE with moderate penetration and fidelity. ProudMe PD was well attended but ProudMe Tech was under-utilized. The pilot intervention as a whole did not show significant effects on student-level outcomes (p > 0.05). Multiple facilitators and barriers across CFIR domains emerged as influential factors for the pilot intervention's implementation and preliminary effectiveness. This study generated mixed evidence concerning the ProudMe intervention. The lessons learned inform future intervention refinement.