Improving nutrition and physical activity policies in afterschool programs: Results from a group-randomized controlled trial

INTRODUCTION: Little is known about wellness policies in afterschool programs, an influential setting for children. We measured the comprehensiveness of policies regarding nutrition, physical activity, and screen time in afterschool programs and assessed the impact of the Out of School Nutrition and Physical Activity (OSNAP) intervention on policy content. METHODS: Twenty afterschool programs in Boston, MA participated in a randomized, controlled trial. Over a school year, intervention programs participated in three learning collaboratives focused on practice and policy change to promote a healthy nutrition, physical activity, and screen time environment. Participating program staff set policy goals and developed policy-writing skills. The Out-of-School Time (OST) Policy Assessment Index was developed to evaluate policies by comparing them to existing nutrition, physical activity, and screen time standards. The inter-rater reliability and construct validity of the measure were assessed. The impact of the intervention on policies was evaluated using linear regression models. RESULTS: The OST Policy Assessment Index demonstrated moderate to excellent inter-rater reliability (Spearman's r=0.53 to 0.97) and construct validity across all domains. The intervention was associated with significant increases in program policy statements meeting standards surrounding snacks (+2.6, p=0.003), beverages (+2.3, p=0.008), screen time (+0.8, p=0.046), family communication (+2.2, p=0.002), and the OSNAP Standards (+3.3, p=0.02). DISCUSSION: The OSNAP intervention demonstrated success in engaging afterschool program staff in improving their program policies to support a healthy nutrition, physical activity, and screen time environment. Future research should focus on policy sustainability and determining the relationship between policies and the practices they specify.