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Table 1 Description of the components, characteristics, focus on potential mediators and executive agent of Fortaleça sua Saúde program strategies

From: Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the “Fortaleça sua Saúde” program

Component descriptions and strategies Specific focus on PA or screen time use mediatorsa Executor agent
Training and activities in general curriculum (Aim: to train and encourage teachers to discuss health topics in the classroom)
➢Training with certification focused on health topics and dynamics in the curriculum Primary: EP (teacher support and modeling) and ENV (school) √ Program members
➢Supplemental manual with proposed activities on health topics to be applied in the classroom Primary: IP (knowledge, risks/benefits, types) and ENV (school) √ Teachers
Secondary: EP (teacher support and modeling)
➢Interactive media for teachers to disseminate ideas and implementation of activities in classroom Primary: EP (teacher support and modeling) and ENV (school) √ Teachers/Program members
➢Exposition of materials (posters, murals) to disseminate health messages in school (integrated with health education) √ Primary: ENV (school) √ Teachers
Secondary: IP (knowledge, risks/benefits, types, self-efficacy) and EP (peer and teacher support and modeling)
Training and activities in PE classes (Aim: to train and encourage teachers to discuss topics on PA and health in PE classes)
➢Training with certification focused on health and active dynamics in PE classes Primary: EP (teachers support and modeling) and ENV (school) √ Program members
➢Supplemental manual with proposed activities on active and health topics to be applied in the classroom Primary: IP (knowledge, risks/benefits, types) √ Teachers/Program members
Secondary: EP (peer and teacher support, modeling) and ENV (school opportunities, school and neighborhood perceptions)
➢Production of material by students (e.g., posters, photos) to be exhibited at school, and health events (integrated with Health Education) Primary: IP (attitude, risks/benefits, types, self-efficacy) √ Teachers/Program members
Secondary: EP (peer and teacher support) and ENV (school environment opportunities, school and neighborhood perceptions)
➢Staff support during PE classes Primary: EP (teacher support and norms) and ENV (school) √ Program members
Active opportunities in the school environment (Aim: to promote structural spaces and materials in school for PA practice, reducing sedentary time and health information).
➢Two 10–15 min supervised sessions per week of dynamic activities during free-time in school Primary: IP (types), EP (peers support, norms and modeling) and ENV (school opportunities, school perception) √ Program members
Secondary: IP (knowledge, risk/benefices, self-efficacy)
➢Equipment for games (e.g., mini-courts, “Squash in Health”) with active opportunities and health messages during free-time Primary: ENV (school opportunities, school perception) and EP (peers support and modeling) √ School manager/students
Secondary: IP (risk/benefices, types, self-efficacy)
➢School equipment (balls, rackets, etc.) available to students during free-time in school Primary: ENV (school opportunities, school perceptions) and EP (peer and teacher support and modeling) √ School manager/students
➢Banners with games rules, material use guidelines and motivational and health messages (integrated with Health Education) Primary: ENV (school opportunities, school perceptions) √ School manager/Program members
Secondary: IP (knowledge, risks/benefits) and EP (social support and norms)
Health education in school community (Aim: to promote health knowledge to the school community, especially students and their families)
➢Pamphlets to students in the classroom or schoolyard: 1) PA and health; 2) screen time use and health; 3) eating behaviors Primary: IP (knowledge, attitude, types and health recommendations) √ School manager/Teachers
Secondary: EP (social and family support) and ENV (opportunities in school and home)
➢Pamphlets to parents in meetings or visits to schools: 1) PA and family; 2) screen time use and family Primary: EP (social and family support, norms and modeling) and ENV (opportunities in school and home) √ School manager/Teachers
Secondary: IP (risks/benefits, types and health recommendations)
  1. PA Physical activity, PE Physical education
  2. aPotential PA and reducing screen time mediators that are included in the Socioecological and Health Promotion School frameworks and were focused during these strategies: IP: intrapersonal mediators (e.g., knowledge, types of PA or screen time, risks and benefits, self-efficacy, perceived barriers); EP: interpersonal mediators (e.g., peers, teachers and parents modeling, support and norms); ENV: environmental mediators (e.g., family environment, school environment and environmental)