Table 2 Intervention components and outcomes of included studies (n = 11)

Al-Failakawi

(2017) [43]

Kuwait

Education: The researcher delivered six educational sessions (45 min. each) once/month about various topics related to health behaviours. The study employed a semi-structured health-related behaviours and attitudes questionnaire (HRBQ) to gather data on multiple behaviours, including physical activity, eating habits, use of medications and other drugs, tobacco smoking, and UVR exposure/sun protection. Additionally, a dietary questionnaire was developed to assess eating habits and the frequency of food intake

Anthropometrics: NS decrease in body weight measures: BMI (p = 0.6), Body fat (p = 0.603), and WC (p = 0.8)

Diet: IG had improved a range of dietary practices: breakfast/week (p = 0.04), dairy intake/day (p = 0.02), and water intake/day (p = 0.003)

Physical activity: IG had a significant increase in the total walking time during breaks (p < 0.0005), in the total time of moderate exercise/sports (p = 0.04) & in transport walking (p = 0.02). However, there was no significant interaction between groups and in time spent in moderate intensity housework (p = 0.3) or in vigorous physical activity (p = 0.2)

Sedentary behaviour: IG had less sedentary behaviour (NS) during breaks (p = 0.2) and had a significant decrease in the frequency of elevator use (p = 0.02)

Other outcomes: The IG had a significant increase in health knowledge of each topic compared to the CG (p < 0.0005)

SCT

Al-Jaaly (2017) [35]

Saudi Arabia

Education: The participants were instructed on changing their dietary and physical activity behaviours, increasing the duration and types of different physical activities, increasing consumption of fruit and vegetables, and reducing the intake of sugar-sweetened beverages

Persuasion: Changes in the perceptions of the intervention group were observed, such as the perceptions of being healthy and the importance of performing physical activity

Anthropometrics: Using the Saudi growth chart, the prevalence of overweight was (15.4% & 16.2%) & obesity (12% & 4.4%) in the public and private school, respectively. WC for 69% of girls in the private schools scored ≥ 90th percentile compared to 45% in public schools. There was a significant decrease in BMI in the intervention group (p = 0.009)

Diet: No significant differences among the IG (pre & post-intervention) in all dietary behaviours in terms of the effect of peers & families on meal size (p = 0.02), meal skip (p = 1.00), purchasing from the school canteen (p = 0.3) or following a specific diet (p = 0.2). No significant differences between the IG and the CG in all previously mentioned behaviours

Physical activity: Significant increase in self-reported physical activity outside school (p = 0.005)

Other outcomes: Not relevant to our research question

NM

Allafi (2020) [36]

Kuwait

Education: The feedback group (FB) received information about the function of the pedometer. In contrast, the feedback with rewards group (FB + R) received information about the pedometer function and was asked to achieve a milestone of 3000 step counts to earn rewards

Incentivisation: The FB + R group was rewarded with stickers for achieving the step count milestone, serving as an incentive to encourage physical activity

Coercion: Participants were randomly assigned to one of the three groups (FB, FB + R, C) to minimise bias and ensure equal distribution of participants. The study’s control group (C) received no information about the pedometer function or rewards

Training: Participants were given pedometers and were instructed to wear the pedometers throughout the physical activity sessions and to achieve a certain number of step counts

Anthropometrics: NS difference between boys and girls in the average BMI (p = 0.15)

Physical activity: The average step counts were (2091 ± 483) for CG, (2655 ± 577) for FB, and (3429 ± 458) for FB + R. Significant increase in the average step counts among FB + R compared with CG as well as among FB group compared with CG (p < 0.001)

NM

Al-Mughamisi (2021) [44]

Saudi Arabia

Training: Students conducted canteen food-scaping to identify the current provisions and assess healthfulness. Intervention-modelling workshops, using semi-structured questionnaires, were executed for stakeholders (10 students, 11 MoE and school staff) to identify the content and mode of delivery of the canteen intervention

Enablement: The study highlights the importance of developing partnerships with relevant stakeholders to assess the acceptability of the intervention and foster communication

Modelling: Students who engaged with the intervention may influence other peers to do so

Environmental restructuring: The school food environment was modified, enabling more healthful food choices

Restrictions: Restricting access to unhealthy foods was applied as part of the environmental changes

Diet: Significant increase in students who consumed healthy food options from 6 to 34% (p = 0.001), healthy drink options from 11 to 32% (p = 0.01)

SEM

Bahathig (2022) [37]

Saudi Arabia

Education: Several information sessions included discussions, educating the participants about nutrition, physical activity, and body image perception. The participants were also asked to provide self-reported data at three-time points: pre-intervention, post-intervention, and follow-up

Training: Participants were engaged in practical activities related to nutrition, physical activity, and body image perception, including matching food groups with the “Healthy Food Palm”, comparing food labels, warm-up exercises, skipping, walking, dancing using the hoop and jogging

Enablement: Various teaching aids such as PowerPoint presentations, booklets, games, papers and cards, school boards, group discussions, and stickers were used to enhance the learning experience and engage the participants in the intervention

Anthropometrics: NS difference in BAZ (p = 0.51) or WC (p > 0.7) between all pre-, post-intervention and follow-up values

Physical activity: Significant difference in physical activity between pre-intervention and post-intervention (p < 0.001), between pre-intervention and follow-up (p < 0.001), and between post-intervention and follow-up (p = 0.05)

Sedentary behaviour: Significant reduction in both screen time and the total SB on both weekdays and weekends between pre- and post-intervention & between post-intervention and follow-up (p < 0.001)

Choudhary (2018) [38]

Qatar

Education: Students were provided with regular face-to-face consultation and feedback by the school nurse and catering staff concerning food selections in the cafeteria, aimed at encouraging students to choose healthier options. Students were also educated about healthy eating habits and portion sizes through various means, including an informational DVD watched during class. Factual nutritional information and advice were provided in the campaign to increase students’ knowledge about healthy food selection. Information and recipe cards were also prepared to educate students about healthy food choices

Incentivisation: Students received stamps in a book when they chose a healthy option in the cafeteria. After obtaining a pre-specified number of stamps, students were awarded a badge to motivate and reinforce students’ healthy eating behaviours

Environmental restructuring: The school cafeteria was redesigned with colourful posters providing information about the benefits of macronutrients and the importance of consuming fruits and vegetables

Anthropometrics: NS increase in obesity (p = 0.51) and NS decrease in overweight (p = 0.15). NS change in BAZ (p = 0.22) and no change in WC (p = 0.11) or waist-to-hip ratio. As measured by bioelectrical impedance analysis, significant increase in fat mass (p = 0.003), muscle mass (p < 0.001) and fat free mass (p < 0.001). Significant increases in hip and neck circumferences (p < 0.001)

Diet: Significant decrease in intake of energy drinks (p = 0.05) and rice (p < 0.001). NS increase in fruits and vegetables’ consumption and NS decrease in eating unhealthy foods

Physical activity: Significant increase in time spent in light activity (p < 0.001) and in moderate (p = 0.031)

Sedentary behaviour: NS change in SB (p = 0.98)

NM

Elfaki (2020) [39]

Saudi Arabia

Education: Health education classes about healthy eating and physical activity were provided to the students. Messages and materials were delivered to students’ parents. The one-day counselling session, including lectures and open discussions, role-playing, games, and questions, was given to convey knowledge to all students and teachers, influence students’ attitudes and behaviours, and assess student’s knowledge and practice toward their healthy lifestyle

Training: A morning session in the form of physical exercise training was conducted before class. An individual intervention plan was prepared for overweight and obese students

Anthropometrics: NS decrease in the prevalence of obesity (p = 0.06) and no change in the prevalence of overweight among students

Diet: Significant decrease in weekly fast food intake (p < 0.001), bread intake (p = 0.01) and in the number of snacks between meals (p < 0.001). No significant difference in eating fruits and vegetables. Significant increase in consumption of water (p < 0.05) and soft drinks

Physical activity: Significant increase in walking at least 10 min/day (p < 0.001) and in moderate physical activity (p = 0.02). However, NS increase in vigorous-intensity physical activity

NM

Hefni (2017) [45]

Saudi Arabia

Education: Education and information about nutrition and obesity-related knowledge were provided to students and their parents. Monitoring and tracking behaviour changes through self-reported questionnaires were completed by students and their parents. Booklets about obesity risk and the diet plan table were prepared, educating students and their parents

Persuasion: Participants were encouraged to choose healthy foods and the importance of a balanced diet. They were promoted to regular physical activity and reduced sedentary behaviour. Participants were encouraged to consume the recommended amounts of fruits and vegetables. They were fostered for positive attitudes towards behaviour change through cultural sensitivity and tailored interventions. Relevant pictures to visualise excellent and lousy eating habits of overweight or obese, including sedentary behaviour and a sugar-dense diet

Training: Interactive session (20 min): three activities or workshops, namely healthy eating and tasting, healthy eating colouring, and healthy quizzes and games

Enablement: Parents were involved in the intervention by asking them to respond to questionnaires that validated their children’s responses

Anthropometrics: The prevalence of girls with normal weight increased and with overweight and obesity decreased. NS significant differences in the average BMI

Diet: Self-reported and parental-reported intake of unhealthy food products (fast food, soft drinks, energy drinks and snacks) decreased. Consumption of healthy food products (meat, beans or nuts, bread or cereals, vegetables, fruits and dairy products) increased

Physical activity: Significant increase in vigorous physical activity (p < 0.001)

Sedentary behaviour: The number of participants with more than 1 h per day watching TV, on the computer and playing video games decreased

SCT

Hussein (2017) [40]

United Arab of Emirates

Education: Health education sessions, awareness sessions, and competitions aiming to educate and raise students’ awareness about the importance of healthy behaviours and reinforcement of behaviour change. Families were given parents’ guidelines to handle obesity within the family environment

Training: Competitions for healthy food selection. Physicians, nurses, and nutritionists were trained on childhood obesity management guidelines. Healthcare professionals were equipped with the knowledge and skills necessary to address childhood obesity

Enablement: Different strategies were implemented based on the family’s preference. Some families chose to work with a family physician in the private sector, while others preferred to work with a school nurse and school clinic

Environmental restructuring: In the intervention, foods in the schools’ canteens were classified according to their nutrient value and labelled as healthy and unhealthy foods using different colours (green, yellow, and red)

Anthropometrics: Decrease in the prevalence of overweight in both schools (15.9% and 15.4% pre-intervention – 15.6% & 14.7% post-intervention). Decrease in the prevalence of obesity in both schools (14.4% & 14.8% pre-intervention – 13.9% & 14.2% post-intervention)

NM

Kutbi (2019) [41]

Saudi Arabia

Education: An hour of health education session was provided in the first and fifth weeks. 5–10 min presentations about a task related to a healthy diet were conducted in the third and seventh weeks. Group counselling was delivered in the second and sixth weeks. The presentations prepared by the students were discussed in the fourth and eighth weeks

Anthropometrics: NS difference in BMI (p = 0.15), in body fat percentage (p = 0.16) and in fat mass (p = 0.19), as measured by Tanita BC 418 segmental body composition analyser

Diet: NS increase in daily consumption of vegetables (from 22.9% to 24.3%) and fruits (from 8.7% to 15.7%) and decrease in the intake of milk (from 37.7% to 27.1%)

Physical activity: NS increase among the IG in the total METs between pre (2098.41 ± 1922.67) and post-intervention (2497.95 ± 2291.13). NS difference in total METs between the IG and the CG (2556.27 ± 2048.71). Among the IG, NS increase in the percentage of students who met the recommended > 1680 METs- min/week (from 47.1% up to 54.3%)

Sedentary behaviour: NS difference between the IG and the CG in the time for watching TV (p = 0.58), computer use (p = 0.17), total screen time (p = 0.44) and sleeping time (p = 0.69)

SCT

Shama & Abdou (2009) [42] 

Oman

The specific behavioural change techniques or procedures used in the study are not mentioned explicitly in the provided context. However, multiple interventions assumed to be conducted in the health-promoting school (HPS) initiative, such as:

Education: Health education on various topics related to physical activity, sedentary behaviours, and dietary nutrition was provided to the study’s participants

Enablement: Community partnership with the HPS. Psychological support

Environmental restructuring: School nutrition service and school physical environment

Anthropometrics: Significant decrease in the prevalence of underweight and obesity while increase in the prevalence of overweight male students in the HPS, and NS difference in weight measurements among female students in the HPS and the CS

Diet: NS increase in male and female students having breakfast 6–7 times/week. Significant increase in vegetable intake among girls at HPS (p < 0.05). NS decrease in consumption of fast food and soft drinks among male students in HPS, no difference between female students in HPS and CS in consumption of fast food and soft drinks

NM