{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:15:18Z","timestamp":1783998918993,"version":"3.55.0"},"reference-count":40,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/501100011318","name":"Fondation Botnar","doi-asserted-by":"publisher","award":["REG-19-015"],"award-info":[{"award-number":["REG-19-015"]}],"id":[{"id":"10.13039\/501100011318","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,14]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Comprehensive local data on adolescent health are often lacking, particularly in lower resource settings. Furthermore, there are knowledge gaps around which interventions are effective to support healthy behaviours. This study generates health information for students from cities in four middle-income countries to plan, implement and subsequently evaluate a package of interventions to improve health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We will conduct a cluster randomised controlled trial in schools in Fez, Morocco; Jaipur, India; Saint Catherine Parish, Jamaica; and Sekondi-Takoradi, Ghana. In each city, approximately 30 schools will be randomly selected and assigned to the control or intervention arm. Baseline data collection includes three components. First, a Global School Health Policies and Practices Survey (G-SHPPS) to be completed by principals of all selected schools. Second, a Global School-based Student Health Survey (GSHS) to be administered to a target sample of n=3153 13\u201317\u2009years old students of randomly selected classes of these schools, including questions on alcohol, tobacco and drug use, diet, hygiene, mental health, physical activity, protective factors, sexual behaviours, violence and injury. Third, a study validating the GSHS physical activity questions against wrist-worn accelerometry in one randomly selected class in each control school (n approximately 300 students per city). Intervention schools will develop a suite of interventions using a participatory approach driven by students and involving parents\/guardians, teachers and community stakeholders. Interventions will aim to change existing structures and policies at schools to positively influence students\u2019 behaviour, using the collected data and guided by the framework for\n                      <jats:italic>Making Every School a Health Promoting School<\/jats:italic>\n                      . Outcomes will be assessed for differential change after a 2-year follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by WHO\u2019s Research Ethics Review Committee; by the Jodhpur School of Public Health\u2019s Institutional Review Board for Jaipur, India; by the Noguchi Memorial Institute for Medical Research Institutional Review Board for Sekondi-Takoradi, Ghana; by the Ministry of Health and Wellness\u2019 Advisory Panel on Ethics and Medico-Legal Affairs for St Catherine Parish, Jamaica, and by the Comit\u00e9 d\u2019\u00e9thique pour la recherche biom\u00e9dicale of the Universit\u00e9 Mohammed V of Rabat for Fez, Morocco. Findings will be shared through open access publications and conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04963426\">NCT04963426<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-071353","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T16:44:11Z","timestamp":1688575451000},"page":"e071353","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Effectiveness of a participatory approach to develop school health interventions in four low resource cities: study protocol of the \u2018empowering adolescents to lead change using health data\u2019 cluster randomised controlled trial"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04963426","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3073-6468","authenticated-orcid":false,"given":"Regina","family":"Guthold","sequence":"first","affiliation":[{"name":"Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Kann","sequence":"additional","affiliation":[{"name":"Noncommunicable Diseases Department, WHO, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubna","family":"Bhatti","sequence":"additional","affiliation":[{"name":"Noncommunicable Diseases Department, WHO, Geneva, 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