Protocol for Afterschool Rx 2.0: A pilot randomized crossover trial to determine the feasibility of prescriptions to afterschool care for children with cardiovascular risk factors

Background: CVD risk factors in childhood, including obesity and hypertension, can be mitigated with physical activity and a healthy diet. Existing community-based afterschool programs provide an important opportunity to increase physical activity and improve cardiovascular health, but access remains limited for many families. The Afterschool Rx program enables healthcare providers to prescribe free afterschool care for children with CVD risk factors from families at or below 250% of the federal poverty level. Methods: This study will employ an ORBIT Phase IIb randomized crossover design to conduct a preliminary trial of Afterschool Rx. Participating children (ages 5–11 years; n = 48) will be randomly assigned to receive a voucher for afterschool care at existing community-based programs (e.g., YMCA, Boys & Girls Clubs) along with enrollment assistance, in either the fall or spring semester, with the opposite semester serving as the comparison period (treatment as usual). Primary outcomes will examine the reach and potential for dissemination of the program using the PRISM/RE-AIM framework. Exploratory outcomes include health behaviors (e.g., physical activity, sedentary behavior, sleep, screen use, and diet quality) and cardiovascular health indicators (e.g., cardiorespiratory fitness, blood glucose, blood pressure, HbA1c, and cholesterol levels). Exploratory analyses will examine within-person differences in change between semesters. Discussion: This study will be the first randomized controlled trial to evaluate the reach and feasibility of disseminating afterschool care prescriptions as a clinical strategy for addressing cardiovascular risk factors. Results will inform further testing and development of the Afterschool Rx intervention.