Evaluating a School Community Intervention Health Programme: Grounding Evaluation Models in Context.
Author(s):
Conference:
ECER 2015
Format:
Poster

Session Information

08 SES 02 B PS, Visual Dialogue on Health Education Research

Interactive Poster Session

Time:
2015-09-08
15:15-16:45
Room:
107.Oktatóterem [C]
Chair:

Contribution

Previous research has highlighted the importance of positive physical activity (PA) behaviors during childhood to promote sustained active lifestyles throughout the lifespan (Doolittle & Rukavina, 2014; Telama et al., 2005; 2014). It is in this context that the role of schools and teachers in facilitating PA education is promoted. Research suggests that teachers play an important role in the attitudes of children towards PA (Figley 1985) and schools may be an efficient vehicle for PA provision and promotion (McGinnis, Kanner and DeGraw, 1991; Wechsler, Deveraux, Davis and Collins, 2000). Yet despite consensus that schools represent an ideal setting from which to ‘reach’ young people (Department of Health and Human Services, UK, 2012) there remains conceptual  and methodological ambiguity regarding the mechanisms of change claimed by school based PA intervention programmes. This may, in part, contribute to research findings that suggest that PA interventions have had limited impact on children’s overall activity levels and thereby limited impact in improving children’s metabolic health (Metcalf, Henley & Wilkin, 2012).

Despite long standing public policy and pedagogical models that have aligned physical education curricula with positive PA behaviors, recent research has moved beyond schools as “walled in” institutions (Lawson, 2012), to address the multiple spaces in which young people learn about health and PA. This change, in part, maybe the result of a narrow focus of PA behavioural change outcomes wihch fails to acknowledge the impact of a wider context in influencing health outcomes (Golden & Earp, 2011). This is particularly relevant for school based interventions which has seen a shift  from theoretical models emphasising individual motivational readiness, to a social-ecological model which places a greater importance on the myriad social, physical, and policy environments that influence sustained positive behavior change (Buchan, Ollis, Thomas, & Baker, 2012; Owen, Leslie, Salmon and Fotheringham, 2000; Sallis and Owen, 2004). The interrelationship between these impacting variables acknowledges the connections between the school and the local community in facilitating PA behavioral change. 

In this study, a socio-ecological framework was used to evaluate a multi-agency approach to a PA intervention programme which aimed to increase physical activity, and awareness of the importance of PAto key stage 2 (age 7-12) pupils in three UK primary schools. The agencies involved in the programme administration and intervention design were the local health authority, a community based charitable organisation, a local health administrative agency, and the city school district. In examining the impact of the intervention, we adopted both a process evaluation model (Baranowski & Jago, 2005) and Logic Model (W.K. Kellogg Foundation, 2001) in order to better understand the mechanisms and context that facilitated change. Therefore, the aim of this evaluation was to describe the provision, process and impact of the intervention by addressing two fundamental questions: 1) what are the causal relationships between programme and outcomes, and 2) in what way do situational factors interact with the programme and how do these interactions impact outcomes. 

Method

Evaluation of the intervention was designed as a matched-control study and was undertaken over a seven-month period. The school-based intervention involved 3 intervention schools (n =436; 224 boys) and one control school (n=123; 70 boys) in a low socioeconomic and multicultural urban setting. The PA intervention was separated into two phases: a motivation DVD and 10 days of circuit based exercise sessions (Phase 1) followed by a maintenance phase (Phase 2) that incorporated a PA reward program and the use of specialist kid’s gym equipment located at each school for a period of 4 wk. Outcome measures were measured at baseline (January) and endpoint (July; end of academic school year) using reliable and valid self-report measures. The children’s attitudes towards PA were assessed using the Children’s Attitudes towards Physical Activity (CATPA) questionnaire. The Physical Activity Questionnaire for Children (PAQ-C), a 7-day recall questionnaire, was used to assess PA levels over a school week. A standardised test battery (Fitnessgram®) was used to assess cardiovascular fitness, body composition, muscular strength and endurance, and flexibility. After the Phase 2, similar kid’s equipment was available for general access at local community facilities. The control school did not receive any of the interventions. All physical fitness tests and PA questionnaires were administered and collected prior to the start of the intervention (January) and following the intervention period (July) by an independent evaluation team. Evaluation testing took place at the individual schools over 2-3 consecutive days (depending on the number of children to be tested at the school). Staff (n=19) and student perceptions (n = 436) of the child sized fitness equipment were assessed via questionnaires post-intervention. Students completed a questionnaire to assess enjoyment, usage, ease of use and equipment assess and usage in the community. Qualitative assessment was performed to consider the fidelity of the programme in terms of process, context and implementation. A questionnaire assessed staff perceptions on the delivery of the exercise sessions, classroom engagement and student perceptions. Telephone interviews were conducted with key stakeholders charged with design and delivery of the programme to discuss overall programme administration, funding, resourcing, and school-community interactions.

Expected Outcomes

Findings showed that both the intervention and control group had an increase in mean height, body mass, BMI, and PAQ-C at follow-up compared to baseline (p < 0.05); there was a significant increase in the mean BMI percentile thresholds (UK 1990 Growth reference charts) in the control boys (3.6%; p = 0.035) and girls (3.4%; p = 0.039). No significant improvement was observed in the intervention group in physical fitness, except for trunk strength/flexibility (p < 0.001). At post-intervention, there was a 6% decline in the intervention girls’ attitudes toward PA in the aesthetic sub domains (p = 0.009); whereas the control boys had an increase in positive attitudes in the health domain (p = 0.003). No significant differences in attitudes towards PA were observed in any other domain for either group at post-intervention (p > 0.05). Ninety six percent of the children stated they enjoyed using the equipment; however at post-intervention only 27% reported using the equipment outside of school in the last 7 days. Key themes from staff were that the equipment sessions were enjoyable, a novel activity, children felt very grown-up, and the activity was linked to a real fitness experience. They also expressed the need for more support to deliver the sessions and more time required for each session. The lack of significant change in the intervention group supports the importance of grounding PA interventions using appropriate learning models that adopt an integrated approach with stakeholders. In particular, 1) stakeholders need to make explicit the theory of change that the intervention will address, 2) greater appreciation of the spaces that influence behavior change in young people, 3) the pedagogy of delivery is integrated into the curriculum, and 4) support development of teachers pedagogical content knowledge in PA instruction which is age appropriate.

References

Baranowski, T. & Jago, R. (2005). Understanding the mechanisms of change in children’s physical activity programs. Exercise Sport Science Review. 33(4), 163-168. Buchan, D.S., Ollis, S., Thomas, N.E., & Baker, J.S. (2012). Physical activity behavior: An overview of current and emergent theoretical practices. Journal of Obesity, 2012, 1. W.K. Kellogg Foundation (2001). Logic Model Development Guide. W.K. Kellogg Foundation. Lawson, H.A. (2012). Realizing the promise to young people: Kinesiology and the new institutional designs for school and community programs. Kinesiology Review, 1, 76–90. Metcalf, B., Henley, W. and Wilkin, T. (2012). How effective are physical activity intervention programmes in children? Systematic review and meta-analysis of controlled trials with objectively-measured outcomes. Pediatric Diabetes, 13, 106. Telama, R. Yang, x., Viikari, J., Välimäki, I., Wanne, O. & Raitakari, O. (2005) Physical activity from childhood to adulthood: a 21-year tracking study. American Journal of Preventative Medicine, 28(3), 267-273. Telama, R., Yang, E. and Leskinen, E., Kankaanpää, A., Hirvensalo, M., Tammelin, T., Viikari, J.S. and Raitakari, O.T. (2014). Tracking of physical activity from early childhood through youth into adulthood. Medicine and Science in Sports and Exercise, 46(5), 955-962.

Author Information

Lisa Griffiths (presenting / submitting)
University of Worcester
Institute of Sport and Exercise Science
Worcester
University of Birmingham
School of Sport, Exercise and Rehabilitation Sciences
Birmingham
University of Worcester, United Kingdom

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