Session Information
08 SES 02 A, Perspectives on Health Promotion in Diverse School Contexts
Paper Session
Contribution
The social gradient in self-reported mental health challenges, poor lifestyle, academic performance, and risk of school dropout among adolescents is profound (Directorate of Health, 2023; Marmot, 2015). Due to the reach of diverse subgroups in the youth population, school has been identified by e.g., the World Health Organization (WHO) and the OECD as an important arena for health-promoting initiatives targeted to this age group (WHO, 2018). It has been suggested that in order to be successful, it is necessary to co-create the initiatives with core stakeholders such as the students, the teachers, and the school administration. Moreover, it is necessary to integrate perspectives of health with perspectives of learning (Daly-Smith et al., 2020).
The “Active and Healthy Kids” program from Norway is a whole-school model for health promotion initially developed for primary and secondary school (Bratland-Sanda et al., 2020). This model reached interest among school leaders and teachers at high school level, and thus the aim of this pilot study was to further develop and evaluate the adaptation of the model to a upper secondary school setting. Our research questions were as follows: 1) To what extent did the program reach the students as intended?, 2) How did the students experience the program?, and 3) What were perceived facilitating factors and barriers for the development and implementation of the program in upper secondary school?
Theoretical framework
We frame this project within the theories of the socioecological model of health (SEM) (Sallis & Owen, 2015), and the theory of children’s participation (Hart, 1992). Inspired by Bronfenbrenner’s ecological system theory, SEM is a model which describes the complexity and hierarchy of levels influencing health outcomes in individuals, these levels are divided into individual, interpersonal, community and social/environmental levels (Sallis & Owen, 2015). By acknowledging these multiple levels, the SEM model emphasizes that health behavior and outcomes are not only the result of individual choices, but also the political and structural premises within the society. A study on health promotion programs over the last 30 years showed that although most of the programs acknowledged the importance of multifactor and multilevel approaches, only a few of the programs adhered to this acknowledgement (Wold & Mittelmark, 2018). Most programs targeted one level and one variable, for instance physical activity on the individual level. The “Active and Healthy Kids” program target several lifestyle factors (i.e., physical activity, diet, and sleep) in addition to the outcomes wellbeing and quality of life, and targets both individual (i.e., students), interpersonal (i.e., classes), organizational (i.e., school), society (i.e., collaboration between school and others in public, private and/or civil sector), and political (i.e., policy makers in the municipalities and counties) levels. Hart’s (1992) Ladder of Children’s Participation is based on the postulation that young people have the right to be treated with respect and should be involved in matters concerning themselves. Secondly, it is argued that development of services and arenas for young people requires their participation to make them relevant and suitable to their needs. It is argued that participation of young people in these matters contributes to more sustainable solutions. In this project, we have used Hart’s (1992) description of different levels of youth participation as a point of departure for the study design, however, we argue that youth participation should be considered as a dynamic process rather than static levels of participation (Krane et al., 2021).
Method
Sample. The program was implemented at Kragerø upper secondary school, located in a small town at the coastline of South-Eastern Norway. Students from the two-year vocational study program “Health and upbringing” during the implementation period (n=25 and 23) were recruited to participate in the evaluation. Content. The “Active and Healthy Kids Program” consists of tools such as physically active learning (i.e., integrating bodily movement with curriculum), lectures about diet and sleep, and structural changes to the school canteen’s selection of food. The program was implemented during school years 2020/2021 and 2021/2022. These school years were influenced by the Covid-19 pandemic and periods of lock down and digital school during autumn 2020. Data collection. Data were collected once during spring 2021, autumn 2021, and spring 2022. The two first rounds of data collections were carried out through electronic questionnaires through nettskjema.no nettskjema@usit.uio.no , where the students self-reported on their experiences with the program. The last data collection was carried out through two focus group interviews with the students. The focus groups consisted of one level of the study program each, the interviews were carried out in the classroom and lasted for 30 minutes each. User involvement. To ensure proper user involvement by the students throughout the process of evaluation, a Youth Panel consisting of eight students from the study program was established. This youth panel helped to develop more practical and robust questionnaires and interview guides for the data collection. The Youth Panel was arranged as group meetings at given times and with specific objectives during the research process. Prior to each data collection, the Youth Panel provided comments and revisions to the questionnaire or to the interview guide. After each data collection, the Youth Panel was presented with tables and figures from the questionnaire and transcripts from the focus group interviews, and they discussed and shared their interpretations of the findings. Analyses. The quantitative data from the questionnaires were analysed via IBM SPSS version 28.0, and descriptive data analyses were conducted. The qualitative data from the focus group interviews were analysed through deductive thematic analysis (Braun & Clarke, 2006). As previously described, the Youth Panel participated in the analyses of the data. Ethics. Necessary ethical approval was obtained, data were made anonymous in the transcribing and analyzing process. Involvement of the Youth Panel contributed to adjust the data collection process, and safeguard the wellbeing of the project participants.
Expected Outcomes
This pilot study was partly conducted during a time with extraordinary restrictions due to the Covid-19 pandemic. Despite this, the program reached to a good extent the students in the way it was anticipated. Eighty-eight percent of the students reported good knowledge about the program, the knowledge was most profound for the physically active learning component. Physically active learning was mostly used in the more practice-oriented subjects, and little to nothing in the theoretical subject such as Mathematics, Norwegian or English. A higher percentage of the students reported satisfaction with physically active learning compared to satisfaction with the subject physical education (82% vs 60%). Students experienced physically active learning as positive for the learning environment and their wellbeing at school. They asked for more physically active learning than they were provided with, especially in the theoretical subjects. This expressed need was due to the difficulties experienced with acquiring the curriculum in these subjects with more traditional, sedentary learning activities. They reported that teachers in these subjects were reluctant to use physically active learning. Further, the students asked for more involvement and decision-making in selecting types of activities in the physically active learning. The dietary and the sleep components mostly consisted of lectures on the student level. The students reported that they perceived a greater level of knowledge about healthy diet and sleep hygiene following these lectures. Importantly, especially the sleep lectures also created greater perceived emotional stress and fear due to the awareness of harm caused by insufficient sleep. The students perceived a safe social environment in the class as the most important both facilitator and barrier for successful implementation of the various components of the program. We conclude that the program in general, and the physically active learning component in particular, was well received by vocational study program students.
References
Bratland-Sanda, S., Schmidt, S. K., Karlsen, M. L., Bottolfs, M., Grønningsæter, H., & Reinboth, M. S. (2020). [Liv og røre i Telemark. Sluttrapport]. USN Skriftserie, Issue 61/2020. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101. Daly-Smith, A., Quarmby, T., Archbold, V. S. J., Routen, A. C., Morris, J. L., Gammon, C., Bartholomew, J. B., Resaland, G. K., Llewellyn, B., Allman, R., & Dorling, H. (2020). Implementing physically active learning: Future directions for research, policy, and practice. Journal of Sport and Health Science, 9(1), 41-49. https://doi.org/https://doi.org/10.1016/j.jshs.2019.05.007 Directorate of Health (2023). Review abouth inequalities in health and quality of life in Norway since 2014. Oslo: Directorate of Health. Hart, R. A. (1992). Children's Participation: From Tokenism to Citizenship. Innocenti Essays No. 4. Krane, V., Klevan, T., & Sommer, M. (2021). Youth Involvement in Research: Participation, Contribution and Dynamic Processes. In (pp. 47-71). https://doi.org/10.1007/978-3-030-75941-4_3 Marmot, M. (2015). The health gap: the challenge of an unequal world. The Lancet, 386(10011), 2442-2444. https://doi.org/10.1016/S0140-6736(15)00150-6 Sallis, J. F., & Owen, N. (2015). Ecological models of health behavior. In Health behavior: Theory, research, and practice, 5th ed. (pp. 43-64). Jossey-Bass/Wiley. WHO. (2018). Global action plan on physical activity 2018–2030: more active people for a healthier world. World Health Organization. Wold, B., & Mittelmark, M. B. (2018). Health-promotion research over three decades: The social-ecological model and challenges in implementation of interventions. Scandinavian journal of public health, 46(20_suppl), 20-26. https://doi.org/10.1177/1403494817743893
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