Understanding the social context of school health promotion program implementation

Process Evaluation of a School-Based Program Aimed at Preventing Obesity in Adolescents from Lima and Callao, Peru

The study aims to describe process evaluation measures of the three-year Health Promoting Schools’ obesity prevention program in Lima and Callao, Peru, and to assess factors that influenced the implementation of the intervention leading to the mentioned process outcomes results. The program was implemented in four public high schools located in low-income areas of Lima and Callao. Embedded in a Health Promoting School Intervention, the program consisted of two main components—an education program and several environmental activities. Quantitative data were collected and analyzed based on dose delivered and reach for each specific activity. Dose received was analyzed by satisfaction scores related to six specific activities. Furthermore, qualitative data including documentation of activities and transcriptions from individual in-depth interviews were qualitatively analyzed to identify factors influencing the implementation. The education component of the Health Promoting Schools’ program achieved a 78.4% average nutrition sessions delivery in 2015 and 88.0% in 2017; while for PA sessions, the average delivery in 2015 was of 79.7% and 93.8% in 2017. In the case of reach, at least 75% of total students participated in all sessions per year. Nevertheless, there were differences in terms of delivery and participation in a number of environmental activities within and between schools during the program period. Differences in delivery included education sessions for parents, teachers, Junior Health Promoters, and school food kiosk staff, besides execution of physical activity events every year. Impeding factors included the complexity of the overall intervention, limited strategies to facilitate program implementation and those to maintain the participation of subjects, and related contextual factors.

The adoption, implementation and maintenance of a school food policy in the Canadian Arctic: a retrospective case study

With increasing childhood obesity rates and type 2 diabetes developing in younger age groups, many schools have initiated policies to support healthy eating and active living. Policy interventions can influence not only health behaviours in students but can also impact these behaviours beyond the school walls into the community. We articulate a policy story that emerged during the data collection phase of a study focused on building knowledge and capacity to support healthy eating and active living policy options in a small hamlet located in the Canadian Arctic. The policy processes of a local school food policy to address unhealthy eating are discussed. Through 14 interviews, decision makers, policy influencers and health practitioners described a policy process, retrospectively, including facilitators and barriers to adopting and implementing policy. A number of key activities facilitated the successful policy implementation process and the building of a critical mass to support healthy eating and active living in the community. A key contextual factor in school food policies in the Arctic is the influence of traditional (country) foods. This study is the first to provide an in-depth examination of the implementation of a food policy in a Canadian Arctic school. Recommendations are offered to inform intervention research and guide a food policy implementation process in a school environment facing similar issues.

School-based nutrition interventions for Indigenous children in Canada: a scoping review

Background

Indigenous children in Canada (First Nations, Inuit, and Métis) are disproportionately affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions offer a promising strategy for improving children’s access to healthy foods and sustaining positive eating behaviors. However, little is known about school-based nutrition interventions for Indigenous children. The objectives of this scoping review were to identify school-based nutrition interventions for Indigenous children in Canada and describe their components.

Methods

The scoping review consisted of searches in seven peer-reviewed databases and a general web search for grey literature. Eligibility criteria were applied by two reviewers, and data were extracted and charted by one reviewer using components of the comprehensive school health approach (social and physical environment, teaching and learning, policy, partnerships and services) and additional components with relevance to Indigenous interventions (cultural content, Indigenous control and ownership, funding source, evaluation). Numerical and descriptive summaries were used to present findings.

Results

Thirty-four unique interventions met the inclusion criteria. The majority (97%) of interventions targeted the social and physical environment, most often by offering food programs. Over half of interventions also incorporated teaching and learning (56%) and partnerships and services (59%), but fewer included a policy component (38%). Many interventions included a cultural component (56%) and most (62%) were owned and controlled by Indigenous communities (62%). Finally, over half of interventions disclosed their source(s) of funding (59%), but less than half (41%) included an evaluation component.

Conclusions

The review suggests that school-based interventions for Indigenous children can be more comprehensive by incorporating culturally relevant nutrition education and professional development opportunities for teachers, written school nutrition policies, and activities that actively engage families and community members. The continued focus on Indigenous control and ownership and incorporation of content specific to individual communities may enhance cultural relevancy and sustainability of interventions. Furthermore, there is a need to increase intervention evaluation and the sharing of resources related to funding. These recommendations may be used by communities, as well as by researchers and professionals working with communities, in developing comprehensive school-based nutrition interventions to improve the eating behaviors of Indigenous children.

With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska

This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.

Understanding community-based participatory research through a social movement framework: a case study of the Kahnawake Schools Diabetes Prevention Project

BACKGROUND

A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP).

METHODS

This research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strategies included document (scientific and organizational) review (n = 51) and talking circles with four important community stakeholder groups (n = 24).

RESULTS

Findings provide an innovative and chronological perspective of the evolution of KSDPP as seen through a social movement lens, and identify intermediate outcomes associated with different dimensions of movement building achieved by the project over time (mobilization, leadership, vision and frames, alliance and partnerships, as well as advocacy and action strategies). It also points to areas of improvement for KSDPP in building its potential for action.

CONCLUSION

While this study's results are directly relevant and applicable to the local context of KSDPP, they also highlight useful lessons and conclusions for the planning and evaluation of other long-standing and sustainable CBPR initiatives. The conceptual framework provides meaningful benchmarks to track evidence of progress in the context of CBPR. Findings from the study offer new ways of thinking about the evaluation of CBPR projects and their progress by drawing on frameworks that guide other forms of collective action.

Evaluating an Indigenous health curriculum for diabetes prevention: engaging the community through talking circles and knowledge translation of results

BACKGROUND

Kahnawà:ke is a Kanien'kehá:ka (Mohawk) community in Quebec, Canada. In 1997, the community-controlled Kateri Memorial Hospital Centre in partnership with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project (KSDPP) developed an elementary school diabetes prevention health education program, aimed to increase knowledge of Type 2 diabetes, healthy eating and active lifestyles. Long-term goals for KSDPP community and school interventions are to decrease obesity and diabetes.

OBJECTIVES

To evaluate the Kateri Memorial Hospital Centre Health Education Program for Diabetes Prevention (HEP) and use key principles of knowledge translation to promote understanding of results to upgrade HEP content and improve delivery.

METHODS

A KSDPP community-based participatory research team used mixed methods for evaluation, combining a cross-sectional survey for 23 teachers with interviews of two elementary school principals and three culturally appropriate Indigenous talking circles with HEP authors, teachers and parents. Questionnaire results were presented as descriptive statistics. The thematic textual analysis identified emerging themes from talking circles and interviews.

RESULTS

Facilitators of HEP delivery were an acknowledgement of its importance; appreciation of prepared lesson plans for teachers; and KSDPP's strong community presence. Barriers included reduced administrative support and instructional time due to competing academic demands; the need for increased Kanien'kehá:ka cultural content; and outdated resource materials. Recommendations included increasing teacher training, Kanien'kehá:ka cultural content and administrative support.

CONCLUSION

Community researchers undertook detailed knowledge translation activities of facilitators, barriers and recommendations with hospital and education centre administrators and Kahnawà:ke community to maximize uptake of findings before external dissemination of results.

Implementing Comprehensive School Health in Alberta, Canada: the principal's role

Comprehensive School Health (CSH) is an internationally recognized framework that moves beyond the individual to holistically address school health, leading to the development of health-enhancing behaviors while also improving educational outcomes. Previous research has suggested that principal support for CSH implementation is essential, but this role has yet to be explored. Therefore, the purpose of this research was to examine the role of the principal in the implementation of a CSH project aimed at creating a healthy school culture. This research was guided by the grounded ethnography method. Semi-structured interviews were conducted with APPLE School principals (n = 29) to qualitatively explore their role in creating a healthy school culture. A model consisting of five major themes emerged, suggesting that the principal played a fluid role throughout the CSH implementation process. Principals (i) primed the cultural change; (ii) communicated the project's importance to others; (iii) negotiated concerns and collaboratively planned; (iv) held others accountable to the change, while enabling them to take ownership and (v) played an underlying supportive role, providing positive recognition and establishing ongoing commitment. This research provides recommendations to help establish effective leadership practices in schools, conducive to creating a healthy school culture.

Health status of primary school educators in low socio-economic areas in South Africa

BACKGROUND

Non-communicable Diseases (NCDs) are major health concerns in South Africa. According to the life cycle approach NCD prevention strategies should target children. Educators are important external factors influencing behaviour of learners. The objective of this study was to assess the prevalence of selective NCD risk factors in educators of primary school learners.

METHODS

A cross-sectional design was used to assess the body mass index (BMI) and waist circumference (WC), blood glucose (BG), cholesterol (BC), blood pressure (BP), perceived health and weight, and parental NCD history of 517 educators in the Western Cape of South Africa.

RESULTS

The sample included 40% males and 60% females; 64% urban and 36% rural, 87% were mixed ancestry, 11% white and 2% black. Mean age for the total group was 52 ± 10.1 years, BMI 30 ± 1.2 kg/m(2) (31% overweight, 47% obese), diastolic BP 84 ± 10.0 mmHg, systolic BP 134 ± 18.7 mmHg (46% high BP), BG 4.6 ± 2.3 mmol/L (2% high BG), BC 4.4 ± 0.9 (30.4% high BC) and WC 98 ± 14.1 cm for males (38% high WC) and 95 ± 15.3 for females (67% high WC). BMI was higher (p = 0.001) and systolic (p = 0.001) and diastolic (p = 0.005) BP lower in females. Rural educators were more obese (p = 0.001). BMI (p = 0.001) and systolic BP (p = 0.001) were lower in younger educators. Correct awareness of personal health was 65% for BP, 79.2% for BC and 53.3% for BG. Thirty-eight percent overweight/obese females and 33% males perceived their weight as normal.

CONCLUSION

The findings of this study demonstrated a number of characteristics of educators in the two study areas that may influence their risk for developing NCDs and their potential as role models for learners. These included high levels of obesity, high blood pressure, high waist circumference, high cholesterol levels, and high levels of blood glucose. Furthermore, many educators had a wrong perception of their actual body size and a lack of awareness about personal health.

The adaptive nature of implementation practice: case study of a school-based nutrition education intervention

OBJECTIVE

To describe how and why nutritionists implement and strategize particular program operations across school contexts.

DESIGN

Instrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices.

SETTING

Seven primary schools from disadvantaged Montreal neighborhoods.

PARTICIPANTS

Six nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings.

INTERVENTION(S)

Little Cooks--Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge.

PHENOMENON OF INTEREST

The program-context interface where interventionists' practices form interactively within a given social context.

ANALYSIS

Coding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists' practices against variations in implementation.

RESULTS

Nutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists' past experiences.

CONCLUSIONS AND IMPLICATIONS

Implementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.