Mutual adaptive strategies that teachers believe make physical activity programs work in schools.

Mutual adaptive strategies that teachers believe make physical activity programs work in schools.

ABSTRACT

Numerous physical activity programs have operated in Australian schools and the effectiveness of these is well established. However little attention has been afforded to the strategies teachers believe make programs work in schools. In this study, experienced users of a program known as Canning Stock Route Challenge (CSRC), were asked to identify these strategies. The CSRC uses physical activity challenges and accompanying health education lessons to target the risk factors leading to Type 2 diabetes.

It aims to develop knowledge, understandings and skills to promote a healthy lifestyle among schoolaged children. Data was gathered from experienced users of the CSRC through an online questionnaire and emergent themes were explored in follow up interviews and clustered into groups. Users believed 4 key strategies made the CSRC work in their schools: (1). Use of incentives to motivate teachers and students: (2). Adaption of content to suit the local context: (3). The integration of learning areas: (4). Enlistment of support from the local community. It was found that users adopted mutual adaptive behaviours during the process of implementation, modifying strategies to suit local realities. Users believed this process made a significant contribution to the success of the program in situ.

INTRODUCTION

The evaluation of physical activity programs across Australia has received substantial attention from policy makers and funding bodies (The CO-OPS Collaboration Book of Case Studies for Community Based Obesity Prevention, 2010, Hearn, L., et al 2006, Kahn et al. 2002). Many of these studies have focused on cost effective summative evaluation of programs e.g. pre and post-test surveys of participants. Less attention has been given to the formative evaluation of programs in schools and the literature describing what actually happens when programs are implemented by teachers in ‘real life classroom settings’ is limited (Newman et al, 1992). Whilst some implementation studies have isolated some variables related to implementation process e.g. teacher attitudes, characteristics, training, external facilitators and barriers, and curriculum attributes, far less is known about what teachers actually do with programs behind ‘closed doors’ (Sy, A and Karen Glanz, K, 2008; Goodman et al, 1994).

One of the main aims of this study was to contribute to our understanding of the implementation process by focusing on one aspect of the process – ‘user beliefs’. This study was less concerned about investigation of project outcomes or the specific skills of users but rather what strategies users believed worked when implementing a physical activity program in their context. Programs aimed at increasing levels of physical activity of school children have been used in Australian schools since the mid-1990s e.g. Canning Stock Route Challenge (CSRC), Active-Ate, Walking the Ghan, Murray River Quest, Hunting for Health and Kids on Walk-About.

They were devised to promote physical activity and healthy food habits, both of which are timely, as patterns of behaviour established in early childhood are likely to continue into adulthood (Burke, 2001; Birch, L.L. 1999, NHMRC, 1996). Many of these were modeled on the Australian National Heart Foundation’s Heartwalks program aimed at the improvement of health status of school-aged children. The means to achieve these aims varies between programs but a combination of enhanced physical activity and health education lessons is a common theme. Another important feature in these programs is the setting of a ‘goal’ with appropriate incentives to stimulate interest and motivate participants to achieve goals. In the case of the CSRC, the goal is the completion of a ‘virtual’ journey along the length of the Canning Stock Route (Bowcock, R. 2006).

The Canning Stock Route Challenge

Since its inception in 1996, 45,000 students have participated in the CSRC, with most located in the north west region of WA mainly the Pilbara and Kimberley areas (Bowcock, R, 2005; Chambers, K and O’Brien M, 2006). It targets primary school aged children from 4–12 years, encouraging them to improve their health status by participating in physical activities matched with health education lessons.

The underlying foundation of the CSRC program was the belief that Type 2 diabetes is a preventable disease and that the risk factors can be targeted as part of a healthy school program (Radich, 1999). As a result, four key messages were adopted as the basis of the CSRC program:

1. Stay healthy
2. Be more active
3. Make healthy food choices
4. Beat Type 2 diabetes.

Like many of the other existing challenge programs, the CSRC is competition-based conducted within individual classes in primary schools. It is conducted over an 8-week period wherein classes aim to complete the virtual journey, over the entire length of the Canning Stock Route from Wiluna to Halls Creek, located in the Kimberley region of WA. For every 15 minutes of physical activity completed over the duration of the challenge, participating classes accumulate ‘travel time’ and they move from one well to the next (there are 58 wells in total). Progress is recorded by placing stickers on maps provided for that purpose. Classes receive a package of resources including; a lesson book, a Canning Stock Route map and stickers, instructions, registration and activity record forms. Students also participate in concurrent health education lessons that support the 4 key CSRC messages.

This study formed part of a larger review of the CSRC commissioned by the Western Australian Country Health Service (WACHS) in 2008 and funded through Healthways WA aimed at reconceptualising and updating the CSRC in line with current thinking and evidence based practice. The study contributes to our understanding of the strategies users believe make activity programs work across different contexts. The findings will contribute to the development of a new program called ‘Take the Challenge’ to be implemented across Western Australian schools in 2011.

The focus question of the study was to make explicit the strategies experienced users of the CSRC believed made the program work in their specific context. Findings revealed that user selection and implementation of strategies was influenced by local circumstances and realities and that a process of ‘mutual adaption’ was evident between program intents and local realities. Furthermore, users believed the mutual adaptive process contributed to the success of the program in situ.

METHODOLOGY

This study formed part of a larger summative evaluative review of the CSRC. The aim of this study was identify the strategies experienced users believed made the program work in their schools. The research design used grounded theory principles to glean information from the users perspective. Mixed methods were utilized to triangulate data in an effort to strengthen validity of the findings. An online questionaire used both closed and open-ended questions to establish baseline data that was further explored and amplified in follow up interviews. Further confirmation of strategies used was enabled through documentary analysis of materials supplied by users.

Any experienced users of the CSRC program that had implemented it in their school or classroom during 2009 were invited to participate in the questionaire post intervention during November 2009 (n=100). They were recruited from the Kimberely, Gascoyne, Wheatbelt and Pilbara geographic areas of Western Australia by WACHS regional officers. Participants represented all 3 educational sectors within the WA education system including Catholic, Government and Independent schools. The majority were classroom teachers (Note: Principals, deputy principals and health personnel made up the rest of the sample). Most were located in the Kimberley region of WA, representing schools from Derby in the west to Halls Creek in the east. For the purposes of this study they were referred to as ‘users’ or ‘participants’ rather than their specific title because of the different roles they assumed in the schools i.e. some assumed combined roles of principal and teacher within the school.

The initial survey consisted of an online questionaire designed to: 1. Collect demographic information and 2. Identify the strategies users believed made the program work in their school/classroom. All participants had 1 month to complete the survey. Data was collected in excel databases and ‘identified strategies’ were clustered based on recurring themes and grouped into 4 main headings. All questionnaire participants were invited to elaborate on emergent themes, in follow up focus group meetings. 3 focus groups were formed comprising at least 1 representative from each of the 3 developmental phases of schooling as described in the WA Curriculum Framework – Early Childhood, Middle Childhood and Early Adolescence phases.

Each group consisted of approximately 8 participants and interviews were conducted over a 2 hour period in different venues across WA. All interviews were conducted by the main investigator and discussions were recorded and data was transcribed for post interview analysis. The semi-structured interviews allowed the researcher to further clarify specific strategies used by participants and afforded participants the opportunity to elaborate on their initial responses. This interactive process proved helpful in allowing the researcher to further interrogate questionnaire responses and verify initial findings (Lincoln and Guba, 1985).

To further verify and confirm the types and range of strategies deployed by users, user planning documents and student work were collected prior to interviews e.g. daily lesson planning documents, CDs, DVDs and classroom based work including student projects. Much of this material had been previously submitted to WACHS staff as part of regional competitions designed to promote intra-class and inter-school competitions as part of the CSRC Challenge. These materials provided further information about user strategies and provided an opportunity to clarify and/or confirm data collected in questionnaires. These materials also provided useful background information for preparation of questions for focus group interviews.

RESULTS

Only 31 of the original target group of 100 experience users responded to the online survey. Competing demands from school based assessments and reporting requirements during the final term of the school year may have attributed to the poor response rate. All 31 questionnaire participants were experienced users having used the CSRC at least once. The majority (70%) were classroom teachers but some had other roles e.g. Administration staff – Principals with teaching responsibilities.

Open ended questions were used to establish the range and kinds of physical activity strategies used by participants. Users provided a variety of means for their classes to achieve the physical challenge goals as part of the CSRC, the most common being daily fitness activities e.g. walking to find bush food, playing games and jump rope. Follow up interviews revealed that many of these activities were cross-curricular in nature and users emphasised the importance of involving local community members. Users strongly agreed that the stickers, maps (61%) and merit certificates (63%) were important motivating strategies.

All the strategies identified in the questionaire were listed, and recurring themes were identified and clustered into 4 broad groups:

1. Use of incentives to motivate teachers and students
2. Adaption of content to suit the local context
3. The integration of learning areas
4. Enlistment of support from the local community.

The clustering of strategies into themes was problematic in one sense, as many strategies were often implemented in conjunction with each other and were interconnected by their nature. Users confirmed follow up interviews that the clustering of strategies into groups was plausible as an organizing tool for discussion purposes.

Emergent themes

1. Use of incentives to motivate teachers and students – CSRC users strongly supported the use of incentives maps, stickers and merit certificates and believed these incentives promoted competition e.g. “The kids loved to track their progress. It became a bit of a competition and also became a geography lesson.” (Interview, Teacher G, DET remote school).

The competitive elements and the built in incentives have been shown to be very effective in motivating students in similar programs (Lepere, 2008). Users commented on 3 different forms of competitions that had emerged during the CSRC period:

1. Inter-class competition
2. Intra-class competition
3. Inter-school competition.

They commented that all 3 categories of competition co-existed in their schools/classrooms but some took prominence over others at different times over the CSRC period. Some mentioned that extrinsic prize incentives did motivate teachers and students but that these weren’t the only driving forces behind involvement or the successful deployment of strategies.

2. Adaption of content to suit the local context – Focus group interviews revealed that many teachers had implemented the CSRC in practical and creative ways. Users also demonstrated professional concerns for their students and emphasised a strong desire to take full account of student needs and the immediate environment e.g. users adapted their use of CSRC map in specific lessons to connect students to the context and to enhance the learning experience. Users reported that students were able to recognise local areas on maps and some even visited them on camps, excursions, and sports trips or on holidays e.g. “Maps are especially important for the little kids because they have no idea of distance and local maps help.” (Interview, Teacher A, CEO school).

Users highlighted the significant contextual differences between school communities in terms of history, language and culture, access to resources and support, fresh food and the local fauna and flora. In planning for daily physical activities and in health education lessons, they signaled the importance of taking account of context when designing appropriate strategies e.g. “Connection with the environment is important. Using local animals (sic: in lessons and in materials) that they (sic: the students) recognise is important in terms of learning and language development.” (Interview, Teacher A, CEO school).

In another example, one teacher described how the class worked with local community elders to teach students about locating natural or ‘bush’ food in their community. The teacher described the educational outcomes included: increased physical activity (bush walking), increased knowledge about alternative healthy foods, awareness of the geography, cultural aspects and history of their local area. The fact that healthy food was going home at the end of a school day to be shared with family members was also considered a positive ‘spillover’.

Users argued that the process of adaption and/or modification of CSRC content and strategies, allowed them take account of regional, and cultural differences between students, classes, schools and regions. Adaption of strategies to enhance individual student outcomes was a common theme e.g. “…every school will be different in what they do. You need to see that material and manipulate it.” (Interview, Teacher T, CEO remote school). The ‘mutual adaption’ of content and strategies to suit their context was seen by users as being vital to the success of the program. In this way they could best meet the needs of their students and best take account of the resources within communities. This supports the view that variation or mutual adaption of programs in situ, allows users to take account of local resources, traditions and clientele and is indicative student-centred approach (McGlaughlin, 1998).

Rather than being seen as lack of fidelity to program intents, teacher variation of program delivery at the local context may well be indicative of a professional approach toward teaching and a sign of a healthy education system (Kumanyika et al 2001 and McLaughlin, 1998).

3. The integration of learning areas – Users of the CSRC were well aware of the issue of the ‘crowded curriculum’ and used constructive and creative measures to counteract these pressures. They believed that strategies that integrated learning areas helped alleviate these pressures and assisted them in achieving positive educational outcomes.

Documentary analysis of materials submitted as part of the post CSRC competitions, confirmed that many schools undertook a wide variety of cross-curricular approaches in achieving CSRC goals. Users emphasised the importance of linking physical activities to a range of learning areas to best meet educational outcomes e.g. walk to set venue to sketch, outdoor mathematics games or activities that stimulated writing. Users emphasized the need for students to be active in their learning e.g. sustained daily physical activity, participation in cooking and eating healthy foods and the opportunity to take some of the food home and identified the key characteristics of constructive strategies as being ‘hands-on’ and ‘student centred’. Integration of learning areas provided for many innovative possibilities in schools e.g. creation of school gardens – to grow vegetables (science and mathematics), collecting ‘bush food’ (physical activity through bush walks), and preparing and eating healthy food in class (technology and enterprise). Other examples of integration across learning areas included:

Users also highlighted the need to link CSRC to existing curriculum innovations. One teacher indicated that daily CSRC physical activities were strategically linked to core literacy and numeracy programs in the school e.g. ‘First Steps’ (literacy) and Getting it Right (numeracy) (Teacher S, DET remote school). Existing curriculum incursions such as Blue Earth and Garnduwa (organizations providing physical activities for school children), were seen as complementary strategies allowing further variety and opportunities to increase physical activity.

Finally in terms of general feelings/perceptions of users about the value of integrating the CSRC over the school day is best summed up in this comment: “A lot of teachers complain about overcrowded curriculum and how they are going to fit in all the KLAs (sic: Key Learning Areas). This (sic: CSRC) was one of the easiest integrated units we’ve managed because, yes it had a health focus but we had everything in there – SOSE, The Arts, Science everything!” (Interview, Teacher T, CEO Remote school).

4. Enlistment of support from the local community – Users highlighted the importance of links to the local community e.g. “Engaging families in the area of nutrition has a major impact on children’s choices. Engaging parents in making healthy choices, planning with pre-schools and day care, working with maternal and child health services.” (Online survey, HPO J). Because many of the users in the survey were from remote schools, the importance of establishing links to community stores was considered paramount e.g. “Working with the local store is vital. It is such a central place and it can have a vital effect on the community.” (Interview, Teacher M, CEO Remote school). Users gave examples of productive relationships established with managers of community stores. In one instance, different food types on store shelves had been colour coded by students according to their relative nutritional value e.g. green – ‘go food’; red – ‘sometimes food’.

Other strategies used to engage the community included Health Expos, after school sports with parents involved and shopping visits to local stores. [Source: Online Survey, Items 1-4]. One user gave the example of using local community members during bush tucker trips to show students that there were plentiful supplies of alternative and healthy foods in the local environment including traditional foods such as wild berries, goanna and snake described locally as ‘bush tucker’ e.g. “…(sic: bush trips) incredibly relevant as our boys go on a hunting trip once a week. We would cook this food and at the end of the lesson they would take it home.” (Interview, Teacher M, CEO Remote School).

Given that the majority of young people’s physical activity occurs outside school, there is now growing recognition of the importance of community-based programs and the involvement of the community at all levels if interventions are to be effective (Cale, L and Harris, J. 2006). In this study strategies selected by users often recognized the importance of community engagement and the development of collaborative partnerships. The challenge for program developers and school communities beyond this is how to sustain this engagement beyond primary school and into high school (Mathews et al, 2010). Due to a range of factors, not the least being time restraints, this research study was limited to a small sample located in a particular context – the north west of Western Australia. The applicability of these findings to other school settings with different characteristics was not been tested in this study. Further research would be required in a broader context to build on these findings.

Whilst the findings of this study limited their generalizability to other contexts, user belief about CSRC strategies that work, was particularly illuminating. Further studies would need to examine the relative strengths of strategies targeted at different levels of intervention (individual, community, policy) and how they interact synergistically with each other. Whilst users agreed about the importance of creating Health Promoting School, rarely did schools report that specific policy or strategies were in place. This would need further investigation, as it was not a specific brief in this study.

CONCLUSION

Experienced users of the CSRC believed the implementation of 4 broad categories of strategies helped the program work in their classrooms – (1). Use of incentives to motivate teachers and students; (2). Adaption of content to suit the local context; (3). The integration of learning areas; (4). Enlistment of support from the local community.

The implementation of these strategies was found to be context dependent. Variation in the implementation of strategies by users across was described as a ‘mutual adaptation’ process, whereby users adapted program intents, content and strategies to match local needs and realities. Users believed the process of mutual adaption contributed to the success of the program by attending to student needs through the strategic use of strategies and resources within the local context. These findings also have implications for the development of future physical activity programs, especially where interventions make fixed assumptions about user behaviours e.g. ‘one size fits all’ or include strategies that are ‘overly prescriptive.’ The extent to which the mutual adaption of such programs falls within ‘acceptable levels of fidelity’ to program intents needs further investigation.

ACKNOWLEDGEMENTS

Thanks to all the staff members from schools who participated in this research and to Murdoch University, WACHS and Healthways for the support of this program. Special thanks to Robyn Bowcock Kimberley Public Health Nutritionist for whom without her energy and passion for this program it would not exist.