Using Community-based Participatory Research to Create Sustainable Healthy School Environments and Promote Positive Behavior Changes in School-aged Children

Download or read book Using Community-based Participatory Research to Create Sustainable Healthy School Environments and Promote Positive Behavior Changes in School-aged Children written by Jacqueline Bergman and published by . This book was released on 2014 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The overarching objective of the research included in this dissertation was to identify program models that support healthy behaviors in school-age children. Special emphasis was given to models and methods that focus on the sustainability of community-based health and wellness programs. Chapter I of this dissertation provides a review of literature that explores the prevalence, definition, consequences, and potential causes of childhood overweight and obesity as well as potential methods, theories, and approaches designed to help ameliorate the problem. This review recognizes obesity as a complex issue and presents a variety of approaches that requires coordinated, multifaceted and collaborative approaches that target not only the individual, but also the whole community. In addition to providing a comprehensive review of behavior change theories and examples of their application in the school setting, this review concludes with a proposed solution to a secondary issue: the long-term sustainability of school-based health and nutrition programs and their outcomes. Chapters II provides a Statement of Purpose for the research discussed in Chapters III through Chapter V. Chapter III describes a study conducted in collaboration with the California Department of Education. The purpose of this study was to develop, implement, and assess the impact of a statewide professional development program designed to equip school nutrition directors with the knowledge and skills needed to cost-effectively implement federal health and wellness initiatives and policies at the local level. The professional development program was entitled, the "Stepping Up To the Challenge: Creating a Healthy School Environment" and was a unique partnership among state education agency staff, university researchers, and practitioners. Post-professional development questionnaire identified key "insights, inspirations, and strategies" as (a) marketing of school foods pro- gram, (b) expansion of salad bars, and (c) collaboration with community partners. A six-month follow-up questionnaire identified that 86% of participants made progress toward implementing at least one of their five insights, inspirations, and strategies in their school districts. Most common areas that were implemented were marketing and branding (32%), revamping salad bars (18%), and motivating staff (16%). School and Community Actions for Nutrition survey analysis showed a significant increase in the use of marketing methods in school nutrition programs from baseline to six-month post-program implementation (p = .024). The nutritional impact of several of the techniques presented in this program were tested in a farm to school (F2S) project funded by a specialty block grant program sponsored by the California Department of Food and Agriculture described in Chapter IV. Chapter IV describes a study designed to evaluate the impact of F2S programming on dietary behavior outcomes, specifically fruit and vegetable preferences and consumption patterns, among school aged children attending schools in three distinct California school districts. To ensure that the intervention methods were appropriate for each unique school community, the intervention plan was designed in conjunction with school nutrition directors. As an outcome of this study, the surrounding community benefited through the establishment of a sustainable relationship between local farmers and the school nutrition directors. Data collected from a series of behavioral questionnaires and plate waste observations were assessed pre- and post-F2S programming. Results in the small, rural school district showed an increase in the percent of students able to correctly identify asparagus (34.5% to 58.6%; p= 0.02), an increase in the amount of fruit consumed; (53% to 94%; p = 0.01), and an increase in total produce consumed; (59% to 94%; p = 0.01). Results in the medium rural/urban school district showed an increase in the percent of students able to correctly identify red bell pepper (79% to 92%; p = 0.0415). Students increased their consumption of fruit and total produce at follow-up as compared to baseline (25% to 50%; p = 0.04 and 33% to 58%, p = 0.04). Results in the large, urban school district showed an increase in the percent of students able to correctly identify cucumber (39% to 61%; p=0.05). No significant positive changes were observed in student's willingness to taste a feature produce item, with a decrease willingness to taste a radish at the small, rural school district (90% to 62%; p= 0.01). Overall, results showed that limited intervention strategies yielded positive nutrition behavior changes in school-aged children's eating behavior. Results from these findings informed the wellness component of a multi-component project entitled the Shaping Healthy Choices Program. The Shaping Healthy Choices Program is a school-based intervention that integrated five components: nutrition education; family and community partnerships; regional agriculture; foods available on school site; and school wellness policies. The research discussed in Chapter V used a mixed-methods approach to assess the effectiveness of site-specific school wellness committees (SSWCs) to supplement Shaping Healthy Choices Program activities, and create a best practices model for sustainability of SHCP components. Community-Based Participatory Research principles and approaches were utilized to develop SSWC objectives. Baseline results from the School and Community Actions for Nutrition (SCAN) Survey served as a platform to launch SSWC objectives. An ethnographic approach was to analyze the level of community involvement during each phase of the project. The wellness committee was also involved in a smaller research project through which they identified the strengths and weakness of their school environment and implemented activities based on this information. Results from the wellness committee's study were compared with community-based principals in order to draw any relationships with the wellness committee outcomes and the level of community based participation. Results suggested that the more the community was involved in the planning, implementation, and maintenance phases of an activity, the more likely the School Sites were to implement these activities into the second year. More research is needed to assess the sustainability of the program outcomes over a longitudinal course. This dissertation concludes with Chapter VI, a discussion of research results, implications, conclusions, and future directions.