Adriane Tasco
Improving the health and wellness of students has become more important recently as parents and school faculty have noticed a significant rise in the number of children who are considered overweight or obese. Such factors as a decline in nutrition and physical education, the removal of recess from the regular school day, and increasingly sedentary lifestyles have contributed to growth in the number of children experiencing the onset of weight-related health issues usually seen in adults.
To help schools and communities change the factors contributing to the increasingly poor health of students and school staff, administrators and school health councils or teams assess their current state and create action plans to address identified problem areas. One key to successful implementation is to understand how individuals respond to change. Through the use of theory, administrators and school health teams can anticipate challenges and potential outcomes of the changes they plan to implement. Planning for change will ultimately lay the groundwork for systemic change over time more so than static, one-time events about health and wellness. And students and staff who may or may not be ready to adopt the changes in their current health policies will more readily adopt the changes in a manner that is tailored for them.
Many theoretical models of systems change are available to health promoting teams looking to successfully implement a new program. Let your school climate and the attitude of your team members determine which theory to align with your current state. Here, we highlight three theories that have been demonstrated in the Healthy School Communities Pilot Study.
Social Marketing Theory
Social Marketing Theory, which has been used in public health for about two decades (Bryant et al., 2007), suggests that people are influenced by their interpersonal networks when presented with an option to change (Lefebvre and Flora, 1988). They look to the accepted leader of their particular group for guidance about and acceptance of any change. When your health council or team is forming its action plan, be sure to include an opinion leader in the early discussions. These are the people who are going to spread the word and become champions about the initiatives in the school. By including the opinion leader, you can reach those who are not as open to change unless a credible source can positively influence their groups (Hoyle, 2007). An example of this theory in use would be the Fruit Wizard at the Des Moines Elementary School, in Des Moines, N.Mex.
Upon completing the Healthy School Report Card, the Des Moines health and wellness team identified a need to expose the students and staff to more fresh fruits and vegetables. Des Moines is located in a remote area of New Mexico where the closest grocery store is approximately 60 miles from any residential area, so when families are shopping, they tend to purchase items with longer shelf lives. To help increase the availability of fresh fruits and vegetables to staff and students, the designated Fruit Wizard (students and staff alternate this duty) brings a produce item of the day to each classroom for the students and staff to have as a snack. The wizard gives a minilesson about the nutritional value of the item and provides examples of how to prepare it. On occasion, some of staff and students had not seen or tasted a particular fruit before, and were apprehensive at first, but by having both students and teachers participate in the distribution of the snack, those less likely to try it on their own were more willing once they had seen it was accepted by their peers.
Model for Planned Change Theory
Model for Planned Change Theory holds that school change takes place in four phases:
- There must be a commitment from the organizing health team or council, which includes the principal, teachers, and school staff.
- The health team or council must be willing to assess, evaluate, and alter the current policies or create new policies to bring about improvement, as well as plan for training staff in the new policies.
- Staff must begin to adopt the changes and model wanted behavior for the students.
- The school health council or team must educate students about the changes and provide continued reinforcement throughout various components of the school.
Successful implementation occurs when the health promotion program is related to administrative support, resources and assistance, pressure on program users, and a good fit between the innovation and the school (Parcel et al., 1988). An example of this theory is demonstrated at Hills Elementary in Hills, Iowa.
This pilot site decided to offer a family night in the local community center to reach parents and students, deviating from the traditional form of presenting information to parents and students in the form a of an annual assembly or evening program. The team at Hills is working with parents by giving weekly lessons on nutrition and wellness and offering to help students with homework. This required the team members to evaluate what was missing from their current plan and risk doing something different to meet the needs of their students.
Social Cognitive Theory
Social Cognitive Theory suggests that an individual can adopt a change only if he expects that change will result in the desired outcome. In this theory, individuals believe they can successfully execute the necessary behavior to bring about their preferred consequence (Hoyle, 2007).
Barclay Elementary/Middle School in Baltimore, Maryland, demonstrated this theory through Greening 101, a club for middle school participants that was facilitated by an agent from the Maryland Cooperative Extension office. The students met weekly to learn about gardening, the nutritional value of what they were growing, how to use it to supplement food already available in the home, and the benefits of healthier diets. The students were able to grow their own vegetables (lettuce, beans, cabbage, radishes, tomatoes, and kale) in portable gardens called Earth Boxes. When the produce was ripe, the students used the vegetables to create fresh salads. At the end of the school term, the club members presented a workshop to students and parents about their unit and were given the opportunity to take the Earth Boxes home to care for over the summer.
Theoretically sound implementation of systems change is a best practice for promoting healthy schools. It is important to understand the factors of behavior change when improving the health opportunities for students and staff. Change is not easy, but by presenting information appropriately and preparing the stakeholders, there is a better chance it will be sustained.
Bryant, C. A., McCormack Brown, K. R., McDermott, R.J., Forthofer, M.S., Bumpus, E.C., Calkins, S.A., and Zapata, L.B. (2007). Community-based prevention marketing: organizing a community for health behavior intervention. Health Promotion Practice, 8(2), 154–163.
Hoyle, Tena B. (2007). The mariner model: charting the course for health-promoting school communities. Ohio: American School Health Association.
Lefebvre, C.R., and Flora, J.A. (1988). Social marketing and public health intervention. Health Education Quarterly, 15(3), 299–315.
Parcel, G.S., Simons-Morton, B.G., and Kolbe, L.J. (1988). Health promotion: integrating organizational change and student learning strategies, Health Education Quarterly, 15(4), 435–450.