Research Article: A feasibility study with process evaluation of a teacher led resource to improve measures of child health

Date Published: July 2, 2019

Publisher: Public Library of Science

Author(s): Duncan S. Buchan, Samantha Donnelly, Gillian McLellan, Ann-Marie Gibson, Rosemary Arthur, Andrea Martinuzzi.


Previous school-based interventions have produced positive effects upon measures of children’s health and wellbeing but such interventions are often delivered by external experts which result in short-term effects. Thus, upskilling and expanding the resources available to classroom teachers could provide longer-term solutions. This paper presents a feasibility study of an online health resource (Healthy Schools Resource: HSR) developed to assist primary school teachers in the delivery of health-related education. Four schools (n = 2 intervention) participated in this study. Study feasibility was assessed by recruitment, retention and completion rates of several outcomes including height, weight, waist circumference, blood pressure and several metabolic markers including HDL-cholesterol, triglycerides, glucose and dietary knowledge following a 10-12-week intervention period. The process evaluation involved fidelity checks of teachers’ use of the HSR and post-intervention teacher interviews. A total of 614 consent forms were issued and 267 were returned (43%), of which, 201 confirmed consent for blood sampling (75%). Retention of children participating in the study was also high (96%). Of the 13 teachers who delivered the intervention to the children, four teachers were excluded from further analyses as they did not participate in the fidelity checks. Overall, teachers found the online resource facilitative of teaching health and wellbeing and several recommendations regarding the resource were provided to inform further evaluations. Recruitment and retention rates suggest that the teacher led intervention is feasible and acceptable to both teachers, parents and children. Initial findings provide promising evidence that given a greater sample size, a longer intervention exposure period and changes made to the resource, teachers’ use of HSR could enhance measures of health and wellbeing in children.

Partial Text

Childhood obesity has been identified as one of the greatest global health problems of the 21st century [1]. Childhood obesity levels are of particular concern in the UK, with approximately 28% of children aged 2-15-years from England and Scotland being overweight or obese [2,3]. Physical inactivity and poor dietary habits in childhood are known to be associated with greater levels of adiposity and poor cardiometabolic risk profiles which if left unabated, could track into adulthood [4]. Since children’s participation in physical activity (PA) tends to decline in adolescence [5,6] and poor dietary habits tend to follow similar trends from childhood into adulthood [7], it is important to develop, evaluate and identify potential efficacious interventions which can be introduced early to children to offset the likelihood of becoming physically inactive and developing poor dietary behaviours.

This was a two-arm, parallel group, non-randomized feasibility study comparing the intervention group and usual practice (control) groups. The proposed methodology was granted ethical approval by the University of the West of Scotland Ethics committee (Approval # 4-8-15–001). Thirteen schools were contacted by telephone or email and meetings were arranged with interested Head Teachers to discuss the study proposal. The flow of participants can be found in Fig 1. Due to practical reasons surrounding staff availability and willingness to be randomized, we were unable to randomize schools to either the intervention or control arm of the study.

Findings suggest that the HSR is a feasible teacher-led intervention which has the potential to create positive health outcomes for children. We now discuss the specific findings in relation to the five interlinking aims: 1) The feasibility of recruiting and retaining children and teachers; 2) The feasibility of collecting outcome measures; 3) The potential efficacy of the teacher led HSR intervention, 4) The intervention process including teacher use of the HSR, intervention fidelity and the active ingredients which encouraged HSR use; and 5) The appropriateness of the HSR, possible improvements to both the HSR and the research process, and any unintended HSR outcomes.

In this study, we have demonstrated that it is feasible to recruit participants to participate in a school-based intervention designed to facilitate the teaching of health and wellbeing and improve such measures in children. Our findings suggest that use of the HSR has the potential to positively influence the dietary knowledge of children. Furthermore, teachers who used the HSR reported their participation to be manageable and the HSR to be an effective teaching tool that had a positive impact on the children they taught. These initial findings provide promising evidence that with some refinements, a greater sample size and a longer intervention exposure period, this school-based health intervention may result in improvements in the health and wellbeing of primary school children.