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

RESEARCH ARTICLE A feasibility study with process evaluation of a teacher led resource to improve measures of child health Duncan S. Buchan ID1*, Samantha Donnelly1, Gillian McLellan1, Ann-Marie Gibson2, Rosemary Arthur1 1 School of Health and Life Sciences, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom, 2 School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Buchan DS, Donnelly S, McLellan G, Gibson A-M, Arthur R (2019) A feasibility study with process evaluation of a teacher led resource to improve measures of child health. PLoS ONE 14 (7): e0218243. https://doi.org/10.1371/journal. pone.0218243 Editor: Andrea Martinuzzi, IRCCS E. Medea, ITALY Received: April 20, 2018 Accepted: May 30, 2019 Published: July 2, 2019 Copyright: © 2019 Buchan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. * Abstract 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. Funding: The 2nd and 3rd authors were funded by NHS Lanarkshire to undertake a Masters by research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. PLOS ONE | https://doi.org/10.1371/journal.pone.0218243 July 2, 2019 1 / 21 Effects of a teacher led resource on children’s health Introduction 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. The school environment is considered an ideal setting to facilitate health interventions because of their pre-established infrastructure and the prolonged amount of time children spend there [8]. Indeed, evidence supports school-based interventions as a strategy to educate and improve measures of health and wellbeing in children [9–11]. Yet, systematic reviews which have evaluated the effects of school-based interventions designed to improve diet, physical activity or reduce the incidence of obesity suggest that their influence is limited [9,10]. Whereas previous school-based interventions comprising of PA and nutritional education components have proved successful in the short-term [12,13], evidence is scarce for supporting any long-term effects [9,14,15]. Moreover, as many school-based interventions require external experts or specialists on a short-term basis with little involvement of classroom teachers [11], it is unsurprising there is a dearth of long term evaluations given the questionable cost effectiveness and long term sustainability of such approaches. One such long term evaluation by Kipping and colleagues [15] within the UK highlights the difficulty of positively influencing PA and dietary behaviours through school-based interventions. In this study a large cluster randomized controlled trial was conducted in 60 primary schools with the intervention arm of the cohort provided with 16 detailed lesson plans and 10 parent-child interactive components that were adapted from the Planet Health programme in the US [16]. Even though teachers trained in the resource delivered the lesson content over two out of the three school terms, the intervention failed to increase levels of PA, fruit and vegetable consumption or reduce sedentary behaviour [15]. Despite the limited effects, a notable strength of this study was the use of classroom teachers to deliver the lesson content and facilitate the intervention. Classroom teachers can be effective facilitators of school-based health interventions yet many face significant barriers including lack of time, support and training to effectively increase PA and improve the dietary habits of children [17,18]. Moreover, many teachers can feel overwhelmed when asked to implement health promotion initiatives on top of processing constant educational reforms within their curriculum [19]. Naturally, it has been suggested that if health initia (...truncated)