Development of a school-based health education program

The project consisted of the following steps. University researchers began the development of curriculum by reviewing literature and available evidence. It was decided that a workbook would be the central “organizing force” of the activities. It was clear that the workbook had to be designed to fit pupils’ and parents’ needs (both content and outlook) so that a designer was contracted. Schoolteachers and school nurses as well as students from the medical and district nurse programs were involved in further development activities during six workshops (the last one focused only on the administrative tasks required for project documentation). Those experts who participated in the development process, teachers and school nurses, medical students, school nurse students made a “test-run”: all the assignments had been tried by the experts and educators themselves (for example, children had “fruit names” during the health club, so “fruit names” were used during the trial as well). The health club was piloted at four schools. All of the sessions were visited by an observer (the above mentioned students from the medical and the health sciences faculties), who took notes. Assignments and sessions were evaluated by teachers and school nurses as well as the children. Health-related knowledge of participants were measured before and after the intervention so that the pilot project could have been evaluated.

Not applicable.

A pre-post evaluation of health-related knowledge of parents was measured by using a questionnaire. The average score grew from 6.78 to 7.16, however, this change cannot be considered as a significant change. Due to voluntary participation, the preselection of children and parents with better health-related knowledge might have played a role here. While the health club itself was discontinued after the pilot, several assignments are still used by teachers, and some skills acquired or strengthened during the pilot are evaluated positively (e.g. the school nurse communicates with parents more frequently and more easily).

Due to the voluntary nature of participation, a selection bias occurred in the class: those pupils and parents who had already been more health-centric were more willing to participate. Although the design builds on parents a lot and it is part of its key success factors, it also emerges as a bottleneck: it needs a lot of time and attention from them. This way not everyone can participate, only those, who can attend club activities in the afternoon on a weekly basis (e.g. working parents with less flexible schedules have difficulties). The sustainability of the programme is mostly endangered by the required high resource use: the programme is quite time-intensive from the perspective of both parents and the school staff. It requires preliminary trainings and week-by-week preparation from school nurses and teachers. This amount of after-school activity for 8 consecutive weeks is quite difficult to manage for parents as well. Even though kids enjoyed the activities and did not regard the club as an obligation, it was a serious commitment from all the other parties.

The main outputs of the project are a workbook and an accompanying teachers’ manual (as well as additional materials, like evaluation sheet, leaflets, “key messages to parents” sheets, or a further education short program for school nurses). As intended, any school would be able to reproduce the program based on these materials. However, there was no school continuing or reproducing the program after the pilot. The main reason for this seems to be connected to the high resource use the program requires.

The development process was very user-centric and relied on expertise about how to communicate with children (strengthened by the participation of a service designer). This way, the program was tailored to the needs of children (and parents). On the other hand, the pilot was not followed by a wider-scale implementation (see Challenges).

The main innovation of the programme was the inclusion of parents in health education activities in schools. It is rare that the children and their parents spend time together in school; this feature of the health club had an immense positive impact on the success of the programme by creating a safe atmosphere for the kids at school and engaging them at home, too. It also strengthened child-parent relationships by spending focused quality time together and creating common experiences. The situation was also new for school nurses and teachers because of this model, however, the novelty of the applied interactive methodologies provided a source of innovation for their practices. However, there was a selection bias: those children (and parents) who wanted to participate in the pilot had already been interested in living a healthy lifestyle, and had already deeper knowledge about health. High-risk groups (e.g. children struggling with obesity) were not participating. Moreover, the sustainability of the programme is endangered by the required high resource use: the programme is quite time-intensive from the perspective of both parents and the school staff.