The research pathway to developing a health promotion intervention for the high school curriculum

Dr Lisa Buckley, Rebekah Chapman, Prof Mary Sheehan

Background

• Injury prevention and health promotion are complex processes and there is considerable science in program design

• There is a need for considerable planning and formative research required before programs get to the implementation stage.

Stage 1. Conceptual Development of the Intervention

Literature review on problem identification & previous programs

Local data on injury risk behaviours

Focus groups with adolescents to identifying ecologically valid themes for program goals

Large scale workshop with teachers and school administrators

Additional focus groups with students and teachers to reflect on draft material/ implementation

Research Design

Stage 2. Creating the Intervention

Synthesising results from stage 1 into an intervention – the writing and creating stage

Stage 4. Evaluation Studies

Process & implementation evaluation

Impact evaluation – change in underlying program risk and protective factors

Outcome evaluation – change in risk-taking behaviour and injury

Stage 3. Implementing the Intervention

Implementing the intervention (SPIY Program) in the schools

Risk-taking behaviours & injury over 6 months

Survey with Year 9s (n=661, mean age=13.6 years, 46% male)

• 42.2% injured riding a bike

• 18.1% injured riding a motorbike

• 13.8% injured as a vehicle passenger

• 5.7% injured while driving

• 42.8% injured in a fight (Chapman & Sheehan, 2005)

Percentage and clustering of risk-taking behaviours in past 3 months for 14 year olds

25%13%

12%

8%17%

10%

12% Alcohol Traffic

Violence

(Buckley & Shope, 2007)

Risk and Protective Factors

Adolescent risk taking

Protective FactorsRisk FactorsIndividual:• Sensation

seeking• Impulsiveness• Low self esteemFamily:

• Poor supervision• Parental

modelling• Family conflict

School:• Poor academic

performance• School misbehaviour• Truancy Peers:

• Peer encouragement of risk taking

• Peer modelling

Individual:• Religiosity• Attachment to

parentsFamily:• Parental monitoring• Parental help with school• Parental disapproval of

risksSchool:• Academic achievement• Perceived school

connectedness• School effort/interest

Peers:• Peer disapproval of risks• Pro-social peers

Indepth understanding

Identifying the participants’ experiences enables the

program design to best reflect ‘real world’ experiences

(Perry, 1999).

METHOD

• 30 high risk youth in non-mainstream schools (23 males)

• Semi-structured with open-ended prompts

• 4 focus group discussions

Findings– Motorbike, bicycle,

skateboard, car use– Violent Behaviour– Mostly minor injuries,

some exceptions

“they will find any excuse for drinking and if they don’t have one, they’re excuse is they wanna get drunk”

“yeah, he got knocked out, it was quite funny, probably for about half an hour, he was driving up (the track) on his motorbike and he got hit by a rock, he had his open face helmet on”

“a mate of mine caught fire…the bike was on flames”

“she had a miscarriage” (as a passenger in a stolen car that crashed)

A large scale workshop

• Participants were 42 teachers/ school staff and 8 education department administrators

• Series of discussions regarding best implementation/ delivery methods for a high school injury prevention program & suggestions for content

Intervention methods and processes• Intervention needs to be engaging, interactive and non-

traditional, employing a variety of stimulus• Must be implemented across the board and integrated into

the school curriculum. Some contents should be assessable.

• A Professional Development component is considered important.

• Program should offer teachers greater support in the classroom context.

Youth Risk Taking WorkshopKey Feedback

Comments on Materials

• Specific aspects of delivery discussed, e.g. formatting and layout of materials, unrealistic to include audiovisual/ computing components

• Some examples could be added, e.g. support services within specific schools

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How is SPIY taught?• Integrated with the curriculum

• Taught by teachers trained in program delivery and connectedness

• Year 9 Health Education• 8 x 50 minute lessons (approximately 1 school term)• Formally assessed

• Age-appropriate (research based1)• Personally, developmentally and culturally relevant• Interactive discussions based on scenarios• Practical exercises

1Buckley (2005); Buckley (2006); Sheehan & Chapman (2005); Chapman & Sheehan (2005)

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Typical lesson structure

5-10 mins Risk taking and injury scenario

Brief story of friends’ risk taking and injury to contextualise learning (e.g. getting in car with underage driver)

20-25 mins First aidPractical responses for dealing with injury (e.g. treating fractures/ bleeding; resuscitation)

20-25 mins PreventionSkills to prevent own and friends’ risk behaviour and injury; increasing protective behaviour

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Example lesson Lesson 8 summarised

5-10 minsRisk taking and injury scenario: Lift Home

Students read story: Lift Home (friends taking a lift home from a party)

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Worksheet – Head, Neck & Spinal InjuriesUse the Facts Sheet – Head injuries and Spinal injuries to answer the questions below.

1. If you’re first on the scene what’s the first thing you should check?2. Shannon’s checked the scene for any danger and thinks it’s safe, what should Shannon check next?3. Lee responds and is breathing, how still should Shannon keep the head and neck?4. Should 000 or 112 (mobile) be called urgently?

20-25 minsFirst aid: Head, neck & spinal injury treatment

Students taken through fact sheets and complete worksheet on head, neck and spinal injury treatment

Example lesson Lesson 8 summarised

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20-25 minsPrevention: Getting help & Helping mates

Discussion on importance of getting help when alcohol is involved; Helping mates worksheet

I could...Worksheet – Helping matesWhat could you do if you were Lee that night?

What’s good about that option…

What’s bad about that option…

How good is that decision…

Example lesson Lesson 8 summarised

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Student work