HLTH 434 Measurement in Health Education Discussion

652432 research-article2016 HEJ0010.1177/0017896916652432Health Education JournalGarnett et al. Original Article A mixed-methods evaluation of the Move it Move it! before-school incentive-based physical activity programme Health Education Journal 2017, Vol. 76(1) 89­–101 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0017896916652432 journals.sagepub.com/home/hej Bernice R Garnetta, Kelly Beckerb, Danielle Vierlingc, Cara Gleasonc, Danielle DiCenzod and Louise Mongeonc aDepartment of Education, University of Vermont, Burlington, VT, USA of Educational Leadership and Policy Studies, University of Vermont, Burlington, VT, USA cIntegrated Arts Academy, Burlington, VT, USA dDepartment of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA bDepartment Abstract Objective: Less than half of young people in the USA are meeting the daily physical activity requirements of at least 60 minutes of moderate or vigorous physical activity. A mixed-methods pilot feasibility assessment of Move it Move it! was conducted in the Spring of 2014 to assess the impact of a before-school physical activity programme on student academic measures and behavioural health. Design: Move it Move it! encourages students and families to run/walk laps in the recess yard. Student miles are tracked and incentives are awarded at several benchmarks Setting: Launched in 2012, Move it Move it! is a voluntary morning running/walking programme at the Integrated Arts Academy (IAA) elementary school designed to build community, increase fitness and prepare students for learning. Methods: Self-reported surveys were administered to all consented students in grades 3–5 (N = 129). Semistructured interviews were conducted with school personnel (N = 11). Results: Average Move it Move it! miles ran/walked were significantly positively associated with commitment to school and The New England Common Assessment Program (NECAP) mathematics testing scores. Interviews with school staff/faculty further explained quantitative results including the perceived impact of the programme on academic success and school engagement and the perceived impact of the programme on student behaviour and school climate. Conclusion: Results from this pilot assessment of a community-based initiative suggested that positive academic and behavioural outcomes were associated with engagement in a before-school incentive-based physical activity programme. Keywords Academic performance, before-school physical activity, bullying, Move it Move it!, USA Corresponding author: Bernice R Garnett, Department of Education, College of Education and Social Services, University of Vermont, 533 Waterman Building, 85 South Prospect Street, Burlington, VT 05401, USA. Email: bgarnett@uvm.edu 90 Health Education Journal 76(1) Introduction In order to address the need for increased physical activity programming at a local magnet school1 in Burlington, Vermont, an unstructured before-school physical activity programme, Move it Move it!, was jointly developed by several school stakeholders, including the physical education (PE) teacher, the school nurse and the school social worker. The aim of the programme was to build community, increase fitness and better prepare students for learning. Through the application of community-based participatory evaluation methods (Braithwaite et al., 2013), key school stakeholders and community members worked collaboratively to assess the impact of the Move it Move it! programme. This ensured reciprocity between research activities, community engagement and ownership and the application of assessment findings (Wallerstein and Duran, 2006). Background Childhood obesity remains a national priority for the USA and pressing global public health issue, with 31.8% of US children aged 2–19 being either overweight or obese in 2012 (Ogden et al., 2014; Wang and Lim, 2012). Additionally, the documented socio-economic gradient in excess weight is apparent even in childhood (Singh et al., 2010). Obese children are more likely to experience depression, low self-esteem, bullying and social exclusion compared to their healthy weight counterparts (Lumeng et al., 2010). Furthermore, overweight children have significantly lower mathematics and reading scores compared to their healthy weight peers and exhibit generally lower levels of cognitive functioning (Judge and Jahns, 2007). Currently, less than half of US youth are participating in the recommended levels of daily physical activity requirements of at least 60 minutes of moderate or vigorous physical activity (Centers for Disease Control and Prevention [CDC], 2012), which is a significant behavioural contributor to excess weight among youth. Furthermore, the proportion of children that meet these requirements declines with age (Kohl and Cook, 2013).

Because of this, physical activity interventions targeting young children have the potential to impact physical activity patterns and habits as children develop. Since the passage of the No Child Left Behind Act in 2001 in the USA, the percentage of schools offering PE at least three times a week has declined dramatically, with nearly half of school administrators reporting significant cuts to PE, recess and art to increase time in reading and mathematics (Kohl and Cook, 2013). Moreover, school-based PE classes cannot be the exclusive outlet for daily physical activity given that in the best case scenario young people are engaging in 10–20 minutes of moderate to vigorous activity per session (Bassett et al., 2013). In addition to the physical and mental health benefits of increasing daily physical activity, research has documented the association between physical fitness and physical activity on academic achievement and school success (Castelli et al., 2007; Lees and Hopkins, 2013). Cardiovascular fitness appears to have the strongest relationship to academic performance, specifically to mathematics (Chomitz et al., 2009; Van Dusen et al., 2011).

Extending beyond the physical health and academic domains, there is also evidence linking physical activity to several behavioural and psychosocial factors. Physical activity patterns have been associated with and influenced by several psychosocial variables including individual selfefficacy and social support (Dishman et al., 2009). Emerging evidence also suggests that physical activity interventions may positively impact peer behaviour and school climate through decreased bullying behaviours and increased school connection (Bleeker et al., 2012; Fortson et al., 2013). A before-school physical activity programme is an innovative intervention to increase daily physical activity expenditure of school age-children as children’s physical activity levels are influenced by the opportunities and environment in which they can be active (Mahar, 2011). Prior Garnett et al. 91 research has examined the effects of after-school physical activity programmes, active transport initiatives, as well as classroom-based physical activity programmes, particularly at the elementary school level, on student academic and physical health outcomes (Donnelly and Lambourne, 2011; Kibbe et al., 2011). Less research has focused on the impact of before-school physical activity programmes on academic, physical and behavioural indicators among elementary age youth (Smith et al., 2013; Tompkins et al., 2012).

Building on this mounting research base, this mixed-methods pilot feasibility assessment reciprocally designed and implemented with community partners and provided preliminary results on the relationship between an unstructured low-cost before-school incentive-based physical activity programme across three domains of child health and development: physical, social and academic in a historically underperforming elementary school. Methods Move it Move it! programme description Launched in 2012, Move it Move it! is a voluntary morning running and walking programme designed to build community, increase fitness and better prepare students for learning at the Integrated Arts Academy (IAA). In 2009, IAA became Vermont’s first elementary magnet school, an initiative designed to improve the neighbourhood school, which was failing and underperforming. Burlington is a refugee resettlement city and many refugee families have children that attend IAA. Move it Move it! aims to encourage students, families and school staff to run/walk laps in the recess yard on Monday, Wednesday and Friday from 7:45 a.m. to 8:10 a.m. Individual miles are tracked and student incentives are awarded at several benchmarks: 1 mile = a pencil, 5 miles = a sports bracelet, 10 miles = a water bottle, 25 miles = a T-shirt, 50 miles = a pedometer and ball, 75 miles = a field trip and 100 miles = a medal and name on a community-developed banner housed in the gym. Each Friday at the all school meeting, students’ progress is acknowledged. Those who achieve the revered milestone of 50 miles are welcomed to dance in front of the whole school community with their fellow peers, teachers and classmates. A formal research partnership with the University of Vermont was established in the autumn of 2013 to systematically assess the impact of the programme on student behaviour and academic outcomes as well as overall school climate. Study design A mixed-methods pilot feasibility assessment of the programme was conducted in the spring of 2014. This assessment employed a sequential explanatory mixed-methods design, where the quantitative surveys were administered and analysed prior to the qualitative interviews, which were used to help interpret and extend the results of the quantitative surveys (Clark and Creswell, 2011). The specific aim included to assess the impact of Move it Move it! on (1) academic achievement, (2) social relationships and school engagement and (3) physical health indicators including body mass index (BMI) and self-esteem. Self-reported surveys were administered to all consented students in third, fourth and fifth grades in the spring of 2014. All school parents/caregivers received an informational flyer about the research study and parental consent was obtained through an optout approach. In order to assess the perceived impact of the programme by school staff, semistructured key informant interviews were conducted with classroom teachers and school administrators (N = 6) and with the programme implementation team (N = 5) in the spring of 2014. The Institutional Review Board of the University of Vermont approved all research-related activities. For an overview of the indicators used in the assessment study and sequencing of data collection methods, see Table 1. 92 Health Education Journal 76(1) Table 1. Timing of key measures in the feasibility assessment of Move it Move it!. Existing data Primary data collection Timing of data collection Physical/behavioural BMI Self-esteem Miles walked/ran Move it Move it! saliency Bullying X X X X Academic Self-efficacy for self-regulated learning Mathematics and reading academic X testing Commitment to school Supportive school climate Socio-demographics Grade Gender Home language Free/reduced lunch status X X X X X X Fall 2013 Spring 2014 Spring 2014 Spring 2014 Spring 2014 Spring 2014 Fall 2013 Spring 2014 Spring 2014 Spring 2014 Spring 2014 Spring 2014 Fall 2013 BMI: body mass index; math: mathematics. Measures Academic achievement and school success. The New England Common Assessment Program (NECAP) mathematics and readings scores were obtained for all consented students from existing school records collected in the Fall of 2013. NECAP proficiency is evaluated based on receiving an individual score ⩾40. NECAP testing scores were modelled as continuous variables in the student self-administered survey.

To measure various aspects of the multi-dimensional constructs of school engagement and connection with school, we included previously validated scales measuring commitment to school, a supportive school climate and self-efficacy for self-regulated learning (Austin and Duerr, 2005; Thornberry et al., 1991; Usher and Pajares, 2008). The commitment to school scale was originally developed and implemented in the Rochester Youth Development Study and is a 7-item scale with 4-point response options that measure intrinsic motivation for school work and connection with school (Smith et al., 1995; Thornberry et al., 1991, 2003). Example items include ‘I try hard at school’ and ‘Getting good grades is important to me’. Scores on the 7-item scale were tallied to create a summary score modelled as a continuous variable with higher scores representing higher levels of commitment to school. The supportive school climate scale developed by Austin and Derr, extensively used in the California Healthy Kids Surveys, is an 8-item scale that measures the extent to which students perceive that adults in their school respect them, care about students and want them to do well. Example items include ‘Adults at my school care about all students’ and ‘My teachers respect me’. Scores on the 8-item scale were tallied to create a summary score modelled as a continuous variable with higher scores representing higher levels of supportive school climate.

Self-efficacy for self-regulated learning (Usher and Pajares, 2008) represents a 5-item scale in which students respond to a series of questions that ask them the degree to which certain schoolrelated behaviours are challenging, such as ‘Is it hard to finish your homework?’ and ‘Is it hard to focus on your school work?’ Scores on the 5-item scale were tallied to create a summary score in Garnett et al. 93 which higher scores represent lower self-efficacy to complete school-related behaviours. Based on conversations with IAA community partners, we adapted the 4-point Likert response structure used in the aforementioned scales as our partners felt that this response option structure did not align with their student population. We created four response options: ‘yes, no, maybe and I don’t know’ and also included representative smiley face emoticons within each of the response options to further illustrate the meaning associated with each response option. We preserved the original response options in all analyses with these scales. We piloted our updated scales with three elementary school children from another school in Burlington to assess comprehensibility and face validity of our modifications. Move it Move it! programme saliency and miles ran/walked. To assess student attitudes and perceptions of programme saliency, we created a 7-item scale based on previous research on programme saliency (Garnett et al., 2014), using the same four response option structure, ‘yes, no, maybe and I don’t know’. Sample items included the following: ‘Move it Move it! is really important to me’; ‘I have a better day after Move it Move it!’; ‘I can control my body after Move it Move it!’ The Move it Move it! saliency scale demonstrated adequate internal consistency reliability in our sample, Cronbach’s alpha = .81. At each Move it Move it! session, student miles ran/walked were tracked by the IAA implementation team and stored on a master school database. We obtained Move it Move it! miles ran/walked from all consented students. Move it Move it! miles ran/walked were modelled as a continuous predictor in all analyses. Physical and behavioural health. We obtained height and weight measurements, administered by the school nurse, for the autumn 2013 academic year (year of assessment) from school records. Students’ BMI was calculated following procedures and gender–age specific growth charts from the US CDC.

Involvement in bullying victimisation and perpetration in the past month was assessed using Cornell’s school climate bullying survey (Cornell, 2015). Response options included the following: ‘never, once or twice, about once a week, and several times a week’. In the final analyses, we collapsed ‘about once a week’ and ‘several times a week’ to represent frequent involvement in bullying victimisation and perpetration. Self-reported self-esteem was measured by Rosenberg’s Self-Esteem Scale (RSE), a widely used global self-esteem scale with previously demonstrated reliability and validity (Rosenberg, 1965). HLTH 434 Measurement in Health Education Discussion

A combined score of the 10-item scale was calculated for individual students, where higher scores indicated higher levels of self-esteem, ranging from 0 to 3, 22.4 (mean [M]) and 6.2 (standard deviation [SD]). Socio-demographic characteristics. On the self-administered survey, students indicated their gender, grade in school and language that they spoke ‘at home most of the time’. Free and reduced lunch status was obtained for all consented students through 2013–2014 school intake records collected and managed by IAA administration. Analysis Descriptive statistics for all variables of interest were calculated. Correla