Investigating the implementation and impact of participation in a health promotion programme on the social attitudes and behaviours of children in New Zealand schools

Abstract

The social health and wellbeing of vulnerable children in New Zealand, particularly those from low-decile neighbourhoods, is not ideal. The New Zealand government and the New Zealand public have called for educators to redress this issue through the delivery of a comprehensive school-based health education programme. To date, however, little is known about the implementation or outcomes of participation in school-based health education classes, most notably under low-decile, highly transient school conditions. This PhD thesis, therefore, investigated the implementation of the traditional health education curriculum and, subsequently, evaluated the impact of participation in an externally provided health promotion programme on the social attitudes and behaviours of children attending low-decile primary and intermediate schools around the country. The results of the traditional health education study indicated that teachers (n = 198) were delivering social health education classes infrequently, if at all, and that many schools (n = 61) were using external providers for social health education provision. The implementation of one externally provided programme, Kiwi Can, was then explored and a stratified sample of Year 4-6 students (n = 319) reported that Kiwi Can was being delivered with fidelity, adherence to participant responsiveness, and to a high standard (quality) in all participating regions. It was followed by a longitudinal, quasi-experimental outcome evaluation in which pre-post survey data were gathered from control (n = 456), new Kiwi Can (n = 464), and experienced Kiwi Can (n = 299) school students. Significant differences in self-reported prosocial attitudes and behaviours were explored as a function of school condition and transience level using confirmatory factor analysis and structural equation modelling techniques. A hierarchical, autoregressive structural model most closely fit the data. Further, subscale means for measures of positive social attitudes and behaviours (PYD) and classroom climate (CC) decreased for all three groups over time. They decreased significantly more for new Kiwi Can students than for experienced Kiwi Can students under highly transient school conditions. These results suggest that sustained participation in Kiwi Can may have attenuated the negative effects that a highly transient environment had on the social attitudes and behaviours of vulnerable children who were not themselves transient. This finding has significant implications for both the design and delivery of school-based, social health promotion programming for children.