MATH Kids: Moving And Thinking for Healthy Kids Heidi Knoblock Behavioral, Social, and Community Health Synthesis Project April 12, 2013

Transcription

1 MATH Kids: Moving And Thinking for Healthy Kids Heidi Knoblock Behavioral, Social, and Community Health Synthesis Project April 12, 2013

2 Part 1 Community and Context The targeted community includes third, fourth, and fifth grade classrooms at Lulu M. Stevens Elementary School in Houston, Texas. Lulu M. Stevens Elementary, commonly referred to as Stevens, is a Title 1 school in the Houston Independent School District (HISD). Total enrollment typically ranges from 630 to 700 students (Stevens Elementary, 2013). With regard to academics, Stevens typically receives annual academic ratings of Academically Acceptable or Recognized, indicating the need to improve academic performance to achieve the highest rating of Exemplar (TEA, 2012). These ratings are primarily determined by the scores third, fourth, and fifth grade students receive on the State of Texas Assessments of Academic Readiness (STAAR) examination. As a result, there is an emphasis on improving performance on standardized tests and it is common for students in these grades to spend their recess and physical education (PE) time in tutoring sessions or extended class periods. Reduced PE time also occurs because of the lack of a gym space to exercise, which is especially problematic during inclement weather. Although Texas requires elementary schools to provide at least 135 minutes of structured physical education each week, students in third, fourth, and fifth grades at Stevens Elementary have PE class for only 45 minutes each week (NASPE & AHA, 2010). Furthermore, students typically have a 30-minute recess 1-2 times per week, if at all. Agency and Role I have been hired as the HISD Wellness Coordinator. I have many responsibilities related to improving nutrition, physical activity, and overall wellness in elementary, middle, and high schools within the district. For this particular intervention, I will be conducting a pilot test at Stevens Elementary to see if MATH Kids, a math curriculum that incorporates physical activity into each lesson, increases the amount of time students spend engaging in physical activity while maintaining high math performance. I will be responsible for modifying the current math curriculum, envisionmath, to include physical activity in all of the lessons. If successful at Stevens Elementary, this adapted curriculum will be delivered in other elementary schools in HISD. Scope and Importance of Health Issue Childhood obesity in the United States has more than tripled over the past four decades (Ogden & Carroll, 2010). According to the National Health and Nutrition Examination Survey, nearly 18% of youth ages 6-11 living in the United States are obese (Ogden & Carroll, 2012). Childhood obesity is associated with health consequences including high blood pressure, high cholesterol, type 2 diabetes, fatty liver diseases, and depression (Whitlock et al., 2005; Freedman et al., 2007). Furthermore, children who are obese are more likely to be bullied, have lower academic performance, experience a shorter life, and become overweight or obese adults (Lumeng et al., 2010; Taras & Potts-Datema, 2005; Franks et al., 2010; Whitlock et al., 2005; Freedman et al., 2007). Because of the increasing rates of obesity among this age group and multitude of health consequences associated with obesity, it is imperative that the current childhood obesity trend is reversed. Priority Group Description MATH Kids has been developed for children who are between eight and eleven years old. This age group not only has high rates of overweight and obesity, but also includes children in grades where physical education and recess opportunities are limited. Approximately 83% percent of students are Hispanic, 11% are African American, and 5% are White. Additionally, 95% of 2

3 students received free or reduced lunch during the school year (Stevens Elementary, 2013). Behavior Description MATH Kids aims to increase daily physical activity in the classroom by 10 minutes. Physical activity can reduce the risk of childhood overweight and obesity. Short exercise sessions of as little as ten minutes have been shown to have health benefits (CDC, 2012b; DHHS, 2008). The United States Department of Health and Human Services recommends that people ages 6-17 be physically active for at least sixty minutes each day (DHHS, 2008). Walking, running, playing outside during recess, and jumping are activities children can perform to meet this daily requirement. Outside of school, youth ages 8-18 typically spend 7.5 hours a day engaging in sedentary activities including watching television and movies, playing video games, and using the computer (CDC, 2012b). It is critical, then, to engage students in physical activity as much as possible at school, as the time out of school likely does not include much physical activity. Because physical activity is not being provided regularly in PE class or during recess, there is a need to incorporate physical activity at other times during the school day to meet the recommended 60 minutes of physical activity each day. Determinants Description Physical activity levels of eight to eleven year old children may be determined by a number of developmental, environmental, psychological, social, and demographic factors. Sallis, Prochaska, and Taylor (2000) found that sports competence, perceived barriers to physical activity, access to play spaces and equipment, and time spent outdoors were significantly associated with being physical active as a 3-12 year old. Kohl and Hobbs (1998) confirmed these results and suggested that conditions in the school environment can have a major role in determining the physical activity levels of youth. For example, they determined that the substitution of recess for PE and the lack of PE classes were significantly associated with being inactive (Kohl & Hobbs, 1998). They also found that beliefs about physical activity and the amount of time children and adolescents spend watching television are associated with physical activity levels (Kohl & Hobbs, 1998). Interventions Description Several interventions exist that aim to increase the amount of time elementary students spend engaging in physical activity during the school day. For example, PE2GO and SPARK are two evidence-based physical education curriculums that are designed for PE specialists and non-pe teachers to implement in the classroom (Sallis et al., 1999; Martine, Martin, & Rosengard, 2010). These curriculums have been thoroughly evaluated and have been implemented in schools that have limited physical activity opportunities. An evaluation of SPARK demonstrated that students who participated in the program were physically active for more minutes a week than students who did not participate in the program (Sallis et al., 1999). Similarly, an evaluation of PE2GO demonstrated that students who participated in the program increased the time spent being physically active by 52 minutes a week (Martine, Martin, & Rosengard, 2010). Thus, it is clear that these physical education curriculums positively affect the amount of time students spend engaging in physical activity. Despite their effectiveness, both programs require a substantial amount of teacher training to implement, do not address state-specific physical education standards, and still take away time that could be spent on other academic subjects. Another intervention, Take 10!, has been developed to incorporate short physical activities into traditional classroom subjects including language arts, math, science, social studies, and general health (ILSI Research Foundation, 2012). Take 10! has been shown to not only increase physical 3

4 activity levels, but also improve academic performance (Hollar et al., 2010). Despite its success, Take 10! is a curriculum that teachers must learn to implement, on top of the other curriculums they are already required to use. Furthermore, Take 10! is not aligned to specific state educational standards and may not be relevant for all objectives. Its proven effectiveness, however, demonstrates that classroom teachers can be a useful agent for implementing classroom-based physical activity curriculums. Part 2 MATH Kids is a standards-based mathematics curriculum for third, fourth, and fifth grade students that incorporates physical activity in all lessons. The curriculum is based on the envisionmath mathematics curriculum that is already being used in elementary schools throughout Houston Independent School District (HISD). Instead of using traditional textbooks and worksheets to help students retain the information that is taught, MATH Kids provides individual and group physical activities for each lesson, to reinforce the taught material while simultaneously providing physical activity for students. Each activity provides ten minutes of moderate physical activity, uses existing or inexpensive resources, is adaptable for varying academic and exercise abilities, and is easy for teachers to implement in a classroom setting. The MATH Kids Pilot Test proposed in this document will be conducted at Stevens Elementary School to determine the feasibility of implementing the program in other elementary schools in HISD. The MATH Kids program includes a training guide for teachers and administrators, a standards-based math curriculum, and physical activity guides and templates for each lesson. 1. Identify basic theories, concepts, and models from a range of social and behavioral disciplines that are used in public health research and practice. Theories, concepts, and models are useful because they serve as a road map for learning about a problem (DHHS, 2005). Theories can be used to understand behaviors, the factors that influence them, the processes for changing them, and outcomes to evaluate success (DHHS, 2005). To identify basic theories, concepts, and models that are used in childhood obesity research and practice, I will conduct a thorough literature review. I will use key search phrases such as childhood obesity interventions, school-based interventions, and youth physical activity interventions to understand the kinds of theories and models that have been used to develop successful childhood obesity prevention programs. The Theory of Reasoned Action (TRA), for example, serves as an appropriate theoretical foundation for MATH Kids. This theory states that the most important determinant of behavior is an individual s intention to perform the behavior, with attitude and subjective norm affecting intention (DHHS, 2005). In the case of MATH Kids, a student s intention to be physical active will be determined by the individual s attitude about being physical active and his/her perception about whether or not being physically active is socially acceptable. By creating activities that are fun, exciting, and emphasize teamwork, MATH Kids will target student attitudes and subjective norm, ultimately affecting intention to be physically active. In addition to TRA, a logic model will be useful to summarize the desired outcomes, targeted behaviors, methods, and materials needed to implement MATH Kids (Bartholomew et al., 2011). 2. Identify the social and behavioral determinants that affect health of individuals and populations. Social and behavioral determinants are factors that cause or influence a particular outcome or behavior (Glanz, Rimer, & Viswanath, 2008).To understand the social and 4

5 behavioral determinants of being physically active, I will interview teachers, school administrators, parents, students, and health professionals who work with children. For example, I will interview Lucy Anderson, the principal at Stevens, and Nora Ryan, a fourth grade teacher. These individuals will be able to provide a wide array of reasons for why students do not engage in physical activity for the recommended 60 minutes each day as well as barriers to providing physical activity during the school day. Initial research with Shane O Neal, a teacher at Stevens, suggests that a lack of supervision, area for safe recreation, and organized sports affects students ability to be physically active outside of school. He also indicated that barriers to physical activity during the school day include a lack of time and equipment, the structure of the school day, other academic priorities, minimal outdoor facilities, and reduced recess time (S. O Neal, personal communication, March 31, 2013). MATH Kids addresses several of these determinants (e.g. lack of time and equipment, other academic priorities) by providing the resources to easily incorporate physical activity into an already established priority academic subject. By addressing these determinants, MATH Kids is more likely to increase the amount of time students spend participating in physical activity during the school day. 3. Use information from individual, organization, and community concerns, assets, resources, and deficits to plan community-based public health programs, policies, and interventions. Using information from community concerns, assets, resources, and deficits to plan programs allows for programming that is locally relevant, feasible to implement, and sustainable. To gather this information, I will conduct a thorough needs assessment using surveys and focus groups. I will survey the principal, Lucy Anderson, and assistant principal, Bernadette Williams, and teachers at Stevens to learn about their perceptions of students current physical activity levels, how often students attend PE and recess, the extent to which teachers are already incorporating physical activity into classroom activities, and existing resources and deficits. For example, existing resources include the envisionmath curriculum and a strong parent network whereas deficits include temporary ( trailer ) classrooms with limited space and a lack of healthy adult role models at school. Additionally, I will conduct three focus groups: One group will be comprised of teachers from all grade levels, another group will involve potential participants, and the final group will include parents and community members. Individuals from local public health and children-specific organizations will be encouraged to attend the parent and community members focus group. These focus groups will gauge interest in the program, understand concerns, and provide a forum for suggestions. 4. Use input from critical stakeholders to plan community-based public health programs, policies, and interventions. Many stakeholders will be involved during the planning stage from the fields of education, kinesiology, and public health. Some stakeholders will be consultants whereas others will serve on an advisory board. Stakeholders will include third, fourth, and fifth grade teachers, Lucy Anderson (principal), Bernadette Williams (assistant principal), school district administrators such as Terry Grier (superintendent), curriculum development specialists, representatives from Pearson Education (the publisher for envisionmath ), Jay Larson (PE teacher), physical activity experts such as kinesiology professors, public health professionals, and parents. These individuals will be invited to participate via phone or . The advisory board will be composed of approximately ten members. Participants will include a fifth grade student, a third, fourth, and fifth grade math teacher, Lucy Anderson (principal), a district-level administrator, a public health professional with experience providing 5

6 physical activity to children (someone from the YMCA, for example), a parent, a representative from Pearson Education, and a curriculum development specialist. Consultants will include professors at a local university such as Rice University, University of Houston, or Texas Southern University. These individuals will assist in developing age-appropriate activities that provide moderate physical activity for students. They will be encouraged to use the intervention as a research project and publish the results in a peerreviewed journal under their name. The advisory board members and consultants will provide diverse perspectives, help tailor MATH Kids to Stevens unique needs and resources, and facilitate buy-in from major stakeholders. Ultimately, this will result in easier implementation, more successful outcomes, and sustainability of the program. 5. Apply established steps and procedures to plan community-based public health programs, policies, and interventions. I will use the steps of Intervention Mapping as a guide for planning the development of MATH Kids. I have outlined below the six steps of Intervention Mapping and corresponding actions (Bartholomew et al., 2011). Step 1 - Conduct a Needs Assessment: A needs assessment will be used to create a planning group, determine the need for MATH Kids, assess Stevens ability to implement the program, and determine the desired outcomes (Bartholomew et al., 2011). The needs assessment for MATH Kids will consist of surveying teachers and administrators and conducting focus groups with students, teachers, parents, and community members. Additionally, the needs assessment will involve an extensive review of the literature. Sample research questions include: What interventions currently exist that provide physical activity opportunities in the classroom? What are the barriers and supports to being physically active in the classroom? What are current physical activity levels of children ages eight to eleven years old? What are the environmental and behavioral determinants of being physically active during the school day? This information will be used to develop a logic model of the relationship between childhood obesity and physical activity and to determine the primary health, behavioral, and environmental outcomes of MATH Kids (Bartholomew et al., 2011). A primary health outcome of MATH Kids is increased healthy weight status, a behavioral outcome is increased physical activity, and an environmental outcome is increased administrative support for physical activity in the classroom. As mentioned previously, an advisory committee of relevant stakeholders will be created to assist in planning and conducting the needs assessment. Step 2 - Create Change Matrices: This step involves stating the behavioral and environmental outcomes, developing performance objectives, selecting determinants, and creating a matrix of change objectives (Bartholomew et al., 2011). The table below displays example outcomes, performance objectives, determinants, and change objectives that may be included in the MATH Kids change matrix. Table 1: Outcomes, Performance Objectives, Determinants, and Change Objectives Outcome Performance Objective Determinant Change Objective Increased physical activity (behavioral) Students engage in physical activity for at least 10 minutes Self-efficacy (to perform the Demonstrate the ability to perform the activities Increased administrative support for physical activity in the classroom each day during a math lesson The superintendent establishes structures to implement MATH Kids in additional elementary activities) Attitude (toward incorporating physical activity into Express a positive attitude toward incorporating physical activity into the 6

7 (environmental) schools in the district math lessons) classroom Step 3 - Select Methods and Applications: The next step involves identifying theoretical methods, choosing program methods, and selecting practical applications that are associated with the change objectives (Bartholomew et al., 2011). For example, theoretical methods such as modeling and guided practice (Social Cognitive Theory) would be used to affect the change objective, demonstrate the ability to perform the activities. Each MATH Kids activity would involve practical applications such as the teacher modeling the physical activity followed by the students doing the activity with the teacher (guided practice). This would build the students confidence in their ability to do the activity without assistance. To affect the change objective, express a positive attitude toward incorporating physical activity into the classroom, theoretical methods such as environmental reevaluation (Trans-theoretical Model) or discussion (Theories of Processing Information) could be used (Bartholomew et al., 2011). A practical application such as a discussion about the benefits of physical activity in the classroom could be incorporated into the MATH Kids training for administrators to address this change objective. Step 4 - Translate into Programs and Materials: This step requires developing a program theme, determining the scope and sequence, creating a list of needed materials, reviewing available materials, and developing, pilot testing, and revising the materials (Bartholomew et al., 2011). Materials for MATH Kids include a training guide for teachers and administrators, a standards-based math curriculum (envisionmath ), and physical activity guides and templates for each lesson. The advisory board and consultants will be involved in the development of these program materials. Specific activities and templates will be pre-tested with students to make improvements. Because this intervention is a pilot test for MATH Kids, the materials will be further revised based on the evaluation at the end of the program. The revised version of MATH Kids will then be offered to other elementary schools throughout the district. Step 5 Plan Adoption, Implementation, and Sustainability: After the program has been developed, tested, and revised, I will identify potential adopters (Bartholomew et al, 2011). Stevens Elementary has already been selected to implement MATH Kids for this pilot test, but additional teachers, principals, or superintendents in other schools or districts may be future adopters of the program. For example, charter districts such as KIPP and YES Prep may be interested in the program. Furthermore, after school programs and tutoring services may also find MATH Kids activities useful for reinforcing mathematical concepts. Step 6 Generate an Evaluation Plan: As part of the evaluation, I will review the logic model to ensure the evaluation measures the desired outcomes, write process and outcome evaluation questions, develop indicators and measures, and specify an evaluation design (Bartholomew et al., 2011). The following table provides possible outcome and process evaluation questions for MATH Kids and their corresponding indicators. Table 2: Evaluation Questions and Indicators Evaluation Question By how many minutes did MATH Kids increase the amount of time students spend engaging in daily physical activity? (Outcome) How many times per week did teachers implement MATH Kids? (Process) Indicator Number of minutes students spent participating in MATH Kids activities each day (as reported by a teacher survey) Number of times teachers implemented MATH Kids each week (as reported by a teacher survey) The design of the MATH Kids evaluation will be determined by input from relevant evaluation stakeholders such as Pearson Education and the funding organization (e.g. Texas Department of 7

8 Education). The design will include quantitative and qualitative components such as teacher surveys that are collected before, during, and after the program and administrator surveys that are collected before and after the program. 6. Outline behavioral, social, and community interventions that cover multiple levels in the ecological framework that address multiple behaviors, and that include policy and environmental as well as individual change. The ecological model includes the following levels: Individual, interpersonal, organization, community, society, and supranation (Bartholomew et al., 2011). The model is useful for understanding the interactions between individuals and the environment and the interrelationships that exist between them (Bartholomew et al., 2011). The following table highlights how MATH Kids addresses the individual, interpersonal, and organizational levels of the ecological model: Table 3: Levels of the Ecological Framework Level of MATH Kids Description Ecological Model Individual The activities in which students participate will increase knowledge of safe physical activity practices and be fun and exciting, therefore changing attitude. Interpersonal Many activities focus on students working together as a group and supporting each other during the activities. Organization The MATH Kids training that teachers and administrators attend will provide information on the importance of daily physical activity. This, in turn, may contribute to the development of school-level policies that support physical activity in the classroom. Behaviors Addressed Being physically active Being physically active Encouraging healthy behaviors Establishing policies to increase physical activity during the school day MATH Kids primarily targets one behavior: Physical activity. However, the intervention strives to change the school environment by promoting school-level policies that increase physical activity opportunities throughout the school day. Therefore, additional behaviors include encouraging healthy behaviors and establishing policies that promote physical activity. 7. Develop social and behavioral interventions, policies, and programs that are grounded in theory, supported by evidence, and based on input from the community. Theories are used as road maps to understand how to change behavior (DHHS, 2005). Equally important to theory is the context in which the intervention is delivered. Thus, designing interventions using theory and input from the community ensures the intervention not only targets the desired behavior, but is also realistic and feasible in that community. To ensure MATH Kids is grounded in theory, I will conduct a literature review to identify theories that have commonly been used to understand physical activity behaviors. Additionally, I will utilize the steps of Intervention Mapping to select theoretical methods that address the desired change objectives. To ensure MATH Kids is supported by evidence, I will use best practices in physical activity as determined by well-respected entities including the Centers for Disease Control and Prevention and the American Alliance for Health, Physical Education, Recreation, and Dance. For example, I will consult the reference, Strategies to Increase Physical Activity among Youth that was recently published by the United States Department of Health and Human Services (DHHS, 2013). Finally, to ensure MATH Kids is based on input from the community, I will 8

9 create an advisory board of relevant stakeholders to assist in the development, implementation, and evaluation of MATH Kids and consult with local youth physical activity experts to ensure the activities developed are safe, age-appropriate, and effective at increasing physical activity among youth. 8. Develop and adapt approaches that acknowledge the role of cultural, social, and behavioral factors in public health practice. A culturally sensitive program embraces diversity, incorporates cultural knowledge into program elements, recognizes aspects of culture than can affect health and behavior, and is adaptable to various cultures (Augustine, 2004). Because MATH Kids will primarily be delivered to Hispanic and African American students, the included material and activities will be relevant to these cultures. As part of the needs assessment student focus group, I will ask participants to describe the kinds of exercises they enjoy and feel comfortable doing. This will provide information about the types of activities that could be part of MATH Kids. Additionally, I will incorporate two or three physical activity options in each lesson so the teacher implementing the intervention can choose the most appropriate activity for current participants. Furthermore, activities will have different intensity levels, to allow all students to participate regardless of skill or experience. Finally, all program materials will be developed to reflect the cultural and ethnic diversity of the targeted students. This includes using images that represent African American and Hispanic children and translating program materials into Spanish to ensure the students enrolled in the bilingual program can participate. 9. Apply principles of community-based participatory research to improve health in diverse communities. Community-based participatory research (CBPR) is comprised of the following principles: Collaborative and equitable partnerships, mutual benefit for all partners, community as a unit of identity, utilizing existing resources, promoting capacity of all partners, long-term commitment, local relevance, involvement of all partners in the dissemination process, and a cyclical and iterative process (Israel et al., 2001). Because of the MATH Kids advisory board, there will be continual opportunities for CBPR in all phases of program development. In particular, the advisory board will be involved in the design of the evaluation, and in generating evaluation questions, collecting pre- and post-data, and sharing program results with the community (Israel et al., 2001). By including representatives from various sectors of the local community, these individuals will be aware of existing resources and infrastructures that can support MATH Kids. Furthermore, the advisory board will be consulted regularly during program development to continually improve the process and develop strategies for sustainability. Partners will benefit in several ways including media recognition, networking with other professionals, and using the evaluation results for research or publication purposes. 10. Use input from critical stakeholders to evaluate community-based public health programs, policies, and interventions. Many of the same stakeholders that were involved in the planning stage will also be involved during the evaluation of the program. Instead of emphasizing the development of the intervention, however, evaluation stakeholders will focus on whether or not the program met the established goals and objectives or was implemented fully. These individuals will be identified and selected early in the program development process (Bartholomew et al., 2011). I will select stakeholders that are using the evaluation results, those involved in implementing and operating 9

10 the program, those who participated in the program, those who work to prevent childhood obesity, and the organization that provides funding for the program and its evaluation (Bartholomew et al., 2011). For example, the funding organization (e.g. Texas Department of Education), HISD administrators, and publishing companies (e.g. Pearson Education) may want to use the results of the evaluation to justify funding, expand the program to other schools, or publish a curriculum that includes program components. District administrators such as Terry Grier, the HISD superintendent, will likely be more involved in the evaluation stage of MATH Kids compared to the planning stage because of the intervention s potential to be used in several HISD schools. Individuals involved in the implementation of the program will include third, fourth, and fifth grade teachers at Stevens, Lucy Anderson (principal), Bernadette Williams (assistant principal), and those who assisted in developing the program (e.g. physical activity experts, public health professionals, curriculum specialists). Program participants including third, fourth, and fifth grade students will be able to provide valuable input on how to evaluate the program as well as recommendations for improvement. Finally, parents and childhood obesity researchers and professionals are important for bringing a larger context to the evaluation and its potential impact on childhood obesity. I will also contract a statistician from a local university and an evaluation coordinator to assist in the evaluation design, data collection, and analyses. 11. Apply established steps and procedures to evaluate community-based public health programs, policies, and interventions. I will use the Centers for Disease Control and Prevention s Framework for Program Evaluation as a guide to evaluate MATH Kids (CDC, 1999). I have outlined below the six steps of this framework and the plan for using each step: Step 1 Engage stakeholders: To engage stakeholders, I will identify the primary users of the evaluation, the people involved in implementing and operating the program, and the people served by the program (CDC, 1999).The primary users of the evaluation for MATH Kids will likely be a publishing company such as Pearson Education, the funding organization such as the Texas Department of Education, and HISD administrators such asterry Grier, the superintendent. The primary individuals involved in implementing and operating the program include teachers, Lucy Anderson (principal), and Bernadette Williams (assistant principal). Finally the people served by the program will be third, fourth, and fifth graders at Stevens. Step 2 Describe the program: To describe the program, I will come to an agreement with the stakeholders on the need for the program, the expected effects of the program, the specific activities that make up the program, and the resources needed to make the program function as designed (CDC, 1999). For example, I will work with advisory board members to survey teachers and administrators to determine the need for the program. We will refer to the results of the needs assessment together to determine the activities and expected outcomes for the program. For example, the needs assessment may suggest that there is low administrative support for physical activity during the school day or an unawareness of the importance of daily youth physical activity. This information may result in the inclusion of an administrator-specific training related to the benefits of physical activity and how MATH Kids is valuable to students and schools. Resources needed for this activity would include an administrator training manual and a PowerPoint presentation on the benefits of physical activity. Step 3 Focus the evaluation design: To focus the evaluation design, I will consult an evaluation coordinator and the engaged stakeholders to ensure the evaluation is feasible and meets the needs of those using the evaluation. During this step, I will determine the purpose of the evaluation, identify individuals who will use the evaluation results and how they will use it, 10

11 and determine questions and methods that will be used to evaluate the program. For example, one purpose of the evaluation will be to determine the extent to which MATH Kids increases the amount of time students spend engaging in physical activity in the classroom. Individuals who will use the evaluation results include curriculum publishing companies, school district administrators, and the funding organization. They may use the evaluation to modify other curriculums, implement MATH Kids in other schools, or justify investing funds in the program. Example outcome and process evaluation questions for MATH Kids include: By how many minutes did MATH Kids increase the amount of time students spend engaging in daily physical activity? (Outcome) To what extent did MATH Kids increase administrator support for increased physical activity during the school day? (Outcome) How many times per week did teachers implement MATH Kids? (Process) To what extent were teachers comfortable implementing MATH Kids? (Process) Step 4 Gather credible evidence: To gather evidence, I will determine the indicators that will be used, how the data will be gathered, and how much evidence is needed to evaluate the program. The table below outlines data sources and indicators that will be used to gather data for the MATH Kids evaluation. All data sources will gather qualitative and quantitative information. Table 4: Evaluation Data Sources, Indicators, and Frequency of Collection Data Source Indicators Frequency of Collection Teacher Surveys Minutes of daily physical activity in classroom Before program Level of support for physical activity in the classroom Middle of program School-level Administrator Surveys Knowledge of the importance of physical activity Attitude toward physical activity in the classroom Barriers/Supports to physical activity in the classroom Student Surveys Attitude toward MATH Kids Self-efficacy of performing activities in MATH Kids After program Before program After program After program Step 5 Justify conclusions: To justify conclusions of the evaluation, I will determine the standards against which to measure the results and conduct an analysis, synthesis, and interpretation of the results (Bartholomew et al., 2011). I will contract a statistician to conduct the analyses and report the results back to the advisory board. After the analyses have been conducted, the advisory board and I will make a judgment regarding the success of the program as well as recommendations to improve the program. For example, the advisory board may recommend that the program be deemed successful only if it increases the amount of time students spend engaging in physical activity by fifteen minutes each day. If this standard is not met, recommendations to improve the program may include additional teacher training or modification of activities to make them easier to implement. Step 6 Ensure use and share lessons learned: To ensure use and share lessons learned, feedback will be given and received by all the engaged stakeholders and a follow-up and dissemination plan will be developed. The dissemination of MATH Kids may involve inviting local newspapers to write a cover story and interview students, presenting the results to the school board or at a district-wide principals meeting, and publishing the results in a peerreviewed journal. 11

12 Evidence Tables Evidence Table A: Scope and Significance of Childhood Obesity Why is childhood obesity important to address? Author & Date Research Method Findings Relevant to Scope and Significance Ogden, Carroll, Kit, & Flegal, 2012 Summarizes trend data from the National Health and Nutrition Examination Survey (NHANES). The NHANES is a cross-sectional survey that consists of home interviews, physical examinations, and laboratory tests in randomly selected cities in the United States. The sample is selected via a multistage probability design. Collection is based on a representative sample of the U.S. population. Survey data includes information about diagnosed & undiagnosed conditions, growth & development, overweight & obesity, diet & nutrition, risk factors, environmental exposures. Nearly 18% of youth ages 6-11were obese in % of boys, 15.7% of girls No change in prevalence of childhood obesity between and Significant increase in boys from and (not girls) Freedman et al., 2007 Franks et al., 2010 A cross-sectional (n=10,099) and longitudinal study (n=2,392) on participants in the Bogalusa Heat Study. The study began in 1972 to study the cardiovascular risk factors of children and adolescents. A cohort study of 4,857 American Indiana children (average age = 11.3) was conducted. BMI, glucose tolerance, blood pressure, and cholesterol were assessed to see if there was an association with premature death. Risks include high blood pressure and high cholesterol and becoming severely obese as an adult. BMI 95 th percentile 39% had 2+ risk factors 65% had excess adiposity 65% had an adult BMI of 35 BMI 99 th percentile 59% had 2+ risk factors 94% had excess adiposity 88% had an adult BMI of 35 Premature death was double in the highest BMI quartile than in the lowest quartile Premature death was 73% higher in the highest quartile of glucose intolerance than in the lowest quartile Childhood hypertension was significantly associated with premature death Evidence Table B: 60 Minutes of Physical Activity Each Day and 3 rd -5 th Grade Students Why attaining 60 minutes of physical activity each day among 3 rd, 4 th, and 5 th graders needs to be addressed to improve childhood obesity. Author & Date Research Method Findings Relevant to Deciding Behavior and Priority Group 12

13 Centers for Disease Control and Prevention, 2012b United States Department of Health and Human Services, 2008 NASPE & AHA, 2010 Texas Education Agency, 2012 This information is provided in the CDC s State Indicator Report on Physical Activity, Information was retrieved from peer-reviewed studies. This resource identifies the national recommendations and health benefits of physical activity for all ages. The document also discusses the health consequences of physical inactivity. The committee who put the report together reviewed all peer-reviewed scientific data relating physical activity to health that had been published since This resource states the Texas standards for physical education. This website reviews the Texas accountability rating system that measures academic success of elementary, middle, and high schools in Texas. -50% of children in the U.S. do not have a park, community center, or sidewalk in their neighborhood where they can engage in a safe place for physical activity year olds spend 7.5 hours a day using TVs, computers, video games, cell phones, and movies -Lack of daily, quality physical activity in schools is a cause of childhood obesity -60 minutes of physical activity recommended per day for children/adolescents - Benefits: Better concentration, increased attentiveness, higher academic achievement, strong bones and muscles -Consequences: Obesity, diabetes, heart disease, colon cancer -Elementary school students must be provided 135 minutes of structured physical education each week. -Scores on the State of Texas Assessments if Academic Readiness (STAAR) test is part of the rating system. -Historically, Stevens Elementary ratings have included mostly Academically Acceptable or Recognized. Evidence Table C: Formative Research on Determinants of Behavior What are the intrapersonal & environmental factors are associated with physical activity of 3 rd, 4 th, and 5 th graders? Author(s) & Date Behavior & Priority Group Research Method Findings on Determinants Comments Including other findings Sallis, Prochaska, Taylor, 2000 Physical activity, children ages A comprehensive review with semiquantitative results summarized for children and adolescents (separately). 108 studies were reviewed. 40 physical activity variables were Determinants Associated w Intention or Behavior Physical/sports competence Perceived barriers Intention Access to play spaces/equipment Time spent outdoors Healthy diet Determinants NOT Associated NOT addressed in present study Demographic Determinants Associated Physical activity/inactivity is COMPLEX Substantial inconsistencies between studies Measurement error? Sample size? Sample characteristics? Analysis strategies? 13

14 What are the intrapersonal & environmental factors are associated with physical activity of 3 rd, 4 th, and 5 th graders? Author(s) & Date Behavior & Priority Group Research Method Findings on Determinants Comments Including other findings analyzed for children. Male Overweight parent Kohl & Hobbs, 1998 Physical activity, children/adolescents A comprehensive review of the literature to summarize the determinants associated with physical activity in children and adolescents(most studies reviewed were cross-sectional) Gender (boys more than girls) Cardiorespiratory fitness Physical health status Substitution of recess for PE Lack of PE classes Lack of certified PE specialist to teach PE Amount of time spent watching television Seasonal/geographic influences Self-efficacy with performing exercises Beliefs about physical activity Perceived barriers to physical activity Parent behaviors Peer influences Most of the surveys reviewed were cross-sectional and selfreport. Evidence Table D: Evaluations of Effectiveness of Interventions What effective interventions have been tested to change physical activity and of 3 rd, 4 th, and 5 th graders? Author & Date Behavior & Priority Group Intervention Description Determinants being addressed, theoretical methods being used, Evaluation Method Design, data collection, sample type and size Findings on Effectiveness of Intervention Martine, Martin, & Rosengard (2010). Physical activity, 4 th and 5 th grade students practical strategies Pilot intervention to address the efficacy of PE2GO, a physical education program that is taught by classroom teachers Determinants addressed include a lack of funding for physical education, perceived lack of safe outlets for physical activity, lack of recess, lack of physical education, emphasis on standardized testing Theoretical methods: technical assistance (Diffusion of Innovations Theory). For example, funding, training, and resources 6 districts included 114 classroom teachers, 19 PE specialists, and 18 school-level administrators Pre-, mid-, and post-test design Pencil paper survey at pre (114)and mid (94) and online survey at post (65) Students increased time spent engaging in physical activity (128.7 minutes/week to minutes/week) Teachers were satisfied with curriculum (sustainability), especially its positive effect on students and ease of implementation. Comments Low response rate as intervention continued Feedback from implementers only, not participants Difficult to determine the impact of the evaluation because there was no standard against which it could be compared 14

15 were provided. Practical strategies: train teachers to provide physical education Sallis, McKenzie, Alcaraz, Kolody, Faucette, & Hovell, 1997 Hollar et al., 2010 Physical activity, 4 th and 5 th grade students Classroo m physical activity, Kindergar ten through 6 th grade SPARK is a physical education curriculum designed to increase physical activity during PE classes. It can be implemented by classroom and PE teachers. Determinants addressed include a lack of quality PE for students, lack of time spent engaging in moderate to vigorous physical activity in PE Theoretical methods: technical assistance (Diffusion of Innovations Theory). For example, funding, training, and resources were provided. Practical strategies: train teachers to provide physical education Take 10! Is a classroom-based physical activity program that strives to increase structured physical activity time without sacrificing academic time. The curriculum is integrated into other academic subjects (e.g. math, reading, language arts, science, social studies, health) 7 schools, quasiexperimental design, SPARK was taught by PE specialists or trained classroom teachers, 955 students participated during 2 years. 45,888 students in Florida, ages 6-13 years old. Longitudinal study (students were followed for 2 years) Students spent more time/week being physically active (40 minutes with PE specialist, 33 minutes with trained teacher) No effects on physical activity outside of school Intervention students had significantly higher math achievement test scores during both years of the study Time to train teachers? Small number of schools in only one school district Explanation for why other subjects did not improve as well? Perhaps is related to the activities or implementation. 15

16 Reference List 1. Augustine, J. (2004). Creating Culturally Competent Programs. Transitions: Serving Youth of Color, 15(3), 6-7. Retrieved from 2. Bartholomew, L.K., Parcel, G.S., Kok, G., Gottlieb, N.H., & Fernandez, M.E. (2011). Planning Health Promotion Programs: An Intervention Mapping Approach. San Francisco, CA: Jossey-Bass. 3. Centers for Disease Control and Prevention (1999). Framework for Program Evaluation in Public Health. MMWR; 48(No. RR-11), Centers for Disease Control and Prevention (2012b). Overweight and Obesity: A Growing Problem. Retrieved from 5. Franks, P.W., Hanson, R.L., Knowler, W.C., Sievers, M.L., Bennett, P.H., & Looker, H.C. (2010). Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. New England Journal of Medicine, 362, Freedman D.S., Mei Z., Srinivasan S.R., Berenson G.S., & Dietz W.H. (2007). Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Pediatrics, 150(1), Glanz, K, Rimer, B.K., & Viswanath, K. (Eds.). (2008). Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass. 8. Hollar, D., Messiah, S.E., Lopez-Mitnik, G., Hollar, T.L., Almon, M., Agatston, A.S. (2010) Effect of a two-year obesity prevention intervention on percentile changes in body mass index and academic performance in low-income elementary school children. American Journal of Public Health, 100, International Life Sciences Institute (ILSI) Research Foundation (2012). Background. Retrieved from Israel, B.A., Schulz, A.J., Parker, E.A., & Becker, A.B. (2001). Community-based Participatory Research: Policy Recommendations for Promoting a Partnership Approach in Health Research. Education for Health, 14(2), Lumeng, J.C., Forrest, P., Appugliese, D.P., Kaciroti, N., Corwyn, R.F., Bradley, R.H. (2010). Weight Status as a Predictor of Being Bullied in Third through Sixth Grades. Pediatrics 125(6), Martine, M., Martin, S., & Rosengard, P. (2010). PE2GO: Program Evaluation of a Physical Activity Program in Elementary Schools. Journal of Physical Activity and Health, 7, National Association for Sport and Physical Education & the American Heart Association (2010). State Profiles. Retrieved from Ogden, C.L, & Carroll, M.D (2010). Prevalence of Obesity Among Children and Adolescents: United States, Trends Through Retrieved from 16

17 15. Ogden C.L., Carroll M.D., Curtin, L.R., Lamb, M.M., & Flegal, K.M. (2008). Prevalence of high body mass index in US children and adolescents, Journal of the American Medical Association, 303, Ogden, C., Carroll, M., Kit, B, & Flegal, K. (2012). Prevalence of Obesity in the United States, Retrieved from Sallis, J., McKenzie, T., Alcaraz, J., Kolody, B., Faucette, N., & Hovell, M. (1997). The Effects of a 2-Year Physical Education Program (SPARK) on Physical Activity and Fitness in Elementary School Students. American Journal of Public Health, 87, Sallis, J., Prochaska, J., & Taylor, W. (2001). A review of correlates of physical activity of children and adolescents. Journal of the American College of Sports Medicine, Stevens Elementary (2013). School Profile. Retrieved from Taras, H. & Potts-Datema, W. (2005). Obesity and Student Performance at School. Journal of School Health. 75, doi: /j x. 21. Texas Education Agency (2012). Accountability Rating System for Texas Public Schools and Districts. Retrieved from United States Department of Health and Human Services. (1996). Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 23. United States Department of Health and Human Services: National Cancer Institute (2005). Theory at a Glance: A Guide for Health Promotion Practice. (NIH Publication No ). Washington DC: U.S. Government Printing Office. 24. United States Department of Health and Human Services (2013). Physical Activity Guidelines for Americans. Retrieved from Whitlock E.P., Williams S.B., Gold R., Smith P.R., & Shipman SA.(2005). Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics, 116(1),

18 Appendix MATH Kids Logic Model Priority Group: 3 rd, 4 th, and 5 th Grade Students Context or Setting: Stevens Elementary Process Evaluation Outcome Evaluation Determinants Program Materials A standards-based math curriculum (e.g. envision- MATH) Training Guide for teachers and administrators Physical activity lesson guides Physical activity templates for each lesson guide Methods and Practical Applications Guided Practice Modeling Direct Experience Participation Practical Application: Demonstration of exercises by the teacher followed by the students performing the exercises themselves Methods and Practical Applications Discussion Environmental reevaluation Public Commitment Practical application: A discussion about the benefits of physical activity in the classroom that is incorporated into the MATH Kids training for teachers and administrators. Change Objectives Demonstrate ability to perform exercises Recognize that being physically active in the classroom will be beneficial Change Objectives Describe reasons for why it is important to incorporate physical activity into the classroom Express a positive attitude toward incorporating physical activity into the classroom Publicly state intention to require teachers to implement MATH Kids Demonstrate ways to support teachers in implementation of MATH Kids Expect that MATH Kids will increase physical activity among students without sacrificing academic achievement Self-efficacy of performing exercises Attitude toward being physically active in the classroom Determinants Knowledge of the importance of incorporating physical activity into the classroom Attitude toward incorporating physical activity into math lessons in the classroom Intention of requiring teachers to implement MATH Kids in the classroom. Self-efficacy to support teachers during the implementation of MATH Kids. Outcome Expectations of incorporating physical activity into the classroom Performance Objectives Perform physical activities for at least 10 minutes a day during math lessons in the classroom Performance Objectives Establish structures to implement MATH Kids in additional elementary schools in the district (Superintendent) Require 3 rd, 4 th, and 5 th grade teachers to implement MATH Kids in the classroom (Principal) Behavioral Outcome Increased physical activity Environmental Outcome Increased administrative support for physical activity in the classroom Improved Health or Quality of Life Reduced overweight and obesity and improved quality of life Environmental Agents: Superintendent, Principal, and Assistant Principal 18