Social inclusion is an often stated goal for education, health and social development programs. But how can we measure progress towards this challenging goals in educational systems that have a mandate to certify students for further studies and ultimately, social placement? An article in Volume 96 of the International Journal of Educational Research "presents the results of a descriptive survey study developed with the objective of identifying the level of inclusion (LI) of elementary schools in Catalonia (Spain) and classifying them according to the consolidation level of their inclusive practices in six dimensions: school organization, inclusive school climate, classroom organization, educational support, community involvement and lifelong learning. Conclusions form a starting point to generate changes in future educational policies of Catalonia based on evidences, that could influence international trends." Read more...
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The art & science of student assessment is often an overlooked element of Health, Personal & Social Development education. Generally, we compete with the traditional demand for students marks in academic subjects with a call for more holistic assessment practices but we rarely examine what we are suggesting students learn beyond the basic facts (literacy) of health. Issue #31, 2019 of ASCD Express gives us some insights as it covers the debate within education about moving to student evaluation without grades and marks. The articles in this issue suggest that "High-quality feedback should describe work against criteria students themselves understand and suggest attainable next steps at the appropriate level of challenge, points and averages mask what students actually know and are able to do, a straightforward reporting system gives students the information to take ownership of learning by measuring their performance relative to defined standards and making mastery, not points, the reward for your students...." Read more...
The unique challenges related to building teams of teachers (and others) to improve programs and school practices has been discussed in educational research but less in health and social development. There is very little planning time in the teacher's work day, the regular working environment (the classroom) is isolated from other adults, teacher backgrounds are often derived solely from their previous experiences as students and their relatively low professional status makes other prone and willing to "fix the teachers" as their primary strategy.This is why the July 2019 issue of Educational Leadership should be of interest to school health & development advocates. The issue examines the barriers to teacher teams, "collective efficacy" as a driving concept, ensuring that team meetings work for teachers and treating teachers like professionals. Read more.....
An article in Volume 40, 2019 of the Annual Review of Public Health states that "Most of the clinical research conducted with the goal of improving health is not generalizable to nonresearch settings. In addition, scientists often fail to replicate each other's findings due, in part, to lack of attention to contextual factors accounting for their relative effectiveness or failure." To address these problems, the authors "review the literature on assessment of external validity and summarize approaches to designing for generalizability. When investigators conduct systematic reviews, a critical need is often unmet: to evaluate the pragmatism and context of interventions, as well as their effectiveness. Researchers, editors, and grant reviewers can implement key changes in how they consider and report on external validity issues. For example, the recently published expanded CONSORT figure may aid scientists and potential program adopters in summarizing participation in and representativeness of a program across different settings, staff, and patients." They go on to highlight three key areas where “science as usual” is failing public health settings:
An July 2019 article in BMC Public Health underlines the need for greater clarity when we discuss scaling up programs as opposed to more effective ways to implement an effective program. "The implementation of interventions at-scale is required to maximise population health benefits. ‘Physical Activity 4 Everyone (PA4E1)’ was a multi-component school-based program targeting adolescents attending secondary schools in low socio-economic areas.An efficacy trial of the intervention demonstrated an increase in students’ mean minutes of moderate-to-vigorous physical activity (MVPA) per day and lower weight gain at low incremental cost.This study aims to assess the effectiveness and cost effectiveness of a multi-component implementation support intervention to improve implementation, at-scale, of the evidence based school physical activity (PA) practices of the PA4E1 program. Impact on student PA levels and adiposity will also be assessed, in addition to the cost of implementation." A cluster randomised controlled trial, utilising an effectiveness-implementation hybrid design, will be conducted in up to 76 secondary schools located in lower socio-economic areas across four health districts in New South Wales (NSW), Australia.Schools will be randomly allocated to a usual practice control arm or a multi-component implementation support intervention to embed the seven school PA practices of the PA4E1 program. The implementation support intervention incorporates seven strategies including executive support, in-School Champion, teacher training, resources, prompts, audit and feedback and access to an external Support Officer. The primary trial outcome will be the proportion of schools meeting at least four of the seven physical activity practices of the program, assessed via surveys with Head Physical Education teachers at 12 and 24-months. Secondary outcomes will be assessed via a nested evaluation of student PA and adiposity at 12-months (Grade 8 students) and 24 months (Grade 9 students) undertaken in 30 schools (15 per group)" . ISHN Commentary: This promises to be an excellent study but will it measure the effect and cost effect of an implementation strategy as opposed to different methods for scaling up the multi-intervention program to other schools or other regions? Read more....
An article in Volume 233, 2019 of Social Science & Medicine discusses the potential weaknesses of systematic reviewes, even when they are following the PRISMA Guidelines for such reviews. The authors "advocate that SR teams consider potential moderators (M) when defining their research problem, along with Time, Outcomes, Population, Intervention, Context, and Study design (i.e., TOPICS + M). We also show that, because the PRISMA reporting standards only partially overlap dimensions of methodological quality, it is possible for SRs to satisfy PRISMA standards yet still have poor methodological quality. As well, we discuss limitations of such standards and instruments in the face of the assumptions of the SR process, including meta-analysis spanning the other SR steps, which are highly synergistic: Study search and selection, coding of study characteristics and effects, analysis, interpretation, reporting, and finally, re-analysis and criticism". Read more...
Community representatives or "connectors" can play a critical role in helping health services and schools to reach out and engage disadvantaged and minority communities. Often these connectors are elders or key leaders in the local communities being served. An article in Volume 232, 2019 of Social Science & Medicine describes the "boundary spanning practices of community connectors for engaging ‘hardly reached’ people in health services.... The institutionalised nature of health services with associated professional and organisational boundaries create ongoing challenges to achieving this policy aim. We present an approach to this challenge by exploring how health services can tap into the existing boundary spanning activities of community members we term as ‘community connectors’ who undertake valuable boundary work within the community to include people who are hardly reached. We address the research questions: what are the behaviours and characteristics of community connectors?; to what extent are they motivated to help out with health?; and how can health service personnel identify community connectors? We identified the three key roles of ‘noticer and responder’, ‘connector’ and ‘provider’ that make connectors a valuable asset for health services. Community connectors seek opportunities to negotiate new boundaries with health services that support their boundary spanning with people hardly reached and also enable health services to transgress their own boundaries and access people who are hardly reached. We conclude that by paying attention to their own production, maintenance and transgression of boundaries, health services can apply this approach, noting that the local and iterative nature of identifying community connectors means that each cohort of community connectors will be unique as determined by local boundaries and relationships. Read more...
Critical Incidents are an important concept within a systems science approach to implementing, maintaining, scaling up and sustaining programs. An article in Volume 232, 2019 of Social Science used CI to describe and understand how critical incidents or junctures in the implementation of s multi-intervention school physical activity program. The analysis revealed 39 critical incidents in the trial. " The "Let's Move It” (LMI) randomized trial evaluated a theory-based whole school system intervention aiming to increase physical activity (PA) of adolescents attending vocational schools. This article serves two main purposes: to describe how to use the critical incident technique (CIT) to conduct in qualitative process evaluation to identify events, including intervention elements, which LMI trial participants perceived to enable or support behavior change.The CIT seems a promising approach for directing analysis towards potentially crucial intervention elements as described by the participants themselves..." Read more...
Three articles in Issue #1, 2019 of Journal of the American Medical Association debate whether randomness is maintained when the samples from different studies are combined in meta-analysis of their data. Essentially, the concern is that "However, a long-term concern in meta-analysis has been the apples-and-oranges comparison problem when studies that are too different are combined into a single estimate of effect. Random-effects meta-analysis can exacerbate this problem". Further, there is concern that "risk estimates from small trials are overweighted. However, small trials are known to be biased toward reporting an effect (typically, why they were originally published) and are often of lower quality. This is the opposite of how one would disproportionally weight trials if such weighting were thought necessary" jamanetwork.com/journals/jama/issue/322/1Read more....
The July Issue of Health Promotion Practice includes an article describing the systems-based approach used by the Prevention Institute. "In October 2018, Prevention Institute released System of Prevention, a book that uses graphic design to illustrate Prevention Institute’s framework for a systems approach to population health that can achieve health equity. The Elements of a System of Prevention include: A shared vision, multilevel action, elevated community voices and leadership, facilitated community partnerships and multisector collaboration, an empowered and skilled prevention workforce grounded in social justice, making the case for prevention and equity, gathering and sharing data and stable sources of funding. Read more about the PI model.(ISHN Comment: All the PI elements are valid but we would categorize them as different elements of system or organizational capacity. In our view, we need to examine the features of the publicly funded systems that need to alter their structures and practices. These include new structures, joint budget-making, jointly named staff positions, negotiated and explicit joint annual priorities and more. See the ISHN statement calling for a new paradigm for school health promotion based on systems-focused action.
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