Building Support for Coordinated School Health Programs

This study sought to identify successful strategies for garnering stakeholder support for coordinated school health programs (CSHP) an interactive, multi-component approach to health promotion among students and school staff. In the late 1990's several states were awarded federal funding to build infrastructure for CSHP. Directors from these states previously participated in interviews pertaining to their accomplishments directly related to this funding. A three stage, qualitative study utilized this interview data along with follow-up interviews and document analysis to compile a list of successful support-building strategies. Using the diffusion of innovations model, effective support-building strategies were drawn together and areas of weakness were identified. A multitude of chronic health problems experienced by adults result from unhealthy behaviors adopted in childhood and adolescence. To illustrate, the best predictors of adult obesity and smoking the top causes of morbidity and mortality (Johnson, Dominici, Griswold, & Zeger, 2003; Mokdad, Marks, Stroup, & Gerberding, 2004) are overweight and tobacco use in childhood and adolescence (Salbe, Weyer, Lindsay, Ravussin, & Tataranni, 2002; Spooner, 1999). Hence, the Centers for Disease Control and Prevention (CDC) recommend adoption of healthy behaviors early in childhood to prevent chronic disease in adulthood. This is the goal of coordinated school health programs (CSIm. CSHP is a concept that focuses on creating a healthpromoting culture inside and outside the school to encourage, support, and reinforce students' healthy decisions to set the stage for a healthy lifestyle in adulthood. In addition, CSHP strive to improve students' health thereby improving academic performance (McKenzie & Richmond, 1998). The approach involves coordination of health programs across a variety of components including (1) physical education that teaches students how to incorporate physical activity into their daily lives, (2) health education * Randi J. Alter, MA; Indiana University Department of Applied Health Science, Indiana Prevention Resource Center, 2735 E. 10th Street CA110, Bloomington, IN 47401; Telephone: 812-855-1237; E-mail: [email protected] David K. Lohrmann, PhD; Indiana University Department of Applied Health Science, 1025 East 7th Street, Room 116, Bloomington, IN 47405; Chapter Nu * Corresponding author that provides students with health-related knowledge and skills, (3) health services that provide basic screening and health care for students, (4) counseling and psychological services that provide support for students dealing with emotional or adjustment challenges, (5) healthy school environment that provides a psychologically and physically safe and clean learning environment for all students, (6) nutritionlfood services that provide healthy meal and snack choices, (7) health promotion for school faculty and staff so as to provide students with healthy adult role models, and (8) family and community involvement to support healthy lifestyle choices outside of the school (Max & Wooley, 1998). To facilitate the adoption of CSHP, the CDC's Division of Adolescent and School Health offered funding to states on a competitive basis for development of infrastructure to support statewide implementation of CSHP. Funds were utilized to support personnel at state education and health departments with responsibilities to provide direction, coordination, training, and technical assistance for CSHP in school districts statewide. Part of this initiative included garnering support from key stakeholders (e.g., teachers, administrators, and parents). Expected outcomes of CSHP included improved student health and decreased risk for developing chronic diseases later in life as well as enhanced school attendance and educational achievement. More specifically, CSHP focused on tobacco use prevention, adequate physical activity, and proper nutrition. Initial stages of infrastructure development involved introducing CSHP to stakeholders and garnering support. Rogers' (1995) diffusion of innovations model highlights processes and stages associated with the introduction of innovations such as CSHP. The model predicts that stakeholders progress through a series of stages leading to adoption or rejection of the innovation. These stages involve information gathering, attitude formation, decision to adopt or reject the innovation, utilization of the innovation, and reinforcement seeking all leading up to continued implementation or rejection. Individuals initiate adoption at different points in the introduction of the innovation and progress through stages at different rates. That is, some adopt the innovation rather early (innovators), while others have delayed response (laggards) (Rogers, 1995). Successful adoption of an innovation is dependent upon information communicated by a change agent. The change agent must develop a need for change, create intent to change, translate the intent into action, and assure continued adoption (Rogers, 1995). In the case of the CSHP, the statelevel CSHP directors working in departments of education Spring 2005, Vol. 37, No. 1 The Health Educator and health served as change agents. The current study focused on the diffusion strategies used by the state-level CSHP directors to introduce and garner support for CSHP from stakeholders. Of particular interest were strategies that translated intent into action (e.g., formation of CSHP coalitions) and continued adoption (e.g., involvement in CSHP activities). These action-oriented strategies are particularly important because implementation of new programs in schools is often met with resistance (Norris, 2003) stemming from increased pressures placed upon schools by federal mandates to meet minimum educational achievement standards such as those set by the No Child Left Behind Act (United States Department of Education, 2001). In 2000 and 2001, a PhD level school health professional with assistance of a support staff person from the Academy for Educational Development conducted one hour guided interviews via telephone with two to three staff members from 15 of the 20 states that had received funding for CSHP infrastructure development (Lohrmann, Thomas, Coleman, Anderson, & Schlagel, 2001). Five states excluded from data collection were newly funded and thus could not provide meaningful input. The primary objective of these interviews was to explore the accomplishments of CSHP in each state that were directly linked to the CDC funds. Some unanswered questions that arose from the prior study arose served to guide the current study. What was the initial level of stakeholder support for CSHP? What buy-in strategies were implemented by CSHP directors? Which strategies were perceived as successful in garnering buy-in and support from schools for CSHP? Conversely, which strategies were perceived as unsuccessful in garnering buy-in?