Implementing a Whole School Physical Activity and Healthy Eating Model in Rural and Remote First Nations Schools: A Process Evaluation of Action Schools! BC

Published in Rural and Remote Health, this article explores the question: How do we deal with the obesity and related diabetes epidemic among First Nations peoples in British Columbia (BC), Canada? The researchers were motivated to undertake a study based on the fact that Aboriginal people who reside in rural and remote areas of Canada often have poorer health than other Canadians. For instance, the prevalence rate of type 2 diabetes is 3 to 5 times higher than for the general population, and chronic disease risk factors such as obesity are more prevalent. Based on the research, the authors suggest taking a "whole school framework" approach, which is a positive approach to addressing childhood inactivity and unhealthy eating patterns during the school day because it was found to be effective for children in a large urban centre.

Specifically, the Action Schools! BC (hereafter, "AS! BC") model provides tools for schools and teachers to create individualised action plans to increase the opportunities for physical activity (PA) and healthy eating (HE) across 6 "action zones", including: school environment; scheduled physical education; classroom action; family and community; extra-curricular; and school spirit. Initially designed for and evaluated with students in the upper elementary grades (grades 4-7), the school model was then adapted (a modified selection of resources and activities) for lower elementary (K-3) and middle school (grades 6-9). Teachers received specialised training and support, a planning guide, and classroom-based resources. Regarding the latter, the classroom action bin contained equipment and resources to facilitate classroom action (PA and HE) activities (for example, skipping ropes, dyna-bands, and grippers, as well as DVDs, posters, and how-to manuals). The PA resources prioritised gender- and skill-level-inclusive activities. Schools had 3 visits from the AS! BC support team. Teachers were asked to provide students with a minimum of 15 additional minutes of PA each school day and at least one HE activity per month in the classroom action zone.

Information about implementation was gathered from weekly classroom logs completed by teachers and focus groups with school staff. The logs showed that all 3 schools implemented PAs (mean = 140 minutes (min)/week, range = 7-360 min/week) and HE activities (mean = 2.3 times/week, range = 0-10 times/week), but this varied by school and teacher. Focus group data showed that the programme was well received and that support from the AS! BC master trainer and support team was crucial to delivery of the programme. Staff highlighted challenges (e.g., time, high staff turnover at the schools, and lack of financial resources), but felt that with continued support and cultural adaptations they would continue to implement AS! BC in their schools.

The researchers note that (footnote numbers removed by the editor) "[s]ome participants adapted some of the activities. For example: 'bounce at the bell' became 'bounce at the drum'; some teachers incorporated Aboriginal stick and bone games into their activities; and fruit and vegetables were incorporated into cultural feasts. However, further adaptations related to local food and language were recommended. These adaptations are also challenges for the scaling up of AS! BC in rural and remote Aboriginal communities because of the variety of local food, language and cultures across First Nations communities. For instance there are First Nations languages in BC, 10 language families and 14 biogeoclimate zones where vegetation and food supplies differ."

That said, in conclusion, the evaluation demonstrated that AS! BC was appropriate and feasible for use in the First Nations schools in these rural and remote communities with some cultural adaptations and ongoing support. "It was flexible, it engaged the community in planning and implementation, it connected the school to the broader community, and it provided learning opportunities for staff and students."

For further information on AS! BC, visit the project website.