A Structured Peer-Mentoring Method for Physical Activity Behavior Change Among Adolescents

Effectiveness of the Walking in ScHools (WISH) Study, a peer-led walking intervention for adolescent girls: results of a cluster randomised controlled trial

BACKGROUND

Most adolescent girls fail to meet current physical activity guidelines. Physical activity behaviours track from childhood into adulthood and providing adolescent girls with opportunities to be physically active may have health benefits beyond childhood. The effects of walking interventions on adult cardiometabolic health are known, however less is understood about the potential of walking to promote physical activity in adolescents. Following the Walking In ScHools (WISH) feasibility study, this definitive trial aimed to evaluate the effectiveness of a novel, low-cost, school-based walking intervention at increasing physical activity levels of adolescent girls (aged 12-14 years).

METHODS

Female pupils were recruited from eighteen schools across the border region of Ireland and in Northern Ireland. In intervention schools (n = 9), girls aged 15-18 years, were trained as walk leaders, and led the younger pupils in 10-15 min walks before school, at break and lunch recess. All walks took place in school grounds and pupils were encouraged to participate in as many walks as possible each week. The primary outcome measure was accelerometer determined total physical activity (counts per minutes, cpm).

RESULTS

In total, 589 pupils were recruited to the study. At baseline, pupils engaged in a median (interquartile range (IQR)) 35.7 (21.2) mins moderate-vigorous physical activity (MVPA) per day and only 12% (n = 66) of participants met physical activity guidelines (60 min MVPA per day). The intervention was delivered for a mean (standard deviation (SD)) 19.9 ± 0.97 weeks. The mean post-intervention total physical activity for the intervention group was 676 cpm and 710 cpm in the control group. Post-intervention total physical activity did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline physical activity (mean difference, -33.5, 95% CI = -21.2 to 88.1; p = 0.213).

CONCLUSIONS

'Scaling-up' physical activity interventions is challenging and despite a promising feasibility study, the results of this fully powered trial suggest that in this context, the WISH intervention did not increase device measured physical activity. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low, indicating that there is a need to better understand how to implement interventions within schools.

TRIAL REGISTRATION

ISRCTN; ISRCTN12847782; Registered 2nd July 2019.

'Including us, talking to us and creating a safe environment'-Youth patient and public involvement and the Walking In ScHools (WISH) Study: Lessons learned

BACKGROUND

Young people have the right to be informed and consulted about decisions affecting their lives. Patient and public involvement (PPI) ensures that research is carried out 'with' or 'by' young people rather than 'to', 'about' or 'for' them. The aim of this paper is to outline how youth PPI can be embedded within a physical activity intervention, reflect on the impact of PPI and provide recommendations for future PPI in a similar context.

METHODS

A Youth Advisory Group (YAG) was set up within the Walking In ScHools (WISH) Study to involve adolescent girls in the delivery, implementation and dissemination of a physical activity intervention targeted at adolescents. Schools invited pupils aged 12-14 years and 15-18 years to YAG meetings (n3, from 2019 to 2023). Participative methods were used to inform recruitment strategies and data collection methods for the WISH Study.

RESULTS

Across the three YAG meetings, n51 pupils from n8 schools were involved. Pupils enjoyed the YAG meetings, felt that their feedback was valued and considered the meetings a good way to get young people involved in research. The YAG advised on specific issues and although measuring impact was not the primary aim of the YAG meetings, over the course of the study there were many examples of the impact of PPI. Recruitment targets for the WISH Study were exceeded, the attrition rate was low and pupils were engaged in data collection.

CONCLUSION

Youth PPI is a developing field and there are few physical activity studies that report the PPI work undertaken. Within the WISH Study, three YAG meetings were held successfully, and the views of adolescent girls were central to the development of the study. Considering the specific issues that the YAG advised on (study recruitment, attrition and data collection), there was evidence of a positive impact of PPI.

PATIENT OR PUBLIC CONTRIBUTION

Pupils from post-primary schools interested/participating in the WISH Study were invited to attend YAG meetings. YAG meetings were set up to consult adolescent girls on the delivery, implementation and dissemination of the WISH intervention.

How to develop young physical activity leaders? A Delphi study

The International Society for Physical Activity and Health advocates for increased capability of the physical activity workforce as a key ingredient to a system-based approach. Young leader programmes are gaining traction globally as peers are a primary influence on young people and positive role models are important for increasing or maintaining physical activity. Yet, there is limited understanding of 'what works' for training young physical activity leaders. This study aims to develop a consensus on how to identify and support young people to become physical activity leaders. An iterative three-phased mixed methods Delphi consensus approach. A rapid review focused on the feasibility, acceptability and impact of existing young leader physical activity training (phase one); focus groups (n = 3) and interviews (n = 6) with 15 practitioners and young leaders to examine young physical activity leader training needs (phase two); and a three-round questionnaire process (phase three). Stakeholders (n = 43) from across the public, voluntary and education sectors, academics and young leaders completed all questionnaires. A consensus was reached for 75 statements related to: young leader traits prior to and following training, recruitment methods, training content, delivery format and context, relationships, incentives, and skill development. The Delphi process, combining insight from multi-sectoral stakeholders, identified a range of factors that underpin young leader training programmes. These factors should be applied to develop a curriculum and comprehensive training programme to provide young leaders with the required capability to be effective within their roles, and ultimately support an increase in physical activity amongst children and young people.

Empowering Community Leadership: Perspectives of Peer Mentors Facilitating a Food Pantry-Based Nutrition Education Program

Peer Mentors (PMs) are valuable health educators within food-insecure communities; however, little is known about PMs' perspectives and experiences after serving in their peer mentor role. Therefore, this qualitative study explored PMs' (n = 10) perceptions and analyzed data using thematic analysis based on descriptive phenomenology. Four themes emerged: (1) Successes and Struggles in Sharing Nutrition Knowledge; (2) Establishing a Conducive Learning Environment; (3) The Peer Mentor and Mentee Connection: Impact of Shared Experiences; (4) Empowerment of the Peer Mentor Experience. PMs have many advantages; however, more research is needed to evaluate the sustainability and efficacy of PMs within food-insecure communities.

Nurse Mentorship to Support Healthy Growth of Adolescent Girls

Adolescent girls from many urban communities are a vulnerable population, with high rates of school dropout, pregnancy, sexually transmitted infections, and substance use disorders. Mentorship programs can support the growth and development of this at-risk population. We report on the content of a pilot girls' empowerment program created by nurse faculty to promote health and self-awareness among underserved adolescent girls. Pre/post program scores of 15 participants using the Harter Self-Perception Profile for Adolescents found positive changes in seven of eight domains: scholastic (p = 0.001), social (p = 0.001), appearance (p = 0.001), job competence (p = 0.003), conduct (p = 0.02), close friendship (p = 0.006), and self-worth (p = 0.001). Nurse faculty and students might consider the development of similar mentorship programs for adolescent girls. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 15-18.].

The impact of peer mentoring on students’ physical activity and mental health

Purpose

A peer-mentoring scheme was implemented in a secondary school using a physical activity (PA) intervention to improve mental health outcomes of students who were at risk of developing mental ill health. These students are referred to as mentees. The evaluation was a qualitative design using focus groups and semi-structured interviews. The participants reported an increase in PA in both peer mentors and mentees. By the end of the project many of the mentees recognised that they had increased their levels of PA, they were more aware of the benefits of PA and the relationship between PA and their mental health. In addition, mentees reported feeling more confident and were more confident in forming social relationships. Peer mentors reported developing many leadership skills during the project. These included improved communication, confidence, empathy for others, relationship building and improved self-awareness. The paper aims to discuss these issues.

Design/methodology/approach

Qualitative data were primarily collected from nine case study schools. Each visit included interviews with peer mentors, mentees and the Wellbeing Champion.

Findings

Mentees developed improved social confidence and were generally more positive after completing the intervention. Mentors developed leadership skills and greater empathy for their peers.

Originality/value

There is limited research on school-based PA interventions using peer mentoring to improve students’ mental health.

Successes and challenges of using a peer Mentor model for nutrition education within a food pantry: a qualitative study

Background

Delivering nutrition education within an emergency food pantry (EFP) provides an opportunity to reach many food insecure households and underserved populations. However, little is known about using a peer mentor model, “Community Cooks,” as a modality to deliver nutrition education within this setting. This research aimed to identify the successes and challenges of using a peer mentor model within an EFP to better understand the best approaches to deliver nutrition education among community residents.

Methods

In spring 2018, semi-structured interviews were conducted with 11 peer mentors after they delivered a series of nutrition workshops to community members of the EFP. Interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was used to analyze the data.

Results

All peer mentors were women over 40 years-of-age, were recruited from the EFP community; most were high school graduates and currently received some form of federal nutrition assistance. All peer mentors reported that the “Community Cooks” nutrition education program offered many benefits. Key successes of the program included serving in the role as a peer mentor was an empowering experience which gave them a sense of community, purpose, and camaraderie; 2) the nutrition education was appropriately tailored towards those living with food insecurity; 3) the recipes required minimal cooking skills and included low-cost easily accessible foods available at the EFP. Key challenges of the program were the lack of community member engagement in the nutrition education workshops.

Conclusion

Challenges continue to exist when delivering nutrition education within a community EFP setting. While the use of peer mentors to deliver nutrition education messages is promising, more research is needed to quantify the impact of using a peer mentor model in underserved and food insecure communities.

Peer Support and Role Modelling Predict Physical Activity Change among Adolescents over Twelve Months

Physical activity levels decline during adolescence; however, some individuals initiate or maintain physical activity participation during this period of life. Socialisation impacts physical activity participation, yet few studies have explored the role of parental and peer processes concurrently on youth physical activity transitions over time. This study examined whether mother's father's and friends' support, modelling and teasing predicted adolescents' physical activity initiation, drop-off or maintenance over twelve months. In total, 803 adolescents (62.5% females, M age = 13.72) from Dublin, Ireland, completed self-report measures of support, modelling, teasing, and physical activity. Participants were classified as physical activity maintainers (17.8%), low active maintainers (58.8%), drop-offs (10.3%) or physical activity initiators (13.1%). The results revealed that parental support and modelling were unrelated to adolescents' physical activity transitions, however mother's and father's support predicted sustained physical activity participation twelve months later. In contrast, peer processes predicted physical activity maintenance, initiation and drop-off at one-year follow-up underscoring the salient role of peers for adolescents' behaviour change. In line with expectancy-value theory, the findings indicate that parents and peers represent distinct socialising agents that impart their influence on adolescents' physical activity maintenance and behaviour change through various mechanisms, highlighting the need to consider both sources of socialisation concurrently in future studies of adolescent behaviour change.

A whole-school approach to supporting children and young people’s mental health

Purpose

Supporting the mental health of children and young people is a global priority. The issue is not specific to England. However, evidence suggests that one in ten children and young people in England has a mental health need. This represents approximately three students in every classroom. The purpose of this paper is to highlight the role of schools in supporting children and young people’s mental health. Whilst the paper acknowledges that teachers are not trained health professionals, it is argued that a whole-school approach to mental health can support individuals in schools to remain mentally healthy. The elements of a whole-school approach are identified and discussed and some of the challenges in relation to implementation are considered. Critical to the development of a whole-school approach is the commitment from the school leadership team to promoting student and staff wellbeing.

Design/methodology/approach

This is a policy paper not an empirical study.

Findings

This paper has outlined the policy context in the UK in relation to children and young people’s mental health. It has addressed the risk and protective factors which can cause or mitigate against mental ill health and it has outlined the elements of a whole-school approach to mental health.

Originality/value

This paper explores the contribution that schools can make to supporting students’ mental health. There is limited research which addresses mental health in young people from a non-therapeutic angle.

"Bringing Tap Back": Expanding the "Sodabriety" Teen Advisory Council Approach in Tennessee High Schools

Sugar-sweetened beverages (SSBs) are a large source of added sugar in teenagers' diets, comprising 20-25% of daily calories. Despite efforts, teens in rural and southern states continue to have the high SSB consumption rates. Using Teen Advisory Councils (TAC), students designed and delivered school-specific interventions at five Tennessee schools. Using repeated measures models with Bonferroni correction, data were collected on SSBs and water consumption at baseline and 30 days postintervention. The 573 participants ranged from 13 to 19 years; mean age 15.97 years (SD = 1.4). Daily SSB servings decreased from a mean of 2.37 (SD = 2.06) to 1.87 (SD = 1.89; p = .024). Weekly SSB behaviors decreased 10%. Daily water consumption increased 19.5% to 4.46 (SD = 2.97) servings (p = .03). Student-led efforts supported behavioral changes. TACs were effective at changing lifestyle behaviors. Community-driven solutions may result in manageable changes to sustain behaviors.

Compañeros: High School Students Mentor Middle School Students to Address Obesity Among Hispanic Adolescents

INTRODUCTION

Promotoras, Hispanic community health workers, are frequently employed to promote health behavioral change with culturally bound Hispanic lifestyle behaviors. Peer health mentors have been used in schools to promote healthy nutrition and physical activity behaviors among students. This study investigates the efficacy of combining these 2 approaches by training high school health mentors, called compañeros, to engage Hispanic middle school students in a school-based obesity intervention as a strategy to promote and sustain reductions in standardized body mass index (zBMI).

METHODS

High school compañeros were trained to participate in a 6-month obesity program alongside middle school students in Houston, Texas. Middle school students were randomized to participate in the program either with compañeros (n = 94) or without compañeros (n = 95). The intervention was conducted from 2013 through 2016 in 3 cohorts of students, 1 each school year. Students were followed for 12 months. The primary outcome was zBMI, which was analyzed at baseline, 6 months, and 12 months.

RESULTS

Significant differences were found between conditions across time (F = 4.58, P = .01). After the 6-month intervention, students in the condition with compañeros had a larger decrease in zBMI (F = 6.94, P = .01) than students in the condition without compañeros. Furthermore, students who received the intervention with compañeros showed greater sustained results at 12 months (F = 7.65, P = .01).

CONCLUSION

Using high school compañeros in an obesity intervention for Hispanic middle school students could be effective in promoting and maintaining reductions in zBMI.