URBANA, Ill. – Health and wellbeing education can be an important addition to a school curriculum. But for these programs to be effective, they must be delivered in a way that works for everyone, including students, instructors, and school administrators. A new study from University of Illinois evaluates the implementation of two prevention programs, using a mixed-methods approach with input from multiple sources.

“Soliciting diverse perspectives is important. The more we can listen to everyone who's involved, the better we can learn what can be done to improve the programs. And we really need to include the youth voice, because they're the experts of their own experience,” says Jacinda K. Dariotis, professor in the Department of Human Development and Family Studies and director of the Family Resiliency Center, both part of the College of Agricultural, Consumer and Environmental Sciences at the U of I. Dariotis is lead author on the paper, published in Prevention Science.

The study was conducted in three urban public schools in low-income neighborhoods. Participants were ninth-grade students, the majority of whom (84%) self-identified as Black. The students volunteered for the study and were randomly assigned to either a mindfulness or a health education class. The programs were delivered in 30-minute sessions four times a week for 10 weeks.

To evaluate program implementation, the researchers asked instructors to note student attendance and engagement, as well as their own adherence to the program. Some class sessions were videotaped and rated by independent observers. Finally, students discussed their experiences in focus groups after program conclusion.

Dariotis and her colleagues identified four themes that had a positive impact on delivery. For example, it is essential that instructors are attentive and engaging. A variety of activities are needed to hold attention, including more student involvement. There needs to be sufficient time for program delivery. Student preferences should also be considered in program scheduling.

“One of our key takeaways is that students’ relationship with the instructor really matters, because that builds connection,” Dariotis says. “We also found that active learning is important, including physical activity and opportunities to help and train other students.”

The researchers measured program fidelity, which addresses how closely instructors adhere to a program protocol, through instructor self-reports and observer notes. Instructors sometimes deviated from protocol due to environmental circumstances and interruptions, but that’s not necessarily a bad thing, Dariotis points out. Some flexibility in program delivery can help to accommodate student and school needs.

Several barriers to implementation also emerged from the study, including insufficient time, behavior management issues, and environmental disruptions in the school environment.

“These are very low-resource schools in disadvantaged neighborhoods. When you’re trying to provide preventive programs like these, there are so many distractions that make implementation difficult. The more we can do to bring greater predictability and reduce distractions, the better chances of success,” Dariotis says.

Schools need to balance limited time and many different demands, but listening to youth perspectives and learning about their challenges can help to increase participation.

“It’s important to bring in youth input and perceptions early on to ensure the programs can be designed and implemented in ways that meet the needs of the students, as well as the teachers and the schools,” Dariotis states.

“These types of programs can be provided in any school or afterschool program wanting to invest in low cost, highly scalable, and sustainable programs that can make a difference,” she concludes. 

The paper, “Implementing Adolescent Wellbeing and Health Programs in Schools: Insights from a Mixed Methods and Multiple Informant Study,” is published in Prevention Science [DOI: https://doi.org/10.1007/s11121-022-01481-2]. Authors include Jacinda Dariotis, Keren Mabisi, Rachel Jackson-Gordon, Nan Yang, Emma Jane Rose, Tamar Mendelson, and Diana Fishbein.

This work was supported by the National Center for Complementary and Integrative Health.