The Effects of Photovoice as a Comprehensive School Health Intervention in Grade 5 Classrooms
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Objective: The primary goal of the study was to explore the effects of a photovoice intervention within a Comprehensive School Health (CSH) framework. The objectives of the study were to: understand the context of each case with respect to school readiness; understand healthy eating and physical activity influences (facilitators and barriers) within a school, from the perspective of a participating students; determine if photovoice enhanced students understanding of healthy school environments and CSH pillars; and determine key factors for success of a CSH facilitator to enhance school environments. Methods: This study employed an embedded and descriptive case study approach. One grade 5 and one 5/6 class from different schools were selected to participate in the PV intervention. Schools were purposively selected from a broader facilitated school health intervention. The study used a mixed methods approach that included both quantitative and qualitative methods of data analysis. Quantitative data sources included the Healthy School Planner survey to assess school readiness. Qualitative data sources included facilitator interviews and email exchanges with the researcher, and photovoice data (pictures and discussion transcripts). The study utilized a framework analysis approach to manage the large amounts of qualitative data. Results: Quantitative analyses showed that School 1 scored higher across all indicator scores, suggesting greater readiness for a CSH intervention. Of the 345 photovoice pictures submitted, 220 were analysed using NVivo 10. Also analysed were 3 facilitator interview transcripts, 4 photovoice non-verbatim discussion transcripts and email exchanges between the facilitator and researcher. The final analytical framework identified three overarching themes: CSH Pillars (what is happening in schools to support healthy environments); how to create healthy school environments; and barriers. Facilitator data identified key factors for successful facilitation, which included creating action plans, enhancing buy-in, communicating, enhancing engagement and supporting sustainability. At the student-level, participating photovoice students demonstrated an increase in references to CSH pillars from time 1 to time 2, suggesting an increase in engagement and understanding of CSH pillars. Finally, time and dose were identified as large barriers to successful facilitation for a school health program. Conclusion: This study suggests that student engagement interventions can enhance students’ understanding of the theoretical grounding driving a school health program (i.e., CSH Pillars). This may result in increased engagement in policy and individual-level behaviour outcomes. Furthermore, key factors for successful facilitation were identified and should be considered for future CSH facilitation. Recommendations of smaller facilitator to school doses, longer interventions and more touch points may enhance CSH results and should also be considered in future research. Finally, this study also identified lessons learned for implementing photovoice as a student engagement intervention within a CSH context.