Background
Modification of the recess environment (recreational equipment and staff training) may increase youth physical activity (PA) at school. However, successful implementation of environmental changes may require the school community to have a minimum level of readiness for change to assure that environmental changes are sustained. More importantly, readiness levels of particular key informants within the school community (e.g., principals, recess staff) may be more critical to the implementation and sustainability of environmental changes than the school community’s overall readiness level. An improved understanding of school community readiness may help researchers to better tailor interventions and help sustain environmental changes for PA.
Objectives
The purpose of this study was to: 1) identify key informants who scored highest on school community readiness at baseline, and 2) determine the effects of Ready for Recess, an intervention aimed at implementing environmental changes to school recess (i.e., staff training, recess equipment), on changes in community readiness levels among key informants from baseline to post-intervention.
Methods
Seventeen schools (13 with free/reduced lunch status) participated in Ready for Recess and were randomly assigned to one of four interventions: recess staff training and equipment, recess staff training only, recess equipment only, or control. Six key informants (principal, physical education (PE) teacher, nurse/health aide, 3rd-6th grade teacher, recess staff, and parent) were interviewed using the Community Readiness Model (CRM) at each of the 17 schools at baseline (August/September 2009 or 2010) and post-intervention (May 2010 or 2011). As per the CRM, six dimensions of readiness were scored. Nine stages of readiness characterize each dimension. Overall readiness scores and dimension scores were calculated for each school and for each key informant type across schools at baseline and post-intervention. Key informants’ average readiness levels were represented by a mean of the sum of all six dimensions along the nine stage continuum (Possible Range = 6-54). Analyses were conducted using repeated measures ANOVA and ANCOVA. The classification variable was the key informant, and the covariates included intervention type and baseline community readiness.
Results
All 17 schools aggregated toward the bottom of the CRM continuum (denial/resistance, vague awareness, and preplanning stages). No differences in community readiness by key informant were observed between schools at baseline or post-intervention. At baseline principals scored highest across all dimensions (mean=23.2), while teachers scored lowest (mean=17.6). After Ready for Recess, the readiness of the principals decreased (mean=21.1), as did the readiness levels of the recess staff and teachers, though these latter changes were not statistically significant. In univariate analyses significant decreases were observed in the leadership (F=10.9, p=0.001) and resources available (F=8.3, p=0.005) dimensions across all key informants. Partialing out the effects of baseline school community readiness strengthened the association between baseline and post-intervention key informant scores on the leadership dimension (F=11.9, p=0.0009). Decreases in the resources available dimension were due to teachers’ decrease in readiness. The specific intervention type was not significantly associated with changes in readiness in any of the six dimensions. Overall readiness at schools in the preplanning and vague awareness stages stayed the same or decreased after Ready for Recess, while overall readiness at schools in the denial/resistance stage increased.
Conclusions
Consistent with previous research, this study suggests that leaders (i.e., principals) may be an important target for increasing community readiness for change. Further research is needed to uncover why principals’ readiness and the leadership dimension decreased after Ready for Recess. These decreases may be due to premature commitment to the intervention, the attraction of incentives (i.e., staff training and/or equipment), and/or the perceived efforts required in implementing the intervention. Recess staff and teachers, both directly involved in the implementation of Ready for Recess, decreased in readiness from baseline to post-intervention. Further, teachers contributed most to decreases in the resources available dimension, suggesting that, amidst an increase in resources (i.e., training and equipment), teachers felt that the resources available were not sufficient to promote PA in the context of Ready for Recess. Previous research provides evidence that key informant readiness levels may be significantly correlated with management level key informants’ readiness. In other words, recess staff and teachers’ decreases in readiness may be due to lack of readiness and leadership from principals. Additional research using qualitative methods to examine the interviews may provide better understanding of the school leadership’s association with readiness levels of other key informants, such as recess staff and teachers. This inquiry may also provide further information on how the school community defines leadership in the context of promoting youth PA. Finally, readiness at schools at the denial stage increased across all dimensions, except leadership and knowledge about the issue. Targeting these two dimensions among principals and staff implementing PA programs, prior to initiating interventions, may be crucial to the effectiveness of school-based interventions aimed at promoting PA among youth.
Support/Funding
Robert Wood Johnson Foundation via Active Living Research, Round 8; Alegent Health Systems.
