Despite widespread concern over children’s health, elementary health educators struggle to compete for instructional time and resources in an era dominated by core instruction. Districts also tend to employ a constantly changing mix of prevention programs. The aim of this research was to determine whether K-5 students who received a comprehensive, grade-levelled curriculum would acquire greater health knowledge than students whose schools followed their districts’ standard health guidelines. Treatment students received Healthy Lifestyle Choices Behavioral Health (HLC), a series of 144 heavily scripted lessons (24 per K-5 grade) covering life skills, conflict resolution, nutrition, fitness, substance abuse and safety.
Method:
The three-year, mixed methods quasi-experimental study began in fall 2010 in 15 rural and urban schools serving both low- and high-risk communities. Schools were paired on key risk factors, then randomly assigned to condition. Students in grades 3-5 were pre- and post-tested annually using a grade-leveled health knowledge assessment developed for this study. A structured observation protocol was used to describe and measure the quality and fidelity of HLC instruction.
Analysis/Results:
Knowledge data were analyzed using an ANCOVA model with one dependent variable (spring knowledge), one fixed factor (treatment), and three covariates (fall knowledge, income, and race). Classroom observations data were analyzed both qualitatively and quantitatively and were used to categorize teachers into “higher” and “lower” fidelity groups. Consistent with instructional change theory, the treatment groups exhibited comparable knowledge in Year 1, while HLC instructors adjusted to using a comprehensive curriculum. Treatment students gained significantly deeper knowledge than comparison students in Years 2-3. (Probability levels in Year 2 were p<.001, p<.0001, and p<.001 for grades 3-5 respectively, and in Year 3 were p<.001, p<.003, and p<.0001 for grades 3-5 respectively). Regardless of treatment, low-income students were consistently less knowledgeable than their moderate income peers. Low-income treatment students acquired significantly deeper knowledge than comparison students (p<.010, p<.0001, p<.005 at grades 3-5 respectively in Year 1 and p<.018, p<.003, and p<.001 in Year2 at grades 3-5). Students taught by “higher-fidelity” instructors made significantly larger knowledge gains (p<.01) than students taught by “lower” fidelity teachers.
Conclusions:
Although the current preoccupation with core instruction has exacerbated barriers to high-quality health instruction, students can make significant health knowledge gains when they receive consistent and coherent instruction throughout elementary school. Students make the greatest knowledge gains when their teachers maximize instructional time and use multiple instructional strategies to reinforce student learning.