Evaluating the impact of the Students As LifeStyle Activists (SALSA) project on dietary and physical activity of high school students

The SALSA program is a peer-led educational intervention to motivate high school students to make healthier lifestyle choices. The broad aims of the SALSA program are to promote healthy eating patterns and regular physical activity in an engaging, fun and supportive school environment. The SALSA program is incorporated into each school’s Personal Development, Health and Physical Education (PDHPE) curriculum to complement lessons taught by PDHPE teachers. The program specifically targets schools in western Sydney where the risk for overweight and obesity development is a major public health concern. The theoretical framework of the SALSA program is based on Bandura’s Social Cognitive Theory and empowerment education approach. The Social Cognitive Theory proposes a reciprocal determinism in the interaction between a person, a targeted behaviour and a particular social context. It emphasises that people learn not only from their own experiences but also by observing the actions of others. Accordingly adolescents are encouraged to (i) observe and imitate the positive behaviours of others; (ii) see positive behaviours modelled and practised; (iii) empower and increase their own capability and confidence to implement new skills; (iv) adopt positive attitudes about implementing new skills and; (v) use their new skills in a supportive environment. The intervention strategies are based on the empowerment education approach, wherein students gain knowledge through group sharing and understanding of the social influences that affect their lives, set their own priorities and decide on group action in order to change conditions or resolve issues. A variety of strategies including a video, games, role-playing and a quiz show are used in the program, with participation and fun central to all aspects of learning. The program materials and delivery of the four lessons by the SALSA Year 10 Peer Leaders to Year 8 students are standardised through the use of structured lessons using the Peer Leaders Manual and the ‘Ryan’s Goal’ video (available at www.sydney.edu.au/medicine/public-health/salsa-triple-a/). Implementation of the SALSA program in 2014-15 Initially, project staff train volunteer university students from health and education disciplines as SALSA Educators. The SALSA educator training is completed in a face-to-face, one-day (~8 hour) workshop. University students are required to attend one workshop and provide a Working With Children Check clearance before visiting the high schools. [96 university students were trained in four workshops, two in 2014 and two in 2015] Next, the SALSA program is delivered to high schools as a three-step process involving university students, and high school students as both learners and educators. Delivery of the SALSA program is designed to be flexible and work within the school timetable. Each participating school appoints a teacher (SALSA coordinator) to coordinate the following intervention components in conjunction with SALSA program staff. Three step process: Step 1: Trained SALSA Educators (university students) coach volunteer or teacher selected Year 10 students as SALSA Peer Leaders for the program, during a one-day workshop. The Peer Leaders learn about nutrition and physical activity and acquire skills in group facilitation, teaching and leadership. [32 peer leader workshops were held, with 96 university students training 869 Year 10 SALSA peer leaders across 23 high schools] Step 2: The school SALSA coordinator allocates trained peer leaders to deliver the SALSA lessons in groups. We recommended a minimum of four students per group. Each group of peer leaders delivers the 4 x 70 minute lessons to Year 8 students using the Peer Leader’s Manual as a guide. Lesson delivery is usually completed in less than 4 weeks. Students learn about nutrition, physical activity and healthy lifestyle behaviours through videos, games and activities. The Year 8 PDHPE teacher provides general supervision and only assisted with behaviour management as needed. Schools [869 SALSA peer leaders educated over 3,800 Year 8 students in 23 high schools] Step 3: Wider dissemination of healthy lifestyle information occurs when students from the Year 8 classes develop a personal goal and a school-action plan in the final SALSA lesson. We expect that students implement the personal goals set as part of the SALSA program, leading to health-related behaviour change, and share their experience in the program with their friends and family. The school action plan is developed during the final SALSA lesson for students to lead in improving their school environment e.g. organise sports, start breakfast clubs, change food availability in canteens. The implementation of these action plans was not recorded in this study. Study design The present study adopted a pre-post evaluation design. At each school, all Year 8 classes and a select group of Year 10 students (to be trained as SALSA peer leaders) completed a 10-minute online evaluation questionnaire. A range of process data was collected throughout the project to monitor implementation fidelity and the acceptability of the SALSA program to the target populations. *Training workshops: At the conclusion of the training workshops, all university SALSA Educators and Year 10 Peer Leaders completed a paper-based feedback questionnaire regarding their training experience. *Year 10 peer leader debriefing session: A second paper-based questionnaire was completed by Year 10 Peer Leaders to obtain further feedback after the four SALSA lessons had been delivered. A debrief discussion was also facilitated post-workshop and responses were scribed and recorded for analysis. *Year 8 teachers: School PDHPE teachers were asked to complete lesson logs to monitor the SALSA program implementation in 2014 and 2015. For each of the four SALSA lessons, the date of completion, number of Peer Leaders and number of Year 8 students were recorded by the teachers, and returned to SALSA staff at the completion of the program. *Principals and School SALSA coordinators: The Project Leader and Project Officer conducted additional informal interviews with the teachers who coordinated the SALSA programs and school principals to get their feedback on the program.