School-based peer-education and peer-support for healthy lifestyles.

The assignment of participants to the intervention or control group will be based on the location and school population size. There will be two intervention and two control schools. We will select one intervention school in the city center area and another intervention school in a sub-urban location which is far from the city center. The intervention and control schools will be matched by the school population size with one control school in city center area and another control schoolin further away from the city centre. The intervention combines a peer-led education and a peer-led support system in total 5 months. The peer-led education part comprised three steps involving training the peer-educators (undergraduate students), peer-leaders (grade 8 students) and target grade 6 students. In the first step, two 4-hour training workshops for volunteering peer-educators (PE) are organized at Pham Ngoc Thach University of Medicine by Australian and Vietnamese expert team using a local culture-adapted material for teaching and training (PEPS manual). This PEPS manual is translated from the manual of the original SALSA program (conducted by the same Australia team) for junior high schools in New South Wales, Australia. Peer-educators also spend time to work together as teams to learn to teach and train for high school students in the next step in the following fortnight. The second step is organized at intervened schools for peer-leaders (PL) grade 8 students by the trained PE covering the content of the PEPS manual, the approach to teaching and developing communication skills. The four 2-hour workshops which are allocated in 2 weeks will cover crucial knowledge and update of healthy active lifestyles (through 4 lessons of the PEPS manual) and communication skills for the PL to gain trust and to build strong influence to lead their adolescent peers in this behaviour changing pilot intervention. Adolescent factors and challenges will also be dealt with based on the principle of transparency, care and student’s benefit using peer groupwork. The ratio between PE and PL in training sessions is maintained as 1:5 to 1:6. During the training, the PL are grouped in working team of five to six PL with two PE in each team as supervisors. Each team is dedicated for each class of grade 6 which is the program final target (total number of teams equal to the total number of grade 6 classes). Prior to the second step, preparations for the program are made which include explaining the intervention and seeking support with project partners, including the school principal, school staff, school youth association and parental associations. All PL are selected based on their volunteer will and by the suggestion of principle teachers of grade 8 classes. All participated PL need to fulfil and sign a consent form which is also signed by parents or guardians prior to get to the next step happening in the following fortnight. The third step is the main part of the program where teams of PL take responsibility to teach grade 6 classes the four 50-minute teaching sessions from PEPS Manual (which are Food Choices, Movement Matters, Healthy Lifestyles and PEPS Actions). Each session comprises of two main parts involving theory and practice skills. The theory part is based on specific facts and active learning which involves student participation and peer to peer interaction. Practice skills are sketched through the team or individual problem-solving games. Each session is delivered once a week by a team of 5 PL and 2 PE (as supervisors) to the class of grade 6 during their free learning hour every week (varied between schools) with the pre-agreement of all stakeholders. The four PEPS Manual sessions are delivered in four consecutive weeks which has been planned before. If any unforeseen obstacle happens and the session of the week is put on hold, the Core team members of PEPS project will discuss with school Principle and School Board to find a solution (better day to compensate for the on-hold session or extending the project to one or two weeks more). All sessions are from the PEPS Manual and additional teaching material are prepared by PE and reviewed by Expert (content author), and PE help the PL to practice and deliver the content on time. At any teaching week on any school, there are at least one Core team member of PEPS project and one reserve PE to deal with field work logistic issue and to support all teaching teams. During the last peer-education session (PEPS Actions), each class of grade 6 produce several strategies and plans and choose the best one for putting into practice in the class. The strategies and plans are based on the child health benefits, child health objectives, school environment and the will to make the behavioural changes of the children. Of those best plans of all classes, two most suitable plans will be selected to apply to the whole school after the teaching sessions finish. The other main part of PEPS program is peer-supporting system which include a behaviour reinforcement monitoring system and social network support which will be run and led by peers (PE, PL) but also monitored by PEPS core team members. The personal reinforcement monitoring system consists of a pre-distributed personal health record diary (HRD), a classroom merit board (monthly) and school awards every semester. The class reinforcement system includes organizing school events that stimulate the participating of the class which produce activity for class members. These school events are the plans for actions at school (i.e. raising awareness of healthy lifestyle through funny health slogans, welcoming behavioural changes by adopting new action objectives…). School events also include sport fair for all grade 6 classes happening one month after the teaching sessions end. The peer-supporting online social system is introduced to children of grade 6 during the teaching sessions (step 3) which attract students to view, like and share health posts on PEPS Project Facebook public page. A working IT team with one author is taking responsibility for updating and coordinating the page to targeted schools. We will also support every school to have a student community/social platform (Facebook, Zalo, ZingVN or other networks) which will be managed by peers with teacher monitoring to share experiences and answer questions or help solve challenges given during school events. PE and PL take important role in this system as they are placed as online helpers for children to fulfil their health objectives raised in session 4 PEPS Actions. Three core team members supervised all social platforms weekly to help the PE dealing with students queries.