Engaging Canadian youth in conversations: Using knowledge exchange in school-based health promotion
The voice of youth is crucial to advancing solutions that contribute to effective strategies to improve youth health outcomes. The problem, however, is that youth/student voices are often overlooked, and stakeholders typically engage in decision-making without involving youth. The burden of chronic disease is increasing worldwide, and in Canada chronic disease accounts for 89 per cent of deaths. However, currently, youth spend less time being physically active while engaging in more unhealthy eating behaviours than ever before. High rates of unhealthy behaviours such as physical inactivity, unhealthy eating and tobacco use are putting Canadian youth at risk of health problems such as increased levels of overweight and obesity, cardiovascular disease and type 2 diabetes. Focus group methodology was utilised to conduct 7 focus groups with 50 students in grades 7–12 from schools in Prince Edward Island, Canada. The key themes that emerged included: (1) youth health issues such as lack of opportunities to be physically active, cost and quality of healthy food options, and bullying; (2) facilitators and barriers to health promotion, including positive peer and adult role models, positive relationships with adults and competitiveness of school sports; and (3) lack of student voice. Our findings suggest that actively engaging youth provides opportunities to understand youth perspectives on how to encourage them to make healthy choices and engage in healthy behaviours. Attention needs to be paid to inclusive knowledge exchange practices that value and integrate youth perspectives and ideas as a basis for building health promotion actions and interventions.
Keywords: knowledge exchange, youth health, youth engagement
Active Healthy Kids Canada 2011, Don't let this be the most physical activity our kids get after school: Active Healthy Kids Canada 2011 Report Card on physical activity for children and youth, Toronto, ON, Canada, viewed 8 May 2014, http://dvqdas9jty7g6.cloudfront.net/reportcard2011/ahkcreportcard20110429final.pdf.
Altman, D, Feighery, E, Robinson, T, Haydel, K, Strausberg, L, Lorig, K, Killen, J 1998, 'Psychosocial factors associated with youth involvement in community activities promoting heart health', Health Education & Behavior, vol. 25, no. 4, pp. 489500. http://dx.doi.org/10.1177/109019819802500407
Bandura, A 2004, 'Health promotion by social cognitive means', Health Education & Behavior, vol. 31, no. 2, pp. 14364. http://dx.doi.org/10.1177/1090198104263660
Bauer, K, Yang, Y & Austin, S 2004, 'How can we stay healthy when you're throwing all of this in front of us?" Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity', Health Education & Behavior, vol. 31, no. 1, pp. 3446." http://dx.doi.org/10.1177/1090198103255372
Bond, L, Butler, H, Thomas, L, Carlin, J, Glover, S, Bowes, G & Patton G 2007, 'Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes', Journal of Adolescent Health, vol. 40, no. 4, p. 357, 918e.
Butler-Jones D 2008, The Chief Public Health Officer's report: Report on the state of public health in Canada, Public Health Agency of Canada, Ottawa, ON.
Canadian Institutes of Health Research 2014, 'More about knowledge translation at CIHR', viewed 17 April 2014, www.cihr-irsc.gc.ca/e/39033.html.
Cargo, M, Grams, G, Ottoson, J, Ward, P & Green, L 2002, 'Empowerment as fostering positive youth development and citizenship', American Journal of Health Behavior, vol. 27, no. 1, suppl., pp. 6679s. http://dx.doi.org/10.5993/AJHB.27.1.s1.7
Clark, M, Berry, T, Spence, J, Nykiforuk, C, Carlson, M & Blanchard, C 2010, 'Key stakeholder perspectives on the development of walkable neighbourhoods', Health & Place, vol. 16, no. 1, pp. 4350. http://dx.doi.org/10.1016/j.healthplace.2009.08.001
Dobbins, M, Ciliska, D & DiCenso, A 1988, Dissemination and use of research evidence for policy and practice: A framework for developing, implementing and evaluating strategies, Canadian Nurses Association, Ottawa, ON.
Eisenberg, M, Neumark-Sztainer, D & Perry, C 2003, 'Peer harassment, school connectedness, and academic achievement', Journal of School Health, vol. 73, no. 8, pp. 31116. http://dx.doi.org/10.1111/j.1746-1561.2003.tb06588.x
Faulkner, G, Adlaf, E, Irving, H, Allison, K & Dwyer, J 2009, 'School disconnectedness: Identifying adolescents at risk in Ontario, Canada', Journal of School Health, vol. 79, no. 7, pp. 31218. http://dx.doi.org/10.1111/j.1746-1561.2009.00415.x
Freeman, J, King, M, Pickett, W, Craig, W, Elgar, F & Janssen, I (eds) 2011, The health of Canada's young people: A mental health focus, Public Health Agency of Canada, Ottawa, ON.
Gagnon, M 2011, 'Moving knowledge to action through dissemination and exchange', Journal of Clinical Epidemiology, vol. 64, no. 1, pp. 17. http://dx.doi.org/10.1016/j.jclinepi.2009.08.013
Graham, I, Logan, J, Harrison, M, Straus, S, Tetroe, J, Caswell, W & Robinson, N 2006, 'Lost in knowledge translation: Time for a map?',
Journal of Continuing Education in the Health Professions, vol. 26, no. 1, pp. 1324. http://dx.doi.org/10.1002/chp.47
Graham, I & Tetroe, J 2007, 'Some theoretical underpinnings of knowledge translation', Academic Emergency Medicine, vol. 14, no. 11, pp. 93641.
Halcomb, E & Davidson, P 2006, 'Is verbatim transcription of interview data always necessary?', Applied Nursing Research, vol. 19, no. 1, pp. 3842. http://dx.doi.org/10.1016/j.apnr.2005.06.001
Hanson, M & Gluckman, P 2011, 'Developmental origins of non-communicable disease: Population and public health implications', American Journal of Clinical Nutrition, vol. 94, no. 6, suppl., pp. 175458s. http://dx.doi.org/10.3945/ajcn.110.001206
Just, D & Wansink, B 2009, 'Smarter lunchrooms: Using behavioral economics to improve meal selection', Choices, vol. 24, no. 3, viewed 2 October 2012, www.choicesmagazine.org/magazine/article.php?article=87.
Krueger, R 1994, Focus groups: A practical guide for applied research, 2nd edn, Sage, Thousand Oaks, CA.
Kubik, M, Lytle, L & Fulkerson, JA 2005, 'Fruits, vegetables, and football: Findings from focus groups with alternative high school students regarding eating and physical activity', Journal of Adolescent Health, vol. 36, no. 6, pp. 494500. http://dx.doi.org/10.1016/j.jadohealth.2004.05.010
Lavis, J, Ross, S, McLeod, C & Gildiner, A 2003, 'Measuring the impact of health research', Journal of Health Services Research and Policy, vol. 8, no. 3, pp. 16570. http://dx.doi.org/10.1258/135581903322029520
Leatherdale, S, Manske, S, Wong, S & Cameron, R 2009, 'Integrating research, policy, and practice in school-based physical activity prevention programming: The school health action, planning, and evaluation system (SHAPES) physical activity module', Health Promotion Practice, vol. 10, no. 2, pp. 25461. http://dx.doi.org/10.1177/1524839906298499
Leininger, M 1985, 'Ethnography and ethnonursing: Models and modes of qualitative data analysis', in M Leininger (ed.), Qualitative research methods in nursing, Grune & Stratton, Orlando, FL, pp. 3372.
Lerner, R & Thompson, L 2002, 'Promoting healthy adolescent behaviour and development: Issues in the design and evaluation of effective youth programs', Journal of Pediatric Nursing, vol. 17, no. 5, pp. 33844. http://dx.doi.org/10.1053/jpdn.2002.127176
McNeely, C & Falci, C 2004, 'School connectedness and the transition into and out of health-risk behavior among adolescents: A comparison of social belonging and teacher support', Journal of School Health, vol. 74, no. 7, pp. 28492. http://dx.doi.org/10.1111/j.1746-1561.2004.tb08285.x
McNeely, C, Nonnemaker, J & Blum, R 2002, 'Promoting school connectedness: Evidence from the National Longitudinal Study of Adolescent Health', Journal of School Health, vol. 72, no. 4, pp. 13846. http://dx.doi.org/10.1111/j.1746-1561.2002.tb06533.x
Mitton, C & Perry, B 2007, 'Knowledge transfer and exchange: Review and synthesis of the literature', Millbank Quarterly, vol. 85, no. 4, pp. 72968. http://dx.doi.org/10.1111/j.1468-0009.2007.00506.x
Morrison, J, Friedman, L & Gray-McGuire, C 2007, 'Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: The Princeton Lipid Research Clinics Follow-Up Study', Pediatrics, vol. 120, no. 2, pp. 34045. http://dx.doi.org/10.1542/peds.2006-1699
Morrow, V 2001, 'Using qualitative methods to elicit young people's perspectives on their environments: Some ideas for community health initiatives', Health Education Research, vol. 16, no. 3, pp. 25568. http://dx.doi.org/10.1093/her/16.3.255
Murnaghan, D 2011, '2010-2011 SHAPES/YSS-PEI: Prince Edward Island Student Health Profile', Propel Centre for Population Health Impact, Waterloo, ON.
Murnaghan, D, Morrison, W, Griffith, E, Bell, B, Duffley, L, McGarry, K & Manske, S 2013, 'Knowledge exchange systems for youth health and chronic disease prevention: A tri-provincial case study', Chronic Diseases and Injuries in Canada, vol. 33, no. 4, pp. 25766.
Morse, J & Richards, L 2002, README FIRST for a user's guide to qualitative methods, Sage, Thousand Oaks, CA.
Neumark-Sztainer, D, Martin, S & Story, M 2000, 'School-based programs for obesity prevention: What do adolescents recommend?', American Journal of Health Promotion, vol. 14, no. 4, pp. 23235. http://dx.doi.org/10.4278/0890-1171-14.4.232
Nixon, S, Casale, M, Flicker S, Rogan, M 2013, 'Applying the principles of knowledge translation and exchange to inform dissemination of HIV survey results to adolescent participants in South Africa', Health Promotion International, vol. 28, no. 2, pp. 23343. http://dx.doi.org/10.1093/heapro/dar094
Rasmussen, M, Damsgaard, M, Holstein, B, Poulsen, L & Due, P 2005, 'School connectedness and daily smoking among boys and girls: The influence of parental smoking norms', European Journal of Public Health, vol. 15, no. 6, pp. 60712. http://dx.doi.org/10.1093/eurpub/cki039
Resnick, M, Bearman, P, Blum, R, Bauman, K, Harris, K, Jones, J, Tabor, J, Buehring, T, Sieving, R, Shew, M, Ireland, M, Bearinger, L & Udry, R 1997, 'Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health', Journal of the American Medical Association, vol. 278, no. 10, pp. 82332.
Rice, M, Kang, D, Weaver, M & Howell, C 2008, 'Relationship of anger, stress, and coping with school connectedness in fourth-grade children', Journal of School Health, vol. 78, no. 3, pp. 14956. http://dx.doi.org/10.1111/j.1746-1561.2007.00277.x
Roberts, K, Shields, M, de Groh, M, Aziz, A & Gilbert, J 2012, 'Overweight and obesity in children and adolescents: Results from 20092011 Canadian Health Measures Survey', Statistics Canada, vol. 23, no. 3, pp. 17.
Roth, J, Brooks-Gunn, J, Murray, L & Foster, W 1998, 'Promoting healthy adolescents: Synthesis of youth development program evaluations', Journal of Research on Adolescence, vol. 8, no. 4, pp. 42359. http://dx.doi.org/10.1207/s15327795jra0804_2
Sandelowski, M & Barroso, J 2003, 'Classifying the findings in qualitative studies', Qualitative Health Research, vol. 13, no. 7, pp. 90523. http://dx.doi.org/10.1177/1049732303253488
Straus, S, Tetroe, J & Graham, I 2011, 'Knowledge translation is the use of knowledge in health care decision making', Journal of Clinical Epidemiology, vol. 64, no. 1, pp. 610. http://dx.doi.org/10.1016/j.jclinepi.2009.08.016
Tugwell, P, Knottnerus, J & Idzerda, L 2011, 'Definitions and framework for knowledge translation to continue to evolve', Journal of Clinical Epidemiology, vol. 64, no. 1, pp. 12. http://dx.doi.org/10.1016/j.jclinepi.2010.11.001
Vanhala, M, Vanhala, P, Kumpusalo, E, Halonen, P & Takala, J 1998, 'Relationship between obesity from childhood to adulthood and the metabolic syndrome: Population based study', British Medical Journal, vol. 317, no. 154, pp. 31920. http://dx.doi.org/10.1136/bmj.317.7154.319
Vu, M, Murrie, D, Gonzalez, V & Jobe, J 2006, 'Listening to girls and boys talk about girls' physical activity behaviours', Health Education & Behavior, vol. 33, no. 1, pp. 8196. http://dx.doi.org/10.1177/1090198105282443
Ward, V, House, A, & Hamer, S 2009, 'Developing a framework for transferring knowledge into action: A thematic analysis of the literature', Journal of Health Services Research and Policy, vol. 14, no. 3, p. 15664. http://dx.doi.org/10.1258/jhsrp.2009.008120
Wilson, M, Lavis, J, Travers, R, & Rourke, SB 2012, 'Community-based knowledge transfer and exchange: Helping community-based organizations link research to action', Implementation Science, vol. 5, no. 33, p. 215.
'Wingspread Declaration on School Connections' 2004, Journal of School Health, vol. 74, no. 7, pp. 23334.
Wong, N, Zimmerman, M & Parker, E 2010, 'A typology of youth participation and empowerment for child and adolescent health promotion', American Journal of Community Psychology, vol. 46, nos. 12, pp. 10014. http://dx.doi.org/10.1007/s10464-010-9330-0
World Health Organization 2012, 'Obesity and overweight', fact sheet no. 311, viewed 3 July 2012, www.who.int/mediacentre/factsheets/fs311/en/index.html.
Yin, R 2009, Case study research: Design and methods, 4th edn, Sage, Thousand Oaks, CA.
Yoshida, S, Craypo, L & Samuels, S 2011, 'Engaging youth in improving their food and physical activity environments', Journal of Adolescent Health, vol. 48, no. 6, pp. 64143. http://dx.doi.org/10.1016/j.jadohealth.2010.09.007