Examination of the St-Louis du Parc Heart Health Project in terms of the recommendations found in the literature and formulated by experts
| Elements | Recommendations | St-Louis du Parc project | Comments |
|---|---|---|---|
| CDC, Centers for Disease Control; IM, Institute of Medicine; LR, literature review; NCI, National Cancer Institute. | |||
| Content of the curriculum | LR: A school based intervention should focus on information, attitudes, and skills to resist social and behavioural influences | The curriculum was developed based on the social learning theory and dealt with knowledge, attitudes, skills, and behaviours to adopt regarding abstinence from tobacco | Recommendations respected |
| NCI: The school based programme should emphasise social factors, consequences, and refusal skills | |||
| CDC: The intervention should focus on the physiologic and social consequences, social influences, peer norms regarding tobacco use, and refusal skills | |||
| Incorporation | NCI: Incorporated into existing curricula IM: Incorporated into drug programmes | The school based intervention was negotiated with a view to being incorporated into PSE (personal and social education) classes. In fact, the implementation assessments indicate that it was also incorporated into other subjects | Recommendations respected |
| Intensity of the curriculum | NCI: minimum of five sessions/year LR: in all, 10 sessions to observe sustainable effects | Programme content: 4th grade: eight 50 minute sessions on smoking (5 compulsory and 3 optional). 5th grade: five 50 minute sessions. 6th grade: five 50-minute sessions | Two recommendations respected |
| Note, however, a variation in the number of hours by school. The four schools in which the majority of the sessions were given reported more negative effects | |||
| Curriculum booster sessions or spread out over more than one school year | LR: 5 booster sessions LR: At least three consecutive years | Programme offered to the same students over three consecutive years | Both recommendations respected |
| Curriculum administration time | NCI: Initiated during the transition from elementary school to high school (6th grade and secondary 1) CDC: From kindergarten to the end of high school | Programme offered from 4th to 6th grade, therefore initiated at the beginning of the transition | Recommendation respected. An evaluation by the former Montreal General Hospital community health department of the impact of smoking related programmes available to kindergarten and 1st grade students indicated that they had very little effect |
| Teacher rather than an outside health professional delivering the curriculum | The literature makes two comments on this subject: Direct interventions with youth without going through teacher training, therefore with a health professional. In traditional health education type interventions, teachers generated more positive results than an outside health professional | A health professional offered the programme directly to the first cohort. For the other cohorts, the interventions were conducted jointly by the teacher and the health professional | Recommendation respected. Note that the outside health professional was present for five years in the same schools. In this case can we still describe the person as an outside health professional? |
| Teacher training | NCI: Adequate teacher training CDC: Programme specific teacher training | Each year, the teachers were trained on the whole programme for 2 days, including a half day on smoking. In addition, the health professional was available on request for additional supervision | Recommendation respected. What criteria are used to define adequate training? These were not explicitly defined by the NCI. Can regular support by the health professional be considered a training aid for teachers? The implementation assessments of Heart Health St-Louis du Parc suggest that the teachers learned with the presence of the health professional |
| Intervention by peers | LR: The student gives information to the other students. The teacher is a facilitator NCI: Students should be involved in the presentation and delivery of the programme | The 6th grade students are responsible for conveying information to the 4th and 5th grade students | Recommendation respected for 6th grade. Because of the children’s age (see below on cognitive development and moral judgement), we did not feel that peer based intervention was appropriate before the 6th grade |
| Cessation course | CDC: Support cessation efforts among students and teachers | When required, the health professional offered assistance to student smokers who asked for help, on an individual basis. On occasion, the health professional suggested the help. At the beginning of the project, the teachers clearly indicated that they objected to the intervention being directed at their own habits. However, in the last 18 months, some of the teachers asked us to organise cessation sessions | Recommendation partially respected because of the age of the students. We did not systematically plan cessation |
| Research | LR: The implementation assessment identifies the process explaining the success or failure of the programme CDC: Assess the smoking programmes on a regular basis IM: Idem and research should be conducted to identify needs, and develop and evaluate prevention programmes among ethnic groups | The school intervention was the subject of several types of evaluation: adjustment of the programme for ethnic communities, implementation assessment, and impact assessment | Recommendations respected |
| Comprehensive approach | IM: A comprehensive approach for a programme includes broader social networks such as parents, community, and the media | The school based intervention was part of an overall Heart Health Program involving interventions on policies, parental and teacher involvement, and the involvement of ethnic groups. Specifically, no media intervention designed exclusively for our population was organised. The Portuguese, Hispanic, and Chinese communities, through their own community organisations, produced media interventions for the project (radio, TV, newspapers) | Recommendation respected |
| CDC: Enforce school policies on tobacco use and involve parents | However, tobacco was not the central theme. Parental involvement was concretised through letters that they signed but also by their presence at certain activities. Parental participation varied from school to school. At first, the programme ensured the existence of policies, particularly on tobacco. Although there was a smoking room in the school, teachers were smoking in the corridors and particularly in the school yard. The intervention on the prohibition of cigarette sales to minors by convenience stores was not supported by parents | Recommendation respected for parents, but not respected in terms of policy reinforcement, for instance. Resistance was clearly expressed by teachers in this regard | |
| Cultural adaptation | NCI: Programme socially and culturally acceptable to each community | The intervention was designed and tested to reach children in different ethnic communities. Children, parents, and representatives of the four largest ethnic communities in the St-Louis du Parc area were consulted on their habits. This information was incorporated into the curriculum. Then, the ethnic components as we had understood them were evaluated by children, teachers, content committees and an advisory committee. Note that at this stage, our position on using children as an agent for change within the family had been challenged and had to be rejected | Recommendation respected. The implementation assessment of the school based curriculum indicated that the teachers sometimes had difficulty incorporating attitudes or activities related to ethnic dimensions |