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Exploring the Impact of Schools on the Quality of Diet and Physical Activity in Their Students: a Mixed Methods Study in Irish Post-Primary Schools

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Exploring the Impact of Schools on the Quality of Diet and Physical Activity in Their Students: a Mixed Methods Study in Irish Post-Primary Schools Exploring the impact of schools on the quality of diet and physical activity in their students: A mixed methods study in Irish post-primary schools Sarah Browne, B.Sc. Thesis suBmitted for the award of Ph.D. School of Nursing and Human Sciences Dublin City University Supervisors: Dr. Mary Rose Sweeney Prof. Anthony Staines Dr. Carol Barron December 2016 I hereby certify that this material, which I now submit for assessment on the programme of study leading to the award of PhD is entirely my own work, that I have exercised reasonable care to ensure that the work is original, and does not to the best of my knowledge breach any law of copyright, and has not been taken from the work of others save and to the extent that such work has been cited and acknowledged within the text of my work. Signed: ______________________ (Candidate) ID No.: __________________ Date: ___________ Sarah Browne Acknowledgements I would like to thank my supervisors Mary Rose Sweeney, Anthony Staines and Carol Barron for their guidance, time, expertise, and encouragement over the last few years. It has been a very fulfilling and interesting journey. Thank you Veronica Lambert and Davide Susta from DCU for giving valued time and expertise at many stages of the project. I would like to thank all at the School of Nursing & Human Sciences for supporting this work. A number of people assisted with the busy anthropometry and fitness fieldwork days at schools and I am grateful for their help – Ann Reilly, Karinda Tolland, Aileen Kennedy, Debbie Keogh, Ellie Marley, Clodagh Cox. Thank you also to PE teacher and Cardiff University MSc student Eve McCartney for working closely with the physical activity side of the study. I owe thanks to Clare Corish from UCD (formerly DIT) for sitting on my doctoral panel and giving valued advice at various stages. Thank you to Olive McGovern from the Department of Children and Youth Affairs, Ursula O’Dwyer from the Department of Health, and Aoibheann McMorrow from UCD for advising in the early stages of the project. For facilitating interesting visits to health promoting schools in Denmark, I wish to thank Jens Aagaard-Hansen from the Steno Institute, Copenhagen and Lisbeth Bryld Mortensen from Roskilde Katedralskole, Denmark. Thank you also to Safefood for funding one of these trips. Without the support of some very wonderful people I could not have embarked on or completed this PhD. Thank you to my sister Katie Glynn, my parents Caitlín and Gerry Browne, my parents-in-law Brid and Willie Mugan, and my brother Coman Browne. The words of support from other family and friends along the way have been so welcome – thank you all. A special thank you to my husband Brian Mugan for the steady supply of encouragement, patience and love. Hopefully you won’t run out of enthusiasm for my new ideas after this! Welcoming little James along the way has been fun and thank you James for encouraging me to take lots of breaks. This thesis is dedicated to the students who gave so much to the project. Students, teachers and principals in participating schools were incredibly generous. They welcomed me for weeks at a time and gave the project great freedom and scope. I owe a great deal of gratitude to all of them for their participation and enthusiasm. Table of Contents ABSTRACT ........................................................................................................................................... 1 Chapter 1 ........................................................................................................................................... 2 1 Introduction ........................................................................................................................... 2 1.1 Researcher Position and Contributions .............................................................. 3 Chapter 2 ........................................................................................................................................... 5 2 Literature Review ................................................................................................................ 5 2.1 Background and Introduction ................................................................................. 5 2.1.1 Search methods .................................................................................................... 5 2.2 The adolescent years .................................................................................................. 7 2.3 Physiological Growth and Overweight and Obesity Rates ......................... 10 2.4 Obesity: A Bio-ecological Issue ............................................................................ 16 2.5 Current knowledge: Diet and Physical Activity Behaviours ...................... 21 2.5.1 Physical activity participation ...................................................................... 21 2.5.2 Physical activity levels and physical fitness ............................................ 24 2.5.3 Dietary intake, patterns & quality ............................................................... 26 2.5.4 Body image and food/activity behaviours .............................................. 29 2.5.5 Implications of current diet/physical activity patterns ..................... 30 2.6 School Policies and Practices ................................................................................. 34 2.6.1 Role of formal education in Ireland ............................................................ 34 2.6.2 Foods in Irish post-primary schools .......................................................... 35 2.6.3 Physical activity practices in Irish post-primary schools .................. 38 2.6.4 What’s happening at policy level? ............................................................... 39 2.6.5 How school food impacts students ............................................................. 42 2.6.6 How physical activity at school impacts students ................................ 48 2.6.7 School physical activity contribution to fitness, BMI and other health measures ................................................................................................. 50 2.6.8 Barriers to nutrition and physical activity policies at school........... 51 2.7 Local Environment to School ................................................................................. 54 2.7.1 The impact of food environments ............................................................... 54 2.7.2 The impact of the built environment on physical activity ................. 57 2.8 The Views of Adolescents ....................................................................................... 61 2.8.1 Qualitative research with adolescents ...................................................... 63 2.9 Peers and Participatory Research ....................................................................... 68 2.9.1 Participatory research ..................................................................................... 69 2.10 Gaps in Current Knowledge ............................................................................... 73 2.11 Research Question, Study Aim, and Study Objectives ............................. 75 Chapter 3 ......................................................................................................................................... 76 3 Methodology ........................................................................................................................ 76 3.1 Introduction ................................................................................................................. 76 3.2 Study Design ................................................................................................................ 76 3.3 Mixed-method Research (MMR) .......................................................................... 79 3.3.1 Rationale for MMR Approach ....................................................................... 80 3.3.2 Mixed-method versus single-method research ..................................... 82 3.4 Participatory Research ............................................................................................ 88 3.5 Research Context, Setting and Participants ..................................................... 92 3.5.1 Context: Post-primary schools .................................................................... 92 3.5.2 School recruitment ........................................................................................... 93 3.5.3 Youth advisory panel ....................................................................................... 95 3.5.4 Participant recruitment .................................................................................. 95 3.6 Participatory Qualitative Methodologies ....................................................... 100 3.6.1 Recruitment & peer researcher selection ............................................. 100 3.6.2 Peer-led focus groups ................................................................................... 100 3.6.3 Peer led photography of the school environment ............................. 106 3.6.4 Evaluation of peer research methods ..................................................... 110 3.7 Researcher-led Qualitative Methods ............................................................... 112 3.7.1 Focus groups with teachers and interviews with principals ........ 112 3.7.2 Focus groups with parents ......................................................................... 114
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