Lisa Marriott - Working with Local Schools on Nutrition Education

1. Working with Local Schools on Nutrition Education Game-based approaches for improving health and education on an academic budget Lisa Marriott, PhD Assistant Professor marriott@ohsu.edu

2. About Us 2017 2007 2009 2014 2011 2015 Program launched as 2 week exhibit at science museum (no dedicated staff) Funded to go to schools & communities (1 local programmer, 1 coordinator) First game about skin cancer (2012 Serious Play Award), 2 prgmrs + 1 coord Second “game” about epigenetics (2014 Serious Play Award); CTSA-housed team of programmers Technology Award, Soc. Public Health Education; Worksite wellness program in Thailand By the Numbers 33,000+ participants 25+ schools, 1 tribal school 4 school districts, longitudinally 1200 volunteers trained 6 teacher professional development sessions Integration with EMR for worksite wellness; Migration of platform to online

3. Body Composition Height, weight, waist circumference, body mass index, body fat percentage Cognitive Function Computerized assessments of short-term visuospatial memory and attention Epigenetics Education Diet What is “Let’s Get Healthy!” ? Computerized assessment with tailored feedback. Bitter taste sensitivity Cancer Risk Skin cancer, lung cancer, and breast cancer risk assessment Data linked anonymously to each participant by scanning their random wristband barcode Automatically added to database at OHSU Sleep Blood Pressure Systolic and diastolic blood pressure measurements Computerized assessment of sleep quality, morningness / eveningness, and daytime sleepiness with tailored feedback Communities Schools Researchers - - Automated content Tailored feedback

4. How can we get schools to use their health data? Elements applied: • Exploration, discovery, & learning in a time-pressure environment • Branching choices for participation leading to measurement • Success/failure feedback based on their results • Anonymity for participation • Competition (in # stations completed, comparisons with peers) • Debrief with their teacher (peers, family) www.letsgethealthy.org

6. Using Data for Play and Learning • Support students’ interest in science (particularly MS) • Increase understanding of the importance of research and its personal relevance • Increase students’ data literacy through inquiry and data play • Support schools in their ability to get grants to improve local health

7. Theory-based Design Component Key Theory Applied Getting students initially interestedin their health data via the health fair Health Belief Model -- seeing their own results expected to increase awareness of perceived susceptibility of themselves and others. (Pulls in knowledge, efficacy, benefits) Getting teacher buy in to using the data in the classroom – and why health data are relevant for students Social Cognitive Theory - human behavior is an interaction of personal factors, behavior, and the environment. E.g. A class can explore through inquiry “Does our school have higher sugar consumption than other schools and what school factors might influence that?” (Pulls in observational learning, outcome expectations, reciprocal determinism). Or classes can examine together how the student fits into their world via ecological perspective to examine health behaviors in family/school/community contexts Students’ ability and intention to use the health data Theory of Planned Behavior – Attitudes toward use of data in research; norms/motivation for using the data within the classroom, behavioral control to interact with the data; intention to use it; Actual usage. Supporting interest and skills in students’ science development Self-Determination Theory – Goal of satisfying 1) competence (science self-efficacy); 2) relatedness (building students’ STEM identity and interest); and 3) supporting autonomy (ability to have control over decisions)

8. Addressing factors that influence the behavior Target Components for Intervention When considering what we want to change, what are the…. When designing an intervention, what programmatic characteristics would specifically target this identified factor? • Supply interactive, pre-analyzed data • Make the data about themselves Predisposing factors Intellectual and emotional “givens” that tend to make individuals more or less likely to adopt healthful or risky behaviors or lifestyles or to approve of or accept particular environmental conditions. • Knowledge, Attitudes, Beliefs/Norms (mistaken or legit), Values, Confidence/Efficacy Enabling factors Internal and external conditions directly related to the issue that help people adopt and maintain healthy or unhealthy behaviors and lifestyles, or to embrace or reject particular environmental conditions. Among them are:  Availability of resources, Accessibility of services  Community and/or government laws, policies, priority, and commitment to the issue.  Issue-related skills. (e.g., job placement programs). Reinforcing factors People and community attitudes that support or make difficult adopting healthy behaviors or fostering healthy environmental conditions. These are largely the attitudes of influential people: family, peers, teachers, employers, health or human service providers, the media, community leaders, and politicians and other decision makers. An intervention might aim at these people to most effectively reach the real target group. Other. Any policies, regulatory issues, and/or organizational/participant culture to consider? • Students may not know how to use raw data Students may find data boring • • • Teachers may not have the time to devote to new resources. Teachers may not know how to teach it Make it easy for teachers; integrate with existing coursework Provide lesson plans • • • • Peers are a big deal -- who is like me? Families Principals -approving at a school level Show comparisons for students Provide summaries Pulling in the whole school, anonymously • • • • • Transparency • Research! IRB! Based on Precede-Proceed model

9. Defining Activities based on Factors • Working with schools?-- what is the context of its use. What gaps exist? – Need for lesson plans across subjects; integrate with national/state educational standards. – Teacher professional development sessions for lesson and teacher guide creation – Teachers lack time • to plan fairs (used team of 5) + health department stakeholder • to analyze data (developed visualization website) – Funding is tight; support teachers’ substitute time ($150/day in Oregon)

10. Defining Activities based on Factors • Focus groups for developing data website – three steps – Show examples of similar sites to pick specs that are liked – Wireframe mock up of selected items – Actual site, simplified, to make sure on track www.letsgethealthy.org

11. Defining Activities based on Factors • Health fairs highly sought after -- after – New sites don’t know what to expect; Not all teachers are on board – Pre-fair workshop with the five teachers and principal; bring food – Demonstration by someone like them who’s gone through it (call in; works amazingly well) • After the fair – Check in and debrief session, 6 weeks or so after. Time to process, check in with colleagues, parents, students – Lesson learned: data summaries are really important here to provide taste of the data • Follow-up to the fair – Lesson learned: more time and support are needed among teachers in using the data – Available lessons provide a safety net for adaptation

12. Planning the evaluation • Go back to what you want to accomplish • What is incorporated into the game versus what is a pre/post? • Who is your comparison group? • Find short- and long-term goals for each – so in case long-term fails, you can predict it and/or course correct before it’s too late 29% 17% ADDED SUGAR INTAKE

13. Outcomes Specifics: • Experimental schools>Comparison schools; loads of repeat fair requests and dissemination to new sites. • Data used for two funded school-based grants, another site runs an ongoing nutrition and physical activity projects. • Primary lessons learned: • Data use needs to be even easier, interactive, and visually appealing. • Health departments and schools are really, really interested when health data can be linked with learning outcomes. General for other projects: • People LOVE learning about themselves. Aim for 7th grade reading level. • The “fun” aspects pull in more people (adult vs kid materials; new partner interest) • Leave more time than expected for evaluation. Plus >10% budget • Be open to unexpected findings - turned out to be my best parts • What new procedures increase your goals? For us, partners offered new tracking options

14. Worksite Wellness OHSU-BDMS Occupational Health Centers of Excellence • Integration with BDMS employee check-up (EMR) • 3 modules started in 2015 (Sleep, Cognitive, Diet (Thai)) • Migrated platform to a web- based system • Same individual feedback, plus Corporate Report -- show change over time

15. Development of Permanent Kiosk for Great Lakes Science Center • Leveraged online functionality from Thailand to build museum kiosk Subcontract from their SEPA award funded migration of intranet-based NCI/NHANES Diet Screener into online platform for use with museum visitors Crowd-sourced approach to module development • • 2015; Launch early 2016 https://www.foodmaster.org www.letsgethealthy.org

16. Refinements based on the Project Flexible • Modules can be used as part of a health fair, kiosk, or completed online from home. • Demo options exist where participants can complete modules without data being collected, important for building trust with communities. Personalized • Content and recommendations automatically tailor to participants’ age and gender; • Algorithms support immediate calculation of results to show participants as feedback. Long-term • Organizations given administrative access to create their own events; they define the permissions and access levels (e.g. data privacy; administrator access) • Built-in programming supports cohort development. Consent, enrollment, and longitudinal tracking all built into program for simplicity; • New! Change over time automatically calculated for individuals and shown in real time. 2015 Technology Award, Society of Public Health Education

17. School interested in using the free online modules? Contact marriott@ohsu.edu www.letsgethealthy.org