Implementing a whole school physical activity and healthy eating model in rural and remote First Nations schools: a process evaluation of Action Schools! BC

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Aboriginal people who reside in rural and remote areas of Canada often have poorer health than other Canadians. For instance, the prevalence rate of type 2 diabetes is 3 to 5 times higher than for the general population. Chronic disease risk factors such as obesity are also more prevalent. Overweight and obesity have become major health challenges for all Canadian children, but for Aboriginal children, the numbers are 2 to 3 times higher. 'Action Schools! BC' (AS! BC) is a whole-school framework designed as a positive approach to addressing childhood inactivity and unhealthy eating patterns during the school day that was effective for children in a large urban center. The purpose of this study was to explore the feasibility and implementation of AS! BC in 3 remote Aboriginal communities in northern British Columbia. The AS! BC model provided tools for schools and teachers to create individualized 'action plans' to increase the opportunities for physical activity (PA) and healthy eating (HE) across 6 'action zones'. These zones included: (1) school environment; (2) scheduled physical education; (3) classroom action; (4) family and community; (5) extra-curricular; and (6) school spirit. Teachers (primarily generalists) were provided with the training and resources necessary to implement their action plan for their class. Schools had three visits from the AS! BC support team. Teachers received specialized training and support, a 'planning guide' and classroom-based resources. Gender- and skill-level-inclusive activities were prioritized. Although the model emphasized choice using a whole-school framework, 'classroom action' was a flagship component. Teachers were asked to provide students with a minimum of 15 additional minutes of PA each school day and at least one HE activity per month in the 'classroom action zone'. Information about implementation was gathered from weekly 'classroom logs' completed by teachers and focus groups with school staff. The logs showed that all 3 schools implemented physical activities (mean = 140 min/week, range = 7-360 min/week) and HE activities (mean = 2.3 times/week, range = 0-10 times/week) but this varied by school and teacher. Adherence to logging was low (34% of eligible weeks). Focus group data showed that the program was well received and that support from the AS! BC master trainer and support team was crucial to delivery of the program. Staff highlighted challenges (eg time, high staff turnover at the schools and lack of financial resources), but felt that with continued support and cultural adaptations they would continue to implement AS! BC in their schools. The evaluation demonstrated that AS! BC was appropriate and feasible for use in the First Nations schools in these rural and remote communities with some cultural adaptations and ongoing support. Rural and remote locations have very specific challenges that need to be considered in broader dissemination strategies.