Title of Study : Preliminary findings from “An evaluation of the impact of the inclusion of a "Health and Well Being Module" in the undergraduate curriculum on selected health behaviours of a group of students in St Angela College, Sligo. Title of Study : Preliminary findings from “An evaluation of the impact of the inclusion of a "Health and Well Being Module" in the undergraduate curriculum on selected health behaviours of a group of students in St Angela College, Sligo. By: Patsy Mc Sharry: Registered PhD student in the department of Health promotion NUIG Supervisor = Dr. Margaret Hodgins

Background and Rationale: Increased obesity rates Increased obesity rates Increased levels of inactivity Increased levels of inactivity Increased levels of psychological stress Increased levels of psychological stress

Research Aim: The aim of this Quasi experimental study was to evaluate the impact of the inclusion of a “Health and Well Being Module” in the undergraduate curriculum on selected health behaviours of a group of students. The aim of this Quasi experimental study was to evaluate the impact of the inclusion of a “Health and Well Being Module” in the undergraduate curriculum on selected health behaviours of a group of students. A total study population of 110 participants were non- randomly divided into an intervention (55 Undergraduate Nursing Students) and a comparison group of (55 Undergraduate Home Economics students) A total study population of 110 participants were non- randomly divided into an intervention (55 Undergraduate Nursing Students) and a comparison group of (55 Undergraduate Home Economics students) The selected health behaviours in question involve physical activity behaviours, eating behaviours and psychological well being. The selected health behaviours in question involve physical activity behaviours, eating behaviours and psychological well being.

Nature of Intervention: The introduction of a Module entitled” Health and Well Being” into the first year of the undergraduate nursing curriculum and incorporated into the overall assessment strategy of the first year. The introduction of a Module entitled” Health and Well Being” into the first year of the undergraduate nursing curriculum and incorporated into the overall assessment strategy of the first year. Structure and Content of Module: Structure and Content of Module: Module focusing on all three areas of Physical activity, Healthy eating and psychological well being Module focusing on all three areas of Physical activity, Healthy eating and psychological well being Theory (lectures aimed at increasing knowledge on these health behaviours). Theory (lectures aimed at increasing knowledge on these health behaviours). Practical element i.e. Practical element i.e. Workshops focused on developing self awareness (health assessment workshops) Workshops focused on developing self awareness (health assessment workshops) Workshops based on developing skills for improving health behaviours (via motivational interviewing) Workshops based on developing skills for improving health behaviours (via motivational interviewing) Workshops aimed at identifying possible stressors and exploring coping strategies. Workshops aimed at identifying possible stressors and exploring coping strategies.

Main Outcome Measures Physical Activity Healthy Eating Psychological well Being Physical activity levels (IPAQ) BMI WHO (five) Well-Being Index Stages of Change for PA Stages of Change for HE 14 item GP Core (Jan 10) Self Efficacy For PA Self Efficacy for HE Social Support for HE Social Support for PA Weight management aims and strategies Food Pyramid

Preliminary analysis across three time periods re.  Physical Activity  Healthy Eating Behaviours  Psychological well being

IPAQ scores between groups across all three time periods. (Friedman Test) IPAQ scores between groups across all three time periods. (Friedman Test) GroupX2 /Z value P value Median Intervention Pre. = Post Follow-up = Comparison Pre. = 1046 Post Follow-up =896

IPAQ scores between groups across all three time periods. Overall changes in PA between groups. Overall changes in PA between groups. There was a statistical significant differences in the scores across all three time periods within the intervention group (p=.023).These differences were in the form of a large increase between time 1 and time 2 and a small decrease between time 2 and time 3. There was a statistical significant differences in the scores across all three time periods within the intervention group (p=.023).These differences were in the form of a large increase between time 1 and time 2 and a small decrease between time 2 and time 3. On the other, within the comparison group, there was an increase between time 1 and time 2 and a decrease between time 2 and time 3. This was not statistically significant. On the other, within the comparison group, there was an increase between time 1 and time 2 and a decrease between time 2 and time 3. This was not statistically significant.

Healthy Eating Behaviours: Body Mass Index Stages of Change for Healthy Eating Self efficacy for Healthy Eating Social support for Healthy Eating Weight Management Aim Weight management Strategies Eating Behaviours according to food pyramid recommendations

Mean BMI InterventionComparison Pre Post Follow up

Summary of statistical tests applied to BMI scores: To conclude, on one way repeated measures ANOVA, there was no statistically significant effect over time in the intervention group across Time 1, Time 2, and Time 3. However there was a statistically significant effect for time in the comparison group. This was characterised by an increase in BMI mean scores between pre and post intervention, this was then followed by a small decrease between post intervention and follow up.. To conclude, on one way repeated measures ANOVA, there was no statistically significant effect over time in the intervention group across Time 1, Time 2, and Time 3. However there was a statistically significant effect for time in the comparison group. This was characterised by an increase in BMI mean scores between pre and post intervention, this was then followed by a small decrease between post intervention and follow up.. Paired T testing on BMI scores across all three data collection episodes revealed a statistically significant increase in BMI scores in the comparison group between pre intervention and post intervention. All other t test between post intervention and follow up and between pre intervention and follow up did not show statistically significant changes in either group. Paired T testing on BMI scores across all three data collection episodes revealed a statistically significant increase in BMI scores in the comparison group between pre intervention and post intervention. All other t test between post intervention and follow up and between pre intervention and follow up did not show statistically significant changes in either group. On mixed between with ANOVAs testing, changes in BMI scores across all three times showed a statistically significant main effect for time across all three time periods. However no interaction effect or main effect for time between groups were observed On mixed between with ANOVAs testing, changes in BMI scores across all three times showed a statistically significant main effect for time across all three time periods. However no interaction effect or main effect for time between groups were observed

Those wishing to loose weight in response to the question re weight loss aim When participants were asked about their weight management aim, the majority wished to loose weight. 69.1% (18)of intervention group wished to loose weight pre intervention. Post intervention this increased to 85.7% and reduced to 80% by follow up. Within the comparison group 75.8% wished to loose weight at pre intervention, this reduced to 65.5% post intervention and increased again to 86.4% by follow up. When participants were asked about their weight management aim, the majority wished to loose weight. 69.1% (18)of intervention group wished to loose weight pre intervention. Post intervention this increased to 85.7% and reduced to 80% by follow up. Within the comparison group 75.8% wished to loose weight at pre intervention, this reduced to 65.5% post intervention and increased again to 86.4% by follow up.

Weight management strategies in intervention group: (Pre Post and follow up intervention) Within the intervention group, participants used all or some of the three strategies to lose weight i.e 37.4% utilised the “eat fewer calories” strategy, 33.3% utilised the “eat less fat” strategy and 62.9% utilised the “take more exercise “strategy at pre intervention. At post intervention 17% were utilising the “eat fewer calories” strategy, 40% the “eat less fat” strategy and 80% were utilising the “take more exercise “strategy. By follow up 47.6% were utilising the “eat fewer calories” strategy, 52.3% utilised the “eat less fat” strategy and 66.6% utilised the “take more exercise “strategy.

Weight management strategies in comparison group: (Pre, Post and follow up in comparison group Within the comparison group, participants used all or some of the three strategies to lose weight also, i.e. 64.5% utilised the “eat fewer calories” strategy, 41.9% utilised the “eat less fat” strategy and 74.1% utilised the “take more exercise “strategy at pre intervention. At post intervention 70% were utilising the “eat fewer calories” strategy, 26.6% the “eat less fat” strategy and 70% were utilising the “take more exercise “strategy. By follow up 57.14% were utilising the “eat fewer calories” strategy, 66.6% utilised the “eat less fat” strategy and 57.14% utilised the “take more exercise “strategy

Summary of those consuming the recommended number of food portions according to the Food Pyramid. Pre intervention: Intervention=2.3% (1) Comparison = 9.8% (4) Post intervention: Intervention =8.3% (3) : Comparison =6.2%(2) Follow Up: Intervention =17.4%( 4); Comparison group = 28%(7) Pre Intervention: Intervention=46.7% (21) Comparison = 67.4% (29) Post Intervention Intervention = 41.5% (17) Comparison=72.2%(26) Follow up: Intervention = 58.6% ( 17) Comparison = 62.1%(18) Pre intervention:Interv.= Pre intervention:Interv.=17.8% (8):Comp.= 20.9% (9) Post Interven:Interv= Post Interven:Interv=14.6% (6): Compar.= 19.4%(7) Follow Up:Interv.= Follow Up:Interv.= 21.4% (6):compar.=17.2%(5) Pre Interven:Interv.= Compar= Pre Interven:Interv.= 11.1% (5) Compar=25.6% (11) Post Interv: Interv.= Compar= Post Interv: Interv.= 21.9% (9) Compar= 38.9%(14) Follow Up: Interv.= Compar.= Follow Up: Interv.= 14.3% (4) Compar.=27.5%(8) Pre intervention: Intervention= 46.7% (21) Comparison = 34..9% (15) Post intervention: Intervention =52.3% (21) : Comparison = 50%(18) Follow Up: Intervention = 32.1%(9); Comparison group = 31%(9)

Summary of those consuming the recommended number of food portions according to the Food Pyramid. Pre intervention: Intervention=2.3% (1) Comparison = 9.8% (4) Post intervention: Intervention =8.3% (3) : Comparison =6.2%(2) Follow Up: Intervention =17.4%( 4); Comparison group = 28%(7) Pre Intervention: Intervention=46.7% (21) Comp.rison = 67.4% (29) Post Intervention Intervention = 41.5% (17) Comparison=72.2%(26) Follow up: Intervention = 58.6% ( 17) Comparison = 62.1%(18) Pre intervention:Interv.= Pre intervention:Interv.=17.8% (8):Comp.= 20.9% (9) Post Interven:Interv= Post Interven:Interv=14.6% (6): Compar.= 19.4%(7) Follow Up:Interv.= Follow Up:Interv.= 21.4% (6):compar.=17.2%(5) Pre Interven:Interv.= Compar= Pre Interven:Interv.= 11.1% (5) Compar=25.6% (11) Post Interv: Interv.= Compar= Post Interv: Interv.= 21.9% (9) Compar= 38.9%(14) Follow Up: Interv.= Compar.= Follow Up: Interv.= 14.3% (4) Compar.=27.5%(8) Pre intervention: Intervention= 46.7% (21) Comparison = 34..9% (15) Post intervention: Intervention =52.3% (21) : Comparison = 50%(18) Follow Up: Intervention = 32.1%(9); Comparison group = 31%(9)

Psychological Well Being Measured by the WHO (five) psychological well being index

Total Psychological Well Being scores (WHO-5 Index) between groups

Psychological Well Being One Way ANOVA’s One Way ANOVA’s The intervention group showed a substantial increase in mean psychological well being scores between pre and post intervention and a small decrease from post intervention to follow up. On one way repeated measures these changes showed a significant effect for time. The intervention group showed a substantial increase in mean psychological well being scores between pre and post intervention and a small decrease from post intervention to follow up. On one way repeated measures these changes showed a significant effect for time. The comparison group showed a small increase in mean psychological well being scores between pre and post intervention and a subsequent large decrease from post intervention to follow resulting in a mean score of 9.2, which indicates poor psychological well being and is indicative of the need for testing for depression according to the WHO index.. On One way repeated measure these changes showed a significant effect for time. The comparison group showed a small increase in mean psychological well being scores between pre and post intervention and a subsequent large decrease from post intervention to follow resulting in a mean score of 9.2, which indicates poor psychological well being and is indicative of the need for testing for depression according to the WHO index.. On One way repeated measure these changes showed a significant effect for time.

Possible Conclusions & Recommendations:  The further development of the Health Promotion Colleges Network at local level between staff and student bodies.  Inclusion of a “Health and Well being module” within all undergraduate curricula..  Development of further Health Promotion intervention initiatives at college level which address physical infrastructure and motivational factors to support Health and well being.  Promote the concept of “Active Living” (Bauman et al, 2002) throughout the college campus.  More emphasis to be placed on the psychological well being of students in acknowledgement of the stress they are under. Development of programmes that address coping strategies and the building of student’s mental resilience.