Evaluation of a school-based intervention aimed at increasing the nutritional awareness
of 7-10 year olds using performing arts.
H.R. Lees and Dr. P. Mani Das Gupta
Psychology and Mental Health, Faculty of Sciences, Staffordshire University, Stoke-on-Trent,
England
Address for correspondence: Dr. P. Mani Das Gupta. Email [email protected]
(Received ....; final version received ....)
Despite a number of interventions aimed at children, research continues to highlight increasing
evidence of the detrimental short and long-term health implications of obesity in childhood. One
reason why childhood interventions do not seem to be making a huge impact may be the use of
developmentally inappropriate educational material.
The current study investigated the effectiveness of Active participation within a drama workshop
for delivering existing health education material in contrast with Observation of Drama, and a No
Drama intervention. In addition to a scored meal depiction questionnaire, the meal choice
justifications of the 219 participants, aged between 7 to 10 years, were explored using thematic
analyses.
The results indicated a developmental difference in the effect of the intervention type.
Specifically, the 7-9 year olds use of the 'Balance of Good Health Model' (BGHM) themes to
justify their meal choice, was supplemented by drama observation as appose to a reverse in this
trend by the age of 10, when active participation in drama was more effective. These finding are
discussed in relation to Piagetian research, criticism of the BGHM’s use with younger children
and suggestions for future investigation.
Both the quantitative and qualitative findings suggested that older children were more able to
depict a ‘healthy meal’, and justify their reasoning in accordance with the intervention themes
following a drama intervention. Therefore, drama could be an effective way of supporting the
education of 9-10 year olds when using themes from the Balance of Good Health Model (BGHM;
FSA, 2001). However, 7-8 yr olds understanding of the model was not found to be supplemented
by drama participation or observation. This finding is discussed in relation to criticism of the
BGHM’s use with younger children and suggestions for future research.
Introduction
Childhood Obesity; The Issues
“We are in the midst of an obesity epidemic and must use all the weapons in our armoury to
prevent the next generation of British children being the most obese and unhealthy in
history” Dr Vivienne Nathanson, Head of Science and Ethics at the British Medical
Association (2006)
The increase of childhood obesity in Britain between 1995 and 2007 (NHS, 2009a)
has been the cause of much alarm considering the strengthening evidence of its detrimental
effects. Reilly & Wilson’s (2006) review of the literature, for instances, describes the ‘major
health burden’ obesity can cause at any age, including cardiovascular risk factors, diabetes,
cancers, arthritis, and psychological ill health .
Dietary imbalance has been highlighted as an influential factor with regards
increasing obesity rates in childhood. The National Dietary Survey (2000) investigating the
eating habits of 4-18 years olds, reported a worrying increase in the consumption of high
energy-dense foods such as white breads, crisps and confectionary snacks by Britain’s young
people, and reduced intake of fruit and vegetables. Of further concern is the evidence that
these dietary trends appear to be unaffected by national nutritional awareness campaigns such
as “5 a Day” and “Change for Life” (DOH, 2009; NHS, 2009b), with the latest NHS statistics
suggesting that still only one in five children between 5 and 15 yrs are meeting their
recommended daily fruit and vegetable allowance (NHS, 2010). These worrying dietary
trends are particularly noticeable in the North Staffordshire region where the overweight and
obesity prevalence amongst the under 12s is higher than the National average. Consequently,
this region has been targeted as of ‘high priority’ for receiving intervention (Staffordshire
Children’s Trust, 2007).
Interventions
A number of interventions have been used to tackle imbalance in children’s diets.
Nutritional Education through schools is seen as an effective option. , Aldinder & Jones
(1998) in their Health Promotion in Schools review, suggested that the school environment ,
is particularly effective for passing on information not only to a large number of pupils, but
also to school staff, families and whole communities . Past multidisciplinary school
interventions, such as that implemented by Sahota et al (2004), have been relatively
successful in positively impacting children’s dietary behaviour, specifically their vegetable
consumption. This improvement in early behaviour is all the more important in light of
findings that some aspects of dietary behaviour, particularly fat intake, remain reasonably
stable between childhood and adulthood (Bertheke Post et al, 2001)
During a review of school-based nutritional interventions, Perez-Rodrigo and
Aranceta (2003) identified a number of characteristics which appeared important for an
effective interventions. Those found to be key included the need for a theory driven strategy
that is developmentally appropriate, creative and engaging. In addition to exploring these
suggestions in greater detail, the current article will also aim to investigate the extent to
which Perez-Rodrigo and Aranceta’s findings are fulfilled by using Theatre in Education
(TIE) as a creative and engaging approach to health education.
Theatre in Education: A creative and engaging approach
Theatre in Education (TIE) derived in the mid 1960s from a desire to facilitate social
change by encouraging greater interaction between theatre and the community. More
recently, Theatre in Health Education (THE) has emerged as a distinct form of TIE concerned
specifically with health education. A major advantage of THE interventions is their success in
engaging children who are not responding well to conventional teaching methods. Amongst
the sources reporting this outcome, is the teachers involved in the Starbites performing arts
intervention by Perry & May (2006). The aim of the research was to increase pupils
awareness of healthy eating from 7 primary schools in Cheshire, which the teaching staff felt
was achieved. In addition self-esteem and team building skills also increased as a result of
this intervention.
The success of unconventional approaches to teaching, such as THE, is arguably
because of their employment of Intrinsic motivations. Intrinsic motivations, or the enjoyment
gained purely from performing a certain behaviour, was found by Parker and Lepper (1992)
to be a more effective educational tool than extrinsic motivations (external rewards received
as a result of certain behaviours). Parker and Lepper used fantasy or non fantasy embellished
computer programs to teach children about geometric shapes, and found that understanding
and retention of knowledge was significantly better in the group using the, intrinsically
motivating, fantasy computer program.
Furthermore, a literature review of school-based drug prevention programmes by
Cuijpers, (2002), also found that ‘interactive delivery methods’ were ‘superior’ to noninteractive programmes. Relating this to THE , it has been shown that while observation of a
drama performance can positively impact children’s nutritional awareness, active
participation with the subject matter (linked to intrinsic motivation) has a stronger impact
upon behaviour. For example, while Perry et al’s (2002) ‘Alls Well That Eats Well’ school
tour production produced a significant effect on knowledge, the interventions effect on actual
eating behaviour in the short-term was not significant. However, despite Perez-Rodrigo and
Aranceta’s recommendations for using creative and engaging material, the effectiveness of
employing intrinsic motivations through participation in THE, and the insertion of ‘fun’ into
health education, are under investigated (Perry & May, 2006).
Developmental appropriateness
Developmental appropriateness of educational material is another characteristic
highlighted by Perez-Rodrigo and Aranceta as essential for successful interventions. Hart,
Bishop, & Truby (2002) investigation the nutritional awareness of 7-11 year olds and found
the majority grouped foods in terms of concrete ideas, such as eaten for main meal, rather
than abstract concepts, such as nutrients. They therefore, questioned the emphasis upon
abstract ideas in current educational material, such as that based upon the Balance of Good
Health Model (BGHM; FSA, 2001). This model advocates the importance of eating a
“balanced” diet, i.e. a diet containing a variety of the right amounts of foods from each of the
5 food groups, and is currently taught as part of the UK National Curriculum (NC) from
around the age of 5 years (British Nutrition Foundation, 2008).
Based on their research, Hart et al, suggested that cognitive barriers determine
children’s understanding more than quality or quantity of educational information provided.
Hart et al’s (2002) findings are in line with a body of developmental research, which argues
that younger children are more able to deal with concrete rather than abstract thinking (Piaget
& Inhelder, 1969). This is also supported by more recent research that demonstrates agerelated development in children’s health concepts (Zeinstra et al, 2007; Contento, 1981).
Working with 5-11 yr olds, Contento (1981) for example, reported that younger children
(pre-operational stage -aged about 2-6years) were able to name healthy foods but not give
reasons as to why they considered these foods healthy. The older, (concrete operational
stage- age 7-11years) children, understood that foods change in the body to produce effects
such as strength and growth, but were not able to explain how this occurred.
Similarly, Zeinstra et al (2007) demonstrated that 4-5 yr olds relied upon concrete
concepts, such as colour, while 12 yr olds were able to categorised food using abstract
concepts like food groups. In light of this research, THE could be employed to give a
physical aspect to abstract concepts in support of younger children’s understanding. Indeed,
Ulas (2008) noted during an investigation into the use of dramatic activities in the
development of primary school children’s oral skills, that the variety available meant drama
is a method of education which lends itself well to accommodating for the needs, interests
and developmental level’s of individuals. Such research emphasises the need to use material
that is not only engaging but also appropriate to a child’s cognitive level in order to deliver
effective health promotions.
Research Aims
In light of these observations, the primary aim of the current study is to investigate if
Active participation in a drama workshop will increase 7-10 yr olds ability to depict a healthy
meal as outlined in the BGHM in comparison to that of participants Observing the drama (as
in Perry et al, 2002), and a Control group who will not be exposed to drama at all. Reviewing
the literature suggests that THE’s ability to depict/ ‘give flesh’ to abstract concepts as well as
promote intrinsic motivation will result in active participation in the drama having the
greatest impact on children’s knowledge of what a ‘healthy meal’ contains. A secondary aim
of this study is to investigate the developmental progression of children’s nutritional
understanding, especially with regards observing any age differences in the justifications
given by children regarding their dietary choices.
The Research Project
This study was designed to compare children’s ability to depict a ‘balanced’ meal and
the reasons for their choices, both before and after an intervention. Therefore, a mixed
before-after design was used, with 2 independent variables (age and intervention), and 2
dependant, within-subject variables (Healthy meal descriptions before and after intervention).
There were four age groups (7, 8, 9 and 10 yrs) and three intervention techniques were used
(Active participation in drama, Observation of drama and Control – no drama). The
dependant variable was assessed by obtaining an annotated depiction of a healthy meal before
and after intervention that was scored in accordance with the BGHM.
Who took part
A total of 219 children (both males and females) from community groups and primary
schools in the Newcastle-under-Lyme area of North Staffordshire took part. They were all
being taught at KS2 and aged between 7 and 10 yrs. , Both a group/school representative and
parent/guardian supplied informed consent for participation. Equal sample sizes and at least
20 participants in each group according to age, sex and intervention condition were found to
be required to maintain the robust nature of the multivariate technique being used to analyse
the data (Stevens, 2009). However, time and school attendance constraints meant that this
was not possible (as shown in Table 1), therefore, compensations were made during analysis.
Materials used
Questionnaire
Pre and post intervention dietary awareness was measured using an identical ‘Draw
and Write’ questionnaire (DWQ) shown in Figure 1, requesting the depiction of a ‘healthy
meal’ as well as written reason for meal choices drawn. The DWQ was based on previous
research as well as current NC KS2 assessment of nutritional knowledge (QCDA, 1999). It
was used to enable the children to express their food choices in a more ‘fun’ way than simply
writing text. The drawings were scored in conjunction with the written responses, used to
explain their choices, so as to avoid misinterpretation.
Figure 1. Draw and Write Questionnaire
The Action!!
Firstly, for identification purposes, the participants consent forms (collected
beforehand) were assigned individual numbers to correspond with the subsequent material
each participant would receive during the project. These were also used to randomly assign
the participants into one of the three conditions done on the day to allow for absences.
Secondly, a scripted introduction was delivered to the participants to introduce the
researchers, and to inform them of the procedure. All participants were then given their
appropriately numbered pre-test DWQ receiving verbal explanations on how to complete the
questionnaire before being pretested as a group in exam style conditions.
Then, all participants were taken to the drama room to participate in a group warm up
designed to be fun, motivate and prepare those who were to take part in the drama. All
participants were then read the intervention material (BGHM information) in the form of a
complex scenario written especially for the research (Box 1; Figure 2). information adapted
from the BGHM.
Box 1. The Golden Lunchbox Story Extract
Scene 1 the golden lunch box
1.
Our scene opens to Jo sitting on a bench with his lunch box in the school playground.
2.
Thinking to himself, Jo looks up into the sky and begins to wonder what is for lunch
today
3.
Another child sits down opposite Jo and opens their lunch box
4.
Looking across, Jo watches with intrigue as it falls open to reveal an egg and cress
sandwich, an apple, carrot sticks, a carton of milk and with a small packet of wine gums.
5.
Jo closes his eyes, holds his breath and opens his lunch box to reveal a jam sandwich,
packet of crisps a chocolate bar and bottle of cola.
6.
Jo shouts “Yes!” (wait for actor to say line) and began to brag how he had gotten all
of the nicest food to the other child
7.
The other child says “well your meal is very nice, (wait for actor to say line) but mine
is made to be a tasty balanced meal, (wait for actor to say line) to give me energy and keep
me healthy”
8.
Jo doesn’t understand and claims that it’s not that healthy because it includes a small
bag of wine gums which contain a lot of sugar that is bad for you.
9.
The other child looks at Jo and says “no foods are bad for if you (wait for actor to say
line) if you eat them in the right amounts. Because it’s important to have a balance of all five
food groups to achieve a healthy meal.”
Figure 2: Story telling at Bursley Way Primary School
Following delivery of the intervention material, the three groups were split up as
follows; The Active and Observation groups remained in the warm up venue. The
Observation group were seated and watched participants from the Active group act out the
‘Golden Lunchbox’ scenario using props and costumes (Figure 3). At the same time, the
Control group was taken to a separate classroom to watch a DVD version of a story (Dahl,
1982) unrelated to the initial ‘Golden Lunchbox’ story.
Figure 3: Photos of children in the Active group at Chesterton and Richard Heathcote
Primary School’s
All participants were then brought back to the original classroom and instructed to
complete a recall questionnaire regarding information from the ‘Golden Lunch Box’ Story as
part of a colleagues research. Following this, all participants were given their appropriately
numbered post-test DWQ (identical to the pre-test DWQ) and debriefed as a group regarding
the research aims after completing the testing.
The Results
Quantitative
Multivariate Analysis of Variance (MANOVA) was used to analyse the effects
between age, condition and pre and post ‘healthy meals’ depiction scores, the assumptions for
which were met in accordance with Pallant (2007). To improve the unevenness of the groups
sample sizes, the 10 yr old quantitative data was not included in the MANOVA analysis
because of the lack of participants in this age group (Table 1). Similarly, although gender was
controlled for by including both sexes, it was not included as a variable during analysis
because of the lack of evidence supporting gender as a factor affecting interventions
promoting healthy eating at KS2.
Table 1 depicts an increase in the post-DWQ mean scores for all three conditions and
across the ages; most markedly for the Active 9 yr olds and interestingly, the Control group
post-scores also showed an increase.
Table 1. Descriptive Statistics
Pre-score
Age
7
8
9
10
Condition
Active
mean
Post-score
SD
mean
SD
N
3.81
1.72 5.86
2.59 21
Observation 4.59
2.32 4.88
2.37 17
Control
4.53
1.62 5.35
2.03 17
Total
4.27
1.90 5.40
2.35 55
Active
4.38
1.86 5.24
2.45 21
Observation 4.81
1.72 5.32
2.27 31
Control
4.43
1.75 5.11
2.18 28
Total
4.56
1.76 5.22
2.27 80
Active
4.76
1.92 7.00
2.78 17
Observation 4.88
2.55 6.38
1.98 26
Control
4.17
1.29 6.39
2.28 18
Total
4.64
2.07 6.56
2.29 61
Active
-
-
-
-
7
Observation -
-
-
-
2
Control
-
-
-
-
14
Total
-
-
-
-
23
The MANOVA showed a significant main effect for age (F (4,372)=3.591,p=.007,
η2=.037) indicating that the DWQ scores improved with age. However, the main effect of
age was found to be significant across the post-test (F (2,187)=6.55, p=.002, η2=.065) and
not pre-test scores (F (2,187)=.379, p=.685, η2=.004). This indicates that the pre-test scores
between the age groups were not significantly different, whereas the post-test scores were.
Three post-hoc t-tests were conducted between the post-test scores for 7-8, 7-9, and 89 yr olds to explore the significant main effect for age upon the DWQ post-test scores. A
Bonferroni correction was used to adjust the alpha level to permit multiple testing (α =.002).
A significant difference was found between the 8 and 9 yr olds post-test DWQ scores (t
(139)=-3.437, p=.001, 2-tailed, d=.88) with a large effect size according to Cohen(1988).
This indicated that the 9 yr olds had scored significantly higher than the 8 yr olds. There was
a verging on significant difference between 7 and 9 yr olds post-test scores (t (114) = -2.681,
p=.008, 2-tailed, d=.76) with a medium to large effect size (Cohen, 1988), signifying the 9 yr
olds had scored better than the 7 yr olds on the DWQ post-tests but not quite significantly so.
Finally, there was no significant difference between the 7 and 8 yr olds post-test DWQ scores
(t (133) = .433, p=.67, 2-tailed, d=.26), suggesting the 7 and 8 yr olds post-test scores were
the least different of the three age-group comparisons.
Qualitative
Thematic analysis was used to report the 7-10 yr old participant’s written responses.
This analysis was used to investigate justifications for meal choices and expand upon the
quantitative data interpretations. In answer to the question (on the DWQ) “Why is the meal
you have drawn healthy?”. Four dominant themes were identified Each dominant theme
accounted for over 10% of the total responses (Table 2).
The theme with the highest overall frequency was found to be the Food-Health link at
34% of the total responses (Table 2), and is exampled in the following extracts, “Because
peas are vegetables, carrot is a vegetable. Broccoli is a vegetable. Chicken is a meat”, (age
7); “It includes vegetables and a healthy drink, you also have some dairy (cheese) plus
potatoes and bread. You also have some meat (chicken)”, (age 10).
Secondly, Food- nutrient links accounted for 13% of the total responses and included
mention of protein, carbohydrates, vitamins and minerals, calcium and one mention of fibre,
“The tuna steak has protein, the potatoes has carbohydrates and the bread has fibre” (age
7); “I think it is healthy because it has vitamins in it”, (age 8); “The spicy chicken leg gets
calcium in you”, (age 9).
Table 2. Four most frequent theme descriptions and frequencies
Themes
Description
1. Food-health link **
Considered healthy because
it contains a single or
combination of foods or
food groups
34
2.
Foods or food groups
linked to the specific
nutrient they provide but
not detailing how these are
used
13
3. Balance
Using the word “balance”
or indicating the need for
right amount.
12
4. Food-health
outcome links*
Food, food groups or
nutrient linked to an effect
upon the body without
detailing mechanism.
12
Food-nutrient link
*
Total
frequency
%
* Themes from Hart et al, (2002)
** Themes from Zeinstra et al, (2007)
Similarly, the theme of Balance, which is key to the BGHM, accounted for 12 % of
the total responses (Table 2), and is evidenced in the following quotes, “My meal is healthy
because it is a balanced meal”, (age 10); “This is healthy because it has veg in and you need
a little amount of everything but not too much otherwise it is bad”, (age 7).
Food-health outcome links also accounted for 12% of the total responses, featuring a
wide range of ideas including whole body effects such as being good for the body, aiding
growth and strength, and extending life, “Lettuce sandwich is good for your body”, (age 7).
Specific benefits to teeth, bones, the brain and heart were also reported. Furthermore, the
provision of energy was mentioned, and extended in some cases with reference to the use of
energy for activities, “I think that healthy food gives you energy to do things like running
walking and jogging”, (age 9). Finally, healthy and unhealthy foods were discussed in terms
of their capacity to change body weight, “My meal is healthy because that it does not contain
sugar in the inside of it. Because the sugar can cause fat in your body!!!”, (age 9).
The frequency of the top four themes between pre and post-testing for each age group
was also investigated to expose any intervention effect (Table 3).
Table 3. Pre and post- test % responses by the four most frequent themes and age
Age
7
8
9
10
Response time in
relation to
intervention
Pre
1 Foodhealth
2 Foodnutrient
3 Balance
4 FoodHealth
outcome
42
13
7
10
Post
39
12
7
11
Pre
35
14
10
15
Post
36
20
12
12
Pre
28
10
7
11
Post
16
7
33
7
Pre
47
10
6
16
Post
16
5
34
10
On the pre-test, the Food-Health theme was the most frequently used by all of the age
groups ( average of 38%). At post-test, frequency remained similar and highest for the 7 and
8 yr olds, however, frequency dropped by 12% for the 9 yr olds and 31% for the 10 yr olds to
become the 2nd most frequent theme after Balance (Table 3). The Food-Nutrient and FoodHealth outcome links were found to follow a similar trend. Responses regarding these two
themes were relatively similar at pre-test across the ages from between 10-16%. At post-test,
use of the themes remained the same for the 7 yr olds, with a relatively small increase in the 8
yr olds use of Food-Nutrient themes. and decrease in the use of both themes by the 9 and 10
yr olds (Table 3). This result supports past research that older children do seem to take
abstract ideas like nutrients into account when making food choices.
The Balance theme was used with a similar frequency across the age groups at pretest, with the 7 and 8 yr olds maintaining comparable use at post-test. For 9 and 10 yr olds,
however, the frequency increased by 26% and 28% respectively (Table 3) with an example of
theme change between pre and post-test depicted below (Figure 4 & 5).
Figure 4. Pre-test use of Variety theme
Figure 5. Post-test change to depiction and use of the Balance theme
Breaking this down further, Table 4 represents the frequency of Balance themed postintervention responses according to the three intervention conditions. Post-test Balance theme
use, was highest from participants in the Passive condition for 7, 8 and 9 yr olds, but most
notably by the 7 and 9 yr olds. The 10 yr olds from the Active group, by distinction, used the
theme most frequently.
Table 4. Percentage frequency of Balance themed post-intervention responses represented via
age and intervention
Age
7
8
9
10
Active
0
25
33
77
Intervention
Passive
75
42
67
15
Control
25
33
0
8
In summary, while 7 and 8 yr olds appeared to maintain relatively similar use of a
range of theme between the pre and post-tests, the 9 and 10 yr olds were found to change the
frequency of theme use in all areas and choose the Balance theme as a justification to a
greater extent following the intervention.
Discussion
Use of active and passive participation in drama to present information about the
importance of eating a balanced meal, had a significant effect on children’s meal choices in
this study. Although there was no difference between the children’s pre-test scores, their
scores improved significantly after the interventions, especially for 9 year olds in the Active
(4.8 To 7.00 meal depiction score average) and Observation groups (4.9 To 6.4). The nine
year olds post-test scores were also significantly higher than the 8 yr olds, suggesting that
they benefited more from the intervention.
According to Piagetian research, the concrete operational stage starts around the age
of 7, though children may achieve this stage a little later. By the age of 9 or 10, children are
nearing the end of the concrete operational stage, and their reasoning is more advanced. The
difference in impact of the concrete (Active) intervention on children’s post-test scores (7
year olds mean score of 5.86 versus 9 year olds mean score of 7.00) is consistent with this
view, as is evidence from the qualitative analysis. Specifically, percentages of pre and posttest responses of the four most frequent themes by age (Table 3) showed that although some
children are picking up on the connections between food and health, they are not in the
majority and they do not seem to be picking up the theme of balance which is a major driver
in the BGHM initiative. However, the post-test results show that the balance theme
increased a lot after the intervention (7-33% and 6-34% for the 9 and 10 year olds). There
was little or no change in themes for the younger children.
These results may be explained by Table 4 which indicates a developmental
difference in the effect of the type of intervention. The youngest children don’t use the
Balance theme at all if they have been participating in drama, which could be because they
are focusing on the fun aspect and not on the content. According to Piaget, children of this
age find it harder to hold two things in mind simultaneously. However, 7 year olds seem to
absorb Balance knowledge better when watching an enactment (75% use this theme) rather
than simply remembering information from a story (25% used the theme in the Control
group). By the age of ten, this trend is reversed, and children who have actively participated
in the drama use the theme much more (77%) than those who have just watched it (15%).
In summary, the mode of presentation seems to have different effects at different ages
(Table 4). The results suggest that the youngest children absorb and use more information
when they observe the material presented in an interesting way till about the age of nine. The
ten year olds however, who are capable of holding more than one thing in mind, do much
better in the Active condition. These finding supports the criticism that the BGHM models
traditional use with younger children at the start of KS2 may be developmentally
inappropriate (Hart, Bishop, & Truby, 2002). This trend should be investigated in order to be
able to enhance the presentation of health material to children in the most effective and
developmentally appropriate manner.
Lastly, it is felt important for the improvement of future research to note the current
study’s limitations that are indicationed by both sets of results even though the quantitative
and qualitative results do appear to support each other and correspond with past research. For
example, the lack of significant intervention effect from the quantitative data could be
explained by the unequal group sizes. Though attempts were made to reduce this, the large
number of 8 yr olds especially, could have affected the results. Two further limitations relate
to the procedure. Firstly, the study was conducted with a colleague, which meant all
participants were asked to recall information from the ‘Golden Lunchbox’ story before
completing the post-test DWQ. Consequently, the recall condition could have bolstered
participant’s memory, potentially resulting in the high post-test control group scores observed
particularly in the 9 yr olds. Secondly, fatigue may have been a factor possibly evidenced in
the overall drop in post-test written responses. This may have been due to consecutive
questionnaires, and an entire procedure time of 2 hours.
With regard to subsequent research, these effects could be mediated by obtaining
equal sample sizes and counterbalancing the design to control for memory bolstering and
practice effects (Clark-Carter, 2004). Furthermore, fatigue effects could be controlled for by
presenting the post-test DWQ a few days or even a week after the intervention. This would
also assess the longer-term effect, if any, of the drama intervention, which is suggested to be
an under researched area (Perry & May, 2006). Additional confounding variables noted
during data collection included variability in resources and drama performance between
schools which could have impacted upon the effectiveness of the interventions. The necessity
of getting different children involved in the drama inevitably created differences between the
performances. The observers were therefore watching different productions in different
schools. This flaw could be addressed by separating Active and Observation groups using
pre-recorded drama workshops for the observers to watch in future research.
Conclusion
Observation of drama could be an effective way of delivering nutritional material to 7
and 8 year olds, while active involvement appears more helpful for 9 and 10 year olds.
Ultimately, these findings that the same educational material is understood and/or represented
differently by different age groups, highlights the need to generate developmentally
appropriate nutritional teaching methods for different age groups if health education is to
have a real impact.
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