Anexos

School-based alcohol misuse prevention programmes

Our review of recent studies identified that, while schools are generally acknowledged to be an important setting for the delivery of alcohol misuse prevention interventions and activities, there are a number of significant gaps in the literature. The majority of research on school-based alcohol misuse prevention interventions has been conducted in the USA, and the evidence base for UK programmes is, therefore, limited.50_{There is relatively little research on prevention interventions for primary school-age children,}31,82

despite the recognition that this age group is the most appropriate development point for family-based

programmes.31_{Long-term follow-up of participants is relatively rare. Although the involvement of parents}

and other community members has been shown to enhance intervention effectiveness, many school-based alcohol misuse prevention do not include them.

Our exploratory trial of KAT, therefore, makes an original contribution to the evidence base in these areas. KAT demonstrates features which have been shown to characterise effective prevention interventions: a

theory-based design, interactive delivery styles and community involvement.29–34We deal with each of

these in turn.

The importance of a strong theoretical design

Kids, Adults Together addresses key risk and protective factors for young people’s use of alcohol,

particularly family relationships and communication.29,31,32,52–54The programme’s intended change processes

are well explained by the SDM, which emphasises the critical role played by children’s attachment to

prosocial adults in preventing later risk behaviours, and the important roles played by opportunities for prosocial interaction, the perceived availability of these opportunities, reinforcement of prosocial

behaviour, and skill development in forming prosocial attachment.73_{The goals and activities within the}

KAT programme map very clearly onto this theoretical framework. For instance, the family evening provides clearly articulated opportunities for prosocial interaction (through encouraging children and parents to work together on quizzes), reinforcement of the achievements of children (through parental

interest in pupils’ displays of work, and applause for pupils’ presentations), while the classroom component

seeks to build children’s knowledge about the key health aspects of alcohol and develop their skills in

discussing these issues with others.

Our findings suggest that within this overarching theoretical framework there are a number of key processes which may help KAT to achieve acceptability and engagement. For instance, findings from the process evaluation suggest that the mechanisms used by teachers to present a balanced view of alcohol, rather than focus solely on its negative health effects, were designed to allay concerns children might have about the appropriateness of moderate alcohol consumption by parents, and to ensure that communication between children and parents on the topics raised by KAT was not inhibited. Similarly, the attendance by parents at the KAT evening was mainly motivated by a desire to support their children,

and children’s expressed desire that their parents should attend.

Interactive delivery

Interactive activities form an important aspect of all KAT components (classroom work, family event and the programme DVD). Teachers appeared to be comfortable with the interactive nature of the KAT classroom work, and there was evidence that interactive teaching methods were used consistently across the three intervention schools which completed intervention delivery. Pupils enjoyed the group-based work that they did as part of the KAT classroom work.

Rates of parental engagement in the programme

Involvement of parents/carers in school-based prevention programmes is important, as it can strengthen effectiveness through creating opportunities for prosocial interactions within families. Family and

community engagement, more generally, is an important aim for many schools. However, previous studies have highlighted the challenges of engaging parents/carers in school-based prevention programmes.

Rates of engagement are typically low, even when programmes have been modified to promote involvement.62–64There are also significant gaps in the literature, with relatively little written about why

some strategies to engage parents/carers appear to work, while others do not.110

The high rate of parental engagement in the KAT programme is, therefore, one of its key strengths, and create important opportunities for prosocial communication in families to take place. The rates of engagement compare favourably with those of other school-based programmes and appear to be achieved consistently across a range of school contexts. An important strength of the current study (and our previous research on KAT) is that we have been able to identify some of the key engagement processes and the ways in which they may be operating. In this way, it should be possible to identify aspects of programme implementation which contribute to these processes, and which need to be emphasised in future training activities and manuals. Two key processes were identified in our process evaluation. First, pupils were keen to go to the family event with their parents, and this may have

encouraged family members to attend. Second, the family event was largely promoted and framed around

parents/carers coming to school to see their children’s work and to support their children. The importance

of this is that the event was not primarily marketed or understood as being about alcohol education. It may be that the opportunity to see the work that their children have done in school is a stronger draw for parents/carers than a more generic focus on a particular health issue or message, which has less of a personal connection. These insights should be generalisable to other similar interventions which seek to engage parents/carers in school-based health education activities.

Chapter 5 Conclusion

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