Directory UMM :Data Elmu:jurnal:I:International Journal of Educational Management:Vol15.Issue1.2001:
Impact of a health promotion program on the health
of primary school principals
Rod Green
La Trobe University,
Susan Malcolm
La Trobe University,
Ken Greenwood
La Trobe University,
Gregory Murphy
La Trobe University,
Keywords
Health, Stress, Teachers, Schools
Abstract
The role of a school principal has
changed dramatically in the last
decade and there has been
widespread concern regarding the
impact of this change of role on
principal health and wellbeing.
Worksite health promotion
programs have been used in many
different settings to encourage
employee health, but there is very
little information on the
effectiveness of such programs,
particularly in improving principal
health. This study evaluated the
impact of a 12-month health
promotion program on a group of
50 volunteer principals.
Participants in the program
reported improvements in their
diet and exercise habits and this
was reflected in improvements in
blood pressure, cholesterol and
body fat measures. These results
indicate that worksite health
promotion can play a significant
role in improving the health and
wellbeing of school principals.
This is the second
article in the series of the
health of primary school
principals in Victoria,
Australia. Please contact
the first author for further
details: Dr Rod Green
rod.green@latrobe.edu.au
The International Journal of
Educational Management
15/1 [2001] 31±38
# MCB University Press
[ISSN 0951-354X]
Bundoora, Victoria, Australia
Bundoora, Victoria, Australia
Bundoora, Victoria, Australia
Bundoora, Victoria, Australia
Introduction
Over the recent past, there has been
widespread concern internationally
regarding the stress associated with the
changing role of the principal in the public
school system (Savery and Detiuk, 1986;
Cooper et al., 1998; Tung and Koch, 1980).
Further, this stress associated with the
changing role and responsibilities of school
principals has been implicated in some
studies as a causative factor in work-related
ill-health and disease. One survey of the
health and fitness of principals in Victorian
primary schools confirmed that, despite their
relatively high socioeconomic status, they
typically had poor exercise and nutrition
habits and faced elevated risks of
cardiovascular disease (Green et al., 2000).
Improved employee health, morale and
productivity have been cited as the major
perceived benefits of health promotion
programs in the workplace in Australia and
internationally (Rearck Research, 1992;
Department of Health & Human Services,
1992). There has been a wealth of literature
reporting the benefits of such programs, but
much of it suffers from methodological
problems (Green, 1997; Shepard, 1992;
Wanzel, 1994). It has been suggested that the
postulated benefits, based largely on research
from private-sector companies, may be
generalizable to schools (Allegrante, 1998).
Although some studies in US schools have
suggested health and productivity benefits as
a result of conducting school-based health
promotion programs (Bjurstrom and
Alexiou, 1978; Blair et al., 1986; Yang et al.,
1988), others have not been as conclusive
(Resnicow et al., 1998; Allegrante and
Michela, 1990).
An additional reason for undertaking
health promotion programs in schools is the
suggestion that increasing the interest of
teaching staff in their own health might
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provide role models for pupils and encourage
support for the implementation of broader
health promotion programs within schools
(Allegrante, 1998; Monaghetti et al., 1993).
One of the recommendations of the
Victorian Government's Committee for the
Review of Physical and Sport Education in
Victorian Schools was ``that the importance
of the fitness and wellbeing of principals and
staff be recognised by the Department of
Education'' (Monaghetti et al., 1993). Three
years later the Victorian State Government's
Department of Education (DoE) in
conjunction with VicHealth (The Victorian
Health Promotion Foundation) initiated
health promotion frameworks which were
distributed to all schools in Victoria in 1996
(Directorate of School Education, 1996). This
document provided a policy framework and
accompanying resources which could be
modified to suit individual schools. The
framework proposed was based on a broad
approach to organisational functioning
whereby the link between organisational
effectiveness and the health and wellbeing of
employees is recognised and health and wellbeing programs are integrated into general
school planning and management processes.
As outlined elsewhere (Green et al., 2000),
the Victorian Primary Principals
Association (VPPA) was concerned about the
health of their members in a climate of
increased workloads and responsibility
associated with the introduction of selfgovernance programs for state schools. In an
attempt to assist members in maintaining
their health in the face of major
organisational change, the VPPA initiated a
pilot health promotion program. This
program was funded equally by the VPPA,
the DoE, the health promotion provider (HBA
Health Management) and the principals
participating in the program. Initial health
appraisals, the first stage of the program,
took place in March 1996 (Green et al., 2000),
and post-tests were conducted in March 1997.
This study aimed to evaluate the impact of
a health promotion program on the health
and wellbeing of school principals.
[ 31 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
Method
Research design
An intervention (INT) group was selected
from all principals expressing interest in
participating in the HP program. After
stratifying all potential subjects on the basis
of age, gender and school location
(metropolitan vs. country), the 50
intervention subjects were randomly selected
to match the distribution of all VPPA
members and hopefully all principal class
employees. This method was adopted in an
attempt to make the intervention group
representative of the entire principal class in
the DoE on the basis of the demographic
information available.
The remaining principals who had
expressed interest in participating were
asked to participate as a control (CON) group.
This group received no health appraisal as
this was considered to be a significant part of
the intervention for those participating in
the HP program, but completed
questionnaires.
Subjects
All VPPA members were contacted and asked
to give an expression of interest in
participating in a HP program conducted by
an external provider which included a
comprehensive health assessment at
significantly reduced cost. Fifty INT subjects
were selected from 99 respondents as
described above. Participation in the
research program was obligatory for all
participants in the HP program (Green et al.,
2000).
As indicated above, after the 50 INT
subjects were selected, the principals not
selected were requested to participate as
CON subjects for the subsequent HP
program. Twenty-nine of the remaining 49
principals (59 percent) agreed to participate
as control subjects.
Although the INT group was selected to
match the demographic characteristics of the
entire population and the CON group were
selected from the remainder of respondents,
the groups did not differ on the basis of
demographic characteristics (Table I). The
two groups did not differ at pre-test on any
behavioural or attitudinal data (Green and
Small, 1997). Physical data could not be
compared because they were not collected for
the CON group.
Both the INT and CON groups better
represent principals, rather than all
principal class employees (which includes
assistant principals) (Green et al., 2000).
Three of the INT group and one of the CON
group had retired at post-test, but still
[ 32 ]
completed the questionnaire. All subjects
except one completed the post-test
questionnaire, and 43 of the 50 intervention
subjects completed the post-test physical
assessment representing retention rates of 99
percent and 86 percent respectively. Subjects
not participating at post-test did not differ
from the full INT group on the basis of
demographic, health or health-related
behaviour at pre-test (Green and Small, 1997).
All subjects completed an informed
consent form and the project had approval
from the La Trobe University Human Ethics
Committee.
Health promotion program
The project was officially launched by the
Director of the DoE and the President of the
VPPA at a meeting in Melbourne. The
general manager of HBA Health Management
discussed the impact of lifestyle habits on
disease and outlined the health screening
program, and the primary author explained
the research project. At the conclusion of the
presentation, attendees were asked to sign an
informed consent form for the research
project. They were subsequently given pretest questionnaires for the research project
and booked dates for their health appraisal.
Forty-nine of the 50 INT subjects attended the
launch.
The program centred on a comprehensive
health appraisal and counselling session
conducted at the premises of the external
provider of the program. The health
appraisal included: a medical examination
with medical history, rest and stress
electrocardiogram (ECG), physical measures
(height, weight, strength, flexibility and body
fat), fitness test (maximum oxygen
consumption), questionnaire-based nutrition
assessment, psychological mood profile
(Stress Arousal checklist) and blood and
urine pathology. Results were presented
during counselling sessions with the doctor
and exercise physiologist and strategies for
lifestyle modification were suggested.
Subjects with particular health problems
were referred to either a dietitian or
psychologist for additional consultations as
required.
Health screenings were initially all booked
for March 1996, although a few were delayed
due to unforeseen circumstances.
Approximately 14 weeks after attending for
the health screening, all participants were
contacted by mail. The letter contained a
brief summary of their results and a
reminder to see their doctor about any
abnormal results. They were also invited to
contact the program provider if they had any
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
Table I
Demographics of the intervention (INT) and and control (CON) groups (MSD, unless specified
otherwise)
The International Journal of
Educational Management
15/1 [2001] 31±38
Gender (%) male
Variable
INT (n = 50)
CON (n = 29)
62
55
47.5 4.6
46.8 5.2
Age category (% under 44)
26
41
Age category (% over 49)
36
41
Seniority (% above Principal Class Level 2)
52
69
Duration employed (years)
27.7 5.4
27.2 6.4
Duration employed as principal (years)
6.5 5.8
6.4 4.7
Age (years)
28
28
Students enrolled at school (n = 47 and n = 28)
296 145
338 113
Salaried staff employed at school (n = 47 and n = 29)
19.9 8.9
20.3 7.4
Location at school (% rural)
questions or concerns regarding their
progress.
In August 1996 all INT subjects were
invited to attend a presentation of the
interim report on the project based on the
initial screening results. The group results
were presented by the Medical Director from
HBA Health Management and an opportunity
provided to ask questions. This was followed
by a nutrition seminar presented by a
dietitian, again with an opportunity to ask
questions.
Questionnaires
Questionnaires were distributed to the INT
group at the launch of the HP program and
mailed to the CON group. All questionnaires
were number-coded to ensure anonymity and
returned via pre-paid reply envelopes.
The questionnaire has been described in
detail elsewhere (Green, 1997), but, for
comparative purposes, questions relating to
health-related behaviour were drawn from
those used in previous health surveys of the
Australian population by the National Heart
Foundation.
The NHF surveys use a two week recall of
recreational exercise at three different levels
of intensity (vigorous, less vigorous and
walking). While there has been considerable
debate over the intensity of exercise required
for health benefits the total time spent in all
three levels of activity was used as a measure
of exercise participation in determining
behavioural change in response to the HP
program, that is comparison of pre- and posttest results.
The INT group were given the opportunity
to describe the best features of the HP
program and those features which could have
been improved. This information was
collected by the use of open-ended responses
at the conclusion of the program. Up to three
best or worst features were coded for each
subject.
Data analysis
Prior to the conduct of data analysis the
distributions of all variables were examined
to evaluate the normality of each
distribution. One variable (Arousal) which
deviated significantly from a normal
distribution was transformed and the
transformed variable used in subsequent
analyses.
The INT and CON groups were compared
at pre-test using either t-tests where
variables were continuous in nature, or
appropriate non-parametric tests (chi-square,
Kruskal-Wallis) when categorical data were
involved. Changes between the INT and CON
groups over time were analysed using (for
continuous data) a split-plot factorial design
ANOVA with one repeated measure (preversus post-test). For non-parametric
variables where there was no difference
between groups over time, but there
appeared to be a similar change for both
groups, pre- and post-test data for both
groups pooled were compared using tests for
related samples (McNemar's test or Wilcoxon
matched pairs signed ranks test).
The physical assessment data, available
only for the INT group, were analysed using
paired t-tests.
To test the possibility that only employees
with already healthy behaviours may be
participating in HP program modules, pretest comparisons of categorical data for those
attending and not attending were conducted
using the Kruskal-Wallis test for independent
samples. To test the efficacy of the HP
program modules variables representing
changes between pre- and post-test were
compared between those attending and not
attending using t-tests. Where there were no
[ 33 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
differences between attendees and nonattendees for change, but there appeared to
be a change for the groups pooled,
comparisons were made using the Wilcoxon
matched pairs tests. Analysis of continuous
data for those attending and not attending
were conducted using two-way ANOVA as
described previously.
Results
Table II contains information on the
attendance at activities in the HP program.
Subjects reported increased health-related
knowledge after attending program
activities. Of the six subjects who had
individual consultations with the dietitian,
one had five sessions, one had two sessions
and the remainder had only one session. Of
the three subjects who had individual
consultations with the psychologist, one had
two sessions, and the remainder had only one
session.
There were no differences between
attendees and non-attendees for the dietitian,
psychologist and nutrition seminar on the
basis of age, gender or seniority (Green and
Small, 1997). The referral pattern from the
initial counselling session to the dietitian
and the psychologist was reflected in
attendees. Although raw data are presented
elsewhere (Green and Small, 1997), those who
saw the dietitian at pre-test had higher
cholesterol (t (48) = 2.6, p < 0.05), and those
who saw the psychologist had lower arousal
(t (48) = 2.2, p < 0.05) and higher stress levels
(t (47) = 1.9, p = 0.06) at pre-test. Dietitian
attendees showed greater reductions in
cholesterol between pre- and post-test (Group
by time interaction, F (1, 40) = 5.5, p < 0.05)
than non-attendees and although the changes
in raw data were substantial for both stress
and arousal, low subject numbers precluded
any statistically significant differences
between psychologist attendees and nonattendees between pre- and post-test.
Attendees at the nutrition seminar had
better diet patterns at pre-test than nonattendees (t (48) = 2.0, p = 0.05) and attendance
Table III
Intervention subjects reporting behavioural
change in response to HP program
Table II
Attendance at program activities by intervention group
Activity
Health appraisal and counselling
Dietitian consultation
Psychologist consultation
Nutrition seminar
[ 34 ]
had no apparent effect on diet or healthrelated variables (Green and Small, 1997).
Open-ended responses by the INT group
revealed general satisfaction with the
program. There were 91 best features
described by 44 subjects and 33 features for
improvement by 27 subjects. The most
common best features cited were the health
assessment (25 percent of responses), the
motivation to consider and/or change health
stimulated by the program (23 percent) and
increased general awareness of health (18
percent). The most commonly cited features
for improvement were the need for more
regular activities (30 percent), regional
support groups (18 percent) and offering the
program to all principals (15 percent).
Thirty-eight subjects reported behavioural
change in response to the HP program at
post-test (Table III). Both INT and CON
groups increased the amount of time spent
exercising, and the greater increase for the
INT group approached significance (F (1, 76)
= 3.3, p = 0.07, Table IV). Diet intentions
improved for both groups as did the
proportion of subjects reporting a modified
diet. The greater improvement in diet
intentions for the INT group approached
significance (t (76) = 1.8, p = 0.07). There were
no significant changes in reported alcohol
consumption.
Physical and psychological variables for
INT and CON groups at pre- and post-test are
shown in Table V. There were no differences
in stress and arousal between groups or over
time (Table V). This was also true if retirees
were excluded from the analysis.
Weight, body fat and waist-to-hip ratio
decreased at post-test and the reduction in
body mass index (t (42) = 1.7, p = 0.09)
approached significance. HDL cholesterol
increased and total cholesterol, cholesterol
ratio, systolic and diastolic blood pressure
decreased at post-test. Not surprisingly,
cardiac risk score also decreased at post-test.
In separate analyses not shown in the Table,
group by time interactions indicated that
weight (F (1, 41) = 14.8, p < 0.001), body fat
(F (1, 41) = 16.3, p < 0.001) and body mass
Behavioural change
N (%)
Reported increased
knowledge of health-related
activities (% of attendees)
50 (100)
92
Better able to manage stress
6 (12)
80
Quit smoking
3 (6)
100
22 (45)
96
N (%)
Increased physical activity
14 (29)
Improved diet
32 (65)
Modified in response to one or more
activities
9 (18)
0
38 (78)
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
index (F (1, 41) = 9.4, p < 0.005) decreased for
males, but increased for females. Changes in
all other variables were consistent for both
males and females.
Discussion
The present study was conducted with the
aim of documenting the impact of a health
promotion program on the health and wellbeing of a group of 50 volunteer school
principals. The main study result was that
INT subjects reported improvements to diet
and exercise patterns after 12 months and
these were reflected in improvements in
blood pressure, cholesterol and body fat
measures. This resulted in a lowering of
overall risk of cardiovascular disease.
Before discussing these results in detail,
the strengths of the study need to be
recognised. First, the post-test retention rate
for the questionnaire was exceptionally high
(99 percent), with few similar rates having
been reported previously for 12-month
periods (Green and Small, 1997). This may
Table IV
Pre- and post-test health-related behaviours for intervention (INT) and control (CON) groups (M SD, unless stated
otherwise
INT (n = 49)
Pre-test
Post-test
Variable
18
Usual diet (% modified in some way)
b
53
CON (n = 29)
Pre-test
Post-test
17
38
Z (n = 78) = 4.2**
79
Z (n = 78) = 2.5*
63
88
72
278 297
427 365
348 348
No recreational exercise (% none in last two weeks)
16
12
10
14
Alcohol consumptiond (% intermediate or greater risk)
6
6
0
0
Current smoke (%)
6
6
3
3
Healthier eating intentions (% preparation stage or better)
Time spent in recreational exercisec (mins/last two weeks)
Differencea
415 371 T: F (1.76) = 10.0**
a
Notes: For continuous variables: T = time main effect. For categorical variables: Z for Wilcoxon test between pre- and post-test with groups
pooled; bAs opposed to pre-contemplation or contemplation based on Prochaska's model of stages of change (Prochaska et al., 1992); cTotal of
vigorous exercise, less vigorous exercise and walking (National Heart Foundation of Australia, 1991); dHealth risk of alcohol consumption.
Classified as none, low, intermediate, high or very high (National Heart Foundation of Australia, 1991) * p < 0.05; ** p < 0.01
Table V
Pre- and post-test psychological and physical characteristics for intervention (INT) and control (CON) groups (M SD
INT (n = 50)a
Pre-test
Post-test
Variable
CON (n = 29)
Pre-test
Post-test
Stressc
Arousalcd
7.5 5.1
8.1 3.4
6.3 5.4
8.9 3.0
8.4 5.3
7.8 3.4
8.6 5.2
7.6 3.9
Systolic blood pressure (mm Hg)
132 12
125 13
N/A
N/A
Differenceb
ns
ns
t (42) = 4.1**
82 8
79 9
N/A
N/A
t (42) = 2.7*
Cholesterol (mmol/1)
5.75 0.97
5.34 0.92
N/A
N/A
t (42) = 3.9**
HDL Cholesterole (mmol/1)
1.12 0.39
1.20 0.31
N/A
N/A
t (42) = 2.1*
Cholesterol ratiof
5.67 1.97
4.72 1.34
Weight (kg)
77.9 12.7
77.1 12.1
N/A
N/A
t (42) = 2.0***
Body mass indexg (kg/m2)
26.1 3.2
25.8 3.1
N/A
N/A
ns
0.89 0.08
0.87 0.09
N/A
N/A
t (42) = 3.1**
25.5 5.8
24.1 6.3
N/A
N/A
t (42) = 3.5**
19.0 8.4
15.1 7.6
N/A
N/A
t (42) = 3.4**
Diastolic blood pressure (mm Hg)
Waist-to-hip ratio
h
Body fat (%)i
Cardiac risk score
a
j
b
t (42) = 4.3**
c
Notes: n = 43 for all physical variables; Significance of difference between groups; Stress arousal checklist (SACL) typical scale (Mackay et al.,
1978). Response to 30-scale items, resulting in a score from 0-12 for arousal and 0-18 for stress; dRaw data are presented in the Table, but
analysis was conducted on transformed variable; eHigh density lipoprotein cholesterol. The fraction of cholesterol which serves a preventive role in
terms of cardiovascular disease; fCholesterol ratio = cholesterol/HDL cholesterol. Higher results indicate increased risk of cardiovascular disease;
g
BMI = (weight±1)/(height/100)2. Note: 1kg is deducted from the weight to allow for the weight of clothing (National Heart Foundation of
Australia; hWHR = (waist girth/hip girth) in minimal clothing (Gore and Edwards, 1992); iBody fat (% of body weight). Calculated from skinfold
thicknesses according to established formulae (Sloan and Weir, 1970); jCardiac risk score (arbitrary units). Calculated on the basis of know risk
factors measured during the assessment. Risk classification: 0-8 = ``low''; 9-16 = ``average''; 17-23 = ``average''; 24-31 = ``above average''; >31 =
``high''; * p < 0.05; ** p < 0.01; *** p = 0.05; ns = not significant
[ 35 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
reflect the highly motivated state of the group
in terms of concern about their health. Two
other factors reflected the motivation of this
group in adopting healthier lifestyles. First,
HBA Health Management reported greater
enthusiasm in the VPPA group for additional
consultation with the dietitian and
psychologist than was exhibited by other
corporate groups. The second noteworthy
factor was the high degree of enthusiasm
shown by the subjects who were not
successful in being chosen for the INT group,
with more than half volunteering to
participate in the CON group. A recruitment
rate of 59 percent for a control group, with no
intervention offered, is very high in worksite
programs (Green and Small, 1997).
The retention rate for physical
assessments was also high (86 percent). There
was no evidence to suggest any differences in
demographics or pre-test physical health
associated with this group which may have
biased the outcomes of the study.
There were no differences between the INT
and CON groups at pre-test. This reflects the
identical recruitment patterns and the
random selection of the INT group. The low
number of assistant principals in both
groups, despite their apparent representation
in the VPPA membership (approximately 33
percent compared to 38 percent in the DoE
principal class), appears to indicate a lack of
interest in the program by this group.
Assistant principals could be expected to be
younger, although these data were not
available, and are more likely to be female (47
percent compared to 34 percent for the entire
principal class). Higher participation rates in
health promotion programs are often
reported for older employees (Green and
Small, 1997).
The major limitation of the study was the
self-selected status of all subjects. Although
volunteers were randomly allocated to either
the INT or CON groups, all had indicated
their willingness to participate in the health
promotion program. Thus results may not be
generalisable to all school principals.
Participation in the HP program
Although assistant principals were less
likely to participate in the project as a whole,
participation in HP activities, other than the
health assessment, was not related to age,
gender or seniority (Green and Small, 1997).
The higher pre-test cholesterol for dietitian
consultation attendees probably reflected the
referral process utilized during the health
assessment, whereby those considered at
high risk were referred for further
consultation by the attending doctor. Dietary
change was reported by both groups,
[ 36 ]
although the increase in the number of
attendees reporting dietary modification was
greater than for non-attendees. Both
attendees and non-attendees decreased their
cholesterol, blood pressure and BMI.
The low number of attendees for
psychologist consultation hampered the
statistical analysis of this part of the data.
The higher stress and lower arousal levels for
attendees at pre-test again probably reflect
the referral process used in the health
assessment. Arousal increased for both
groups, but the suggestion of major changes
in both stress and arousal for attendees in the
raw data could not be supported statistically.
Encouragingly, the results suggested by the
raw data were enhanced if retirees were
excluded from the analysis. That is,
reductions in stress associated with
retirement could not be held to be
responsible for the results observed.
Subjects attending the nutrition seminar
had better diets. Although dietary
improvement was reported for both attendees
and non-attendees, the trend for greater
improvements in diet intentions for
attendees may be indicative of a motivating
effect of seminar attendance. In general,
attendees at sessions other than the health
assessment appear to have reported greater
changes in health-related behaviours and
health. Cholesterol, blood pressure, and
probably BMI, again decreased for both
attendees and non-attendees.
Changes in health and health-related
behaviour
The overall reduction in the risk of
cardiovascular disease evident in the INT
group, due to reductions in cholesterol, blood
pressure and body fat levels, was substantial.
Despite similar changes in diet and exercise
for both males and females, a greater weight
loss was reported for males than females
during the program (data not reported). This
gender difference in weight loss associated
with diet or exercise programs is consistent
with previous reports (Ballor and Poehlman,
1995).
Although both groups showed
improvements in diet and exercise over the
course of the program, the changes in diet
intentions and the amount of time spent
exercising were greater for the INT group.
There was a pattern of improved healthrelated behaviour in both the INT and the
CON groups, although some benefits were
more pronounced in the INT group. The
latter finding suggests a program effect on
such behaviour. There may be two possible
explanations for CON group improvements.
First, as indicated above, the CON group
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
were probably highly motivated to improve
their health and disappointed not to be
selected in the INT group. Such conditions
may induce compensatory rivalry, which
tends to mask the effectiveness of the
intervention because the CON group seeks
their own intervention (Conrad et al., 1991).
Such an effect may have been enhanced by
the reporting of the progress of the program
back to the VPPA membership in the form of
the interim report. Second, the results may
reflect the increased awareness of health
among principals as a whole. Factors
inducing this may again relate to awareness
of the program among VPPA members, but
additionally to the MBF health survey which
was also conducted over the program period
(Green et al., 2000). Although the
participation rate of CON group members in
the MBF health survey was unknown, it was
likely to be high given their interest in
participating in the VPPA project.
Compensatory rivalry and unintended
outside influences on a control group are
both threats to the internal validity of a
program which tend to mask program
effectiveness (Conrad et al., 1991). However
the positive changes associated with the
program in inducing lifestyle changes
amongst enthusiastic volunteers who
contribute individually to the funding of the
program is consistent with previous reports
of the benefits of such a program amongst
school staff (Yang et al., 1988).
It is also worth noting that the program in
this study is unlike many other worksite HP
programs, in that it was conducted entirely
outside the workplace and the principals all
returned to their own schools. As such it
lacked a supportive local environment which
is a feature of the more effective worksite HP
programs (Worksafe Australia, 1995). As
indicated earlier, two of the most common
suggestions for improvement of the program
were the need for more regular sessions and
for regional support groups to assist in the
encouragement and maintenance of
behavioural change. This may be an
important factor in maintaining ongoing
effectiveness of the program or others
similar to it.
Two studies involving HP programs in a
school setting found that reduced staff
absence was associated with participation
(Bjurstrom and Alexiou, 1978; Blair et al.,
1986). A non-significant trend for a reduction
in absence for both CON and INT subjects in
this study (Green, 1997) is consistent with
those previous findings. Studies in nonschool settings have found improved job
performance associated with participation in
a HP program (Pender et al., 1987; Bernacki
and Baun, 1984). Although there were no
direct measures of job performance in this
study, it is possible that the substantial
health improvements associated with
participation in this HP program may have
improved the productivity of the
participants.
Conclusion
The introduction of the health promotion
program appeared to be successful in
improving the cardiovascular health and
health-related behaviour of primary
principals, although reductions in body fat
levels were confined to males only. The
apparent success of this program should be
qualified by the self-selected status of the
participants. Although no different in health
status from their peers (Green et al., 2000),
the participants in this program had
volunteered to participate in the program
and contributed to the cost of the program.
The similar changes observed in the healthrelated behaviour of the control group,
although not as substantial as the
intervention group, support the suggestion
that the benefits of this program may be
related to the enthusiastic nature of the
participants and therefore may not be
expected to occur more generally across all
school principals eligible to participate in
such a program.
Although there have been benefits for both
attendees and non-attendees at dietitian
consultation and the nutrition seminar, the
changes appear to be greater for the
attendees. Benefits evident in raw data for
attendees at the psychological counselling
were unable to be substantiated statistically
due to low subject numbers, but the possible
benefits of health counselling should be
further investigated in future studies of the
impact of any health promotion programs
organised for primary school principals.
Although employee productivity is very
difficult to measure, future studies should
also look at the possibility that
improvements in health and wellbeing
associated with a HP program (as
demonstrated in this study) may be
associated with improved productivity of
participants.
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[ 37 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
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of primary school principals
Rod Green
La Trobe University,
Susan Malcolm
La Trobe University,
Ken Greenwood
La Trobe University,
Gregory Murphy
La Trobe University,
Keywords
Health, Stress, Teachers, Schools
Abstract
The role of a school principal has
changed dramatically in the last
decade and there has been
widespread concern regarding the
impact of this change of role on
principal health and wellbeing.
Worksite health promotion
programs have been used in many
different settings to encourage
employee health, but there is very
little information on the
effectiveness of such programs,
particularly in improving principal
health. This study evaluated the
impact of a 12-month health
promotion program on a group of
50 volunteer principals.
Participants in the program
reported improvements in their
diet and exercise habits and this
was reflected in improvements in
blood pressure, cholesterol and
body fat measures. These results
indicate that worksite health
promotion can play a significant
role in improving the health and
wellbeing of school principals.
This is the second
article in the series of the
health of primary school
principals in Victoria,
Australia. Please contact
the first author for further
details: Dr Rod Green
rod.green@latrobe.edu.au
The International Journal of
Educational Management
15/1 [2001] 31±38
# MCB University Press
[ISSN 0951-354X]
Bundoora, Victoria, Australia
Bundoora, Victoria, Australia
Bundoora, Victoria, Australia
Bundoora, Victoria, Australia
Introduction
Over the recent past, there has been
widespread concern internationally
regarding the stress associated with the
changing role of the principal in the public
school system (Savery and Detiuk, 1986;
Cooper et al., 1998; Tung and Koch, 1980).
Further, this stress associated with the
changing role and responsibilities of school
principals has been implicated in some
studies as a causative factor in work-related
ill-health and disease. One survey of the
health and fitness of principals in Victorian
primary schools confirmed that, despite their
relatively high socioeconomic status, they
typically had poor exercise and nutrition
habits and faced elevated risks of
cardiovascular disease (Green et al., 2000).
Improved employee health, morale and
productivity have been cited as the major
perceived benefits of health promotion
programs in the workplace in Australia and
internationally (Rearck Research, 1992;
Department of Health & Human Services,
1992). There has been a wealth of literature
reporting the benefits of such programs, but
much of it suffers from methodological
problems (Green, 1997; Shepard, 1992;
Wanzel, 1994). It has been suggested that the
postulated benefits, based largely on research
from private-sector companies, may be
generalizable to schools (Allegrante, 1998).
Although some studies in US schools have
suggested health and productivity benefits as
a result of conducting school-based health
promotion programs (Bjurstrom and
Alexiou, 1978; Blair et al., 1986; Yang et al.,
1988), others have not been as conclusive
(Resnicow et al., 1998; Allegrante and
Michela, 1990).
An additional reason for undertaking
health promotion programs in schools is the
suggestion that increasing the interest of
teaching staff in their own health might
The current issue and full text archive of this journal is available at
http://www.emerald-library.com/ft
provide role models for pupils and encourage
support for the implementation of broader
health promotion programs within schools
(Allegrante, 1998; Monaghetti et al., 1993).
One of the recommendations of the
Victorian Government's Committee for the
Review of Physical and Sport Education in
Victorian Schools was ``that the importance
of the fitness and wellbeing of principals and
staff be recognised by the Department of
Education'' (Monaghetti et al., 1993). Three
years later the Victorian State Government's
Department of Education (DoE) in
conjunction with VicHealth (The Victorian
Health Promotion Foundation) initiated
health promotion frameworks which were
distributed to all schools in Victoria in 1996
(Directorate of School Education, 1996). This
document provided a policy framework and
accompanying resources which could be
modified to suit individual schools. The
framework proposed was based on a broad
approach to organisational functioning
whereby the link between organisational
effectiveness and the health and wellbeing of
employees is recognised and health and wellbeing programs are integrated into general
school planning and management processes.
As outlined elsewhere (Green et al., 2000),
the Victorian Primary Principals
Association (VPPA) was concerned about the
health of their members in a climate of
increased workloads and responsibility
associated with the introduction of selfgovernance programs for state schools. In an
attempt to assist members in maintaining
their health in the face of major
organisational change, the VPPA initiated a
pilot health promotion program. This
program was funded equally by the VPPA,
the DoE, the health promotion provider (HBA
Health Management) and the principals
participating in the program. Initial health
appraisals, the first stage of the program,
took place in March 1996 (Green et al., 2000),
and post-tests were conducted in March 1997.
This study aimed to evaluate the impact of
a health promotion program on the health
and wellbeing of school principals.
[ 31 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
Method
Research design
An intervention (INT) group was selected
from all principals expressing interest in
participating in the HP program. After
stratifying all potential subjects on the basis
of age, gender and school location
(metropolitan vs. country), the 50
intervention subjects were randomly selected
to match the distribution of all VPPA
members and hopefully all principal class
employees. This method was adopted in an
attempt to make the intervention group
representative of the entire principal class in
the DoE on the basis of the demographic
information available.
The remaining principals who had
expressed interest in participating were
asked to participate as a control (CON) group.
This group received no health appraisal as
this was considered to be a significant part of
the intervention for those participating in
the HP program, but completed
questionnaires.
Subjects
All VPPA members were contacted and asked
to give an expression of interest in
participating in a HP program conducted by
an external provider which included a
comprehensive health assessment at
significantly reduced cost. Fifty INT subjects
were selected from 99 respondents as
described above. Participation in the
research program was obligatory for all
participants in the HP program (Green et al.,
2000).
As indicated above, after the 50 INT
subjects were selected, the principals not
selected were requested to participate as
CON subjects for the subsequent HP
program. Twenty-nine of the remaining 49
principals (59 percent) agreed to participate
as control subjects.
Although the INT group was selected to
match the demographic characteristics of the
entire population and the CON group were
selected from the remainder of respondents,
the groups did not differ on the basis of
demographic characteristics (Table I). The
two groups did not differ at pre-test on any
behavioural or attitudinal data (Green and
Small, 1997). Physical data could not be
compared because they were not collected for
the CON group.
Both the INT and CON groups better
represent principals, rather than all
principal class employees (which includes
assistant principals) (Green et al., 2000).
Three of the INT group and one of the CON
group had retired at post-test, but still
[ 32 ]
completed the questionnaire. All subjects
except one completed the post-test
questionnaire, and 43 of the 50 intervention
subjects completed the post-test physical
assessment representing retention rates of 99
percent and 86 percent respectively. Subjects
not participating at post-test did not differ
from the full INT group on the basis of
demographic, health or health-related
behaviour at pre-test (Green and Small, 1997).
All subjects completed an informed
consent form and the project had approval
from the La Trobe University Human Ethics
Committee.
Health promotion program
The project was officially launched by the
Director of the DoE and the President of the
VPPA at a meeting in Melbourne. The
general manager of HBA Health Management
discussed the impact of lifestyle habits on
disease and outlined the health screening
program, and the primary author explained
the research project. At the conclusion of the
presentation, attendees were asked to sign an
informed consent form for the research
project. They were subsequently given pretest questionnaires for the research project
and booked dates for their health appraisal.
Forty-nine of the 50 INT subjects attended the
launch.
The program centred on a comprehensive
health appraisal and counselling session
conducted at the premises of the external
provider of the program. The health
appraisal included: a medical examination
with medical history, rest and stress
electrocardiogram (ECG), physical measures
(height, weight, strength, flexibility and body
fat), fitness test (maximum oxygen
consumption), questionnaire-based nutrition
assessment, psychological mood profile
(Stress Arousal checklist) and blood and
urine pathology. Results were presented
during counselling sessions with the doctor
and exercise physiologist and strategies for
lifestyle modification were suggested.
Subjects with particular health problems
were referred to either a dietitian or
psychologist for additional consultations as
required.
Health screenings were initially all booked
for March 1996, although a few were delayed
due to unforeseen circumstances.
Approximately 14 weeks after attending for
the health screening, all participants were
contacted by mail. The letter contained a
brief summary of their results and a
reminder to see their doctor about any
abnormal results. They were also invited to
contact the program provider if they had any
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
Table I
Demographics of the intervention (INT) and and control (CON) groups (MSD, unless specified
otherwise)
The International Journal of
Educational Management
15/1 [2001] 31±38
Gender (%) male
Variable
INT (n = 50)
CON (n = 29)
62
55
47.5 4.6
46.8 5.2
Age category (% under 44)
26
41
Age category (% over 49)
36
41
Seniority (% above Principal Class Level 2)
52
69
Duration employed (years)
27.7 5.4
27.2 6.4
Duration employed as principal (years)
6.5 5.8
6.4 4.7
Age (years)
28
28
Students enrolled at school (n = 47 and n = 28)
296 145
338 113
Salaried staff employed at school (n = 47 and n = 29)
19.9 8.9
20.3 7.4
Location at school (% rural)
questions or concerns regarding their
progress.
In August 1996 all INT subjects were
invited to attend a presentation of the
interim report on the project based on the
initial screening results. The group results
were presented by the Medical Director from
HBA Health Management and an opportunity
provided to ask questions. This was followed
by a nutrition seminar presented by a
dietitian, again with an opportunity to ask
questions.
Questionnaires
Questionnaires were distributed to the INT
group at the launch of the HP program and
mailed to the CON group. All questionnaires
were number-coded to ensure anonymity and
returned via pre-paid reply envelopes.
The questionnaire has been described in
detail elsewhere (Green, 1997), but, for
comparative purposes, questions relating to
health-related behaviour were drawn from
those used in previous health surveys of the
Australian population by the National Heart
Foundation.
The NHF surveys use a two week recall of
recreational exercise at three different levels
of intensity (vigorous, less vigorous and
walking). While there has been considerable
debate over the intensity of exercise required
for health benefits the total time spent in all
three levels of activity was used as a measure
of exercise participation in determining
behavioural change in response to the HP
program, that is comparison of pre- and posttest results.
The INT group were given the opportunity
to describe the best features of the HP
program and those features which could have
been improved. This information was
collected by the use of open-ended responses
at the conclusion of the program. Up to three
best or worst features were coded for each
subject.
Data analysis
Prior to the conduct of data analysis the
distributions of all variables were examined
to evaluate the normality of each
distribution. One variable (Arousal) which
deviated significantly from a normal
distribution was transformed and the
transformed variable used in subsequent
analyses.
The INT and CON groups were compared
at pre-test using either t-tests where
variables were continuous in nature, or
appropriate non-parametric tests (chi-square,
Kruskal-Wallis) when categorical data were
involved. Changes between the INT and CON
groups over time were analysed using (for
continuous data) a split-plot factorial design
ANOVA with one repeated measure (preversus post-test). For non-parametric
variables where there was no difference
between groups over time, but there
appeared to be a similar change for both
groups, pre- and post-test data for both
groups pooled were compared using tests for
related samples (McNemar's test or Wilcoxon
matched pairs signed ranks test).
The physical assessment data, available
only for the INT group, were analysed using
paired t-tests.
To test the possibility that only employees
with already healthy behaviours may be
participating in HP program modules, pretest comparisons of categorical data for those
attending and not attending were conducted
using the Kruskal-Wallis test for independent
samples. To test the efficacy of the HP
program modules variables representing
changes between pre- and post-test were
compared between those attending and not
attending using t-tests. Where there were no
[ 33 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
differences between attendees and nonattendees for change, but there appeared to
be a change for the groups pooled,
comparisons were made using the Wilcoxon
matched pairs tests. Analysis of continuous
data for those attending and not attending
were conducted using two-way ANOVA as
described previously.
Results
Table II contains information on the
attendance at activities in the HP program.
Subjects reported increased health-related
knowledge after attending program
activities. Of the six subjects who had
individual consultations with the dietitian,
one had five sessions, one had two sessions
and the remainder had only one session. Of
the three subjects who had individual
consultations with the psychologist, one had
two sessions, and the remainder had only one
session.
There were no differences between
attendees and non-attendees for the dietitian,
psychologist and nutrition seminar on the
basis of age, gender or seniority (Green and
Small, 1997). The referral pattern from the
initial counselling session to the dietitian
and the psychologist was reflected in
attendees. Although raw data are presented
elsewhere (Green and Small, 1997), those who
saw the dietitian at pre-test had higher
cholesterol (t (48) = 2.6, p < 0.05), and those
who saw the psychologist had lower arousal
(t (48) = 2.2, p < 0.05) and higher stress levels
(t (47) = 1.9, p = 0.06) at pre-test. Dietitian
attendees showed greater reductions in
cholesterol between pre- and post-test (Group
by time interaction, F (1, 40) = 5.5, p < 0.05)
than non-attendees and although the changes
in raw data were substantial for both stress
and arousal, low subject numbers precluded
any statistically significant differences
between psychologist attendees and nonattendees between pre- and post-test.
Attendees at the nutrition seminar had
better diet patterns at pre-test than nonattendees (t (48) = 2.0, p = 0.05) and attendance
Table III
Intervention subjects reporting behavioural
change in response to HP program
Table II
Attendance at program activities by intervention group
Activity
Health appraisal and counselling
Dietitian consultation
Psychologist consultation
Nutrition seminar
[ 34 ]
had no apparent effect on diet or healthrelated variables (Green and Small, 1997).
Open-ended responses by the INT group
revealed general satisfaction with the
program. There were 91 best features
described by 44 subjects and 33 features for
improvement by 27 subjects. The most
common best features cited were the health
assessment (25 percent of responses), the
motivation to consider and/or change health
stimulated by the program (23 percent) and
increased general awareness of health (18
percent). The most commonly cited features
for improvement were the need for more
regular activities (30 percent), regional
support groups (18 percent) and offering the
program to all principals (15 percent).
Thirty-eight subjects reported behavioural
change in response to the HP program at
post-test (Table III). Both INT and CON
groups increased the amount of time spent
exercising, and the greater increase for the
INT group approached significance (F (1, 76)
= 3.3, p = 0.07, Table IV). Diet intentions
improved for both groups as did the
proportion of subjects reporting a modified
diet. The greater improvement in diet
intentions for the INT group approached
significance (t (76) = 1.8, p = 0.07). There were
no significant changes in reported alcohol
consumption.
Physical and psychological variables for
INT and CON groups at pre- and post-test are
shown in Table V. There were no differences
in stress and arousal between groups or over
time (Table V). This was also true if retirees
were excluded from the analysis.
Weight, body fat and waist-to-hip ratio
decreased at post-test and the reduction in
body mass index (t (42) = 1.7, p = 0.09)
approached significance. HDL cholesterol
increased and total cholesterol, cholesterol
ratio, systolic and diastolic blood pressure
decreased at post-test. Not surprisingly,
cardiac risk score also decreased at post-test.
In separate analyses not shown in the Table,
group by time interactions indicated that
weight (F (1, 41) = 14.8, p < 0.001), body fat
(F (1, 41) = 16.3, p < 0.001) and body mass
Behavioural change
N (%)
Reported increased
knowledge of health-related
activities (% of attendees)
50 (100)
92
Better able to manage stress
6 (12)
80
Quit smoking
3 (6)
100
22 (45)
96
N (%)
Increased physical activity
14 (29)
Improved diet
32 (65)
Modified in response to one or more
activities
9 (18)
0
38 (78)
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
index (F (1, 41) = 9.4, p < 0.005) decreased for
males, but increased for females. Changes in
all other variables were consistent for both
males and females.
Discussion
The present study was conducted with the
aim of documenting the impact of a health
promotion program on the health and wellbeing of a group of 50 volunteer school
principals. The main study result was that
INT subjects reported improvements to diet
and exercise patterns after 12 months and
these were reflected in improvements in
blood pressure, cholesterol and body fat
measures. This resulted in a lowering of
overall risk of cardiovascular disease.
Before discussing these results in detail,
the strengths of the study need to be
recognised. First, the post-test retention rate
for the questionnaire was exceptionally high
(99 percent), with few similar rates having
been reported previously for 12-month
periods (Green and Small, 1997). This may
Table IV
Pre- and post-test health-related behaviours for intervention (INT) and control (CON) groups (M SD, unless stated
otherwise
INT (n = 49)
Pre-test
Post-test
Variable
18
Usual diet (% modified in some way)
b
53
CON (n = 29)
Pre-test
Post-test
17
38
Z (n = 78) = 4.2**
79
Z (n = 78) = 2.5*
63
88
72
278 297
427 365
348 348
No recreational exercise (% none in last two weeks)
16
12
10
14
Alcohol consumptiond (% intermediate or greater risk)
6
6
0
0
Current smoke (%)
6
6
3
3
Healthier eating intentions (% preparation stage or better)
Time spent in recreational exercisec (mins/last two weeks)
Differencea
415 371 T: F (1.76) = 10.0**
a
Notes: For continuous variables: T = time main effect. For categorical variables: Z for Wilcoxon test between pre- and post-test with groups
pooled; bAs opposed to pre-contemplation or contemplation based on Prochaska's model of stages of change (Prochaska et al., 1992); cTotal of
vigorous exercise, less vigorous exercise and walking (National Heart Foundation of Australia, 1991); dHealth risk of alcohol consumption.
Classified as none, low, intermediate, high or very high (National Heart Foundation of Australia, 1991) * p < 0.05; ** p < 0.01
Table V
Pre- and post-test psychological and physical characteristics for intervention (INT) and control (CON) groups (M SD
INT (n = 50)a
Pre-test
Post-test
Variable
CON (n = 29)
Pre-test
Post-test
Stressc
Arousalcd
7.5 5.1
8.1 3.4
6.3 5.4
8.9 3.0
8.4 5.3
7.8 3.4
8.6 5.2
7.6 3.9
Systolic blood pressure (mm Hg)
132 12
125 13
N/A
N/A
Differenceb
ns
ns
t (42) = 4.1**
82 8
79 9
N/A
N/A
t (42) = 2.7*
Cholesterol (mmol/1)
5.75 0.97
5.34 0.92
N/A
N/A
t (42) = 3.9**
HDL Cholesterole (mmol/1)
1.12 0.39
1.20 0.31
N/A
N/A
t (42) = 2.1*
Cholesterol ratiof
5.67 1.97
4.72 1.34
Weight (kg)
77.9 12.7
77.1 12.1
N/A
N/A
t (42) = 2.0***
Body mass indexg (kg/m2)
26.1 3.2
25.8 3.1
N/A
N/A
ns
0.89 0.08
0.87 0.09
N/A
N/A
t (42) = 3.1**
25.5 5.8
24.1 6.3
N/A
N/A
t (42) = 3.5**
19.0 8.4
15.1 7.6
N/A
N/A
t (42) = 3.4**
Diastolic blood pressure (mm Hg)
Waist-to-hip ratio
h
Body fat (%)i
Cardiac risk score
a
j
b
t (42) = 4.3**
c
Notes: n = 43 for all physical variables; Significance of difference between groups; Stress arousal checklist (SACL) typical scale (Mackay et al.,
1978). Response to 30-scale items, resulting in a score from 0-12 for arousal and 0-18 for stress; dRaw data are presented in the Table, but
analysis was conducted on transformed variable; eHigh density lipoprotein cholesterol. The fraction of cholesterol which serves a preventive role in
terms of cardiovascular disease; fCholesterol ratio = cholesterol/HDL cholesterol. Higher results indicate increased risk of cardiovascular disease;
g
BMI = (weight±1)/(height/100)2. Note: 1kg is deducted from the weight to allow for the weight of clothing (National Heart Foundation of
Australia; hWHR = (waist girth/hip girth) in minimal clothing (Gore and Edwards, 1992); iBody fat (% of body weight). Calculated from skinfold
thicknesses according to established formulae (Sloan and Weir, 1970); jCardiac risk score (arbitrary units). Calculated on the basis of know risk
factors measured during the assessment. Risk classification: 0-8 = ``low''; 9-16 = ``average''; 17-23 = ``average''; 24-31 = ``above average''; >31 =
``high''; * p < 0.05; ** p < 0.01; *** p = 0.05; ns = not significant
[ 35 ]
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
reflect the highly motivated state of the group
in terms of concern about their health. Two
other factors reflected the motivation of this
group in adopting healthier lifestyles. First,
HBA Health Management reported greater
enthusiasm in the VPPA group for additional
consultation with the dietitian and
psychologist than was exhibited by other
corporate groups. The second noteworthy
factor was the high degree of enthusiasm
shown by the subjects who were not
successful in being chosen for the INT group,
with more than half volunteering to
participate in the CON group. A recruitment
rate of 59 percent for a control group, with no
intervention offered, is very high in worksite
programs (Green and Small, 1997).
The retention rate for physical
assessments was also high (86 percent). There
was no evidence to suggest any differences in
demographics or pre-test physical health
associated with this group which may have
biased the outcomes of the study.
There were no differences between the INT
and CON groups at pre-test. This reflects the
identical recruitment patterns and the
random selection of the INT group. The low
number of assistant principals in both
groups, despite their apparent representation
in the VPPA membership (approximately 33
percent compared to 38 percent in the DoE
principal class), appears to indicate a lack of
interest in the program by this group.
Assistant principals could be expected to be
younger, although these data were not
available, and are more likely to be female (47
percent compared to 34 percent for the entire
principal class). Higher participation rates in
health promotion programs are often
reported for older employees (Green and
Small, 1997).
The major limitation of the study was the
self-selected status of all subjects. Although
volunteers were randomly allocated to either
the INT or CON groups, all had indicated
their willingness to participate in the health
promotion program. Thus results may not be
generalisable to all school principals.
Participation in the HP program
Although assistant principals were less
likely to participate in the project as a whole,
participation in HP activities, other than the
health assessment, was not related to age,
gender or seniority (Green and Small, 1997).
The higher pre-test cholesterol for dietitian
consultation attendees probably reflected the
referral process utilized during the health
assessment, whereby those considered at
high risk were referred for further
consultation by the attending doctor. Dietary
change was reported by both groups,
[ 36 ]
although the increase in the number of
attendees reporting dietary modification was
greater than for non-attendees. Both
attendees and non-attendees decreased their
cholesterol, blood pressure and BMI.
The low number of attendees for
psychologist consultation hampered the
statistical analysis of this part of the data.
The higher stress and lower arousal levels for
attendees at pre-test again probably reflect
the referral process used in the health
assessment. Arousal increased for both
groups, but the suggestion of major changes
in both stress and arousal for attendees in the
raw data could not be supported statistically.
Encouragingly, the results suggested by the
raw data were enhanced if retirees were
excluded from the analysis. That is,
reductions in stress associated with
retirement could not be held to be
responsible for the results observed.
Subjects attending the nutrition seminar
had better diets. Although dietary
improvement was reported for both attendees
and non-attendees, the trend for greater
improvements in diet intentions for
attendees may be indicative of a motivating
effect of seminar attendance. In general,
attendees at sessions other than the health
assessment appear to have reported greater
changes in health-related behaviours and
health. Cholesterol, blood pressure, and
probably BMI, again decreased for both
attendees and non-attendees.
Changes in health and health-related
behaviour
The overall reduction in the risk of
cardiovascular disease evident in the INT
group, due to reductions in cholesterol, blood
pressure and body fat levels, was substantial.
Despite similar changes in diet and exercise
for both males and females, a greater weight
loss was reported for males than females
during the program (data not reported). This
gender difference in weight loss associated
with diet or exercise programs is consistent
with previous reports (Ballor and Poehlman,
1995).
Although both groups showed
improvements in diet and exercise over the
course of the program, the changes in diet
intentions and the amount of time spent
exercising were greater for the INT group.
There was a pattern of improved healthrelated behaviour in both the INT and the
CON groups, although some benefits were
more pronounced in the INT group. The
latter finding suggests a program effect on
such behaviour. There may be two possible
explanations for CON group improvements.
First, as indicated above, the CON group
Rod Green, Susan Malcolm,
Ken Greenwood and
Gregory Murphy
Impact of a health promotion
program on the health of
primary school principals
The International Journal of
Educational Management
15/1 [2001] 31±38
were probably highly motivated to improve
their health and disappointed not to be
selected in the INT group. Such conditions
may induce compensatory rivalry, which
tends to mask the effectiveness of the
intervention because the CON group seeks
their own intervention (Conrad et al., 1991).
Such an effect may have been enhanced by
the reporting of the progress of the program
back to the VPPA membership in the form of
the interim report. Second, the results may
reflect the increased awareness of health
among principals as a whole. Factors
inducing this may again relate to awareness
of the program among VPPA members, but
additionally to the MBF health survey which
was also conducted over the program period
(Green et al., 2000). Although the
participation rate of CON group members in
the MBF health survey was unknown, it was
likely to be high given their interest in
participating in the VPPA project.
Compensatory rivalry and unintended
outside influences on a control group are
both threats to the internal validity of a
program which tend to mask program
effectiveness (Conrad et al., 1991). However
the positive changes associated with the
program in inducing lifestyle changes
amongst enthusiastic volunteers who
contribute individually to the funding of the
program is consistent with previous reports
of the benefits of such a program amongst
school staff (Yang et al., 1988).
It is also worth noting that the program in
this study is unlike many other worksite HP
programs, in that it was conducted entirely
outside the workplace and the principals all
returned to their own schools. As such it
lacked a supportive local environment which
is a feature of the more effective worksite HP
programs (Worksafe Australia, 1995). As
indicated earlier, two of the most common
suggestions for improvement of the program
were the need for more regular sessions and
for regional support groups to assist in the
encouragement and maintenance of
behavioural change. This may be an
important factor in maintaining ongoing
effectiveness of the program or others
similar to it.
Two studies involving HP programs in a
school setting found that reduced staff
absence was associated with participation
(Bjurstrom and Alexiou, 1978; Blair et al.,
1986). A non-significant trend for a reduction
in absence for both CON and INT subjects in
this study (Green, 1997) is consistent with
those previous findings. Studies in nonschool settings have found improved job
performance associated with participation in
a HP program (Pender et al., 1987; Bernacki
and Baun, 1984). Although there were no
direct measures of job performance in this
study, it is possible that the substantial
health improvements associated with
participation in this HP program may have
improved the productivity of the
participants.
Conclusion
The introduction of the health promotion
program appeared to be successful in
improving the cardiovascular health and
health-related behaviour of primary
principals, although reductions in body fat
levels were confined to males only. The
apparent success of this program should be
qualified by the self-selected status of the
participants. Although no different in health
status from their peers (Green et al., 2000),
the participants in this program had
volunteered to participate in the program
and contributed to the cost of the program.
The similar changes observed in the healthrelated behaviour of the control group,
although not as substantial as the
intervention group, support the suggestion
that the benefits of this program may be
related to the enthusiastic nature of the
participants and therefore may not be
expected to occur more generally across all
school principals eligible to participate in
such a program.
Although there have been benefits for both
attendees and non-attendees at dietitian
consultation and the nutrition seminar, the
changes appear to be greater for the
attendees. Benefits evident in raw data for
attendees at the psychological counselling
were unable to be substantiated statistically
due to low subject numbers, but the possible
benefits of health counselling should be
further investigated in future studies of the
impact of any health promotion programs
organised for primary school principals.
Although employee productivity is very
difficult to measure, future studies should
also look at the possibility that
improvements in health and wellbeing
associated with a HP program (as
demonstrated in this study) may be
associated with improved productivity of
participants.
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The International Journal of
Educational Management
15/1 [2001] 31±38
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