Hunter New England Local Health District
Shake A Leg is a schools-based health promotion program for both primary and secondary schools which is delivered to all students with an Indigenous perspective. The main aim of the program is "to reduce preventable health conditions in Aboriginal and Torres Strait Islander children through the provision of appropriate information which will strengthen health knowledge and build community expertise to improve health outcomes for Aboriginal children and families".
Increasing the children's knowledge in health topics that impact them allows the children to take the information back to their families and communities and educate their brothers and sisters, mother and father, aunts and uncles, Nan and pop and so on. The program aims to address the health issues early and reduce the likeliness of the children/young people developing health illnesses commonly known to Aboriginal people i.e. chronic disease.
Indigenous Australians in general have the poorest health and can be compared to that of a Third World country. Evidence shows that this poor health commences early in life, as do the behaviours which can increase or decrease the likelihood of poor health.
Within Hunter New England Health, 51% of the Aboriginal population are aged under 20 years, compared to 28% in the non-Aboriginal population.
Consultation with local Aboriginal communities identified health education and promotion for young people as a high priority.
The aim of Shake A Leg is to reduce preventable health conditions in Aboriginal and Torres Strait Islander children through the provision of appropriate information which will strengthen health knowledge and build community expertise to improve health outcomes for Aboriginal children and families.
Shake A Leg has been written to meet the syllabus outcomes in the Physical Education, Personal Development and Welfare. The content of the resources is age appropriate and are fun and interactive to which teachers can extend the students learning further.
The program strengthens the health knowledge of students, parents and teachers as well as building community expertise to improve health outcomes in Indigenous children and their family.
Objectives and intended outcomes of the program are below:
- That Aboriginal communities will have a better understanding of disease processes and prevention and how to continue effective ongoing care for children by empowering the children with early intervention strategies to share in the home environment
- Greater understanding of health prevention strategies – for teachers, parents and students
- Long-term better health outcomes, and confidence for children, parents and carers and other key people who interact with children on a regular basis e.g. schools
- The continuation of education of Aboriginal and Torres Strait Islander children about health conditions and ways to prevent them, and more importantly for those children to educate parents/carers, aunts, uncles, and the wider community.
The program has been developed to meet the key priorities from national, state and local Aboriginal Health strategic plans, in that it:
- Addresses identified health issues –the program covers a wide range of health topics related to Indigenous health
- Improving social and emotional well being (of children and young people) – the program allows for Indigenous and non-Indigenous children/youth to learn about Aboriginal and Torres Strait Islander culture, as well as building their self-esteem and overall well being
- Increasing the effectiveness of health promotion – this is reflected in the aim of the program and in the plans key priorities "…to reduce morbidity amongst Aboriginal people through the effective targeting of known major causes of morbidity and mortality"(TWT Plan), the health issues identified in the program target and address ill causes of health faced by Indigenous people, in particular chronic disease.
- Creating an environment supportive of good health – addressing hygiene in the program with the children/young people allows the target audience to enable change in their home environment and essentially their community.
A range of information is collected to measure the effectiveness of the program. Further information is provided in the section on evaluation.
Shake A Leg evolved from a partnership network meeting between the Hunter New England Local Health District (HNELHD) and the Awabakal Aboriginal Medical Service in 2005. Staff within the partnership felt that there was a missing link between health staff accessing and delivering health programs within the schools. The group developed some criteria for what they felt would be key aspects of the program – see following diagram:
Shake A Leg commenced in 2005 with a pilot project in Fennel Bay in the Newcastle region. The HNELHD at that time was piloting an Indigenous Women's Group in the West Lake Macquarie area, therefore we anticipated that the information we were giving to students at school was being reinforced by the women in the family. The Local Aboriginal Land Council was heavily involved in guiding the process of where to set the program and when.
Consultations with the Department of Education staff shaped the structure of the program so that it was easily adapted into the school system and could be used to complement the school curriculum. Staff researched health information on key topics and developed a program including Aboriginal cultural specific and mainstream resources already in existence such as Mr Germ (Environmental health), Healthy Jarjums (QLD health), The Tooth Book (WA Health), Physical Activity (NSW Sport and Recreation), BodySafe (Taree Community Health). Aboriginal health workers were trained to deliver information using national accredited training modules.
The pilot was considered successful and funding was received from the Northern Child Health Network for a two year project (mid 2006-mid 2008) to include schools in all 3 NSW Child Health Networks across the state – Bourke, La Perouse and Kempsey.
The program was further developed and refined. On going consultations with key stakeholders is an integral part of maintaining and further building capacity of the program. Regular meetings and updates with the area health service proves to be effective as some of the components of Shake A Leg have been re-developed and re-written to meet current NSW Health guidelines. Expressions of Interests were sent out to schools across the HNELHD with high number of Indigenous students to which some schools, Aboriginal Education Officers and local community members were trained in the resources and the program for the program to become self-sustainable.
In 2008 HNELHD again committed funding in order to continue the program and look for sustainable models of delivery. Now roughly 15-20 schools across the HNELHD will have implemented the program.
In 2009, the oral health lesson has was reviewed. The Aboriginal Health Unit - Greater Newcastle Cluster worked in partnership with the Oral Health Unit HNELHD who ensured that the lessons were updated and aligned with the NSW Health messages for a healthy mouth. It was from this that lesson plans were developed for stages 2 and 3 (years 3-6).
The program fits in with the NSW Aboriginal Health Strategic Plan guidelines by developing and maintaining key and crucial partnerships such as between Aboriginal Community Controlled Health Services, the local health services, Department of Education and Training, and other local key stakeholders.
Aboriginal health workers within the area health service and the Aboriginal Medical Services are trained in the resources and deliver the program as well as using other staff who work in specialised fields such as oral health, drugs and alcohol and environmental health. Staffs are timetabled according to the topic and expertise of staff.
Community is also consulted with regards to the program to inform them of what children will be learning. Such community groups and organisations as local Aboriginal land councils, education, mothers/fathers groups as well as students from universities and TAFE have knowledge about the program and aware of its content.
The program is delivered to a class in 40 minute sessions, one session per week for the full school term (9-11 weeks).
Figure 1. A health worker discusses nutrition with Taree students
For example, in the nutrition lesson, the children are asked cut out and make their own healthy lunch box, and have the options of choosing what foods to put in it, this allows them to take their new found knowledge back to the home and have discussions with their families about what they should and should not eat/drink.
To make the program become self-sustainable, schools have the option to purchase the resource kit and train up the AEO and any other community member willing to implement and deliver the program.
An example of this can be represented by Windale Public School. They purchased the kit, and the AEO and two parents were trained in the resources and now have taken full control over the program at their school in which they plan, and deliver the program to a designated class. This allows the freedom of the school to change and adapt the program to suit their local needs and has been proven to be very successful in engaging students to make better health choices.
"I believe that the class we presented the program to started year 7 with more confidence and self esteem than they would have shown without Shake a Leg." - SaCC Facilitator, Windale Public School
Schools that have and are continuing to implement the program:
- Karuah Public School
- St Ignatious – Bourke
- Ballina Public School
- Taree Public School
- Taniliba Bay Public
- Biraban Public
- Fennell Bay Public
- Windale Public
- Soldiers Settlement
- Toronto High School
Schools that will be implementing the program throughout the year:
- Forster Public School
- Newling Public School – Armidale
- Ross Hill Public – Inverell
- Inverell Public
- Moree East
Evaluation of the program is based on a number of indicators:
Health changes child has made due to Shake A Leg program
|Fennell Bay||Karuah||St Ignatius||Tanilba Bay||Windale|
|Shows correct way to wash hands||13||19||0||1||3|
|Washes hands regularly||17||19||2||1||3|
|Child is aware of how easily germs are spread||11||16||0||0||3|
|Correct way to brush teeth||21||17||2||1||3|
|Importance of blowing your nose||12||12||0||0||3|
|Understanding the difference between healthy & bad foods||15||15||1||0||3|
|Know how to pack a healthy lunch||10||12||1||0||3|
|Loves to play sports||12||17||1||0||3|
|Importance of physical activity||12||16||1||0||3|
|Blows nose daily||9||6||0||0||2|
|Not to drink||8||13||0||0||3|
|Not to do drugs||8||14||0||0||3|
|Learning about others||5||12||0||0||3|
|Drink more water||10||15||1||1||3|
|Child enjoyed the program||11||19||1||1||3|
|Learnt about the ear||7||15||1||0||2|
Based on quantitative data from the evaluations, there has been noticeable change in the health behaviours of the children between starting and finishing the program.
Parents have also increased knowledge about the program, as well as noticing significant change in their children’s behaviour.
The table above shows since the program has been implemented children are showing behavioural changes in the respective health topics. Significant change has been noticed in the hygiene topic with a number of children washing their hands regularly. The data also reveals students are using the correct techniques to brush their teeth and the importance of drinking water. Students can now differentiate between 'everyday foods' and 'sometimes foods' and the importance of maintaining a healthy diet and lifestyle.
The student satisfaction surveys indicate secondary student perceptions after completing the workshops. Topics were geared towards high school students in relation to human relationships, nutrition and exercise, drugs and alcohol.
The table below shows that students at Ballina Public in years 3 & 4 expressed that they learnt a lot about themselves. Identity was a major component of the program in which it gets students to start thinking about them, their family, their culture and values. Learning about Aboriginal and Torres Strait Islanders proved to be a major part of the program with 86% of the students stating that they have learnt more about the culture. Physical Activity – Traditional Games proved to be a successful component of the program with 97% of students found best about the workshop. Students found that the resources and lessons were fun and interactive, students found that they got to know their fellow classmates better with 81% of the class agreeing to this, with 73% learnt more about nutrition and healthy eating.
|Students indication of the best things about the Shake a Leg workshop|
|Ballina Public School|
|Learning about yourself||35||95|
|Learning about Aboriginal & Torres Strait Islanders||32||86|
|Doing cool stuff||36||97|
|Learning about drinking too much alcohol||5||14|
|Learning about lots of things||32||86|
|Shouldn’t take drugs||6||16|
|Shouldn’t drink alcohol||5||14|
|Getting to know people||30||81|
|Learning about nutrition||27||73|
|Bring the class together||16||43|
The teacher’s evaluation survey covers the teacher’s opinions of the success of the program.
Teachers ratings of Shake a Leg aspects of the lesson
|Excellent Count (%)||Good Count (%)||Poor Count (%)||Missing|
|Ability to hold the children's attention||23
|Success in presenting core message||21
|Ability to inspire behaviour change||16
|Lesson plan ease of use||22
|Success of activities||22
The above table conveys the aspects of the lessons from those who were delivering it. Comments from teachers such as: "Activities proved to be fun, interactive and successful", "very good program", "fantastic" shows the ease of the lesson plans and the success of the resources with 68% found the lesson plans easy to use and understand.
There has been significant changes in the students attitudes towards looking after their health and ensure they educate and inform their family and extended family members. Children have more knowledge about health behaviours, and how to ensure that they live a healthy life to increase their overall wellbeing. Children are becoming more aware of good and bad health, by giving them the opportunity to learn and increase their knowledge about the life that surrounds them allows the children to make better and informed healthy choices.
Figure 2. Hygiene lesson with Mister Germ visiting the Taree year 1 & 2 class
Teachers have also extended the program to include in their school lessons, so that the information is again relayed to the target audience. A significant change that health workers have noticed is the difference in the Aboriginal students, they are participating more in class and have become more confident in answering questions, and are proud to be sharing their culture with their classmates.
Shake A Leg has grown in popularity with other area health services interested in implementing the program in their area. Orange community health centre has partnered up with the local AMS and will be implementing the program in Term 2 of 2009.
Coonabarabran community health centre has just received funding for the program and will be looking at implementing it in the schools later this year. North Coast area health service has purchased the kits and ran the program in 2009. Other areas such as Dubbo and Bathurst have also made contact and wanting to learn more about the program.
- The Shake A Leg program won the NSW Aboriginal Health Award in 2009 for the 'Strengthening Aboriginal Children and Families" category.
- The Shake A Leg program was a finalist in the 2009 Regional Achievement and Community Awards - nominated for 'the Land and Property Management Authority (population over 15,000). Community of the Year Award.
- 2010/2011 Nominee for the Regional Achievement and Community Awards
Aboriginal Health Officer
Aboriginal Health Unit - Greater Newcastle Cluster
Hunter New England Local Health District
Phone: 02 4924 6073