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Adolescence is a critical time for developing healthy lifestyle behaviours. It is a period where young people assume a greater responsibility for their physical activity and eating habits, which often persist into adulthood.1 Schools are an ideal setting for promoting health, as most adolescents attend school and can be easily reached. There is also strong evidence demonstrating that school-based programmes can increase physical activity and improve dietary habits of students.2 3
The Students As LifeStyle Activists (SALSA) programme uses a peer educational model, driven by students, to promote physical activity and healthy eating in a supportive school environment.4 Our premise is that students not only learn through teaching their peers, but they also serve as powerful motivators and role models for others.5 Adolescents can also be effective ‘change agents’ within their family and the wider school community.
Key features of the programme
The SALSA programme is underpinned by social cognitive theory and the empowerment education approach and aligns with the WHO’s health promoting schools framework.4 6
Our unique peer education model involving university and high school students as learners and educators is demonstrated in this brief animation: http://tinyurl.com/SALSAprogram-model. In summary, volunteer university students from health/education faculties, who have trained as SALSA educators, visit high schools in small teams and coach volunteer Year 10 students (aged 15–16 years) as SALSA peer leaders building group facilitation, teaching and leadership skills.
Again in small teams, these peer leaders then deliver four 70 min lessons, during class time, to Year 8 students (aged 13–14 years) who learn about practical ways to be more physically active and to eat healthily through videos, games and activities. They are guided by the peer leaders in how to identify, critically analyse and overcome the barriers they encounter in living a healthy lifestyle. Year 8 students then go on to develop a personal goal and as a class work on a ‘school action plan’ to create a supportive school environment for healthy living. Process evaluation is conducted annually to inform programme relevancy and fidelity.
Students are encouraged to share what they have learnt with their families using the SALSA workbook used during the programme lessons. SALSA ‘health snippets’ are also provided to participating schools to feature in school newsletters. As part of our integrated approach, peer leaders can enhance their leadership skills through additional training and be connected with government representatives to advocate for improvements in their neighbourhoods (figure 1).
The SALSA programme focuses on the richest resource of our community—students themselves. The programme has been sustained for over a decade through a synergistic partnership between high schools, universities and local government healthcare providers, including general practitioners, allied health and health promotion experts. For example, funding support is received from local general practitioner associations to facilitate implementation of student-led school action plans that improve the school environment. Tailored grass root action has enabled the viability of a locally relevant and effective programme.
The SALSA programme has demonstrated capacity to be translated internationally with trials undertaken in the Middle East (Jordan) and China.2 The programme has been cited by the United Nations Inter-agency Technical Task Team on Young People as ‘good practice in adolescent and youth programs in the Middle East and Africa’.7
We recently evaluated the SALSA programme in 22 high schools using a pre–post study design. Students’ reported actual improvements and intentions to improve their lifestyle behaviours after participating in the programme.8 The programme provides an important nudge to improve the often declining health-related behaviours of adolescents. For example, both Year 10 peer leaders and Year 8 students reported a decrease in drinking ≥1 cup of sugar sweetened beverages each day by 6% and 4%, respectively.8 These short-term outcomes are promising and support the need for further long-term evaluation.
Lessons to be learnt
Partnerships between health and education sectors are essential for continued success and sustainability of the Students As LifeStyle Activists programme.
Sharing evaluation data in the form of a brief report with school principals and teachers is valuable to initiate changes to their school environment, such as increasing the availability of healthy foods in school canteens.
For primary prevention programmes in high schools to be effective, sustained government funding is crucial.
Aspects of the 7 best investments that the program addresses are:
‘Whole-of-school programs’ – The SALSA program is integrated into high schools’ Year 8 curriculum and initiates student driven ‘school action plans’ to create supportive school environments.
‘Physical activity and NCD prevention integrated into primary health care systems’ –The training workshops build competencies in university students, general practitioners and allied health professionals for NCD prevention.
‘Public education, including mass media to raise awareness and change social norms on physical activity’ – The peer education approach engages high school students in changing social norms.
What sectors it involves
The SALSA program has been developed and sustained through a strong partnership between education and health sectors, specifically high schools, universities, local general practitioners and government health districts.
Estimated program reach
Since 2004, the SALSA program has reached over 13,900 students in 30 high schools in Sydney, Australia.
What is unique about this program?
The SALSA program involves university and high school students as both learners and educators to empower adolescents to take control of their health and wellbeing.
Contributors SS and K-SL are founders of the SALSA programme. SS is the director of the SALSA programme and has been since its inception. SS contributed to this editorial equally with BCF and VAS. IM and K-SL revised and edited the editorial after programme implementation.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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