Barriers to parent involvement in middle school health education.

Abstract: This study examined barriers to parent involvement in health education of children in two suburban middle schools in the Southeastern United States. A random sample of 500 households with middle school children received survey. Results showed the parent population to have unusually high socioeconomic status. Parents lacked knowledge about the health curriculum and lacked sufficient health content knowledge to comfortably address children's health-related questions. These two factors were identified as significant barriers to parental involvement in middle schoolchild health education. Additional questions were raised about the impact of multiple barriers on parent involvement. Study results and implications are discussed.

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With education reform as a primary concern during the 1990's and continuing well into the next millennium, parent involvement has taken a key position in the minds of many educators, school administrators, and politicians. Pivotal documents like Goals 2000 (National Education Goals Panel, 1995) and Code Blue (National Commission on the Role of the School and Community in Improving Adolescent Health, 1990) emphasize the importance of parent involvement in children's overall education. Over the last two decades numerous studies have documented the positive impact that parent involvement plays on test scores and student achievement (Cooper, Lindsay, & Nye, 2000; Furr, 1998), literacy (Snow, Barnes, Chandler, Goodman & Hemphill, 1991), school drop out rates (Rumberger, Ghatak, Poulos, Ritter & Dornbusch, 1990), desire to continue education after high school (Furr, 1998), and student social and emotional development (Donnermeyer, 2000; Spence, Donovan & Brechman-Toussaint, 2000). This same parent involvement has been shown to facilitate greater learning on behalf of the child while providing more positive home and living environments, through modeling and reinforcement (Edwards & Young, 1992).

Parent involvement in school health education has also been shown to positively impact youth smoking (Kurtz, Kurtz, Johnson & Cooper, 2001), improve dental care (Thomas, Tandon & Nair, 2000), improve poor diet and low physical activity (Nader, Sallis, Abramson, Broyles, Patterson, Rupp, et al., 1992), and decrease alcohol use (Komro, Perry, Williams, Stigler, Farbakhsh, & Veblen-Mortenson, 2001). Programs that involve parents in children's health education have resulted in improved parent-child communication about health topics (Komro, Perry, Williams, Stigler, Farbakhsh, & Veblen-Mortenson, 2001; Werch, Young, Clark, Garett, Hooks & Kersten, 1991), and even improved parental health behaviors (Perry, Pirie, Holder, Halper & Dudovitz, 1990). Because of these benefits, parent involvement has been highly recommended by experts in the field for inclusion in school health education programs (Allensworth & Wolford, 1989; Birch, 1996; Dryfoos & Santelli, 1992; Joint Committee on National Health Education Standards, 1995, Kurtz et al., 2001).

Parent involvement levels decrease to minimal levels as children age from elementary to high school (Dauber & Epstein, 1993; Dryfoos, 1984; Paulson & Sputa, 2000). This occurs despite the knowledge by teachers, administrators, and even some parents, that parent involvement in education is beneficial if sustained over time (Ascher, 1988).

Teachers have the potential to effectively increase parent involvement due to their exposure to the majority of young people in most communities and ultimately their indirect exposure to these childrens' parents. At times though, even teachers are in need of additional subject-specific training. Typically, teachers feel more comfortable and more effective when they have more training in a particular area (Boscarino & DiClemente, 1996; Cameron, 1991; MacGilcrist, 1996). As noted by Birch and Hallock (1999), teachers feel similarly about parent involvement in middle school health education.

Multiple barriers exist related to parent involvement in their children's education including time constraints (Leitch & Tangri, 1988), mistrust of schools (Edwards & Young, 1992), miscommunication between parents and schools, lack of knowledge about subjects that children are learning about in school (Brock & Beazley, 1995; Finders & Lewis, 1994), and lack of parent understanding of how to be involved (Bright, 1996). These barriers have been articulated by parents related to their involvement in general education, but in a very limited way in regards to health education. Parents perceptions of barriers to involvement in school health education are potentially more difficult to identify than in general education. Although some barriers to parent involvement in health and general education may be similar, additional barriers may exist for parents related to health education, due mainly to the sensitive subjects addressed in this content area.

The purpose of this study was to determine what factors middle school parents perceived as barriers to involvement in their children's health education. This research purpose is directly in line with Birch and Hallock's (1999) call for further research "to determine parental perceptions of their interests, needs, and barriers pertaining to involvement in school health education programs (p. 114)." This charge comes because of limited research on barriers to parent involvement in the health education.

METHODS

LOCATION AND INSTRUMENTATION

Two middle schools in a suburban Southeastern school district cooperated in this study. Approval was obtained from the district superintendent and subsequently the principals of both middle schools. School principals acted as primary liaisons between the researcher and the school district. They also responded directly to parent questions and inquiries regarding this study, acted as reviewers for draft surveys, and helped with the logistics of implementing the study. The school district was upper-middle class and predominantly white, although growing rapidly with ethnic diversity. Both middle schools had in place an actively used health education curriculum. The study was completed during the Spring of 1998.

A qualitative pilot study was initially conducted with middle school parents in order to identify primary barriers to parent involvement in health education. PRECEDE (Green & Kreuter, 1999) constructs of predisposing, reinforcing, and enabling factors and Health Belief Model (Strecher & Rosenstock, 1997) constructs of perceived threats, perceived barriers, perceived enablers, self-efficacy, and cues to action were used to inform the development of focus group and telephone interview questions. A convenience sample of parents self-selected to participate in two focus groups (N=13, mostly White females). In order to counter a potentially biased sample of focus group participants (already highly involved), random telephone interviews were conducted with middle school parents screening out the highly involved parents.

A 53-item mail-out questionnaire was developed from pilot study results. This parent questionnaire was primarily fixed response driven, with three open-ended questions. The questionnaire contained six major sections: 1) information about their children, 2) feedback on the most important subjects in school and most important health education topics, 3) information on personal history of family involvement, 4) perceived barriers to parent involvement, 5) perceived enablers to parent involvement, and 6) demographic information.

Pilot testing of the mail-out questionnaire and expert panel review preceded the final random mailing to 500 households (25% of total middle school households). Parents, teachers, principals and state and nationally recognized experts reviewed the survey for face validity and readability. The instrument reading level was determined to be grade 12. Surveys were coded for tracking purposes and mailed. Households that did not return surveys in a ten days were contacted by telephone and were encouraged to either return the survey in the mail or complete the survey over the telephone.

Parents received advance notice of the surveys from two weeks to one month prior to the mailing of surveys. Each school ran a short informational note in their school parent newsletter, encouraging parents to expect a survey in the mail and to participate by completing and returning the survey. Mailings were addressed to the parents of middle school students and contained a cover letter on school letterhead, survey, and a stamped return envelope. Parents were asked to complete and return the surveys within the next one to two days. Parents were also informed that they might receive a telephone call in the next week to verify that they had indeed returned the survey.

Upon completion of the data collection and analysis, each school principal and the district superintendent received a summary of the research findings, complete with a list of recommendations and implications for their school district.

DATA ANALYSIS

The dependent variable for this study was a trichotomous survey item focusing on level of parent involvement: "how active are you in your child's health education?" The fixed parent response choices were "nor very active," "active," and "very active." Fourteen trichotomous barrier variables acted as the independent variables. Data analysis was completed using SPSS for Windows[TM] statistical analysis software. Descriptive statistics and a test of association were computed using chi square analysis. The test of association was computed in order to assure that there were no statistically significant differences between parents from each school, allowing surveys from both schools to be analyzed as a whole.

Multiple regression was employed to test the association between the dependent variable (parent involvement level) and each of the barrier variables. Additionally, a composite barrier scale was constructed by tallying the total number of barriers identified by parents. This new independent variable (barrier score) was analyzed for its relationship to the dependent variable, level of parent involvement. Reliability analysis was used to test the association between the barrier scale and the dependent variable.

RESULTS

Of the 500 surveys originally mailed, 274 were returned (55%). Of these, 77% were returned through the mail and 23% were completed over the telephone. Over 400 telephone calls were made in an attempt to contact non-responding parents. If there was no answer when the telephone call was made, a voice mail message was left for the parent. If there was no answering machine, the number was retried at least two additional times at later dates.

In order to justify analyzing the surveys of parents from each school together, a chi square test of association was performed to compare every variable by school. Results of the test showed that the two samples were not significantly associated (p=0.078). However, upon further investigation of the significant variables, numerous cells in each chi square table were either empty or had fewer than four subjects. Either situation could compromise the integrity of this analysis lending to the conclusion that samples of parents from the two schools did not differ significantly and could therefore be analyzed as a whole.

DEMOGRAPHICS

Of those parents who responded, the majority were mothers (80%) between 40-49 years of age (64%), had 2-3 children (75%), had at least a college degree (71%), an annual family income of at least $50,000 (83%) and were white (91%). The racial breakdown of survey respondents was nearly identical to the racial breakdown for students attending the two middle schools. Additionally, most respondents were married (88%) and were current PTA/ PTO members (85%). Parents were asked how active they were in their children's general and health education. They were also asked about a history of parent involvement in their own lives while growing up. Most parents commented that they were "active" or "very active" in both their child's general education (96%) and health education (88%). However, these parents recalled much less participation by their own parents while growing up.

BARRIERS

The survey asked parents to rank order 15 barriers to involvement with their children's health education (Table 1). The top five barriers identified by parents were time, being unaware of opportunities to participate in children's health education, having few chances to volunteer with health education, not being asked by the school to participate, and perceiving that the health curriculum did not encourage parent involvement.

Multiple regression identified a significant negative relationship between increasing levels of parent involvement in health education and only two barriers: 1) lack of knowledge to answer child's health questions, 2) not knowing what children learned about health at school. There was also a negative association between the total barrier score and the dependent variable. This total barrier score indicated that the more barriers parents experienced or perceived, the less involved they became in their child's health education (Table 2). Because of the significant association with barrier score, reliability testing of the 15 components of this composite variable occurred. Cronbach's alpha was used to measure the degree of association between the 15 barrier variables (alpha=0.5931). This measure indicated that the reliability of the barrier scale was weak and thus unusable. From this study multiple barriers cannot be said to have a negative compounding effect on parent involvement.

DISCUSSION

The sample parent population for this study was demographically unique when compared to parents in other school districts in the state. Most parents were financially well-to-do, married, highly educated, and reportedly very active in their children's education. Despite these unique characteristics, most parents had strong feelings and perceptions regarding barriers to their involvement with health education. Additionally, these feelings and perceptions did impact the level of their involvement in their children's health education.

Self-identified barriers to involvement did include a lack of time, substantiating previous studies (Leitch & Tangri, 1988). Anecdotal reasons for this barrier, ascertained from telephone interviews and focus groups with parents, included two working parents trying to meet the needs of two or more children, hectic social schedules which sometimes precluded academic involvement, and the perception that parents are not needed by the school when children get older (e.g., move beyond elementary school). Other self-identified barriers included lack of knowledge about the school health curriculum, lack of school requests for parent involvement, and lack of knowledge about how to participate with children's health education. Additional barriers included not knowing what children learn about health at school, lack of personal knowledge to adequately answer the child's questions, and the perception that children are embarrassed by parental presence at school. These final two barriers may be directly tied to parent's self-efficacy about being involved with a child's health education. Potentially important were the multiple regression findings that less involved parents tended to lack information about the school health curriculum (what the child was learning about health at school), and lack of sufficient health education content knowledge to answer their child's health-related questions properly. Parents as well as teachers need to feel knowledgeable and comfortable with health topics in order to properly address child questions (Boscarino & DiClemente, 1996; Cameron, 1991; MacGilcrist, 1996).

Birch and Hallock (1999) discovered that the primary modes of middle school parent involvement in a Mid-west state were serving on health curriculum committees and involvement on text book committees. These committees typically require only a few parents to participate. For those few parents, they are tied in closely with the educational process, but for the vast majority of others, their link to service with academic subjects is quite limited.

Findings from this study highlight the need to inform parents about school health curricula and current classroom health education. Results also show that parents need to be solicited for their involvement in school health education activities. Parents lacked adequate health information to answer their children's questions, which leads to reduced self-efficacy about whether they could 'indeed answer these questions. Schools and teachers should therefore consider providing parents with the resources and opportunities to increase their own knowledge, in the hopes that this could possibly facilitate greater parent involvement. This could possibly be accomplished through parent news letters, or handouts and assignments that students take home and share with parents, corresponding to the class health lesson.

The issue of a total barrier score (the impact of multiple barriers) as it relates to parent involvement raises additional questions. The initial multiple regression analysis showed a significant negative association between the total number of barriers and parent involvement. This finding suggested that the compounding effect of multiple barriers decreased the likelihood of parent involvement. However, when the barrier scale was tested for reliability, the reliability score was very weak (alpha=0.5931), thus indicating that the barrier scale was not usable. Based upon these two potentially conflicting findings, additional research should further examine the compounded effect of multiple factors on parent involvement in health education.

IMPLICATIONS

Schools and teachers should consider developing more effective ways to actively involve parents as well as making more parents aware of the opportunities that do exist. Knowing why parents do not actively engage in their children's health education can shed light on the development of future methods to increase their involvement. Research with more diverse groups of parents is needed to further clarify these findings. Multiple barriers, especially certain combinations of barriers could have a particularly deleterious impact on parent involvement and future research should examine this issue in more detail.

Table 1. Top 10 Reported Barriers to Participating in Health Education

Rank                     Barrier                     Percent Response

1      Lack of Time                                        22.1
2      Unaware of opportunities to participate in          14.7
       health education
3      Few actual chances to volunteer in health           11.0
       education
4      School does not ask parents to participate          10.5
       in health education
5      Health curriculum does not encourage parent          7.9
       involvement
6      I seldom receive notices sent home from              7.7
       school
7      I do not know what my child learns about             5.3
       health in school (health curriculum)
8      I have insufficient health information to            4.9
       answer my child's questions
9      My child is embarrassed by my presence at            4.0
       school
10     Other (combination of the seven remaining           11.9
       barriers)
Table 2. Multiple Regression: Significant Associations between
Dependent and Independent Variables (p [less than or equal to] 0.05)

Variable               B        df      Standard Error

Q20 (1)             -1.127       1          0.4238
Q25 (2)             -0.982       1          0.4145
Barrier Scale (3)   -0.227       1          0.0936

Variable            p-value   R-value       95% CI

Q20 (1)             0.0078    -0.8164     0.14-0.74
Q25 (2)             0.0178    -0.1555     0.17-0.84
Barrier Scale (3)   0.0152    -0.1597     0.66-0.96

(1) Not knowing what children were learning in school about health
(health curriculum).

(2) Having insufficient knowledge to comfortably answer child's
health questions.

(3) An increasing number of barriers identified by parents.

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Scott D. Winnail, MSPH, Ph.D., CHES, is an Assistant Professor in the Department of Kinesiology and Health at the University of Wyoming; 114A Corbett Building; Laramie, WY 82071-3196; [e-mail]. Brian F. Geiger, EdD, Associate Professor, David M. Macrina, PhD, Chair, Scott Synder, PhD, Professor, and Cynthia J. Petri, PhD, CHES, Associate Professor are all with the Department of Human Studies at the University of Alabama at Birmingham. Stephen Nagy, PhD, is a Professor at The University of Alabama, Tuscaloosa. Address all correspondence to Dr. Winnail.