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The University of Toronto’s (Toronto, Ontario) Paediatric Resident Child Advocacy Committee has been involved in a very positive partnership with a local elementary school since 1999. This urban elementary school is located in a low-income downtown neighbourhood and is comprised of a diverse, multicultural student body.
Children with low socioeconomic status are affected by multiple environmental and social factors that decrease their ability to optimally access health information, putting them at risk for compromised health (1). Risk factors for poor health outcomes include single-parent families, family conflicts, maternal health concerns and depression, lack of health insurance, community violence, low social class and belonging to an ethnic minority group (2). Such factors are increasingly being recognized as important influences on health outcomes in the paediatric population (3). Moreover, cumulative effects of multiple social risks on child health have been studied in relation to socioemotional health and cognitive outcomes, as well as physical health outcomes, such as obesity and global health status (2). For example, childhood injury – a leading cause of mortality, morbidity and permanent disability in children – has been found to be more frequent among children living in urban areas with lower socioeconomic status (4,5). The United Nations Declaration of the Rights of the Child states that “the child who is…socially handicapped shall be given special treatment, education and care required by his particular condition” (6). Children with multiple social risks may benefit from supplemental evidence-based strategies to traditional well-child care (7).
With this in mind, the University of Toronto’s Paediatric Resident Child Advocacy Committee at The Hospital for Sick Children (Toronto, Ontario) collaborated with the school over the past decade to create a series of advocacy projects addressing various health issues affecting this target population. Projects to date have included clothing drives, health information workshops for parents and health-related activities with students. A recent article (8) published in the September 2007 issue of Paediatrics & Child Health outlined the development, implementation and evaluation of these child advocacy initiatives at the University of Toronto. One particular challenge identified through this advocacy work was the ability to provide health education and awareness to students and parents in a way that met their specific needs. In considering the population’s social context, we believed that a more flexible and innovative approach to providing health information was necessary to deliver meaningful resources to this community.
The medical literature (9–12) shows that newsletters can effectively encourage healthy lifestyle behaviours in numerous target populations, including low-income groups and children. One particularly relevant study (12) used a newsletter as a health promotion strategy in elementary schools. In this empowerment model, educators worked with clients and communities to meet their perceived needs, thus enabling positive changes in health behaviour and increasing health knowledge (12). This concept of working with communities to meet perceived needs stems from participatory action – a type of research that involves members of target communities as active participants in all stages including reflection on problems, brainstorming strategies for change, facilitation of change and evaluation (13).
In 2006, the Paediatric Resident Child Advocacy Committee developed an ambitious new project and approached the school staff about their idea: to develop a health magazine that would appeal to children and have a positive impact on their health. The magazine was based on the concept that children can better identify what their peers want to learn and read about when it comes to health. Therefore, the entire magazine was created and written ‘by kids for kids,’ with a goal of empowering the students with skills to educate themselves and others about health. This innovative project complemented the current Ontario health curriculum, which emphasizes healthy eating, growth and development, personal safety, injury prevention, and substance use or abuse (14). The process of creating and writing the magazine may also be a creative way to promote and develop literacy skills.
The residents were awarded the Canadian Paediatric Society Resident Advocacy Grant to produce and publish this student-driven magazine. A dedicated magazine team was assembled for the project. The paediatric residents recruited a core group of 10 resident volunteers to work with the students on a weekly basis and to provide advice regarding the magazine’s medical content. Student writers for the magazine were members of the school Leadership Club, an established group of 20 students from grades 5 and 6 (10 to 12 years of age) who were selected yearly by the teachers and the principal to participate in extracurricular activities that promoted leadership skills. Three dedicated school teachers provided mentorship for the project and helped keep students on task with encouragement and editorial guidance throughout the process. A professional graphic artist was hired to incorporate ideas and feedback from the team into child-friendly illustrations and designs.
An initial needs assessment was conducted at the school by engaging the students through focus groups and questionnaires. The goal was to identify health content as well as magazine stylistic features that students found most appealing. The results of the needs assessment were very interesting and, in parts, unanticipated. The students’ top healthy living topics of interest included healthy eating, cleanliness and physical fitness. The top health issues of interest ranged from bone health to death and dying, allergies, cancer and injuries or emergencies. The most appealing magazine stylistic features included interviews, recipes and fun facts. These results highlighted the importance of understanding the target audience to create a meaningful final product.
Over the following months, the results of the focus groups and surveys were translated into the health magazine. The team met weekly for 10 weeks as the students talked, read, researched, interviewed, wrote and illustrated under dedicated guidance from their teachers, the paediatric residents and the graphic designer. As the weeks went by, the students became increasingly engaged in the project as they applied their efforts and interest in each topic to create the magazine articles.
The Kids on Kids’ Health Magazine was published, formally launched by the students and distributed to the elementary school students in May 2007. This public launch was a true community event, attended by students, teachers, family members, paediatricians, paediatric residents, interdisciplinary health care providers, community leaders and politicians at various levels of government. The final product was a professional quality publication covering a variety of health topics including head injuries, healthy food choices, common cold and the ‘flu’, physical activity and Kids Help Phone. Content was delivered in a colourful, child-friendly format with interesting features that included trivia games, interviews, recipes and a comic strip (Figure 1). Student involvement at the launch was key to ensuring that the entire venture was child-centred and child-driven from inception to completion. The students displayed confidence and pride in their work as they showcased the final magazine product.
The success of this project has been multifaceted. The entire magazine team received positive feedback from many attendees at the launch. The Honourable George Smitherman, Ontario Minister of Health and Long-Term Care, was so encouraged by the project that he agreed to support expanded publication and distribution to elementary students in the Greater Toronto Area. This project has also been formally presented at various national and international paediatric academic meetings, and has been met with a lot of enthusiasm, stimulating discussion in the medical community about the future of this project and other similar social paediatric endeavours. In addition, this project was a unique opportunity for paediatric residents to experience sociocultural determinants of health in action and build on creative child-friendly strategies to promote preventative health. Involvement in this project allowed for development of advocacy skills as well as other key competencies outlined in the Royal College of Physicians and Surgeons of Canada’s Canadian Medical Education Directions for Specialists (CanMEDS), including manager, collaborator and communicator (15).
Residents are currently gathering data to evaluate the impact of this unique health information tool on student health knowledge, health interests and healthy behaviour choices. The increasing number of children with social and environmental health risks underscores the necessity for continued advocacy efforts to reduce the negative impact of such risks. There are multiple avenues through which children’s health status might be improved at the community level. This ‘at-risk’ population of children may benefit from more varied and comprehensive health programs, which can include both traditional and less conventional models for delivering health information and resources (2). Our use of an innovative, child-driven initiative can serve as an example of community paediatric advocacy and successful collaboration with dedicated community partners.