Elementary School Students
For the 2008-2009 academic year, a quasi-experimental pretest/posttest research design was used to assess whether elementary school students’ science knowledge and attitudes changed as a result of the intervention (). The 2 curriculums, Immunization Plus and Using Live Insects were implemented in 16 classrooms (4 elementary schools) per study site (California, Washington, and Arizona).
Study Design Used to Implement the HealthWISE Programa in Elementary Schools
The pretest and posttest were intended to gather data to answer the following questions: (1) To what extent did knowledge and attitudes change as a result of the program? (2) Did the effectiveness of the intervention vary by who presented the educational material (teacher only vs. student pharmacist only vs. teacher + student pharmacist)? (3) To what extent did gender, ethnicity, and language mediate treatment impact? (Questionnaires are available from the author upon request.) Pretest questionnaires were administered to all elementary student participants (intervention and control groups) prior to the first teaching session by the student pharmacists. Six weekly 1-hour curriculum sessions for elementary students in the intervention group followed. One week after the curriculum sessions were completed, a posttest questionnaire was administered to all elementary school students in the intervention and control groups. In addition to the same knowledge and attitude questions asked in the pretest, the posttest included questions on satisfaction with the intervention curriculum. Unique identifiers were assigned to each student to allow for matching of baseline and follow-up data.
Demographic data were collected from students at the time the pretest questionnaire was administered. All analyses were conducted using STATA 10.0 (Stata Corporation, College Station, TX). Due to missing data, the Arizona site was not included in the analyses or results presented here.
Second-grade students and the Using Live Insects curriculum. Forty-eight percent (48%) of the second-grade students were male and 52% were female. The mean age of the students was 7.4 years. Over half of the students were white (56%), with other key racial/ethnic groups including Latino (20%) and American Indian (12%). English was the predominant language read and spoken at school (90%) and in the home (82%) ().
Demographic Characteristics of Elementary School Students Who Participated in the HealthWISE Programs Administered by the University of Pacific and Washington State Universitya
While second-grade students’ knowledge increased significantly from pretest to posttest for each of the intervention conditions, attitude towards science increased significantly only in the teacher only group (). Among intervention groups, no significant differences in mean scores from pretest to posttest were found (). After adjusting for pretest knowledge scores, intervention conditions, and demographic characteristics; pretest knowledge scores (p < 0.01), and the teacher only, student pharmacist only, and teacher + student pharmacist intervention conditions remained significant predictors of posttest knowledge (p < 0.001, p < 0.05, and p < 0.01, respectively). Demographic characteristics were not significant predictors of posttest knowledge.
Second-Grade Students’ Knowledge and Attitude Towards Science Before and After Completing the Live Insects Curriculum (N = 280)
Differences in Mean Scores from Pretest to Posttest Within Groups for the Using Live Insects Second-Grade Intervention Conditions
Fifth-grade students and the Immunization Plus Curriculum. Forty-seven percent (47%) of fifth-grade students were male and 53% were female. The mean age of students was 10.4 years. Less than half of the students were white (41%), with other key racial/ethnic groups including Latino (22%), Asian/Pacific Islander (10%), and American Indian (9%). While English was the predominate language read and spoken at school (84%) and in the home (78%), 14% of students reported speaking both English and Spanish in school and 15% reported speaking both English and Spanish or just Spanish in the home ().
While fifth-grade students’ knowledge increased significantly from pretest to posttest for each of the intervention conditions, attitude towards science did not (). In comparing differences in mean scores from pretest to posttest among intervention groups, all interventions had an impact when compared to scores of students in the control group, with the teacher + student pharmacist group demonstrating the greatest impact (). Each of the intervention groups had significant improvement between pre-test and post-test scores when compared to the control group. The elementary students taught by the classroom teacher and student pharmacist together had the greatest improvement. After adjusting for pretest scores, intervention conditions and demographic characteristics; the pretest knowledge scores (p < 0.001), and the pharmacy only and the teacher + student pharmacist conditions remained significant predictors of posttest knowledge (p < 0.001 and p < 0.001 respectively). Demographic characteristics were not significant predictors of posttest knowledge scores.
Fifth-Grade Students’ Knowledge and Attitude Towards Science Before and After Completing the Immunization Plus Curriculum (N = 264)
Differences in Mean Scores from Pretest to Posttest Within Groups for the Immunization Plus Curriculum
Classroom Teacher Satisfaction with the Curriculum
Elementary school teacher satisfaction with the curricula was assessed using post-intervention questionnaires. Teachers were asked to evaluate the following 4 components of the curricula: ease of use; grade appropriateness for your class; elementary student interest in subject matter; and your interest in the subject matter. A 5-point Likert-type scale was used that ranged from 1 = poor to 5 = outstanding. Each of the 4 questions was worth a maximum of 5 points for a potential cumulative score of 20 points.
Using Live Insects curriculum. Eleven of 12 second-grade teachers completed the evaluation. The mean cumulative rating was 18 out of 20. In response to an open-ended question of the features of the curriculum they liked best, 4 teachers responded the hands-on activities, 3 responded enthusiasm of the student pharmacists, 4 responded literature/children's books, and 1 responded lessons plans. In response to an open-ended question of the features they liked least, 2 teachers responded that the lessons were sometimes confusing or not easy to follow, 2 responded the songs did not always match the CD, 1 responded the handouts were sometimes lacking information, and 1 responded the handouts were not always engaging. Although teachers did provide recommendations for improving the curriculum, 100% of the respondents indicated they would choose to implement this curriculum again in their classrooms.
Immunization Plus Curriculum. Ten of twelve fifth-grade teachers completed the evaluation (n = the number of teachers providing the indicated response). The mean cumulative rating was 19 out of 20. In response to an open-ended question of the features of the curriculum they liked best, 6 teachers responded hands-on activities, 4 responded student pharmacist enthusiasm, and 2 responded high level of student interest. In response to an open-ended question of the features they liked least, 2 teachers responded too short, 1 responded some difficult vocabulary, 1 responded that some lessons were vague/time expectations were off, and 1 was confused with KWL charts (KWL is an active participation technique that stands for what I Know, what I Want to know, what I Learned). Although teachers provided recommendations for improving the curriculum, 100% of the respondents indicated that they would choose to implement this curriculum again in their classrooms.
Comments from the teachers were positive overall and showed great enthusiasm for the program. Teachers in the program expressed that the curricula were excellent and appreciated that they focused on science but included attention to both literacy and math skills. Teacher comments emphasized that the curricula were engaging and interactive and appreciated that the student pharmacists arrived with handouts, games, and experiments. Lessons for the younger students also involved children's literature and student pharmacists read quality trade books to the children.
Classroom Teacher Evaluation of Student Pharmacist
For the 2008-2009 and 2009-2010 academic years, classroom teachers at the Washington site completed 17 assessments of 16 student pharmacists. Four student pharmacists were evaluated by 2 different teachers as they delivered the curriculum in 2 different classrooms. Evaluations were not available for 3 student pharmacists. Teachers were asked to rate the student pharmacists on the following performance criteria using a 5-point Likert-type scale: (1) communication; (2) professionalism; and (3) teaching skills. Response categories ranged from 1 = does not meet expectations to 5 = exceeds expectations. The mean rating for all questions combined was 4.8. In response to an open-ended question regarding student pharmacist performance, 6 teachers commented that the students communicated well 7 were impressed with white coats/professionalism, 4 responded enthusiastic, 5 responded well-prepared/confident, 2 responded good role models, and 1 responded that the student pharmacists talked (at the appropriate) level of the students.
Anecdotal responses from the teachers who welcomed the student pharmacists into their classes with the California program were positive. Teachers also claimed the student pharmacists were well prepared for the experience, and that their elementary students responded well to both the curricula and the students.
Student Pharmacist Satisfaction with Classroom Teacher and Site
For the 2008-2009 and 2009-2010 academic years, 14 of 16 student pharmacists at the Washington site completed assessments of the classroom teacher and site. Students were asked to evaluate the teachers and sites on a 3-point Likert-type scale. They were first asked to rate the classroom teacher on helpfulness in orienting them to the school, assisting in classroom management, and scheduling teaching sessions. The response categories ranged from 1 = not helpful to 3 = very helpful. The mean rating was 8 out of a possible 9 points.
Student pharmacists were asked to rate the classroom teachers and sites as future HealthWISE partners, using a 3-point Likert-type scale on which 1 = not recommend and 3 = highly recommend. The mean rating was 5 out of a possible 6 points.
End-of-course papers at the California site gave information about student pharmacists’ reactions to their experience. Student pharmacists met the challenge of teaching with enthusiasm and gained a new found knowledge of the challenges of dealing with young children, schools, and the obstacles that teachers face in their daily work.
Student Pharmacist Reflection on Learning
For the 2008-2009 and 2009-2010 academic years, student pharmacists at the Washington state site were asked to identify a learning outcome from the course syllabus that they felt they achieved in the course. They were then asked to reflect upon their experiences and identify how this experience helped them to achieve the outcome. All 16 student pharmacists completed the paper. The outcomes the student pharmacists identified that they felt they had achieved included: 9 indicated improved communication skills (n = 9), promoting health and wellness (n = 8), and professional mentorship (n = 1), (2 student pharmacists identified 2 outcomes they had achieved). Student pharmacists were able to positively relate their teaching experiences to impact their future effectiveness as pharmacists. Many elementary schools in the program at the California site had high percentages of ELL students and student pharmacists responded to this challenge by incorporating strategies that were taught in their training. The student pharmacists were surprised by the number off ELL students in the elementary schools and the experience reminded them of the importance of effective communication in educating and caring for their patients.