Healthy Lifestyles Project for newly arrived young people

This project addressed two significant gaps in service provision for newly arrived young people from refugee and migrant backgrounds:

• prevention of rapid weight gain during the settlement and post arrival period
• intervention for weight issues for those arriving overweight or obese.

The project delivered an integrated set of interventions, co-designed with health staff, students and teachers including:

• nurse led health coaching for students who were overweight or obese
• whole-of school initiatives to promote healthy lifestyles.

Aim

By December 2019: Increase engagement of newly arrived migrant and refugee young people in health promoting behaviours in a school setting by 10%.

Benefits

• Students benefit through increased knowledge, skills and motivation to adopt health promoting behaviours. Increased physical activity, sleep and nutritional value of food enhances concentration and reduces future risks of chronic diseases associated with overweight and obesity.
• The school benefits by having a student body that is engaged around healthy lifestyles.
• The health system benefits through reduced waiting lists for dieticians; weight clinics and long term cost savings around decreased presentations of chronic diseases associated with overweight and obesity.

Background

Since the start of the ‘Optimising Health and Learning’ program, a targeted, school based health screening program for newly arrived refugee and migrant young people, there has been an emerging trend of young people arriving who are experiencing overweight and obesity. In 2017, 31% of newly arrived young people seen through the program were overweight or obese.

Concerns about increasing overweight and obesity in newly arrived refugee young people are shared by other refugee health screening programs across NSW. While there is a range of evidence based programs available for children (such as Go for Fun) and adults (such as Get Healthy Coaching Service), there are no effective referral pathways for students who are overweight or obese.

Adolescence is a critical time to change life trajectories in relation to healthy eating and physical activity. Excess weight, especially obesity, is a major risk factor for cardiovascular disease, type two diabetes, some musculoskeletal conditions and some cancers (Australian Institute of Health and Welfare, 2017).

Young people of refugee and vulnerable migrant backgrounds arriving in Australia have often had poor access in their countries of origin and of transit to nutritional foods; preventative health care and health promotion messages; health services and schooling. There is evidence to suggest that refugee and migrant young people rapidly gain weight in the first three years post arrival in high income countries (Dawson-Hahn et al. 2016). Providing healthy lifestyle interventions, in a supportive educational environment, offers young people an opportunity to establish health promoting behaviours for their life in Australia.

Implementation

Six key change ideas were implemented.

To increase student knowledge, skill and motivation, and as part of an existing targeted health screening program.

1. Introduce a nurse led health coaching program.

To increase health promoting factors in the school environment, a range of ‘whole of school’ initiatives were implemented based on consultation and co-design with students, teachers and parents.

2. Increase access to physical activities in the school environment; during recess lunch and after school.
3. Provide an ‘open kitchen’ at lunch time so that students could bring lunch from home and heat it up in microwaves; and reduce reliance on cheap, unhealthy food options available at the school canteen.
4. Provide a water refill station at the school to improve access to drinking water and reduce intake of sugary drinks.
5. Tech free Tuesday – students are required to not use their mobile phones on Tuesdays to encourage social interaction and physical activity during recess and lunch times.
6. Cross curriculum projects – embedding learning about healthy lifestyles into the school curriculum.

Status

Sustained – The project has been implemented and is sustained in standard business.

Dates

• Start date: June 2018
• Roundtable Discussion with key stakeholders: July 2018
• Literature review: July 2018 - January 2019
• Baseline data collection: April 2019
• Follow up data collection: October 2019
• End date: December 2019.

Implementation sites

The program was implemented in the context of the South Eastern Sydney Local Health District (SESLHD) ‘Optimising Health and Learning’ program, a targeted, school based health screening program for newly arrived refugee and migrant young people at Beverly Hills Intensive English Centre, a public high school.

Partnerships

• Beverly Hills Intensive English Centre
• Red Cross
• SESLHD Health Promotion Service
• SESLHD Integrated Care Unit
• Executive Clinical Leadership Program, Clinical Excellence Commission

Results

Student surveys were conducted between April 2019 and October 2019. These surveys measured the impact of the project in its first six months of implementation. Clinical records were reviewed to monitor implementation of the nurse-led health coaching.

Results for the first six months of the project included the following.

Reported levels of engagement:

• 100% students were engaged in one or more healthy lifestyle initiatives
• 75% were engaged in tech free Tuesdays
• 70% were engaged in sports activities at recess and lunch time
• 68% were engaged in classroom learning activities relating to healthy lifestyles.

Reported changes in health behaviours:

• 29% decrease in the number of students eating three or more snacks per day (46% to 17%)
  15% increase in the number of students bringing food from home for lunch (76% to 91%)
• 24% increase in the number of students doing 60 minutes or more of physical activity each day (9% to 33%)
• 24% increase in the number of students exercising at lunch time (36% to 60%).

Finally, 86% of students reported that they would continue these changes when they left the Intensive English Centre.

Lessons learnt

Nurse-led health coaching

Critical success factors included:

• highly motivated students
• parent support.

Issues and limitations in working with this target group on this setting included:

• newly arrived students have little control or autonomy within home environment
• working within school terms limits continuity with student engagement
• parental engagement can be challenging during the early settlement period when other settlement issues such as housing, employment or education are a priority for the family.

Whole of school initiatives

Critical success factors included:

• engaged and motivated school staff
• agility to make changes along the way in response to student requests and preferences
• funds from small grants.

Issues and limitations in working with this target group in this setting included data collection in a school environment.

References

1. Dawson-Hahn E, Pak-Gorstein S, Hoopes AJ, 2016, Comparison of the nutritional status of overseas refugee children with low income children in Washington state, Pediatrics. 2016 Dec; 138(6): e20160953, doi: 10.1542/peds.2016-0953
2. Australian Institute of Health and Welfare. An interactive insight into overweight and obesity in Australia. Sydney; AIHW; 2020.

Further reading

• Kearns R, Woodland L. Overweight and obesity among adolescent refugees and migrants arriving in Australia: A review of the literature. Sydney: South Eastern Research Collaboration Hub, part of the Centre for Primary Health Care and Equity, UNSW Sydney; 2019.

Contact

Lisa Woodland
Manager, Priority Populations
South Eastern Sydney Local Health District
Phone: 02 9382 8676
lisa.woodland@health.nsw.gov.au