Implementation and evaluation of the population-based programme "health literacy in school-aged children" (GeKoKidS)

Aim Health literacy (HL) is a key outcome of health education. Low HL is associated with a higher risk of health-related impairments and high health-related costs. This article therefore describes the contents and evaluation of the school-based programme "Health literacy in schoolaged children" (GeKoKidS) and its acceptance by teachers. A second focus of the study is the description of methods to increase the response of schools, students and parents as a crucial condition for the validity and generalizability of results from epidemiologic prevention studies. Subjects and methods The evaluation of the prevention program GeKoKidS included 5th grade students aged 9-13 years in schools in the region of Greifswald and East Pomerania [longitudinal randomised control group pre-post design (RCT)]. Data collections took place within the extended school dentist examination visits at the beginning of the 2007/2008 school year and at the beginning of the second half term of the 2008/2009 school year. This included medical examinations and self-completion questionnaires of students, parents and teachers. The study was authorised by the data protection commissioner of Mecklenburg-West Pomerania, the Ministry of Education, Science and Culture of Mecklenburg-West Pomerania and the Ethics Commitee of the Ernst Moritz Arndt University Greifswald. Based on the authorisation of the data protection concept and concerns about selective response, parents were not granted a consent but rather a right to refuse participation. In order to attain a high participation rate of the schools, the school principals were informed about the research project by an invitation letter, telephone calls and personal visits. Additionally an agreement on participation was handed out to all schools as a binding criterion for participation. By signing this agreement schools committed to using the offered teaching material, to participate in teacher training and evaluation, and to provide resources with respect to time and space. At the beginning of the 2007/2008 school year, all parents of 5th grade students were informed about the research project, the prevention programme and aspects of data protection. In order to increase the response rate parents also received a supporting letter from the Minister of Education, Science and Culture of Mecklenburg-West Pomerania, which mainly provided information about the importance of the research project and asked for support of this study. Results In Greifswald/East Pomerania, 19 of 22 schools with 5th year classes participated in GeKoKidS (response rate: 86.3%). Out of 914 eligible students in the participating schools, 882 children (96.4%) took part in the school dentist examinations. A total of 863 children (94.4%) participated in the extended school dentist examination; 852 children (93.2%) took part in the student survey. In the parental survey 721 parents participated (response rate: 78.8%). A high level of acceptance referring to teacher training and the appropriateness of the GeKoKidS programme was achieved. Conclusion As shown by the low rate of refusal, the programme and the evaluation study were well accepted. Possible reasons for these results could be the chosen procedure of establishing contact with schools before sending the questionnaires and the parent's right to refuse their child's participation instead of giving an active confirmation. Because of this high response rate, the database enables comprehensive conclusions to be reached on the health-related state of students in Greifswald/East Pomerania. © Springer-Verlag 2011.