Reconciling Concept and Context : A grounded theory study of implementing school-based health promotion

In response to high prevalence rates of alcohol and other drug use by adolescents in British Columbia (BC), the BC Ministry of Health initiated a pilot project in secondary schools aimed at preventing alcohol and drug misuse among students. The School-Based Prevention Project involved placement of a Prevention Worker (PW) in selected secondary schools. The PW was expected to engage the school community in a collaborative process to develop and implement a comprehensive prevention program in the school using the School-Based Prevention Model (SBPM), an adaptation of the Precede- Proceed Model for health promotion planning. This grounded theory study explored the process by which the PWs implemented a PW role and the SBPM in the schools. Initial data collection involved one hour telephone interviews with 28 of 31 eligible PWs from across the province, conducted 4 to 6 months after the second annual training session. On the basis of the theoretical conceptualizations emerging from analysis of the PW interviews, 6 schools with varied implementation experiences were selected to conduct one week site visits to explore implementation in context. Field notes were" kept on all interactions with PWs and schools over the four . year study period. Over 100 interviews were conducted in the 6 sites with various members of the school community. Data analysis was conducted using the constant comparative method of grounded theory. Analysis yielded the core category of Reconciling Concept and Context. The core category is composed of three sub-categories, Entering the Field, Confronting the Model and "Doing" the Model. Before implementation of the SBPM could begin, PWs had to gain entry to the school by establishing program legitimacy and personal credibility, and by learning the ropes. This was often a challenging and lengthy process. As part of Entering the Field, PWs created a role by finding a focus that was acceptable to all concerned, and by striking a balance between: a) the schools' demand for intervention and the program focus on prevention, and b) the schools' propensity for crisis management and the program focus on pro-active planning. Many schools were not "ready" to implement the prevention program as intended, so PWs also had to enhance school readiness to develop and implement the program in the school. Before PWs could begin "Doing" the Model, they went through a personal Confrontation with the Model, which involved reacting to, learning and contemplating it. When PWs ultimately tried to "Do" the Model, conditions in the school context led them to reinvent, retrofit, reframe, approximate, or abandon the model rather than implement it as intended. Thus, in Reconciling Concept and Context, PWs had to facilitate changes in the school context to accommodate the concept. The concept, in turn, did not fit with the schools' goals and ways of doing things. The challenge for PWs was to modify the concept to fit the context, while retaining the integrity of the concept. In most instances, the concept was modified to a much greater extent than the context and was therefore co-opted by the status quo.Graduate and Postdoctoral StudiesGraduat