Early years education in the primary years programme (PYP): Implementation strategies and programme outcomes : interim report

This is the October 2013 Interim Report as part of the 'Early Years Education in the Primary Years Programme (PYP): Implementation Strategies and Programme Outcomes' Project submitted to the International Baccalaureate Organisation. This project is investigating implementation strategies and outcomes in Early Years Education in the Primary Years Programme of the IB, through a mixed-methods approach using both quantitative and qualitative data. It is based on intensive case studies of five Early Years Stage programmes within the IB Primary Years Programme, at three sites in Australia and two sites in Singapore.

Early years education in the primary years programme: implementation strategies and programme outcomes

This mixed-methods study investigated implementation strategies and child learning outcomes in early years education in the Primary Years Programme. Researchers from Deakin University evaluated processes and outcomes in four early years programmes, two in Singapore and two in Melbourne, Australia. Researchers collected qualitative data through classroom observations, drawings and writing produced by children, and interviews with educators, coordinators and parents. Quantitative data was collected through assessments of children’s literacy, developmental school readiness and learning skills. Three of the early years programmes appeared to support the development of learner profile attributes through inquiry-led learning and play-based approaches, while one site in Singapore was still in a developmental stage of implementing the programme. The study suggested that literacy skills at all sites were fairly developed; that children were performing at levels commensurate with or better in terms of school readiness; and that children were developing learning skills at higher rates than a comparative sample.

Assessment of student development and learning in IB PYP schools

The aim of this study is to examine how International Baccalaureate (IB) Primary Years Programme (PYP) schools define the purpose of educational assessment in their assessment policies and practices. Educational assessment in this study is broadly defined to include standardized tests, and formative and summative assessment. This investigation offers a deeper understanding of the assessment cultures of eight PYP schools and provides insights into the current assessment literacy of teachers. The researchers employed a multiple case-study approach, with two phases of data collection: an online survey of teachers and detailed teacher focus groups and coordinator interviews to follow-up on themes identified in the survey. Assessment in the PYP case-study schools was described as holistic and ongoing, and involved a wide range of assessment strategies. Assessment as learning, however, emerged as an approach still in development in the schools. Teachers enthusiastically supported the development of learner profile attributes, although assessing progress in any particular attribute was regarded as challenging. Finally, while teacher feedback and student self-assessment were common practices, teachers were more equivocal about peer assessment. The authors conclude the report with a number of recommendations for further improving PYP assessment practices.

Fun or profit : primary students' perceptions of mathematics and science

As the number of students pursuing mathematics and science in higher education decline, it becomes imperative· that we look for the causes of the decline. As part of the Australian Improving Middle Years Mathematics and Science (IMYMS) project, students were asked to rate their perceptions of classroom practice in mathematics and science and their attitudes to these subjects. Results of this survey reveal little difference in perceptions of classroom practice, but significant differences in students' attitudes between mathematics and science. Differences were particularly evident for items relating to the usefulness of mathematics and science (mathematics was more useful) and enjoyment of the subjects (science is more fun). If teachers are aware of such perspectives, it may be possible to change students' attitudes.

Effective student engagement depends on students enjoying their studies in mathematics and science, being confident in their ability and recognising the relevance of these subjects to everyday life, now and in the future.
(Education Training Committee, 2006, p. xvii)

Science and technology are the widely acknowledged foundation of Australia's future development. Underpinning these are the key learning areas of mathematics and science. However, Australia is experiencing a decline in numbers of mathematics and science students in higher education. Moreover, studies over the last two decades have shown a general decline in Australian students' interest and enjoyment of science across the compulsory secondary school years, with a particularly sharp decline across the primary to secondary school transition (e.g. Adams, Doig, & Rosier 1991; Goodrum, Hackling, & Rennie, 200 I) and a decline in the numbers of students studying' advanced mathematical courses in upper secondary school (Thomas, 2000).

Improving teaching and learning in the middle years of schooling (Years 5 to 9) is receiving particular attention because of the coincidence of the disengagement of students with the significance of these years for the preparation of students for their future role in society. Thus the Improving Middle Years Mathematics and Science: The role of subject cultures in school and teacher change (IMYMS) project, which is the source of data for this paper, is investigating the role of mathematics and science' knowledge and subject cultures in mediating change processes in the middle years of schooling.

Mathematics and science are sometimes seen as "love-hate" subjects, rating highest for subjects disliked, but also rating relatively highly among preferred subjects (Hendley & Stables, 1996). Students, even primary aged students, can often shed light on what constitutes good practice (see, for example, 'van den Heuvel-Panhuizen, 2005). Students' attitudes towards mathematics and science and their perceptions of what they regard as positive aspects of classroom practice have been shown to decline from the primary years to junior secondary (Race, 2000). The decline in interest in science in the early years of secondary school is of particular concern, since it is in these years that attitudes to the pursuit of science subjects and careers are formed (Speering & Rennie, 1996). Students' negative attitude towards the relevance of science ,content for their lives was a strong theme in the report by Goodrum, Hackling, & Rennie (2001) on the status and quality of teaching and learning of science.

As part of the IMYMS project, the IMYMS Student Survey was administered to all students in 2004 and 2005. The survey included a 36 item section on students' perceptions of classroom practice and attitudes towards mathematics and science, and a 24 item section on students' learning preferences. Students completed separate, parallel surveys for mathematics and science.

This paper focuses on students' perceptions and attitudes. It explores the differences in 700 Year 5 and 6 students' perceptions of their learning environment and their attitudes to mathematics and science during 2005, the second (and final) year of schools , involvement in the IMYMS project.

Putting literacy in the middle: key learnings from the middle years literacy research project

This article discusses the Middle Years Literacy Research Project and its design. The authors report on key findings and recommendations from the research. In particular the authors look at what is distinctive about teaching adolescent learners in middle years and what does the research show that is distinctive about teaching, the ways that literacy is understood and talked about, its various positioning in the middle years and, connections between effective literacy and effective learning. The article describes a Four Resources model as a framework for literacy teaching and learning for middle year education; literacy leadership, coordination, professional development and collaborative partnerships; and, what school strategies have the most potential to bring about long-term change and improvement in students' literacy and learning outcomes.

Two of everything: developing functional thinking in the primary grades through children's literature

Traditionally algebra has been regarded as the domain of the secondary school years in Australia and many other countries. Non-mathematics teachers, parents and students often narrowly regard algebra as the manipulation of symbols adhering to tightly prescribed rules (Serow, Callingham & Muir, 2013). It is now recognised, however, that foundational ideas associated with algebraic thinking can, and should be, included in mathematics curricula in the pre-school and primary years (Bobis, Mulligan & Lowrie, 2009). This stance is reflected in the Australian Curriculum: Mathematics (Australian Curriculum Assessment & Reporting Authority, 2012) which extends key algebraic ideas to patterns and generalisations, and acknowledges that number and algebra are developed together as each enriches the study of the other. This article explores the concept of functional thinking and demonstrates how the story, ‘Two of Everything’ (Hong, 1993) is employed as a springboard for developing functional thinking with students from the early years through to upper primary schooling.

Microworlds and mathematics: what shape is that?

The author provides ways to explore and use MicroWorlds to enhance mathematics teaching and learning. The procedures given randomly choose a shape from the specified list, draw the shape and require the user to type the name of the shape.

Using assessment data : does gender make a difference?

Since 2000 gender differences in mathematics achievement in Australia have reappeared. In this paper we report on the achievement outcomes of girls and boys in a longitudinal study of reform in low economic school communities. Analysis of student data to inform teaching was one element of student centred approaches implemented by teachers. Teachers targeted students’ next point of learning and more girls than boys participated in mathematics intervention programs. Growth in achievement was greater for boys than for girls in the primary years, and so the achievement gap that favours males widened. It is concluded that student centred approaches need to be gender inclusive.

Current approaches to obesity management in UK Primary Care: the Counterweight Programme

Background/Aims Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current management practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care.

Method A total of 141 general practitioners (GPs) and 66 practice nurses (PNs) from 40 primary care practices participated in structured interviews to examine clinician self-reported approaches to obesity management. Medical records were also reviewed for 100 randomly selected obese patients from each practice [body mass index (BMI) ≥30 kg m−2, n = 4000] to review rates of diet counselling, dietetic or obesity centre referrals, and use of anti-obesity medication. Computerized medical records for the total practice population (n = 206 341, 18–75 years) were searched to examine the proportion of patients with a weight/BMI ever recorded.

Results Eighty-three per cent of GPs and 97% of PNs reported that they would raise weight as an issue with obese patients (P < 0.01). Few GPs (15%) reported spending up to 10 min in a consultation discussing weight-related issues, compared with PNs (76%; P < 0.001). Over 18 months, practice-based diet counselling (20%), dietetic (4%) and obesity centre (1%) referrals, and any anti-obesity medication (2%) were recorded. BMI was recorded for 64.2% of patients and apparent prevalence of obesity was less than expected.

Conclusion Obesity is under-recognized in primary care even in these 40 practices with an interest in weight management. Weight management appears to be based on brief opportunistic intervention undertaken mainly by PNs. While clinicians report the use of external sources of support, few patients are referred, with practice-based counselling being the most common intervention.

A new evidence-based approach to weight management in primary care: the Counterweight Programme

Background/Aims Obesity has become a global epidemic, and a major preventable cause of morbidity and mortality. Management strategies and treatment protocols are however poorly developed and evaluated. The aim of the Counterweight Programme is to develop an evidence-based model for the management of obesity in primary care.

Methods The Counterweight Programme is based on the theoretical model of Evidence-Based Quality Assessment aimed at improving the management of obese adults (18–75 years) in primary care. The model consists of four phases: (1) practice audit and needs assessment, (2) practice support and training, (3) practice nurse-led patient intervention, and (4) evaluation. Patient intervention consisted of screening and treatment pathways incorporating evidence-based approaches, including patient-centred goal setting, prescribed eating plans, a group programme, physical activity and behavioural approaches, anti-obesity medication and weight maintenance strategies. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Eighty practices were recruited of which 18 practices were randomized to act as controls and receive deferred intervention 2 years after the initial audit.

Results By February 2004, 58 of the 62 (93.5%) intervention practices had been trained to run the intervention programme, 47 (75.8%) practices were active in implementing the model and 1256 patients had been recruited (74% female, 26% male, mean age 50.6 years, SD 14). At baseline, 75% of patients had at one or more co-morbidity, and the mean body mass index (BMI) was 36.9 kg/m2 (SD 5.4). Of the 1256 patients recruited, 91% received one of the core lifestyle interventions in the first 12 months. For all patients followed up at 12 months, 34% achieved a clinical meaningful weight loss of 5% or more. A total of 51% of patients were classed as compliant in that they attended the required level of appointments in 3, 6, and 12 months. For fully compliant patients, weight loss improved with 43% achieving a weight loss of 5% or more at 12 months.

Conclusion The Counterweight Programme is an evidence-based weight management model which is feasible to implement in primary care.

Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting : Greater Green Triangle (GGT) Diabetes Prevention Project

Background
Randomised controlled trials demonstrate a 60% reduction in type 2 diabetes incidence through lifestyle modification programmes. The aim of this study is to determine whether such programmes are feasible in primary health care.

Methods
An intervention study including 237 individuals 40–75 years of age with moderate or high risk of developing type 2 diabetes. A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004–2006. Main outcome measures taken at baseline, three, and 12 months included weight, height, waist circumference, fasting plasma glucose and lipids, plasma glucose two hours after oral glucose challenge, blood pressure, measures of psychological distress and general health outcomes. To test differences between baseline and follow-up, paired t-tests and Wilcoxon rank sum tests were performed.

Results
At twelve months participants' mean weight reduced by 2.52 kg (95% confidence interval 1.85 to 3.19) and waist circumference by 4.17 cm (3.48 to 4.87). Mean fasting glucose reduced by 0.14 mmol/l (0.07 to 0.20), plasma glucose two hours after oral glucose challenge by 0.58 mmol/l (0.36 to 0.79), total cholesterol by 0.29 mmol/l (0.18 to 0.40), low density lipoprotein cholesterol by 0.25 mmol/l (0.16 to 0.34), triglycerides by 0.15 mmol/l (0.05 to 0.24) and diastolic blood pressure by 2.14 mmHg (0.94 to 3.33). Significant improvements were also found in most psychological measures.

Conclusion
This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care settings, with reductions in risk factors approaching those observed in clinical trials.

Trial Number
Current Controlled Trials ISRCTN38031372

A low intensity, community based lifestyle programme to prevent weight gain in women with young children : cluster randomised controlled trial

Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children.
Design Cluster randomised controlled trial.
Setting A community setting in urban Australia. 
Participants 250 adult women with a mean age of 40. 39 years (SD 4.77, range 25-51) and a mean body mass index of 27.82 kg/m2 (SD 5.42, range 18-47) were recruited as clusters through 12 primary (elementary) schools. Intervention Schools were randomly assigned to the intervention or the control. Mothers whose schools fell in the intervention group (n=127) attended four interactive group sessions that involved simple health messages, behaviour change strategies, and group discussion, and received monthly support using mobile telephone text messages for 12 months. The control group (n=123)
attended one non-interactive information session based on population dietary and physical activity guidelines. 
Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months. Secondary outcomes were changes in serum concentrations of fasting lipids and glucose, and changes in dietary behaviours, physical activity, and self management behaviours.
Results All analyses were adjusted for baseline values and the possible clustering effect. Women in the control group gained weight over the 12 month study period (0.83 kg, 95% confidence interval (CI) 0.12 to 1.54), whereas those in the intervention group lost weight (−0.20 kg, −0.90 to 0.49). The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg (−2.03 to −0.24 kg; P<0.05) on the basis of observed values and −1.11 kg (−2.17 to −0.04) after multiple imputation to account for possible bias created by missing values. Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration (−0.35 mmol/l, −0.70 to −0.001), self management behaviours (diet score 0.18, 0.13 to 0.33; physical activity score 0.24, 0.05 to 0.43), and confidence to control weight (0.40, 0.11 to 0.69). Regular self weighing was associated with weight loss in the intervention group only (−1.98 kg, −3.75 to −0.23).
Conclusions Weight gain in women with young children could be prevented using a low intensity self management intervention delivered in a community setting. Self management of health behaviours improved with the intervention. The response rate of 12%, although comparable with that in other community studies, might limit the ability to generalise to other populations.    
Trial registration Australian New Zealand Clinical Trials Registry number ACTRN12608000110381.