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An Indigenous Program Evaluation of the Drop the Pop Challenge in Manitoba

Schools from 2015 to 2016

Written by Anna Huard, Paige Sillaby, and Leah McDonnell

Edited by Melanie Ferris

April 2016

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Contents

......................................................................................................................................................... 1

Acknowledgements ......................................................................................................................... 2

Evaluation Team Biographies ......................................................................................................... 3

Introduction ..................................................................................................................................... 4

Executive Summary ........................................................................................................................ 4

Literature Review............................................................................................................................ 4

Program Overview .......................................................................................................................... 6

Evaluation Questions ...................................................................................................................... 9

Evaluation approaches .................................................................................................................. 10

Program Theory ............................................................................................................................ 11

Logic Model: A Tool for Program Planning and Delivery ........................................................... 13

Methodology ................................................................................................................................. 15

Analysis of Evaluation Data ......................................................................................................... 17

Conclusions and Recommendations ............................................................................................. 19

References ..................................................................................................................................... 21

Acknowledgements

Our team of program evaluators wishes to acknowledge Dr. Linda DeRiviere from the University

of Winnipeg for her teaching and guidance on the topic of evaluating programs.

We also acknowledge Manitoba schools North Memorial in Portage la Prairie and Roseau Valley

School in Dominion City for welcoming us into their spaces to conduct focus groups with their

teachers and other school staff.

The evaluators thank the countless Elders and traditional teachers who have passed on their

cultural knowledge and wisdom to help us conduct our work in a grounded way that respects the

wisdom of Indigenous peoples.

Lastly, we are thankful to CN Rail for funding the Drop the Pop Challenges in Manitoba.

Without program funding, this evaluation would not be possible.

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Evaluation Team Biographies

Melanie Ferris is a proud Ojibway/Cree/Sioux woman who is a member of the Long Plain First

Nation. She pursued her undergraduate and graduate studies in English Literature and Women’s

Studies at Carleton University in Ottawa. She spent most of her adult years working in Ottawa

and Toronto, where she worked in national Aboriginal health organizations, provincial health

charities, as well as the federal government. Melanie is an avid researcher of Aboriginal health

and cultural teachings, and is published in international academic journals. She has authored and

edited numerous books on First Nations health and culture; her most recent book is Supporting

the Sacred Journey: From Preconception to Parenting for First. Nations Families. In 2012,

Melanie was appointed as an expert advisor to the Minister of Health and Long-Term Care in

Ontario. She is a proud mom to one child.

Anna Huard is a graduate student at the University of Winnipeg in the Masters of Development

Practice program, with a focus on Indigenous Development. She was born and raised in

Winnipeg. Her family is from Couchiching First Nation. She studies language and cultural

revitalization, as well as policy analysis toward reintegrating traditional perspectives into

contemporary discourses. Anna works as a research assistant with Dr. Angela Failler on a project

involving Shoal Lake 40 First Nation’s Museum of Canadian Human Rights Violations. She

aspires to work in securing Indigenous languages to re-establish First Nations identity.

Leah McDonnell is from Toronto, ON and currently lives in Winnipeg, where she attends the

University of Winnipeg for the Master’s in Development Practices: Indigenous Development.

She has traveled the world and worked in different countries, most recently in Israel working

with asylum seekers from Africa. Her main academic interests are in regards to human

trafficking in Canada, the integration of Traditional Knowledge into Western academic systems

using anti-oppressive and decolonized theory, and researching topics in regards to Missing and

Murdered Indigenous Men and Women (boys and girls). Leah has a background in international

development, politics, and communications and currently works for Manitoba First Nations

Centre for Aboriginal Health Research (MFN CAHR) through the University of Manitoba as a

research assistant.

Paige Sillaby is a proud Anishinaabe kwe from the Chippewas of Georgina Island, Otter clan.

She was raised on Dokis First Nation, a small community in northern Ontario, Canada. In 2015,

Paige received her Honours Bachelor of Arts in Global Studies with a minor in Psychology at

Wilfrid Laurier University. Currently, she is working towards a Masters of Developmental

Practice (MDP) with and Indigenous focus on development at the University of Winnipeg. Paige

is actively involved and identifies with her Aboriginal heritage. She has worked at varies student

and community agencies including the Wilfrid Laurier University Aboriginal Student Centre,

Council of Ontario Universities (COU), Canadian Roots Exchange and the Wii Chiiwaakanak

Learning Centre. From 2014-2015 she served as President of Laurier’s Aboriginal Students’

Association. When she is not studying, Paige enjoys visiting family, Netflix and attending

ceremonies. In her future career, Paige aspires to continue her work supporting Aboriginal

student initiatives in education.

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Introduction

This program evaluation, using an Indigenous perspective, was developed by three graduate

students from the Master’s in Development Practice, Indigenous Development Program at the

University of Winnipeg. It was developed from January to April 2016. The three students

received guidance and worked closely with Melanie Ferris, who manages the Drop the Pop

Challenge on behalf of the Kidney Foundation of Canada – Manitoba Branch (referred to as “the

Foundation” in this paper).

This paper outlines how we executed the program evaluation and also provides an analysis of the

data we collected. We found that the Drop the Pop Challenges have a significant impact on

Manitoba children, as well as their schools, families, and communities.

Executive Summary

The Drop the Pop Challenge lasts approximately a week long, where consumption of pop

and other sugary drinks is discouraged and teachers implement lesson plans that have

been designed by the Foundation.

Once the challenge has been completed, participating schools submit a short written

report about their school’s activities, teacher evaluations of the program, as well as five

photos from the challenge.

The Drop the Pop program has a significant impact on participating children and has

room to grow.

The Drop the Pop Challenge reached at least 2,436 children and youth in Manitoba in

March 2016.

Literature Review

To determine the relevance and rationale of the Drop the Pop program, a brief literature review

was conducted on issues impacting Indigenous peoples’ health in Canada. Key findings are: the

impacts that colonization have on the social determinants of health for Indigenous peoples; high

rates and susceptibility to diet-related diseases amongst Indigenous peoples; and the severe

issues with food security experienced by Indigenous communities. Outlined below are the

findings:

The social determinants of health for Indigenous Peoples in Canada

The colonization of Indigenous people in Canada has created and continues to impose ongoing

stigmatization, marginalization, and oppression (Native Women’s Association of Canada, 2010).

Outcomes of colonization create definitive factors in maintaining economic, social, and political

barriers for Indigenous peoples (Kingsley & Mark, 2001). Barriers created by colonization

include poverty, racial stigmatization, and violence within Indigenous communities. These

barriers negatively impact Indigenous peoples and their social determinants of health.

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Social determinants of health are the social and economic realities or conditions that impact the

health and well-being of peoples1 (Mikkonen & Raphael, 2014). Overall, Indigenous people have

poorer health and well-being outcomes compared to non-Indigenous peoples in Canada,

indicating substantial inequities between Indigenous and non-Indigenous Canadians (Statistics

Canada, 2015).

Indigenous People and health topics, locally and globally

Around the world, Indigenous communities have been, and currently are, experiencing a global

epidemic of developing diabetes and remain disproportionately impacted by Type 2 diabetes

(Naqshbandi et al, 2008). This alarming trend has been on the rise for the past few decades—a

rapid change in lifestyle contributed to this (Young, Reading, Elias, 2000). The rapid change in

lifestyle can be traced to the onset of colonization and the forceful removal of the traditional

Indigenous cultures and subsequent forced assimilation in the dominant society (Gracey, & King,

2009).

More disturbing is the increase of Type 2 diabetes in Indigenous children in Canada, as Type 2

diabetes is most typically found in adults and not children (Young, Reading, Elias, 2000).

Overall, the prevalence rates for diabetes range to be over three times as high (17%) for First

Nations people who live on reserve and twice as high for First Nations peoples who live off

reserve, when compared to non-Indigenous Canadians (PHAC, 2011).

In Manitoba, 12.45 out of 100,000 children have Type 2 diabetes (Amed et al, 2010). The

Diabetes Integration Project found that 54 of 64 First Nations communities in Manitoba have a

child with Type 2 diabetes (2014). When children are found to have Type 2 diabetes, they must

be flown/moved from their community to visit a pediatric diabetes clinic in Winnipeg for a full

assessment and education.

Although diabetes is a prevalent issue for Indigenous communities in Canada and across the

globe, issues of obesity, kidney-related illnesses, and tooth decay are alarmingly present in

Canadian First Nations communities. While there are many contributing factors to these various

conditions, it is noted that the consumption of sugary foods and beverages has a direct

correlation with increasing rates of these illnesses (DHSSGN 2006, 2007, 2008 & 2009; PHD

2007, 2008 & 2009).

In Manitoba, Dr. Alison Dart, a pediatric kidney doctor, found that 2.4 percent of our province’s

children have chronic kidney disease (CKD) compared to only 1.5 percent of children having

CKD at a national level. She says Manitoba has the highest percentage of children with CKD in

all of Canada. Dr. Dart found that 43 children in Manitoba were either on dialysis or had

received a kidney transplant (2014).

1 More specifically, there are 14 identified health determinants of health: income and income distribution, education,

unemployment and job security, employment and working conditions, early childhood development, food insecurity,

housing, social exclusion, social safety network, health services, Aboriginal status, gender, race and disability

(Mikkonen, & Raphael, 2014).

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Food security in Indigenous communities

As mentioned previously, many people are aware that the overconsumption of sugary, sweetened

drinks (such as pop and juice) increases the risks of developing Type 2 diabetes, kidney-related

diseases, obesity, and tooth decay. As such, diet and access to healthy foods becomes even more

important when considering risk factors for developing Type 2 diabetes and other diet-related

diseases in Indigenous communities (Apovian, 2004; DHSSGN 2006, 2007, 2008 & 2009; PHD

2007, 2008 & 2009).

Issues of food security plague Indigenous communities throughout Canada and substantially

increase the risk of Indigenous peoples developing chronic diseases (Power, 2008). In their

study, Paul Fieldhouse and Shirley Thompson found that “while there appears to be a growing

interest in local food production and the reintroduction of traditional foods to the diet, an

important key to successful change is the engagement of youth, whose food habits and

preferences have been heavily influenced by mainstream commercial food culture” (2012).

Given the challenges with accessing healthy, affordable food along with the move away from a

traditional lifestyle, it is understandable that Indigenous Canadians, especially those who live on

reserve or in remote communities, are vulnerable to developing Type 2 diabetes. In response,

Health Canada and other civil society actors have—and continue to—implement programming to

combat diet-related diseases borne disproportionately in Indigenous Canadians.

Program Overview What is Drop the Pop?

In many of Canada’s northern communities, there are concerns about the high consumption rate

of pop and other sugary drinks. Unhealthy lifestyle choices have led to increasing rates of

obesity, Type 2 diabetes, and tooth decay amongst children and adolescents. To address this

concern, a program called the Drop the Pop Challenge was implemented in Nunavut in 2003-

2004 for students in kindergarten to grade 12. According to the Drop the Pop website, this

project “is an annual health promotion campaign designed to increase students’ awareness of

how sugary drinks affect their health, and to encourage students and their families to drink/eat

healthier beverages and foods and make healthy lifestyle choices” (2013). In Nunavut, students

compete for and earn prizes by abstaining from sugary drinks for an entire school week. They do

this as part of an educational campaign about the long- and short-term health impacts of

consuming too much sugar.

In 2010, the Manitoba Branch of the Kidney Foundation of Canada adapted the Drop the Pop

Challenge to promote healthy dietary choices amongst Indigenous children (First Nation, Inuit,

and Metis) in Canada.

Our evaluation focuses solely on the Drop the Pop Challenge in our province, Manitoba, looking

at outcomes from schools taking part in the program in 2015 and 2016.

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What makes Drop the Pop unique?

When the project was first implemented in Nunavut, it

“involved 14 schools and the number of participating

schools grew year over year” (Drop the Pop website). The

Drop the Pop campaign is adapted to the needs of the

region according to differences in community-based

partnerships and funding. Funding generally comes from

the Canadian government, non-governmental organizations,

and charitable organizations. Funding covers promotional

activities, school awards, and activities within the

classroom. Community partnerships may contribute fresh

food, drinks, and store coupons.

According to the Drop the Pop website, “the Childhood

Obesity Foundation has proposed that the success of the

Drop the Pop program is due to its flexible and evolutionary

approach. It responds to needs that are identified at the

school level and reflects the innovations and ideas of

teachers, schools, and communities” (2013). It is

evolutionary in that it considers the physical health of

community member, but also incorporates why First

Nations customs are beneficial to emotional and spiritual

health. Finally, the program also takes the needs of the

environment into consideration by encouraging the

community to recycle and reuse.

The Drop the Pop Challenge in Manitoba is unique because

it links high rates of diabetes and obesity with CKD. Many

Manitobans are not aware of their risks for CKD, although

our province has the highest rate of end-stage kidney

disease in all of Canada (Chartier et al, 2015).

CKD has no cure, and the only treatments are time-

consuming dialysis treatments or a kidney transplant. These

treatments are challenging for anyone, but especially for

people living in remote and northern communities, as there

may be no access to a dialysis centre—relocation to an

urban centre may need to happen if a person wants to

access life-saving treatment.

Manitoba has the lowest rates of organ donations amongst

all of Canada; the wait for a kidney transplant from a

deceased donor is at least five years (Kidney Foundation of

Canada, 2012).

Manitoba youth share thoughts on the Drop the Pop Challenge

A class of 39 students in grade 7 took

part in the challenge in March 2016.

Students completed evaluations sharing

thoughts in response to the challenge.

Eight of their responses show that

young people see the effects of chronic

disease all around them:

“My mom and dad have to take pills

for meds and for food.”

“My dad is affected by diabetes and

he goes for dialysis three times a

week.”

“My dad has diabetes + three

problems are: 1. Gets mad real easy;

2. Takes needles every day; 3.

Sleeps a lot.”

“My grandma has Diabetes. It

effects (sic) her life because she

takes needles. And she goes to the

doctors regularly.”

“My kunshi has diabities (sic) and

she has to check her blood sugar

levels every day she cannot eat

anything sweet.”

“My auntie has diabetes and it

affects her life because she can

never do anything fun because she

is in a wheel chair and she rarely

comes to our family meals at my

grandpa’s because she has to go to

dialasis (sic).”

“Makes me sad to see my grandma

she takes needle and checked her

blood and get her eye checked.”

“One of my teachers has diabetes

and how it effects (sic) her life? She

has to take insulin needles for it she

can’t drink, eat junk food or drink

pop of any kind.”

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The statistics around Indigenous health in Manitoba are alarming and depressing. The Drop the

Pop Challenge in Manitoba aims to be culturally appropriate and empowering by addressing

these issues amongst Indigenous children and their families in a fun and strength-based way.

Children are eligible for prizes if they make an effort to take part in the challenge, and many

schools also provide access to healthy “treats” such as milk, fresh produce, and smoothies as part

of their learning process. The challenge aims to help them to be proud of their culture and

Indigenous identity while understanding that Type 2 diabetes is a leading cause of CKD, and is

preventable through healthy lifestyle choices. Many Indigenous children are surrounded by

family members living with Type 2 diabetes, so the challenge aims to help them learn that

making healthier lifestyle choices may lessen their risk for chronic diseases.

Similar interventions to the Drop the Pop Program

As outlined in the literature review, nutrition-related diseases are a prevalent issue in Indigenous

populations in Canada. Several programs have targeted interventions that are aimed at youth and

parents, focusing on encouraging a healthy diet and lifestyle.

Health Canada committed over $275 million between 2010-2015 for programming that targets

health promotion and awareness of diabetes among Indigenous Canadians (Health Canada,

2011). Canadian Feed the Children has a multi-pronged approach that targets Indigenous youth

through schools and community centres and provides: nutritional education classes, Indigenous-

focused nutrition, after-school food programs, community gardens, and in-school nutrition

education (Canadian Feed the Children, 2015).

Most relevant in this case is the Drop the Pop Challenge initiated in Nunavut in 2003 and now

subsequently run through all three territories (Nunavut, Yukon, and Northwest Territories). The

northern Drop the Pop Challenge encompasses the same idea as the Manitoba-based challenge—

it initiates school-based challenges that encourage youth to not drink sugar-filled drinks for a

specific period of time. This challenge also increases the capacity of teachers to educate children

on nutritional information and healthy lifestyle choices (Government of NWT, n.d.; Glacken,

2011).

Successes, challenges, and lessons learned

The successes for similar interventions, especially the Drop the Pop Challenges in the territories,

have yielded a growing number of participants per challenge and individuals who have a higher

level of understanding of nutrition, healthy choices, nutrition-related diseases, and prevention.

Factors that are attributed to this success are strong organization, incentive-based challenges,

awareness, and advocacy surrounding nutritional topics and healthy lifestyle choices (Glacken,

2011; Canadian Feed the Children, 2015).

Challenges faced by similar programs include issues such as other commitments that faculty/staff

and students had made during the same time. Another challenge is the lack of interest or

engagement from parents and students, and a lack of interest from the schools or community

centres to host the challenge (Glacken, 2011).

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Lessons learned from the project include recommendations to run the challenges in conjunction

with other health initiatives brought in from the school, community centres, or other bodies.

Another lesson learned, or best practice, is to have support from the school and staff members of

the school that help to facilitate the program. This also means giving the teacher’s information

regarding the program far ahead of the challenge so they can prepare well in advance for their

class-implemented activities, giving the students a take-home letter explaining to the parents

what the challenge was about and having organizational support from the Drop the Pop

organizers (Glacken, 2011).

Evaluation Questions

The overall purpose of our evaluation project is to review the implementation and immediate

outcomes of the Drop the Pop Challenge in Manitoba. The findings in this report will be used as

a guideline to improve the challenge. The following questions informed the direction of our Drop

the Pop evaluation:

1. To determine how many children participate in the Drop the Pop Challenge. Does the challenge decrease consumption of sugary drinks for a week (or time set by

schools)?

2. To determine the extent of support provided to schools that take part in the Drop the Pop

Challenge. Does the Foundation provide support for the successful implementation of the Drop the

Pop Challenge to the various schools in Manitoba? In which ways do they provide

support?

3. To assess awareness among parents and teachers about the dangers of sugary drinks at the

end of Drop the Pop Challenge. Does the challenge help stakeholders to become aware of the harmful effects of sugars,

and promote alternatives to sugary drinks?

4. To identify factors that facilitated and inhibited the implementation of the project in order

to determine ‘promising practices.’

What works and does not work when implementing the challenge in schools?

5. To determine the level of awareness of children of the benefits of healthy eating and

lifestyle choices.

Does the program educate children about healthy eating? If so, how?

6. To determine changes in the awareness, knowledge, and behaviours of key school-based

stakeholders including teachers, administrators, school boards, and Chief/Councillors

concerning healthy eating and lifestyle choices.

7. To evaluate the extent to which the overall goal of Drop the Pop was met.

8. To determine whether schools used culturally-relevant approaches to teaching Indigenous

students about health.

How many schools use cultural practices, ceremonies, or resources to help children learn

more about how their culture(s) can help them maintain their health? How many

children/families felt more empowered or proud about their cultural identity after the

challenge happened?

9. To identify unanticipated outcomes of the Drop the Pop Challenge.

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Evaluation approaches Research design

The research design of our Drop the Pop evaluation uses a decolonized approach to gather,

interpret, and analyze data. This approach uses aspects of ceremony and First Nations’

ontologies to conduct culturally relevant data gathering (Scott, 2009; Smith, 1999; Wilson,

2008). The evaluation design is guided by First Nations’ epistemologies, which is reflected in the

evaluation’s logic model design as a Medicine Wheel. The basic theory behind Drop the Pop

Challenge is based on creating a positive behavioural change through education-based

programming.

The theory behind the program is guided by the literature review and general observations made

in regards to education-based programming and intended outcomes. It aims to provide evidence

of the efficacy of education-based programming for Drop the Pop and does not aim to provide an

“absolute truth” of education-based programming always being effective (Birks and Mills, 2011,

p 212).

The Drop the Pop Challenge engages students in a fun way, asking them to undertake a change

in their diets for a full week, while simultaneously supporting the children with lesson plans,

incentives (such as prizes), and culturally relevant materials, among other things.

The evaluation methods utilized for our report are divided into the Ownership, Control, Access,

Possession/Self-Determination (OCAP/S) principles, multiple perspectives, and methodologies

(qualitative and quantitative methods). The principles are outlined below.

Ownership, control, access, and possession/Self-determination (OCAP/S)

In Canada, it is important to use Indigenous research principles when conducting research with

Indigenous communities. Our Drop the Pop evaluation uses the OCAP/S principles through the

research aspects of the program. This means that the schools we work with get to have

ownership and control over the data we collected. For example, when conducting our focus

groups, we were sure to explain to participants that we would share our transcripts with them and

provide them with the opportunity to edit and approve them before using them as part of our

evaluation project. The schools also “own” the evaluations completed by their students, but

allow us to use the information to inform our evaluation project.

While the Drop the Pop Challenge has documentation available for dissemination regarding

health impacts on Indigenous communities, this evaluation of the Drop the Pop Challenge is

meant to be a useful guide for the overall challenge to help direct the Foundation’s

implementation of the program and to reflect the wants and needs of participants for the future.

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Program Theory

Program theory examines the linkages between activities and outcomes within a program and the

underlying theory, which drives the program. In the case of the Drop the Pop Challenge, the

program theory is guided by an impetus for a behavioural change delivered through health and

nutrition-related education. Therefore, the underlying program theory of the Drop the Pop

Challenge is that if children (in kindergarten through grade six) participate in the week-long

challenge, it will contribute to a small decrease in the consumption of pop and other sugary

drinks and overall awareness about the dangers of too much sugar on a person’s body. Drop the

Pop is using the working theory that if we provide the support for children to reduce their intake

of sugary beverages for one school week, then children will have the tools and knowledge to

make healthier choices in regards to their health and well-being. The program is hoping for

healthy behaviour to continue following the one-week challenge.

The challenge requires participants to eliminate sugary drinks from their diet for five consecutive

days, which contributes to a short-term decrease of sugar intake. The challenge also provides

educational material throughout the week, in which children are made aware the harmful effects

of sugary drinks. Teachers receive a resource book called Drop the Pop: Lessons Plans and

Activities for Teachers.

The lesson plans are available as a hard copy book as well as a PDF file. They include “cultural

teachings from various First Nations... research shows that including culture in education often

results in more successful learners” (Kidney Foundation of Canada, 2015).

In addition, the challenge creates a platform for students to learn about alternatives to pop, such

as water and milk, thus they are learning about making healthier nutrition choices. Overall the

program seeks to decrease the consumption of sugary drinks among Indigenous children in

Manitoba. The theory is that if sugary drinks are removed from a child for one week, then it will

decrease consumption short-term (at least), while also providing an opportunity for children,

parents, and teachers to be empowered to make the healthier food and drink choices.

Implementation theory

Implementation theory is about transforming inputs into activities and then outputs and

outcomes. It does not just look at outputs. The problem that this challenge is trying to address is

that Indigenous children in Manitoba are suffering from higher rates of chronic diseases

compared to non-Indigenous children in Manitoba.

Prevention programming looks at what factors can reduce a certain outcome before it becomes

an issue. In the case of diabetes and CKD in Indigenous children and their communities, the

challenge addresses a need to educate and reduce risk factors that contribute to diabetes and

CKD, such as the overconsumption of sugar.

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The inputs that the Drop the Pop Challenge utilizes for programs include: grant funding,

applications from schools across Manitoba, awarded grants for $250, videos about chronic

diseases, curriculum for teachers, a resource website, Elders and community health

workers/educators to deliver nutrition-related and culturally-relevant messages, social media,

traditional media, and volunteers. These inputs contribute to program activities. For example, the

grants are being used by the schools to cover a variety of program costs including: healthy food

options for the week, participant awards, and additional resources that promote health education.

If the Foundation did not provide grants, then schools would not have the funds available to

provide healthy alternatives to pop and other sugary drinks during the program. Therefore,

having funds to buy healthy snacks for children, then having students consume food, leads to the

program’s goal of promoting health education through food choices (outcome).

Drop the Pop Challenge program description

The Drop the Pop Challenge has various stages of implementation prior to the challenge. The

program is run by the Foundation of Canada, managed by the Kidney Health and

Communications Manager. The program is funded through grants, with the main source of

funding coming from CN Rail.

Once funding is secured, the Foundation develops and executes a media strategy. It develops and

shares a media release to all Manitoba media outlets. Those outlets can do interviews with

Foundation staff or simply copy, paste, and adapt the information from the media release about

the opportunity.

The Foundation also advertises the grant opportunity by sending emails to all Manitoba school

boards and Aboriginal Diabetes Initiative workers, faxing applications and information sheets to

all First Nation communities, and sending out emails via various list serves that are targeted to

Indigenous audiences. The Foundation also alerts schools that have done the challenge in the

past that the grants are being made available once again.

Once the announcement is made public, schools/administrators have about four weeks to apply

for the grant. The schools complete a simple 1-page application form (see Appendix) that gives

information on their plans for a Drop the Pop Challenge. The Foundation invites applications to

come from any Manitoba elementary schools that have at least 50% Indigenous student

population. The program distributes funding to schools to do the program twice a year, in March

(Kidney Health Month) and November (Diabetes Awareness Month). The number of schools

that receive grants depends on how much funding is available. The amount of money distributed

to schools is $250 each.

Schools are selected based on their plans—they must do the challenge for five days and should

provide some kind of plan on what they will do for their students. They also are more likely to

receive the grant if they plan to include any culturally relevant activities during the challenge.

One volunteer (usually a retired dietitian or social worker) scores each application sheet, and so

does the Kidney Health and Communications Manager. The scores are combined and top-rated

applications are selected to receive the grants.

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Selected schools must sign a simple, one-page agreement before they receive the grant funding.

It says they will provide a quote for a media announcement, at least five photos from their

challenge, and a short report about what happened during their challenge. Once they have signed

and returned the agreement, they receive a cheque for $250 as well as teaching resources to help

them implement the challenge over the course of five days.

Schools are provided with ideas on how they can implement their own challenge. The schools

are able to use the $250 grant money in whichever way they wish, as long as it promotes healthy

lifestyles in some way. Schools are not required to provide receipts to the Foundation to account

for their expenditures. Some schools ask the Foundation to provide a presenter for their students.

Once the challenge is complete, the schools have a few weeks to report on their challenges and

provide five photos from the challenge. They send this information to the Kidney Health and

Communications Manager from the Foundation. Schools must submit a report in order to be

eligible for future funding.

Now that the description of the program has been provided, it is important to understand how the

logic model of the Drop the Pop Challenge flows. As such, the next section outlines and explains

the logic model used to guide the Drop the Pop Challenge.

Logic Model: A Tool for Program Planning and Delivery

The purpose of the logic model is to help program managers from all fields of work to clearly

understand the logistics of the program under analysis. See the appendix Figure 1.0, for the Drop

the Pop mainstream logic model, which is designed to help community members, project

managers, stakeholders, and evaluators; thus, “the Logic Model is the basis for a convincing

story of the programs expected performance” (McLaughlin & Jordon, 1999). Although this logic

model shows single relationships between the project features, it is important to mention that all

elements influence the other, which also shows that there are no hierarchies of features.

In other words, one feature is of no more significance than another. The mainstream model uses

a basic flowchart to indicate the logical connections between the resources that lead to the

programs various activities, which lead to the determined outputs, which help to determine the

impact (participants reached) and outcomes (short, intermediary, and long-term). The specific

relationships between the aspects of the logic model are outlined in greater detail in the

alternative logic model description.

In keeping with the wisdom and traditional knowledge of the First Nations communities, as well

as our own knowledge and identities as First Nations people and respect for First Nations

identities and knowledge as allies, our logic model (Appendix Figure 2) reflects the First Nations

Medicine Wheel. A Medicine Wheel is a circular symbol that shows that everything is connected

and related. Using a Medicine Wheel to evaluate a program ensures that we take a holistic

approach to understanding and assessing the Drop the Pop Challenge. The evaluation logic

model employs the Medicine Wheel as a guide for understanding how the Drop the Pop

Challenge is implemented.

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Children are at the centre of the Medicine Wheel. We put them in the middle because the

challenge specifically targets children. Traditional teachings in First Nations culture tell us that

all children are sacred and the most important part of our communities as they are closest to the

Creator. Traditional knowledge teaches us to create a good life for all children in our

communities. Putting children at the centre and using this Medicine Wheel as a visual to help us

carry out our evaluation of the program reminds us to look at the program through our

Indigenous lens. By doing so, this framework encourages the celebration and inclusion of

cultural practices, ceremonies, teachings, and knowledge.

Outside of the wheel are the formal resources that are needed to implement the Drop the Pop

Challenge. These include media, volunteers, and office resources (eg; fax machine, computers,

phone, email, etc.).

The white quadrant of the wheel is dedicated to the mind and making mindful decisions. As

such, the model uses this for the initial description of what resources are needed/how the project

will get off the ground. Resources in this area include the manager for the program, funding,

prizes, as well as curriculum.

The black quadrant of the wheel looks at the body and actions taken, thus is used to guide the

specific activities created by Drop the Pop. Activities include making the grants public, grading

the applications, notifying selected schools, and providing curriculum and other resources to the

schools.

The red quadrant of the wheel looks at emotions and reactions. In this section we list the outputs,

as they are types of reactions from activities and inputs. These include how many children are

taking part in the challenge in Manitoba schools, lessons delivered to children, prizes or healthy

snacks that children received as part of their challenge, and any other outputs that are the result

of the $250 grant (for example, some schools have used the funds to help pay for physical

activity outings, camps on the land, teachings from Elders, etc).

The yellow quadrant of the wheel focuses on the connections between spirit and values and

guides the challenge for its outcomes. These include: children that know how to make healthier

choices by reading food labels and knowing how much sugar they should have each day;

children learning about the negative effects of sugary drinks on a person’s health and what that

can mean (i.e. diabetes, kidney issues); families that understand the need to support their children

in making health lifestyle choices overall—including what they eat, drink, and how much

exercise they get; families also making health lifestyle choices at home after the challenge has

ended in what they eat and drink at home and what they provide for their children to eat and

drink; teachers being able to act as role models in regards to health and nutrition, including

healthy living education into normal curriculum; and schools having more resources and

encouragement to support healthy lifestyle choices, specifically encouraging students to reduce

their sugar intake (both in liquids and foods).

15

To the right of the yellow quadrant, the logic model delves into a greater exploration of the

overall community benefits from this program. We have chosen to display these using the

diagram of a ripple in the water. This visual describes how the challenge starts off small, as a

ripple does, but grows.

The overall benefits for the Drop the Pop Challenge include encouraging healthy and happier

communities and culturally relevant programming implemented through the Drop the Pop

Challenge.

Methodology Multiple perspective data collection

Data collection methods involve gathering information from stakeholders and beneficiaries who

deliver the program (teachers, guidance counselors, principals, etc.) and beneficiaries of the

program (students, family members, etc.). Although the evaluation team is unable to work

directly with children, as per the legal regulations in Manitoba2, we developed a survey for

children and youth to enable us to gather feedback from them, with help from the teachers of the

involved schools (discussed further below). Methodology

With a mixed methodology approach, the team conducted qualitative and quantitative research,

using a triangulated approach, with teachers who implement the program and other adults who

function in a support manner (i.e. guidance counselors, educational assistants, and principals).

The specific methods of data collection are divided into two categories and explained in detail

below.

Quantitative methods

Quantitative data collection methods for this project include:

1. Pre and post tests to determine what was learned before and after the week-long

challenge:

a. Questionnaires designed to discover what teachers, students, and other support

workers know about the impacts of sugary drinks on their overall health, both

before and after the challenge.

2. Survey questionnaires regarding the effectiveness (or lack thereof) of the program:

a. Basic survey questions designed to gather ordinal data in regards to the overall

effectiveness of the program according to participants (specifically those who

implemented the program).

2 Note that we would be able to work directly with children (minors) if we had more time to work on this evaluation

project, as we would have been able to secure our child abuse registry checks.

16

Qualitative methods

Qualitative data collection methods for this project include:

1. Focus groups:

a. Using the guiding aspects of a focus group methodology, our team organized two

focus groups that concentrated on how the Drop the Pop Challenge

affects/impacts children and teachers.

2. Coding:

a. An assessment of data collected from schools that completed the Drop the Pop

Challenge in November/December 2015 was conducted; major themes are

identified and discussed in the analysis section.

3. Picture drawing (for children and youth):

a. Designed specifically for students,

some schools administered a colouring

sheet after the challenge took place; the

child or youth drew a picture to

represent their feelings about the Drop

the Pop Challenge and also had the

opportunity to name things they liked

and did not like about the challenge.

You can see an example of a child’s

drawing to your right.

b. The pictures themselves are not analyzed, instead the comments about what

participants liked and did not like were tallied and used to inform the final

analysis. Limitations

The major limitation identified for the evaluation was timing—there was not enough time to

evaluate all schools that took part in the Drop the Pop Challenge. At the time of writing this

report, several schools were implementing the challenge. Another limitation was the remoteness

of some school locations; due to limited funding and time, it was not possible to visit these

schools to facilitate focus groups, although surveys and phone interviews were options.

In our two focus group sessions, there were limited numbers of participating teachers and other

implementers (such as principals and others) who identified as Indigenous. This creates a limited

perspective that is not inclusive of a strong or representative Indigenous voice(s).

17

Although the evaluation team was very aware of Indigenous perspectives and tried to include an

Indigenous worldview and lens when working on the evaluation, larger research projects on this

topic with Indigenous teachers and other Indigenous school faculty would be beneficial.

Analysis of Evaluation Data

To reach a large scope of perspectives, our team analyzed data from the children’s surveys;

transcripts from our two focus groups; qualitative evaluations teachers and principals submitted;

and written narrative reports that teachers and principals submitted to us following their Drop the

Pop Challenges in November and December 2015. The full transcripts from our two focus

groups are included in the appendices (see appendices B).

We received feedback from the following Manitoba schools to help inform this evaluation:

1. Ashern Central School, Ashern

2. Chief Clifford Lynxleg Anishinabe School, Tootinaowaziibeeng First Nation

3. Duke of Marlborough School, Churchill

4. Fisher Branch Collegiate, Fisher Branch

5. Joe A. Ross School, Opaskwayak Cree Nation

6. Keeseekoowenin Elementary School, Keeseekoowenin First Nation

7. Langruth Elementary School, Langruth

8. Neil Dennis Kematch Memorial School, Sepetewayak Cree Nation

9. North Memorial School, Portage la Prairie

10. Peter Yassie Memorial School, Tadoule Lake

11. Roseau Valley School, Roseau Valley

12. Ruth Betts Community School, Flin Flon

13. Ruth Hooker School, Selkirk

14. Sioux Valley High School, Brandon

15. Walter Whyte School, Grand Marais

16. Waywayseecappo Community School, Waywayseecappo First Nation

The written reports submitted by schools in late 2015 were overwhelmingly positive. Teachers

stated that they enjoyed participating in the Drop the Pop Challenge and felt it was influencing

the behaviours of family members as well. A comment from our focus group at the North

Memorial School shares, “When one child was offered pop for dinner, they told their parents

they couldn’t have any because it was bad for them” (Ferris, Huard, and McDonnell, 2016).

Another comment from a report shared by the Chief Clifford Lynxleg Anishnabe School says,

“Some students even encouraged their parents at home to quit drinking pop for that week.”

While the students encourage their parents to stop drinking pop at home, teachers also expressed

concern that parents need to show support for their students. A comment from our focus group at

North Memorial School says, “Without the parents and guardians being open to learning about

sugary consumptions and making better choices, the health benefits will not be fully realized”

(Ferris, Huard, and McDonnell, 2016). This comment is reinforced by thoughts shared by

teachers who attended our focus group at the Roseau Valley School:

18

Many students do not come with a prepared lunch and rely on inexpensive, processed

foods from the corner store during the lunch hour. Since students have limited funds,

many purchase the largest quantity of food for a lower price. This means that students

are often eating large bags of chips and bottles of pop because it is less costly than

nutritional foods. Due to the lack of choices in lunches for younger students, teachers feel

that many children are malnourished. (Ferris, Huard, McDonnell, and Sillaby, 2016).

This comment reflects what we found in our literature, that food security and poverty is an issue

for many Indigenous children in Manitoba. This is an issue that the Drop the Pop Challenge is

unable to address, but it is important to recognize that food security and poverty is an issue that

will continue to impact the health of Indigenous children in Manitoba if it is not addressed by

different levels of government.

Another finding from the data was that the Drop the Pop Challenge helps affect a change in

children’s behaviour on multiple levels. For example, students were reusing and recycling water

bottles, as well as consuming more alternative beverages to pop. Many students stopped bringing

pop and sugary drinks to school. “The amount of pop consumed in the school since the challenge

has declined significantly because anytime pop is brought to the school by students, we exchange

it for milk” (Waywayseecappo Community School). Teachers also reported on how beneficial it

was to have health professionals and dietitians speak about the dangers of kidney disease.

The evaluations from the majority of schools that participated in the Drop the Pop Challenge

were positive. Our data demonstrates that 51% of children who filled out the picture survey tool

had no, or very little, negative feedback on the entire program. The majority of negative

feedback from participants entailed being unable to drink pop, specifically, 32.5%. Furthermore,

44% pointed out they enjoyed the other activities that went along with the challenge; these

included everything from art projects to making smoothies. We also found that 14% of students

were unhappy with other students in the challenge whom were able to “cheat.” This is a common

concern for participating children, as they are expected to come to school and truthfully report to

their teachers whether they drank pop or sugary drinks the day before. Teachers mentioned that

children who resisted participating with the challenge were generally those who were the

“unhealthiest.”

The resources in the handbook, such as classroom activities, were very useful in how the

program was implemented. Not only were these activities educational but also incorporated a

cultural perspective to nourish a spiritual well-being. Indigenous practices, such as smudging,

round dancing, and teachings on traditional foods, helped expand the program to reach

community members—not just students and teachers at the community school.

Some of the unanticipated outcomes of the program were how connected recycling is with

Indigenous worldviews and nurturing Mother Earth. Finally, teachers noticed the importance of

having role models for younger children. Specifically, younger students responded exceptionally

well to older students teaching them about health choices.

19

The results of the focus groups were similar to the 2015 report and gave positive feedback on the

program. A suggestion was made to include community businesses, such as corner and grocery

stores, in the challenge to help promote healthy choices. For example, by lowering the price of

milk and bottled water, students would be more apt to buy nutritious food since they would be

able to afford it with their lunch money. It was also suggested to expand the program to be

implemented many times during the school year and even using the same model to teach children

about the dangers of other unhealthy choices, such as salt or fat.

There is also a lack of awareness from the resources that the Foundation provides to support

schools who implement the Drop the Pop Challenge. For example, in some cases the Foundation

is able to arrange for guest speakers to tell students about the benefits of making healthy

choices—many schools are not aware that they can ask for this service.

The Foundation also offers teaching tools and prizes that the schools can use to enhance the

Drop the Pop Challenge. Teachers present in both of the focus groups at North Memorial School

and Roseau Valley School had little knowledge about what programs and supportive services the

Kidney Foundation can/does offer. Both focus groups agreed that more contact with a

representative from the Foundation would be helpful and increase the long-term success of the

Drop the Pop Challenge (Ferris, Huard, and McDonnell, 2016; Ferris, Huard, McDonnell, and

Sillaby, 2016).

Conclusions and Recommendations Recommendations

The recommendations identify factors that facilitated and inhibited the implementation of the

project to determine ‘promising practices.’ Based on the evaluation the following

recommendations for the Drop the Pop Challenge are made:

1. The Foundation ideally should provide more support staff available to aid schools with

implementation and planning for the Drop the Pop Challenge. This support also allows

for donor relationship development, as many participants were unaware of what services

and programs the Foundation provides for Manitoba residents.

2. Increased funding for Kidney Foundation staffing, which enables staff to foster capacity

building with schools and mentorship from the Foundation in regards to healthy

alternative to sugary drinks and activities encouraging health lifestyle choice on an

annual basis. Access to the Foundation and its resources (such as guest speakers) would

greatly aid in the knowledge transfer for healthy lifestyle choices on a year-round basis.

3. The overwhelmingly positive perception of the program demonstrates that those who

were involved generally enjoyed participating in the challenge. Feedback from the focus

groups suggests that the challenge should take place more than once a school year.

4. The Drop the Pop Challenge should be expanded outside of schools and incorporated

into a larger community challenge.

5. Traditional knowledge and health teachings, including traditional medicines, should be

expanded upon in the Drop the Pop lesson plans and include more options for traditional

knowledge to be interwoven with the challenge.

20

6. Create a monthly spotlight section on the Foundation’s website that details the strengths

and successes of other schools, including how they overcame any challenges they

encountered and the various types of activities created for the children.

7. Create a section in the lesson plans and activities that looks into accountability for

students in the program; these should be open-ended suggestions (i.e. weekly sharing-

circles, drink diaries) that allow students to create their own methods for keeping one

another accountable.

8. There is a need for more research regarding how many schools use cultural practices,

ceremonies, or resources to help children learn more about how their culture(s) can help

them maintain their health.

Conclusions

Overall the evaluation was able to determine that the Drop the Pop Challenge has positive health

outcomes and is enjoyed by the majority of those who participate in it, with some longer lasting

healthy lifestyle changes being made by both teachers and students. For those who participated

in the focus groups, it was evident that awareness about the negative impacts of sugary drink

consumption and what the Foundation is and does greatly increased after contact from a Kidney

Foundation representative. All those involved in the evaluation process felt this aspect was an

integral aspect in implementing an effective program for the Foundation.

One of the repeated challenges identified, especially by teachers who implemented the program,

was that knowledge transmission of health concerns related to ingesting high amounts of sugar,

is not just aimed towards the students, but also the extended family members as well as the entire

community. For the program to create a positive behaviour change, the family must become

active in making healthier decisions for their health outcomes. If the children who participate in

the program continue to receive sugary drinks at home, the change in diet and sugar consumption

will only be temporary. So again, while the challenge is successful, a long-lasting and

sustainable change can only be made when sugar consumption decreases overall generally, not

just for the week-long challenge.

21

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979.

Birks, M., & Mills, J. (2011). Grounded theory: A practical guide. Sage publications.

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McGowan, K., & Rajotte, L. (2015) Care of Manitobans Living with Chronic Kidney Disease. Winnipeg,

MB. Manitoba Centre for Health Policy.

Dart, A. (2014). First Nation Community Based Screening to Improve Kidney Health and Prevent

Dialysis (FINISHED) Pediatric Perspectives. Presentation to the Nor-West Community Health Co-op.

Department of Health and Social Services of the Government of Nunavut (DHSSGN) (2006, 2007, 2008

and 2009). Drop the Pop. James Bay: Public Health Department of the Cree Board of Health and Social

Services.

Diabetes Integration Project (DIP). (2014). Addressing Type 2 Diabetes and Complications for Rural and

Remote First Nation Communities: The Manitoba Experience. Presentation provided at the University of

British Columbia’s Diabetes Educator Course. Winnipeg.

Ferris, M., Huard A., & McDonnell L. (2016). Talking circle/Focus Group: North Memorial School –

Portage la Prairie. Focus group transcript. Focus group conducted on March 8, 2016.

Ferris, M., Huard, A., McDonnell, L., & Sillaby, P. Evaluation – Focus Group #2 Notes. Roseau Valley

School. Focus group transcript. Focus group conducted on March 22, 2016.

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http://www.naho.ca/documents/fnc/english/FNC_OCAPCriticalAnalysis.pdf

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frame-cadre/index-eng.php#a3.0

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http://www.kidney.ca/document.doc?id=1376

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Resources

Program manager

$15,000 CN Rail Funding

Prizes from donors (water bottles, pens,

bags, etc.)

Information for schools: •  1) adaptable lesson

plans; •  2) cultural competence/

connection to Elders

Media/website

Volunteers

Office space (fax machine, computer, phone, email, etc.)

Activities

Call for applicants

Notifying which school have been selected

Providing lessons plans/information on

kidney disease to schools

Delivering the challenge

Outputs

Lessons plans given to the 12 participating

schools

DVD – Live With Hope and Kidney Disease

created

Prizes for participating schools

Healthy snack ideas for participating

schools

Incentive of $250 to each participating

school

Surveys/evaluation to be filled out by school

and returned to Kidney Foundation for

analysis

Participants Reached

Consumers of sugary drinks

Unhealthy/at-risk youth

School/community members

Outcomes (short-term)

Children learn more about the negative effects of sugary

drinks on their health

Schools have more resources and are

encouraged to promote health

Establish healthy lifestyles through an

Indigenous lens

Learn to respect Mother Earth by recycling/reusing

Outcomes (intermediate)

Families understand the need to support their child’s healthy

choices

Teacher will consider themselves as role

models and influence healthy behaviours

Influencing the community to re-use

and recycling

Outcomes (Long-term)

Lower incidences of diabetes, tooth decay, and obesity in children

and community

Mainstream Logic Model

Outcomes

Mind/Decisions

Body/

Actions s

Emotions/Reactions

Spirit/Values

*Children learn

more about the

dangers of

sugary drinks

and their health *Families

understand

the need to

support their

children

*Teachers think

about role-

modeling and

changing health

teachings

*Schools have

more resources

and

encouragement

to promote

health

*Kids make

healthier choices

Resources

• Media • Volunteers • Fax machines • Office space • Computers • Phone • Email

Resources

Program manager ->

$15,000 CN Rail Funding ->

Prizes (from donors) ->

Information for schools needs (easy to use lessons, cultural

competence/connection

to elders)

Activity

Call for applicants ->

Assessing applications->

Notifying selected school ->

Providing resources ->

Delivering the challenge

Lesson plans (12 schools) ->

DVD Live with Hope ->

Prizes (12 schools) ->

Healthy snacks (12 schools) ->

Anything that is purchased

(with $250)

Outputs

Larger Cultural

Outcomes

Entry Form for Schools in ManitobaPlease complete all fields. Submit your form by February 21, 2016, via: Email: mferris@kidney.mb.ca | Fax: 204.989.0815 | Mail: 1-452 Dovercourt Drive, Winnipeg, MB, R3Y 1G4

School name: Principal:

Mailing address:

Contact name: Community:

Email: Phone:

Your role: o Student o Teacher o Other:

About your idea (continue on the other side if you need more space) Date of challenge (must be at least five days in March 2016):

What grades/ages will you be engaging during the challenge?

Why do you want your school/community to take part in this challenge?

Describe your overall idea for helping children learn about why they should “Drop the Pop”:

Please provide us with a plan on what you would do with the reward money. A few examples include: buying fruit and vegetables to host a food tasting fair; buying blenders/fruit to teach children to make smoothies; buying milk to provide the children with a daily “healthy” drink during the challenge; using the funds for a special outing connected to traditional health; hiring an Elder who can help the children develop new skills; etc.

Aboriginal cultures are important for health and well-being. In which way(s) will your challenge incorporate culture?

Are you willing to complete an evaluation after the challenge ends? o yes o no o maybe

Thank you for completing this form. We will review all forms after the February 21 deadline. We will let all winners know of their success by February 26, 2016.

We acknowledge funding from CN for this program

DROP THE POP CHALLENGE

Appendix B.1 Huard, Anna March 11, 2016McDonnell, Leah

GDP 7791

Focus Group Questions –

Pre Test for Drop the Pop Challenge

1. How do you feel about consumptions of sugary drinks in the community and amongst your students?

a. Prompt: Do you know how much they’re drinking? b. What do you think about it? c. What do you think the connections are between health and sugary drinks?

2. What would you like the program to do?

a. Prompt: How do you think the progam will/will it affect you and your students? b. Family? c. Community? d. Is inclusion of traditional knowledge important?

3. If you had a magic wand, what would you want the program to do? a. Prompt: What are current issues in the community? I.e. housing, food, health?

4. In the long term, do you think this program could affect you and students sugary drink consumption?

a. What do you need to make program successful? b. Do you think the program will be successful? Why/why not? c. What support or series would you like to have?

5. What do you know about the Kidney Foundation?

a. What do your kidneys do? b. What does the Kidney Foundation do? c. What are some resources for you in dealing with Indigenous communities’ health

topics?

1

Appendix B.2

Tuesday March 08, 2016

Talking circle/Focus Group: North Memorial School- Portage La Prairie

11 participants present (Teachers and principal) 2 Interviewers (Leah and Anna) 1 Kidney Foundation Representative (Melanie) The focus group took place during the lunch hour (12:55-1:55 pm) in the teacher’s lunch room. Sandwiches, fruit, and vegetables were provided. The Kidney Foundation representative (Melanie) brought a package regarding the Drop the Pop Challenge that included various prizes, teaching curriculum, and tobacco ties as an offer. The tobacco ties are specific to First Nations culture and are a sign of respect. This also outlines the idea of reciprocity, that is an important factor for a First Nations worldview. The use of offering lunch is also an important aspect of reciprocity demonstrated by the Kidney Foundation and falling in line with Indigenous World views. Melanie gave a brief introduction of the Kidney Foundation and the program, while also explaining the importance of offering the tobacco in First Nations culture. There were two interviewers: Anna lead the group, while Leah took notes, asked supplementary questions, and completed the write up. Questions/Notes:

1. How do you feel about consumption of sugary drinks in the community and amongst your students?

a. Prompt: Do you know how much they’re drinking? b. What do you think about it? c. What do you think the connections are between health and sugary drinks?

Major health concerns were discussed by the teachers. Many were concerned about the sedentary lifestyle that children have although there was mention that half of the student body was active, while the other half was less. The students were described to be on a wide spectrum without a happy medium. There were also many children who have lived with health problems in their family -- many have seen their relatives with severe diabetes or receiving dialysis. Leah’s note- this is concerning as it leads to the normalization of serious health conditions.

2

Some of the teachers brought up that the children do not understand the connection of what is going into their bodies (i.e. sugar) and how that can result in serious health conditions for the future.

1. How much sugar are the students consuming? The teachers brought up the fact that children are not allowed to have sugar on school -- so any

sugar that they are consuming is off campus. Leah note- this means that the Drop the Pop challenge is a nice compliment to the activities that are already (and have been) taking place at the school. I believe this will aid in the challenge’s success. The teachers discussed that with the education around sugar consumption at the school and banning it from the premises, the children are also telling their parents that sugar is bad for them. One teacher remarked that when one child was offered pop for dinner, they told their parent they couldn’t have any because it was bad for them. The teachers then discussed how the banning of sugars on campus has had a direct benefit in the children's’ behaviour. However, they have only put the ban in place and are just starting with the education component to go along with why sugar are bad. Leah’s note- the Drop the Pop curriculum can provide some great advice and guidance on educating the youth on the dangers of overconsumption of sugar.

The principal then started to discuss how to go around nutritional information and healthy eating

without body-shaming or making anyone feel uncomfortable. The staff wants to make sure that everything on campus that takes place regarding healthy eating is not misconstrued to make any child feel bad about their physical appearance. This is also in keeping with First Nation’s focus on using a strength-based perspective in life/education. Leah’s note - this is a wonderful perspective to maintain while dealing with health and body image - the attention to this detail means that the staff have been thinking about this for a long time, in my opinion.

1. What would you like the program to do?

a. Prompt: How do you think the program will affect you and your students? b. Family? c. Community? d. Is inclusion of traditional knowledge important?

The teachers want to see the knowledge being transferred over to the home units, so the parents and guardians of the children can also make better choices from themselves and the children. Leah’s note- this seemed to be one of the most important points for the staff at the school. Without the parents and guardians being open to learning about sugary consumptions and making better choices, the health benefits will not fully be realized. The teachers then spoke about how they had been running a breakfast program for 18 years, provide healthy snacks during the day and healthy soups for lunch once a week.

3

1. What will be some challenges? The teachers were mainly in agreement that the home piece will be difficult. Education for the parents will be hard to do and the teachers hope to educate the children (that in turn can help educate the parents) to make better and healthier choices. They also brought out the confusing nature of shopping and how easy it is to buy something that is called juice, but is really just full of water and sugar. For example, as companies specifically market “punches” as juice, but punches are not natural juices and contain astronomically high amounts of sugars. The discussion around inclusion of First Nations culturally relevant approaches was touched upon, as the principal explained that there would be a split between wanting to include them and not wanting to include them from the parent’s and guardian's perspectives. The principal note that some families are interested in First Nations culture but about half the families follow Christian traditions rather than First Nation culture. Melanie asked a few questions:

1) How many people know what the kidneys do? 6/11 raised their hands. Melanie discussed briefly what the kidneys do in the body.

2) How many people know who the Kidney Foundation is? 11/11 Leah’s note - proving the Kidney Foundation does have a name for itself.

3) How many people know what the Kidney foundation does? 0/11 could answer although one person did say that the Kidney foundation fundraises a lot.

These questions let Melanie go into a greater discussion about what the foundation does and other supports that it offers to people in Canada. She then went into other details about other supports that are available for First Nations communities that the teachers seemed now as familiar with. Melanie then went through what other schools have done during the challenge to give the staff some ideas of what to do. She was able to show the teaching tools she had brought -- a bag of recycled drink containers as a teaching aid for children to learn how to read labels -- and answered other questions about what to replace sugary drinks with and how much sugar kids can consume a day. At this point, the teachers did not really know much about the challenge itself, as they had just applied for it and this was the first point of contact Melanie had with the teachers themselves, other than 1 teacher in particular. Melanie was able to use this time to discuss other schools that had doe the challenge, how these schools had administered the challenge, tips and tricks of how to run the challenge, and Melanie went through the various teaching aides the Kidney Foundation had supplied for the challenge. Leah’s note: Melanie gave off a very strong and supportive presence that showed her passion for the program. I believe the teachers responded very well to this and were incredibly open and receptive to myself and Anna as well.

4

Strengths: School took the initiatives to ban sugary drinks from school premises already The Drop the Pop Challenge is complimenting several other healthy food and education program the school has already been taking part in (some for several years). Weaknesses: It was pointed out by Melanie that Leah and Anna did not ensure to hear from everyone who was sitting at the table there were some participants that didn’t speak at all or spoke very little. Leah and Anna have made note of this for future interviews to create a better space and make sure everyone is heard from. The logistical setup of the focus group/sharing circle also became problematic as the facilitators were unable to see everyone's facial expressions, thusly, not able to make any notes about non-verbal cues or expressions made during the session. If the facilitators we re set up differently and able to see everyone in the room, it may have ensured that everyone was given a chance to speak and express their opinion and non-verbal data could have been noted. This will be taken into account for the next facilitation. Findings: There was a large push to have the knowledge learned from the children about health concerns translate to the family units outside of the school. There was not a large understanding of the program available to Indigenous students through the Kidney Foundation's support system and other areas. The face-to-face contact with the representative from the Kidney Foundation was positive, engaging and seemed to help answer questions the faculty had. The face-to-face interaction between Melanie and the school staff was important. Leah’s note - I think the interaction with Melanie and the support she offered (teaching tools, prizes, information) is integral for the success of the program. I believe the interaction with Melanie is integral for the greatest success of the program. The school staff were very happy with Melanie there and I also believe it aided in making the staff feel (and see how they are) supported.

Appendix B.3

GDP – 7791Student: Anna Huard

March 22, 2016

Evaluation – Focus Group #2 Notes

13 Participants3 Facilitators (Melanie, Leah and Paige)1 Note Taker (Anna)

Once we set up our focus group instruments and laid out the lunch that we had

provided, nine teachers had arrived (four more had trickled in just before the focus group

started). When everyone was seated and had a plate of food, Melanie handed out a

consent form to read over, as well as tobacco ties. She then stated the importance of

tobacco in Indigenous cultures and explained how accepting the tobacco ties meant that

they are consenting to the focus group. All teachers accepted the tobacco ties and the

focus group facilitators were introduced.

1. How many of you thought about your kidneys before you started administering

the Drop the Pop Challenge? Put your hand up to indicate a “Yes.” (One student

counts all responses, other records number)

Only two of the nine teachers raised their hands, meaning the majority of teachers did not

associate kidney health to the Drop the Pop challenge.

2. How many of you think about your kidneys NOW? Put your hand up to indicate a

“Yes.” (One student counts all responses, other records number)

Eight out of nine teacher raised their hands; therefore, almost all teachers were now

aware of the negative impacts of sugary drinks on their kidneys.

3. How many of you knew anything about the Kidney Foundation of Canada before

the Drop the Pop Challenge? Put your hand up to indicate a “Yes.” (One student

counts all responses, other records number)

All teachers agreed that they were aware of the Kidney Foundation of Canada prior to the

challenge.

4. How many of you feel you know something about the Kidney Foundation of

Canada NOW? Put your hand up to indicate a “Yes.” (One student counts all

responses, other records number)

Only one of the teachers knew what services the Kidney Foundation of Canada provides.

The other eight teachers were not sure what the foundation does, nor what they offer

outside of the Drop the Pop challenge.

5. What kinds of concerns do you have around the health of your students and/or

larger community?

Note: Facilitator to ensure that each attendee has a chance to contribute their

thoughts. We will record some notes on a flip chart to ensure all teachers have a

visual of what’s been shared for this question.

All teachers were asked to contribute their input for this question. Most teachers

expressed concern over unhealthy life choices, which could lead to diabetes. One teacher

said that many students do not come with a prepared lunch and rely on inexpensive,

processed foods from the corner store during the lunch hour. Since students have limited

funds, many purchase the largest quality of food for a lower price. This means that

students are often eating large bags of chips and bottles of pop because it is less costly

than nutritional foods. Due to the lack of choice in lunches for young students, teachers

feel that many children are malnourished, despite the options from the cafeteria and

breakfast program. Furthermore, younger students feel peer pressured to drink energy

drinks, such as Poweraid, because the older students are drinking it – this instils a sense

of popularity around consuming these drinks. In conclusion, the main themes of their

concern were risk of obesity, diabetes, lack of activity, and unaware of what is in their

food.

6. How has the Drop the Pop program influenced your students or children?

Most of the teachers claimed that they have seen less kids bringing litres of pop to school.

They felt that the challenge has opened up their options (such as choosing chocolate milk

or watering down juice) and are now awareness of what is in the food/drink. One teacher

has a mini fridge and offers to trade their unhealthy snacks and drinks for milk and water

or 100% fruit juice. The challenge has also inspired the local grocery store to offer free

fruit to customers while they are shopping. In conclusion, teacher have seen that kids are

now engaging in conversations about sugary drinks between peers and teachers, from all

ages (k-6) – many of the younger students are finding it “cool” to not like pop.

7. How has the program influenced your own behaviours?

One teacher felt very guilty about drinking a can of pop after the challenge. This program

has shown this teacher that you can make excuses to eat anything (mainly because of

habit) but this shows why you should self-reflect. Another teacher claimed that they now

look at sugar content on nutrition label than just calories.

8. What was the best part about the program?

All teachers agreed that making smoothies and engaging children to talk about healthy

life choices was the best part of the program for their students. Incentives, such as prizes,

were also beneficial.

9. What did you find challenging about the program?

A few teachers felt it to be a challenge to not have pop and continue conversations about

healthy life choices after the challenge. There were many key people who lead the

challenge but one teacher said that it could have been more successful to have a

collaborative effect between teachers. It was also difficult to engage all students to take

part in the challenge, especially for the kids who could benefit from the challenge the

most were also the most reluctant to participate.

10. How could the Kidney Foundation of Canada make the program more effective

for you as teachers, as well as for your students and community members?

A few teachers would have liked more hands-on visuals, such as someone on dialysis or

from the Kidney Foundation to come in and speak to the school. Most agreed that an

information event in the evening for parents would be beneficial. Although it would be

best to collaborate with corner/grocery store, most teachers felt it would be too difficult

to combat the economic drive of the stores. Another teacher felt it would be helpful to

have consistent education around healthy lifestyles and not just getting a reward for a

single behaviour. Most teachers also suggested engaging in a longer challenge, such as

doing it one week, every month.

11. Would you be interested in having your students do the challenge again in

November 2016?

All teachers said yes, even if it was just one day or week out of the month. One teacher

was encouraged to always have a mini fridge available for students to trade their

unhealthy snacks and drink. Many teacher also expressed wanting to expand the

challenge to mitigate other unhealthy life choices, such as Halt the Salt.

Melanie gave out prizes and talked about what kind of services the Kidney Foundation of

Canada provides. Everyone was very engaged; we made sure everyone was able to

contribute from the 5th question on.

1Appendix C.1

CODING Drop the Pop ChallengeAnalysis of 2015 Report

By: Paige SillabyThis section will assess the the Drop the Pop Challenge, Report to CN, December 2015. This report is complied from feedback at eight Manitoba schools that have already completed the Drop the Pop Challenge. From this report six themes have been identified.Report from following schools: Chief Clifford Lynxleg Anishnabe School, Duke of Marlborough School (Churchill), Joe A. Ross School (Opaskwayak Cree Nation), Langruth Elementary School (Langruth), Peter Yassie Memorial School (Tadoule Lake), Roseau Valley School (Roseau Valley), Walter Whyte School (Grand Marais), Waywayseecappo Community School (Waywayseecappo First Nation)Themes:

1) Knowledge transmission2) Change in behaviour3) Education and resources4) Program and implementation5) Incorporating culture into the Drop the Pop Challenge6) Unanticipated outcomes

Knowledge transmissionThe intergenerational effects of the Drop the Pop Challenge was important to consider for understanding the role of teachers and parents in the challenge. Based on the report, many schools stated that having children participate in challenge encourage parents to also Drop the Pop for a week. In addition, teachers were also noted as participating in the challenge. This is significant because it demonstrated that the challenge also provided awareness of the danger of sugary drinks to parents and teachers.

“… some students even encouraged their parents at home to quit drinking pop for that week” (Chief Clifford Lynxleg Anishnabe School)

“Teachers showed a healthy alternative and made fruit smoothies with milk, vanilla yogurt and frozen berries with the students and bannock” (Duke of Marlborough School) “Students continue to watch the drinks they consume and encourage their parents to do the same” (Duke of Marlborough School)

2

“Parents were invited in to look and presentations and to show the amount of sugar in pop” (Joe A. Ross School)

“Students brought in healthy family recipes… currently the school is in the process of putting a a Healthy Family cookbook” (Langruth Elementary School)

“Many of our students did complete the challenge along with some of their parents” (Peter Yassie Memorial School)

Change in behaviourThis program evaluation wanted to look at potential changes in children’s behaviour, during and after their participation in the Drop the Pop Challenge. Based on the report, many schools cited that pop consumption had decreased. Some students even traded in their liter bottles of pop. During the challenge students were able to trade in sugary drinks for healthy alternatives such as water and milk. An interesting behavior challenge includes the the increase in reusable bottles and a shift towards healthier drink alternatives, water, milk, and vitamin water.

“most of our students were bringing in re-usable water bottles with milk or water, instead of their regular, sugary juice” (Chief Clifford Lynxleg Anishnabe School)

“One students mother in the primary grades brought in soda by accident and the child’s eyes got big and he ran to his mother to tell her he could not drink it and he gave it back to her” (Joe A. Ross School)

“We saw a large increase of vitamin water and regular water for alternative beverage brought into the school for recess and gym time” (Peter Yassie Memorial School)

“The highlight for me was a grade 1 and grade 9 student who came up to me to trade their Pepsi that their parent had packed them for something better. The grade 9 boy was a particular victory as he regularly would bring in a 1-litre of pop” (Roseau Valley School)

“The amount of pop consumed in the school since the challenge has declined significantly because anytime pop is brought to the school by students, we exchange it for milk” (Waywayseecappo Community)

Education and Resources A couple of the school’s reported that health professionals such as nurses and dietitians came to the schools and did informative talks on the dangers of sugary drinks.

3

“Week started with a visit from the public health nurse, Shanna Hart Cowley, who taught about the amount of sugar in drinks such as pop, energy drinks, apple juice, chocolate milk, white milk and water” (Duke of Marlborough School)

“We worked in cooperation with the Public Health and the Dietitian who did presentation on having students measure out the sugar in a variety of drinks and discussed having healthy kidneys. Public Health disused diabetics, showed sugar cells and showed the dangers of sugar to the body using a model body. (Joe A. Ross School)

“Divisional Social Clinician spoke to the students about kidney health and the risk of diabetes and other health related problems” (Langruth Elementary School)

“Health department also ran stations that focused on the health alternatives we can eat and drink” (Waywayseecappo Community)

Program implementationAn important aspect of the report was looking at how the Drop the Pop Challenge was being implemented at the Manitoba schools. Many of the schools held interactive and delicious activities for the children participating in the challenge. For instance, a couple of the schools talked about, how much the children enjoyed smoothies. Looking at how the Drop the Pop Challenge is being implemented in schools is extremely important because it highlights how the schools are utilizing the materiel provided by the Kidney foundation. A couple of schools, talked about science experiments they did with the children, and drink exchange programs which demonstrates that children are being educated about the bad effects of sugary drinks.

Nursery children/ kindergarten- sang songs about why sugar is bad Grade 1 & 2- students were asked to draw a picture of what they thought sugar did to the body and why it is bad for the body.Grades 5, 6 & 7- some students used the information (from Drop the Pop Challenge) for their science projects, for example, what sugar/ pop does to the body, and its long term and short term effects (Chief Clifford Lynxleg Anishnabe School)

“A few classes placed an egg in different glasses of pop to see what would happen. They looked at the staining and deterioration of the egg. A YouTube video showed the students what would happen if a tooth was placed in a cup of coke from 48 hours” (Duke of Marlborough School)

“Milk and water was given out and all juice was traded for milk and water” (Joe A. Ross School)

“Students helped make and deliver 62 strawberry banana and 34 blueberry smoothies to all of our students and staff received some too” (Walter Whyte School)

4Incorporating Culture into Drop the Pop ChallengeIn additional to health awareness, our assessment looks at if and how community specific cultural practices, ceremonies and teachings are being applied to the Drop the Pop Challenge. In particular, one school explained how culture was incorporated at the beginning if the challenge with a community round dance, and continued through out the week. This was done through daily smudging.

“We started our event our event with a Round Dance. The Elders and leaders of the community were in attendance… The entire school top part in the round dance and it was started off by the drumming group” (Joe A. Ross School)

“We did smudging in the morning to help clear our minds… The Elders talked about when they were child and how they lived off the land and ate off the land” (Joe A. Ross School)

Mini health fair “community members were involved and did presentations on traditional food and how it was prepared” (Waywayseecappo Community)

Unanticipated outcomesWhen doing any program, there is going to be unanticipated outcomes, these vary from school to school. Some interesting outcomes include, a recycling program, older students being role models from young students, and lastly the structural changes. We can also connect these unanticipated outcomes to the importance of culture, as recycling is connected to Indigenous people’s beliefs that it is important to care for the earth and environment. As well, role modelling has been found to be an important concept in programs that promote health for Indigenous people. An Australian article on the psychosocial mediators of health found that, “role models were a key factor in the development of positive self-identity in Indigenous youth… self-identity is domain specific, meaning that while positive self-identity as a student led to better outcomes at school, there was no association with better outcomes in other domains” (Darwin, Contributors, & Shoemborn, 2009, p. 206)It is important to note that only positive outcomes were reported from the schools.

“extended the challenge a couple extra days due to the snow one day and some students not in attendance for the presentations” (Joe A. Ross School)

“Recycling was incorporated daily into the challenge as plastic water bottles and milk cartons were collected for recycling” (Joe A. Ross School)

“Students really seemed to respond to the older students teaching the younger students about healthier choices” (Joe A. Ross School)

5

“A couple weeks later during the Christmas party.... all they served the entire evening was water” (Joe A. Ross School)

“Many students were very interested in the challenge because a majority of them know someone with diabetes and/ or high blood pressure” (Peter Yassie Memorial School)

“Community saw the article in the Nickel Belt News, which led to a lot of positive feedback from the community members” (Peter Yassie Memorial School)

References

Darwin, N. T., Contributors, V., & Shoemborn, D. (2009). Leadership and role models for young Indigenous Australians involved in the Rumbalara Football Netball Club. Pimatisiwin, 7(2), 201. Retrieved fromhttp://www.pimatisiwin.com/online/wp-content/uploads/2010/jan/03O'BrienParadiesReilly.pdf

Appendix C.2

ExampleofDatatocodeAshernCentralSchoolByChelseaLowry,teacherAshernCentralSchooltookpartintheDropthePopChallengethelastweekinMarch.Thechallengewaspromotedtoallstudentsintheschool,grades5-12,fortheentiremonthofMarchleadinguptothechallengeweek.Thegrade9FoodsandNutritionstudentswereinchargeofinformingstudents,staffandparentsofthechallengetodropthepopandothersugarydrinksfortheweekofthechallenge.TheFoodsandNutritionstudentswhoranthechallengecreatedHealthyLivingDisplayswhichweresetupinthemulti-purposeroomintheschoolduringtheweekofthechallenge.Thestudentsalsopreparedhealthysnackstosharewiththeentireschoolasawayofpromotinganoverallhealthylifestyle.Thedisplayscoveredavarietyoftopics,includingHealthySnacking,HealthyEatingwithCanada’sFoodGuide,EatThisNotThat,andtheEffectsofDiabetesontheBody.Theyalsocreatedadisplaytoeducatestudentsonthenegativeeffectsofsugaronthebody,andtohighlighttheamountofsugarfoundinmanydrinks,includingpop,icedtea,sportsdrinksandenergydrinks.Thisdisplayremainsinadisplaycabinetneartheentrancetotheschool.Asafinalcelebrationforthechallengeweek,thestudentswhosuccessfullydroppedthepopandothersugarydrinksfortheentireweekweregivenare-usablewaterbottletohelpthemdropthepopforgood!!RuthBettsCommunitySchool,FlinFlonSubmittedbyLindaLoweTheDropthePopChallengehasproventobeasuccesshereatRuthBettsschool.Westartedthechallengebysettinguppresentationsforthekindergartentogradefiveclassrooms.Wepickeddifferentsubjectsforthedifferentgradesbasedonwhatwethoughtwouldgettheirattentioninawaytheywouldremember.Wealsofoundthattheydiscussedthepresentationswithchildrenofdifferentgrades,somanystudentshaveheardmorethanwhatwaspresented.Inkindergartenwetalkedaboutwhatsugardoestoourteethanddiscussedfoodsthatarehealthyforourbodyandteethcomparedtofoodsthataren't.Wethengavethemacolouringsheetshowingahappytoothsurroundedbydifferentfoods,andaskedthemtodrawlinesfromthehealthychoicestothetooth

Inthegrade1to3classroomswecomparedourteethtotheshellofanegg.Weexplainedthatpopisveryacidic,justlikevinegar,andletthekidspredictwhatwouldhappenifwelefttheegginthevinegarovernight.Wealsoleftaneggincokeovernightandaskediftheythoughttheeggwouldstillbewhitethenextday.Whenwereturnedthenextdaytheshelloftheegghadbeeneatenaway.Wetoldthekidsthatrepeatedexposuretohighlyaciddrinksandfood(likepop)woulddothesamethingtotheenamelofourteeth,andexplainedsomeofthepainsandproblemsthatwouldcomewiththis.Inthegrade4classroomweconductedablindwatertastetest.WepouredthreedifferentkindsofbottledwaterandsometapwaterintojugsmarkedA,B,C,andD.Afterthestudentshadalltriedeachdifferentwaterwehadthenrateeachwateroutof5.Attheveryendwevotedonwhichwatertheythoughtwastapwater,anddiscussedthebenefitsofdrinkingtapwater.Wecreatedadisplayforthehallwaywithourgrade4to5boy'sandgirl'sgroup.Weboughtavarietyofpopulardrinksandhadthekidsmeasureouttheamountsofsugarinthatdrink.Wesetupthedisplayinthemainhallwayandhadalmostallpeople(adultsandchildrenalike)stopandtakeinexactlyhowmuchsugarpeopledrink.Onthelastdayofourchallengewebroughthealthysmoothiestoeachoftheclassesasatastyalternativetopopandothersugarydrinks.Wewantedtoshowthemthatitdoesn'tneedtobeloadedwithaddedsugartotastelikeatreat.Thischallengehasbeenasuccessinourschoolbecauseithasvisiblymadepeopleherestopandthinkabouthowunhealthysomeofthechoiceswemakeare.Wehopethatopeningthesestudent’seyeswillhelpthemmakehealthierchoicesinthefuture.

Appendix D.1

CONSENTFORMFORIN-PERSONFOCUSGROUP

You’reinvitedtovoluntarilytakepartinanevaluationstudyontheDropthePopChallenge.ThestudywillbeconductedbyLeahMcDonnell,PaigeSillabyandAnnaHuard,allgraduatestudentsintheMastersofDevelopmentPracticeinIndigenousDevelopmentattheUniversityofWinnipeg,incollaborationwithMelanieFerris,theKidneyHealthandCommunicationsManagerattheKidneyFoundationofCanada–ManitobaBranch.Yourparticipationiscompletelyvoluntary. Purposeofthestudy:You’llbeaskedtoengageinafocusgroupinpersonatyourschool,completingthefocusgroupwilltakeabout30minutes.Thebenefitsofthisevaluationwillindicatewhethertheprogramgoalsarebeingachieved,whatthestrengthsandweaknessesoftheprogramare,andifneeded,guideusonimprovingtheprogram.Allparticipantsmustbeatleast18yearsofagetoparticipateinthestudy. Yourvoluntaryparticipationwillinvolveacommitmentofabout30minutestoanswersomeopen-endedquestionsonyourobservationsandinsightsoftheprogramasagroup.Wewillaskthegroupaseriesofquestionsabouthowperceivethehealthstatusofyourstudentsandwhetherthestudentbodywillbenefitfromtheprogram.Wewillaskyouquestionsandmakewrittennotesofyouranswers.Youmayrefusetoanswerquestionsyouprefernottoanswer.Youarefreetowithdrawfromtheevaluationatanytimebeforethecompletionofthefinalreportwithoutconsequence. We’llkeepyourresponsesinalockedcabinetinanofficeattheKidneyFoundationofCanada–ManitobaBranch.We’llkeeptheconsentformsseparatefromthefocusgroupresponses.We’llkeepyouridentityconfidentialbyusinganumbercodingsystem.Nooneelsewillhaveaccesstoyourresponses.Wewillnottape-recordorvideotapethefocusgroups.Followingthepreparationofthefinalreport,we’llshredyourresponseswithinoneyear(March2017).We’ll

reportdatacollectedfromthefocusgroupinaggregateformonly.Wemaypresentresultsofthestudyataconferenceand/orpublishtheminabookorarticle. Weareaccountabletoyoufortheaccuracyoftheinformationandforotheraspectsoftheresearch.Ifyouhaveanyquestionsorconcernsaboutthework,weencourageyoutoemailusatmferris@kidney.mb.ca.Youcanalsocontactusifyoulaterdecideyoudonotwantustousetheanswersyougaveus.ThiswouldbeokayanytimebeforeApril15,2016.WearealsoaccountabletotheUniversityofWinnipeg,UniversityHumanResearchEthicsBoard.Ifyouhaveanyremainingconcernsaboutthewaythisstudyisconducted,youmaycontacttheEthicsBoardbyphoningtheProgramOfficerat204-786-9058oremailingethics@uwinnipeg.ca. Pleasecheckone:

□ Iagreetoparticipateintheevaluationstudydescribedabove. □ Idonotagreetoparticipateintheevaluationstudydescribedabove.

□ Oralconsentisindicated

If I want to use a positive quote/excerpt from your interview in the final report, withoutspecificallyidentifyingyou,doyouconsenttothis?Yes___No____ Name(pleaseprint):___________________________________________________________ Yoursignature:______________________________________Date:___________________

PrincipalInvestigator’ssignatures:_____________________Date:____________

_____________________Date:____________ _____________________Date:____________

Acopyofthisconsentformwillbeprovidedtoyou. Thankyouforyourconsiderationofthisrequest.

AppendixD.2 Drop the Pop Challenge Evaluation: Pre-Challenge Survey The following is pre and post-test that will be distributed to students (grade two to grade six) that are participating in a Drop the Pop Challenge. This is because children that are under this grade level will not have the skills/ reading ability to do the pre and post test. Pre and post-tests are a quantitative instrument for gathering data at the being and at the end of a program. These surveys apply simple language in order to ensure that children can complete the survey, however, some support might be needed for the younger children. The tests are beneficial because they will highlight any improvement in children’s understanding of the negative impacts of sugary drinks, and provide statistics on how many children participate in Drop the Pop Challenge.

The Kidney Foundation needs your help! Tell us what you think about the Drop the Pop Challenge.

**All information will remain anonymous **School Name: _____________________________Grade: _____________________________Community: _____________________________On average, how many sugary drinks (Pepsi, Dr. Pepper, juice) do you have per week?

a) under 2 b) 3-4 c) 5-6 d) over 7

How many sugary drinks (Pepsi, Dr. Pepper, juice) do you think you should be drinking per week?

a) under 2 b) 3-4 c) 5-6 d) over 7

In the chart below, check mark the box that best answers the sentence.

Sentence/ Statement Yes!! Definitely

Yah, I think so

Maybe a little

Umm… I don’t

think so

No Way! Not at all

Drinking pop is bad for your health. You can become overweight from drinking too many sugary drinks. (eg, Pepsi, Dr. Pepper, juice)

Sugary drinks are good for your teeth.

Drinking water is better than drinking sugary drinks (eg, Pepsi, Dr. Pepper, juice)

Drinking too many sugary drinks causes Type 2 diabetes.

Pop does not contain caffeine.

Drop the Pop Challenge Evaluation: Post-Challenge Survey

The Kidney Foundation needs your help! Tell us what you think about the Drop the Pop Challenge.

Your input is greatly appreciated. **All information will remain anonymous **

School Name: _____________________________Grade: _____________________________Community: _____________________________

Did you successfully Drop the Pop for one week (5 days)?� Yes � No

After participating in the Drop the Pop Challenge, do you think sugary drinks. (eg, Pepsi, Dr. Pepper, juice) are bad for you ?

� Yes � No

Why or why not?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In the chart below, check mark the box that best answers the sentence.

Sentence/ Statement Yes!! Definitely

Yah, I think so

Maybe a little

Umm… I don’t

think so

No Way! Not at all

Drinking pop is bad for your health. You can become overweight from drinking too many sugary drinks. (eg, Pepsi, Dr. Pepper, juice)

Sugary drinks are good for your teeth.

Drinking water is better than drinking sugary drinks (eg, Pepsi, Dr. Pepper, juice)

Drinking too many sugary drinks causes Type 2 diabetes.

Pop does not contain caffeine. There is potential for intergenerational effects as a result of the Drop the Pop Challenge which this survey seeks to evaluate. The following is a survey that will be distributed to parents and teachers of children that are participating in the Drop the Pop Challenge. The Kidney Foundation will send the surveys to a participating school. From there, it will be school’s responsibility to give to teachers and to send home with children. Completed surveys will be returned to the school’s head office. Once there have been collected, they will be sent to the Kidney Foundation for analysis.

Drop the Pop Evaluation Survey

Please help the Kidney Foundation improve our Drop the Pop Challenge by filling out the following evaluation survey. The purpose of this survey is to contribute to the assessment of the Drop the Pop Challenge at the various host schools in Manitoba. We value your feedback and will try to incorporate your idea into future Drop Pop Challenges.

**All information will remain anonymous. **

1.) What is your occupation? (eg, parent, teacher): __________________

2.) School: _______________________________________________

3.) Community: _______________________________________________

4.) How did you learn about the Drop the Pop Challenge? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6.) On average how many sugary beverages to do you consume in per week? (Please circle)

a) Under 2

b) 3 to 4

c) 5 to 6

d) over 7

In the chart below rate your agreement level for the following statements.

Strongly Disagree Disagree Neutral Agree Strongly Agree

7.) Consumption of sugary drinks has a negative effect on health.

8.) Consumption of sugary drinks is high among Aboriginal communities.

9.) Drop the Pop Challenge provided opportunities for community (parents, and teachers) to become involved.

10.) Drop the Pop Challenge improved your knowledge of the impacts of sugary drinks. (eg, Pepsi, Dr. Pepper, juice)

11.) Drop the Pop Challenge provided sufficient educational material on alternatives to sugary drinks.

12.) Drop the Pop Challenge educated children on the benefits of healthy eating and lifestyle

choices.

13.) Drop the Pop Challenge has created health awareness for teachers.

14.) Drop the Pop Challenge has created health awareness for school boards.

15.) There was a cultural component to the Drop the Pop Challenge? For example: smudging, education on traditional foods etc.

16.) Did you notice any behavioral changes in the children that participated in the Drop the Pop Challenge?

17.) Did you notice any attitude changes in the children that participated in the Drop the Pop Challenge?

18.) Did the Drop the Pop Challenge meet its goal; to decrease consumptions of sugary drinks by children and teens in Manitoba’s First

Nations Communities?

19.) Did the Drop the Pop Challenge meet its goal; to make students, parents, and community members aware of the harmful health effects of sugary drinks.

20.) Did the Drop the Pop Challenge meet its goal; to promote water and milk as alternatives to sugary drinks?

21.) What are 3 things you like about the Drop the Pop Challenge?

1)____________________________________________________________________________2) ___________________________________________________________________________

3)____________________________________________________________________________

22.) Do you have any suggestions on how to improve the Drop the Pop Challenge?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Strongly Agree Agree Neutral Disagree Strongly Disagree23.) I would recommend the Drop the Pop Challenge to other schools?

22.) This space is for any additional comments on the Drop the Pop Challenge.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Miigwetch/ Thank you for your participation!

Appendix D.3

Evaluating the Drop the Pop Challenge Dearteachers:WeappreciateyourfeedbackontheDropthePopChallenge.Thishelpsusensurethatfutureactivitiesmeetyourneedsandexpectations.Pleasereturnyourcompletedevaluationformto:

• thepersoninchargeofthechallengeforyourschool;• TheKidneyFoundation’sfaxat(204)989-0815;orby• Email:mferris@kidney.mb.ca

School:________________________________

Grade:_________________________________

Community:____________________________

1 Howdoyouratethefollowingaspectsofthechallenge?

1–Poor2–Fair3–Good4–VeryGood5–ExcellentN/A–Notapplicable

Content 1 2 3 4 5

Howdoyouratethecontentoftheteachers’guidebook?

Didyoudoeducationalactivitiesfocusedonnutrition?Yes£No£Ifyes,howdoyouratethem?

Didyoudoeducationalactivitiesfocusedonoralhealth?Yes£No£Ifyes,howdoyouratethem?

Didyoudoactivitiesfocusedonenvironment?Yes£No£Ifyes,howdoyouratethem?

1–Poor2–Fair3–Good4–VeryGood5-Excellent

Organizationandmaterials 1 2 3 4 5

Durationofthechallenge(5days)

Timingofthechallenge(March)

Distributionoftheactivitiesaccordingtogrades

Thestructureanddesignoftheteacher’sguide

Prizes(purchasedbyyourschool)

General

General 1 2 3 4 5

Overall,howdoyourateDropthePopChallenge?

2 Whicheducationalactivitiesdidyoudoinyourclass?Pleasewritethenamesofthelessonsbelow:

3 AreyouinterestedintakingpartintheDropthePopChallengeinNovember2016?

£Yes£NoPleaseexplain:

4Howcanweimprovethischallenge?

Miigwetch/thank you for taking part!

Fill out thesurvey asbest as youcan!

1 1

2 2

3 3

Appendix D.4

AppendixD.5Picture/surveyanalysisdatacompilation

Column1 Column2 Column3 Column4 Column5 Column6Positive NegativeNopop 4 Nothing 22Gottohavesmooties 13 Nopop 14Likedotherdrinks 20 Poplewerecheating 6Feltgood/healthy 8 Hadlessenergy 2Gottoeatyogurt 5 Tooeasy 4Activities 19 Toohealthy 1Prizes 10 Notenoughsupport 1Educational 1 Kidshelptoomuch 1DTPwaseasy Only1thing 3Energy 2 Noawarenessfordietpop 1Nolittering 1 Poplecomplained 1Healthsnacksprovided 2

N-43