The Relationship Between Health Belief Model Constructs and Elementary Teachers' Use of Food Rewards

Background

Teachers’ actions can influence student health and eating preferences. However, few school policies adequately address classroom food practices. Despite recommendations to the contrary, food rewards are often used to manage student behavior and recognize academic success.

Objective

To examine the association between elementary teacher use of food rewards and constructs of the Health Belief Model (HBM).

Study Design, Settings, Participants

Elementary school teachers (n=256) from schools located within the midwestern region of the United States completed an online survey which included demographic questions and rating scales to measure a) the types and frequency of classroom food rewards, b) perceived health and wellbeing threats associated with the use of food rewards, c) perceived barriers to de-implementing the use of food rewards, and d) awareness of food policy cues relating to classroom food rewards.

Measurable Outcome/Analysis

Pearson correlation coefficients were used to measure the association between food reward frequency and scores for each of the HBM constructs. Multiple regression analysis was used to predict food reward frequency and scores for perceived threat, perceived barriers to de-implementing the use of food rewards, and school food policy cues.

Results

Candy was the most frequently used food reward and only 14% (n=35) reported that food rewards were never used. In the univariant analysis, food reward frequency was negatively correlated with school food policy cues (r=-.22, p<.01) and positively correlated with barriers to de-implementing food rewards (r=.47, p<.01). The multiple regression analysis predicted food reward frequency [R2=22, F (3,247) 23.62, p<.001], but only barriers to de-implementing food rewards (β=.45; p<.001) contributed significantly to the prediction.

Conclusions

Teachers do not understand the risks associated with the use of food rewards. Barriers to de-implementation, but not perceived threats or school food policy cues to action, influenced the frequency of food rewards in this sample of elementary school classrooms. The findings of this study have future implications for efficacious policy and training for the discontinuation of the use of food rewards in classrooms.

Funding

Kansas State University Health and Human Sciences Graduate Student Research Award, Kansas State University Arts, Humanities, and Social Sciences Small Grant