1

ToyBox Study Malaysia

WORKSHOP 2 : THEORY OF CHANGE (TOC) MEETING WITH TOYBOX MALAYSIA STAKEHOLDERS

Vistana Hotel, Kuala Lumpur, 22 – 24 May 2017

WORKSHOP AIMS

1. To revise and adapt the ToyBox Study Module in line with FGD session (based ontranscripts from FGD sessions conducted in KL and Sarawak)

2. To finalise the four main components of ToyBox Malaysia Study Module3. To discuss and prepare a TOC for the implementation of the ToyBox Study Malaysia

WORKSHOP PARTICIPANTS

PARTICIPANTS LIST (DAY 1 & DAY 2)

Researchers:

1. Prof Dr Cecila Essau (Roehampton, TOC Expert)2. Prof Dr Poh Bee Koon (UKM, Malaysian Project Leader)3. Assoc Prof Dr Cheah Whye Lian (UNIMAS Project Leader)4. Prof Dr Ruzita Abd Talib (UKM)5. Dr Julia Lee Ai Cheng (UNIMAS)6. Dr Denise Koh Choon Lian (UKM)

Post-doctoral Researcher:

1. Dr Rafidah Aini Pakri Mohamed (UKM Post-doc cum Project Manager)

Post-graduate Students:

1. Noor Hafizah Yatiman (UKM PhD student)2. Gordon Nicolaus Jemat Anchang (UNIMAS PhD student)3. Wan Nurul Najwa bt Wan Nik (UKM Masters student)4. Muhammad Zulhanif bin Mohd Haron (UKM Masters student)5. Enoch Hung Shu Rong (UNIMAS Masters student)6. Nurul Afiqah bt Ahmad Saberi (Masters student)

Invited :

1. Dr Melvin Chung (UNIMAS DPH student)

2

PARTICIPANTS LIST (DAY 3) Researchers: 1. Prof Dr Cecila Essau (Roehampton, TOC Expert) 2. Prof Dr Poh Bee Koon (UKM, Malaysian Project Leader) 3. Prof Dr Ruzita Abd Talib (UKM) 4. Dr Denise Koh Choon Lian (UKM) Post-doctoral Researcher: 1. Dr Rafidah Aini Pakri Mohamed (UKM Post-doc cum Project Manager) Post-graduate Students: 1. Noor Hafizah Yatiman (UKM PhD candidate) 2. Wan Nurul Najwa bt Wan Nik (UKM Masters student) 3. Muhammad Zulhanif bin Mohd Haron (UKM Masters student) 4. Nurul Afiqah bt Ahmad Saberi (UKM Masters student) KEMAS Officers : 1. Cik Khairun Nisa' Binti Roshdi (Pegawai Alat Bantuan Pembelajaran) 2. Puan Nurul Izzati binti Hj Mohd Zain (Pegawai Kurikulum) 3. Nor Azelawati Binti Zainal (Pegawai Operasi KL) 4. Lindawati Hj Padiel (Pegawai Sarawak) 5. Zurain binti Abdul Rahim (KEMAS Negeri Selangor) 6. Sherill Aida binti Mohd Sirin (KEMAS Negeri Selangor) Teachers : 1. Wan Anis Erneey Wan Rya (PM Tabika Kemas Taman Jaya 2) 2. Kamisah binti Mat Som (PM Tabika Taman Angkasa 2) 3. Nur Aziah binti Jasni (PM Tabika Kemas Setia Bakti, DTHO) 4. Norlelah binti Sanang (PPMS Tabika Kemas Setia Bakti, DTHO) 5. Noor Hafiza binti Anjang Ali Othman (PM Tabika Komuniti Court 2) 6. Nor Khasni bin Shariff (PM Tabika Komuniti Court 2) 7. Zaini binti Hassan (PM Tabika Komuniti Court 2) 8. Haslina binti Kamaruzaman (PM Tabika Mentari Court) 9. Roslinda binti Zakaria (PM Tabika Mentari Court) Parents : 1. Mahfuzah binti Wahab (Tabika Taman Jaya 2) 2. Siti Zubaida binti Othman (Tabika Taman Angkasa 2) 3. Raja Mohd Shafiq bin Raja Shaharudin (Tabika SS 4A Kelana Jaya) 4. Hafiz bin Mohd Nor (Tabika SS 4A Kelana Jaya) 5. En Asyren bin Arsyad (Tabika SS 4A Kelana Jaya)

3

WORKSHOP SUMMARY REPORT DAY 1: 22 MAY 2017 (MONDAY) To kick-off the 3 day workshop : l Prof Poh explained the aims of the 3-day workshop l Assoc Prof Dr Cheah Whye Lian presented the transcript from FGD sessions conducted

in Sarawak l Noor Hafizah Yatiman presented the transcript from FGD sessions conducted in Kuala

Lumpur l Prof Cecilia gave some information tips on how to revise and adapt the ToyBox Study

Module in line with FGD session SESSION 1: Adaptation of ToyBox Study Modules/Components Aims of Session 1 1. To revise, adapt and finalise all 4 revised modules in line with input from FGD (Focus

Group Discussion) session in KL and Sarawak

Participants Grouping :

a) Drinking - Afiqah & Prof Ruzita b) Eating & Snacking - Najwa, Pjad & Dr Julia c) Physical Activity - Gordon, Dr Cheah & Dr Rafidah d) Sedentary Behaviour - Zulhanif, Enoch & Dr Denise

2. Presentation of Revised ToyBox Module that contain either adopted / adapted component in each module based on Malaysian scenario and culture & FGD input

Drinking Module Presenter : Nurul Afiqah bt Ahmad Saberi l Changes of certain drinking item in the module to local Malaysian drinks l Changes of picture in the module to local Malaysian kids with similar age l Gave suggestion in terms of method of delivery (email, magnet poster A4 size) l Suggest to bring the kids to animal farm or food factory (Excursion)

Eating & Snacking Module Presenter : Wan Nurul Najwa bt Wan Nik l Suggest to combine both Eating & Snacking and Drinking Newsletter on week 9 l Replace certain food / fruits in the module to local Malaysians food l Suggest traffic light to be added in Newsletter 1 for food classification l Suggest to bring the kids to bakery and farm (Excursion) Physical Activity Module Presenter : Gordon Nicolaus Jemat Anchang l Suggest Poster to be in fishtail form and dual language l Tips Card to be designed like a calender and stickers for parents participation l Changes of text in Newsletter 1 & 2 according to Malaysian context

4

l Suggest to remove the questions for club activities. For e.g. “Adakah anak anda ahli kepada kelab sukan tersebut?” D8-D10 based on feedback from FGD session in Kuala Lumpur and Sarawak l Suggest to bring the kids to visit Museum, Theme / Recreation Park

Sedentary Behaviour Module Presenter : Muhammad Zulhanif bin Mohd Haron l Suggest all the newsletter to be send through email and watsapp group l Tips Card to be designed like a calender and stickers for parents participation l Suggest to do activities in Tips Card like Drawing / Colouring / Puzzle / Cooking with parents while standing l Suggest to replace the screen time to iPad and Mobile Phone and not just on TV l Suggest to have a movement stations according to the themes : Animals, Books, Friends, Family, Around the World and Local celebrations (Chinese New Year, Gawai, Hari Raya Aidilfitri) l Suggest to have 1 to 5 minutes between sedentary activities l Suggest to have classroom activities such as College of Fun Activities and Television Bingo under Art & Craft Time l Suggest parents to reinforce the activities in Newsletter 1 at home and be a role model to their kids l Encourange the parents to monitor their children’s screen time behaviour

3. To share experience on conducting a preschooler intervention program in KEMAS

kindergartens in Sarawak

Intervention Project Presentation : Dr Melvin Chung l Dr Melvin shared his experience conducting his PhD project in Bau, Sarawak and the

challenges he faced throughout the journey and some solutions to overcome the problems

Output from Session 1 1. Each component in the Module was thoroughly discussed together with input from FGD,

revised and presented to the whole team. 2. For some modules, all components/contents were adopted, but with suitable

modifications to suit the Malaysian (KL & Sarawak scenario). 3. Discussions and decisions were made for specific issues that arose from the

presentations of each module. What next? Revised ToyBox Module will be translated into Malay for use with KEMAS pre-schoolers in Malaysia (Kuala Lumpur & Sarawak).

5

DAY 2 : 23 MAY 2017 (TUESDAY) SESSION 2 : TOC MAPPING Aims of Session 2 1. To learn how to conduct a TOC Workshop 2. To prepare Powerpoint Module for TOC Workshop 3. To discuss and finalise the TOC Mapping 4. To create the TOC Map with its various components, impacts, outcomes, indicators,

interventions, assumptions / rationale and pathways Participants Grouping : a) Drinking - Afiqah & Prof Ruzita

Eating & Snacking - Najwa, Pjad & Dr Julia

b) Physical Activity - Gordon, Dr Cheah & Dr Rafidah Sedentary Behaviour - Zulhanif, Enoch & Dr Denise

Output from Session 2 1. Prof Cecilia presented the Theory of Change Map 2. Each major component in TOC Map were throughly explained to the participants by Prof Cecilia

Terminology Definition Examples

Impact (ultimate outcome, goal)

The program may contribute towards achieving this impact.

Is to improve health, productivity and economy of the country…

Long-term outcome Final outcome of the program is able to change on its own.

Primary outcome : Reduce rates of obesity in the population in the next 25 years. Secondary outcome : Improve quality of life

Intermediate outcomes (preconditions, milestone)

The intended results of the interventions. Things that don’t exist now, but need to exist in order for the logical causal chain not to be broken and the impact achieved.

Improve the knowledge among all the stakeholders. Drinking, Eating & Snacking, Sedentary and Physical Activity behaviors of the target population.

Ceiling of accountability Level at which you stop measuring whether the intermediate outcomes have been achieved and therefore stop accepting responsibility for achieving those intermediate outcomes.

At 2nd follow-up. Note : 4 months + 2 months then measure Follow-up evaluation after 4 months’ of intervention, then 2 months (repeat) and then follow-up.

6

Indicator Things you can measure to determine whether you are making progress towards or have achieved.

1) Drinking, Eating, Physical & Sedentary = Log Book obtained by Implementation Team.

2) Core-Q Primary Care Giver questionnaire – water, drinking – all factors. Provide FFQ data (baseline, follow-up)

3) Parents’ post intervention - Motivation of parents to change the behaviour

4) Teacher’s training evaluation Q – personal perspective of the ToyBox programme

5) Teachers’ post intervention - Receptivity of the ToyBox project, perception about how ToyBox contribute to the 4 indicators.

6) Teachers’ training researcher report questionnaire - Receptivity (teachers showed interest on the presentation and the programme in general and actively participated with questions and suggestions).

Assumptions External condition beyond the control

of the project that must exist for the intermediate outcome to be achieved.

1) Kemas HQ support 2) Parents’ support the ToyBox

programme and can understand the newsletters and tip cards.

3) Parents are receptive of the ToyBox programme.

4) Teachers have the time and are interested to be trained.

5) Implementation team supports the ToyBox programme

6) Children internalize, maintain, and act on what they have learned about ToyBox.

7) Innovation team (parents, teachers, HQ officers) will champion the ToyBox programme.

8) Specialist team (ToyBox project team members= UK, Gr) are very dedicated and committed to the ToyBox programme.

9) Language compatibility (translate to Iban/Bidayuh/Sarawak/ Malay)

Intervention (strategies) • Different components of the

complex intervention. • Dotted arrow: to show when an

intervention is needed to move from one intermediate outcome to the next.

• Solid arrow: when an intermediate outcome leads to the next without the need for any intervention.

• Newsletters, Tip cards • TOT (Training of Trainers) • Social media (e.g., whatsapp, website,

FB….) • Launching/Recruitment strategies • Appreciation and public dissemination–

to ensure sustainability. • Monitoring of the whole process and

indicators by the Implementation Team.

Rationale • Key beliefs that underlie why one intermediate outcome is a precondition for the next, and why certain activities are needed to

• Evidence that kindergarteners-based, family-involved intervention increase among preschool children and more likely to change their behaviors in

7

produce the desired intermediate outcomes. Can be based on evidence or experience.

terms of drinking, eating, snacking, and physical activity (De Craemer et al., 2014, IJBNPA).

• Primary caregivers can give reliable reports on preschoolers (Gonzalez-Gil et al., 2014, Obesity Review)

3. Prof Cecilia explained about each stage of the TOC process

Stage 1: Context for the Initiative

ü Analysis of the problem and issues ü Mapping of actors, stakeholders and power relations in the context. ü Receptiveness of stakeholders in the program.

Stage 2: Long-term Change ü How will the problem change? ü What changes in practice? ü How will the stakeholders behaviour change? ü How does the research project contribute? ü For whom it is significant?

Stage 3: Sequence of Events (Patway of Change) ü Show the complete set of necessary and sufficient preconditions that must exist prior to the existance

of the long-term goal ü "Backwards mapping" Stage 4: Assumptions ü Assumptions are the theories in a TOC process.

Stage 5: Diagram and Narrative Summary

4. The team and Prof Cecilia discussed and prepare a TOC Guideline Questions with the Stakeholders (KEMAS HQ, Teachers, Assistance Teachers and Parents)

Obesity and Health Discussion u What is your perception about childhood obesity? Is it bad to his/her health? u What do you want for your child in terms of his/her quality of life and health? u What action would you take if your child is obese?

ToyBox Implementation u What do you see are the challenges in the implementation of the ToyBox in your kindergarten in term

of :

² Time to participate in training (three times) ² Fitting into current school schedule ² Doing extra activities as part of the program. For example: excursion,

updating logbook, attending monthly project meeting, supporting parents (Newsletters & Tip Card) ² In case of injuries (during physical activities and excursion), Are teachers trained with first aid

kits? (if no , do you need us to provide?)

8

u Are you willing to stay until the end of the programme? u Are you willing to participant in the training or in the whole programme? u Do you think the ToyBox activities can fit into your school schedule? u Is this project an extra workload to you? u Do you think you can commit to the logbook? u Would you like to have excursions as part of the programme?

Parents u What are the challenges that you see as parents in implementing the ToyBox activities (for xample :

eating healthy food, drinking water, having regular physical activities, less sugary food) u Are you willing to be good role models in terms of health, physical activity, and eating habits? u What are the limitations that prevent you to follow the programme or to implement good eating,

snacking, drinking, and physical activity habits? u What motivates you to follow the programme or to implement good eating, snacking, drinking, and

physical activity habits? u What are your suggestions to overcome the barriers mentioned above? u How can teachers and parents collaborate more effectively in executing the Toybox programme? u How do you monitor your child eating, drinking, physical activities and screen time? u Are you willing to let your child put on the accelerometer (define for the TOC participants)? Are you

willing to take good care of the accelerometer? u Are you willing to read and learn from the newsletter and tip cards and to carry out this

programme? Means of communication u What is a suitable form of communication? u Are you willing to be part of a social media group (Whatsapp, FB, Telegram)? u Is there a suitable day in the week to distribute/receive newsletter and tip card (printed)? (e.g Monday,

Friday) u If we can send soft copy through e-mail/whatsapp group u What is a suitable form of communication?

5. Dr Cheah presented some ideas for the TOC Mapping based on the Revised ToyBox

Module in line with FGD discussion output from both KL and Sarawak team.

Component on TOC Maping : a) Resources : Recruitment, Training & Programme set up, Implementation of Intervention, Outcomes and

Impact b) Innovation Team : Individual who remind the people whom we have trained (booster session) c) Implementation Team : Individu who regularly go to school to make sure the staff deliver the training,

comply with what they are supposed to do and also talk to the parents. Usually Implementation Team consist of Teachers, Assistance Teachers, Parents and also UKM/UNIMAS Team. Implemetation Team also tend to act as an Intermediary team

d) ToyBox Specialist : UKM/UNIMAS Team

9

DAY 3 : 24 MAY 2017 (WEDNESDAY) SESSION 3 : TOC MAPPING DISCUSSION WITH KEMAS STAKEHOLDERS Aims of Session 3 1) To conduct TOC session with KEMAS stakeholders in small groups 2) To investigate the barriers for the implementation of the Toybox Study program in a new

setting 3) To discuss the solutions to overcome those barriers with the key stakeholders (Putrajaya

Officers, Kindergarten Teachers, Assistance Teachers & Parents) Participants Grouping : Overall Facilitator: Prof Cecilia Essau (Roehampton) Group 1 : Noor Hafizah Yatiman (UKM) Muhammad Zulhanif bin Mohd Haron (UKM) Wan Anis Erneey Wan Rya Noor Hafiza binti Anjang Ali Othman Cik Khairun Nisa' binti Roshdi Nor Azelawati binti Zainal Group 2 : Prof Ruzita Abd Talib (UKM) Nurul Afiqah bt Ahmad Saberi (UKM) Siti Zubaida binti Othman Hafiz bin Mohd Nor Nur Aziah binti Jasni Nor Khasni bin Shariff Cik Nurul Izzati Group 3 : Dr Denise Koh (UKM) Wan Nurul Najwa bt Wan Nik (UKM) En Asyren bin Arsyad Kamisah binti Mat Som Zaini binti Hassan Roslinda binti Zakaria Pn. Lindawati Padill Group 4 : Prof Poh Bee Koon (UKM) Dr Rafidah Aini (UKM) Raja Mohd Shafiq bin Raja Shaharudin Haslina binti Kamaruzaman Norlelah binti Sanang Zurain binti Abdul Rahim Sherill Aida binti Mohd Sirin

10

Output from Session 3 1. Prof Dr Ruzita Abd Talib presented the Scenario of Obesity in Malaysia 2. Prof Poh presented the ToyBox Study overview, components/modules and timeline 3. Prof Cecilia presented the overview of Theory of Change Concept to the stakeholders

(KEMAS HQ, Teachers, Assistance Teachers and Parents) 4. Each component of the TOC Maping was throughly discussed and presented to the whole

team 5. Prof Poh presented two designs of the ToyBox Study Malaysia Logo (see below) and the

stakeholders agreed to choose the one with the Malaysian flag in a heart shape (Logo 2). 6. The tagline “Taste and move adventures” was also translated to Malay, and after

dsicussion with the stakeholders, it was agreed to use the tagline “Terokai gerak dan rasa”

LOGO 1

-­‐ This version is very close to original toybox logo

-­‐ Added 2 more stars to make 14 (Malaysia has 14 states/federal territory)

-­‐ Added the word “Malaysia” next to ToyBox

-­‐ Changed tagline to Malay

LOGO 1 -­‐ This version also kept close to original

toybox logo -­‐ Added 2 more stars to make 14

(Malaysia has 14 states/federal territory)

-­‐ Added Malaysia flag in a heart shape and the word “Malaysia” underneath ToyBox

-­‐ Changed colour to reflect the colours of the Malaysian flag.

-­‐ Changed tagline to Malay Group Presentations Group 1 TOC Maping Presenter : Nor Azelawati binti Zainal u Innovation Champion Team

Researcher team, BPAK, supervisor at parliaments u Implementation Team

Preschool teachers, assistant teachers u OUTCOMES for each group

11

KEMAS ² Able to collaborate with the research team which comprise from various established Universities ² Outcome from the project can be useful for improvision ² Chance to receive ToyBox product ² Training for all involved teachers (PM) can be used as a expert trainer (JU) to other teachers in future

PRESCHOOLS ² Be a model/benchmark to other preschools in Malaysia ² Receive ToyBox product ² Implement a corner/section for health education

YOUNG CHILDREN ² Better health status ² Able to achieve normal/ideal body weight ² Children become more active and encourage logical thinking skills ² More stable emotional

PARENTS / CAREGIVER ² Gain knowledge on healthy lifestyle ² Able to prepare healthy foods and healthy routine ² Discover more activities that suits their children age ² Awareness on health and safety of physifal and mental among children ² Positive behavior changes for parents

TEACHERS ² Receive new skills to be used at preschools and home as well ² Able to be a specialist trainer to colleagues, parents, family and community ² Receive ToyBox product ² Satisfaction from the outcome and impactful to children and teachers

u IMPLEMENTATION

PRESCHOOL ² Space adapt based on teachers suitability and creativity ² Drink station - to be placed at a reachable area (advised to be at teaching area) ² Physical and Sedentary Activity - subjected to space and preschools area ² Eating behavior - practice variety and balance eating. ² Creativity on food presentation (shapes, colours and decoration). ² Tell story to the kids on benefits of vegetables. Teachers are also advise to eat together with the kids. ² Try to make a theme by week: vegetables, fruits etc. ² Create a vegetables garden at school

AT HOME ² Eating behavior - Make variety of foods available / Explore foods / Parents/caregiver as a role model /

Lifestyle at home / Refer menu at preschool Group 2 TOC Maping Presenter : En Hafiz bin Mohd Nor u Innovation Champion Team

Researcher team, KEMAS, PPAK u Implementation Team

Preschool teachers, assistant and parent

u OUTCOMES for each group

12

KEMAS ² Able to collaborate with the research team which comprise from various established Universities ² As an intermediate platform in receiving the outcome of ToyBox Project

PRESCHOOLS ² Outcome of the Toybox Project enable to improvise the kindergarten environment and its syllabus

YOUNG CHILDREN ² As a role model to other kids ² Able to be a subject in ToyBox Feasibility Study ² Able to improve kids health status

PARENTS / CAREGIVER ² Parents being more cooperative in joining the kindergarten activities ² More positive attitudes in kindergarten parents TEACHERS ² Able to play a very important role in implementing the ToyBox Study ² Able to improve teachers teaching skills

Group 3 TOC Maping Presenter : Pn. Lindawati Padill u Innovation Champion Team

KEMAS (state) management / KEMAS District officer u Implementation Team

Supervisor (parliament) / PPAKK / Parents / Teachers u OUTCOMES for each group

KEMAS ² Modules enhancement ² Enhance knowledge among teachers ² Obtain ToyBox Products

PRESCHOOLS ² Promote conducive environment in kindergarten

YOUNG CHILDREN ² Improve children health status ² Interactive learning ² Increase outdoor activities

PARENTS / CAREGIVER ² Create awareness among parents on healthy lifestyle ² Change mentality towards practising more healthy lifestyle TEACHERS ² Activities variation in kindergarten after the implementation of ToyBox module ² Able to attract the kids ² Increase creativity among teachers

u IMPLEMENTATION

Innovation Team ² Meeting ² Unit meeting ² Professionalism workshop

13

Champion Team ² Workshop ² Open Day ² Report and audit

Teachers ² Report and Audit Workshop with parents ² Home visit ² Survey ² Healthy cooking demo with kids ² Healthy eating info ² Kitchen garden to be implemented at kindergarten

Group 4 TOC Maping Presenter : Raja Mohd Shafiq bin Raja Shaharudin u Innovation Champion Team

UKM Team / KEMAS HQ / Kemas Negeri

u Implementation Team PPAK / Teachers

u OUTCOMES for each group

KEMAS ² Able to introduce a new modules in the kindergarten ² Obtain ToyBox Products ² Able to improvise the current kindergarten syllabus

PRESCHOOLS ² More new activity that will be introduced to the kindergarten kids ² Able to a role model to other kindergarten in practising healthy lifestyle ² Introduce new physical activities to the kindergarten kids ² Parents will be more active in joining kindergarten ativities ² Able to produce a healthy and active children in the kindergarten

YOUNG KIDS ² Children will be trained to choose more healthy food ² Practising more healthy lifestyle ² Children will be more focus in kindergarten ² Less sedentary activity and more physical activity and kids become more active and healthy ² Reduce the risk of obesity among children PARENTS / CAREGIVER ² Create awareness among parents on healthy lifestyle and the benefits of practising healthy food in the

family ² Create a healthy and stronger bonding between parents and teachers ² Create a healthy and stronger bonding between parents and children ² Able to reduce the risk of unhealthy kids by practising healthy lifestyle

TEACHERS ² Improve knowledge among teachers ² Teachers become more active in classroom ² Able to practice more healthy eating and snacking with children in the kindergarten ² Improve teaching skills and become more creative

14

u IMPLEMENTATION

Innovation Team (Support Team) ² Meeting ² Workshop ² Watsapp Group

Champion Team (Support Team) ² Meeting ² Watsapp Group ² Facebook ² Training

CONCLUSION OF WORKSHOP 1. The workshop concluded with words of thanks from Prof Ruzita and Prof Poh to the

whole ToyBox Malaysia team members for their ideas, input and hard work over the past 2 days.

2. Prof Ruzita reminded the KEMAS stakeholders to not share information with control kindergartens.

3. Prof Poh also thanked the ToyBox stakeholders (KEMAS HQ, Teachers, Assistance Teachers and Parents) for their cooperation, ideas in presenting the TOC Maping and their input during the 3rd day of TOC Workshop which it turns out to be a very successful event.

Report prepared by: Dr Rafidah Aini Pakri Mohamed with input from all team members Dated: 27 May 2017 Report checked and improved by: Prof Dr Poh Bee Koon Dated: 7 June 2017