Overweight or obese students' perceptions of caring in urban physical education programs.

Li, Weidong ; Rukavina, Paul B. ; Foster, Chelsea 等

The purpose of the study was to explore overweight or obese students 'perceptions of caring in urban physical education (PE) programs. Forty-seven overweight or obese students were recruited and participated in a semi-structured interview. Inductive analysis and constant comparison were used to analyze the data. The findings indicated that overweight students perceived being cared-for when their peers were supportive, and when teachers made instructional adaptations, built interpersonal rapport, and created a positive, motivational climate in PE. It is suggested that to create a caring climate, teachers need to allow overweight or obese students to work at their ability level, provide quality instruction and feedback and make developmentally appropriate instructional adaptations, foster a positive, motivational learning climate, create a connection between teacher and student (interpersonal rapport), and create a learning community with positive peer interactions. Creating an inclusive environment that enhances their sense of caring and belonging, has a great potential to increase overweight or obese students' engagement in PE.

Due to weight stigmatization (Cramer & Steinwert, 1998; Puhl & Brownell, 2001 ; Tiggemann & Wilson-Barrett, 1998), overweight or obese students are often teased and commonly excluded from participating in physical activity (PA) (Faith, Leone, Ayers, Heo, & Pietrobelli, 2002; Pierce & Wardle, 1997; Storch et al., 2007)and physical education (PE) (Bauer, Yang, & Austin, 2004; Fox & Edmunds, 2000; Li & Rukavina, 2012; Trout & Graber, 2009). Because of potential psychological and emotional damage for overweight or obese students as a result of weight-related teasing (e.g., Eisenberg, Neumark-Sztainer, & Story, 2003; Puhl & Brownell, 2003) and serious health implications as a result of living a physically inactive lifestyle, it has become increasingly critical that PE teachers create a safe, caring and inclusive learning climate to enhance overweight or obese students' engagement and learning in PE, thus developing and sustaining a healthy, physically active lifestyle.

A perceived caring learning climate has great potential to affect overweight or obese students' engagement and learning in PE for two reasons: 1) overweight or obese students are socially isolated and commonly excluded from participation in PE (Bauer et al., 2004; Fox & Edmunds, 2000; Li & Rukavina, 2012; Trout & Graber, 2009). 2) Research has demonstrated that caring teaching behaviors are strongly linked to positive attitudes and motivation to learn among general student population in general education (Battistich, Solomon, Watson, & Schaps, 1997; Wentzel, 1997; Wentzel & Asher, 1995) and PE (e.g., Cothran & Ennis, 1999, 2000; Larson, 2006). According to Noddings (1984, 1992), the ethic of caring is created through making a connection between the 'one-caring' and the 'caredfor'. This interactive, relational process is composed of engrossment, action and reciprocity. Engrossment refers to the one's desire to understand the person's, who is cared-for, physical and personal situation. For example, the teacher who cares for an overweight or obese child learns about their individual characteristics, such as home life, health habits, or interests. Caring is then communicated through the carer's actions. Noddings (1984) defines actions as any behaviors or communications that are geared toward the welfare, protection and enhancement of the one being cared for. And finally, caring can only exist when the one being cared for reciprocates or responds to the actions or presence of the 'one caring'. For example, if a teacher gave an overweight or obese student a compliment on their basketball jump shot, the student would reciprocate by practicing harder or following the teacher's instructions.

In general education, the interpersonal interactions between teachers and students are considered as being at the core of the teaching-learning processes (e.g., Bruner, 1996; Nod-dings, 1992, 2002). A number of studies have investigated the relationship between students' perceptions of caring and their attitudes and motivation. The findings have demonstrated that students' perceptions of being cared for are strongly connected to students' evaluation of their teachers and their perceptions of cognitive and affective learning (Teven & McCroskey, 1997), their attitudes toward school (e.g., Battistich, Solomon, Watson, & Schaps, 1997), and student motivation to learn (Wentzel, 1997; Wentzel & Asher, 1995).

Researchers in the field of PE have also conducted research on students' perceptions of caring (e.g., Cothran & Ennis, 1999, 2000; Ennis et al., 1997; Larson, 2006). Consistent with the findings from general education, the findings in school PE have indicated that teaching caring behaviors were strongly related to students' attitude toward PE and their engagement in PE (e.g., Cothran & Ennis, 1999, 2000; Cothran, Hodges Kulinna, & Garrahy, 2003; Ennis et al., 1997; Larson, 2006). Students participated more in PE when they perceived that teachers were willing to work with them, showed an authentic attentiveness for their well-being, and fostered a safe and supportive learning environment that focused on personal growth and cooperation.

Larson (2006) has argued that the uniqueness of PE contexts can offer opportunities for caring teaching behaviors to emerge that can be dissimilar to those in general education. Larson investigated perceptions of caring teaching among 518 United States elementary and secondary students using critical incident forms to elicit descriptions of caring teaching. The findings revealed 11 clusters of caring teaching behaviors: 1) Showed me how to do a skill; 2) honored my request to choose an activity; 3) gave me a compliment; 4) confronted my behavior; 5) inquired about my health; 6) attended to me when I was injured; 7) allowed me to re-do my test; 8) motivated me; 9) played/participated with me during class; 10) persuaded me; 11) showed concern for my future health. These 11 clusters were further sorted into three subcategories: Recognize me; help me learn; and trust/respect me, and a primary category of pay attention to me. Even though certain caring teaching behaviors are PE context specific, the central concept of caring is the same regardless of the context.

The previous studies, however, have mainly focused on perceptions of caring among the general student population. Little is known about overweight or obese students' perceptions of caring. In PE, it is expected that teachers provide differentiated instruction for all students, including overweight and obese students (National Association for Sports and Physical Education: NASPE, 2001). For example, PE teachers may simplify the skills for overweight or obese students to work on or allocate more time and attention to them. PE teachers may also give advice to overweight or obese students on losing weight. It is unclear how these instructional modifications based on overweight or obese students' skills and abilities would be perceived. Due to the internalization of weight stigma and sensitivity of obesity in PA, it is possible that overweight or obese students may interpret these teaching practices as negative. In addition, the previous literature has investigated perceptions of caring behaviors in relation to teachers. However, no research has been conducted to examine perceptions of caring behaviors exhibited by their peers. To effectively and successfully include overweight or obese students in PE, there is an urgent need to understand their perceptions of caring from their teachers and peers. Therefore, the purpose of the present study was to qualitatively describe perceptions of caring among 47 overweight or obese students in urban PE programs. The information gathered from the present study can better inform practitioners and teachers of strategies for effective inclusion.

Method

A descriptive qualitative research design was employed to explore the perceptions of caring among overweight and obese adolescents in an urban city school district in the Southern USA. The present study was part of a larger one, which investigated overweight or obese adolescents' experience in PE (Li & Rukavina, 2012; Li, Rukavina, & Wright, 2012).

Setting

The setting in which the data were collected was a Southern urban city school district in the United States, which delivers education to more than 119,000 students in grades K-12. There are many challenges that the district faces: Approximately 87% are African Americans, 71% of the students receive free or reduced lunch, and 61% of the students graduate with a high school degree. Moreover, 19.7% of high school students in this school district were overweight and additionally 16.2% were obese (Eaton et al., 2008).

Participants

The study was delimited to overweight and obese students, which made recruitment difficult due to the sensitivity of the topic. This is consistent with other studies that have investigated issues related to childhood overweight and obesity (e.g., O'Keefe & Coat, 2009; Trout & Graber, 2009). Selection bias or bias from recruiting from a particular subpopulation in the city school district was minimized by using a variety of methods, such as recruitment through the schools, summer camps (organized through a community recreation center), distributing flyers to weight loss clinics, and participant word of mouth. All participants were enrolled in school PE classes (six high schools, three middle schools, and one k-6 elementary school) during the study or in the previous year.

Forty-seven students who had a body mass index (BMI) greater than the 85th percentage (19 males and 28 females; 14 European Americans and 33 African Americans) participated in the study. Their ages ranged from 11 to 19 year olds (M = 14.86, SD = 1.97). At first, students were visually identified as being overweight or obese by the first two investigators or their PE teachers. We then measured their height and weight to calculate BMI adjusted for gender and age. The adolescents' BMI ranged from 25 to 62.2 (Overweight= BMI of 25-29.9; Obese= BMI of 30 or greater). The participants were self-selecting volunteers. Both child assent and parental consent were obtained. Demographic variables included age, gender, grade, and ethnicity. Adolescent participants and their family were provided $50 for participation in the study.

Recruitment

Recruitment was a lengthy and rigorous process. At first, we recruited from the city schools to identify a pool of adolescents and their parents. The PE teacher handed consent forms to the students and if they and their parents were interested. Due to the sensitivity of the topic, much care was taken with interpersonal communication with the participants and their families. A heterogeneous and adequate sample size was ensured through several methods. Consent forms were handed out at multiple schools, flyers were handed out at summer camps organized through a local community center and weight loss clinics, and we asked the adolescents to tell their friends about the study (i.e., word of mouth). Recruitment was also completed with flyers. The flyers included information similar to what was written in the consent form, but were more general. Specific details were provided to parties that contacted the researchers. Child assent and parental consent were obtained if they were interested. At the clinics, the supervising physician handed out the flyers to the families in the waiting room. If the family was interested in the study, the researchers would explain the consent form and answer any questions they may have. For the participants that were recruited from the schools, multiple approvals were obtained, which included the PE teacher, school principal and school district. For recruitment from the weight loss clinics and summer camps, administrative approval was obtained. All participants' and their guardians' consent were obtained prior to the start of the study as required from the University IRB.

Data Collection

Data were collected about perceptions of caring using interviews from overweight or obese adolescents. Knowledge about sensitive topics, such as talking about one's weight and how teachers care, are best achieved with interviews because of the flexibility in conversations and means of achieving a personal connection (Edmunds, 2005). A conversational style face-to-face interview was guided by two initial questions: 1) What are the situations where you feel being cared-for by your PE teachers? 2) What are these situations where you feel being cared-for by your peers? Based upon participant's responses, their comments were followed by prompts to gain further information or clarification. These questions were a part of larger interview that addressed their experience in PE and weight-related teasing and coping. The overall interview for the larger study lasted about 40 minutes on average. The first two researchers conducted the interviews privately at the first author's university office, participant's home, or school or weight loss clinics offices. Both researchers had training in qualitative research and experience conducting interviews. The participants were provided choices and they selected the place where they felt most comfortable being interviewed and fit their schedule and family commitments.

Prior to the beginning of the interview, the interview was framed through establishing a personal connection with participants to put them at ease (Kvale, 1996), discussing the study and explaining the importance of having overweight students' voices heard. Participants were assured at any time they could stop and take a break or drop from the study without any penalty if they felt uncomfortable during the interview. After all the interviews were transcribed and coded, six students volunteered to participate in a focus group for an interpretative member check. All participants provided permissions to audio-tape their interview.

Data Coding and Analysis

Each participant was assigned an ID number for identification to facilitate analysis and reporting of the data. Audio tapes were transcribed verbatim, and inductive content analysis and constant comparison were used to analyze the data (Denzin & Lincoln, 1994). The first phase of the analysis involved the first two authors reading the interviews multiple times to ensure familiarity with the data. Following the first phase, both researchers deliberated and identified the most consistent concepts emerged from the data and developed an initial coding template upon a 100% agreement. Seven participants' interviews were then independently double-coded by both researchers and the inter-rater reliability was assessed using the formula: number of agreements/(number of agreements + number of disagreement). A reliability coefficient of 0.93 was obtained. The disagreements were discussed and changes were made until both researchers reached a 100% agreement. For the remaining interviews, each investigator independently coded the data. The major concepts that arose most frequently were then identified and formed into upper level themes by the first author. A peer debriefing session was held with the second author and changes were made to the identified themes until reaching a 100% agreement. Finally, the interpretation of the themes and the relationships among the themes were identified. Data from the focus group were incorporated as the narratives were written. A final reshaping of the themes was completed after the focus group.

Data Trustworthiness

Multiple procedures and strategies were used to establish trustworthiness of the data (Creswell, 2003). First, we recruited as diverse a sample as possible of overweight or obese students so that the themes would represent the diverse population inherent in the urban city school. Second, peer debriefing was completed with a colleague who was adept and experienced in qualitative research. The peer de-briefer provided insights in regard to data collection procedures, formation of conceptual linkages, overall representation of the data, alternate interpretations, and focus group interview procedures. Third, transcripts were mailed to all participants for review using the addresses provided during the interview. They were asked to read, check for accuracy and mail them back with the self-addressed stamped envelope. Only ten of the transcripts were received. The rest of transcripts were returned due to incomplete address information or family relocations without any forwarding address. Of the received transcripts, participants only made typographical and grammatical errors. Fourth, an interpretative member check was performed with a focus group interview. Six adolescent participants were recruited and participated voluntarily in the focus group with consent from their parents. All of the themes and the relationships among them were presented to the participants to check for the accuracy of the interpretations. We also further explored issues that emerged from the themes. Finally, a search of negative cases was completed to refute the themes or provide an alternative viewpoint throughout the entire data analysis process.

Findings

Themes are illustrated through overweight or obese adolescents' voices taken from the individual and focus group interviews. Four major themes emerged from the data, which included teachers' instructional adaptations, a positive, motivational climate (e.g., choices, made it fun, not put them "on the spot"), built interpersonal rapport (e.g., gave advice, did things with them), and supportive peers.

Teachers 'Instructional Adaptations

Instructional adaptations are an important component of pedagogical content knowledge (PCK) (Shulman, 1987). A key feature of instructional adaptations to diverse learners is how teachers can transform content knowledge to their diverse backgrounds and varied abilities and skill levels (Shulman, 1987). For the present study, three different types of instructional adaptations were mentioned by the overweight students: task support, refinements, and task simplification. Even though these instructional adaptations were made specifically to accommodate overweight or obese students' physical limitations and capabilities as a result of their body size and shape, overweight or obese adolescents in the present study felt being cared-for by these teaching behaviors. First, overweight students commented on how they felt cared-for when the PE teacher would provide support for the task, such as spotting them with a difficult exercise. One overweight student commented, When the PE teacher tell you to do something and you can't do it, they will try to help you with it, like if you are trying to do a toe touch, I mean not a toe touch but a hand stand or something they will go up there and hold your feet, and then let go and you will still be up there and they will help you with something like that.

Overweight or obese students also reported that they felt cared-for when their PE teachers provided specific feedback to refine the tasks. PE teachers would show overweight or obese students how to do the skill correctly or provide specific feedback on the skill execution, (e.g., dancing, soccer, and basketball). For example, one overweight student commented, "When I was playing kickball a few weeks ago, I tried to catch the ball and missed it, just by a little bit. Coach was like, next time, stand in front of it. Don't be scared of it." Overweight students felt good when they were successful and learned it. Another overweight student perceived the teacher's comment as caring when the teacher listened to him after the teacher provided him feedback. The student commented, PE teacher help me understand things that I don't understand and things that he showed us how to do, he will go back over and show me how to do it and his way, and I show him I do it in the way that I know how. He accepts it as that.

Other overweight students felt cared-for when teachers simplified the task if they were tired or could not finish what everybody else was assigned, such as running laps or doing other fitness activities. One student reported, Yeah, they care about us a lot because they tell us, they try to help us get better and don't slack or whatever. And sometimes, if they know we can't do it, like if we're too overweight, like most people if they know we can't do it, they will just tell us, we have to do ten of everything. They just tell some people that they know can't do it to just do five or four.

Other times, the overweight student appreciated when the teacher allowed them to sit on the side, such as when they became too tired. One overweight student commented, When I just got finished running up and down the bleachers and I didn't feel like playing basketball, so he let me sit out that day because he see I couldn't catch my breath. We were outside playing baseball. When I got in the sun, I got real bad headaches. So he let me go sit in the shade, up under the tree, and watch them play.

Knowing that overweight students tire more easily than the other students and adapting the task for them was important to them. They felt connected to them especially when they knew the teacher understood what it was like to be overweight. One student commented, I mean, the physical education teacher, she was kind of heavy, and she won't make it so hard that the bigger people they get tired quicker than the smaller people or the people who have problems doing stuff, she won't make it too hard for them or she'll say that you go to keep going, keep pushing yourself, so you can be the best you can be.

A Positive Motivational Climate

Many overweight or obese students felt being cared-for when PE teachers created a positive motivational learning climate. There exist two different types of motivational learning climates in an achievement motivation context: An ego involved versus a task involved learning climates (e.g., Ames & Ames, 1984; Ames & Archer, 1988; Meece, Blumenfeld, & Hoyle, 1988). An ego involved learning climate focuses on social comparisons. Whereas a task involved learning climate is one where teachers focus on cooperative learning, effort, and personal improvement rather than social comparison and performing the best with minimal effort. An ego-involved motivational learning climate is positively associated with an ego goal orientation. Whereas a task involved motivational learning climate is positively related to a task goal orientation. For students who adopt a task goal orientation, they are likely to exhibit adaptive motivational and behavioral responses in physical education (e.g., Li & Lee, 2004 for a review; Xiang, McBride, Bruene, & Liu, 2007). In the present study, students talked about how they felt cared-for when they had choices to run the number of laps they wanted to run or if they were in the weight room. One overweight student commented, She [PE teacher] let you go where you want to stand and choose how you want to do it ... she said you do it as a group so you don't stand out. .... she won't say that these people get these amounts of weight and these people get these weights. She let you pick your own weight.

Thus, when teachers designed fun activities where students got to feel they worked at their ability level and their ability was not being spotlighted or compared to other students, they felt cared-for.

Overweight students commented that they felt cared-for when the teacher focused on improvement in challenging, developmentally appropriate activities and were very supportive as they put in effort. Encouragement was very important to the overweight students. They felt cared-for and supported when the teachers encouraged them to do better. For example, one student who was overweight commented, "She [PE teacher] will not give up on me like if I couldn't do. She tell me keep on trying, trying until I get it right." Another overweight student reported, When I was doing the running thing, urn, he [PE teacher] would always encourage me: 'Yeah come on you can, you can do it you can keep going just a little bit farther'. He's always encouraged me and all the other kids ...

Sometimes overweight students knew they were not putting in a lot of effort and liked it or felt cared-for when the teacher reinforced their expectations. They commented, "Yeah, they care about us a lot because they tell us, they try to help us get better and don't slack or whatever." And then, after they put in the effort, the overweight students felt cared-for when teachers would give them a compliment or recognized the effort they put forth. One overweight student commented, "... at the end of the PE, they'll be like 'you did good today, you really did good.' Stuff like that." These PE teachers expected overweight or obese students to improve, and then encouraged and complimented them when they tried to achieve them. The overweight students really appreciated the "motivation" provided by the teacher, which in turn, helped them succeed at their own level.

Built Interpersonal Rapport

Building interpersonal rapport was another dimension of caring that emerged from the data. Open communication with students, especially with ones that are disenfranchised, is an effective strategy to establish a connection and further to get to the root cause of what is troubling them. In these situations, the teacher communicates through nonverbal and verbal communication that the student "matters", which most of the time is not expected teacher behavior or typically experienced by the students. In the present study, overweight or obese students felt being cared-for when PE teachers paid attention and made personal connections with them. One student said he liked when the teacher told him stories. Well, I've always been good with my teachers pretty much, like the one coach he was really funny like. ... he'd always tell these funny stories and I'd go to him after class and like if I couldn't remember a part of the story I'd ask him to tell me ...

Other overweight students felt cared-for when the teachers responded by being nice and making them feel special. For example, when students did good and kept quiet in class, teachers responded with rewards, such as letting them play basketball or providing special treats. Or they really liked it when teachers participated in activities. Overweight students felt cared-for or special when the teachers selected them and allowed them to be on their team.

In other situations, personal connections were made when the teachers talked to overweight or obese students about improving in a sport or improving their current health (e.g., losing weight). These personal connections are often specifically related to the overweight or obese students' unique characteristics. For example, one overweight student reported, "my

PE teachers and coaches help me out a lot. They'll tell me about my weight, or sometimes they'll tell me I need to be playing football and stuff like that." Overweight students felt cared-for when teachers gave them information about their performance or weight status, offered to help them, and gave them opportunities or information on how they could improve.

PE involves movement and physical interaction with equipment and other people, so often there are injuries or mishaps. Sometimes teachers would warn students of safety issues like running on bleachers, such as make sure you "catch yourself". Other times, if an accident would happen, students were injured or happened to stumble, their PE teachers would come over to see if they were okay. For example, one overweight student commented, If I stumble, they [PE teachers] usually come and see if I need ice or anything, make sure I can still walk, they look at it, make sure there is no damage done. And then they ask me 'am I okay', and I say yeah and they be 'Are you sure?' I would be like 'yeah', so I guess they have very caring personality, making sure that I'm ok if I stumble.

Another overweight student said if the injury was bigger, it was nice that the teacher would suggest that they go to see the nurse. Often overweight students had negative interactions with their peers due to weight stigma. When overweight students got teased by their peers and felt hurt, teachers came over and say things to cheer her up even though the teachers did not say anything to the teasers. Overweight students felt cared-for when they gave them advice on how to cope with teasing. One overweight student commented, Yeah, they tell me, 'Don't worry about what other people say about you because, what they said about you, is the same thing as they say about other people too. So don't worry about what they say just keep it to yourself and keep rolling but if you feel like it's hurting you too bad then come tell somebody that you really know, and we will get on them about it' ...

The teachers gave strategies to the overweight students and reinforced to them that they would be there for them if it got really bad, such as when teasing incidents evolved into physical altercations. This happens when overweight students do not have the coping mechanisms to deal with the teasing. How the teacher reacts and handles the fights made a big difference in how the overweight students handle the content in PE. One overweight student commented, They [PE teachers] always stuck up for me on certain things so if I were getting to fighting or something like that or whatever they would always stick up for me, I mean they would never let things get too out of hand things like that so I mean I just made me feel comfortable sticking with the physical fitness.

Supportive Peers

Peer acceptance and friends' support are critical to the development of an individual's social and emotional functioning (La Greca & Bearman, 2000). Overweight or obese students felt being cared-for if they received support and encouragement during activities in PE or even outside school from their peers or friends. These supportive behaviors varied in many different forms, ranging from helping overweight students learn the subject matter in PE, providing emotional and social support, to encouraging them to keep trying. Some overweight students felt being cared-for when their friends helped them to learn motor skills or lose weight by working out with them. For example, one overweight student reported, "I was having problems with basketball, and then a couple days after school he invited me to come down and play with his friends and he showed me a couple good tricks on how to play." Another overweight student reported, "Like, on my weight, they'd like me to do better, and sometimes we'll go to the bottom of the gym and we'll be lifting weights, and I'll be losing weight and stuff." Another overweight student also commented, "When we have to run and stuff, they will be like 'come on you can do it'. They also tried to run with me so I don't stop."

Overweight students also felt be cared-for when their friends did not pick on them, buffered them from the teasers, played sports and did exercise together with them, or selected them on teams and backed up on their weakness or let them have time to shine if they are better at something. For example, one overweight student reported, I have like one good, good friend, if she hear people talking about me she will say 'don't talk about her, you don't know anything about her, that's mean' and she would be like 'don't worry about them, they don't know no better' and she would just say something like that to make me feel good, and I love her, she's my best friend. Because she always help me like, help me with everything like showing me how to do it, and she would be like 'I could help you' and my other friends they would laugh you know how girls do, talk behind your back and then when you go confront them it's a whole other story. So I just have one good friend.

Overweight students felt being cared when peers were concerned about their well-beings by providing comfort when they got hurt, felt sad about their peers cheating in a game, or had a death in their family. For example, one overweight student commented, I was sitting there sad and kind of all to myself and they all came over there and was like it's going to be ok and they tried to do things to make me get mind off of my grandmother's death, which did help a lot.

In other situations, overweight students felt being cared-for when peers encouraged them to keep trying or demonstrate confidence in them to do the activities. Sometimes, their peers even slowed themselves down for overweight students to catch up with them. For example, one overweight student commented, When we are like doing our exercises or whatever, like say if I'm tired, and I don't do them right, sometimes they try to give us extra numbers on them, but sometimes they tell me 'You can do it,' and 'Just keep on trying you can do it.' if we were doing pushups, I just lay there if I'm tired, and they tell me I can do it and don't quit and keep doing it and then I just start doing it.

Another overweight student reported how his peers slowed down so that he could catch up with them. When I am running, and I get tired, they say keep on going and when I can't catch anybody, they say that urn, 'we'll slow down for you,' because um, they can run fast and I can't run that fast, they say 'we'll slow down so you can run and catch us'.

Discussions and Implications

The purpose of the present study was to examine overweight or obese students' perceptions of caring in PE. Four themes emerged from our data: teachers' instructional adaptations, a positive, motivational learning climate, built interpersonal rapport, and supportive peers. According to Noddings (1984, 1992), the ethic of caring is created through making a connection between the 'one-caring' and the 'cared-for'. This interactive, relational process consists of three components: Engrossment, action and reciprocity. As illustrated from our themes, the ethics of caring was enacted between overweight or obese students and their teachers and peers in PE. Peers and PE teachers engrossed or considered overweight or obese students' personal physical situation (e.g., history of teasing, body shape and size), and conveyed regard and desire for overweight or obese students' well-being (e.g., Noddings, 1984) through their actions. These actions included teachers' making instructional adaptations, creating of a positive motivational learning climate, and building an interpersonal rapport, and peers' providing instructional assistance, feedback, and encouragement. Overweight or obese students perceived that their PE teachers' and peers' actions were to improve their well-being. As a result, overweight or obese students responded to their teachers' and peers' actions in many different positive ways, such as showing appreciation, being positive, and being more engaged. These findings are consistent with studies in general PE where students are more engaged when they perceive teacher caring (e.g., Cothran & Ennis, 1999, 2000; Cothran, Hodges Kulinna, & Garrahy, 2003; Ennis et al., 1997; Larson, 2006).

The quality of teacher-student interactions (i.e., instructional adaptations, feedback, social interactions, learning climates) has a great impact on students' engagement and learning in PE (Ayvazo & Ward, 2011; Carlson, 1995; Li & Lee, 2004; Silverman & Subramaniam, 1999). The findings showed that overweight or obese students reported that they felt being cared-for by their teachers when PE teachers made instructional adaptations to their abilities and skills, such as refinements (feedback), task supports and simplifications. Due to their body weight, overweight or obese students generally have difficulty performing the same instructional tasks as their peers, such as fitness activities and playing sports. To effectively and successfully include overweight or obese students in PE, teachers need to strategically design appropriate instructional tasks and make corresponding adaptations to the original stated tasks based on the responses from these students. By doing so, overweight or obese students would felt being cared-for and thus be more willing to engage in PE. Due to the sensitivity of obesity, PE teachers very often worry that content adaptations may make overweight or obese students feel embarrassed by "spotlighting" them. The data from the present study showed that these teaching behaviors made overweight or obese students feel good and be more motivated to learn.

Previous research on achievement motivation has demonstrated that when PE teachers foster a learning climate focusing on learning mastery and personal improvements (For a review, see Li & Lee, 2004), empower students with choices and autonomy (e.g., Hellison & Walsh, 2002), and make PE fun and enjoyable (e.g., Chert & Ennis, 2004; Li, Lee, & Solmon, 2005, 2008), students are likely to display more adaptive motivational and behavioral responses. The findings of the present study showed that overweight or obese students felt being cared-for (engrossment and action) and therefore reciprocated, or were motivated to be engaged in PE when teachers foster a positive, motivational learning climate. Effective motivational strategies for successful inclusion of overweight or obese students include, empowering students with leadership opportunities and choices, listening to students' voices, providing autonomy support, teaching personal and social responsibility, focusing on personal improvement and effort, and setting realistic individualized goals.

Lowman (1984) has defined teaching excellence along two dimensions: good interpersonal rapport and effective teaching skills. Good interpersonal rapport is a key to teaching excellence because it involves mutual appreciation, trust and a sense that teachers and students understand and share each other's concerns (Lowman, 1984). There is a plethora of anecdotal evidence, supporting the key role that good interpersonal rapport plays in effective teaching in PE. The findings of the present study have showed that overweight or obese felt being cared-for and were more motivated to be engaged in PE when teachers had good interpersonal rapport with them. Practical strategies for building good interpersonal rapport with overweight or obese students include being nice, listening to their voices, appreciating and working with the differences with them, paying attention to them when they feel sad, stumble, or get injuries, being on their sides when they need support, and giving advice on living a healthy lifestyle. There is a lack of valid and reliable measurement of assessing interpersonal rapport in PE and little research has been conducted to examine how interpersonal rapport contribute to effective teaching. This is an important area of research worthy of future endeavor.

The previous studies have mainly focused on teachers' caring behaviors (Larson, 2006; Lee & Ravizza, 2008) and not student-peer interactions that lead to caring. Peer acceptance and friends' support play a critical role in the development of an individual's social and emotional functioning (e.g., La Greca & Bearman, 2000). The present study extended the literature on perceptions of caring by examining the caring behaviors from peers and friends in PE. Our data showed that overweight or obese students felt being cared-for when their peers and friends helped them learn the skills, encouraged them to keep trying, and supported them emotionally and socially, etc. This was especially evident in situations where overweight or obese students could be teased or where their body shape and size puts them at a disadvantage and they need to work harder than other students. The supportive behaviors from peers and friends have become an important motivator for overweight or obese students to continually be engaged in PE.

The findings of the present study and the previous literature in PE (Larson, 2006; Lee & Ravizza, 2008) and general education (e.g., Hayes, Ryan, & Zseller, 1994; McCroskey, 1992) have also demonstrated that the essence of the concept of caring is context free. However, the specific caring behaviors are influenced by a particular context and student population. Many caring behaviors reported by overweight or obese students in the present study were context-specific responses to their unique characteristics and experience in PE. For example, teachers in the present study provided advice on how to cope with weight-related teasing and let overweight or obese students sit out of the activities when they could not catch their breath. Peer friends in the present study worked out together with overweight or obese students to help them lose weight. These context specific caring behaviors provide critical insights for PE teachers to develop and implement strategies to successfully and effectively include overweight or obese student in PE.

Recently, Newton et al. (2007) developed a measurement of caring in physical activity settings: The Caring Climate Scale (CCS). The CCS is a 13-item questionnaire with a five point Likert scale. It assesses the degree to which an individual perceives a participant learning environment as being inviting, safe, supportive, valuable, and respectful. Even though the preliminary study showed that the CCS measurement was valid and reliable (Newton et al., 2007), caring was conceptually defined as a single-dimensional construct. The findings from the previous studies (Larson, 2006; Lee & Ravizza, 2008) and the present study have suggested that the concept of caring is a multiple-dimensional rather than single-dimensional construct. It consists of three dimensions, including instructions, interpersonal rapport, and the type of learning environments from both teachers and peers. Currently, there is a lack of a valid and reliable measurement of perceptions of caring in PE from a multi-dimensional perspective. Information from both students and expert teachers on how they set up inclusive learning environments and care about students could provide excellent information to design this instrument. This is an important area worthy of future research to move forward the literature on caring in PE.

There were some limitations in the present study. The data were collected in an urban school district located in the Southern United States. The findings of the present study may be not transferable to southern suburban or rural areas or other areas of the country due to social-cultural and economic differences. Another limitation is that a single one-time interview research design was used (except for those who participated in the focus group). Interviews were used because of several constraining factors, including lacking access to participants, difficulty in scheduling multiple interviews due to parents' work schedule and school schedules, dangerous nature of inner city neighborhoods, and the emotionally charged nature of obesity and weight-related teasing. Future research should include data from other resources for triangulations.

Our findings have significant teaching implications. It is suggested that to create a caring climate, teachers need to allow overweight or obese students to work at their ability level, provide quality instruction and feedback and make developmentally appropriate instructional adaptations, foster a positive, motivational learning climate, create a connection between teacher and student (interpersonal rapport), and create a learning community with positive peer interactions. Creating an inclusive environment that enhances their sense of caring and belonging, has a great potential to increase overweight or obese students' engagement in PE.

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Author's Note

This project is part of a larger one, funded by American Association of Health, Physical Education, Recreation, and Dance--Research Consortium Grant Programs.

Weidong Li, Ph.D.

The Ohio State University

Paul B. Rukavina

Adelphi University

Chelsea Foster

The Ohio State University

Address correspondence to: Weidong Li, Ph.D., The Ohio State University, Department of Human Sciences, PAES Building A270, 305 West 17th Avenue, Columbus, OH. 43210-1224 Tel: 614-247-6506 Fax: 614-688-4885, Email: li.832@osu.edu