08. Health and Wellbeing Education
Paper
School Health Promotion – A Comparative Study between Malaysia and Switzerland
Simona Betschart1, Anita Sandmeier1, Guri Skedsmo1, Donnie Adams2
1Schwyz University of Teacher Education, Switzerland; 2Universiti of Malaya, Malaysia
Presenting Author: Betschart, Simona
Since the publication of the Ottawa Charter (WHO, 1986) schools have been regarded as a central location for health promotion. In particular, a holistic approach involving all members of a school and the school community is considered desirable (WHO Expert Committee, 1997). School leaders are seen as key players in the implementation of health promotion measures (Dadaczynski et al., 2021; Gieske & Harazd, 2009; Zumbrunn et al., 2016), although little is known about how exactly they manage health promotion and what characteristics are important for their related leadership practices (Dadaczynski et al., 2022). At the school leadership level, various contextual and personnel factors, such as gender, attitudes toward health promotion, or health literacy of school leaders may be relevant to the implementation of health promotion (Clarke et al., 2015; Dadaczynski et al., 2020; Dadaczynski & Paulus, 2015).
This comparative project focuses on the extent to which school leaders from Malaysia and Switzerland were able to implement school health promotion during the Covid 19 pandemic. The comparison between Switzerland and Malaysia is of interest because the two countries differ in terms of educational governance. In Switzerland, school principals can set local priorities, but at the same time must adhere to governmental guidelines. In contrast, Malaysia has a much more centralized system: in education, formal goals are clearly set for schools. Notwithstanding these differences, both countries faced similar challenges in the context of the Covid 19 pandemic. Nevertheless, the national and local context influences the extent to which school leaders are empowered and enabled (see Sears & Marshall, 1990) to respond to challenges such as the Covid 19 crisis and are able to make adjustments according to the local context.
The following research questions were of interest:
What is the level of implementation of emotional and social health promotion in Swiss and Malaysian Schools?
What are the relationships between health promotion implementation and contextual factors and School leader’s attitudes and wellbeing in Switzerland and Malaysia?
Can we explain the different levels of implementation with regulations and educational policy in the two countries?
Methodology, Methods, Research Instruments or Sources UsedTo answer the research questions an online survey was conducted in June 2021, with N = 1058 school leaders from both countries participating. Implementation of health promotion is measured using the Survey of School Promotion of Emotional and Social Health (SSPESH) scale (Dix et al., 2019), which is based on the World Health Organization (WHO) Health Promoting Schools (HPS) framework (Langford et al., 2015) and measures the extent to which a school has implemented measures and practices to promote students' emotional and social health. We conducted regression analyses and simple slope analyses using SPSS 28 and PROCESS for SPSS. Following the quantitative survey, a qualitative follow-up study was conducted in May 2022, including interviews with school principals in Switzerland and Malaysia. Eight Interviews were conducted in Malaysia and ten interviews in Switzerland. The interviews were transcribed and analyzed based on a deductively developed coding system. The coding systems was developed using the WHO global standards and indicators for Health Promoting Schools (World Health Organization & UNESCO, 2021) as a guidance, ensuring comparability between the two countries.
Conclusions, Expected Outcomes or FindingsResults indicate that Malaysia has higher levels in the implementation of a positive school climate, student social and emotional learning and engaging families (primary prevention) whereas Switzerland has a higher implementation level on supporting students facing difficulties (secondary and tertiary prevention). Preliminary results from regression analyses and simple slope analyses indicate that attitudes toward health promotion, student body composition, and school level are relevant factors for health promotion implementation in both countries. Attitudes toward health promotion also show a different effect in the two countries. It In Switzerland the level of health promotion depends highly on the attitude of the school leader. In Malaysia the wellbeing of the school leader has a small effect on the level of health promotion.
Initial findings from the Interviews provide further evidence on potential factors at the national and local levels that influence health promotion practices (e.g., scope of action of school principals, guidelines and requirements of the government, etc.). In addition, relevant actors and processes could be identified. For example, in Malaysia, each school has special school leaders who are responsible for health promotion and counselors for students are also permanently installed In Switzerland, such strongly institutionalized structures do not exist. Health promotion is therefore highly dependent on individuals and there is an enormous variety of health-promoting activities.
ReferencesClarke, J. L., Pallan, M. J., Lancashire, E. R., & Adab, P. (2015). Obesity prevention in English primary schools: Headteacher perspectives. Health Promotion International, 32(3), 490–499. https://doi.org/10.1093/heapro/dav113
Dadaczynski, K., Carlsson, M., & Gu, Q. (2022). Guest editorial: Leadership in school health promotion. The multiple perspectives of a neglected research area. Health Education, 122(3), 261–266. https://doi.org/10.1108/HE-04-2022-138
Dadaczynski, K., & Hering, T. (2021). Health Promoting Schools in Germany. Mapping the Implementation of Holistic Strategies to Tackle NCDs and Promote Health. International Journal of Environmental Research and Public Health, 18(5), 2623. https://doi.org/10.3390/ijerph18052623
Dadaczynski, K., & Paulus, P. (2015). Healthy Principals – Healthy Schools? A Neglected Perspective to School Health Promotion. In V. Simovska & P. Mannix- McNamara (Hrsg.), Schools for Health and Sustainabilty (S. 253–273). Springer. 10.1007/978-94-017-9171-7
Dadaczynski, K., Rathmann, K., Hering, T., & Okan, O. (2020). The Role of School Leaders’ Health Literacy for the Implementation of Health Promoting Schools. International Journal of Environmental Research and Public Health, 17(6), 1855. https://doi.org/10.3390/ijerph17061855
Dix, K. L., Green, M. J., Tzoumakis, S., Dean, K., Harris, F., Carr, V. J., & Laurens, K. R. (2019). The Survey of School Promotion of Emotional and Social Health (SSPESH): A Brief Measure of the Implementation of Whole-School Mental Health Promotion. School Mental Health, 11(2), 294–308. https://doi.org/10.1007/s12310-018-9280-5
Gieske, M., & Harazd, B. (2009). Schulisches Gesundheitsmanagement an Grundschulen. In C. Röhner, C. Henrichwark, & M. Hopf (Hrsg.), Europäisierung der Bildung (S. 246–252). Verlag für Sozialwissenschaften.
Langford, R., Bonell, C., Jones, H., Pouliou, T., Murphy, S., Waters, E., Komro, K., Gibbs, L., Magnus, D., & Campbell, R. (2015). The World Health Organization’s Health Promoting Schools framework: A Cochrane systematic review and meta-analysis. BMC Public Health, 15(1), 1–15. https://doi.org/10.1186/s12889-015-1360-y
Marshall, J. D., Otis‐Wilborn, A., & Sears, J. T. (1989). Leadership and pedagogy: Rethinking leadership in professional schools of education. Peabody Journal of Education, 66(3), 78–103. https://doi.org/10.1080/01619568909538650
WHO. (1986). Ottawa-Charta zur Gesundheitsförderung, 1986.
WHO Expert Committee. (1997). Promoting Health Through Schools Rport of a WHO Expert Committee on Comprehensive School Health Education and Promotion.
World Health Organization & UNESCO. (2021). Making every school a health-promoting school: Global standards and indicators. World Health Organization. https://apps.who.int/iris/handle/10665/341907
Zumbrunn, A., Solèr, M., & Kunz, D. (2016). Umsetzung Gesundheitsförderung und Prävention in Schulen. Fachhochschule Nordwestschweiz.
08. Health and Wellbeing Education
Paper
School Based Health Promotion in Sweden- Policy Discourses as Social Functions
Hadil Elsayed, Linda Bradley, Mona Lundin, Markus Nivala
University of Gothenburg, Sweden
Presenting Author: Elsayed, Hadil
Health promotion (HP) is linked to democratic and social values including equity and societal cohesion (Akerman et al., 2019). Health literacy, the critical and empowering component of HP, has been acknowledged as a health determinant across the life span (Carlsson, 2015; WHO, 2013). Schools are key arenas for HP (Paakkari & George, 2018). Apart from having positive implications for student wellbeing and academic performance, HP in schools can be operationalized to address some social issues such as the humanely problematic health divide (Braveman et al., 2011; Cerda et al., 2021; Mannix-McNamara & Simovska, 2015). This study explores the articulation of school-based HP in Swedish education policies, in relation to democratic and social values (e.g., autonomy, empowerment, and equity). The study also investigates how far this articulation acknowledges health literacy as a core element in HP work.
School-based HP can be a contested domain where different agendas compete. For example, some health discourses may encroach on personal autonomy, while others may depoliticize health (Malmberg & Urbas, 2019; Paakkari & George, 2018; Petersen, 1996). HP work in schools has been repeatedly problematized from moral and social perspectives including inquiries into how far it adheres to democratic tenets and how well it fosters autonomy and empowerment (Danielsen et al., 2017; Jensen, 1997; Paakkari & George, 2018). It is informative to explore school-based HP from a sociological perspective to elucidate the links between ideologies, social values, and behaviors at the individual, group, and institutional levels.
Scholars have repeatedly highlighted the relations between policy discourses and health-related activities or outcomes in schools (e.g., Danielsen et al., 2017; Wolpert et al., 2015), suggesting that educational policy discourses co-shape the manner in which health issues are addressed in school contexts. Swedish schools incorporate HP in the legally mandated student health services governed by local student health plans at both the municipal and school levels. However, there is a national guide that outlines the general aims, responsibilities, and potential areas for action across the whole country (Swedish National board of Health and welfare and Swedish National Agency for Education, 2017).
In this study, four education policies were analyzed, the national guide for student health services in Sweden and three municipal student health plans. The analysis was informed by Fairclough’s (1992) model of critical discourse analysis. The findings indicate that policy articulations in the analyzed documents exhibit an awareness of the democratic and social dimensions of HP. However, tensions were identified between different discourses deployed in the documents including ethical, public health, biomedical and governance discourses. For example, there was a tension between the biomedical and public health discourses, where the former frequently focused on risk factors and framed students as passive recipients of care, while the more socially oriented public health discourse acknowledged the meaningfulness of the social determinants of health and the value of student empowerment.
While the local policies mostly recapitulated the national guideline, they occasionally negotiated and recontextualized parts of the national discourse. This recontextualization was sometimes beneficial in the sense that it concretized key social values such as student participation. However, local discursive representations could also inadvertently undermine the democratic dimension of HP. For example, one municipal health plan used the floating term “norm-breaking behavior” which is potentially open to uncritical interpretations at the school level with possibly unfavorable implications for student autonomy as well as for equity. The differences between the three municipal documents may be related to differential interpretations of the national document but can also represent a local adaptation to the sociodemographic context in which the policy is to be deployed. The policies acknowledged health literacy in spirit rather than semantics.
Methodology, Methods, Research Instruments or Sources UsedData generation started by selecting relevant policy documents. Online searches by the authors (university librarians were consulted) were conducted to map out the field of potentially relevant documents for the study. These documents were then filtered to select the most pertinent ones for HP work in Swedish schools. The filtration process was informed by reading through said documents to get well acquainted with their content as well as consulting relevant professional experts who had worked in the field of school-based HP in schools, municipalities as well as in academia. Meetings were arranged with some key actors to further our understanding of which policy documents were considered relevant in practice in different schools (e.g., different parts of Sweden, private vs. municipal schools).
Eventually, the national student health services guide (known in Swedish as “Vägledning för elevhälsa”) was selected as the primary document for analysis to explore how HP-related issues are articulated on a national level. The analysis also extended to include three municipal student health plans. The municipalities in question varied in terms of geographical location as well as in terms of their sociodemographic profiles. The municipal documents were included by way of exploring how the national discourse gets translated at the local level. The documents are all publicly available. Data sources amounted to a total of 252 pages.
Data analysis was informed by Fairclough’s (1992) critical discourse analysis model which allows for exploring policies in terms of their linguistic structures and discursive practices while simultaneously accounting for the societal and institutional contexts in which they are formulated and enacted. The socially oriented model allows for exploring power struggles and potential discursive conflicts. Data analysis proceeded along four stages. The first stage was an iterative in-depth reading of the selected documents for data immersion and familiarization. The second was an open inductive coding that identified key discursive representations and tensions. During the third stage of analysis a more detailed linguistic scrutiny was applied to particular text blocks selected based on findings from the first two stages of analysis as well as on expert advice as recommended by Fairclough (1992). During the fourth phase of analysis, the findings from the different local documents were contrasted against each other as well as against the national document to explore the extent of (in)congruence between the different policy documents.
Conclusions, Expected Outcomes or FindingsThe findings indicate that the analyzed policies exhibit a fair level of awareness of social and democratic values involved in HP work. However, the interdiscursive tensions detected within the policies can have implications for the extent to which these values become observed in practice. The discerned tensions reflect ideological differences between various stakeholders particularly considering the shared authorship of the document (between the school and health boards) but could also be an indication of impending social change where stakeholders and policy makers are actively trying to adjust school practices to adapt to a rapidly mutable societal and global landscape.
HP discourse is being renegotiated as it travels from the national to the local level. It is then important to consider how incongruent interpretations of the same national document in different municipalities may undermine the assumed equity in providing student health services across the country. Moreover, the implicit rather than explicit acknowledgment of health literacy may provide spaces for less critical policy enactments, thereby jeopardizing the empowering dimension of HP work. In light of our findings, we recommend that future education policies exercise more caution in deploying various discourses in their rhetoric. It is also important that HP discourses maintain a social and moral compass and that they are comparably committed to social and democratic values at various levels of action, e.g., national and municipal.
This analysis has provided an opportunity for exploring discourse as a social force thus opening up venues for reflection about relations between policy discourses and various ideologies and social actions. However, we do acknowledge the importance of broadening our investigation to policy implementation in schools. We intend to pursue this in a subsequent study where we will explore how school professionals enact education policies in the course of their professional HP practices.
ReferencesAkerman, M., Mercer, R., Franceschini, M. C., Peñaherrera, E., Rocha, D., Prado Alexandre Weiss, V., & Moysés, S. T. (2019). Curitiba Statement on Health Promotion and Equity: voices from people concerned with global inequities. Health Promotion International, 34(Supplement_1), i4-i10. https://doi.org/10.1093/heapro/daz009
Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell, L. N., Manderscheid, R., & Troutman, A. (2011). Health disparities and health equity: The issue is justice. American journal of public health (1971), 101(1), S149-S155. https://doi.org/10.2105/AJPH.2010.300062
Carlsson, M. (2015). Professional competencies within school health promotion — between standards and professional judgment. In V. Simovska & P. Mannix McNamara (Eds.), Schools for Health and Sustainability: Theory, Research and Practice (pp. 191-209). https://doi.org/10.1007/978-94-017-9171-7_9
Cerda, A. A., García, L. Y., & Cerda, A. J. (2021). The effect of physical activities and self-esteem on school performance: A probabilistic analysis. Cogent Education, 8(1). https://doi.org/10.1080/2331186X.2021.1936370
Danielsen, D., Bruselius-Jensen, M., & Laitsch, D. (2017). Reconceiving barriers for democratic health education in Danish schools: an analysis of institutional rationales. Asia-Pacific journal of health, sport and physical education, 8(1), 81-96. https://doi.org/10.1080/18377122.2016.1277546
Fairclough, N. (1992). Discourse and social change. Polity Press
Jensen, B. B. (1997). A case of two paradigms within health education. Health education research, 12(4), 419-428. https://doi.org/10.1093/her/12.4.419
Malmberg, C., & Urbas, A. (2019). Health in school: stress, individual responsibility and democratic politics [Article]. Cultural Studies of Science Education, 14(4), 863-878. https://doi.org/10.1007/s11422-018-9882-0
Mannix-McNamara, P., & Simovska, V. (2015). Schools for Health and Sustainability: Insights from the Past, Present and for the Future. In V. Simovska & P. Mannix-McNamara (Eds.), Schools for health and sustainability. Theory, research and practice. (pp. 3-18). Springer.
Paakkari, L., & George, S. (2018). Ethical underpinnings for the development of health literacy in schools: Ethical premises ('why'), orientations ('what') and tone ('how') [Review]. BMC Public Health, 18(1), Article 326. https://doi.org/10.1186/s12889-018-5224-0
Petersen, A. R. (1996). Risk and the regulated self: the discourse of health promotion as politics of uncertainty. Australian and New Zealand journal of sociology, 32(1), 44-57. https://doi.org/10.1177/144078339603200105
Swedish National board of Health and welfare and Swedish National Agency for Education. (2017). Vägledning för elevhälsa [Guide to Student Health Services]. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/vagledning/2016-11-4.pdf
WHO. (2013). Health literacy: The solid facts. http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf?ua=1
Wolpert, M., Humphrey, N., Deighton, J., Patalay, P., Fugard, A. J. B., Fonagy, P., Belsky, J., & Vostanis, P. (2015). Children, research, and public policy an evaluation of the implementation and impact of England's mandated school-based mental health initiative in elementary schools. School psychology review, 44(1), 117-138. https://doi.org/10.17105/SPR44-1.117-138
08. Health and Wellbeing Education
Paper
Pilot SHE4AHA Project Training Course Contributions to Health Promoting Schools: A Multiple Case-Study in Portuguese Schools
Teresa Vilaça1, Graça Carvalho2
1University of Minho, Portugal; 2University of Minho, Portugal
Presenting Author: Vilaça, Teresa
The Green Paper on Aging (European Commission, 2021) recognizes that living a healthy childhood shapes our future prospects, health situation and wellbeing, and presents three key questions: How can healthy and active ageing policies be promoted from an early age and throughout the life span for everyone? How can children and young people be better equipped for the prospect of a longer life expectancy? What kind of support can the EU provides to the Member States? To contribute to answering these questions, a partnership representing the Schools for Health in Europe Network (SHE) was created to carry out the School for Health in Europe project for Active and Healthy Aging (SHE4AHA), an ERASMUS+ Project (2021-1-DK01-KA220-SCH-000032766) involving Denmark, France, Iceland, Portugal and Slovenia.
SHE has a set of materials that policy makers, school board and teachers can use to make each school a Health Promoting School.These SHE material includes the SHE School Manual 2.0 (Vilaça, Darlington, Miranda, Martinis, & Masson, 2019), the SHE Rapid Assessment Tool (Safarjan, Buijs, & Ruiter, 2013), which is an assessment of the current situation and priorities of schools regarding health promotion and education, and a set of European Standards and Indicators for Health Promoting Schools version 2.0 (Darlington, Bada, Masson, & Santos, 2021). The main aim of the SHE4AHA project is to show that the Health Promoting School (HPS) framework can be used as a validated and evidence-based contribution to implement the Commissions’ green paper on ageing that calls for solutions to support healthy and active ageing from an early age. The SHE4AHA project will develop teaching material to help schools around Europe to use and implement the SHE material.
Portugal has been a member of the European Network of Health Promoting Schools (ENHPS) since 1994, and in 2005 Health Promotion and Education (HPE) became compulsory for all schools. Currently in our country exist the following priority areas of intervention which have been worked on within the values of health promoting schools: Mental Health and Violence Prevention; Diet and Nutrition Education; Physical Activity; Addictive Behaviours and Dependencies; Affects and Sexuality Education. Portuguese school curriculum should empower students with knowledge, attitudes and values to help them to make choices and decisions appropriate to their health, and physical, social and mental wellbeing, as well as the health of those around them, giving students an active and participatory role in school-based health and wellbeing promotion (Lopes, Ladeiras, & Lima 2015). Health promotion and education, as a component of the National Strategy for Citizenship Education, is mandatory at all levels of education. To operationalize it, each school or network of schools has a multidisciplinary team for health education, including a representative of the local health unit, the school psychologist and other technicians. The coordinating teacher of this team should liaise the activities/project of HPE with the coordinating teacher of the strategy for education for citizenship of the school.
Therefore, a critical health education approach within the paradigm of health-promoting schools (e.g. Clift & Jensen, 2005; McNamara & Simovska, 2015), was used as a theoretical framework for this study.
Against this background, this study aims to investigate: i)How do teachers' conceptions about health, health determinants, health promotion and ethics in health promotion (SHE values), the setting approach, and the SHE Pillars evolve during the Course?; ii)What is the current situation and priorities of schools in relation to health promotion and education?; iii)How do the teachers who participated in the in-service training organize themselves to plan, implement and monitor health promotion processes in their schools?; iv)What are the perceptions of these teachers regarding the teaching material developed by the SHE4AHA team?
Methodology, Methods, Research Instruments or Sources UsedIn this context, teachers from the multidisciplinary team for health of one rural network of schools, one urban preparatory school and one semi-urban preparatory and secondary school in the District of Braga, Portugal, were invited to participate in this project.
The rural network of schools includes a set of schools from pre-school education to the 9th grade with over 700 students aged 6-14 years old (grades 1-9) and about 300 children from 3 to 5 years old. This network of schools has several leisure clubs and projects, such as school sports, gardening club, science and sexuality education club. The urban preparatory school has around 700 students from the 5th to the 9th grade. This school currently has the Healthy School seal and the Eco-Schools seal. The school has several clubs and projects. The semi-urban preparatory and secondary school has about 700 students from the 5th to the 12th grade (10 to 17 years old). This school has participated in several ERASMUS+ and eTwinning projects and has several clubs, such as the arts, sports, robotics and “living science”.
The SHE4AHA project started with a b-learning in-service teacher training course (25 hours for the whole group and 25 hours for each school). The first 10 hours took place online . In this component, the concepts of health, health determinants, health promotion and ethics in health promotion (SHE values), the setting approach, and the SHE Pillars were co-(re)constructed. The SHE website was also explored and participants were invited to explore the Material for Teachers on Health Promotion at home in more depth. At this stage, these teachers wanted to expand the group and involve more teachers and some technicians from the school. The second phase of the training (15hours) at the University of Minho aimed to present the SHE materials, the Revised SHE School Manual, the SHE rapid assessment tool, and the SHE Standards and indicators. Subsequently, co-creation and the implementation theory of Evert Vedung will be worked on, and the planning of a strategy to promote health at school will be made.
Data were collected through a focus group in each school at the beginning and at the end of the training, which included the teachers and technicians (n=15) who carried out the training, the analysis of the documents produced by the participants during the project and the analysis of collaborative logbooks constructed by each school group after each session.
Conclusions, Expected Outcomes or FindingsData are still being collected. However, a positive evolution during the Course in the concepts of health, health determinants, health promotion and ethics in health promotion, the setting approach, and the SHE Pillars is expected. It is also expected that the assessment of the current situation and priorities of schools in relation to health promotion and education will be done in each school collaboratively, within co-creation groups. A positive perception of the teaching material developed by the SHE4AHA team and the identification of barriers/difficulties in its use and ways in which they were overcome is still an expected result.
ReferencesDarlington, E., Bada, E., Masson, J., & Santos, R. (2021). European Standards and Indicators for Health Promoting Schools version 2.0. Schools for Health in Europe Network Foundation (SHE) Ed.. https://www.schoolsforhealth.org/sites/default/files/editor/standards_and_indicators_2.pdf
European Commission, Directorate-General for Communication, Green paper on ageing, Publications Office of the European Union, 2022, https://data.europa.eu/doi/10.2775/785789
Safarjan, E., Buijs, G., & Ruiter,S. (2013). The SHE Rapid Assessment Tool. Schools for Health in Europe Network Foundation (SHE) Ed.. https://www.schoolsforhealth.org/resources/materials-and-tools/health-promoting-school-manuals/english
Vilaça, T., Darlington, E., Velasco, M.J.M, Martinis, O., & Masson, J (2019). SHE School Manual 2.0. A Methodological Guidebook to become a health promoting school. Schools for Health in Europe Network Foundation (SHE) Ed.. https://www.schoolsforhealth.org/resources/materials-and-tools/how-be-health-promoting-school
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