Processes and outcomes in school health promotion: engaging with the evidence discourse

Citation

Simovska, V. (2012), "Processes and outcomes in school health promotion: engaging with the evidence discourse", Health Education, Vol. 112 No. 3. https://doi.org/10.1108/he.2012.142112caa.001

Processes and outcomes in school health promotion: engaging with the evidence discourse

Article Type: Guest editorial From: Health Education, Volume 112, Issue 3

This is the second special issue of Health Education which features research, theory and practice based perspectives on what counts as desirable outcomes of health promotion in schools in terms of health as well as education, and the effective processes in schools which lead to these outcomes. The focus in the first special issue was on highlighting the argument that the question about the outcomes of the health-promoting schools should not be limited to narrowly defined health outcomes but needs to be closely linked with the core tasks and values of the school. Building further on this argument, the papers in this issue feature a number of research issues of relevance for the effectiveness of the health-promoting schools approach, as well as a variety of research and evaluation methodologies contributing to the debate about what counts as reliable evidence within the health-promoting schools discourse.

The quest for evidence-based health promotion in schools has been growing significantly over the last decade. The concept of evidence seems to be one of the major themes not only in health but also in the social and sciences and humanities. Consequently, it is becoming an imperative in health education and health promotion research, policy and practice, constituting a new mantra within health education and health promotion. With its origins in medicine and medical treatment, which can be traced back to the nineteenth century, if not earlier, the gold standard of evidence-based medical practice has been associated with randomised controlled trials (RCT) that is, clinical experimental studies and evaluations measuring the effectiveness of the treatments through narrowly defined biomedical indicators. With the RCT as the gold standard, hierarchies of evidence have been established outlining of strength and the value of different evaluation and research methodologies that diverge, to a larger or lesser degree, from the golden standard (see, for example, Denman et al., 2002).

The usefulness of this narrowly defined evidence discourse for health promotion, including health promotion in schools, has been questioned (Raphael, 2000; Tones and Tilford, 2001; Carlsson and Simovska, 2009; Green and Tones, 2010; Hill et al., 2010). The main argument in the critique has been that health promotion in different settings, including schools is complex, multidimensional and multidisciplinary, it is informed by health sciences, but also by humanistic and social sciences including educational research. These different disciplines draw on different epistemological and methodological traditions, which endorse different quality criteria. Moreover, health promotion is embedded in “real life” settings, such as schools, which are dynamic, relational and impossible to control in the sense of laboratory research in RCT.

Thus, although unavoidable and very important, the issue of evidence within health promotion in schools embodies a number of complexities that call for a more layered discussion about the types of outcomes as well as the adequate research and evaluation methods to measure these outcomes and produce usable, or actionable, evidence informing policy and practice. The six papers published in this issue, contribute in their distinctive ways to bringing new nuances into this debate, both in terms of the issues that are researched, and the methodologies used.

Mannix McNamara and colleagues draw the attention on the importance of the pre-service teacher professional development for school-based health education and health promotion, the relevance of which is evident, given that teacher attitudes and knowledge are key factors in their intention to work with health related content. Taking the point of departure in the national policy in Ireland stating that all teachers are teachers in Social, Personal and Health Education (SHPE), this paper reports on the findings illuminating the attitudes of the undergraduate post primary teacher education students towards the teaching of SPHE. Only one in four teacher students indicated that they intend to teach SHPE upon graduation, with female teacher students being more inclined toward it than their male colleagues. The study points to the vital role initial teacher education can play in shaping the teachers identities as educators of the whole person as well as subject experts, which is of great consequence for the effectiveness of the whole-school approach to health promotion.

Räihä and colleagues report on the views of the school staff’s (teachers, school health nurses and school catering managers) on a health promotion project focusing on nutrition implemented via an ICT-based learning environment in a secondary school. The purpose of this qualitative interview-based study was to point to the importance of in-service professional development of the school staff working with promotion of healthy eating and health in school, particularly in terms of use of technology for this purpose. The paper argues that the challenge of the ICT use in nutrition projects is to transform the existing “taken for granted” practices so that education is delivered more efficiently and is of better quality. The development of new teaching methods and pedagogical strategies requires investment in skills, knowledge, teaching resources and infrastructure, as well as a coherent framework for the health-promotion work of the teachers but also of the school nurses and the school catering staff.

Teachers, as well as the other school staff, are also a central focus in the paper by Saaranen and colleagues. This paper examines the school as a workplace for the school staff and the staff’s occupational wellbeing as a constitutive dimension of health promotion at school. The paper reports on the baseline findings of a school-based intervention in 21 Finnish and 40 Estonian schools aiming to improve the occupational wellbeing of school staff. The findings suggest that the wellbeing of the school staff is related to professional competence and to opportunities for its continuous development as a part of the work life, with the social support and collegial collaboration, and with country and local context-specific resource related factors. These findings are treated as a point of departure in an action research based development work to improve the staff occupational wellbeing in the participating schools in both countries. Accordingly, the findings provide baseline measures to evaluate the effectiveness of the interventions and thus inform policy and practice of health promotion in schools.

Haapasalo and colleagues report on the associations between pupils’ perceptions of the psychosocial school environment, health compromising behaviours and selected family factors, based on the Health Behaviour in School-aged Children in Finland from 2006. The findings suggest that negative perceptions on school are associated with increased health compromising behaviour in pupils of both sexes. Some gender differences however were identified: for the boys the social relationships seem to have larger importance, while engagement with the school and school-related strain is more significant for the girls. The findings indicate that attention to gender differences should be paid in terms of planning of school based health promoting interventions, but also in the structure of the regular everyday school life and the pupil study-load.

The paper by Sormunen and colleagues engages with the evidence debate in a more direct way, by reporting on the process evaluation which was conducted as a part of the more comprehensive effect evaluation with a control and experimental (intervention) group, focusing on home-school partnership in enhancing health-related learning of pupils in 17 schools in eastern Finland. The findings addresses in this paper concern the findings of the midterm process evaluation in two intervention schools. Data were generated through in-depth interviews with two teachers and three focus group discussions with pupils’ families. The implications of this study go beyond the specific findings reported in the paper. The overall research methodology, of which the process evaluation reported on here is a part, is exemplary for its unique combination of an effect evaluation using intervention and control group, participatory action research design, and qualitative evaluation taking into account the processes of implementation as well as the context in which the intervention takes place.

Carlsson and Simovska (2009) also indicate how complex multi-dimensional intervention studies can contribute to generating usable evidence by using research designs alternative to the dominant ones place highly in the evidence hierarchies. The paper reports the results of cross case analysis examining the outcomes of a European health promoting intervention project aiming to prevent obesity among children (four to 16 years) and promote their health and well-being. Data were generated through five qualitative case studies conducted at schools in Denmark, the Netherlands, Spain, Italy and Austria. The findings demonstrated that pupils were meaningfully involved in bringing about changes which improved school policies, provisions and affordances for a healthier diet and regular physical activity. They also identified three forms of participation, each with a different level of pupil involvement and degree of agency.

In summary it can be argued that the six papers in this issue set the agenda for further research and debate related to evidence based health promotion in schools, as well as provide valuable knowledge for the policy makers and the practitioners in the field.

Venka SimovskaGuest Editor