Abstract
Teachers play a key role in promoting children and young people’s health and therefore require health training during their initial teacher education (ITE). However, little is known about the impact of such training on teachers’ knowledge, attitudes, confidence, and competence toward promoting health in school, especially long term. We report on Phase 1 of an 18-month project examining the long-term impact of an innovative health education program, based on socio-constructivist learning and critical reflection, during preservice teacher training at one ITE university in England. It also explored barriers and facilitators to promoting health in school. We sent a questionnaire to 1,014 primary and secondary school teachers from three consecutive cohorts: preservice teachers (N = 334), newly qualified teachers (N = 334), and early careers teachers (N = 346). Of these, 164 (16%) responded (32% of preservice teachers, 8% of in-service teachers). This low response rate presents limitations but is in accordance with other research following up early career teachers. The majority of the respondents found the training useful, felt confident and knowledgeable teaching and dealing with health issues, and held positive attitudes about promoting health. They indicated that practical experience, supportive colleagues, and a positive school ethos toward children’s health and well-being were important facilitators to teaching health education. We conclude the training is associated with a positive, long-term effect in the minority who responded, and we argue that the socio-constructivist nature of the health education training is a contributor. However, school environment factors might mitigate or support the impact of training provided during ITE.
Background and Aims
Teachers play a key role in providing health education and supporting the health and well-being of children and young people (Dewhirst, Pickett, et al., 2014; Tang, Nutbeam, & Aldinger, 2009). It is therefore vital that teachers entering the profession are able to perform this role effectively and are cognizant of the importance of good health for successful educational outcomes. Yet previous research (Dewhirst, Pickett, et al., 2014) found that training in health and well-being during preservice teacher (PST) education is variable in England, and there is sparse evidence of the impact of preservice health training on teachers’ practice once qualified (Shepherd et al., 2013). To address this gap, we report on Phase 1 of an 18-month longitudinal research study that explores the longer-term impact of a preservice health education program on three consecutive cohorts of teachers’ perceived attitudes, confidence, and competence to teach and promote health and well-being in schools during the early stages of their careers. The health education program was developed by researchers at the Southampton Education School and the Faculty of Medicine at the University of Southampton and has been delivered annually to postgraduate PSTs since 2010 (Byrne et al., 2012; Dewhirst, Byrne, & Speller, 2014; Speller et al., 2010).
Literature Overview
Globally, through initiatives such as health promoting schools, schools are an important setting for promoting children and young people’s health and well-being (e.g., Tang et al., 2009). Teachers are therefore key in promoting health in school, but this role is often conducted alongside their subject teaching and is not one in which they have usually specialized. In the United Kingdom, teachers take on a pastoral care role for pupils, and they may be involved in delivering health interventions or may teach aspects of health education through, for instance, Personal, Social, Health and Economic education (PSHEe), and Spiritual, Moral, Social, and Cultural (SMSC) education (Department for Education [DfE], 2013a) as well as through their subject area teaching. However, several factors influence how schools approach and deliver the promotion of pupil health and well-being and the degree to which preservice programs incorporate health training. One considerable factor (Formby, 2011; Shepherd et al., 2013) is that PSHEe is likely to remain a nonstatutory requirement (DfE, 2013b) despite recommendations that it should become statutory and be included in PST training courses (House of Commons Education Committee, 2015). Since 2010, the U.K. government has focused on high-quality subject-specific teaching (DfE, 2010) with much less emphasis on pupil health and well-being, and schools can decide themselves about how and to what extent they deliver PSHEe. Despite this, most schools address PSHEe to some extent (Formby, 2011), but because of the wide range of topics included under the PSHEe and health and well-being umbrella, its delivery varies widely from school to school and between primary and secondary phases of education (Formby, 2011). As a consequence, preservice programs may be hesitant to include health education within their curricula, and health training provided at placement schools is variable (Shepherd et al., 2013).
The variability of delivery across schools and preservice courses would indicate that more comprehensive training in health and well-being is essential to prepare aspiring teachers to teach PSHEe effectively before they enter the profession as qualified teachers (Ofsted, 2013). Furthermore, the Carter review of initial teacher training (DfE, 2015) has recommended that courses provide teachers with a grounding in child and adolescent development, including emotional and social development, and introduce them to strategies for character education and supporting well-being, thus placing further demand on preservice providers to ensure quality health training is integrated as part of their teacher training programs.
In the United Kingdom and elsewhere, PST training is delivered by higher education providers at undergraduate (e.g., Bachelor of Education) and postgraduate levels (e.g., Postgraduate Certificate in Education [PGCE]), with courses comprising a mixture of college-based training and school-based practice teaching experience. Teachers may also train directly in schools via school-led teacher training schemes (e.g., School Direct; School-centered initial teacher training; and, previously, the Graduate Teacher Programme [GTP]). In the past decades both preservice (Warford, 2011) and continued professional development (Townsend, 2010) have seen a shift in focus from fostering teachers’ knowledge and skill development theoretically, to learning in practice with guidance from accomplished practitioners while emphasizing reflection on their own practice, their classroom roles, and pupil outcomes (Vescio, Ross, & Adams, 2008). This shift is based on the notion that teaching and learning have become increasingly complex and teachers are required to continually rethink their own practice in the light of ongoing national education reforms (Vescio et al., 2008). The approach assumes a constructionist view of learning which involves the processes through which learners link new knowledge to what they already know and appropriate it within personal and social–cultural contexts (Kafai, 2006). It allows them to assimilate and accommodate new knowledge about teaching and learning alongside experienced others (Piaget, 1929). The preservice health training program evaluated here is based on this model and will be outlined further in the Method section.
Studies of training PSTs to teach health education have only generally examined the impact during or at the end of courses (e.g., Byrne et al., 2012), with only a few studies examining outcomes in the longer term, once teachers are working in schools (Shepherd et al., 2013). Bostock, Kitt, and Kitt (2011), for example, investigated the impact of a 1-day mental health preservice conference on PSTs’ knowledge and confidence in dealing with pupils’ mental health issues at school via a mixed-methods study. They found that, overall, the sample of 73 surveyed teachers (response rate not provided) reported an increased understanding of the important role teachers have in detecting early warning signs of mental health problems in pupils, and increased confidence in dealing with mental health issues at school. A follow-up focus group with 5 trainee teachers 18 months later showed that the increased confidence was sustained long term; however, the small size of this study presents a limitation. Weatherby-Fell and Vincent (2005) investigated the impact of a mental health teacher training program 1 year after graduation at a university in Australia and found that among a small group of eight respondents, most felt more confident in identifying young people in need of support than teachers (five) in a control group not having mental health training. However, the number of respondents was again limited. Evans and Evans (2007) assessed the impact of PSHEe training on a small sample of 11 PGCE PSTs and that of in-service health training on 10 newly trained teachers. The respondents reported confidence in using a variety of interactive teaching and learning methods in their delivery of PSHEe. However, confidence in planning and teaching a PSHEe curriculum or delivering specific topics such as sex and drugs education was lower than suggested by respondents’ awareness of the importance of using a variety of interactive teaching methods for PSHEe, particularly among the PSTs. The latter is generic but explicitly recommended for PSHEe by Ofsted, and the authors indicated a need for further training in these areas to make trainee teachers’ learning in PSHEe delivery explicit.
All three of these studies are based on small numbers of in-practice teachers but provide some indication of longer term impact as teachers take up teaching roles in schools. However, in-depth further investigation is needed as no research has yet investigated the longer term impact of a comprehensive preservice health education program, embedded across a range of subject routes, on large samples such as whole cohorts of trainee teachers. The aim of this study was, therefore, to explore the long-term impact of the preservice health program on the perceived knowledge, attitudes, confidence, and competence of three cohorts of teachers (preservice, newly qualified, early career) to engage in teaching and promoting health and well-being in schools; and to explore the factors that influence the teachers to promote health and well-being in schools.
Method
Overall Research Design
We conducted the survey reported here as part of a larger, mixed-methods longitudinal study that evaluated the health education training delivered in the preservice courses at the University of Southampton, United Kingdom. In this article, we report the findings from a survey we conducted in May to July 2014 with three cohorts of teachers who had trained at the University of Southampton between 2011/2012 and 2013/2014.
The Preservice Health Education Program
There has been a call for better reporting of the interventions evaluated in research to aid their implementation and replication. Hoffmann et al. (2014) have created the Template for Intervention Description and Replication checklist with a list of the intervention elements that authors should provide details about when reporting their research (e.g., the intervention aim, how it was delivered, and where). In our description of the preservice health education program, we have covered the items listed in the Template for Intervention Description and Replication (Hoffmann et al., 2014) to provide a clear account of what the intervention involved.
The health program was developed by a multidisciplinary team of experts across the university and external agencies to address a gap identified in the PST training program and aims to raise awareness of the importance of PSHEe/health and well-being education and increase PSTs’ knowledge, skills, and confidence to teach the subject (Byrne et al., 2012; Speller et al., 2010). Critical reflection and a socio-constructivist view of the learning process (Vygotsky, 1978) form the philosophical foundation of the program. This approach provides PSTs not only with basic knowledge and skills to develop their competence and capabilities to teach and promote health in school, but also opportunities to reflect alone and with others on personal values and attitudes toward health.
The program has both university and school-based components and centers on an annual Health Day taking place at the university, early in the training program, consisting of an introductory lecture; a range of interactive workshops (e.g., gaining confidence in teaching sensitive issues, healthy eating, emotional health and well-being); an exhibition in which various governmental and nongovernmental public health and education agencies take part; with tasks to be completed after each activity. Later in the course, the trainee teachers are expected to complete follow-up school-based tasks, such as finding out about the school’s PSHEe/Health Education program, observing a PSHEe lesson and coplanning and teaching a PSHEe lesson, to consolidate their learning. Trainees can also complete a noncompulsory health portfolio to be considered for the PSHEe Association’s Chartered Teacher Certificate (70.7% of this survey’s respondents opted to do this). They are also expected to reflect on their learning and write a reflective account outlining the importance of PSHEe at whole school and classroom level. The Health Day is a multidisciplinary event with personnel from a wide range of statutory (i.e., Public Health England; Local Authority Public Health bodies), nonstatutory, and charitable health organizations (i.e., the Children’s Society, St John Ambulance, the Alcohol Education Trust) as well as academics specialized in specific public health areas, attending to give keynote speeches and/or facilitate workshops. As a result of evaluations an element of choice was included for some of the workshops that tailor the day to meet individual needs. Mandatory elements for primary PSTs include emotional first aid; sex and relationship education (SRE); and healthy eating. Mandatory elements for secondary and further education PSTs include SMSC development; SRE; and drug awareness. Optional workshops include, for example, health issues about local school-aged children, first aid, the role of school nurses, young carers, financial education, and HIV. Therefore, even though all PSTs received the same intervention, the specific content of some sessions may have varied depending on their choice of workshops. This content has also changed somewhat since the first delivery of the Health Day in 2010, in response to feedback from all stakeholders and to developments in the fields of public health, PSHEe, and education as well as preservice teacher training requirements, such as Ofsted regulations. In addition to these health education elements of the course, PSTs take part in separate training on child protection, behavior management, and special educational needs elsewhere in their course.
Evaluations at the end of the program have been consistently positive with PSTs indicating that their confidence and competence has increased as a result of the training. This article goes further by reporting on the longer term impact of this training.
Ethics
Ethical approval was obtained from the University of Southampton Ethics Committee prior to the research commencing.
Participants
We sent the Phase 1 questionnaire to 1,014 primary and secondary school teachers from the three cohorts of the University of Southampton trained teachers: (1) PSTs who had trained in 2013/2014 and who took part in the questionnaire at the end of their training (n = 334); (2) Newly Qualified Teachers (NQTs) who had trained in 2012/2013 and who took part in the questionnaire during their first year of teaching (n = 334); and (3) early career teachers (ECTs) who trained in 2011/2012 and took part in the questionnaire during their second year of teaching (n = 346). The University of Southampton offers four training routes: the primary and secondary PGCE courses, and primary and secondary School Direct courses (formerly GTP programs). All teachers in each cohort, from all four of these courses, for whom we had contact details available were invited to take part in a survey (97.4% of the PST cohort, 98.5% of the NQT cohort, and 93.8% of the ECT cohort) with the aim of obtaining a representative sample to include primary and secondary, male and female teachers from a wide a spectrum of geographical areas and school types. Supplemental Table 1 (available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data) summarizes the number of teachers who were in each cohort and the number to whom we sent a questionnaire. Due to the low response rate to the questionnaire from the NQTs and ECTs (see Results section below), we combined the NQTs and ECTs into one cohort for data analysis; we refer to this cohort as in-service teachers (ISTs).
Questionnaire
The questionnaire was adapted from one which was used at the University of Southampton for the end of the training year evaluation of the health education program and which had been administered to previous cohorts. The questionnaire was piloted in 2013 with PSTs and NQTs, adapted and then piloted again in 2014 with PSTs before being administered. During piloting, we invited the respondents’ feedback on the clarity of the questions, the suitability of the questions for trainee and early career teachers, question order, how long the questionnaire took to complete, and any other suggested changes. We made amendments to the questionnaire in response to the feedback we received. The project advisory group, consisting of regional public health specialists and PSHEe experts, also contributed to the development of the questionnaire.
All three cohorts of teachers received the same questionnaire. The broad categories of the issues explored in the questionnaire are presented below. The full questionnaire is provided in the Supplemental Appendix of this article (available online at http://php.sagepub.com/content/by/supplemental-data).
Perceived Usefulness of the Preservice Health Education Program
Questions covered the usefulness of different aspects of the course as preparation and for gaining confidence, for their teaching of and role in dealing with health and well-being issues in school.
Perceived Impact of the Preservice Health Education Program
To further gauge the impact of the health education program, questions included perceptions of skill, knowledge, and confidence in teaching and dealing with health and well-being issues and whether these aspects had increased, stayed the same, or decreased since they had started their course (if they were a PST) or since qualifying (if they were an IST). Attitudes about PSHEe and the promotion of children and young people’s health and well-being in schools, and the impact of the training on personal health and well-being, were explored.
Perceived Barriers and Facilitators in Teaching PSHEe or Managing Pupils’ Health and Well-Being
Questions probed teachers’ experiences of barriers and facilitators to teaching PSHEe and managing pupils’ health and well-being in their school during training (e.g., while on school placement) or during their early teaching career, in order to understand the factors that can support or impede the development of effective health education. These questions were informed by the barriers and facilitators identified in a previous survey of preservice programs and a systematic review of the research literature about PST training in health and well-being (Shepherd et al., 2013).
Other Questions
Background and demographic information was collected about the teachers and their perceptions of the socioeconomic status of the catchment of the schools they were training or employed at.
Questionnaire Response Options
Most of the questions were answered on scales ranging from 1 to 4 (e.g., with “1” indicating “strongly disagree” and “4” indicating “strongly agree”). A middle response option was not provided to encourage participants to either give a positive or negative response. These questions were about how useful the teachers had found the training, their attitudes, their perceptions of their current knowledge, skills, and confidence, and their perceptions about the impact on their health and well-being. We felt it would be more informative for the participants to provide either a positive or negative response to these questions, so that we and any research users could understand if, on balance, the program was associated with positive or negative effects. Questions about the extent to which the teachers felt that their school’s catchment area, modes of PSHEe delivery, and level of parental and community engagement had been beneficial or a difficulty in teaching PSHEe and managing pupils’ health and well-being issues were answered on a 5-point scale, with “5” indicating “very beneficial” and “1” indicating “very much a difficulty,” and with a middle option to enable participants to express a neutral opinion. Additionally, some open-ended response questions were asked.
Procedure
All three cohorts were e-mailed a link to the online questionnaire in May 2014, and received one reminder e-mail between 3 and 10 days if they did not respond to the initial contact. To increase response rates, hard copies of the questionnaire were subsequently distributed either by post or by hand. The survey took approximately 15 minutes to complete, and a small incentive was offered in the form of a prize drawing for 15 gift vouchers. Prior to sending the questionnaire, we publicized the research and the survey to the PSTs via their online student noticeboard.
Data Analysis
Data were analyzed in SPSS using standard descriptive statistics (counts and percentages). To present and interpret data in this article for the questions where participants gave answers on a 4-point scale, we have combined the percentages of respondents giving positive responses to each question (i.e., “4” and “3” combined) and negative responses (i.e., “2” and “1” combined). Similarly, for the responses given on a 5-point scale, we have combined the positive responses (i.e., “5” and “4” combined), combined the negative responses (i.e., “2” and “1” combined), and provided the neutral responses (i.e., “3”). Full results are provided in the Supplemental Appendix (available online at http://php.sagepub.com/content/by/supplemental-data).
We conducted cross-tabulations to explore the association of teachers’ perceptions of the socioeconomic status of their school’s catchment area with their perceptions of their school’s level of parental and community engagement, as well as the association of both of these variables with the extent to which they felt these factors had been beneficial or a difficulty in teaching PSHEe or managing pupils’ health and well-being issues. We used basic content analysis to analyze the qualitative data from the open-ended response questions. Tables of the full, coded responses are provided in the Supplemental Appendix (available online at http://php.sagepub.com/content/by/supplemental-data), with selected findings presented in this article.
We present response rates to the questionnaire in the Results section and in the Supplemental Appendix (available online at http://php.sagepub.com/content/by/supplemental-data). A respondent was defined as someone who had completed more than just the background and demographics questions in the questionnaire. All the percentages reported in the article are the valid percentage. We have indicated the level of missing data for each question here and in the Supplemental Appendix. In our presentation of the results below, we comment on the overall findings across all cohorts of teachers and then comment on the differences and similarities of the PSTs’ and ISTs’ responses to explore how teachers’ perceptions of the impact of the training change or are maintained once they are working in schools.
We did not perform chi-square tests to calculate the significance of the differences between PSTs and ISTs on the various variables, as this would involve conducting multiple comparisons which would have increased the likelihood of Type I errors.
Results
Response Rates and Participant Characteristics
A total of 164 teachers completed the questionnaire, resulting in a 16% response rate. Of these respondents, 108 (65.9%) were PSTs, and 56 (34.1%) were ISTs (36 NQTs and 20 ECTs). The response rate was 32% for the PST cohort and 8% for the IST cohort (for the NQTs and the ECTs cohorts individually, the response rates were 11% and 6%, respectively). Eighty-nine (54.3%) respondents were training or had qualified as a primary teacher and 75 (45.7%) as a secondary teacher at the time of completing the questionnaire. See Supplemental Tables 1 to 4 (available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data) for the separate response rates for each cohort and for secondary and primary teachers.
Overall, the majority had undertaken either the primary PGCE (47.6%) or the secondary PGCE (26.2%), with those remaining having undertaken primary or secondary School Direct or GTP programs. Of the ISTs, 85.2% were currently employed as a teacher, one (1.9%) was a teaching assistant (who had trained as teacher on one of the courses, but who had taken a job as an assistant), and seven (13%) were not employed as either a teacher or a teaching assistant (see Supplemental Table 6, found in the Supplemental Appendix, for more details, available online at http://php.sagepub.com/content/by/supplemental-data). Respondents were included in the analysis regardless of their current occupation. Of the respondents, 34.8% described the socioeconomic status of the catchment area their school as “high,” 35.4% as “low,” and 29.8% as “neither high nor low.” The majority of the teachers were women (70.4%) and were aged 20 to 29 (72.0%). (Further background and demographic information is presented in the Supplemental Appendix.)
Perceived Usefulness of the Preservice Health Education Program
Table 1 shows how useful respondents rated various aspects of the health education training as preparation for their future or current health promotion role.
Teachers’ Ratings of the Usefulness of Aspects of the Teacher Training Course for Preparing Them for Their Health Promotion Role.
Note. Missing data for this question ranged from 1.8% to 10.4% across each of the training activities listed. PST = preservice teacher; IST = in-service teacher; PSHEe = Personal, Social, Health and Economic education.
The percentage of all the questionnaire respondents (n = 164) who reported that they had not taken part in a particular activity. bThe “other” aspects, where specified, were PSHEe (11.6%), Professional Themes (6.7%), specific sessions of various topics (5.5%), practical experience (1.8%), “All of it” (1.8%), and other (3.7%).
The majority of the teachers felt that most aspects of their university-based learning and school placement experience were either very useful or useful preparation and had helped increase their confidence for teaching about and dealing with health and well-being issues (Table 1, Panels A, B, and C). Of the university-based elements, 65.6% and 74.1% of the teachers, respectively, rated the Health Day and other health-related aspects of the university course as very useful or useful for preparing them for their future role (Table 1, Panel A). High proportions of the teachers rated speaking with experienced teachers and discussion with other trainee teachers (90.0% and 76.9%, respectively) as very useful or useful for gaining confidence (Table 1, Panel C). The health portfolio, which was a voluntary activity, was viewed by proportionally fewer teachers as very useful or useful for gaining confidence (Table 1, Panel C) or as preparation than other aspects of the course (Table 1, Panel A).
Regarding school placement experience (Table 1, Panel B), 24.4% of the participants reported that they did not have an opportunity to gain practical experience of teaching PSHEe and 22.0% said they did not obtain observational experience of PSHEe or pastoral care on their school placement. Where received, though, practical experience was viewed by a slightly higher proportion of the teachers as very useful or useful for gaining confidence or as preparation than many of the university-based elements, suggesting that practical experience was highly valued.
Larger percentages of PSTs than ISTs rated the university-delivered health training as very useful or useful for gaining confidence or as preparation. Health Day aspects (introductory lectures, exhibitions, and workshops), seminars as part of the university course, and completing the health portfolio were considered very useful or useful for gaining confidence by a greater proportion of the PSTs than the ISTs. Similar proportions of PSTs and ISTs felt that practical experience on placement and opportunities to talk with other trainee teachers, experienced teachers, and health experts from external agencies were useful for developing confidence.
The most common comments to an open-ended question about what teachers had found useful or less useful on the course for preparing them to teach about or deal with health and well-being issues in school included three teachers who felt that practical experience of teaching, helping with a lesson, or mentoring in school had been or would be beneficial: I think actually teaching the content is what is helpful. (ECT primary teacher)
Among the other comments, the teachers’ responses related to a felt lack of practical experience in the school placement part of the course and the usefulness of gaining this practical experience or training in the pedagogy of PSHEe: To have set times in school timetable to teach PSHE rather than to organize them yourself would be of a benefit in training as this was not one of my priorities of teaching which it should [have] been. (NQT secondary teacher)
For full responses to this open question, see Supplemental Table 16 (available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data).
Perceived Impact of the Preservice Health Education Program
Tables 2 and 3 present the results for the questions about the teachers’ perceptions of the impact of the health education training. The majority reported feeling skilled, knowledgeable, and confident in teaching and dealing with a range of health issues. The issues that the lowest percentage of teachers felt skilled, knowledgeable, and confident with were teaching substance and drug abuse and SRE and dealing with sensitive issues. In response to separate questions, most respondents stated their skills, knowledge, and confidence for (1) teaching and (2) dealing with health and well-being issues had increased since starting the course (85.9% and 73.9%, respectively, of the PSTs) or since qualifying (80.4% and 84.3%, respectively, of the ISTs), with no respondents reporting a decrease (see Supplemental Table 18 and Supplemental Table 20, found in the Supplemental Appendix, for the full results for these questions, available online at http://php.sagepub.com/content/by/supplemental-data).
Teachers’ Perceptions of Their Skills, Knowledge, and Confidence for Teaching About and Dealing With Health and Well-Being Issues.
Note. Missing data for these questions ranged from 0.6% to 3.0% across all the topics listed. PST = preservice teacher; IST = in-service teacher.
Teachers’ Views on the Impact of the Health-Related Training on Their own Health and Well-Being and About PSHEe and Health and Well-Being in Schools.
Note. Missing data for these questions ranged from 1.8% to 3.7% across all the statements listed. PST = preservice teacher; IST = in-service teacher; PSHEe = Personal, Social, Health and Economic education.
Proportionally more ISTs felt skilled, knowledgeable, and confident about teaching the listed topics than the PSTs, except for physical activity and emotional/mental health and well-being, which a slightly greater proportion of PSTs expressed confidence about than the ISTs. The more detailed statistical analysis in Supplemental Table 17 (available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data), however, highlights some differences between PSTs and ISTs. Proportionally more ISTs than PSTs reported feeling “very skilled, knowledgeable, and confident” in teaching about substance and drug abuse (30.4% of ISTs and 17.8% of PSTs), alcohol use (35.7% and 19.6%, respectively), smoking prevention (41.1% and 29.0%, respectively), and sex and relationships (36.4% and 17.8%, respectively).
Regarding dealing with health and well-being issues, proportionally more PSTs than ISTs felt confident in dealing with safeguarding and child protection, safety- and accident prevention, and antibullying. A similar proportion of PSTs and ISTs felt skilled, knowledgeable, or confident about dealing with the other issues listed. The more detailed statistical analysis in Supplemental Table 19 (available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data) did not highlight any stark differences between PSTs and ISTs, but generally proportionally more ISTs than PSTs reported feeling “very skilled, knowledgeable, and confident” in dealing with the issues listed.
Around a third to nearly half of the respondents felt that the health education training they had undertaken on the course had had a positive impact on their own health and well-being (see responses to various related items in Table 3), with 65.2% also reporting they had tried to maintain a work–life balance as a result of the training (Table 3). A greater percentage of the PSTs reported an impact of the course on their health and well-being than the ISTs. In response to an open-ended question, among the responses received, three teachers commented as follows: Already healthy/active. Knowledgeable due to sports undergrad. (PST primary teacher) Good curriculum lecture on work/life balance— helpful. (PST secondary teacher) Teacher health is not an industry priority. Irritating to hear it discussed as such. (PST secondary teacher)
Nearly all (99.4%) of the teachers felt it was important to teach PSHEe and to promote health and well-being in schools and reported that they enjoyed teaching it. Most (95.6%) also recognized that the school environment can affect pupils’ health and well-being, and almost all (98.8%) believed in a link between health, motivation to learn, and attainment. A similarly high percentage of PSTs and ISTs held these positive views, suggesting that further teaching experience did not generally diminish them. The more detailed statistical analysis in Supplemental Table 34 (available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data), however, highlights one difference between PSTs and ISTs. Proportionally more ISTs strongly agreed (89.1%) than PSTs (73.6%) that “it is very important for schools to teach PSHE education and to promote the health and well-being of children and young people.”
Perceived Barriers and Facilitators in Teaching PSHE Education or Managing Pupils’ Health and Well-Being Issues in School
Table 4 shows the percentage of teachers who endorsed various factors as facilitators and barriers to teaching PSHEe and dealing with pupils’ health and well-being issues in their school. Overall, having practical experience was rated as a facilitator by the highest proportion of teachers, followed by support and guidance from colleagues. Around half of the respondents (49.1%) viewed access to good support, guidance, and resources from external agencies as facilitators, and 51.5% regarded their school prioritizing PSHEe and pupils’ health and well-being as a facilitator. Fewer felt support and guidance from senior management colleagues had been a facilitator.
Perceived Facilitators and Barriers to Teaching PSHE Education and Dealing With Pupils’ Health and Well-Being Issues.
Note. Teachers were asked to select all the facilitators and barriers from each list that in their experience or opinion had been beneficial or a difficulty (i.e., there was no limit to the number they could select). It is possible for a teacher to select a factor (e.g., practical experience) as both a barrier and facilitator, and so percentages may sum to more than 100% across the table rows. All percentages are the valid percentages. Across the facilitators and barriers question items, the missing data rate was 0.6% for each item (i.e., only one participant did not provide any response to these questions). PST = preservice teacher; IST = in-service teacher. PSHEe = Personal, Social, Health and Economic education.
Examples given in the questionnaire were: resilience, mindfulness, and Spiritual, Moral, Social, and Cultural Education.
More than half (51.5%) of the respondents felt lack of practical experience was a barrier. The nonstatutory status of PSHEe was felt to be a barrier by 35.6%, and 25.8% felt that a lack of priority placed on PSHEe and pupils’ health and well-being in their school was a barrier. Lack of support and guidance from colleagues, senior management, and external agencies were viewed by a minority as barriers.
There were few marked differences between PSTs and ISTs in perceived facilitators, except that proportionally fewer ISTs than PSTs felt that regular introduction of new government policies and initiatives was a facilitator. However, greater proportions of PSTs than ISTs stated that not yet having enough practical experience and the school not considering PSHEe and health and well-being to be a high priority were barriers.
“Other” facilitators mentioned by four teachers mainly related to having relevant personal or professional experience, including life experience and previous experience dealing with similar issues. One teacher felt that their subject specialism was a facilitator and another stated that self-directed research had been beneficial: Personal life experience, lifestyle and self-directed research. (IST secondary teacher) Previous experience as parent, and working in a school as cover supervisor. (PST secondary teacher)
None of the teachers who stated they had experienced “other” barriers provided a response to the open-ended question asking them to state these.
The results of the cross-tabulations showed that 43.6% of the teachers who reported being in a high socioeconomic status catchment area felt that the locality had had a very beneficial or beneficial impact on teaching and managing health and well-being issues (with a further 54.5% indicating a neutral response). A slightly lower proportion of the teachers (35.2%) who reported their school was situated in a low socioeconomic status catchment area, however, felt that the locality had been beneficial to teaching or managing health and well-being issues (with 33.3% reporting a neutral response). (See also Supplemental Table 28, available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data.)
Teachers in low socioeconomic status catchment areas tended to describe the level of parent and community engagement in their school as low (62.5%), and teachers in reported high socioeconomic status areas tended to describe this as high (82.1%). When teachers described parent and community engagement as high, they tended to view it as beneficial (57.4%) or neutrally (36.2%) for teaching about and managing health and well-being issues. When teachers described parent and community engagement as low, they tended to view it as a difficulty (51.2%) or neutrally (44.2%). (See Supplemental Table 31, available online as part of the Supplemental Appendix at http://php.sagepub.com/content/by/supplemental-data.)
Discussion
In this study, we gauged the potential impact of an innovative preservice health education program on PSTs at the end of their courses and ISTs in their first and second years of teaching in schools in the United Kingdom. We are aware of only three other studies (Bostock et al., 2011; Evans & Evans, 2007; Weatherby-Fell & Vincent, 2005) that have followed teachers into practice in schools related to the topic under study. Our study is the first anywhere to examine how a whole cohort-wide, comprehensive health education program may affect teachers’ self-reported attitudes and their perceived competence and confidence to teach and promote health and well-being in the first couple of years of working in schools. Our findings show that, overall, the respondents rated the usefulness of the health program positively. All the teachers indicated that their knowledge, skills, and confidence in teaching and dealing with health and well-being had increased, or at the very least remained the same since the end of their course. However, the PSTs, who are in more immediate receipt of this training, rated its usefulness generally higher than the ISTs. Proportionally more PSTs than ISTs may have found it useful as they have less experience of teaching about or dealing with health and well-being issues or because the training was fresher in their minds. For the ISTs the training had been completed 1 or 2 years previously, and was therefore perhaps difficult to remember (as some of the responses to the open-ended questions indicated). The ISTs may have additionally acquired more recent and relevant experience which they may view as more useful than their initial training or, having had more experience, they may view the training less positively. As others (e.g., Thomas & Jones, 2005; Wight & Buston, 2003) have reported, training is often positively evaluated immediately after it has taken place, as would appear to be the case with the PSTs. It is encouraging, nevertheless, to note that there seems to have been a longer term effect for everyone with regard to this training.
The ISTs also reported more confidence, skill, and knowledge than PSTs in teaching about the more challenging PSHEe topics of substance and drug abuse; alcohol use; smoking prevention; and SRE. This would suggest that teachers’ knowledge, skills, and confidence develop further after training, possibly due to gaining more experience or having taken part in other training opportunities.
The Health Day workshops, opportunities to engage with experts, and other seminars were regarded as the most successful elements of the university-based part of the program. However, given that the Health Day directly addresses health and well-being, it is surprising that other aspects of the PST training were rated as useful by a slightly greater proportion of the teachers. The relevance and value of new ideas and concepts are not always immediately apparent and require time to be assimilated and accommodated into one’s cognitive structures (Reiman, 1999). Therefore, the timing of the Health Day could have affected teachers’ views. This was held at the beginning while other aspects were delivered later in the course. Other aspects of the course also provided opportunities to reflect on prior learning from elements of the Health Day, as well as putting this learning into context during school placement. Good pedagogical practice should provide occasions for reflection to consolidate learning (e.g., Pollard et al., 2008; Schön, 1983) and this is possibly why later parts of the course, including practical experience in school, were regarded as more useful. Therefore, having the chance to put theory into practice during school placement seems to have enabled and facilitated learning in an active and experiential manner that is both contextual and situated, which appears to have given it more meaning for these teachers (Lave & Wenger, 1991). Furthermore, learning within the community of practice in school was regarded as highly valued (Lave & Wenger, 1991). Encounters with experienced teachers as more knowledgeable others, a cornerstone of socio-constructivist learning (Vygotsky, 1978), were considered to be highly useful and an important part of learning about teaching and dealing with health and well-being issues during training. Discussion with other trainees, as part of a socio-constructivist and dialogic approach to learning (Mercer, 2000) was also considered helpful in gaining confidence in managing health and well-being in schools (Mead, 2004). It would appear that teachers not only found these approaches to learning useful during their training but that they have benefitted their practice in the longer term, by becoming more skilled and confident to deal with health and well-being issues.
In contrast, completion of the health portfolio was less valued. While this was to be done individually, communication with others and critical reflection are essential aspects of the tasks included in the portfolio. Despite the portfolio being reported as less useful, the trainees regarded speaking to external experts, colleagues, and other trainees as a useful strategy for gaining confidence. The noncompulsory status of the health portfolio may have contributed to them viewing it to be less useful. Additionally, they may have regarded having to complete it individually as counterproductive to the overall ethos of the social approach to learning evident in the rest of the program.
With regard to teaching particular health issues, proportionally fewer teachers agreed that they were knowledgeable, skilled, and confident in teaching sensitive topics such as SRE and drug education than other topics such as healthy eating. Wight and Buston (2003) noted that teachers in receipt of in-service training in SRE requested further opportunities to develop their skills and confidence in this topic. Preservice training is only the beginning of these teachers’ training in health and it would appear that further training is needed at an in-service level. Teachers may especially benefit from further training in applying appropriate pedagogies to help them deal more confidently with sensitive issues. As part of this, training in the social and emotional aspects of these topics may be useful, so that teachers can take an effective and holistic approach to these issues. The findings indicate that there is a need for continued professional development to incrementally increase the knowledge and skills that have been initially developed in teachers’ preservice training.
Earlier research (Byrne et al., 2012; Speller et al., 2010; Thomas & Jones, 2005) has shown that preservice training encourages the development of positive attitudes toward teaching about health so that these PSTs are more likely to become involved in health education in their future careers. It was encouraging that almost all of the teachers had a positive attitude toward including PSHEe in schools, their role in teaching it, and promoting health and well-being more generally through being a role model. Positive attitudes to promoting health are key to its success. Pupils may also be supported to develop positive attitudes and behaviors toward their own health and well-being as a result of teachers acting as role models. These findings are important for the role teachers may be able to play in the future of the development of the wider public health workforce.
Furthermore, around half the PSTs felt that the health-related training they had participated in had had a positive influence on their awareness of taking care of their own health and well-being. It is notable that proportionally fewer ISTs than PSTs felt that the health-related training had had a positive impact on their health. We suggest a couple of explanations for this. First, the reality of school life and the pressures of day-to-day teaching are likely to have affected these teachers’ views, as they took on more responsibilities during their early careers. Marshall (2013) noted that the stress levels of ECTs can lead to burnout and this clearly has a negative impact on their own health and well-being, which means that the likelihood of being a positive role model is reduced. What is also significant is that this stress can cause teachers to be unable to engage with their pupils and build successful relationships (e.g., Troman, 2000). Positive relationships with pupils are crucial for dealing with and teaching PSHEe effectively. Preservice training appears to have some, although a diminishing, effect in the longer term on teachers’ ability to manage their own health and well-being, as they further experience the realities of teaching and the stress it may bring. Second, the ISTs may have already been healthier than the PSTs and so did not feel the training had influenced their health or had found other sources of health and well-being support.
With this in mind, it is interesting to note that the teachers regarded support and guidance from colleagues as well as the school prioritizing PSHEe as facilitators of their teaching and management of health and well-being in school. PSTs on school placement and those in the early years of their careers working in a school with a supportive ethos may be more likely to have the confidence and be encouraged to “have a go” at teaching PSHEe. In such schools, new teachers will be aware that they have the safety net of appropriate mentoring and support to help them improve (e.g., LoCasale-Crouch, Davis, Wiens, & Pianta, 2012). Furthermore, while it is not necessarily axiomatic that prioritizing PSHEe will ensure that novice teachers have the opportunities to practice their skills in teaching PSHEe, this was nevertheless regarded as an enabling factor in managing PSHEe/health and well-being. A whole school approach to promoting health aims to engage the whole community in the business of health (World Health Organization, 1993), and therefore, it is likely that such schools will endorse young teachers in their endeavors to learn how to teach and manage health and well-being effectively.
By far the main facilitator was regarded to be practical experience and conversely the lack of opportunities to practice was seen as a barrier to teaching PSHEe and dealing with pupils’ health and well-being effectively. Around a fifth to a quarter did not gain experience of teaching or observing PSHEe or pastoral care on school placement. This means that these PSTs were denied opportunities to put into practice what they had learned in the university-based element of their course. All schools are unique and therefore experience during school placement is inevitably variable, but this seems to be much more apparent in certain aspects of placements than others, such as PSHEe (Shepherd et al., 2013). This may be due to the nonstatutory nature of PSHEe and therefore the low priority some schools give to it. A consequence of this is that the long-term impact of the university-based training is mitigated by the inconsistency of these placement experiences. Given that high proportions of the teachers regarded practical experience as a facilitator to their teaching of health education and managing of pupils’ health and well-being issues, the variable and ad hoc opportunities for them to gain this experience on school placements presents a substantial challenge for training providers. Providers will need to balance the realities of different school’s approaches to health promotion and timetables with trainee teachers’ learning needs. A key message from our findings is that initial teacher education providers and schools may need to find better ways to integrate practical opportunities into training courses.
It is encouraging that half of the responding teachers saw the support, guidance, and resources from external agencies and experts as a facilitator to their teaching of PSHEe and managing of pupils’ health and well-being issues. We based the delivery model of the Health Day on a multiagency approach, with the aim of exposing trainees to the range of agencies that may be available in their school area to support teaching. Given that around half of the teachers valued this input, this aspect of the training seems to have been reasonably successful in its aims.
Strengths and Limitations
Although we used a number of techniques to try to obtain a good response rate to the questionnaire, one limitation of this study is the 16% response rate. Therefore, the findings are unlikely to be representative of all teachers who trained at the University of Southampton between 2011 and 2014. It is possible that those who were more interested in PSHEe and health and well-being were more likely to fill-in the questionnaire. The response rate from the ISTs was particularly low. Part of the aim of this study was to assess the feasibility of following up University of Southampton trained teachers as they began their teaching careers in schools, to determine whether further research evaluating the long-term effects of the program in a controlled study would be possible. This was an innovative and ambitious aspect of this research, as few previous studies have followed teachers into practice to assess the longer term effects of preservice training, and none included whole year cohorts. Our response rate from the ISTs shows that it may be challenging to assess the longer term effects of training, as it is difficult to later engage newly practicing teachers in such research. Nevertheless, the total number of ISTs we successfully followed up (n = 56) is substantially higher than in the three existing studies that have included longer term follow-up of preservice training effects among teachers now in practice (Bostock et al., 2011; Evans & Evans, 2007; Weatherby-Fell & Vincent, 2005). A further limitation is the lack of a comparison group, so it is not possible to infer that the training caused the positive effects observed on teachers’ attitudes, confidence, and competence. However, the longitudinal design of this study is a strength and offers some insights that the benefits associated with PST training in health education may be maintained during the early stages of teachers’ careers in schools.
Conclusion
The survey findings indicate that the usefulness of training in health is associated with a long-term beneficial impact on teachers’ ability to manage and teach PSHEe/health and well-being, although the confidence to deal with and teach certain topics was lower than others. The variability of experience in school placements is likely to be a factor in some PSTs lacking confidence to teach certain topics, and it is clear that greater consistency in training is needed. However, this training is only an introduction to the many and varied aspects of PSHEe; continued professional development, including opportunities to gain experience and reflect on it, will be necessary to ensure these teachers develop from novices to experts. Further training will be most effective when a pedagogical approach that is inclusive and socially constructed is adopted. Indeed, this approach models best practice in PSHEe.
Positive attitudes toward teaching health education and to some extent the relevance of teachers’ own health also seem to have been sustained. Where there is an existing community of practice and a whole school approach to health and well-being, teachers new to the profession will more readily be able to apply and consolidate what they have learnt during their preservice training about their own and others’ health and well-being than those who do not have such a collegiate environment to work in. Given the nonstatutory status of PSHEe and the many competing priorities in school, the support from colleagues is vital if new teachers are to continue to develop their expertise and enthusiasm for PSHEe throughout their careers.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research has been funded by the Leverhulme Trust.