Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.     

Danish pupils' perceived satisfaction with the health dialogue: Associations with the office and work procedure of the school health nurse

The aim is to identify how environmental factors, perceivedby the pupils, are associated with the pupils' perceived satisfactionwith a good health dialogue. This article focuses on the pupils'perception of the health office and the work procedure of theschool health nurses. The present article is based on data fromthe 1994 Danish part of the WHO-collaborative study Health Behaviourin School-aged Children. A nation-wide random sample of pupils11, 13 and 15 years old (n = 4046) answered a standardized questionnaireabout perceived health, health behaviour, social situation,the school as a workplace and the health dialogue. The finalmodel of the multivariate logistic regression analysis revealedeight predictor variables of perceived satisfaction with thehealth dialogue and three confounder variables. The predictorswere: comfortable health office OR = 1.20 (95% CI 1.11–1.30),pupils sat by the desk OR = 1.12 (95% CI 1.03–1.23), pupilsinfluenced the content of the dialogue yes/no: OR = 1.43 (95%CI 1.27–1.60), yes/don't know: OR = 0.80 (95% CI 0.72–0.89),sufficient time OR = 1.33 (95% CI 1.23–1.44), the schoolhealth nurse listened carefully OR = 1.24 (95% CI 1.13–1.35),the school health nurse talked a lot OR = 0.91 (95% CI 0.85–0.98),gave good advice OR = 1.28 (95% CI 1.18–1.43), let thepupils talk OR = 1.17 (95% CI 1.07–1.28). The confounderswere: pupils' sex: female OR = 1.23 (95% CI 1.14–1.33);and age: low age OR = 1.20 (95% CI 1.07–1.35) or highage OR = 0.84 (95% CI 0.76–0.93), but not medium age,high school satisfaction OR = 1.53 (95% CI 1.31–1.77),and low school satisfaction OR = 0.74 (95% CI 0.63–0.87).     

Environmental justice at school: understanding research, policy, and practice to improve our children's health

BACKGROUND: No overarching federal agencies or policies are responsible for ensuring environmental health at schools in the United States, potentially allowing many inequities for low‐income and minority communities to persist. This article examines emergent research, policy, and practice‐based efforts that may be used to identify and address environmental justice at school. METHODS: A brief literature review was conducted to understand (1) major mental, behavioral, and physical outcomes associated with environmental risk for school‐aged children and (2) current research methods for assessing these relationships. Documents prepared by government agencies, school districts, and advocacy groups were also collected and synthesized to improve understanding of the state of planning and policies for maintaining or improving school environments. RESULTS: Environmental risk can manifest in diverse ways such as mold, poor air quality, poor community design, or contaminated playgrounds. Deeply rooted in national and state structures of school funding and planning, such risks can lead to outcomes including respiratory illness, poor performance in school, and reduced levels of physical activity. With growing attention to these concerns, methods for measuring environmental risks and underlying disparities have advanced tremendously in the last few decades, yet development of innovative research approaches may be necessary to further advance and evaluate appropriate interventions. CONCLUSIONS: Environmental injustice is generally unacknowledged during decision‐making in US school districts. Continued dialogue reflective of translatable science is necessary to support school districts with limited funding in ensuring safe, healthy environments for learning.     

Australian teachers' understandings of the health promoting school concept and the implications for the development of school health

The health promoting school has emerged as a comprehensive framework to enhance the health status and health potential of school students. It requires teachers to be proactive in a number of areas beyond the formal curriculum. The success of health promoting schools will depend largely on what teachers know about its building blocks and the likelihood that they will be adopted. A number of teachers were interviewed and surveyed in a sequential study to ascertain their understanding of what constitutes a health promoting school. The findings indicate that teachers think mainly about school health in terms of the curriculum; have little understanding of how community partnerships might work; are very supportive of the concept; and have limited preservice and inservice training in health issues. It is argued that the growth of health promoting schools will be dependent on comprehensive professional development programmes; the production of resources which link teachers' perceived core business - teaching the mandated curriculum - to the building blocks of the health promoting school; closer collaboration between the health and education sectors; and a recognition by the community that schools cannot easily address (and solve) society's health concerns.Keywords: health promoting school; school health; teachers understandings      

Anti-bullying interventions at school: aspects of programme adaptation and critical issues for further programme development

Recently, a growing interest in problems at school of peer aggression and victimization was observed. As a result, intervention strategies appropriate for this kind of problem were required. The Norwegian anti-bullying intervention that was developed and evaluated by Olweus (1992) in the region of Bergen was considered to be a good model for other countries to implement interventions against peer aggression within the school environment. It was therefore adapted to the educational settings of other countries. This paper aims to discuss the adaptation processes of the Bergen anti-bullying programme and to give guidelines to advance further programme development. For this, the DFE Sheffield Bullying Project (Smith and Sharp, 1994), the Anti-bullying Intervention in Toronto schools (Pepler et al., 1994) and the Flemish anti-bullying project (Stevens and Van Oost, 1994) were considered in the analyses. Discussion of the adaptation processes of the Bergen model programme revealed that the adapted interventions largely succeeded in incorporating the core components of the Bergen model programme, taking into account the characteristics of the implementation environment. This suggests that for bully/victim interventions, the dilemma of programme fidelity and programme adaptation could be solved adequately. However, from a health promotion perspective, some critical issues for programme improvement were observed. Three suggestions for change were made, indicating that anti-bullying actions at schools may benefit from: (i) a clear overview of the learning objectives, specified per target population; (ii) more attention to parental involvement and family interventions; and (iii) additional information about the adoption processes of the anti-bullying interventions within schools.     

A comparative analysis of communication about sex,health and sexual health in India and South Africa: Implications for HIV prevention

This paper provides a comparative analysis of modes of dialogue, non‐verbal communication and embodied action relating to sex and health in two contrasting countries—India and South Africa—which have the world's two most heavily HIV‐affected populations (in terms of numbers of people living with HIV). Drawing on material derived from multiple studies, including ethnographic and other forms of qualitative and multi‐disciplinary research, the paper identifies commonalities as well as differences in communication relating to sex and sexual health in these diverse settings. The paper considers: first, how and by whom sex is and is not talked about, in public discourse and private conversation; second, how sexual intention and desire are communicated through indirect, non‐verbal means in everyday life; and third, how references to sexuality and the sexual body re‐enter within a more explicit set of indigenous discourses about health (rather than ‘sexual health’ per se), such as semen loss in India and womb ‘dirtiness’ in South Africa. The concluding section reflects on the implications of a comparative analysis such as this for current policy emphases on the importance of promoting verbal communication skills as part of ‘life skills’ for HIV prevention.     

Towards a new (or rearticulated) philosophy of mental health nursing: A dialogue-on-dialogue

The following dialogue takes up recent calls within nursing scholarship to critically imagine alternative nursing futures through the relational process of call and response. Towards this end, the dialogue builds on letters which we, the authors, exchanged as part of the 25th International Nursing Philosophy Conference in 2022. In these letters, we asked of ourselves and each other: If we were to think about a new philosophy of mental health nursing, what are some of the critical questions that we would need to ask? What warrants exploration? In thinking through these questions, our letters facilitated a collaborative enquiry in which philosophy and theory were generative tools for thinking beyond what is and towards what is yet to come. In this paper, we expand the dialogue within these letters—in a ‘dialogue-on-dialogue’—and take up one thread of our discussion to argue that a new philosophy of mental health nursing must rethink the relationships between ‘practitioner’/‘self’ and ‘self’/‘other’ if it is to create a radically different future. Further, we posit solidarity and public love as possible alternatives to foregrounding the ‘work’ of mental health nursing. The possibilities we present here should be received as partial, contingent and unfinished. Indeed, our purpose in this paper is to provoke discussion and, in so doing, to model what we believe is a necessary shift towards criticality in our communities of nursing scholarship.     

Communicating about pupils in mainstream school with special health needs: the NHS perspective

AIM: To add to previous research carried out with young people, parents and teachers, by investigating health staff's perspectives on the difficulties, and possibilities for, achieving good communication with school staff with regard to children in mainstream school with a chronic illness or physical disability. RESEARCH DESIGN AND METHODS: A qualitative research study was carried out in one NHS Trust. Twenty semi-structured interviews were carried out with a purposive sample of health staff to cover the spectrum of professionals who have responsibility for meeting the needs of children with a chronic illness or physical disability in mainstream schools (paediatricians, school doctors, school nurses, specialist nurses, health visitors, GPs, speech and language therapists, paediatric occupational therapists, paediatric physiotherapists, clinical psychologists and psychiatrists). RESULTS: The extent to which health professionals communicated with school staff, and the way in which they went about it, varied widely. Communication was facilitated by joint meetings, shared documentation, and local policy development. Sources of difficulty in communication between health and education staff were: the parent as a conduit of information; the practical difficulties of arranging meetings; and lack of knowledge about other professionals' roles. The ethos of the school with regard to health matters, and the flow of information within health services, also had an impact on the communication process. Participants' recommendations focused on two key issues: clarification of the roles of health and education staff with regard to this group of pupils; and how information should flow from health to school staff. DISCUSSION: Many of the findings parallel the previous research with teachers, indicating agreement between professionals from different agencies about aspects of the communication process which are problematic and require attention. The findings suggest that improving communication requires both joint work between health and education staff, and improvements to practice within each agency.     

Lay perspectives on lay health worker roles, boundaries and participation within three UK community-based health promotion projects

This paper examines lay interpretations of lay health worker roles within three UK community-based health promotion projects. It argues that understanding lay health worker roles requires critical analysis of the complex interrelationships between professionals, lay workers and the communities receiving a programme. Findings are presented that are drawn from a qualitative study of lay engagement in public health programme delivery where a key objective was to examine the perspectives of community members with the experience of receiving services delivered by lay health workers. Interviews and focus groups were conducted with 46 programme recipients from three case study projects; a breastfeeding peer support service, a walking for health scheme and a neighbourhood health project. The results show how participants interpreted the function and responsibilities of lay health workers and how those roles provided personalized support and facilitated engagement in group activities. Further insights into community participation processes are provided revealing the potential for active engagement in both formal and informal roles. The paper concludes that social relationships are core to understanding lay health worker programmes and therefore analysis needs to take account of the capacity for community members to move within a spectrum of participation defined by increasing responsibility for others.