Rosemary Thackeray, Ph.D., M.P.H. Susan C. Hill, Ph.D., CHES Brad L. Neiger, Ph.D., CHES

1. Use of Consumer Research to Understand Elementary School Health Instruction: Implications for Healthier Children and Adolescents Rosemary Thackeray, Ph.D., M.P.H. Susan C. Hill, Ph.D., CHES Brad L. Neiger, Ph.D., CHES Michael D. Barnes, Ph.D., CHES Brigham Young University, Department of Health Science

2. Introduction • The literature describing elementary school teachers’ experience with teaching health and its associated barriers and enablers is limited. • Studies have shown that after participation in an inservice, self-efficacy for teaching health and the amount of time spent teaching health increases.

3. Introduction • To understand teachers’ experiences and how these experiences influence decisions to teach health, qualitative research methods are most appropriate. • Qualitative research methods, including focus groups and one-on-one interviews, allow the researchers to understand the context in which classroom health instruction occurs. These methods also provide added meaning and insight to mere number or facts.

4. Purpose • To obtain information to assist public health educators in creating an infrastructure to support school health education instruction.

5. Methods • A qualitative research design, specifically analytic induction. • Purposeful, stratified, criteria and maximum variation sampling, with elementary schools as the unit of selection. • Schools were randomly selected for participation; then principals selected teachers to participate. The teachers were general classroom teachers and not trained health specialists.

6. Methods • 31 schools • 107 teachers • 9 focus groups • 56 one-on-one interviews • Data included in-depth interviews, focus groups, and researcher field notes that resulted in over 350 pages of transcript.

7. Methods • A six-step data analysis process: • organize data; • generate categories, themes and patterns; • code data; • test emergent understandings; • search for alternative explanations; • write the research report. • Qualitative research software Non-numerical Unstructured Data Indexing Searching and Theorizing (NUD*IST 4.0) was used to organize data and produce a summary of the findings.

8. Findings EXISTING POLICIES OR GUIDELINES FOR INSTRUCTION • Nearly all teachers said they taught what the state education core mandated. • A majority of teachers said they taught subjects that were covered on end-of-level tests, or tests that are administered at the end of the academic year to assess subject mastery. Health is not included in end-of-level tests, even though it is part of the core. “Part of it, realistically, is time. I hate to say it, but health is not on the end-of-level test….It [health] is something we don’t require at the end. It is relegated to a less important position in our teaching.”

9. Findings TEACHER PREFERENCES • Teacher preferences or interests determine what was taught. Preferences included personal interest, perceived level of importance, and level of comfort with the subject. • Opportunity often dictated what health subjects were taught in the classroom. The majority of teachers said they taught health topics that addressed the immediate needs of their students. “If there is a kid who was sick, we talk about not coming to school when you’re sick, or covering your mouth when you sneeze….When a certain situation comes up then we touch on that.”

10. Findings TEACHER PREFERENCES • Most teachers thought that health was an important subject. However, most teachers said that health was rarely taught as an independent subject. • Teachers most often integrate health into reading. However, many teachers said that they were unclear about how to integrate.

11. Findings TIME CONSTRAINTS • The largest barrier to teaching health was lack of time. Nearly all teachers said they lacked the necessary time to fit everything in during the day and in the school year. • Teachers said they lacked health-related materials and resources, did not know where to find resources, and did not have time to search for resources and compile lessons.

12. Findings TIME CONTSTRAINTS • Teachers lacked money for purchasing consumable resources, or resources that could not be used more than once, and a lack of money for purchasing current textbooks. “I have so much information I have to give them that extra stuff is cool and fun, but the bottom line is they have given us such a strong and heavy core to teach, we can’t hardly get our core taught. So we don’t have time for a lot of extras.”

13. Discussion • Classroom health instruction appears to be influenced by time and policy constraints, teacher interest, and teaching moments. • Teachers appear to be reactionary, basing health instruction on the immediate needs of students, and less on early prevention, which could enhance the overall health of their students and ultimately improve academic outcomes.

14. Discussion • It is suggested that school health education advocates, including school district personnel and public health educators, consider enhancing the capacity of qualified public and private health community volunteers to supplement teacher instruction. • Teachers also perceived that they have limited time to find and compile health-related materials. Teacher indicated that they would like materials that are hands-on, age appropriate, and linked to the core.

15. Discussion • Inservices are a traditional method of providing teachers with information and resources. Teachers, however, indicated that they generally are not invited to, nor did they participate in health-related inservices. • The majority of teachers said that as part of their undergraduate training they received no preservice training in either health content or teaching methods.

16. Discussion • One way to enhance teacher capacity is to ensure that university preservice training include health content and methodology including how to access health-related information and ways to infuse or integrate that information into other subject areas. • To increase classroom health instruction, one approach could be to integrate health topics into reading or math--two subjects included on end-of-level tests.

17. Discussion • By providing decision makers, including legislators and superintendents, with research that establishes a clear connection between health and academic outcomes, health education advocates could make health a higher priority.

18. Conclusions • The solution to increasing the quantity and quality of school health instruction appears to involve five tasks: • Develop policy measures at the state and district levels which require health instruction by way of end-of-level testing or other outcome measures. • Position health instruction as a second-tier priority; for example, health may not assume the same degree of importance as math, science, or reading, but it may be positioned as the next most important priority.

19. Conclusions • Integrate health instruction with priority subjects, especially reading and math. • Provide teachers with appropriate resources (materials and programs) and collaboration (guest speakers) to minimize their preparation and teaching time. • Help teacher appreciate the importance of health and provide inservice opportunities that encourage their participation.