Donald Edwin Stewart

Promoting and building resilience in primary school communities: Evidence from a comprehensive ‘health promoting school’ approach

This paper reports on the first phase of a multi-strategy health promotion project which uses a whole-school approach to promote resilience in children of primary school age in school, family and community settings in urban and rural/remote locations in Queensland, Australia. The study population comprised students from Years 3, 5, and 7 (ages 8, 10, 12 years), their parents/care-givers and staff in 20 primary schools. Evidence emerging from this phase of the project confirms that the school environment makes a major contribution to the development of psychological resilience in children. Schools in which students reported more positive adult and peer social networks and feelings of connectedness to adults and peers, and a strong sense of autonomy, were associated with higher self-ratings of resilience in the students. There was also high concurrence by parents and caregivers regarding perceptions of the school environment. These schools rated more highly on ‘health promoting school’ (HPS) attributes and principles. Characteristics of such schools included features like shared decision-making and planning, community participation, a supportive physical and social environment, good school-community relations, clearly articulated health policies and access to appropriate health services.

Promoting school connectedness through whole school approaches

Purpose – The purpose of this paper is to develop a framework to demonstrate the contribution of whole school approaches embodied by the health‐promoting school approach, to the promotion of school connectedness, defined as the cohesiveness between diverse groups in the school community, including students, families, school staff and the wider community.Design/methodology/approach – A cross‐disciplinary review of literature was conducted to identify strategies consistent with the health‐promoting school approach and the values and principles that promote school connectedness. The review included peer‐reviewed articles and published books and reports identified from the databases spanning the education, health, social science and science disciplines and used search terms encompassing health and mental health promotion, schools, social connectedness, belonging and attachment. The paper is also a framework of the contribution of the health‐promoting school approach to promoting school connectedness and was d...

Development of population‐based resilience measures in the primary school setting

Purpose – The purpose of the population‐based study in the paper is to report on progress in formulating instruments to measure childrens resilience and associated protective factors in family, primary school and community contexts.Design/methodology/approach – In this paper a total of 2,794 students, 1,558 parents/caregivers, and 465 staff were surveyed in October 2003. A cross‐sectional research method was used for the data collection. Three surveys (student survey, parent/caregiver survey, and staff survey) were developed and modified to measure student resilience and associated protective factors. Exploratory factor analysis with Oblimin rotation and confirmatory factor analysis were used to analyse the reliability and validity of the scales of the three surveys.Findings – The surveys in this paper find good construct validity and internal consistency for the social support scale of parent/caregiver survey, which had been modified from previous studies. Confirmatory factor analysis indicated a goodne...

Promoting Connectedness through Whole-School Approaches: A Qualitative Study.

Purpose – School connectedness, or a sense of belonging to the school environment, is an established protective factor for child and adolescent health, education, and social well‐being. While a comprehensive, whole‐school approach that addresses the school organisational environment is increasingly endorsed as an effective approach to promote connectedness, how this approach creates a sense of belonging in the school environment requires systematic in‐depth exploration. This paper aims to address these issuesDesign/methodology/approach – This study examines the influence on school connectedness of a whole‐school approach to promote health in school, using a qualitative case study method. Three school communities in Southeast Queensland, Australia, are investigated as case studies in order to formulate a theoretical model of how health promotion approaches can build school connectedness.Findings – This study finds that a health promotion approach builds school connectedness by encouraging a “whole‐school” ...

Health promoting schools: consensus, strategies, and potential

Purpose – The purpose of this paper is to summarize a consensus statement generated on the current challenges, strategies, and potential of health promoting schools (HPS) at a 2011 colloquium at the Stellenbosch Institute for Advanced Study where 40 people from five continents came together to share their global and regional experience surrounding the World Health Organization (WHO) HPS model. Design/methodology/approach – Using the consensus as its foundation, this review summarizes the underlying educational and social science concepts and factors that contribute to success or failure of HPS, and incorporates peer reviewed papers based on invited presentations at the colloquium and key related literature. Findings – HPS increase knowledge and develop behaviors that benefit the health of children, such schools are also an investment in the well-being of the larger community. Importantly for their long-term psychological health “resilience” is generated by effective HPS programs. Professional development ...

Executive management and IT innovation in health: identifying the barriers to adoption.

This study aims to understand IT investment decisions from the perspective of senior health system executives. A two-stage study was used to investigate this highly influential, very specialized and small population of interest. The first stage involved qualitative interviews with top health executives and analysed their opinions and beliefs using an innovation diffusion theory framework. The second stage involved quantitative surveys of senior health executives to gain an understanding of their opinions regarding the organizational and technological drivers (the independent variables) and the level of IT adoption (the dependent variable). It was found that the majority of drivers identified as being significant to organizational and technological innovation are degraded in respect to IT and health. It was concluded that health executives hold a range of views that potentially inhibit the increased adoption of IT in health. In particular, beliefs about the technology itself have been identified as the most influential deterrents.

Promoting connectedness through whole-school approaches: Key elements and pathways of influence

Purpose – A comprehensive whole‐school approach has emerged as a promising model for building connectedness in the school setting. The health‐promoting school model, through its whole‐school orientation and attention to the school organizational environment, identifies structures and processes that influence school connectedness. This paper aims to investigate this model.Design/methodology/approach – This study examines the key mechanisms of health‐promoting school structures and processes, as well as the pathways of their influence on school connectedness, by using a qualitative case study methodology in three school communities in southeast Queensland, Australia. In‐depth interviews, focus groups, observations and documentary evidence provided the data.Findings – Key elements of the health‐promoting school model that facilitated interactions between school community members were events that were characterised as positive, social, celebratory, and with no financial cost, as well as informal gatherings th...

Age and Gender Effects on Resilience in Children and Adolescents

This cross-sectional, population-based study explores the effects of age and gender on resilience and protective factors for mental health in primary school aged children in Brisbane, Australia. Surveys were administered to 1109 male and 1163 female students (N = 2492) in 2004 to assess self-perception of resilience and associated protective factors. Female students are found to be more likely to report higher levels of communication, empathy, help-seeking and goals for future and aspirations. They also report more positive connections with parents, teachers and adults in the community, and peers in school and outside school, as well as sense of autonomy experience. These differences, however, show changes over time. The interaction between age and gender is significant for empathy and help-seeking, and for adult support at home, at school and in the community, peer support at school and outside schools, and autonomy experience. This is largely explained by the sharp decline in scores for Year 7 girls. The gender differences in individual characteristics and protective factors for primary school children deserve further investigation, in view of their potential implications for mental health prevention and promotion.

Implementing Mental Health Promotion in Schools: a Process Evaluation

Recognition of the increasing burden of mental illness and the need for mental health promotion is leading researchers to explore ways of assessing the impact of mental health promotion initiatives. In particular, among young people, the impact of mental health promotion in the school setting is being investigated in terms of achieving change that is sustained. This paper argues that potential indicators of success associated with process need to be identified as a way to support schools and project teams as they implement mental health promotion initiatives. A process evaluation of a project to promote resilience in children and primary school communities using a health promotion school (HPS) approach was conducted in Brisbane, Australia, in 2004 and 2005. Aside from differences in the way in which the participating schools structured and implemented their health-promoting school projects, several critical themes emerged that have relevance to mental health promotion projects in school settings. They include the importance of time, the school context and supportive organisational structures, ethos and environment, and building resilience into the curriculum. Other themes indicated the importance of the engagement of the whole school community and of developing partnerships and services, and the usefulness of the health-promoting school framework. Such key factors should be considered in relation to the challenges facing schools that wish to promote resilience, or other concepts related to mental health.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis

BackgroundHai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices.MethodsFifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants’ understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used.ResultsQualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend’s home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk.ConclusionThe IDUs’ experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.