Sue Dewhirst

Are trainee teachers being adequately prepared to promote the health and well-being of school children? A survey of current practice

BACKGROUND Teachers are a key part of the wider public health workforce in England. We conducted a survey to find out how they are trained for this role during their initial teacher education (ITE). METHODS Between 2011 and 2012, we sent an online questionnaire to 220 ITE course managers and conducted semi-structured interviews with a purposive sample of 19 course managers to explore issues in more depth. RESULTS The response rate to the questionnaire was 34% (n = 74). Although most of the course managers felt inclusion of health and well-being training in ITE was important, provision across courses was variable. Topics which are public health priorities [e.g. sex and relationships education (SRE) and drugs, alcohol and tobacco] were covered by fewer courses than other topics (e.g. child protection, emotional health and anti-bullying). Perceived barriers to training included lack of time and a belief that health and well-being were low priorities in educational policy. CONCLUSIONS Not all of tomorrows teachers are being adequately prepared for their role in helping to address public health priorities. Educational policy does not appear to be supporting the priorities of public health policy, and this is a key barrier to health promotion training in ITE. Keywords children, educational settings, health promotion.

Health promotion in pre‐service teacher education: Effects of a pilot inter‐professional curriculum change

Purpose – The purpose of this paper is to discuss a curriculum change in the provision of health promotion in pre-service teacher education in a one-year postgraduate certificate in education (PGCE) secondary course in one Higher Education Institution (HEI) in England. Design/methodology/approach – The paper describes the iterative development process, from an initial survey and mapping of the existing pre-service teacher training programme, which provided an evidence base for the piloting of a new health promotion component in the curriculum, and its subsequent evaluation. Changes to the health promotion element of the curriculum reflect the programme philosophy which balances the requirements of a competency based curriculum with a more liberal approach to education and training in which pre-service teachers are expected to critically reflect on, and evaluate their practice. This work adopts a socio-constructivist approach to teacher education, in which teachers develop their knowledge, skills and attitudes by interacting with others through dialogue, and learning from more knowledgeable others in a cooperative and scaffolded manner. Findings – The paper presents the results of these changes and discusses implications for their sustainability. The changes made to the health promotion component of the programme and their implementation would not have been possible without the inter-professional collaboration that took place over three years. Originality/value – To the authors’ knowledge similar work involving a multi-disciplinary collaborative approach to the development of a health education component of a pre-service teacher education curriculum has not been employed or reported.

Initial Teacher Training to Promote Health and Well-Being in Schools--A Systematic Review of Effectiveness, Barriers and Facilitators.

Objectives: To conduct a systematic review of effectiveness, and barriers and facilitators, of initial teacher training to promote health and well-being in schools. Design: Systematic review of the literature. Method: A total of 20 bibliographic databases were searched, including MEDLINE, EMBASE and the Social Science Citation Index. Studies were included if they reported research into the processes and/or outcomes of initial (pre-service) teacher training to promote health. Results: A total of 20 studies met the inclusion criteria, mainly from the UK and Australia. Twelve studies assessed outcomes, commonly using uncontrolled before and after assessment designs. Sixteen studies evaluated the processes of training. Training was diverse in terms of content, format and health topics. The studies demonstrated short-term increases in trainee teachers’ factual knowledge of health issues, a general increase in teachers’ confidence to teach about health and to identify and help children with specific health issues. There was an increase in teachers’ positive beliefs about their role in promoting children’s health. None of the studies assessed changes in pupil outcomes. The training was generally considered acceptable and adequate by trainee teachers. However, some of the trainees felt that they still lacked knowledge and confidence to address sensitive health issues on entering teaching practice. Conclusion: This systematic review identified some evidence for the effectiveness of teacher training for health and highlighted factors which facilitate and inhibit effective training. Further evaluation, using controlled trial designs with long-term follow-up of teacher and pupil outcomes, may enable teachers to effectively address the health and education needs of school pupils.

Pre-Service Teacher Training in Health and Well-Being in England: The State of the Nation.

This paper presents findings from a survey of pre-service teacher training institutions in England with regard to the provision of health and well-being education. It examines factors affecting the inclusion of health and well-being, and explores educational implications in light of the changing landscape of pre-service teacher education in England. Provision of health and well-being education is noticeably variable across institutions, and many course leaders are unclear about the coverage in their partner schools. Course leaders regard health and well-being as an important part of the curriculum, but the focus is usually on generic health-related themes such as child protection and behaviour management, which address Government priorities, rather than on specific topics such as education about diet, drugs, alcohol, smoking, sex and relationships and physical activity. The paper argues that these aspects should be addressed for pre-service teachers to have an increased sense of self-efficacy and become capable health promoters.

PP43 Feasibility and Acceptability of a Brief Intervention to Reduce Alcohol Consumption in Sexual Health Clinic Attendees

Background Alcohol misuse and poor sexual health are closely related Hazardous drinking is more prevalent in sexual health clinic (SHC) attendees than in the general population leading to risky sexual behaviours. Little data exists on the feasibility of integrating a Brief Intervention (BI) into the sexual health consultation. Methods The aim was to assess the feasibility and acceptability of a brief intervention to SHC attendees. SHC attendees (≥ 16 years) were screened using the short Alcohol Use Disorders Identification Test (AUDIT) - Consumption (C) questionnaire (AUDIT-C). Males scoring ≥ 5 and females scoring ≥ 4 were randomised to either receive BI or usual care (UC) which included a standard alcohol leaflet. Clinical staff members were randomised to receive BI training. Patients saw only trained staff in BI arm and non-trained staff in UC arm. Patients completed full AUDIT questionnaire, alcohol diary and questions on sexual behaviour at baseline and follow-up. Follow-up at 6 weeks and 6 months was largely by phone interviews. A sample of consultations was audio-recorded for intervention fidelity check. Patients with AUDIT score >15 were initially excluded; this was subsequently relaxed to a score > 20. Results Out of total 664 patients screened, 215 were eligible for randomisation and 207 were included in the final analysis - 103 (BI) and 104 (UC). Mean age was 25 years, 66% were female, most were white, nearly 50% were employed fulltime and 27% were students. Follow-up sample at 6 weeks and 6 months was 54% and 47%, respectively, being slightly higher in the UC group, although not statistically significant at either time. Both groups reduced their alcohol consumption significantly, but the total alcohol units/week fell more sharply in UC (p < 0.05). There was no significant difference in sexual behaviour between the groups though an evidence of decrease over time in the frequency of partners was seen in both groups. The fidelity check showed that BI was delivered as intended and increased consultation time by an average of 5 minutes. The staff found it acceptable and appropriate for the SHC setting. Conclusion The brief intervention for alcohol misuse is feasible and acceptable in a SHC. The study was not powered to detect outcome differences. Screening alone was sufficient to influence drinking and sexual behaviour in both groups. Further research to optimise this intervention is needed in those drinking most heavily.

Delivery of effective teacher training to promote health and wellbeing in schools: a survey of current practice

Abstract Background Teachers play an increasingly important part in the wider public health workforce. Initial teacher training (ITT) should prepare teachers to be effective in promoting health and wellbeing in schools. However, questions remain about the provision and quality of public health within ITT courses. We aimed to assess how teacher training prepares teachers to promote health and wellbeing in schools, what barriers to and facilitators of effective training exist, and the relation between ITT and the changing policy landscape in public health and education. Methods We did a questionnaire survey of the 208 ITT institutions in England to assess how health is addressed in teacher training (eg, health topics covered, time spent on health, external organisations involved). We randomly sampled course leaders (n=220), stratified by region, type of provider (eg, university-based; employment-based), and number of courses offered. Questionnaire data were analysed with standard descriptive statistics. Qualitative follow-up interviews were done with a semistructured interview schedule with a purposive subsample of 19 questionnaire respondents, to investigate issues in more detail. Interview data were analysed with content analysis to create categories, which led to the generation of broader analytical themes. Findings The overall questionnaire response rate was 34% (74 of 220). Most respondents were based in universities (n=43; 58%), followed by school-based training providers (n=21; 28%), and employment-based providers (n=10; 14%). Most courses led by the respondents were postgraduate. 54 (89%) of questionnaire respondents thought emphasis of health of pupils or staff in teacher training was important or very important. The extent to which health was covered in courses varied. 49 (77%) respondents used external organisations to address health issues. Commonly used organisations included with local authorities (n=35; 75%), local schools (n=29; 62%), and charities (n=17; 36%), and less commonly health professionals (n=10; 21%). Some respondents anticipated that changes in educational policy might lead to a reduced focus on health in their courses, whereas others aimed to maintain the inclusion of health. In the follow-up interviews respondents described the ways they were adapting their courses to retain the focus on health. These methods included addressing the health-related aspects of special educational needs, disability, and behaviour management. Evidence of competing priorities existed, with lack of time in a busy curriculum a key barrier to addressing health. A supportive staff ethos and previous health-related experience of teacher educators were cited as facilitators. The interviews also showed that course leaders have a broad idea of health, with some taking a whole-child approach. A common view was that good health is essential for effective learning. This holistic view of education was seen to be in conflict with emerging government educational policy, which seems to place less emphasis on the importance of children and young peoples health and wellbeing than previous policies. Interpretation Variability exists in the coverage of health in teacher training, and in methods and approaches. Policy and service delivery are undergoing a period of change in both public health and education, with the perception of less overt support for health and wellbeing in schools. Support does remain, but teacher educators, who generally remain committed to fostering the role of health in ITT, are interpreting policy changes in different ways in the planning of the content and structure of their curricula. Greater policy links between health and education could enhance the facilitating role of health expertise in teacher education. Our study is limited by reliance on the perspectives of college-based ITT providers; future studies should include placement schools. Funding National Institute for Health Research Public Health Research Programme.