The contextual factors that need to be considered for HPS implementation are described to be not only at the school level, but also at the external community, and societal factors in keeping with the socio-ecological model (Hoyle, Bartee & Allensworth, 2010; Lohrmann, 2010). This section describes the school context, followed by the community context.
2.3.1 School context influencing change processes in schools
It has been well documented that the school context plays an essential role in the implementation of HPS and health promotion programmes in schools, especially if a whole-school approach is being considered (Clarke et al., 2010; Deschesnes, Trudeau, & Kébé, 2010; Lochman, 2003; Ringeisen, Henderson & Hoagwood, 2003). Clarke et al. (2010, p. 288) highlight the many different aspects of the school context:
The whole school context includes the school’s environment and ethos, organisation, management structures, relationships with parents and the wider community, as well as the taught curriculum, and pedagogic practice.
Some literature refers to school climate which encompasses elements including: relationships amongst the different school community members; school physical environment; organisational leadership, structures and values; informal organisation of the school and characteristics of its
34
members (Fan, Williams, & Corkin, 2011; Freiberg, 1998; Hoy, 1990), all of which are similar to the school context7 description of Clarke et al. (2010) above. Gregory et al. (2007) claim that schools with a positive school climate may be better equipped to adopt new innovations. They, however, argue that paradoxically, schools which have climates that are not well-functioning, are most in need of these interventions. Culture, which is another aspect of school context, is
reflected in the norms, the core values, shared values and basic assumptions that give the school “a sense of identity and mission” (Hoy, 1990, p. 158).
Lochman (2003) posits that the social environment of a school organisation and the relationships between its members are key characteristics that have to be taken into account for effective implementation. Some of the characteristics include leadership style, autonomy of individuals, communication among individuals in the school and leaders. What is evident is that these characteristics occur at the different levels of the school systems. Lochman (2003) recommends that, at the personal level, what needs to be considered is the extent to which there is personal development, and how this is linked to the goals of the school. At the interpersonal level, what is important is the extent of involvement of the school community, the support that they give one another and the collegiality and openness experienced. At the organisational level, positive leadership and management is key for change including shared authority, policies, structures and rules (Lochman, 2003). Consistent with and adding to Lochman (2003), Lucarelli et al. (2014) identified key characteristics of a healthy school climate in their study on the barriers and facilitators to healthy eating in low-income schools in Michigan middle schools. The
characteristics included: the presence of school health champions; a high degree of support from administration and staff; the presence of health-related policies and awareness and enforcement of them, and an active school health team. These factors were mainly related to the
organisational and interpersonal levels, implying a whole-school approach. They found that the schools which lacked some of these characteristics were the schools where the fewest changes were made.
7 I have used the term school context in my thesis, although when referring to the literature, I used school climate
when it was denoted as such in the literature.
35
In a study conducted in rural Tanzania the difficulties experienced at school level in
implementation of a participatory health education programme included structural as well as socio-economic factors. These were related to limited teachers’ skills; lack of adequate in- service training; lack of activities and school materials; too many pupils in the classroom; an overloaded curriculum; and poor working conditions for teachers (Mwanga, Jensen, Magnussen & Aagaard-Hansen, 2008). One interesting finding was the concern that the authority of the teachers would be undermined if students became empowered, as students acted as change agents in this programme, highlighting cultural issues at play where adults are meant to be in power and control.
Seeing that schools differ in their contexts, they will need interventions suited to their particular context in order to implement HPS successfully and, therefore, researchers have recommended that a tailored approach suited to specific schools should be adopted (Hopkins, Harris, & Jackson, 1997; Whitelaw et al., 2001; Yoshimura et al., 2009)
Apart from the school context, the external community context has also been found to be an influencing factor for HPS implementation.
2.3.2 Community context impacting on effective HPS implementation
In this section, the socio-economic and social context, and parental involvement is discussed.
2.3.2.1 Socio-economic and social context
Various community factors can influence the implementation of HPS and these factors can impact on student behaviour, which in turn can impact on their behaviour in the school. Some are related to socio-economic factors, which can impact on community involvement in schools, while others are related to cultural norms and beliefs, and still others are related to a lack of understanding of health promotion in general.
In a qualitative case study conducted in Ireland to understand the contextual factors influencing the implementation of a comprehensive emotional well-being programme in disadvantaged school settings, Clarke et al. (2010) highlight the importance of socio-economic and cultural influences of the local communities for effective implementation of the programme. They found
36
that the lack of parental and community involvement in the programme was influenced by lack of social cohesion due to the high percentage of single parents, ethnic minority families,
unemployment and low levels of education (Clarke et al., 2010). Furthermore, O’Brien Caughy et al. (2012) found that neighbourhood social capital and the physical environment were
associated with students’ aggressive behaviour and social competence. They showed that it was a combination of risk factors (high-risk neighbourhood, high-risk peers and low parental
monitoring) that put adolescents at high risk of negative behaviour. On the other hand, it was found that, where the school was in a close-knit community, there was active parental
involvement in many aspects of the school’s life, despite the challenging socio-economic
conditions, which was attributed to family cohesion and nurturing, a positive factor for the social competence of the students (Clarke et al., 2010; Wang et al., 2014).
2.3.2.2 Parental and community involvement in schools
Although partnerships with the community are one of the action areas of HPS, the reality of how to make this happen has been found to be a major challenge (Deschesnes et al., 2003). Parental involvement in HPS has been found to be difficult over a period of time in literature from several countries such as Australia (Marshall et al., 2000; Senior, 2012; St Leger, 1998), Scotland
(Inchley et al., 2007), China (Aldinger et al., 2008), New Zealand (Cushman, 2008), Greece (Soultatou & Duncan, 2009) and Ireland (Clarke et al., 2010), amongst others. However, although identifying the problem of non-involvement of parents, not many studies have described the reasons behind parental non-involvement.
Of the studies that have described the reasons for non-involvement, parents’ lack of understanding of the HPS approach has been attributed to parental non-involvement. For example, a concern was raised by parents in a qualitative study in China that health promotion activities would detract the students from their academic work, which was a reflection of their lack of understanding of HPS (Aldinger et al., 2008). This does not necessarily mean they do not care, but rather that schools needed to find better ways of communicating with parents to
understand their priorities, because schools’ and the communities’ views might not be the same (Clarke et al., 2010; Cushman, 2008). Clarke et al. (2010) recommend that, in order to do so,
37
schools need to devote more energy to forming links with the community and other supporting structures that could facilitate implementation, other than teacher and parent meetings.
On the other hand, the way that schools perceive community involvement gives another
perspective to this issue. It has been found that teachers regard the community only as a means of resources, rather than actively collaborating in HPS implementation (Clarke et al., 2010;
Cushman, 2008; Marshall et al., 2000; St Leger, 1998). Schools in Australia successfully drew on health services in the community for medical emergencies, but there was little evidence of other productive partnerships with the community (Marshall et al., 2000), which goes against the rhetoric of what community involvement is meant to be in HPS. However, the studies in this literature review on HPS are mainly from developed countries so it is not certain whether the same level of community involvement in HPS would be found in developing countries. In summary, the various school and community contextual factors described in this section highlight the complex web of contextual factors that can impact on the effectiveness of HPS implementation. The following sections will go into more detail of some of the factors influencing implementation of HPS, as identified in the previous sections.