It is evident that the implementation of health promotion interventions in schools is influenced by a number of contextual determinants, which may only promote certain elements of these interventions and limit others. For example, a review of Health Promoting Schools (HPS) approaches has suggested that none of the interventions implemented all components of the approach (Lister-Sharp et al. 1999). The majority incorporated classroom- based or curricular approaches. Only a small number also integrated changes to the school environment and family or community engagement due to other priorities (Lister-Sharp et al. 1999). Such a dissonance between policies or protocols and practice can undermine the purpose of interventions (St Leger and Nutbeam 2000; Ridge et al. 2002; Basch 2010; Marks 2010). Indeed, it has been found that an incomplete implementation of complex, multi-dimensional school based health education interventions can limit their effectiveness (Deschesnes et al. 2003). Examples of such interventions were identified in Australia (Marshall et al. 2000), Europe (WHO 1997b), as well as the US (Allensworth and Kolbe 1987).
Such selective implementation has been mainly attributed to contextual or environmental influences that reciprocally interact with individual agency (McLeroy et al. 1988; Spillane et al. 2002). For example, due to policy- driven curricular priorities, very few schools would make the links between academic achievement and pupil wellbeing (Formby and Wolstenholme 2012), despite them becoming increasingly clear in the literature (Crow 2008; Aggleton et al. 2010; Goodman and Gregg 2010). Curricular priorities are mainly represented by grades in examined subjects which determine the allocation of financial and other resources in schools (Basch 2010). For example, a school-based health promotion programme in Australia has been described as poorly integrated into the main curriculum and marginalised by resource allocation to examined subjects (McCuaig et al. 2012). In addition to the allocation of financial resources within the school, the implementation of Personal, Social, Health and Economic (PSHE) education in English secondary schools has been found to be limited by a key tension between
schools’ focus on exam grades in core curriculum subjects driven by league tables and a predominant focus on grades, and their statutory obligations to ensure pupils’ wellbeing (Best 2008; Perryman et al. 2011). If schools considered PSHE as competing with academic subjects, they invested less time and effort into creating a comprehensive PSHE curriculum. This has been found to make PSHE ‘more vulnerable than other subject areas’ (Formby and Wolstenholme 2012, p. 11), a situation seemingly similar to that in Wales. The Inspectorate for Education and Training in Wales (Estyn) have noted that time for PSE is limited in schools and that professional development related to PSE is marginalised, affecting the quality of the subject (Estyn 2007b, c, a).
The prioritization of examined subjects has also been found to influence variations in how PSHE is delivered (Ofsted 2005, 2007; Crow 2008; Macdonald 2009; Ofsted 2010). This demonstrates an interaction between the policy context and organisational arrangements as suggested by McLeroy et al. (1988). Due to time and resource constraints, PSHE is predominantly delivered through discrete lessons or dedicated ‘drop-down’ days, during which the normal timetable is suspended and PSHE is delivered for a whole day. Although this is considered as poor practice and insufficient to achieve the intended aims, this approach appears to be popular (Ofsted 2005; Macdonald 2009; Ofsted 2010).
The fact that PSHE is not examined and does not gain any qualifications results in its lower status with teachers and pupils (Richardson 2010). Assessment practice is an important element in shaping pedagogic practice as it is ‘closely bound up with the legitimization of particular educational practices’ (Broadfoot 2001, p. 87). Examination regimes also define legitimate knowledge that is characteristic of ‘proper school subjects’. Health education usually aims to inform pupils about how to prepare healthy food, how to exercise, how to brush one’s teeth correctly, how to recognise healthy foods or how a balanced diet looks like. Such lessons do not contribute to exam grades, thereby have a lower status and are considered as time spent ‘off task’. Therefore, it has been found that despite explicit
policy efforts to enhance the status of such health related knowledge, PSHE is likely to remain marginalised (Whitty 2002).
Staff arrangements that prioritize examined subjects often involve the random allocation of teachers to delivering PSHE as part of their timetable. Whilst some are enthusiastic about teaching the subject, a large number of teachers are reluctant to delivering such lessons, and they tend to be particularly uncomfortable with sex and relationship education as they feel insufficiently qualified or confident (Ofsted 2007, 2010; Formby et al. 2010a; Formby 2011; Formby 2011b). It has been noted that this reluctance is also due to a number of other reasons that emerge from the interaction between the policy context and individual or intrapersonal influences on policy implementation (Spillane 2002). In order to overcome such issues, many schools invite external speakers to delivering lessons that are perceived as difficult by teachers (Macdonald 2009; Emmerson 2010; Ofsted 2010). However, the quality of teaching provided by these speakers and the integration of such lessons into the on-going PSHE curriculum and overall teaching can be poor. This connects to earlier arguments concerning the challenges associated with integrating non-teaching professionals into the delivery of school curricula (Spratt et al. 2006; Kidger et al. 2009). These arguments demonstrate the importance of contextual influences on the implementation school-based health education, and there appears to be a pathway from policy level influences to lesson processes. Therefore, the next section will examine the context and development of Personal and Social Education in Wales more closely.
1.8. School health education policy: Personal and Social