An illuminative case study of teaching early adolescent health literacy of a health promoting school

Abstract

Health and education are reciprocal. Development of health literacy during early adolescence can have profound life-long impact on adulthood. At school, Teacher Health Literacy (THL) plays a key role in teachers’ teaching considerations for sexuality education to empower students with early Adolescent Health Literacy (AHL). Literature review found that there is limited research concerning THL and it is a knowledge gap worth exploring. Teaching sexuality is challenging to teachers as talking about sex openly in Chinese culture is deemed a taboo and sexuality education is not a mandatory subject in Hong Kong. Health Promoting School (HPS) is a schooling mode that synergises the health sector and the education sector. HPS penetrates deeply into different types of curriculum and associates among school stakeholders for health promotion through daily educational operations. Although HPS paves a desired foundation for health literacy construction, teachers of HPS face similar challenges when introducing puberty sex education in upper primary.

This PhD research adopted a single case study approach. A HPS awardee was recruited for its uniqueness in its HPS evolutionary story. The study aimed to illuminate how the implementation of HPS influences teachers’ THL which further determines the social construction of students’ AHL, adopting the challenging topic ‘puberty sex education’ for illustration. Qualitative data were obtained from semi-structured interviews with school administrators, focus group interviews with frontline teachers, non-participant observations in collaborative lesson planning meetings, module evaluation meetings, lessons and on-site visits. This research focused on teachers’ sophisticated teaching considerations in curricular approaches and pedagogical decisions. Besides, it aimed to investigate the potential influence of HPS implementation on THL. Through observing teachers’ interactions and understanding the rationales behind their teaching considerations, the researcher further explored the attributes to HSP’s sustainability. Models and theories like ‘social constructivism’, ‘levels of health literacy’ and the ‘Conceptual framework of health literacy as an asset’ were adopted for interpretation of findings.

The school’s evolutionary story revealed that HPS was the change agent which induced organisational change and shaped the school’s ‘Clan culture’. HPS also transformed the school into a learning organisation where teachers socially construct their THL. The elevated THL further benefits students with informed and learner-centred teaching considerations. The empowered self-efficacy offers higher readiness of teachers to handle challenging health literate topics and for facing educational changes, internally and externally.

From the teachers’ teaching considerations and the characteristics of social constructivism, the researcher conceptualized the research findings into the ‘SMARTZ Conceptual Model’ which is also applicable to other challenging adolescent health literate topics. Through an in-depth curriculum mapping process of puberty sex education related documents, the researcher adopted the ideas of UNESCO and the local experience to create a sex education roadmap called the ‘essential AHL for 9-12 years’. It can assist the government to revise the existing out-dated Guidelines for sex education. Built on Nutbeam’s (2008) ideas, the influences of HPS implementation on teachers were conceptualized in a conceptual framework namely ‘THL as an Asset’ which serves as a reference for future teacher professional development in the HPS field.