The role of the significance of organisational culture has been historically difficult to define and apply to the school setting. This thesis is concerned with the factors that contribute to the modality (ie. the most typical way of being) of a school and the ways in which this interacts with the teaching and learning of Health Education in England. It draws on the works of Bernstein, Daniels and Vygotsky, where their ideas of power and control are mediated both through discourse and action at both the micro-level of the classroom and the macro-level of the school as an organisation. Their theories form the link between what happens at the level of pupil learning within the school and the outcomes of the pedagogy that is taught. The health aspects can be integrated with the above by combining Antonovsky’s concepts of Salutogenesis and ‘sense of coherence’. Four High Schools within one English LEA participated in the research in 2008. Collected data included interviews, observations and questionnaires from pupils and staff. The outcomes from the analyses considered how the schools operationalised Health Education as part of the Personal, Social, Health and Economic education programme. The research also considered the consequences and learning experiences for the pupils. A link has been found between the type of school modality and the status of Health Education that exists in each school post the 1988 Education Reform Act. The use of the ideas associated with Salutogenesis can be seen as a way towards instilling the notion that health is a valuable personal commodity that is needed throughout the life course. Schools are well placed to continue promoting positive health education and could introduce a ‘Health Passport’. This would effectively encourage individuals to take responsibility for their attitude and behaviour towards their own health because it is a resource for everyday living. The correct modality conditions within a school will enable this idea to succeed.

No description available.

The effectiveness of school-based health education in changing behaviour and health outcomes is limited. This in part can be attributed to the types of classroom exchanges taking place within health education lessons. There is an evident need to examine the potential link between pedagogy and health education. This study comprises a social ecological examination of the implementation of the Welsh Government’s Personal and Social Education (PSE) policy, which seeks to promote health behaviours alongside social and economic wellbeing. A socio-ecological (SE) perspective aims to understand the different influences on practice and take into account individual, social and organisational level influences on implementation. An exploratory case study is used to examine practice in four systematically selected secondary schools from two local authorities in Wales (FSM entitlement >20% and <10%). Methods incorporate analysis of national and local policy documents, interviews with implementers at local authority (n=5) and school level (n=11), lesson observations (n=12 lessons) and pupil focus groups (n= 23 pupils). The findings suggest that a lack of clarity about how PSE should be implemented in schools seems to lead to uncertainties among implementers. These uncertainties are exacerbated by a focus on graded performance that has shaped school staff beliefs and organisational arrangements. A performance focus also re-emerges in classroom practice that is mainly characterised by a transmission of facts although some competency-focused classroom exchanges are apparent. There is some limited evidence of pupils’ understanding and generalising health knowledge and self-reported self-regulation of health behaviours.

Educational discourses, practices and institutions are increasingly shaped today by forces and envoys of a globalised world. Research suggests that functional integration into a neo-liberal world economy compels many nation-states to eschew indigenous educational priorities in favour of a globally structured agenda for education. This thesis explores the emergence of new educational policy responses to this agenda, with a particular emphasis on the practice of policy ‘borrowing’. While numerous studies have explored educational issues including curricular convergence and mass schooling in the context of policy borrowing, few have explored health education from a similar theoretical perspective. This thesis applies the Globally Structured Agenda for Education (GSAE) approach to the study of Uganda’s efforts to borrow an abstinence-only educational intervention as the nation’s primary HIV/AIDS prevention strategy. Uganda is regarded by many AIDS researchers and public health professionals as one of the world’s most compelling success stories in the battle against HIV and AIDS. From the early 1990s until 2003, the Ugandan government actively promoted a comprehensive approach to HIV prevention, encouraging Ugandans of all ages to observe the ‘ABCs’ of sexual health (Abstain, Be Faithful, use Condoms). Unlike the vast majority of its sub-Saharan counterparts, Uganda then experienced a rapid and extraordinary decline in rates of HIV prevalence. In 2004, however, the government of Uganda abruptly abandoned the popular ABC approach in favour of ‘policy borrowing’ PEPFAR, the model of sexual health education advocated by the United States. This exclusively promoted the benefits of abstinence until marriage. The sudden shift in education policy and public discourse in Uganda is the focus of this research. Two forms of documentary analysis are used. The first explores the borrowing process in detail, examining the interests and motivations underlying cross-national policy attraction, decision-making, implementation and ultimately, indigenisation in Uganda. The second explores the social, educational and health consequences of an abstinence-until-marriage approach in the context of Uganda’s localised AIDS epidemic. A discourse-historical approach is utilised to examine the ways in which language and rhetoric establish a narrative correlation between premarital abstinence and HIV prevention in Uganda, and to analyse the extent to which public discourse legitimately reflects the social, economic and epidemiological conditions in-country. The findings suggest the discourse on HIV/AIDS prevention in Uganda focuses mainly on (i) the severity of the national epidemic, (ii) the scope, nature and success of the ABC approach, (iii) the virtues of pre-marital abstinence, and (iv) the prophylactic inefficiency of condom use. The various arguments in support of abstinence-until-marriage education are found to be largely motivated by the political ambitions and economic aspirations of key power elites in Uganda. This finding suggests the neo-liberal, capital-driven imperatives of a global education agenda have indeed come to supersede local health needs in Uganda. The study concludes that Uganda’s efforts to halt the spread HIV/AIDS through abstinence-until- marriage education fail to adequately address the prevention needs of the nation’s adolescents and adults. This is evidenced by the fact the largest percentage of HIV-positive persons in Uganda are married, divorced and/or widowed women. Rather than marriage being seen as – in the American model – a ‘safe haven’ from the virus, it is instead the very place where Ugandans are most at risk. This has profound implications not only for education and health policy-making in Uganda, but also raises serious questions about the efficacy and relevance of ‘borrowing’ policies whose origins, ideologies and political contexts emanate from elsewhere.

Systematic reviews have played an increasingly important role in health promotion in recent years. Yet there are debates about how they should be conducted, particularly about how the quality of evidence should be assessed. The aim of this research was to assess current approaches to, and general views on, the use of quality assessment in systematic reviews of effectiveness in health promotion, and to identify areas of consensus and dissension around the choice of techniques, methods and criteria employed. There were two stages of data collection. The first was a structured mapping of a random sample of 30 systematic reviews of the effectiveness of health promotion to identify and explain trends and themes in methods and approaches to quality assessment. During the second stage semi-structured interviews were conducted with a purposive sample of 17 systematic reviewers who had conducted at least one review of a health promotion topic, to investigate some of these trends and approaches in greater detail. The mapping found that the majority of systematic reviews had assessed the quality of the included studies, to varying degrees. However, procedures were not always explicitly reported or consistent. There was some degree of consensus over criteria, with experimental evaluation methods commonly favoured. Most frequently used quality assessment criteria included participant attrition, the validity and reliability of data collection and analysis methods, and adequacy of sample sizes. External validity was commonly assessed, primarily in terms of generalisability and replicability, but less so in terms of intervention quality. The interviews revealed some of the barriers to effective systematic reviewing, including: lack of time and resources, complexity of some health promotion interventions, inclusion of observational evaluation designs, and poor reporting of primary studies. Systematic reviewing was commonly done in small teams, mostly comprising academics, sometimes with practitioners. Interviewees learned systematic review skills through a combination of training, support from colleagues and mentors, literature and a strong emphasis on hands-on practical learning. Subjective judgement was often required, contra to the popular belief that systematic reviews are wholly objective. The overall conclusions of this study are that systematic reviewing in health promotion is often challenging due the complexity of interventions and evaluation designs. This places additional demands on reviewers in terms of knowledge and skills required, often exacerbated by finite time scales and limited funding. Initiatives are in place to foster shared ways of working, although the extent to which complete consensus is achievable in a multi- disciplinary area such as health promotion is questionable.