The Influence of Preservice Instruction in Health Education Methods on the Health Content Taught by Elementary Teachers in Indiana. (Research Papers)
Seabert, Denise M., Pigg, R. Morgan, Jr., Weiler, Robert M., Behar-Horenstein, Linda S., Miller, M. David, Varnes, Jill W., Journal of School Health
While elementary children may not suffer the immediate effects of lifestyle choices on their health, they already are at risk. Research indicates that once health behaviors are established during childhood, the behaviors often prove difficult to modify during adulthood. (1) Children's health choices have the potential for lifelong consequences.
One way to improve children's health involves providing effective school health instruction. National organizations, (2) government agencies, (3) and educators, parents, and students (4) who believe children benefit from receiving school health instruction have expressed that health instruction be taught as a regular part of the elementary school curriculum. Most states (80.4%) require elementary schools to teach some health education. (5) But most major health topics receive approximately three to five hours of instruction in a school year, totaling less than 30 hours of classroom time on health instruction in a year. (5)
Connell et al (6) determined "more than 50 classroom hours" of instruction are needed to create a significant effect on children's health knowledge, attitudes, and practices. Furthermore, the amount of teacher inservice training is positively correlated with the amount of instruction provided and the fidelity with which it is taught. (6) Wiley (7) found that teachers who completed at least one formal health education course were more likely to teach health education as a regular part of their weekly lessons than teachers who had not completed a formal health course, Based on the finding that only 26% of teachers surveyed indicated they had attended a health education workshop, Wiley (7) concluded that, once teachers become certified, they tend not to upgrade their health education skills.
Lack of teacher training creates a substantial barrier to effective implementation of school health instruction. Despite the fact that most states require elementary health instruction, only 26 of 50 states (51%) require elementary teachers to complete coursework in health education to qualify for elementary certification. (8)
While various studies examined the influence of teacher inservice training on health instruction, teachers' perceptions, and teaching practices, limited research has addressed the influence of preservice teacher preparation on the health teaching practices of elementary teachers. (7,9-14) To influence preservice teacher preparation, and to initiate a national recommendation that a course in health education methods be included in elementary teacher preparation programs, advocates first must determine if preservice instruction in elementary health methods influences the health instruction provided by practicing elementary teachers. (15-17)
Since children rely on adults to provide accurate, trustworthy information, the necessity of adequately preparing teachers to provide such information cannot be understated. While evidence suggests inservice training positively influences the practices of teachers, (9,11-14) and that attitudes of preservice teachers favorably change regarding the value of health instruction after completing a health education methods course, (18-20) researchers know little about how preservice training influences actual classroom health instruction. This study examined the influence of receiving preservice instruction in health education methods on the health instruction provided by elementary teachers. Three research questions were investigated: Does a difference exist between elementary teachers who received preservice instruction in health education methods and those who did not when compared by the: 1) scope of health content areas they teach in their classrooms?; 2) extent to which they cover each of 10 health content areas in their classrooms?; and 3) amount of time spent teaching health?
Elementary teachers in Indiana were selected for this study because while Indiana does not mandate coursework in health education methods en route to elementary teacher certification or licensure requirements, universities in the state require coursework in health education methods for graduation.
In Indiana, coursework in health education methods satisfies an elective option for the General Education and Subject Matter portion of the teacher licensure requirements. Specifically, the Elementary Education License requirements indicate that, "This area shall be designed to develop understanding, knowledge and competence relative to physical and mental health, communicative exceptionality, safety education, recreation, physical activity, and nutrition." (21) No credit hour requirements or course titles are specified in the guidelines.
A list of all third-, fourth-, and fifth-grade teachers employed in Indiana during the 2000-2001 school year was obtained from the Indiana Department of Education. Using random selection, the researchers drew a stratified random sample of 800 teachers (N = 10,773) to equally represent the third-, fourth-, and fifth-grade teachers.
A 122-item questionnaire, including 94 health topics, was developed based on a review of the three most widely adopted elementary health textbook series used by states with a formal textbook adoption process, (22) pilot administration, and expert panel review. Textbooks adopted by 50% or more of the 20 states adopting textbooks were selected for the review process: McGraw Hill (50%), (23) Meeks-Heit (70%), (24) and Harcourt Brace (80%). (25) Each textbook was reviewed for health topics addressed through specific lessons or learning activities. Topic areas were charted, frequencies were tallied, and the lists of topics were examined for themes. Health topics or themes present in more than one publisher series, and at more than one grade level within a series, were selected for the questionnaire.
Respondents were asked to indicate if they covered each of the health topics as part of their classroom instruction. Respondents answered by circling "NO" or "YES." Respondents also provided profile data, answering specific questions about classroom practices, professional preparation, and demographics.
To establish instrument reliability and validity, the questionnaire was pilot tested. Following approval from the Institutional Review Board (IRB), teachers (N = 217) in grades three, four, and five from a central Florida school district served as potential respondents for the pilot administration. After a two-contact mailing, 85 survey responses were received. Of those, 82 were usable, yielding a response rate of 37.8% (N = 217; n = 82). Teachers (n= 13) at two elementary schools in the school district also were invited to provide individual suggestions regarding time required for completion, ease of use, format, clarity, and readability of the questionnaire. In addition, experts in survey methodology, instrument development, and professional preparation of elementary teachers in health education methods assessed the questionnaire for content validity. Changes were made based on recommendations from the expert panel and findings from the pilot administration.
Internal consistency reliability testing of each of the 10 health content subscales was estimated using Cronbach's alpha. Estimates obtained from the main study were between .59 for the Growth and Development subscale and .89 for the Alcohol, Tobacco, and Other Drug subscale. The reliability estimate for the total scale was .96.
Data were collected using a cross-sectional survey research design with a three-contact format: 1) an initial mailing, 2) reminder postcard, and 3) follow-up mailing. (26,27) Survey packets were mailed to the school addresses of a random sample of 800 potential respondents during spring semester 2001. The packets contained a personalized cover letter; the questionnaire; a follow-up study contact information card; and a preaddressed, postage-paid return envelope. The questionnaire included general instructions and 122 items. Respondents marked their responses directly on the questionnaire booklet. One week after the initial mailing, a reminder postcard was mailed to all 800 potential respondents. Approximately two weeks after the reminder postcard was mailed, a second survey packet including a personalized follow-up letter; another copy of the questionnaire; and a preaddressed, postage-paid envelope were sent to respondents who had not responded (n = 570).
This study included one independent variable, preservice instruction in health education methods with four levels: 1) preservice health education methods course (HE), 2) combined health/physical education methods course (COMBO), 3) both a health education methods course and a physical education methods course (HE/PE), 4) no health or physical education methods course (NONE). The study's dependent variables were: 1) degree to which respondents covered all 10 of the health content areas in their classroom instruction, referred to as scope of coverage, 2) extent (depth) to which each health content area is covered, and 3) amount of time spent teaching health.
Chi-square analysis was used to measure how the groups differed from one another. Univariate statistics were used to calculate the topics covered, number of health lessons taught, and amount of time spent teaching health. A one-way analysis of variance (ANOVA) was used to examine differences between the type of health education methods course completed and the health instruction provided by respondents. Level of significance was determined a priori at .05. To maintain an overall alpha level at .05, a Bonferroni adjustment was completed, resulting in an independent alpha level of .0167 (.05/3) for each individual test.
Of 800 teachers selected to participate in the study, a total of 399 responded to the study, providing a response rate of 49.88%. Twenty-eight respondents contacted the researcher or returned the survey because they were part of a departmentalized teaching situation and they were not responsible for health instruction, or they were not classroom teachers, leaving an effective sample of 772. The overall response rate was 48.06% (N = 772; n = 371), including 366 usable questionnaires. Five respondents declined to participate.
Study Demographics and Profile Characteristics
Of 366 usable responses, 84.4% were females (n = 309) and 14.8% were males (n = 54), with a mean age of 44.33 years (SD =10.63). Most respondents were White (n = 340, 92.9%). Mean number of years of teaching experience was 17.49 years (SD = 10.84). Approximately two-thirds of respondents held a master's degree (n = 243, 66.4%), whereas 29% (n=106) held a bachelor's degree. Most teachers held an elementary education license (n = 325, 88.8%). The preservice preparation received by respondents varied, with 25.7% completing no methods course (n = 94), 22.7% completing a combined health/physical education course (n = 83), 17.8% completing both a health education methods course and a physical education methods course (n = 65), and 12.3% completing a health education methods course (n = 45). Additionally, 14.5% of respondents reported completing only a physical education methods course (n = 53). Respondents completing only a physical education methods course were not included in the results of the research questions presented for this study because this study focused on health education methods, thus the following reported results are based on n = 287.
Table 1 describes respondents by type of health education methods course completed. No statistically significant differences between groups based on gender, age, grade taught, and years of teaching experience were detected. Statistically significant differences were noted between groups based on the college/university granting teaching certification, and the highest degree held.
Scope of Coverage
Scope of coverage of health content was determined by recoding the data to show which respondents covered at least 50% of the topics within each content area, with respect to all 10 content areas combined. The degree to which respondents covered all 10 of the health content areas was significant when tested with the one-way analysis of variance (ANOVA) (F = [5.675.sub.(3,219)], P = .001). Post hoc analysis, using a Bonferroni adjustment comparing completion of each course (COMBO, HE, HE/PE) against respondents not completing a preservice methods course (NONE), found that respondents who completed both a health education methods course and a physical education methods course (HE/PE) as part of their preservice teacher preparation taught more of the 10 health content areas (scope) than did respondents who did not complete a preservice health education methods course (NONE) (Table 2). The mean number for the 10 health content areas taught was 7.54 (SD = 2.38).
Extent of Coverage
The depth to which each health content area was covered was statistically significant between groups, at the .05 level when tested with ANOVA, for all content areas except Community and Environmental Health. A Bonferroni adjustment for pairwise comparisons indicated that respondents who completed both a preservice health education methods course and a physical education methods course (HE/PE) taught more topics within all statistically significant content areas except Nutrition than did respondents who did not complete a health education methods course (NONE). Table 3 presents descriptive statistics and Bonferroni adjustment comparing those receiving preservice instruction in health education methods against those not receiving preservice health methods instruction.
Time Spent Teaching Health
One-way ANOVA determined that a statistically significant difference existed in the number of lessons taught per week (F = [3.060.sub.(24,29,732.87)], P = .029) and the number of minutes spent teaching health per week (F = [3.504.sub.(45482.17,1185507.6)], P = .016) when comparing the four groups. Mean number of minutes spent teaching a health lesson was 31.05 (SD = 18.40). Teachers taught approximately two health lessons per week (M = 2.41, SD = 1.63) with an average of 88.25 (SD = 68.17) minutes spent teaching health on a weekly basis. A Bonferroni adjustment for pairwise comparisons indicated no significant differences existed when comparing HE, COMBO, and HE/PE to NONE.
Results from this study indicated type of preservice methods course was less of an influence on teaching practices than the amount of preservice coursework completed. Individuals who completed both a health education methods course and a physical education methods course taught a greater number of the 10 health content areas than did individuals not receiving any preservice instruction in health education methods. The average number of content areas taught by individuals not receiving preservice health education methods instruction was 6.87 (SD = 2.54), while respondents completing both a health education methods course and a physical education methods course averaged 8.59 (SD = 1.86) of the 10 content areas. This finding is consistent with results from the School Health Education Evaluation, which determined that the more inservice training teachers received, the higher the percentage of a curriculum teachers implemented. (28)
The thoroughness with which respondents covered each content area also was influenced by the amount of coursework completed during preservice teacher preparation. Again, respondents completing both a health education methods course and a physical education methods course taught eight of the 10 health content areas in significantly greater depth than did respondents not completing any preservice health education coursework. This finding suggests that, while health education methods courses alone have the potential for exposing university students to a depth of content and teaching methods, additional exposure to content and teaching methods that could be gained by completing both courses significantly influenced the actual classroom practices. Perhaps completing the second course also increased the respondents' understanding of the importance of including health instruction in the curriculum and provided them with additional opportunities to teach health education topics.
Many respondents indicated that the topics included in the content area of Community and Environmental Health were covered in their science curriculum. Therefore, the finding of no statistically significant difference seems less surprising. Participants suggested that science instruction received a greater amount of instructional time in the curriculum than does health. For example, several respondents indicated they taught science for three, nine-week grading periods, and health for one, nine-week grading period. Also, preservice elementary teachers typically are required to complete a science methods course. Given this information it seems reasonable that preservice health education did not influence respondents' coverage of this content area.
There was a statistical difference between groups in the content area of Nutrition, however, no statistical difference was observed in pairwise comparisons. Respondents reported that while they were not required to complete a preservice health education methods course, they were required to complete a personal and family health course. This latter course typically includes significant attention to Nutrition, and thus might explain why no specific group differences existed.
Because classroom teachers do not provide coverage of physical fitness topics, it should not be assumed that children do not receive physical education. Many respondents reported that the physical education teacher covered some or all of the physical fitness topics. Most respondents (86.3%) reported that their students received physical education from a physical education specialist, while only 2.0% responded that their students received physical education from the classroom teacher.
Respondents who completed both a health education methods course and a physical education methods course spent more time teaching health during a week than did respondents not receiving any preservice instruction in health methods. Though the difference was not statistically significant, this finding reinforces the assumption that additional coursework had a positive influence on the amount of health instruction provided. Teachers not receiving preservice instruction in health education methods taught approximately two lessons (M = 1.98, SD = 1.57) per week, while respondents completing the two preservice methods courses taught almost three lessons per week (M = 2.67, SD = 1.62). Because of this difference in the number of lessons taught per week, it is likely that children were exposed to an average of 30 more minutes of health instruction per week from teachers who completed both a health education and a physical education methods course than were students with teachers who completed no preservice health education methods. This finding supports the observation that in order for teachers to teach more of the 10 health content areas, and to teach the content areas more in-depth, they must devote more time to health instruction.
The study results should be interpreted in light of the following limitations. Several respondents indicated they teach science for three, nine-week grading periods, and they teach health for one, nine-week grading period. At the time of the study, some respondents indicated they had taught zero minutes and zero lessons because they were conducting science instruction. Other teachers conducting health instruction during the same week, may have overestimated the amount of time they devote to health instruction throughout the school year.
Further, teachers who reported averaging three lessons a week, for a nine-week grading period, would provide a total of 27 health lessons, which seems an implausible amount of time to cover all 94 topics. Some respondents also reported they do not provide a formal grade for health because it was considered part of the social studies/science/health grade, or some combined grade. This suggests that teachers lacked an incentive to spend time specifically on health instruction.
Limitations of this research might also be borne from the use of survey research. The close-ended format of the questionnaire minimized the potential to determine more information about the actual preservice instruction respondents received or how other factors might have influenced their teaching practices. The monothematic nature of the questionnaire may have caused some classroom teachers to respond in a unique manner. Finally, since data were collected through self-report, some data may be over-reported in comparison to the actual level of practice.
Based on the results of this study the researchers suggest recommendations for policy and practice and future research.
Policy and Practice
1. A preservice health education methods course should be required for all elementary education majors prior to receiving teacher certification. Though significant differences were not found for all forms of preservice instruction, a positive relationship existed between the coverage of content and in the amount of time spent providing health instruction, and preservice instruction in health education.
2. Health education faculty throughout the nation should advocate for requiring preservice health education courses for elementary education majors. They also should assume a more active role in preparing elementary education majors at their institutions, reinforce program standards, and elevate the importance of health education in the preservice elementary education teacher preparation curriculum.
3. National organizations should continue to advocate for nationwide implementation of the "Health Instruction Responsibilities and Competencies for Elementary (K-6) Classroom Teachers." (29) They should develop model curriculum based on these standards to improve the course content and quality of instruction at the preservice level.
4. Health education faculty, school administrators, elementary teachers, and other school personnel must collaborate to address the need for allocating time in the elementary curriculum for health instruction.
1. Follow-up interviews with selected study respondents should be conducted to gain further understanding about the factors that influence classroom teachers' efforts and abilities to include health instruction in their curricula.
2. Preservice health education and physical education methods courses offered at the four largest teacher preparation programs in Indiana should be analyzed to determine similarities and differences in content, methodology, and field experience, and how course-related experiences may impact actual practice.
3. A model that integrates health instruction with other subjects, such as Language Arts and Mathematics, should be tested to determine if teaching across the curriculum when compared to instructional methodology unique to health instruction can positively influence children's health knowledge, attitudes, and skills.
Based on findings from this study, researchers and practitioners involved in preservice teacher preparation of elementary teachers in health education can feel confident that additional coursework in health education methods and related areas positively influences the scope of health content covered, depth of coverage of that health content, and amount of time spent on health instruction. While the completion of a health education methods course, or a combined health education and physical education methods course, produced higher mean scores in scope of coverage, number of topics covered in each content area, and amount of time spent teaching health, the increases were not statistically significant. However, the results of this study provide evidence that a relationship exists between preservice instruction in health education and health content taught by teachers.
Table 1 Demographics by Type of Health Education Methods Course Completed None Combo HE (n = 93) (n = 83) (n = 46) Demographic % % % Gender Female 88.0 83.1 87.0 Male 12.0 16.9 13.0 [X.sup.2] = 3.869, df = 3, p = .276 Age 21-29 18.0 15.0 13.3 30-39 23.6 15.0 11.1 40-49 23.6 31.3 26.7 50+ 34.8 38.8 48.9 [X.sup.2] = 7.931, df = 9, .p = .541 Grade Taught Third 39.8 27.7 30.4 Fourth 26.9 39.8 32.6 Fifth 33.3 32.5 37.0 [X.sup.2] = 5.446, df = 6, p = .488 Years of Teaching Experience 1-10 43.5 29.3 30.4 11-20 22.8 24.4 21.7 21-30 22.8 28.0 28.3 31 + 10.9 18.3 19.6 [X.sup.2] = 0.688, df = 9, p = .298 College/University Granting Teaching Certification Ball State University 4.3 28.9 15.2 Indiana State University 3.2 9.6 6.5 Indiana University 30.1 10.8 23.9 Purdue University 6.5 6.0 8.7 Other 55.9 44.6 45.7 [X.sup.2] = 51.869, df = 12, p = .000 * Highest Degree Held Bachelor 41.9 25.3 28.3 Graduate 58.1 74.7 71.7 [X.sup.2] = 9.395, df = 3, p = .024 * HE / PE Total (n = 65) (n = 287) Demographic % % Gender Female 76.9 83.9 Male 23.1 16.1 [X.sup.2] = 3.869, df = 3, p = .276 Age 21-29 11.7 15.0 30-39 15.0 17.2 40-49 25.0 26.6 50+ 48.3 41.2 [X.sup.2] = 7.931, df = 9, .p = .541 Grade Taught Third 35.9 33.9 Fourth 26.6 31.5 Fifth 37.5 34.6 [X.sup.2] = 5.446, df = 6, p = .488 Years of Teaching Experience 1-10 24.6 33.0 11-20 20.0 22.5 21-30 38.5 28.8 31 + 16.9 15.8 [X.sup.2] = 0.688, df = 9, p = .298 College/University Granting Teaching Certification Ball State University 38.5 20.9 Indiana State University 13.8 8.0 Indiana University 4.6 17.8 Purdue University 4.6 6.3 Other 38.5 47.0 [X.sup.2] = 51.869, df = 12, p = .000 * Highest Degree Held Bachelor 21.5 30.3 Graduate 78.5 69.7 [X.sup.2] = 9.395, df = 3, p = .024 * * Significant at the .05 level. ([dagger]) None = No preservice health education methods course, HE = Health education methods course, Combo = Combined health/ physical education methods course, HE/PE = Both a health education and physical education methods course. Table 2 Mean Number of Content Areas Taught by Comparing Course Taken to NONE Item n M SD p None 70 6.87 2.54 Combo 63 7.32 2.47 1.000 HE 41 7.78 2.12 .281 HE/PE 49 8.59 1.86 .001 * * The mean difference is significant at the .05 level with a Bonferroni adjustment comparing course completed with NONE. ([dagger]) n = Number of RESPONDENTS in group, M = Mean, SD = Standard Deviation, p = Significance level. ([double dagger]) NONE = No preservice health education methods course, COMBO = Combined health/physical education methods course, HE = Health education methods course, HE/PE = Both a health education and physical education methods course. Table 3 Mean Number of Topics Taught in Content Subscales: Course Taken to NONE Health Content Subscale Course n M SD p None 87 10.18 4.11 Combo 77 11.39 3.82 .245 HE 43 11.58 3.17 .279 Alcohol, Tobacco, and Other Drugs HE/PE 61 12.25 3.48 .007 * None 88 6.25 3.28 Combo 79 7.35 3.16 .123 HE 46 7.41 2.88 .223 Disease Prevention and Control HE/PE 61 8.44 2.62 .000 * None 89 3.60 1.58 Combo 78 3.77 1.55 1.000 HE 46 4.04 1.19 .499 Emotional and Intellectual Health HE/PE 61 4.36 1.14 .008 * None 83 9.53 2.63 Combo 75 10.17 2.51 .550 HE 46 10.39 2.23 .303 Family and Social Health HE/PE 60 11.18 1.95 .000 * None 88 2.88 1.44 Combo 76 3.00 1.47 1.000 HE 45 3.09 1.44 1.000 Growth and Development HE/PE 60 3.80 1.55 .001 * None 86 8.62 3.83 Combo 75 9.35 4.02 1.000 HE 44 9.20 3.84 1.000 Injury Prevention and Safety HE/PE 54 10.98 3.33 .002 * None 86 4.67 2.04 Combo 77 5.45 1.94 .074 HE 46 5.70 1.68 .030 Nutrition HE/PE 61 5.30 2.11 .369 None 88 4.80 1.78 Combo 75 5.24 1.79 .531 HE 46 5.54 1.31 .082 Personal and Consumer Health HE/PE 61 5.87 1.52 .001 * None 87 3.85 2.97 Combo 76 4.49 3.13 1.000 HE 44 4.59 2.55 1.000 Physical Fitness HE/PE 60 5.55 3.76 .009 * * The mean difference is significant at the .05 level with a Bonferroni adjustment comparing course completed with NONE. ([dagger]) n = Number of RESPONDENTS in group, M = Mean, SD = Standard Deviation, p = Significance level. ([double dagger]) NONE = No preservice health education methods course, COMBO = Combined health/physical education methods course, HE = Health education methods course, HE/PE = Both a health education and physical education methods course.
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Denise M. Seabert, PhD, CHES, Assistant Professor, Dept. of Health and Kinesiology, Purdue University, 800 W. Stadium Ave., West Lafayette, IN 47907-2046; (firstname.lastname@example.org); R. Morgan Pigg, Jr., HSD, MPH, Professor, Dept. of Health Science Education, University of Florida, P.O. Box 118210, FLG 5, Gainesville, FL 32611-8210; (email@example.com); Robert M. Weiler, PhD, MPH, Associate Professor, Dept. of Health Science Education, University of Florida, P.O. Box 118210, FLG 5, Gainesville, FL 32611-8210: (firstname.lastname@example.org); Linda S. Behar-Horenstein, PhD, Associate Professor, Dept. of Educational Leadership, Policy, and Foundations, University of Florida, PO Box 117049, 285 Norman Hall, Gainesville, FL 32611-7049; email@example.com; M. David Miller, PhD, Professor, Dept. of Educational Psychology, University of Florida, P.O. Box I17047, 1403 Norman Hall, Gainesville, FL 32611-7047; firstname.lastname@example.org; Jill W. Varnes, EdD, CHES, CHE, Professor, Dept. of Health Science Education, University of Florida, P.O. Box 118210, FLG 5, Gainesville, FL 32611-8210; (email@example.com). This article was submitted March 25, 2002, and accepted for publication July 29, 2002.…
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Publication information: Article title: The Influence of Preservice Instruction in Health Education Methods on the Health Content Taught by Elementary Teachers in Indiana. (Research Papers). Contributors: Seabert, Denise M. - Author, Pigg, R. Morgan, Jr. - Author, Weiler, Robert M. - Author, Behar-Horenstein, Linda S. - Author, Miller, M. David - Author, Varnes, Jill W. - Author. Journal title: Journal of School Health. Volume: 72. Issue: 10 Publication date: December 2002. Page number: 422+. © 1999 American School Health Association. COPYRIGHT 2002 Gale Group.