Investigating the Relationship Between Primary School Teacher’s Attitudes Towards Teaching Health Promotion, Teacher’s Efficacy and Understanding of the Philosophy of the New Cypriot Health Promotion Curriculum, Research Proposal Example

Table of Contents

 

  1. Introduction.. 3

Statement of the Problem.. 4

  1. Review of the Literature.. 6

Literature Review.. 6

  1. Research Design.. 13

Critical Issues and Theoretical Framework. 13

Research Rationale. 14

Aims and Objectives. 15

Ethical Issues. 15

  1. Methodology.. 17

Sampling Issues. 17

Measurement Instruments. 18

Data Analysis. 19

Assumptions and Limitations. 20

Plans for Dissemination. 20

Timescale. 21

References. 22

 

  1. Introduction

Promoting healthful attitudes and healthful behaviour is a critical part of helping young students to develop into mature young men and women.  Health promoting schools can be determined by their goals. For example, the European Network of Health Promoting Schools (ENHPS) has identified specific characteristics of such schools, including (among a number of others)  that they take a very broad perspective on health, that they provide their students with tools to encourage and enable healthy choices, offer students the opportunities to make meaningful contributions to both school and community, and increase the quality of life for the students and staff (Barkenow, 2006).

This role is so crucial that in Cyprus, a new health education curriculum has been developed (Ioannou et al., 2011).  The goal of this new curriculum is to allow students, teachers, and school administrators to unite in an effort to move past individual lifestyle and behaviour modification approaches to develop mechanisms to recognise and deal with the issues that determine good health.  Ioannou et al. describe this new curriculum as one that deals with four key themes, including the development and empowerment of each individual person, the establishment of a safe and healthy lifestyle, the development and improvement of the individual’s social skills, and the development of the individual as an active participant in the citizenry.  To this end, the curriculum uses three levels including understanding the factors that determine good health, practicing the skills that develop or maintain good health, and making behavioural changes to support healthful living.  The overall approach of this new Cypriot curriculum is one of active learning, but it is intended to look beyond the individual to the socio-cultural factors that also influence the health of the population.

This new Cypriot health promotion curriculum is directed particularly at primary schools and  offers a larger-scale perspective on the issue of lifetime healthful behaviours. Ioannou (2007) demonstrated the effectiveness of taking such a positive, holistic approach to health promotion.

A recent study by Viig, Tjomsland, and Wold (2010) investigated what conditions improved teacher participation in a health promotion curriculum in Norway.  That study found varying levels of participation in the program, based on such factors as teachers’ personal interests in health promotion and how highly they regarded the specific program being used in that nation.  Also, the teachers reported that other factors affected their decisions to incorporate the specified health promotion curriculum into their teaching plans.

Thus, the Cypriot program may be implemented to the extent intended, or it may be less effective than anticipated.  The new curriculum can be only as effective as the teachers make it.  Because this new curriculum takes a significantly different approach to health promotion, it is not clear whether teachers in Cyprus fully support such a change.  Further, it is not clear whether teachers in primary education schools understand the  philosophy of the new health promotion curriculum, and whether their teacher efficacy affects their implementation of the program.

This proposed research project would consider this issue and investigate the relationship between implementation of the new Cypriot health promotion programme and various factors that may be influencing the incorporation of the programme.

Statement of the Problem

The new Cypriot health promotion curriculum for primary schools is in sharp contrast with the previous approach to health education and promotion. For this reason, it is important to understand how the teachers who have to follow this curriculum understand the curriculum, grasp the philosophy behind it.  It is unknown whether teacher efficacy impacts the teachers’ understanding of and use of the curriculum as well.

Thus, the research problem for this project will be to investigate the relationships among teacher efficacy, teacher attitudes toward the new curriculum, and teacher understanding of the philosophy behind the curriculum. The project will use a quantitative approach to examine the relationships among these elements.

  1. Review of the Literature

My dissertation will explore the relationship between primary school teachers’ attitudes toward teaching health promotion, their efficacy at developing and implementing such curriculum, and their overall understanding of the philosophy that underlies the new Cypriot Health Promotion curriculum.  My aim is to gain a deeper understanding of the role played by teachers in taking health promotion curriculum from a developmental stage to a practical one that will instill children with the skills necessary to take a proactive role in their own personal health.

Literature Review

The perception of teachers and administrative staff toward any health promotion curriculum is an important predictor of success in the curriculum. Mohammadi, Rowling, and Nutbeam (2010) performed a qualitative study in Australian schools to determine their understanding of health promotion in schools and how these professionals perceived such curricula benefitting the schools.  The interviews resulted in a set of themes, the most important of which was the need for having a shared understanding between health and education, and even more importantly, an understanding of how health promotion benefits the core business of the schools (Mohammadi et al., 2010).

One critical social benefit for health promotion curricula was demonstrated by a study by Mogford, Gould, and DeVoght (2010), and that is the usefulness of increasing health literacy as a mechanism for overcoming society’s health inequities.  In the U.S. in particular, with its lack of universal health care for its citizenry, significant socioeconomic health inequities exist.  Mogford et al. reported on the results of efforts to develop a more health promoting curriculum as opposed to a more traditional health education programme.  The four-part curriculum described by Mogford et al. included a segment on teaching the social determinants of health, a segment on teaching students to be their own agents of change in health issues, a segment on teaching specific health promoting skills and strategies, and a segment on creating and implementing an action plan to improve health equity.  Although specific results from implementation of this curriculum are forthcoming in later studies, the preliminary evaluations reported by these authors noted that responses to their proposed curriculum has been positive (Mogford et al., 2010).

When new curricula are introduced, teacher acceptance is a critical factor for the success or failure of that new curricula.  For example, in a study of Greek physical education (PE) teachers presented with a new curriculum, Gorozidis and Papaioannou (2011) reported that teacher characteristics are important determining factors to implementation of the changed curriculum.   In the change studied, the curriculum was a top-down change instituted at the national level rather than driven by teachers’ desires.  The results of the study showed that many teachers did not implement the new curriculum, with fewer than half of the proposed activities being taught two years after the introduction, and with many teachers teaching none of the new activities at all.  The authors concluded that introducing a new curriculum requires extensive attention to teachers’ intension, attitudes, self-efficacy, and orientation toward mastery and attaining goals (Gorozidis & Papaioannou, 2011).

St. Leger (1998) considered the subject of health promotion within the educational system and provided substantial information about the successes and limitations of health promotion curriculum in the Australian  school systems.  Although not specific to the Cypriot Health Promotion curriculum, St. Leger explored the reasons why health promotion is a crucial addition to all school curricula, as well as illustrated universal barriers to creating a comprehensive and sustainable school program that emphasized healthy lifestyles and choices amongst students, parents, and educators.  St. Leger discussed a variety of movements within the European, Australian, and American school systems which sought to provide children with curricula that employed a holistic approach that went beyond mere education of the mind in order to help students develop healthy physical selves through health promotion programs.  Successful health promotion programs were largely dependent on the ability of teachers to accept and understand the reasons for merging such campaigns into their general curricula.  While the author found that a majority of teachers were concerned about the health of their students and eager to provide their students with tools for better health, the author also found that many teachers were hindered in their efforts to implement such programs due to a lack of preparation and education.  Using international efforts in health promotion as a framework through which to explore the specific needs of educators when attempting to implement health promotion programs, the article focused specifically on an Australian research study conducted in the early 1990s.  Interviews and surveys of teachers demonstrated that a majority of respondents had difficulty looking at health promotion beyond its use within the classroom, and were often ignorant of the resources available to them and the manner in which family and community partnerships could be used to improve the programs’ likelihood of success (St. Leger, 1998).  While the overall enthusiasm and acceptance of the majority of the respondents when presented with the opportunity to discuss health promotion within their schools was a positive outcome of the study, illustrating that Australian primary school teachers were generally open to expanding their curriculum to include health promotion, the author noted that there were a number of key areas that acted as potential roadblocks in efforts to create a long-term health promotion program within Australian schools.  Among these were a lack of integration between schools and health services organizations and personnel, the challenge of motivating school administration to support curriculum changes in the area of health promotion, and the continued need for teachers’ continued professional development (St. Leger, 1998).  Many teachers surveyed in the study had difficulty expressing what a ‘health promotion school’ looked like to them, primarily because they had not been exposed to any successful examples of schools who had been able to integrate health promotion into the overall curriculum of their institutions (St. Leger, 1998).  While health promotion curriculum presented an opportunity for educators and administrators to create programs which allowed them to address the health concerns of both their students and society, St. Leger (1998) emphasized  that health promotion efforts ‘will only be successful if teachers can understand it, interpret it, and shape it to meet the needs of their school community’  (p.234).

Research conducted by Tjomsland and colleagues (2009) touched on many of the same areas, including the perceptions that teachers had towards health promotion programs and the manner in which their attitudes can help or hinder the success of such programs. The key difference was that Tjomsland et al. focused on Norwegian schools rather than Australian ones.  Thus, this article evaluated research conducted at ten Norwegian schools which were already participating in the European Network of Health Promoting Schools (ENHPS), an educational network which seeks to develop support and alliances throughout over 40 European countries regarding health promotion in schools.  The authors found that Norwegian teachers wielded a great deal of power when it came to influencing the behaviours of their students, and thus the teachers could be viewed as a largely untapped resource for improving the health behaviours and attitudes of their students (Tjomsland et al., 2009).  As agents of change, teachers were uniquely positioned to take on a greater role within the classroom in order to engage in health promotion campaigns.  Similarly, such programs had difficulty succeeding if teachers are disinterested, uninformed, or resistant to change (Tjomsland et al., 2009).  The health promoting school was defined as an institution which takes a ‘multifaceted approach [in] combining health education in the classroom with a healthy school environment, school health policies, collaboration with parents, and community, and reoriented school services’ (Tjomsland et al., 2009, p.89).    The authors reviewed surveys of 104 teachers that were conducted in 1994 and then again in 1997 in order to determine whether teachers’ initial motivation regarding health promotion programs was sustainable over a period of three years.  The researchers examined how teachers’ attitudes towards health promotion changed during the program, the role that their expectations, general attitude, and intentions played in their ability to participate in health promotion activities, and whether their expectations and intentions during the 1994 survey substantially altered when researchers reinterviewed them in 1997 (Tjomsland et al., 2009).  Their research indicated that, overall, those teachers who were most positive about their potential involvement in health promotion programs continued to demonstrate a positive attitude in the subsequent survey; indeed, Tjomsland and colleagues (2009) suggest that positivity and an openness to curricular change tends to be self-perpetuating.  The researchers also found that 80% of those surveyed reported during the three-year follow-up that health promotion curriculums had been successfully developed, although not all of the respondents had been personally involved in the development of the program.  Tjomsland and colleagues (2009) attribute the statistically high number of positive reports at the follow-up point to the likelihood that ‘the more teachers invest in a program, the more they want the program to succeed, and the more positive their reporting of outcomes will be’ (p. 99).  Overall, the researchers suggested that health promotion programs were more likely to become a long-term and sustainable portion of the general curriculum when teachers themselves believed in the viability and effectiveness of such programs, thereby creating an environment in which teachers were motivated to participate and implement health promotion interventions within the classroom (Tjomsland et al., 2009).

Leurs, Bessmes, Schaalma and de Vries (2007) reported on the relationship between teacher implementation of health promotion activities and attributes of the teachers in Dutch primary schools.  The specific factors studied included attitude, social influence, perceived barriers, and self-efficacy.  In studying teachers of students in late primary grades (9- to 12-year-old students), the authors found that teachers who addressed more health issues tended to be teachers of higher grade levels, perceived fewer disadvantages, had higher self-efficacy, and greater staff  and administrative support.  Of these factors, the authors found that having greater staff support was the most important factor in determining greater health promotion implementation in the curriculum. Thus, Leurs et al. concluded that improving and increasing administrative and staff support for teachers of health promotion was one of the most important factors in increasing health promotion efforts in Dutch schools (Leurs et al., 2007).

A health promotion attitude requires more than support from teachers to succeed. Jourdan et al. (2010) investigated the relevance of factors in non-teaching personnel within a school for health promotion. Specifically, the authors conducted interviews of staff including principals, school nurses and doctors, counsellors, administrative, maintenance, canteen, and cleaning staff as well as teachers in French middle schools (grades 6-9).  These personnel noted three types of roles in health promotion: educator, provider of individual support or a listening ear, and participator in collective projects (including facilitator of such projects).  Jourdan et al. found that to truly promote health education and promotion in schools required gaining support from all personnel in the school, both teaching and non-teaching staff (Jourdan et al., 2010).  In a separate study, Jourdan et al. (2011) found that teachers noted several factors as being of importance to health promotion programmes, including the teachers’ understanding of how the curriculum impacted their roles and staff relationships,  and the quality of relationships between teachers and school organisations and parents.  The teachers in this study felt it was essential to consider and respect the total school environment and context when deciding to implement a health promotion curriculum (Jourdan et al., 2011).

Other researchers have looked at more topic-specific health promotion programmes. For example, Sy and Glanz (2008) considered factors that influenced teacher participation in a specific tobacco prevention programme aimed at multiethnic youth in Hawaii. The authors investigated whether there were specific factors that influenced the implementation of the programme by teachers.  Specific factors considered included teacher attitudes, teacher characteristics, teacher training, external facilitators and barriers, and curriculum characteristics.  Of these factors, the authors found that having a programme be part of a year-long curriculum and teachers having a high self-efficacy perception were most closely related to greater implementation.  In contrast, greater perceived complexity implied less complete implementation of the programme. These authors concluded that improving teacher self-efficacy and confidence, perhaps by providing appropriate background and training for the teachers in the curriculum, should improve implementation compliance (Sy an Glanz, 2008).

  1. Research Design

Critical Issues and Theoretical Framework

Based on the review of literature and the characteristics of the new Cypriot health promotion curriculum, several key issues have been identified as being of interest in this study.  These issues include the attitudes of primary school teachers toward the new curriculum, their efficacy as teachers, and their understanding of the philosophy behind the curriculum.

Based on the literature review, the following theoretical framework is proposed in which the teacher attitudes toward the curriculum is the dependent variable, while teacher efficacy (Sy & Glanz, 2008; Gorozidis & Papaioannou, 2011) and teacher understanding of the philosophy of the curriculum (Tjomsland et al., 2009; St. Leger, 1998; Mohammadi et al., 2010) are independent variables.  This framework is illustrated in Figure 1.

IV1: Teacher Efficacy

(Sy & Glanz, 2008; Gorozidis & Papaioannou, 2011)

IV1: Teacher Understanding of Philosphy

(Tjomsland et al., 2009; St. Leger, 1998; Mohammadi et al., 2010)

DV: Teacher Attitude toward New Curriculum

 

Figure 1.  Theoretical framework for this research.

 

Based on this theoretical framework, the following hypotheses have been identified for investigation in this study.

H1:      Primary teacher efficacy has a positive realtionship with the teacher attitude toward the new Cypriot health promotion curriculum.

H2:      Primary teacher understanding of the philosophy of the curriculum  has a positive realtionship with the teacher attitude toward the new Cypriot health promotion curriculum.

These hypotheses have equivalent null hypotheses:

H0-1:   Primary teacher efficacy has no significant realtionship with the teacher attitude toward the new Cypriot health promotion curriculum.

H0-2:   Primary teacher understanding of the philosophy of the curriculum  has no significant realtionship with the teacher attitude toward the new Cypriot health promotion curriculum

Research Rationale

Studies in the literature have noted that participation and effectiveness of suggested curricula are impacted by a number of teacher-dependent factors. Depending on the study, the curriculum, and the schools involved, the factors can range from the efficacy of the teachers to their personal interest in the curriculum proposed (Viig et al., 2010; St. Leger, 1998; Tjomsland et al., 2009).  Thus, if health promotion is important at a societal scale, it is essential to understand what factors motivate individual primary teachers to participate in the curriculum.

It can be expected that a successful study will provide suggestions for methods of encouraging more teachers to understand and participate in the curriculum by identifying areas in understanding the curriculum or in teacher efficacy that indicate a poorer attitude toward the programme.  Such a study has not yet been done on the Cypriot schools to determine how well this new curriculum has been accepted by the teachers which much implement it.

Aims and Objectives

The primary aim of this research is to understand how the attitudes of primary teachers toward the new Cypriot health promotion curriculum are impacted by  the teachers’ efficacy and by the teachers’ understanding of the philosophy behind the new curriculum.  In this regard, the objectives of this research are three-fold:

  1. To undertake a significant review of the literature on teacher attitudes toward curriculum changes, teacher attitudes toward health promotion curricula, and the impact that teacher efficacy and philosophical understanding of a curriculum impacts the teacher attitude toward that curriculum;
  2. To plan and implement a small-scale study of these elements using a quantitative approach to explore the relationships among these elements;
  3. To analyse both the literature review and the field data to determine the validity of the hypotheses on which this study is based.

The analysis of this study is expected to provide indicators that illustrate areas of teacher education or teacher training that may assist with better implementation of this new curriculum.

Ethical Issues

Because this study involves human participants, full approval of the methodology used in this study will be obtained prior to the beginning of this research project.  All reasonable efforts will be made to preserve the privacy of the participants in this research project.  In order to allay potential concerns of participants, not only will they be provided with full informed consent of the purposes and methods used in this study, their responses will be anonymous, using only numerical codes (i.e., Teacher 1, Teacher 2, etc.) to identify individual responses. None of the information collected will be ascribed to any individual participant, and only statistical summaries of the results made available to administrative personnel.  Further, the original responses will be retained under lock and key by the researcher for a period of seven years, after which the data forms will be destroyed.  Any computerised files that contain individual responses, even though encoded for anonymity, will be maintained by the researcher in a password-protected database, and kept secure from casual access.

 

 

 

  1. Methodology

This research project will be a quantitative study of primary teachers in schools in Cyprus who are participating in the new Cypriot health promotion curriculum.  The basic method of this research will be in the form of Likert-scale questionnaires of primary school teachers on Cyprus.  Details of the methodology including sampling, measurement instruments, and data analysis methods are described in the following sections.

According to Creswell (2008) quantitative research allows researchers to draw inferences about a population by means of statistical analysis of the relevant data; such analysis reveals relationships between variables. In contrast, a qualitative approach such as interviews, case studies, or ethnographic research is appropriate for exploring human behavior, relationships, or beliefs; it illuminates an event, activity, or process in relation to a central phenomenon (Creswell, 2008) and is therefore not appropriate for the proposed study.

The use of a quantitative approach  offers the advantage of allowing the results of this study to be generalized to other demographically similar schools. Thus, a critical element of the data collected will be appropriate demographic information about the teachers and schools. These data include such elements as teacher age;  total teacher experience; years in this school district; teacher training; teacher confidence in their understanding of the curriculum; and teachers’ degree of perceived support by administration, staff, and parents. Such information can be used to identify appropriate other populations where these study results may apply.  The quantitative approach thus provides an opportunity to test the research questions and hypotheses as described earlier to confirm whether evidence exists to support those hypotheses.

Sampling Issues

The total population of primary school teachers in the Limassol district of Cyprus is 1094 , working in a total of  89 schools.  Statistically, to obtain a confidence level of 95% and a confidence interval of 10%, with a population of 3600 it will be necessary to collect at least 88 responses from this population.  This was determined using the online sample size calculator provided by Creative Research systems (http://www.surveysystem.com/sscalc.htm).   The sample size computation is shown in Figure 2.

Figure 2. Sample size computation for the population of all primary teachers in Cyprus.

 

Sampling will be done via a convenience sample of teachers at various schools in Cyprus.  The specific schools and teachers used will be identified based on a convenience sample using available resources to include teachers from a variety of schools.

Measurement Instruments

The measurement instruments used will be focused on the three key variables in this study, the dependent variable, the attitude toward the new curriculum, and the two independent variables, specifically the teacher efficacy and the teacher’s understanding of the philosophy behind the new curriculum.  These three variables will be measured by researcher-generated surveys. All survey questions will use a Likert-type scale of 1 to 5 (e.g., 1=‘I disagree strongly’ and 5= ‘I agree strongly.’).

The teacher’s attitude toward the new curriculum will be assessed based on questions similar to:

‘The new health promotion curriculum is an improvement over the previous curriculum.’

At least three such questions in various forms including negative forms will be used so these responses can be correlated.

The teachers’ efficacy will be assessed using questions modeled on the efficacy measures used by Coladarci (1992), as well as similar efficacy measures used by Gorozidis and Papioannou (2011).  These earlier measures will be adapted for this research purpose, with questions similar to:

‘When my students’ grades improve, it is usually because I am more effective at teaching them.’

The teachers’ understanding of the new curriculum will be assessed by a series of statements that determine how accurately the teachers respond to statements about the rationale for the new curriculum.

Pilot versions of these various questions will be validated using a test-retest methodology to ensure consistency of responses.

Data Analysis

The collected data will be analysed using standard statistical techniques using generally available statistical software. Demographic information and the results of the questionnaires will be assessed using ANOVA and other standard statistical methodologies.

Assumptions and Limitations

Several key assumptions are included in this proposed project. First, it is assumed that the teachers attitudes and understanding of the curriculum impact their attitudes toward it.  Other key limitations are that the sample participants are reflective of the population, and that the researcher-generated measurement instrument is both reliable and valid.

Potential problem issues include recruiting sufficient participants for the study and in disseminating the survey forms and collecting the data.  Because of the nature of this study, and the anonymity of the participants in it, while ethical approval is required and will be obtained, it is not expected to encounter any unusually difficult approval issues.

Plans for Dissemination

Once complete, the results of this study will be made available on online libraries.  In addition, a presentation of the results of the study will be made to education officials on Cyprus, along with recommendations for using these results to further improve teacher attitudes toward the new curriculum.

 

 

Timescale

This research project is expected to follow the timescale noted in Table 1.

Table 1. Timescale for Research

 

Month Activity
January 2012 Submit ethical approval application
February 2012 Receive ethical approval.

Write literature review.

Formulate survey form.

March 2012 Conduct pilot study on survey forms for validation; modify survey as needed.
April-May 2012 Conduct field research.

Write methodology section of report.

June-July 2012 Analyse data collected.

Write first draft of dissertation.

August 2012 Write final draft of dissertation and submit.

 

  1. References

Barnekow, V. , Buijs, G., Clift, S., Jensen, B. B., Paulus, P., Rivett, D., Young, I.  2006. ‘Health-promoting schools: A resource for developing indicators.’ International Planning Committee. Viewed 13 Jan 2012. http://ws10.e-vision.nl/she_network/upload/pubs/Healthpromotingschoolsaresourcefor developingindicators.pdf

Coladarci, T., 1992. Teachers’ sense of efficacy and commitment to teaching. The Journal of Experimental Education, vol. 60, no. 4, pp. 323-337.  Viewed 11 Mar 2010. http://www.jstor.org/stable/201523340

Creswell, J. W., 2008. Educational research: Planning, conducting, and evaluating quantitative and qualitative research (3rd ed.). New York: Pearson Education.

Gorozidis, G., Papaioannou, A., 2011. Teachers’ self-efficacy, achievement goals, attitudes, and intentions to implement the new Greek physical education curriculum.  European Physical Education Review, vol. 2011, no. 17, pp. 231-253.  Viewed 13 Jan 2012.  http://epe.sagepub.com/content/17/2/231

Ioannou, S.,  2010, Moving from health education to health promotion: Developing the health education curriculum in Cyprus. Health Education, vol. 51. Pre-print provided by author.

Ioannou, S., 2007. Advertising a ‘healthy lifestyle’: a Cypriot health education project.  International Electronic Journal of Health Education, vol. 2007, no. 10, pp. 1-8. Viewed 13 Jan 2012, http://www.aahperd.org/aahe/publications/iejhe/loader.cfm?csModule=security/getfile&pageid=27900

Ioannou, S., Charalambous, N. Kouta, C., 2011. Health promotion versus health education: Developing the health education curriculum in Cyprus. Presentation at the European Educational Research Association 2011 Conference. Viewed 13 Jan 2012, http://www.eera.de/ecer-programmes/conference/ecer-2011/contribution/1276/ ?no_cache=1&cHash=db25b15b17

Jourdan, D., Stirling, J., McNamara, P. M., Pommier, J., 2011. The influence of professional factors in determining primary school teachers’ commitment to health promotion. Health Promotion International, vol. 26, no. 3, pp. 302-310. Viewed 16 Dec 2011, http://heapro.oxfordjournals.org/

Jourdan, D., McNamara, P. M., Simar, C., Geary, T., Pommier, J., 2010. Factors influencing the contribution of staff to health education in schools. Health Education Research, vol. 25, no. 4, pp. 519-530. Viewed 10 Jan 2012, http://heapro.oxfordjournals.org/

Leurs, M. T. W., Bessems, K., Schallma, H. P., de Vries, H., 2007.  Focus points for school health promotion improvements in Dutch primary schools.  Health Education Research, vol. 22, no. 1, pp. 58-69. Viewed 16 Dec 2011, http: //heapro.oxfordjournals.org/

Mogford, E., Gould, L., Devoght, A., 2010. Teaching critical health literacy in the U.S. as a means oto action on the social determinants of health. Health Promotion International, vol. 26, no. 1.  Viewed 30 Dec 2011, http: //heapro.oxfordjournals.org/

Mohammadi, N. K., Rowling, L., Nutbeam, D., 2010. Acknowledging educational perpsectives on health promoting schools. Health Education, vol. 110, no. 4, pp. 240-251.  Viewed 13 Jan 2012, http://www.emeraldinsight.com/096504283.htm

St Leger, L 1998, ‘Australian teachers’ understandings of the health promoting school concept and the implications for the development of school health’, Health Promotion International, vol. 13, no. 3, pp. 223-235, viewed 11 Jan 2012, http://heapro.oxfordjournals.org/content/13/3/223.full.pdf

Sy, A., Glanz, K., 2008. Factors influencing teachers’ implementation of an innovative tobacco prevention curriculum for multiethnic youth: Project SPLASH. Journal of School Health, vol. 78, no. 5, pp. 264-273.

Tjomsland, HE, Iverson, AC, & Wold, B 2009, ‘The Norwegian network of health promoting schools: A three-year follow-up study of teacher motivation, participation, and perceived outcomes’, Scandinavian Journal of Educational Research, vol. 53, no. 1, pp. 89-102. Viewed 10 Jan 2012, http://www.tandfonline.com/doi/abs/10.1080/00313830802628364

Viig, N. G., Tjomsland, H. E., Wold, B., 2010, ‘Program an school characteristics related to teacher participation in school health promotion.’  The Open Education Journal, vol. 2010, no. 3, 10-20. Viewed 14 Jan 2012, http://www.benthamscience.com/open/toeduj/articles/V003/10TOEDUJ.pdf