|Year : 2019 | Volume
| Issue : 1 | Page : 31-37
Health education in schools: An analysis of health educator role in public schools of Riyadh, Saudi Arabia
Mohammed Abdulrahman Almohaithef, Ebtesam Abbas Elsayed
Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
|Date of Web Publication||16-May-2019|
Dr. Ebtesam Abbas Elsayed
Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 11673
Source of Support: None, Conflict of Interest: None
Background: Many factors in Saudi society have led to the need for health education services in schools, while concerns related to the role of health educators in schools still unclear. The aim of this study was to analyze the role of health educators in public schools exploring the obstacles which affect their role. Subjects and Methods: A cross-section design was used; data were collected using self-administered questionnaire which consisted of four parts: covered demographic data, roles of health educators, the obstacles that affect them, and the attitudes regarding their role. A sample of 234 health educators working in public schools in Riyadh city participated in the study. Descriptive statistics and a Chi-square test were used for data analysis. Results: The results showed that the mean age of the participants was 40.31 years. There was no statistically significant difference between males and females in performing the majority of roles related to implementing health education activities in their schools, while there was a statistically significant difference between elementary, middle, and secondary schools in performing most of these roles. There are many obstacles that affect the role of health educators in public schools, while they have a positive attitude regarding their role with a mean score of 2.58 ± 0.28. Conclusion: The findings revealed that health educators in public schools face many obstacles when implementing health education activities which negatively impact on the health promotion of school children. The attitude of health educators was positive, indicating that they like their role; therefore, they need more training programs to be well prepared in order to perform their role effectively.
Keywords: Health education, health educator, public school, Saudi Arabia
|How to cite this article:|
Almohaithef MA, Elsayed EA. Health education in schools: An analysis of health educator role in public schools of Riyadh, Saudi Arabia. Saudi J Health Sci 2019;8:31-7
|How to cite this URL:|
Almohaithef MA, Elsayed EA. Health education in schools: An analysis of health educator role in public schools of Riyadh, Saudi Arabia. Saudi J Health Sci [serial online] 2019 [cited 2019 Jul 20];8:31-7. Available from: http://www.saudijhealthsci.org/text.asp?2019/8/1/31/256785
| Introduction|| |
School is considered the most important nurturing and supporting place which encourages students to obtain health information and positive behaviors. Data from the international scientific literature investigated the importance of school as a place where health promotion takes place. According to the WHO, “School health has a leading role in promoting students' health and their exposition to risk factors, secure top health standards through collaboration with all stakeholders, develop school health programs and services, and provide information on health issues as well as required interventions.”
The school health program is an effective strategy that any country might use to control major health and social problems; health education is a part of the school health program, and according to the WHO, health education is important in preparing students with the right knowledge to create an awareness that everyone shares responsibilities to protect their own health to reduce incidences of disease, disability, and death. Health education among children and adolescents, in particular, has been given high priority in many countries, especially health-related behaviors such as smoking. Most of the adult habits rise during the years of growing up. Therefore, it is better to try to prevent health-harmful behaviors in early age. Hence, in response to the challenge of disease-induced health problems, the current strategy for the primary prevention of disease is focused on health education starting in early school life.
It had been seen that there is a clear need for health education and awareness programs, policies, and resources in Saudi schools. In August 2016, the Ministry of Health (MOH) established the School Health General Department (SHGD), which was concerned with school health and had a leading role in promoting students' health and decrease the exposure to risk factors. SHGD assigned this role to school health counselors (two teachers in schools which have more than 100 students and one teacher in schools which have 100 students or less, so health educator in public schools of Saudi Arabia is a teacher who responsible for health education in the school). Therefore, more researches are needed to investigate the role of school health educators and what is the nature of their actual role in schools. According to Alotaibi, teachers are not prepared to deal with health issues in public schools of Saudi Arabia. Saudi public schools could improve the quality of care provided to schoolchildren by focusing on the role of health educators, which could bring about increased health education and awareness in schools, seeing a significant positive benefit on the health of schoolchildren that could result in long-term cost savings to the Saudi National Health Budget. Jamal believed that an increasing rate of health diseases was linked to a lack of educational programs and deficiencies in awareness programs. Furthermore, Debdas and Santosh highlighted the unavailability and lack of effectiveness of health education in schools in Saudi Arabia, as well as inadequate knowledge on child health matters taught in schools. Article 15/11 of the Saudi Commission for Health Specialties guidelines includes health education within school health as a subspecialty, so we are in need to explore and analyze the role of health educators in schools. The aim of this study was to analyze the role of health educators in public schools of Saudi Arabia, to achieve the aim of the study; the information was gathered pertaining to the following research questions:
- What is the role of health educators in implementing health education activities in public schools?
- What are the obstacles that affect health educators' roles in implementing health education programs in public schools?
- Is the attitude of health educators' in regard to their role, positive or negative?
| Subjects and Methods|| |
A cross-section design was used to answer the research questions.
Participants and sample size
According to the Ministry of Education Census 2017, there are 2522 public schools in Riyadh City (1371 schools for girls and 1151 schools for boys). According to the MOH, each school should have one or two health-care counselors who responsible for health education in school.
After the calculation of the sample size, the total number of participants should be 334, but 234 participants actually took part in the study.
Multistage sampling was used in order to select participants which conducted through two stages; the first stage, Riyadh City was divided into five regions (East, West, Middle, North, and South); the second stage, a simple random sample was used in order to select the schools that participated in the study, one health educator from each selected school was participated in the study.
School health educators of both genders, with different school levels (elementary, middle, and secondary school), who were willing to participate in the study.
Setting and filed work
The study was conducted in April 2017. An official letter sent to managers of the selected schools in order to give the permission to health educators to attend the workshop held in the East Riyadh Specialized Dental Center in Riyadh city, under the supervision of the health education department of the center. The participants were divided into groups in order to facilitate the data collection process; written consent was obtained from participants after explanation of the study's aim.
- For data collection, self-administered questionnaires developed by the authors were used, which composed of four parts:
- First part – Concerned with sociodemographic data of the health educator such as age, gender, qualification, and school level
- Second part – Concerned with health educators' role in implementing health education activities in public schools of Saudi Arabia (Cronbach's alpha for the 18 items = 0.94)
- Third part – Concerned with obstacles that affect school health educators' role in implementing health education programs in public schools
- Fourth part – Concerned with health educators' attitude regarding their role (Cronbach's alpha for the 15 items = 0.77).
- Tools for data collection were developed by the researchers and revised by five experts in health education
- A pilot study was carried out on 10% of school health educators to test the validity and reliability of the tool. Health educators who participated in the pilot study were excluded from the study sample.
The data were analyzed by using the Statistical Package for Social Sciences (SPSS) Version 20. For descriptive statistical analysis, frequencies and percentages were used for all variables. Weighted arithmetic means, arithmetic averages and standard deviations are also used. For inferential analysis, The Chi-Square test was used to examine the association between variables. The statistical test of significance, or P-value, in this study was set at <0.05. The internal consistency of the tool was measured by calculating the Cronbach's alpha.
- A consent form was obtained from the participants before starting the interview. Confidentiality and anonymity were maintained to protect the identity and position of the participants.
| Results|| |
The sample size was calculated at the margin of error of 5%, a confidence level of 95%, a sample size calculation was conducted showing that 334 health educators needed to participate in the study (the response rate was 70%). [Table 1] provides a demographic overview of the respondents. The mean age of participants was 40.31 ± 6.5 years and about 47.9% of the health educators were aged 40–49 years. Regarding gender, about 48.7% of participants were men while 51.3% were women. In terms of educational qualifications, most participants (85.5%) have a bachelor degree and only 5.1% have a master degree. Turning to the school level, 53.8% worked in the elementary school, 25.6% worked in the middle school, and 20.5% worked in the secondary school. [Table 2] showed the role of health educators and association between variables and the role of health educators in implementing health education activities. The table reflected that there was no statistically significant difference between males and females regarding their role in implementing health education activities, except in encouraging school environmental sanitation and follow-up of the health status of students who have different health problems. The table clarified that there was a statistically significant difference between elementary, middle, and secondary regarding their role in implementing health education activities in some roles as mentioned in the table.
|Table 1: Sociodemographic characteristics of school health educators participated in the study (n=234)|
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|Table 2: School health educator's role in implementing health education activities in public schools (n=234) of Riyadh, Saudi Arabia|
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[Table 3] concerned with obstacles that affect school health educators in implementing health education activities in public schools, it showed that 65% of health educators had not a clear plan for health education activities in the school without statistically significant difference between elementary, middle, and secondary school. About 70.1% of health educators complain from lack of necessary preparation needed to work in the health education field, and about 70.9% of them, their workload was increased because of health education activities and about 70.1% complained of time limitation. There was a statistically significant difference between elementary, middle, and secondary schools in cooperation of administrators and teachers in participating in health education activities. Lack of motivation was considered an obstacle to (73.5%) health educators, and there was a statistically significant difference between elementary, middle, and secondary school. Most health educators (98.3%) need training programs on health education skills, and there was a statistically significant difference between elementary, middle, and secondary. In relation to assessing health educators' performance as a health educator (67.5%) their role was not evaluated. [Table 4] illustrated the attitude of school health educators regarding their role in implementing health education activities in public schools. The table showed that the average mean score of 2.58 ± 0.28 is above the cutoff point of 2.33, indicating a positive attitude. There was no statistically significant difference between males and females regarding their attitudes.
|Table 3: Obstacles that affect school health educator's role in implementing health education programs in public schools of Riyadh, Saudi Arabia (n=234)|
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|Table 4: Attitude of school health educators regarding implementation of health education activities in public schools of Riyadh, Saudi Arabia (n=234)|
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| Discussion|| |
Health education is considered the main part of primary prevention of disease; this study focused on analyzing the role of health educators in public schools, exploring the obstacles which affect them and determining the attitude of health educators regarding their role.
Many researches demonstrated that appropriate follow-up help in early detection of diseases and can make significant differences to outcomes of diseases, the results of this study revealed that less than half of health educators following up health status of students who have different health problems. Center for disease control and prevention reported that children with unhealthy behaviors or chronic health conditions may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions, so it is very important to health educators in public schools of Saudi Arabia to conduct particular health education sessions for students with health problems and who have risk factors for diseases in order to reduce complication and harmful consequences for these health problems. The results of this study showed a statistically significant difference between males and females; females being more concerned with this role and this finding could be attributed to their domestic role in society.
Nutritional status of schoolchildren is considered an important indicator for many diseases, according to CDC schools are an ideal setting to teach and provide students with information needed to improve their dietary behaviors and manage their chronic health conditions; however, the results of this study showed that less than one-third only of health educators following up the nutritional status of students, as reported by Kwabla et al. childhood malnutrition remains a major public health problem which has a negative effect on the academic competency of school-aged children, especially in limited-resource countries. There was a statistically significant difference between elementary, middle, and secondary schools regarding previous activities; health educators in elementary school showed high percentage in performing these roles, these findings could be attributed to students in this stage of life need more attention. It is important that the SHGD should work on ensuring that every elementary, middle, and high school establishes and maintains comprehensive and well-coordinated school health programs. It is important to mention that more than two-thirds of health educators in the present study encourage school environmental sanitation and encourage students to follow healthy behavior in activities of daily living, these result supported by Berry who stated that cleanliness of schools is an important aspect of school environments because of it lowers the spread of illness, and also convey a caring message to the students and teachers. School environmental sanitation is important because children are at high risk for health hazards such as respiratory infections and diarrheal diseases.
Regarding obstacles that affect school health educators in implementing health education activities in public schools, the study showed that about two-thirds of health educators had no clear plan for health education program in their schools, while it is important to SHGD and school councils to set health education policies and plans to ensure that the objectives of school health program are met and right health messages delivered well to students, parents, and teachers.
Another important finding of this study was more than two-thirds of health educators complained from lack of necessary preparation needed to work in the health education field and the majority of them need training program on health education skills, and most of them had a bachelor degree in different educational specialties, not in the health field, while USA Bureau of Labor Statistics, stated that health educators need at least bachelor's degree and require the Certified Health Education Specialist and complete an on-job training program to work in health education field. These findings coincided with several studies,, which had shown that teachers in Saudi schools were sometimes not well equipped or trained in dealing with a range of health issues affecting students, and it is impossible to be a good health educator without clinical background and deep experience in health issues, furthermore it is reported by Auvergne and Minho that teachers who had experienced health promotion training tend to be involved more frequently in health promotion practice and had a comprehensive approach to health education. Furthermore, as mentioned by Vamos teacher preparation for health education had certain competencies, standards, and expectations outlined by various professional bodies, which serve as a basis for professional practice by using these guidelines as a framework, teacher training programs could effectively train prospective teachers. Hence, it is necessary for health educators in public schools of Saudi Arabia to receive training programs in health education to ensure sustainable development in health education and promotion; this needs more studies to explore the various dimensions of that training.
Although this is the beginning of an era where many health educators need to spend more time dealing with students' health problems and try to manage it, the results of this study showed that more than two-thirds of health educators their workload had increased and complained of time limitation. The data published by the National Union of Teachers mentioned that the main sources of the current high levels of teacher stress include excessive workload and working hours.
The study showed that lack of motivation was considered an obstacle to more than two-thirds of health educators with a statistically significant difference between elementary, middle, and secondary school. This result congruent with Gervase et al. who found that lack of motivation/reward was deemed as the dominant obstacles in meeting teaching and learning goals. Hence, health educators need to be motivated, to perform their health education activities in a proper way; through give them incentives and reward to attract their attention consequently improve performance.
Despite assessment of health educators' role can be mentioned as essential for the success of the quality of health education process, the study revealed that more than two-thirds of health educators' role as a health educator was not assessed, there is no doubt that all health educators should be equipped with strong and professional health education competencies, in order to offer health messages to students in the proper way, so their performance as health educators should be evaluated to be sure that they have these competencies.
It deserved to be noted that most of the health educators in the present study found cooperation from administrators and teachers in schools and also they found positive interaction from students and families; these supportive environments are important for any health work or program conducting in the school, these findings were going in the same line with Al Makadmaa and Ramisetty-Miklerb who mentioned that schools and parents should be encouraged to work as a team and to recognize the importance of school connectedness in improving positive student behavior and outcomes, while the results of this study inconsistent with Alghamdi and Riddick who found that some teachers did not cooperate with counselors, because they did not understand their role. Furthermore, for the same reason, some parents did not help them to achieve their tasks.
The attitude of health educators is important to accomplish the goal of health education programs, the results of this study showed that health educators had a positive attitude regarding their role without statistically significant difference between male and female, and this contradicts with the finding of who indicated that the attitude of male health educators was positive, while the attitude of the females was negative; also other studies done by Debdas and Santosh and Banerjee and Behera, reported that the attitude of female teachers is more favorable than males toward teaching profession.
| Conclusion|| |
It hoped that this study will make a contribution to explore the role of health educators in implementing health education activities in public schools of Saudi Arabia and identifying the problems which affect their role. The study clarified that there was a statistically significant difference between elementary, middle, and secondary schools in performing most of health education activities; therefore, SHGD should ensure that all levels of schools follow health educator guide developed by MOH in implementing health education activities in schools. The study focused on exploring the obstacles that meet health educators in performing their roles, and it revealed that health educators facing many obstacles to implement health education activities in their schools, these obstacles may negatively impact student healthcare counseling in Saudi public schools. It should be noted that attitude of health educators was positive indicating that they like their role as health educators; therefore, they need more training programs to be well prepared in order to perform this role effectively.
We would like to express our special thanks of gratitude to the Deanship of Scientific Research at Saudi Electronic University who motivate and support research environment for faculty and researchers. Also, we would like to thank Mrs. Hanan Alghutaimel, the head of health education department in East Riyadh Specialized Dental Center in Riyadh city, Saudi Arabia who helped us in collecting the data of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]