Factors facilitating and constraining the delivery of effective teacher training to promote health and well-being in schools: a survey of current practice and systematic review

Background Schools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important. Objectives To conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training. Methods Methods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011. Results The overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses were Every Child Matters (100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision. Conclusions Among those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey. Study registration PROSPERO number CRD42012001977. Funding The National Institute for Health Research Public Health Research programme.