08 SES 02, Critical Perspectives on Wellbeing and Health Education
This study stems from the premise that research developments in health education and promotion, especially the shift from pathogenic to salutogenic-oriented approaches, may provide tried-and-tested models and theories to guide the process in developing inclusive schools.
Underpinning current education policies is a social rights-based model that values diversity and aims for school and social wellbeing of all students, irrespective of their needs. This inclusive philosophy envisages a development process that seeks participation of all stakeholders to reform and restructure the school holistically. It calls for a system-wide approach that combats discriminatory attitudes, creates welcoming communities, and removes all forms of physical, social and cultural barriers that may lead to exclusion. Hence, inclusive education is no longer merely about the integration of disabled students into mainstream classrooms. It promises a ‘school and education for all’.
Meanwhile, advances in educational research and issues related to accountability have raised the need to ground any reform in theory and provide evidence of its success has become a priority. Indicators, such as the Index for Inclusion (Booth, 2011) and the Inputs-Processes-Outcomes Model (Loreman et al., 2014), have been developed to help in identifying, measuring, and evaluating the levels of school inclusion at micro, meso and macro levels. Yet, to date, literature is still scant in terms of specific models and theories that can guide the design, implementation and evaluation of interventions aimed at increasing levels of school inclusion.
This paper proposes some emerging theories and models orienting current health promotion research and practice as a potential guide for stakeholders intending to plan and implement interventions with the scope of addressing school needs. It is argued that these theories may be well-suited for two main reasons:
- Firstly, an ecological community-based approach has been acknowledged in both fields of research. The school is a community and for the creation of an inclusive environment, a shared vision and mission are a must. In this regard, there is ample literature on the influence of stakeholders’ beliefs, sentiments, attitudes, concerns and self-percepts of efficacy on the effective implementation of inclusive practices (Aiello et al., 2017; Armstrong, 2017; Bailey, 2004; Bunch & Valeo, 2004; Kuyini & Desai, 2007; De Boer, Pijl & Minnaert, 2011; Hecht et al., Sharma & Jacobs, 2016). Moreover, the frameworks providing indicators to measure the levels of school inclusion propose approaches that simultaneously target multiple levels of influence, address culture, policy and practice, and encourage the participation of all the stakeholders.
- Secondly, health professionals and educationalists alike have endorsed a bio-psycho-social model. Evidence of this is the adoption of the International Classification of Functioning, Disability and Health (WHO, 2001) to identify students with special educational needs. Within this framework, disability is understood as a condition on a continuum between ability and disability where the analysis of body functions is not enough to certify an individual as having a disability. Activity limitations and participatory restrictions are greatly influenced by the social and environmental context in which an individual thrives, and these may result in a subjective form of disability.
This leads to the hypothesis that since both health/ability and ill-health/dis-ability are affected by the same endogenous and exogenous determinants on all levels of influence, these can be considered as the two opposing poles of the same continuum. As a result, whether aiming for a healthy school environment or for more inclusive school policies and practices to address feelings or situations of disability and exclusion, the impact and outcomes should be beneficial for both aims at the same time, provided that an ecological approach that places the community at the centre is adopted.
Still in its exploratory phase, this research has been based on literature available regarding the historical and conceptual developments in both inclusive education and health promotion research to trace the key milestones and identify the various points of intersection between the two fields of study. Based on these results, Antonovsky’s salutogenic model of health (1979) was deemed suitable as the underpinning framework since it guides the reflection from a health/ability perspective and, therefore, encourages the search for theories and models that focus on the positive factors and assets on which to build interventions. Further literature searches were conducted to identify indicators and guidelines being used in schools to create inclusive environments. Whereas over 70 frameworks have been developed to provide indicators to measure the levels of efficacy and effectiveness of inclusive education (Loreman et al., 2014), guidelines for the planning, implementation and evaluation of interventions aimed at combatting all forms of exclusion are still scarce. The PRECEDE-PROCEED model (Greeen & Kreuter, 2005) is suggested as a possible “road map” (Gielen et al., 2008) as it directs initial attention to outcomes rather than inputs. In other words, it guides planners to work backwards to identify, in this case, the origins of sustainable and effective inclusive learning environments. With well over 1,000 published applications (Porter, 2015), this model has been used as a framework of reference for health education and promotion interventions for more than 40 years. It is considered ideal because it is based on the principles of community participation and empowerment, giving individuals the possibility to have their say with regards to the priorities for action. Secondly, within this model, inclusive values and practices are considered a means to improve the quality of life of the whole school community, rather than the end. Thirdly, it is a flexible model that envisages the choice of the most suitable theories. As Gielen et al. (2008) highlight, “its main purpose is to provide a structure for applying theories and concepts systematically for planning and evaluating health behaviour change programmes” (p. 408). Lastly but most importantly, adopting this model to encourage the development of inclusive environments can guide planners to analyse the physical, social, environmental and political impact on inclusive education from a salutogenic lens; i.e. identifying those enabling, predisposing and reinforcing factors on intrapersonal, interpersonal and community levels that will leverage the development of a favourable educational context for all learners.
Currently, a wide spectrum of theories are being examined to support systematic theory-driven programme planning. Attention is being drawn towards the Transtheoretical Stages of Change Model (TTM) (Prochaska & Di Clemente, 1984), Social Cognitive Theory (SCT) (Bandura, 1989), and the Diffusions of Innovations Theory (DIT) (Rogers, 2003). All three theories are rooted within an ecological perspective and have all become robust theories in the field of health promotion research. Each of them respectively provides explanations on intrapersonal, interpersonal and community levels, thus helping to fill the gap on what is successful, what can be improved and what needs to be changed. To date, very few studies have used the TTM in educational contexts (Armstrong, 2017), unless they targeted specific health behaviours. However, as Armstrong (2017) sustains, this theory provides promising prospects for future research “[d]ue to its emphasis upon the process of enabling sustainable behavioural change” (p. 5). In contrast, Bandura’s Social Cognitive Theory has gained wide acknowledgement in the field of education and appears to have strong promise as a guide to understanding behaviours. The DIT offers insight on the channels used to disseminate an innovation and increase the likelihood that the innovation is adopted and institutionalised. This study has, so far, led to the conclusion that there are various points of intersection between the two fields in terms of goals, principles, values and practices. This paper is aimed at creating debate on how health promotion research could contribute to the development of inclusive school environments through theory-driven interventions. It is hoped that through collective reflection and further research, ways are found to unravel and address the wicked problems (Armstrong, 2017) hampering the development of a sustainable and efficacious educational system that celebrates diversity and includes all students, irrespective of their needs.
Aiello, P., Sharma,U., Di Gennaro,D.C., Dimitrov,D., Pace,E.M., Zollo,I., & Sibilio,M. (2017). A study on Italian teachers’ sentiments, attitudes and concerns towards inclusive education. Formazione, Lavoro, Persona, 20, pp.10-24. Antonovsky, A. (1979). Health, stress and coping. San Francisco: Jossey-Bass. Armstrong, D. (2017). Wicked problems in special and inclusive education. Journal of Research in Special Educational Needs, pp.1-8. Bailey, J. (2004). The validation of a scale to measure school principals’ attitudes toward the inclusion of students with disabilities in regular schools. Australian Psychologist, 39(1), pp. 76–87. Bandura, A. (2001). Social Cognitive Theory: An agentic perspective. Annual Review of Psychology, 52, pp. 1-26. Booth, T. (2011). Index for inclusion - Developing learning and participation in schools. Bristol, UK: CSIE. Bunch, G., & Valeo,A. (2004). Student attitudes toward peers with disabilities in inclusive and special education schools. Disability & Society, 19(1), pp. 61-76. De Boer, A., Pijl,S.J., & Minnaert,A. (2011). Regular primary schoolteachers’ attitudes towards inclusive education: a review of the literature. International Journal of Inclusive Education, 15(3), pp. 331-353. Gielen, A.C., McDonald,E.M., Gary,T. & Bone,L.R. (2008). Using the Precede-Proceed planning model to apply health behavior theories. In K. Glanz, B.K. Rimer & K. Viswanath, Health Behavior and Health Education. Theory, Research and Practice (4th ed.) (pp. 407–434). San Francisco, CA: Jossey-Bass. Green, L.W. & Kreuter,M.W. (2005) Health promotion planning: An educational and ecological approach (4th ed.). New York: McGraw-Hill. Hecht, P., Aiello,P., Pace,E.M., & Sibilio,M. (2017). Attitudes and teacher efficacy among Italian and Austrian teachers: A comparative study. European Journal of Research on Education and Teaching, XV(1), pp. 269-282. Kuyini, A.B., & Desai,I. (2007). Principals’ and teachers’ attitudes and knowledge of inclusive education as predictors of effective teaching practices in Ghana. Journal of Research in Special Educational Needs, 7(2), pp. 104–113. Loreman, T., Forlin,C., & Sharma,U. (2014). Measuring indicators of inclusive education: A systematic review of the literature. Measuring Inclusive Education, pp.165-187. Porter, C.M. (2015). Revisiting Precede–Proceed: A leading model for ecological and ethical health promotion. Health Education Journal, pp.1-12. Prochaska, J.O., & Di Clemente,C.C. (1984). The Transtheoretical Approach: Crossing Traditional Boundaries of Change. Homewood, IL: Dorsey Press. Rogers, E.M. (2003). Diffusion of innovations (5th ed.). New York: Free Press. Sharma, U., & Jacobs,K. (2016). Predicting in-service educators' intentions to teach in inclusive classrooms in India and Australia. Teaching and Teacher Education, 55, pp. 13-23. WHO (2001). International Classification of Functioning and Health. Denmark: WHO.
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