Health Promotion in One New Zealand Primary School: a Case Study

Abstract

This research investigated the way in which one low decile New Zealand primary school in the greater Wellington region practised health promotion, as defined by the World Health Organisation when specifying a health-promoting School. The focus was to discern how one purposefully selected school with many potential social, economic and cultural risk factors undertook the challenge of improving student health. The lens used was that of an experienced community nurse / nurse educator who had previous school nursing experience. Objectives were: to explore the concept of the ‘health-promoting school’ in a specific New Zealand context; to develop and use appropriate research methods to assess a single low decile school in relation to World Health Organization health-promoting school components and checkpoints; to work with the school community to identify health issues; and, to record external and internal changes that could impact on school health over a finite time period. Case study, guided by Hartrick, Lindsey and Hills Health Promotion Nursing framework was selected as the most appropriate method to collect both quantitative and qualitative evidence with the aim of providing a clear understanding of the particular case. Previous research validated an intrinsic case study approach for an inquiry that involved both the process of learning about a specific case and the product of that learning. Triangulated evidence from multiple sources accumulated from multiple data collection methods was used to answer the checkpoints of components within the health-promoting school framework developed by the Western Pacific Region of the World Health Organization in 1996. Results confirmed that the school was working appropriately within the scope of their educational practice to provide a health-promoting school environment for the school community. Gaps and issues identified included an element of talking past each other between the cultures of the education organisation and the nominated health service provider respectively that contributed to a lack of appropriate and accessible health service delivery for the school population. Teaching staff considered that they had insufficient access to health knowledge, and input from health service staff did not meet health education requirements for the school. Staff preference for increased school nurse involvement was not realised. The consequence was that two outside agencies (KiwiCan and Life Education Trust) delivered the bulk of the Health and Physical Education curriculum which resulted in a degree of fragmentation of health education for students. The issues that were identified demonstrated that health services in the area were not satisfactorily meeting the needs of the community and were not addressing the health inequities for the predominantly Pacific Island and Maori students and of their families that formed the school community. The conclusion reached was that a full-service school approach should be considered by the school and the local District Health Board as one way to overcome the current lack of access to health services for the school community.Assertions included the potential integration of locally available services by a school-based nurse coordinator supported by health professionals (Nurse Practitioner and Pacific Island Community Health Worker) and social workers. The vision included professionals working within their professional scopes of practice as part of a Primary Health Organisation with the aim of appropriately addressing the health inequities experienced by the school population.