The Integrated School Health Policy of South Africa (Departement van Basiese Onderwys en Departement van Gesondheid 2012:6) emphasises that health literacy is to be promoted in secondary schools in accordance with bespoke health policies and programmes designed for each individual school. The school environment provides teachers with an ideal platform for transmitting their knowledge and skills to learners. The school environment happens to be where most of secondary school learners’ activities take place. In addition, learners find themselves in a critical cognitive, physical and emotional developmental phase. This period and environment decidedly offer ideal opportunities to stimulate critical thinking and to focus learners’ attention on cultivating sound health literacy practices.
Health literacy is a complex concept determined by various factors in diverse contexts. It encompasses health-related knowledge, interpretation and participation. Rather than merely involving the ability to read medical prescriptions, health literacy provides a firm grounding for the handling of continuous health challenges in a (post)modern society. Although health literacy represents a critical element in secondary school learners’ development, it would appear that little research on this subject has, as yet, been done in developing countries ‒ among which South Africa. Secondary school learners in the South African context are confronted with a variety of challenges, for example poverty and the concomitant malnutrition, the stigmatisation of ethnic minorities, illiteracy, parents without full citizenship, uninvolved parents and limitations in respect of tertiary education. The latter factors affect learners’ critical-thinking, problem-solving and communication abilities, which may lead to ill-considered decisions. These decisions may, in turn, give rise to poor health outcomes and have a negative effect on future health development.
In this study, we utilised Engel’s (1977) biopsychosocial model and Bronfenbrenner’s (1979) ecological theory to investigate the holistic perspective on health and the interaction of systems in the promotion of secondary school learners’ health literacy. A holistic perspective acknowledges the combination of biological, psychological and social components that are essential for optimal well-being. Health and well-being are influenced by various social, psychological and environmental systems. The school and the teacher are considered as essential role players that are interactively involved in learners’ development of health literacy.
Given the stated aim, our study was guided by the following primary research question: What are the roles and the experiences of teachers in respect of the development of health literacy in secondary schools? In order to answer the above question, we embarked on a phenomenological study within the framework of qualitative research. Data were collected by means of semistructured individual and focus group interviews with Life Orientation teachers. Data analysis of the semistructured individual interviews enabled us to formulate questions for the focus group interviews, the aim of which was to ask open-ended questions to allow participants to share their experiences with us. By applying a specific criterion, the participants were purposively chosen from seven secondary schools in the Dr Kenneth Kaunda teaching district in the North West Province. Ethical clearance to conduct the research was obtained from North-West University. Verbal and written informed permission were obtained from the district manager of the Dr Kenneth Kaunda teaching district to conduct interviews at the schools in the district.
Thematic data analysis was utilised to analyse and code the information into meaningful units. In order to guarantee the integrity of the study, we employed the Lincoln and Guba (1985) model. Four main themes were identified during the data analysis process: physical development; emotional and spiritual development; cognitive and social development; and challenges experienced by teachers. The various themes were not viewed in isolation but the interaction between the various domains was continuously taken into account. During the analysis of theme 1 (the physical aspect of health literacy), the following subthemes emerged: healthy lifestyle, hygiene, substance abuse and teenage pregnancy. The participating teachers indicated that teachers have an important role to play in the development of secondary school learners’ health literacy in that they can enable the learner to manage the physical domain by means of making responsible choices and following a healthy lifestyle. The physical domain cannot, however, be effectively managed in the absence of emotional, social and spiritual health literacy. During the data analysis of theme 2 (emotional and spiritual health literacy), the role of the teacher in the spiritual support and in the awareness, identification and interpretation of emotions emerged. Participant teachers indicated that teachers and schools are in a position to make a valuable contribution to the development of health literacy if the various role players cooperate. During the data analysis of theme 3, various challenges in the development of health literacy surfaced. It was established that insufficient training, uninvolved and uninformed parents, and a lack of resources and financial support can have a negative impact on the development of secondary school learners’ health literacy. It can be argued that although schools do offer ideal opportunities for the promotion of health literacy, other role players must support the roles and responsibilities of teachers. It would appear that a team effort is fundamental in the promotion of health literacy.
Our findings revealed that although health literacy cannot guarantee health, Life Orientation teachers are especially well positioned to equip learners with the requisite knowledge and skills. It would appear that schools and teachers are influential role models who are able to promote sustainable behavioural change. The ideal would be that secondary school learners are enabled to apply health information, to make informed choices and, as responsible citizens, make a positive contribution to the community.
Keywords: health literacy; holistic; secondary school learners; school; teachers