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Där eleverna är: Ett arenaperspektiv på skolan som en stödjande miljö för hälsa
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.ORCID iD: 0000-0003-2239-5683
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Hälsa skapas inte i ett vakuum utan i relation mellan individer och omgivning. Skolan är därför en viktig arena för barn och ungdomar eftersom de tillbringar större delen av sin vakna tid där. Tidigare forskning har framförallt riktats mot riskfaktorer relaterade till barn och ungas psykiska ohälsa, mindre mot vad som främjar och stärker möjligheterna till deras positiva hälsa. Genom ett salutogent perspektiv kan kunskap erhållas om faktorer som bidrar till en stödjande miljö för hälsa. För att få förståelse för nya generationers behov och värderingar behöver elever göras delaktiga i studier och utveckling av sin egen vardagsmiljö.

Avhandlingens syfte var att studera skolan som en stödjande miljö för hälsa genom att involvera elever och att finna metoder för att studera de positiva aspekterna av hälsa. Artiklarnas syften inkluderade utmaningar och möjligheter att använda en metod för ökad delaktighet, fördjupa förståelsen om aspekter som främjar hälsa och lärande, med särskilt fokus på delaktighet och stöd samt hur positiv hälsa kan mätas.

Elever på en gymnasieskola valdes som deltagare i två kvalitativa studier. Metoden photovoice studerades genom ljudinspelning av elevernas dialog under arbetet med photovoice och deras och lärarnas synpunkter under fokusgruppsintervjuerna. Data analyserades med innehållsanalys (I). Grundad teori användes för att studera elevernas syn på vad som var viktigt för hälsa och lärande (II). En enkät användes för att ta fram en positiv hälsoskala och för att studera faktorer associerade till hälsa bland elever årskurs 6-9. Enkäten besvarades av 1527 elever (52,3% flickor, 47,7% pojkar) i årskurs 6-9 i skolorna i Östersunds kommun. Svarsfrekvensen var 80%. En principalkomponentanalys användes anpassa och validera en positiv hälsoskala till åldersgruppen 12-16 år (III). För att studera associationen mellan faktorer som kunde vara associerade till positiv hälsa valdes multipel logistisk regressionsanalys (IV).

Resultatet visade att photovoice fungerade som en metod i gymnasieskolan för ökad delaktighet i frågor relaterade till hälsa och lärande. Metoden behövde dock anpassas till elevgruppen. Photovoice upplevdes som stimulerande men också utmanade av både lärare och elever. Kritiska aspekter för metodens användbarhet var knutna till lärarrollen och den demokratiska organisationen (I). Elevernas syn på vad som främjade hälsa och lärande var relaterat till bemötande, personligt och pedagogiskt stöd samt möjligheter till återhämtning. Resultatet visade också att eleverna upplevde att skolan bidrog till att skapa skillnad mellan dem som upplevde sig vara låg- respektive högpresterande (II). Den positiva hälsoskalan (PHS) visade sig vara valid för elever 12-16 år och skalan bör kunna användas i ett sytematiskt hälsofrämjande arbetet där utgångspunkten är ett salutogent perspektiv (III). Faktorer associerade till positiv hälsa bland flickor och pojkar, 12-16 år, var: upplevd delaktighet i klassrummet, stöd från lärare och kamrater samt stöd från båda föräldrarna. Socioekonomisk status, mätt som att ha pengar som kompisar, visade sig vara oberoende associerat till positiv hälsa (IV).

Slutsatsen var att betydelsefulla faktorer för en stödjande miljö för hälsa i skolan är; elevers upplevelse av och möjlighet till delaktighet i klassrummet och i skolans arbetsmiljö, personligt stöd från lärare såväl som stöd i undervisningen, stöd från kamrater och förutsättningar för återhämtning under och efter skoldagen. Samtidigt visade resultatet att det finns skillnader mellan olika grupper av elever relaterat till hälsa och stöd.

För att utveckla en stödjande miljö för hälsa i skolan kan photovoice användas för att involvera eleverna och upptäcka unika aspekter på den enskilda skolan. Med hjälp av den positiva hälsoskalan (PHS) kan främjande faktorer kartläggas, vilket ökar möjligheterna till ett systematiskt hälsofrämjande arbete med ett salutogent perspektiv.

Abstract [en]

Health is not created in a vacuum but in the relationship between individuals and their surroundings. School is therefore an important arena for children and youth since they spend the majority of their waking hours there. Earlier research has been particularly focused on risk factors related to mental illness in children and youth, rather than what promotes and strengthens their possibilities for positive health. Through a salutogenic approach, one can obtain knowledge about factors that contribute to a supportive environment for health. In order to gain understanding of the needs and values of new generations, students need to be made a part of their studies and the development of their own everyday environment.

The aim of the dissertation was to study school as a supportive environment for health by involving students and finding methods of studying the positive aspects of health. The aim of the articles included challenges and possibilities for using a method to increase participation, deepen the understanding about aspects that promote health and learning, with a special focus on participation and support and how positive health can be measured.

Students in a high school were chosen to be the participants in two qualitative studies. The method of photovoice was studied through sound recordings of the students’ dialogue during their work with photovoice and their points of view as well as the teachers’ during the focus group interviews. Data was analyzed by using content analysis (Paper I). Grounded theory was used to study the students’ view of what is important to health and learning (Paper II). A survey was used to create a positive health scale and to study factors associated with health among students in grades 6-9. The survey was taken by 1527 students (52,3% girls, 47,7% boys) in grades 6-9 in schools in the municipality of Östersund. The response rate was 80%. A principal component analysis was used to adjust and validate a positive health scale for the age group 12-16 (Paper III). In order to study the association between factors that might be associated with positive health, a multiple logistic regression was chosen (Paper IV).

The results showed that photovoice worked as a method in high school to increase participation in matters related to health and learning. However the method needed to be adjusted to the student group. Photovoice was perceived as stimulating but also challenging by both teachers and students. Critical aspects were tied to the teacher role and the democratic organization (Paper I). The students’ view of what promoted health and learning were related to treatment, personal and pedagogical support and the potential for recovery. The results also showed that students regarded school as something that creates distinction between those who perceived themselves as under or over achievers (Paper II). The positive health scale (PHS) proved to be valid for students 12-16 years old and the scale should be useful for work with systematic health promotion where the starting point is a salutogenic perspective (Paper III). Factors associated with positive health among girls and boys age 12-16 were: a perceived participation in the classroom, support from teachers and friends and support from both parents. Socioeconomic status, measured as having as much money as pupils, was shown to be independently associated with positive health (Paper IV).

The conclusion was that important factors for a supportive environment for health were; students’ perception of and possibility to participate in the classroom and in the school’s work environment, personal support from teachers and support in their education, support from friends and conditions that permit recovery during and after school. At the same time the results showed that there are distinctions between different groups of students in relation to health and support.

In order to develop a supportive environment for health in schools, photovoice can be used to engage students and discover unique aspects of the individual school. With the help of the positive health scale (PHS), promoting factors can be examined, which increases the possibilities for systematic health promoting work with a salutogenic perspective.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet , 2013. , 98 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 174
Keyword [en]
adolescents, empowerment, health promotion, participation, positive health, salutogenic, settingsapproach, pupils, support, supportiv environment, students, teenagers, recuperation, youth
Keyword [sv]
arenabaserat, barn, delaktighet, elever, empowerment, hälsofrämjande, positiv hälsa, salutogenes, stödjande miljö, tonåringar, ungdomar, återhämtning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-20149ISBN: 978-91-87557-20-0 (print)OAI: oai:DiVA.org:miun-20149DiVA: diva2:662148
Public defence
2013-11-29, F229, Mittuniversitetet, Östersund, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2013-11-06 Created: 2013-11-06 Last updated: 2014-02-03Bibliographically approved
List of papers
1. Photovoice: An opportunity and challenge for students' genuine participation
Open this publication in new window or tab >>Photovoice: An opportunity and challenge for students' genuine participation
2013 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 28, no 3, 299-310 p.Article in journal (Refereed) Published
Abstract [en]

It has been highlighted that youth empowerment and participationare important principles for school health promotion.Despite this fact, children and youth are rarelygiven instruments to participate or to influence their situationsand the environments in their schools. Photovoice isa method to increased empowerment and participation.Originally it was created as a community action researchmethod based on Freire’s critical pedagogy and feministtheory. The purpose of this study was to explore challengesand opportunities for applying photovoice in aschool setting to support genuine participation. Togetherwith teachers and students in an upper secondary schoolin O ¨ stersund’s municipality in the north of Sweden, thephotovoice method was field tested and modified to aclassroom situation. The teachers and the students wereinterviewed about their experiences with the method. Theresults were interpreted by content analysis and showedthat the teachers’ capability to be facilitators and the students’possibility to make a difference for the school orthe municipality were the most important factors tosucceed with photovoice. The conclusions were thatphotovoice challenges schools and society to have a betterstructure for genuine participation if youth participation isseen as valuable.

Keyword
health-promoting school; action research; participation; empowerment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-18143 (URN)10.1093/heapro/das011 (DOI)000322975000003 ()2-s2.0-84882410330 (Scopus ID)
Available from: 2013-01-14 Created: 2013-01-08 Last updated: 2017-12-06Bibliographically approved
2. Promoting an Equal and Healthy Environment: Swedish Students' View of the Daily Life at School
Open this publication in new window or tab >>Promoting an Equal and Healthy Environment: Swedish Students' View of the Daily Life at School
2013 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, no 10, 1354-1368 p.Article in journal (Refereed) Published
Abstract [en]

Education is an important factor in health equity, but many students still do not complete high school. A focus on the school context rather than on individual problems might help to create a supportive environment for health and learning. In this study we explored factors that promote health and learning from the perspective of vocational and low-achieving high school students in Sweden. We used grounded theory with a constructivist orientation, informed and sensitized by the concept of salutogenesis. Students from a school in a mid-sized municipality in Sweden participated, and we collected data using the photovoice method and interviews. Students identified general factors as significant to their well-being and success in school. The main theme, "promoting driving forces for health and learning," emerged from the categories "longing to be seen by teachers," "longing for support," and "longing for recuperation."

Keyword
Europe, Western, adolescents / youth, grounded theory, health promotion, photography / photovoice
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-19754 (URN)10.1177/1049732313505914 (DOI)000325153100006 ()24062421 (PubMedID)2-s2.0-84885169969 (Scopus ID)
Available from: 2013-08-21 Created: 2013-08-21 Last updated: 2017-12-06Bibliographically approved
3. Adaptation and validation of a positive health scale for adolescents
Open this publication in new window or tab >>Adaptation and validation of a positive health scale for adolescents
2014 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 119, no 2, 1079-1093 p.Article in journal (Refereed) Published
Abstract [en]

There is a demonstrated need to develop alternative approaches to measuring health from a positive health perspective in order to support systematic planning and evaluation of health promotion in schools. The Salutogenic Health Indicator Scale (SHIS) aims to measure health from a positive perspective, However, it has not been developed, or previously been tested, for use with adolescents between the ages of 12 and 16, at which age youth often exhibit a need for extra support in order to be successful in school and life. Inspired by the SHIS, we generated a Positive Health Scale (PHS) appropriate for 12-16-year-olds and determined its validity and reliability using principal component analysis (PCA). In the study, the scale was tested in a sample of 1,527 Grade 6-9 students, using PCA. The findings indicated the need to reduce the scale to nine items, which was then shown to be valid and reliable for use with both adolescent boys and adolescent girls. We conclude that the PHS can be used in systematic health promotion planning and evaluation. Communities and schools can use this scale to examine and improve health determinants in different adolescent settings.

Keyword
adolescents; health promotion; measuring; positive health; principal component analysis (PCA)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-20148 (URN)10.1007/s11205-013-0516-3 (DOI)000343223100031 ()2-s2.0-84887598906 (Scopus ID)
Note

Published online 20 Nov 2013.

Erratum published online 30 Nov 2013.

Erratum published DOI 10.1107/s11205-013-0517-2

Available from: 2013-11-06 Created: 2013-11-06 Last updated: 2017-12-06Bibliographically approved
4. The role of participation, teachers and peers in grades 6–9: A cross-sectional questionnaire study of factors associated with pupils’ positive health in Swedish schools
Open this publication in new window or tab >>The role of participation, teachers and peers in grades 6–9: A cross-sectional questionnaire study of factors associated with pupils’ positive health in Swedish schools
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The influence of the school environment on pupils’ health has more often been described in terms of health problems than health. From a perspective of health promotion and salutogenesis, schools have opportunities to create supportive environments for health. From this point of departure there is a need for more knowledge about positive health determinants in the school setting. The aim of this study was to analyze adolescents’ self-reported positive health and its association with supportive factors in the school environment. Data were derived from a cross-sectional study in which pupils aged 12–16 completed a questionnaire during school hours (n= 1527). The response rate was 80%). A new positive health scale was used to examine the association with the following determinants: classroom participation, school-related support, peer support, parent support and socioeconomic status. Data were analyzed with chi-squared tests and multiple logistic regression. The results showed that positive health, participation and support from teachers and parents were more common among boys than girls. All determinants except support with homework from the school were significantly associated with pupils’ positive health. The conclusion is that schools have a great potential to enable pupils’ health. The association between support from teachers and peers and participation is a major concern for pupils’ health and it is essential develop these aspects in the school environment.

Keyword
adolescents; logistic regression; PHS; positive health; self-reported
National Category
Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-20129 (URN)
Available from: 2013-11-05 Created: 2013-11-05 Last updated: 2013-11-06Bibliographically approved

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