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Title: Streamlining changes : the grounded theory of schools implementing health-promoting schools
Authors: Hung, Tsz Man Tommy
Degree: Ph.D.
Issue Date: 2018
Abstract: Background Schools were regarded as a strategic setting in health promotion and health education for children since the 1980s. The World Health Organisation (WHO) Health-Promoting School (HPS) framework was widely adopted by primary and secondary schools globally since the 1990s. The framework has been promoted by some Hong Kong healthcare experts and universities in local public primary and secondary schools since the early 2000s, but evidence of its effectiveness is inconclusive. This situation leads to the call of international HPS scholars for more qualitative research in order to better realize the process of implementation, and to develop theoretical understanding of the HPS adapted in local contexts. Therefore, a grounded theory approach was adopted in the study in order to fill the knowledge gap. Aims of Study The study aimed to generate a grounded theory from schools implementing and sustaining to be a HPS, or the status of a health-promoting institution. Research Question The main research question of the study was: What is the process whereby schools become and sustain as health-promoting institutions? Methodology The class grounded theory (CGT) was adopted in this study. A total of 22 interviews (10 individuals and 12 focused groups) were conducted. The participants were recruited by theoretical sampling. Verbatim transcripts of the interviews and memos were the main source of data for constant comparative analysis, with the supplementation of field notes from observations, school documents, and existing literatures relevant to the conceptualisation process. Findings of the Study There were 42 participating individuals interviewed from 15 schools of the public sector in Hong Kong for this study. Overall, there were 8 principals, 5 vice-principals, 13 teachers, 9 school nurses (Registered Nurses), 1 social worker, 1 non-teaching staff (clerk), 3 parents (representatives of the Parent-Teacher Association), and 2 primary school students (student health ambassadors) participated in the interviews. Both normal and special HPS and non-HPS schools were included in the study. The study resulted in the Theory of Streamlining Changes (TSC) which outlined the main concerns of HPS schools in becoming a health-promoting institution, and non-HPS in conducting school health education and health promotion. The TSC explains beyond the process of schools implementing HPS, but organisational changes in general. Streamlining Changes emerged as the core category of schools in coping with the tensional triad. It is the path of the least resistance in accommodating organisational changes to achieve multiple goals of schools and schooling, including the education goals of students, the management goals of schools, and the legal duty of care such as students' health and safety. There were four subcategories (coping strategies) of the TSC: Triangulating/triangulating tensions, Strategising/strategic planning, Empowering/empowering leadership, and Cultivating/cultivating ethos. These subcategories (and their properties) were the coping strategies that schools adopted to address the tensional issues at different decisions levels which were, however, interconnected. The subcategories were hypothesised to be capable to lessen (or to balance) the tensional triad because they helped to decentralise authority, absorb accountability, and promote autonomy which in turns directed school development and streamlined changes. In essence, the TSC consisted of a stage-less three-dimensional model which demonstrated a holistic and integrated view of the coping strategies. The theory described and explained how schools intervening for smoother organisational change at different entry points in order to lessen the resistance of change as much as possible. Ideally, schools would adopt all strategies simultaneously, which is the whole-school approach of change. The schools may need to prioritise in reality based on not only the available time and resources, but also the existing tensional triad. It was hypothesised that when school performed evaluations based on the insights of tensional triad, the "best" or "next" strategy to be applied would be the one that addressing the predominant tensions among authority, autonomy, and accountability.
Discussions The understanding and application of TSC might allow school members to implement whole-school organisational changes more smoothly. Healthcare professionals might also be a catalyst in implementing and sustaining HPS, or health promotion and health education in the educational setting, which in turns fulfilling the goals of education. Further development and specialisation of school nursing as an advanced nursing practice in Hong Kong would require policy support. Intersectoral collaboration between education and health sectors would be important in promoting a healthy learning and growing environment for children. Limitations include the difficulties in finding non-HPS schools for theoretical comparison to enhance the most ideal theory construction. International primary and secondary schools were not successfully recruited in the study. Majority of the healthcare professionals worked in special schools and international schools only. These limitations may affect the scope of applicability of the TSC. Further research can be performed to develop the current TSC. Conclusions The TSC emerged as a middle-range grounded theory explaining the streamlining process of schools in implementing organisational changes, which was overshadowed by the tensional triad. The process of schools in becoming and sustaining as a health-promoting institution depends on the latent and existing change process in the current education system. The TSC provides insights and may suggest directions for healthcare professionals to promote health-related knowledge and skills to children in the educational setting, and reinforcing intersectoral collaborations. The study shaded light on the future possibilities of policy development, professional practices, and research in nursing about school health.
Subjects: Hong Kong Polytechnic University -- Dissertations
Health education -- Evaluation
Health education -- China -- Hong Kong
Health promotion -- China -- Hong Kong
Pages: x, 489 pages : color illustrations
Appears in Collections:Thesis

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