Health education training needs of educators at Makapanstad schools in the North West province

Curationis 33 (1): 33-41 Purpose: The purpose of this study was to explore and describe the health education needs o f educators at health promoting schools in Makapanstad in North West Province. Methodology: Qualitative, exploratory and descriptive paradigm was conducted. The population consisted of educators, at Makapanstad schools, who were directly in­ volved with learners. The participants were purposively selected. Focus group inter­ views were conducted to collect relevant data from the participants. Tesch data analysis process was used to reach the findings of the research. Findings: The following categories were identified and theoretically confirmed: The need for the support by the University for the training of educators; The need for the University’s acknowledgement of educators’ responsibilities; The need for basic knowledge of health promotion; Common health needs of learners; and indirect health problems. Recommendation: It was recommended that a health education package be devel­ oped to assist in empowering learners in Makapanstad schools. Introduction and background The South African School Health Policy and Implementation Guidelines states that school health services should form part of primary health care. This requires integra­ tion of health services for school-going children, both within the health sector, and the services and programmes of other sectors. The policy further states that school health services should be located within the broader Health Promoting Schools’ Initiative (South Africa, Department of Health, 2003:9). The World Health Organization (WHO) framework, on which the Health Promoting


Introduction and background
The South African School Health Policy and Implementation Guidelines states that school health services should form part of primary health care.This requires integra tion o f health services for school-going children, both within the health sector, and the services and programmes of other sectors.The policy further states that school health services should be located within the broader Health Promoting Schools' Initiative (South Africa, Department o f Health, 2003:9).The World Health Organization (WHO) framework, on which the Health Promoting Schools' (HPS) Initiative is based, out lines health education as one o f the key elements to achieving health-promoting school status.South African educators should incorporate health education into the school curriculum and become actively involved in activi ties that promote health in the school (South Africa, Department o f Health, 2003:11).However, in this policy, it is assumed that educators are both moti vated and adequately equipped to teach and promote health.The policy identifies the following health needs of school-aged children (South Africa, Department of Health, 2003:7-9)

Problem statement
Educators reported that they were not well equipped to teach and promote health.According to the educators, their only exposure to health education had been during their initial training and they had not received any subse quent in-service training (Needs as sessment report, 2004   partment of Health, 2003:6-9).

Objectives of the study
The objective o f the study was to ex plore and describe the health educa tion training needs o f educators at Makapanstad schools.(Boyle, 2003 :414).

Definition of concepts
Health status refers to the condition o f a population or individual's health, including estimates o f quality o f life, and physical and psychosocial func tioning (Boyle, 2003:414).
Nutritional status is defined as the condition o f a population or individual as affected by the intake and utilisa tion o f nutrients and non-nutrients (Boyle, 2003:414).

Research methodology
Qualitative methods and techniques were used to collect data from selected participants working at schools in Makapanstad.

Research design
An exploratory and descriptive quali tative research design was used.A de scriptive study was conducted to de scribe the health education needs of educators that will be needed to de sign health education programme serv ices for educators and University mem bers and to allocate resources efficiently (Katzenellenbogen, Joubert & Karim, 1997:66).In addition to this, De Vos et al. (2002:109) state that descriptive studies present a picture o f the spe cific details of a situation.

Research population and sampling
The population of this study consisted of all educators in Makapanstad.Sam pling criteria stipulated the inclusion o f educators who had been working in Makapanstad for a year or longer.The reason for selecting these educators was their experience in working with the learners of the selected community.
Participants were purposively selected because they possessed the relevant information required for this study.To ensure a heterogeneous sample, repre sentatives from each school, as well as from different post levels, were in cluded.

Data collection
Data were obtained from the selected Makapanstad educators by means of focus group interviews.Four focus groups were conducted during the re search project.These interviews were scheduled at times that suited the par ticipants in the study.A focus group interview allows participants to share their thoughts during discussions (Brink, 1999:159)

Ethical considerations
Permission to conduct the research was obtained from the district office o f the education department and concerned authorities.A full explanation o f the purpose o f the research was given to participants.Ethical principles were adhered to and participants assured that they would be protected from harm or injury.If participants wanted to with draw from the study, their right to do so was respected.Respect for human dignity includes the right to self-deter mination and the right to full participa tion.The participants were therefore given a copy o f the consent form (Polit & Hungler, 1997:134).

Data analysis
Data were qualitatively analysed em ploying qualitative coding methods.The Tesch approach, incorporating eight steps, was followed during data analysis.
First, the data were analysed in the lan guage in which the interviews were conducted.The researcher read all the transcripts carefully to obtain a sense o f the whole.Thoughts were written down as they occurred.The topics were abbreviated as codes, and the codes written on the appropriate side o f the transcript.The appropriate descriptive wording for topics was identified and turned into categories.A final decision was made on the abbreviation for each category, and the codes were alphabet ised.Data that belonged to each cat egory were assembled and the results compared (Creswell, 2003:192;De Vos et al., 2001:345).

Trustworthiness
Trustworthiness in qualitative research was applied with positive results.The researchers provided sufficient descriptive data to make transferabil ity judgements possible by potential appliers (Lincoln & Guba, 1985:316).

Discussion of the results and literature control
The sample o f the study comprised of 28 participants.Four individual inter views were also conducted with the principals and/or heads o f departments of the four schools.The 28 participants in the focus groups consisted o f 21 fe male and 7 male educators from the four schools.
The researcher and co-coder agreed on the categories, subcategories, and themes identified in the transcripts.The categories and subcategories are tabu lated (refer to Table 1).

Category 1: The need for support by the university for the training of educators
The subcategories that emerged from this category were formal training and parental intuition.These were sup ported by quotes from the participants.

Formal training
The participants expressed a lack of knowledge about health matters.This was expressed as follows: "

Parental intuition
The participants expressed the impor tance of their own parental intuition.This was expressed as follows: "As a parent I cannot say I d o n ' t have any knowledge ". "I am not trained in health issues but I have children at home, so I must be able to take care o f the learners as well".
Parental intuition is important because educators are advocates for their learn ers.They are not trained in health is sues, but assist learners when the need arises.Parental intuition can assist edu cators to shape their fears regarding what may happen to learners (Meyers, 2007).If educators believe that they have the power, they could be o f great help to learners in a school environ-

Sole responsibility of educators
The participants stated that: "I think we as teachers should make time within our busy schedule to talk to learners about heath issues "Iam not trained to do health education but as a parent I think I have that obliga tion to talk inform ally to students about health "We need to be trained to be better equipped to approach subjects o f life, health an d sexuality, and also be helped to assess i f we are successful ".

Joint responsibility of educators
The participants emphasised the fol lowing:  Schmidt, 2007:506).

Category 4 : Common health needs of learners
In the fourth category, the following subcategories were identified: teenage pregnancy, family planning and HIV/ Aids.

Teenage pregnancy
The aspect o f teenage pregnancy was raised as follows:  HO, 1994)."Very young, adolescent women who become pregnant fa ce serious health risks be cause their bodies may not be physi cally mature enough to handle the stress o f pregnancy " (WHO, 1994).
In addition to their effectiveness in pre venting pregnancy, some contracep tives also have substantial non-contraceptive health benefits.A lack o f knowledge about STDs, poor su p p o rt stru ctu re s and the stigmatisation o f people with STDs were highlighted as problems by the participants.The WHO estimates that every year more than 340 million new cases o f the common bacterial and pro tozoal STIs, such as syphilis, gonor rhoea, chlamydial genital infections and trichomoniasis, occur throughout the world in men and women aged between 15 and 49 years (WHO, 2006)."STIs present a major disease burden fo r South Africa as well as many other developing countries.Sexually trans mitted infections may be present with out symptoms or with symptoms that are mild and transient, but they may have long term consequences such as infertility' , ectopic pregnancy, chronic illness and premature death " (WHO, 2006).
The prevention, management and con trol of STIs is one o f the priority areas o f the national HIV/Aids/STD Strate gic Plan for 2000 to 2005 (South Afri can H ealth R eview 2002-2003, 2003:230).According to a national STI control programme, prevention of new STIs, including HIV, can be achieved by behaviour change campaigns, as well as one-on-one health education and counselling to promote healthy sexual lifestyles and risk reduction through delayed onset o f sexual activ ity, abstinence and correct condom use.Control o f STIs is however blocked by, amongst other factors, ignorance and lack o f information that perpetuate misco n cep tio n s and associated stigmatisation (WHO, 2006).Varga and Shongwe, 1999:13) identify the reasons behind the failure of school-based re productive health and life skills educa tion efforts in the KwaZulu-Natal re gion as division and unequal resource allocation, lack of system-level support for schools, and inadequate prepara tion and training o f educators.

Unique needs of special learners
The problems and health needs o f spe cial learners faced by participants at school were highlighted as follows: "The problem that I see as urgent is the bigger children who start to mas turbate, especially the boys"."They embarrass us when they start mastur bating in p u b lic ". "When the girls start to menstruate, it is a big problem because they cannot took after their hygiene ". "We provide them with sani tary pads but their mothers are too poor to even buy them proper pads ".
Special education needs arise from chil dren's disabilities or learning difficul ties.
A study co n ducted by Engelbrecht, Swart and Eloff (2003) and d iscu ssed by K ibel & W agstaff, 1995:210) identified "sustaining an active learning environment fo r the learners with intellectual disability" as one o f the most stressful issues for educators and concluded: "The school health team may need to be assisted by multidisciplinary academic hospi tals teams, psychological and educa tio n a l te a m s ".L ehr and N oonan (1989:141) stated: "Students with com plex health care needs are generally not ill, but require some health serv ices to participate in special educa tion ".
Category 5: Indirect health problems W ithin the fifth category, four subcategories were identified, namely: poverty, poor family structure, lack of resources and need for a health team.

Poverty
The participants expressed that:  Gleaner, 2006).These behaviours im pact on the performance o f the child.It should be noted that proper assess ment should be done when a child en ters the school environment to rule out any health, social and psychological problems.

Lack of resources
Lack of resources remained a topic of focus for the participants."N eedfor sports facilities "We need better sports grounds and facilities to take the learners' minds away from sex".
Available resources ease strategies and activities directed to helping the com munities.They contribute toward a feel ing of self-reliance and self-sufficiency.Lack of facilities may hamper progress in any situation.The National Indian Educational Association (2002:1) in Washington states that children should be provided with resources in order to help them to succeed in their school performance.Carr (2004) adds that lack of resources hampers school informa tion.Therefore, there is a need for school resources, such as school web information, to ensure the smooth run ning of school activities.

Need for full health team
The participants emphasised the need for a full medical team as follows:

Limitation of the study
The study was limited only to the edu cators who are working in the four schools in Makapanstad community therefore the results cannot be gener alised to other communities.In addi tion, availability of teachers during data collection remained a barrier because the researcher had to wait for these teachers to participate in the research project because at the same time teach ers had to be responsible in their teach ing.

Conclusion
The methodology guided the research ers during the research process and relevant information was obtained from M akapanstad educators.The health education training needs of educators at Makapanstad schools were explored, described and theoretically confirmed.Data were analysed using the Tesch an aly sis p ro cess.C ategories and subcategories were identified and sci entifically controlled.The focus o f the categories was the need for the sup port o f the University for the training of educators, the need for the acknowl edgement of the University for educa tors' responsibility, the need for basic knowledge on health promotion, com mon health needs o f learners and indi rect h ealth p roblem s.The subcategories identified form the ba sis of a health education programme for educators in Makapanstad schools.The investigation assisted in the im provement o f collaboration between the U n iv ersity o f P reto ria and Makapanstad schools.This is impor tant, as Makapanstad is a rural area that needs attention from an academic in stitution.

Recommendations
With reference to the analysed data and the School Health Policy and implemen tation Guideline (2003:4,9 and 10)

Table 1 : Educators' health education needs: categories and subcatergories identified
exercise and hygiene were identified in this category.
Dreyer and Roos,  2006:95).To attain satisfaction in health promoting schools, all stakeholders should share ideas and reach consen sus.Hattingh et al, (2006:218)add that in a multidisciplinary team approach, members share responsibilities, talents, knowledge, functions, expertise, expe rience, ideas and proposals.Both professionals and non-profes sionals need to come together to es tablish a healthy and well-functioning multidisciplinary team that can address health issues affecting the health of learners and educators.In the School Health Policy and Implementation Guidelines (South Africa, Department o f Health, 2003:10), one o f the objec tives stipulated is that the school com munity should be assisted through the development o f intersectoral plans to support and develop health promoting schools.