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A documentary analysis of the British Columbia school health programme (secondary) Auman, Jane Tate 1987

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A DOCUMENTARY ANALYSIS OF THE BRITISH COLUMBIA SCHOOL HEALTH PROGRAMME (SECONDARY) by JANE TATE AUMAN B.A., The U n i v e r s i t y of B r i t i s h Columbia, 1974 M.A., The U n i v e r s i t y of B r i t i s h Columbia, 1981 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION in THE FACULTY OF GRADUATE STUDIES Department of Mathematics and Science Education We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1987 (c) Jane Tate Auman, 1987 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of M a t h e m a t i c s and S c i e n c e E d u c a t i o n The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date 24 A p r i l 1987 i i ABSTRACT The school h e a l t h programme i s an area w i t h i n the school i n which two d i s t i n c t l y d i f f e r e n t communities of teachers and h e a l t h p r o f e s s i o n a l s are represented. I t i s a c o n s t r u c t of unique and complex dimensions that has not been adequately addressed in the e d u c a t i o n a l or h e a l t h p r o f e s s i o n a l l i t e r a t u r e . T h i s study c l a i m s that an i n v e s t i g a t i o n of s e l e c t e d teacher and h e a l t h p r o f e s s i o n a l c u r r i c u l a documents has r e v e a l e d an e x t e n s i v e school h e a l t h programme that i s o f f i c i a l l y p r e s c r i b e d at the secondary l e v e l . The f i r s t area i s the presence of a hidden c u r r i c u l u m of h e a l t h i n the s u b j e c t s of s c i e n c e , p h y s i c a l education, guidance and an e x p l i c i t programme of h e a l t h f o r school h e a l t h p r o f e s s i o n a l s . The second area of r e s e a r c h i n t e r e s t concerns the e x i s t e n c e of d i v e r s e understandings about the school h e a l t h programme that appear in the o f f i c i a l c u r r i c u l a documents of the M i n i s t r i e s of Education and H e a l t h analyzed i n t h i s study. These understandings appear i n the documents as teacher and h e a l t h p r o f e s s i o n a l c o n s t r u c t i o n s of the s o c i a l r e a l i t y of the school h e a l t h programme. T h e o r e t i c a l l y informed content a n a l y s i s i s used in t h i s study to analyze the c u r r i c u l a documents. S p e c i f i c t h e o r i e s from the s o c i o l o g y of knowledge have been u t i l i z e d i n c o n s t r u c t i n g the framework from which the r e s e a r c h q u e s t i o n s and c a t e g o r i e s of a n a l y s i s were d e r i v e d . The a n a l y s i s i n d i c a t e s that there i s a p o o r l y d e f i n e d , l o o s e l y c o n s t i t u t e d plan of h e a l t h t e a c h i n g i n s c i e n c e , p h y s i c a l education and guidance. The m a j o r i t y of h e a l t h education o b j e c t i v e s , b e l i e f s and outcomes are hidden and i n t e r s p e r s e d w i t h i n t h i s c u r r i c u l a of the t e a c h i n g community. In c o n t r a s t , the c u r r i c u l a plan f o r the h e a l t h p r o f e s s i o n a l i s e x p l i c i t and c o n c i s e l y d e l i n e a t e d . Whereas the c u r r i c u l a of both communities d i s p l a y a wide v a r i e t y of h e a l t h r e l a t e d work and t e a c h i n g and a d i v e r s i t y of understandings about h e a l t h , the o v e r a l l impression i s that the school h e a l t h programme at the secondary l e v e l i n the p r o v i n c e of B r i t i s h Columbia i s an e n t i t y that i s both unique and complex. i v TABLE OF CONTENTS A b s t r a c t i i Table of Contents i v L i s t of Tables v i i Acknowledgement v i i i Chapter I STATEMENT OF THE PROBLEM 1 I n t r o d u c t i o n 1 Subproblems 6 The F i r s t Subproblem 6 The Second Subproblem 7 The T h i r d Subproblem 8 D e f i n i t i o n s 8 D e l i m i t a t i o n s 10 Documentary Data Base 11 The C u r r i c u l a as an Information Base 12 I n t e r n a l and E x t e r n a l V a l i d i t y 14 Content V a l i d i t y 14 G e n e r a l i z a b i l i t y and U t i l i t y 15 Chapter II REVIEW OF THE LITERATURE 17 I n t r o d u c t i o n 17 School H e a l t h L i t e r a t u r e 21 Heal t h Education and Schools 22 Heal t h Concept L i t e r a t u r e 23 T r a d i t i o n a l I n t e r p r e t a t i o n of School H e a l t h Programmes 26 L i t e r a t u r e I n d i c a t i n g Complexity 33 S o c i o l o g i c a l Theory 36 I n t r o d u c t i o n 36 Theory of Holzner and Marx 37 Theory of Schutz 39 Theory of Smith 41 Chapter III RESEARCH METHODOLOGY 44 I n t r o d u c t i o n 44 Data Base 44 R a t i o n a l e and Use of Content A n a l y s i s 47 D e f i n i n g Content A n a l y s i s 47 T h e o r e t i c a l l y O r i e n t e d Content A n a l y s i s 48 Advantages and C o n s t r a i n t s 49 The I n t e r p r e t a t i o n of V a l i d i t y 49 R e l i a b i l i t y and V a l i d i t y 50 Q u a n t i t a t i v e versus Q u a l i t a t i v e Aspects of the Study 53 Research Methodology and T h e o r e t i c a l Framework . 54 P r e l i m i n a r y D e c i s i o n s / D e c i s i o n S c o r i n g Rules 56 Reasons f o r Use 56 P r e l i m i n a r y D e c i s i o n s About the Data 57 D e f i n i t i o n of Health 57 D e c i s i o n S c o r i n g Rules 62 Category C o n s t r u c t i o n 65 C a t e g o r i z a t i o n and Theory 65 C a t e g o r i z a t i o n and D e c i s i o n Rules 66 A d d i t i o n a l A n a l y s i s of Category Data 68 Summary of Methodology 73 Chapter IV FINDINGS I n t r o d u c t i o n 75 A n a l y s i s of Junior-Secondary Science C u r r i c u l u m Guide and Resource Book 75 Category I: Health Dimension A n a l y s i s 75 Category I I : Role 77 C a t e g o r i e s II and III Combined (Role and End Product) 78 Category I I I : C u r r i c u l u m I n t e g r a t i o n 81 A n a l y s i s of Secondary P h y s i c a l Education C u r r i c u l u m and Resource Guide 82 Category I and Health Dimension A n a l y s i s 82 Category I I : Role 84 Category I I I and Health Dimension C l a s s i f i c a t i o n End Products Received by Student 85 A n a l y s i s of Secondary School C u r r i c u l u m Guide - Guidance 87 Category I and Health Dimension A n a l y s i s 87 Category I I : Role 89 Category I I I and Health Dimension A n a l y s i s 90 A n a l y s i s of Guide to the Core C u r r i c u l u m (Goal M) . 92 Category I: Health Dimension A n a l y s i s 92 Category I I : Role 92 Category I I I : Health Dimension A n a l y s i s 93 Category I I I : Subject Summary 95 A n a l y s i s of P u b l i c Health Nursing Program fo r School Age C h i l d r e n 96 Category I and Health Dimension C l a s s i f i c a t i o n . 96 Category I I : Role 97 Category I I I and H e a l t h Dimension C l a s s i f i c a t i o n 99 A n a l y s i s of School Health Program Procedures Manual 101 Category I and Health Dimension C l a s s i f i c a t i o n .101 Category I I : Role 103 C a t e g o r i e s II and III Combined 105 Summary of the F i n d i n g s 107 v i Chapter V DISCUSSION OF THE FINDINGS 109 I n t r o d u c t i o n 109 The E x i s t e n c e of H e a l t h Teaching i n the Documents .112 The Hidden C u r r i c u l u m 113 Science 113 P h y s i c a l Education 117 Guidance 121 Goal M: Guide to the Core C u r r i c u l u m 124 The E x p l i c i t C u r r i c u l u m 129 I n t r o d u c t i o n 129 P u b l i c H e a l t h Nursing f o r C h i l d r e n 129 Vancouver H e a l t h Department School Health Program Procedures Manual 132 Summary of the Hidden and E x p l i c i t C u r r i c u l a 137 T h e o r e t i c a l D i s c u s s i o n 139 I n t r o d u c t i o n 139 E p i s t e m i c Communities 140 Frames of Reference 140 Taken-For-Granted Assumptions 140 S p e c i a l i z e d Languages 146 A n a l y t i c a l Devices 148 S p e c i a l i z e d Knowledge 151 Knowledge Boundaries 153 Knowledge Domains and Power 157 The Relevance of t h i s Study to the P r a c t i c e of H ealth Education 163 Suggestions f o r F u r t h e r Research 164 Suggestions f o r Education 165 Suggestions f o r Educators of Teachers and H e a l t h P r o f e s s i o n a l s 165 Suggestions f o r C u r r i c u l u m Developers 166 Suggestions f o r the M i n i s t r i e s of Health and Education 167 Suggestions f o r Teachers and Health Educators ..167 References 169 LIST OF TABLES Table I 76 Table II 79 Table I I I 82 Table IV 83 Table V 86 Table VI 88 Table VII 91 Table VIII . 94 Table IX 97 Table X 1 00 Table XI 101 Table XII 1 06 Table XIII 1 08 v i i i ACKNOWLEDGEMENTS The w r i t e r wishes to acknowledge s p e c i a l a s s i s t a n c e and guidance r e c e i v e d from her re s e a r c h s u p e r v i s o r , Dr. Walter B o l d t , and the other members of her res e a r c h committee. A s p e c i a l thanks i s a l s o given to Dr. Margaret Brumby of Monash U n i v e r s i t y , Melbourne, A u s t r a l i a , who gave advi c e on the f i r s t d r a f t of t h i s t h e s i s . T h i s t h e s i s i s d e d i c a t e d to my husband, Jason. 1 CHAPTER I  STATEMENT OF THE PROBLEM 1 .1 I n t r o d u c t i o n School h e a l t h i s a unique area of l e a r n i n g w i t h i n the world of the s c h o o l . There are few programmes i n schools i n which such d i v e r s e communities as the educator and the h e a l t h p r o f e s s i o n a l are expected to work together i n what appears t o be a most complex m i l i e u . A d d i t i o n a l l y , i t i s an area that i s l o o s e l y s t r u c t u r e d and inadequately d e f i n e d w i t h i n the l i t e r a t u r e . School h e a l t h can be d e s c r i b e d as an unusual phenomenon of work and l e a r n i n g w i t h i n the s c h o o l . I t i s based on the premise that t h i s phenomenon re p r e s e n t s an e c l e c t i c c o l l e c t i o n of c u r r i c u l a i n which f a c e t s of medicine, p u b l i c h e a l t h , the s o c i a l s c i e n c e s , as w e l l as education are represented (Kreuter et a l , 1983). The boundaries of such a programme are p o o r l y d e f i n e d and the goals of the communities i n v o l v e d may not always be c l e a r l y d e l i n e a t e d (Balog, 1981; Auman, 1982, 1983). Indeed w i t h i n the Province of B r i t i s h Columbia, i n which t h i s study was undertaken, there i s no formal c u r r i c u l a f o r the o v e r a l l School H e a l t h Programme that can be compared to the o f f i c i a l l y p r e s c r i b e d c u r r i c u l a of other s u b j e c t areas, e.g. Science or Mathematics. T h e r e f o r e , i n order t o study the nature and i m p l i c a t i o n s of such a programme, i t has been necessary to f i n d the v a r i o u s areas of l e a r n i n g and work i n schools i n which school h e a l t h education appears to e x i s t w i t h i n the c u r r i c u l a documents of the s c h o o l . For t h i s p a r t i c u l a r 2 programme the g u i d e l i n e s , p o l i c i e s , and work a c t i v i t i e s are under the d i r e c t i o n of both the M i n i s t r y of Education and the M i n i s t r y of H e a l t h . L e g i s l a t i v e g u i d e l i n e s f o r the school h e a l t h programme, i n c l u d i n g the work of h e a l t h p r o f e s s i o n a l s i n school s e t t i n g s , are d i r e c t e d by the mandate of the School Act  of B r i t i s h Columbia (Chapter 319, S e c t i o n s 106 - 120). Vari o u s s u b j e c t areas i n which the t e a c h i n g of h e a l t h education occurs are mandated under the g u i d e l i n e s of the School Act of B r i t i s h  Columbia (Chapter 319, S e c t i o n 18). In both i n s t a n c e s the School Act pr o v i d e s more g e n e r i c than s p e c i f i c g u i d e l i n e s f o r the school h e a l t h programme. Th e r e f o r e , a major part of the problem has been the n e c e s s i t y to f i n d , r e c o r d , and c a t e g o r i z e the nature of the school h e a l t h programme as i t appears to e x i s t w i t h i n the f o r m a l l y p r e s c r i b e d c u r r i c u l a documents r e l a t i n g to the school h e a l t h programme of both the M i n i s t r y of Education and the M i n i s t r y of H e a l t h . A content a n a l y s i s of s e l e c t e d documents e s t a b l i s h e d the f o r m a l l y p r e s c r i b e d e x i s t e n c e of a programme of school h e a l t h that i s contained i n the c u r r i c u l a documents of Science, P h y s i c a l Education, and Guidance and the c u r r i c u l a plans of the school h e a l t h p r o f e s s i o n a l s . The second phase of r e s e a r c h was based on the problem that the l i t e r a t u r e p e r t a i n i n g to school h e a l t h programmes has not given s u f f i c i e n t a t t e n t i o n to the c o m p l e x i t i e s of t h i s programme i n which two d i s t i n c t l y d i f f e r e n t i a t e d communities of p r o f e s s i o n a l s c o e x i s t . The major groups that have been i n v o l v e d with p r e s c r i b e d aspects of school h e a l t h programmes are teachers and h e a l t h p r o f e s s i o n a l s . In a d d i t i o n to t h i s s i t u a t i o n p r e s e n t i n g a problem of the s o c i a l c o n s t r u c t i o n of an area of 3 t e a c h i n g and l e a r n i n g w i t h i n the s c h o o l , the problem i s a l s o e d u c a t i o n a l . The e d u c a t i o n a l dilemma here i s the q u e s t i o n of what should the school do. S p e c i f i c a l l y , what tasks and r e s p o n s i b i l i t i e s does s o c i e t y expect schools to be i n v o l v e d i n w i t h i n t h i s area? In p a r t i c u l a r , d i f f e r e n t groups have p e r c e i v e d the concept of school h e a l t h education from d i f f e r e n t p e r s p e c t i v e s . The primary means of e x p l i c a t i n g the d i f f e r e n c e s i n documentary understandings and i n t e n t i o n s of the two communities i n v o l v e d with t h i s programme was to analyze the f o r m a l l y p r e s c r i b e d c u r r i c u l a data from the communities by means of content a n a l y s i s . S p e c i f i c a l l y , the r e s e a r c h task looked at the o b j e c t i v e s , g o a l s , r a t i o n a l e s , and b e l i e f s of these groups of teachers and h e a l t h p r o f e s s i o n a l s c o n s t r u c t e d w i t h i n the documents t h a t were r e l a t e d to the school h e a l t h programme; the ways by which each c u r r i c u l u m guidebook d e f i n e d and apportioned r o l e s t h at were construed as h e a l t h r e l a t e d ; and the means s e l e c t e d as being a p p r o p r i a t e f o r the d i s s e m i n a t i o n of t h i s programme w i t h i n the s c h o o l . The l i t e r a t u r e about school h e a l t h does not appear to address adequately the q u e s t i o n s that are r a i s e d i n t h i s study. The l i t e r a t u r e g e n e r a l l y f a i l s to d e l i n e a t e the complex nuances of s c h o o l h e a l t h education programmes. T h i s l a c k of a t t e n d i n g to the problems of complexity i s most evident i n the f a c t t h a t there i s l i t t l e , i f any, l i t e r a t u r e r e l a t e d t o : 1) The e x i s t e n c e of a hidden h e a l t h education c u r r i c u l u m that can be found w i t h i n f a c e t s of the o v e r a l l c u r r i c u l a of many teac h i n g d i s c i p l i n e s at the elementary and secondary l e v e l s . 4 T h i s v o i d i s e s p e c i a l l y notable i n c u r r e n t Canadian school h e a l t h r e s e a r c h . For example, t h i s study found many ins t a n c e s of h e a l t h r e l a t e d t e a c h i n g g u i d e l i n e s w i t h i n the o v e r a l l c u r r i c u l a of secondary s c i e n c e , p h y s i c a l education, and guidance that are not r e f l e c t e d i n the l i t e r a t u r e . The f a c t that these c u r r i c u l u m guides d i s c l o s e areas of h e a l t h teaching w i t h i n the o v e r a l l format of the s u b j e c t areas' f o r m a l l y p r e s c r i b e d g u i d e l i n e s p r o v i d e s a problematic s i t u a t i o n that i s both complex and worthy of f u r t h e r i n v e s t i g a t i o n . 2) The epistemic d i v e r s i t y that i s represented by teachers and h e a l t h p r o f e s s i o n a l s who i n t e r a c t as p r o f e s s i o n a l communities w i t h i n the o v e r a l l context of the school h e a l t h programme. The term e p i s t e m i c , d e s c r i b e d i n d e t a i l on page 8, r e f e r s i n t h i s study to p r o f e s s i o n a l groups which by nature of t h e i r t r a i n i n g and s o c i a l experience have a r r i v e d at d i f f e r e n t p e r s p e c t i v e s about such i s s u e s as school h e a l t h programmes. For example, the c u r r i c u l a data of these two groups i n d i c a t e s the e x i s t e n c e of d i f f e r e n t frames of r e f e r e n c e . These frames of r e f e r e n c e i n c l u d e such aspects as t a k e n - f o r - g r a n t e d assumptions and s p e c i a l i z e d language that each group uses to look at and understand t h i s phenomena of the school h e a l t h programme. From a s o c i o l o g i c a l p e r s p e c t i v e , i t w i l l be argued that the very f a c t t h a t such d i v e r s e epistemic communities do e x i s t and i n t e r a c t i n t h i s s e t t i n g of the school h e a l t h programme appears to c r e a t e a s i t u a t i o n of complexity that r e q u i r e s e x p l i c a t i o n . 5 T h i s study i s designed to i n v e s t i g a t e the problematic complexity of the school h e a l t h programme; to e x p l o r e the nature of the documentary e x i s t e n c e of t h i s programme and to focus on the d i f f e r e n t o r i e n t a t i o n s of the t e a c h e r s and h e a l t h p r o f e s s i o n a l s that are presented i n t h e i r documents. The focus of t h i s study was to f i n d , r e c o r d , and analyze the e x i s t e n c e of such a programme. Three res e a r c h q u e s t i o n s guide t h i s i n v e s t i g a t i o n of the documentary data: 1) What do these documents d i s p l a y as being h e a l t h r e l a t e d o b j e c t i v e s , g o a l s , r a t i o n a l e s , and b e l i e f s of teachers and h e a l t h p r o f e s s i o n a l s ? 2) Who i s r e f e r e n c e d i n the documents as r e s p o n s i b l e f o r h e a l t h r e l a t e d t e a c h i n g and work a c t i v i t y ? A d d i t i o n a l l y , what are the i m p l i c i t or e x p l i c i t r o l e d e f i n i t i o n s of those delegated as being r e s p o n s i b l e ? 3) How do the documents d e s c r i b e the means by which the s c h o o l h e a l t h programme should reach the intended r e c i p i e n t i n the school? In p a r t i c u l a r , what kinds of h e a l t h r e l a t e d t e a c h i n g and work a c t i v i t i e s are s p e c i f i e d ? The s o c i o l o g y of knowledge theory that p r o v i d e s a framework f o r t h i s study was u t i l i z e d i n the f o r m u l a t i o n of these three r e s e a r c h q u e s t i o n s . S p e c i f i c a l l y , the theory espoused by Holzner and Marx (1979) concerning i n s t i t u t i o n a l i z e d p o s i t i o n s i s r e f l e c t e d i n Category I; t h e i r theory of i n s t i t u t i o n a l i z e d  r o l e s i s contained i n Category I I ; and Category III concerns t h e i r views on i n s t i t u t i o n a l i z e d p r o c e s s e s . An extended d i s c u s s i o n of the t h e o r y / r e s e a r c h q u e s t i o n / c a t e g o r y a n a l y s i s of t h i s t h e s i s i s c o n t a i n e d i n Chapter I I I . 6 An u n d e r l y i n g r e s e a r c h i n t e n t of t h i s study i s to f u r t h e r d e f i n e the documentary understandings of these communities as i t r e l a t e s to the concept of h e a l t h . Research q u e s t i o n s 1 and 3 have a l s o been analyzed by means of the Health Dimension C l a s s i f i c a t i o n scheme d e r i v e d from h e a l t h concept r e s e a r c h i n A u s t r a l i a (Brumby, Garrard, and Auman, 1985). T h i s A u s t r a l i a n r e s e a r c h i n q u i r y i s d i s c u s s e d i n d e t a i l i n Chapters II I and IV. The methodology of t h e o r e t i c a l l y informed content a n a l y s i s i s used i n t h i s t h e s i s . T h i s methodology i s based on s e l e c t e d t h e o r i e s from the s o c i o l o g y of knowledge. These t h e o r i e s form the framework from which the r e s e a r c h questions and the c a t e g o r i e s of a n a l y s i s are d e r i v e d and provide a c o n t e x t u a l b a s i s f o r the making of i n f e r e n c e s . T h i s methodology i s d e s c r i b e d b r i e f l y i n Chapter II and e x t e n s i v e l y i n Chapter I I I . Drawing upon the s o c i o l o g i c a l t h e o r i e s of knowledge development, a p p l i c a t i o n , and d i s s e m i n a t i o n , t h i s study i s designed to extend the body of knowledge that e x i s t s about the l e a r n i n g and work in the world of the s c h o o l , p a r t i c u l a r l y i n the area of school h e a l t h programmes. 1.2 Subproblems 1.2.1 The F i r s t Subproblem The i n i t i a l phase of d e a l i n g with the problem was to f i r s t f i n d i n s t a n c e s w i t h i n the secondary s u b j e c t s of s c i e n c e , p h y s i c a l education, and guidance i n which h e a l t h i s s u e s or h e a l t h concepts were d e s c r i b e d i n the documents as being taught or acted upon. These in s t a n c e s i n c l u d e d such d i v e r s e a c t i v i t i e s 7 as the t e a c h i n g of a l e s s o n about the e f f e c t of drugs on the nervous system w i t h i n the context of a s c i e n c e c l a s s , or the p r o v i s i o n of immunization i n j e c t i o n s by school h e a l t h p r o f e s s i o n a l s . Having found areas of work and teaching i n which the school h e a l t h programme was o f f i c i a l l y s a n c t i o n e d , the researcher then focused on the f o l l o w i n g q u e s t i o n s . The f i r s t q u e s t i o n concerned what the documents s i g n i f y as being h e a l t h r e l a t e d o b j e c t i v e s , g o a l s , r a t i o n a l e s , and b e l i e f s of the teacher and p r o f e s s i o n a l groups. These p a r t i c u l a r understandings about h e a l t h are d e f i n e d through the o f f i c i a l documents of both communities. The second q u e s t i o n focused on the need to determine who the documents s t i p u l a t e as being r e s p o n s i b l e f o r the h e a l t h r e l a t e d t e a c h i n g and work a c t i v i t i e s w i t h i n these programmes. A d d i t i o n a l l y , there was the q u e s t i o n of what are the r o l e d e f i n i t i o n s of those delegated as being r e s p o n s i b l e . The t h i r d q u e s t i o n c e n t r e d on the means by which t h i s school h e a l t h programme i s documentarily d e s c r i b e d as reaching the intended r e c i p i e n t . S p e c i f i c a l l y , by what kinds of teaching or work a c t i v i t i e s d i d t h i s occur? A f u r t h e r q u e s t i o n asked of these data i s how the d i s p l a y of documentary understandings r e l a t e d to the concept of h e a l t h can be c a t e g o r i z e d i n t o v a r i o u s s u b d i v i s i o n s of content p a t t e r n s by means of the H e a l t h Dimension C l a s s i f i c a t i o n Scheme. 1 . 2 . 2 The Second Subproblem The second subproblem was to u t i l i z e the d i f f e r e n t p e r c e p t i o n s a t t r i b u t e d to these two communities that appear w i t h i n the formal documents i n order to i d e n t i f y major 8 d i s c r e p a n c i e s that might e x i s t between teachers and h e a l t h p r o f e s s i o n a l s . T h i s process i n v o l v e d a documentary mapping of the d i f f e r e n c e s d i s p l a y e d as c h a r a c t e r i s t i c s of these two communities. In t h i s manner the d i f f e r e n c e s between the communities that e x i s t i n these data i n terms of t h e i r o b j e c t i v e s , g o a l s , r a t i o n a l e s , b e l i e f s , r o l e d e l i n e a t i o n s , and the means f o r p r o v i d i n g the programme to students c o u l d be analyzed. 1.2.3 The T h i r d Subproblem The t h i r d subproblem was to examine the comparisons between these communities of teachers and h e a l t h p r o f e s s i o n a l s by means of s o c i o l o g i c a l t h e o r i e s which pr o v i d e a framework f o r the study of knowledge development, a p p l i c a t i o n , and d i s s e m i n a t i o n . The e d u c a t i o n a l problem that concerned the r e s e a r c h focus as a whole was r e l a t e d to the unusual and complex nature of t h i s p a r t i c u l a r programme that i s unique w i t h i n the world of the s c h o o l . The study was c o n s t r u c t e d with an on-going o b j e c t i v e of b u i l d i n g upon and extending the work of s o c i o l o g y of knowledge t h e o r i s t s such as Holzner and Marx (1979). In more gen e r a l terms, the o v e r a l l goal was to extend the body of knowledge that p e r t a i n s to the l e a r n i n g and work of the s c h o o l , with s p e c i f i c emphasis on the secondary school h e a l t h education programmes. 1.3 D e f i n i t i o n s E p i s t e m i c communities i s the term used by Holzner and Marx (1979) that d e s c r i b e s communities in which the knowledge of that community i s understood as being a s p e c i a l kind of 9 knowledge. T h i s s p e c i a l knowledge i s acknowledged by the members of t h e i r epistemic community and others as being s p e c i f i c , as having d e f i n i t i v e boundaries of knowledge p r o d u c t i o n and a p p l i c a t i o n , and belonging to the e p i s t e m i c group. In these communities there i s a development and e l a b o r a t i o n of t h i s s p e c i a l knowledge that r e q u i r e s the establishment of an autonomous s o c i a l space. The epistemic communities of t h i s t h e s i s are teachers and h e a l t h p r o f e s s i o n a l s . These communities can be f u r t h e r s u b d i v i d e d i n t o s c i e n c e , p h y s i c a l education and guidance t e a c h e r s , community h e a l t h nurses and p h y s i c i a n s , e t c . School h e a l t h programmes or s c h o o l h e a l t h education programmes r e f e r to the o v e r a l l context of organized t e a c h i n g and s e r v i c e a c t i v i t i e s i n v o l v i n g students, t e a c h e r s , and h e a l t h p r o f e s s i o n a l s i n which f o r m a l l y p r e s c r i b e d h e a l t h concerns and h e a l t h t o p i c s are addressed. The programme i n t h i s i n s t a n c e i s understood as encompassing a l l t e a c h i n g and work a c t i v i t i e s i n which h e a l t h concepts or h e a l t h i s s u e s are taught or a c t e d upon. Educators are those i n d i v i d u a l s employed by the M i n i s t r y of Education under the auspices of the P u b l i c School Act of  B r i t i s h Columbia. These educators teach i n e i t h e r elementary or secondary school s e t t i n g s . H e a l t h P r o f e s s i o n a l s are those i n d i v i d u a l s employed by the M i n i s t r y of Health, and i n the p a r t i c u l a r s i t u a t i o n of school h e a l t h p e r s o n n e l , who a l s o work under the a u s p i c e s of the P u b l i c School Act of B r i t i s h Columbia. H e a l t h p r o f e s s i o n a l s c a r r y out v a r i o u s work and e d u c a t i o n a l a c t i v i t i e s i n both 10 elementary and secondary school s e t t i n g s . Content a n a l y s i s i s a methodological t o o l t h at i s used to o b j e c t i v e l y and s y s t e m a t i c a l l y i d e n t i f y s p e c i f i c c h a r a c t e r i s t i c s of documents and other forms of communication. In t h i s t h e s i s the contents analyzed are the o f f i c i a l l y p r e s c r i b e d documents of educators and h e a l t h p r o f e s s i o n a l s . Documentary or content p a t t e r n s are a schematic device whereby the s o c i a l l y c o n s t r u c t e d p a t t e r n s of documented b e l i e f s and understandings of the teacher and h e a l t h p r o f e s s i o n a l communities are d i s p l a y e d i n the c u r r i c u l a documents, e i t h e r i n t a b u l a r or d e s c r i p t i v e form. Cu r r i c u l u m r e f e r s to the set of school experiences through which the students are educated; the l e a r n i n g a c t i v i t i e s and experiences s e l e c t e d f o r the purpose of a c h i e v i n g e d u c a t i o n a l experiences and the designs of s o c i a l groups for the e d u c a t i o n a l experiences of c h i l d r e n i n school (Holt, 1980, Bent and Unruh, 1969, and Lawton, 1973). The c u r r i c u l u m documents used as data f o r t h i s study are d e s c r i b e d below. 1.4 D e l i m i t a t i o n s T h i s study was l i m i t e d to r e q u i r e d areas of study as they appear w i t h i n the B.C. Secondary School c u r r i c u l a and a d d i t i o n a l s e l e c t e d M i n i s t r y of Education documents that c o n t a i n r e f e r e n c e s to the school h e a l t h programme. I t i n c l u d e d r e p r e s e n t a t i v e documents from the M i n i s t r y of H e a l t h and o f f i c i a l l y p r e s c r i b e d m a t e r i a l s from the C i t y of Vancouver's school h e a l t h programme procedure manual. The secondary school c u r r i c u l a was l i m i t e d to 11 S c i e n c e , Guidance, and P h y s i c a l Education c u r r i c u l u m guides as p r e s c r i b e d by the p r o v i n c i a l government of B r i t i s h Columbia and the Guide to the Core C u r r i c u l u m . 1.5 Documentary Data Base The f o l l o w i n g documents are the educator data base: 1) Guide to the Core Cu r r i c u l u m , M i n i s t r y of Education, V i c t o r i a , B r i t i s h Columbia, 1977, pages 32-33, Goal M: "To Develop S k i l l s and Knowledge f o r H e a l t h f u l L i v i n g " . 2) Secondary P h y s i c a l Education C u r r i c u l u m and Resource Guides, M i n i s t r y of Education, V i c t o r i a , B r i t i s h Columbia, 1980, pages 1-183. 3) Secondary School C u r r i c u l u m Guide - Guidance, M i n i s t r y of Education, V i c t o r i a , B r i t i s h Columbia, 1971, pages 1-66. 4) Junior-Secondary Science C u r r i c u l u m Guide and Resource Book, M i n i s t r y of Education, V i c t o r i a , B r i t i s h Columbia, 1983, pages 1-261 . The f o l l o w i n g documents are the h e a l t h p r o f e s s i o n a l data base: 1) P u b l i c H e a l t h Nursing Program f o r School Age C h i l d r e n , M i n i s t r y of H e a l t h , V i c t o r i a , B r i t i s h Columbia, 1982, pages 1-8. 2) School Health Program Procedures Manual, Vancouver Health Department, Vancouver, B r i t i s h Columbia, 1982, pages 1-100. The above documents are r e p r e s e n t a t i v e of f o r m a l l y p r e s c r i b e d documents that are u t i l i z e d by teachers and h e a l t h p r o f e s s i o n a l s and are understood to be o f f i c i a l l y s anctioned g u i d e l i n e s f o r the v a r i e t y of t e a c h i n g and work a c t i v i t i e s that occur i n the o v e r a l l s chool h e a l t h programmes w i t h i n B r i t i s h 1 2 Columbia. The subject areas of p h y s i c a l education, s c i e n c e , and guidance have been chosen as areas of a n a l y s i s because they represent c u r r i c u l a that are taught to a m a j o r i t y of students w i t h i n the secondary s c h o o l s . They are a l s o r e p r e s e n t a t i v e of s u b j e c t areas i n which h e a l t h teaching i s more l i k e l y to appear. Other h e a l t h r e l a t e d s u b j e c t areas such as home economics have not been i n c l u d e d in the sampling because they do not represent c u r r i c u l a areas f o r the m a j o r i t y of the student p o p u l a t i o n . The h e a l t h p r o f e s s i o n a l documents were chosen with the f o l l o w i n g c r i t e r i a i n mind. The P u b l i c H e a l t h Nursing document (B.C.M.H., 1982) i s the o f f i c i a l g u i d e l i n e f o r B r i t i s h Columbia i n which general p o l i c i e s and g u i d e l i n e s f o r the r e g i s t e r e d nurses' involvement i n school h e a l t h programmes are d e l i n e a t e d . D i s c u s s i o n s with the M i n i s t r y of Health i n d i c a t e that the second document, the School H e a l t h Procedures Manual from the C i t y of Vancouver He a l t h Department, i s r e p r e s e n t a t i v e of the comprehensive g u i d e l i n e manuals used throughout the p r o v i n c e i n which p o l i c i e s , g u i d e l i n e s and s p e c i f i c d i r e c t i o n s on the day to day o p e r a t i o n of school h e a l t h programmes appears. 1.6 The C u r r i c u l a as an Information Base The c u r r i c u l u m data of t h i s study have been used as i n f o r m a t i o n sources i n which v a r i o u s f a c e t s of the school h e a l t h programme have been found to e x i s t . These data, as the o f f i c i a l l y p r e s c r i b e d g u i d e l i n e s to be used by teachers and h e a l t h p r o f e s s i o n a l s , d i s p l a y i n f o r m a t i o n that i s c e n t r a l to the major r e s e a r c h i n t e n t s that were pursued in t h i s study. The f i r s t r e s e a r c h i n t e n t was the i n t e r e s t i n e x p l o r i n g the 13 p o s s i b i l i t y that both hidden and e x p l i c i t school h e a l t h programmes were co n t a i n e d i n the documents. The second i n t e n t was t o i l l u s t r a t e by means of s o c i o l o g i c a l i n t e r p r e t a t i o n the complex and v a r i e d d i s p l a y s of the b e l i e f s and understandings that each document a s s i g n s to i t s r e s p e c t i v e teacher or h e a l t h p r o f e s s i o n a l group. These kinds of data play an important r o l e i n the everyday, shared understandings of i n s t i t u t i o n s such as s c h o o l s . Smith (1974) has observed that our understandings of contemporary s o c i e t y are mediated to us through documents of v a r i o u s kinds and that knowledge i n t h i s sense i s s o c i a l l y accomplished. She f u r t h e r observes that most f a c t u a l documents are not made to be detached from the s p e c i f i c o r g a n i z a t i o n a l c ontexts of i n t e r p r e t a t i o n . The p e r s p e c t i v e taken i n t h i s study i s that these documents, having been developed and s p e c i f i e d f o r use by t h e i r r e s p e c t i v e teacher and h e a l t h p r o f e s s i o n a l groups, can be understood from w i t h i n the framework of t h e i r s p e c i f i c community. An argument i s made i n t h i s t h e s i s that the c u r r i c u l u m documents of t h i s study p r o v i d e r i c h and v a r i e d understandings about the documented e x i s t e n c e of a school h e a l t h programme that h e r e t o f o r e has not been adequately explored. T h i s study i s not concerned with the implementation of these c u r r i c u l a or the i n d i v i d u a l i n t e r p r e t a t i o n s of the teachers and h e a l t h p r o f e s s i o n a l s who make use of these documents. I t focuses i n s t e a d on these documents as re p r e s e n t i n g the o f f i c i a l l y mandated c u r r i c u l a g u i d e l i n e s of the M i n i s t r i e s of Education and H e a l t h . In t h i s context the documents p o r t r a y not only the o f f i c i a l views about the 14 c u r r i c u l a t o be addressed by these two groups but a l s o the o f f i c i a l i n t e r p r e t a t i o n of the d i v e r s e understandings that are p o r t r a y e d w i t h i n the teacher and h e a l t h p r o f e s s i o n a l documents. 1.7 I n t e r n a l and E x t e r n a l V a l i d i t y The educator data base i s made up of f o r m a l l y p r e s c r i b e d and p u b l i s h e d c u r r i c u l u m guides and s e l e c t e d o f f i c i a l m i n i s t r y documents from the B r i t i s h Columbia M i n i s t r y of E d u c a t i o n . The h e a l t h p r o f e s s i o n a l data base i s comprised of o f f i c i a l l y p r e s c r i b e d and p u b l i s h e d g u i d e l i n e s and procedures r e g a r d i n g school h e a l t h programmes i n B r i t i s h Columbia, o r i g i n a t i n g from both the B r i t i s h Columbia M i n i s t r y of Health and the Vancouver He a l t h Department. 1.8 Content V a l i d i t y Content v a l i d i t y of the data i s sound s i n c e only o f f i c i a l l y p r e s c r i b e d and p u b l i s h e d m i n i s t r y documents that are u t i l i z e d by the B.C. school system as r e p r e s e n t i n g g u i d e l i n e s f o r c u r r i c u l a were analysed i n t h i s study. Health p r o f e s s i o n a l data meets s i m i l a r c r i t e r i a i n that only o f f i c i a l l y p r e s c r i b e d and p u b l i s h e d documents p e r t a i n i n g to school h e a l t h were u t i l i z e d . Care was taken to a s c e r t a i n that the documents are i n f a c t the product of the separate m i n i s t r i e s of the government w r i t t e n i n c o n j u n c t i o n with s e l e c t e d members of t h e i r r e s p e c t i v e teacher or h e a l t h p r o f e s s i o n a l groups. 15 1.9 G e n e r a l i z a b i l i t y and U t i l i t y I t i s the b e l i e f of the r e s e a r c h e r that t h i s study i s g e n e r a l i z a b l e to the extent that other r e s e a r c h e r s c o u l d use the modes of a n a l y s i s and research f i n d i n g s as a b a s i s f o r f u r t h e r i n v e s t i g a t i o n i n t o other areas of e d u c a t i o n a l work and l e a r n i n g w i t h i n the s c h o o l . Furthermore, i t should be p o s s i b l e to r e p l i c a t e t h i s type of resea r c h w i t h i n the s e t t i n g s of i n s t i t u t i o n s other than e d u c a t i o n a l environments i n which separate p r o f e s s i o n a l communities are to be s t u d i e d . Very few a r t i c l e s appear i n the l i t e r a t u r e i n which the d i f f e r e n c e s between the communities of the educator and the h e a l t h p r o f e s s i o n a l have been e x p l o r e d . The school h e a l t h programme as i t e x i s t s w i t h i n the world of the school p r e s e n t s a phenomenon of l e a r n i n g and work a c t i v i t i e s t h a t i s both unique and complex. The b a s i s f o r t h i s unusual phenomenon appears to be the e x i s t e n c e of a problematic s i t u a t i o n of epistemic communities with d i f f e r e n t b e l i e f s , i n t e n t i o n s , and understandings about school h e a l t h programmes. I t i s a s i t u a t i o n of work and l e a r n i n g i n which complex b e l i e f systems about the concept of h e a l t h are d i s p l a y e d . The m i l i e u of the programme i s one i n which confused boundaries of r o l e and r e s p o n s i b i l i t y are found. The s e t t i n g of the problem a l s o s i g n i f i e s an area of e d u c a t i o n a l i n t e r e s t i n which a mixture of a c t i v i t i e s and processes are disseminated to the student. T h i s type of study should be a p p l i c a b l e not only to school s e t t i n g s but a l s o to other i n s t i t u t i o n s such as h o s p i t a l s . T h e o r e t i c a l l y , i t can be argued that t h i s type of resea r c h can be pursued i n any s e t t i n g where two or more d i f f e r e n t i a t e d e p i s t e m i c communities work i n a 16 s i t u a t i o n of s o c i a l i n t e r a c t i o n t h a t i s bounded by a programme or a c u r r i c u l a . T h i s p a r t i c u l a r study has been designed to b u i l d upon the e x i s t i n g body of knowledge about s c h o o l h e a l t h programmes and should p r o v i d e other r e s e a r c h e r s with f i n d i n g s that can be u t i l i z e d i n s i m i l a r s i t u a t i o n s . 1 7 CHAPTER II  REVIEW OF THE LITERATURE 2.1 I n t r o d u c t i o n The body of l i t e r a t u r e that forms the background f o r the s e t t i n g of t h i s study i s d i v i d e d i n t o two s e c t i o n s : a) School H e a l t h and H e a l t h Concept L i t e r a t u r e ; b) S o c i o l o g y of Knowledge L i t e r a t u r e . In the areas of school h e a l t h and h e a l t h concept l i t e r a t u r e , r e p r e s e n t a t i v e a r t i c l e s have been s e l e c t e d f o r the f o l l o w i n g purposes. F i r s t l y , there i s a complexity and ambiguity present i n much of the l i t e r a t u r e that serves as a b a s i s f o r c o n s t r u c t i n g one of the c e n t r a l arguments of t h i s t h e s i s . T h i s argument c e n t r e s around the f a c t that there are few, i f any, attempts i n the l i t e r a t u r e to e x p l o r e the amorphous, m u l t i f a c e t e d nature of the o v e r a l l school h e a l t h programme. Furthermore, there are numerous a r t i c l e s about the development, implementation and e v a l u a t i o n of such programmes, but few that address the complex nature of these programmes i n which d i v e r s e p r o f e s s i o n a l groups work to g e t h e r . Secondly, in a d d i t i o n to the complex s i t u a t i o n of d i v e r g e n t groups, there i s another, warrant for j u s t i f y i n g a study of t h i s nature. T h i s reasoning i s based on the f a c t that the l i t e r a t u r e c o n t a i n s few a r t i c l e s i n which the e x i s t e n c e of such a programme w i t h i n the v a r i o u s subject areas of t e a c h i n g has been i n v e s t i g a t e d . As f u r t h e r background to the review of the l i t e r a t u r e i t should be p o i n t e d out that the U.S. school h e a l t h 18 l i t e r a t u r e g e n e r a l l y r e f e r e n c e s t h i s area of t e a c h i n g and l e a r n i n g i n schools as being t r e a t e d as a separate content course by a h e a l t h education s p e c i a l i s t . In some i n s t a n c e s h e a l t h education i s taught by a p h y s i c a l education or s c i e n c e teacher who i s designated as r e s p o n s i b l e f o r t h i s content, e i t h e r as a separate course or subsumed w i t h i n a p a r t i c u l a r s u b j e c t . Yager (1981) i s r e p r e s e n t a t i v e of a r e l a t i v e l y small group of s c i e n c e educators who have w r i t t e n about t e a c h i n g h e a l t h w i t h i n v a r i o u s subject a r e a s . He has r a i s e d v a r i o u s q u e s t i o n s about the r o l e of the s c i e n c e teacher as h e a l t h educator and the p a r a l l e l concern of whether h e a l t h education should be taught w i t h i n s u b j e c t areas or as a separate c u r r i c u l u m . As an American educator he g e n e r a l l y p l a c e s h i s concerns w i t h i n the framework of that system. G a r r a r d (In Press) i s an example of another s c i e n c e educator who w r i t e s about the te a c h i n g of h e a l t h w i t h i n the context of s c i e n c e education i n s c h o o l s . As an A u s t r a l i a n , she observes that h e a l t h concepts appear to be embedded i n much of t h e i r s c i e n c e c u r r i c u l a and that s c i e n c e teachers take on t h i s r o l e as they work w i t h i n the framework of the c u r r i c u l a . In the Canadian context there are few s t u d i e s that have addressed the o v e r a l l s i t u a t i o n of h e a l t h t e a c h i n g as o c c u r r i n g i n the v a r i o u s subject areas of the s c h o o l . However, there have been some attempts by the p r o v i n c e s to develop h e a l t h t e a c h i n g w i t h i n the c u r r i c u l a of the elementary s c h o o l . Many g e n e r a l i s t elementary teachers i n t h i s p r o v i n c e and elsewhere i n Canada appear to have i n c o r p o r a t e d h e a l t h concepts i n t o t h e i r t e a c h i n g 19 agenda. In a number of i n s t a n c e s t h i s h e a l t h c u r r i c u l u m appears to have been l o c a l l y developed with an uneven d i s t r i b u t i o n of implementation. In Vancouver, f o r example, the Guide f o r L i f e c u r r i c u l u m resource guide (Vancouver School Board, 1982b) pro v i d e s e x t e n s i v e g u i d e l i n e s f o r i n c o r p o r a t i n g h e a l t h t e a c h i n g i n t o the elementary classroom. T h i s h e a l t h education c u r r i c u l u m , while a v a i l a b l e f o r o p t i o n a l use by the elementary teachers, i s c u r r e n t l y i n l i t t l e use w i t h i n the classroom. With the e x c e p t i o n of the A c t i v e H e a l t h c u r r i c u l u m , a l s o researched and developed f o r o p t i o n a l use by the Vancouver Secondary P h y s i c a l E d u c a t i o n Departments (Vancouver School Board, 1982a), there i s no comparable c u r r i c u l u m guide. Given the gen e r a l l a c k of r e s e a r c h about t h i s complex area of teaching and l e a r n i n g w i t h i n the s c h o o l , p a r t i c u l a r l y at the secondary l e v e l , there appears to be a need f o r such s t u d i e s . At present there are no s t u d i e s a v a i l a b l e w i t h i n t h i s p r o v i n c e that have s p e c i f i c a l l y addressed the complex embedding of h e a l t h teaching w i t h i n the v a r i o u s t e a c h i n g d i s c i p l i n e s of the elementary and secondary s c h o o l system. T h i s s i t u a t i o n e x i s t s d e s p i t e the c l a i m s that have been made by Canadian h e a l t h education r e s e a r c h e r s such as Mutter (1982, 1985), the task f o r c e on the s t a t u s of h e a l t h education i n schools (B.C.M.A., 1984), and Johnson (1986) that s t u d i e s have been conducted and the o v e r a l l s c h o o l h e a l t h programme found to be d e f i c i e n t . The B.C.M.A. (1984) r e p o r t , i n p a r t i c u l a r , o u t l i n e s i n d e t a i l a recommendation f o r the c r e a t i o n of a separate h e a l t h education c u r r i c u l u m but f a i l s to show the o v e r a l l scope and sequence of h e a l t h t e a c h i n g p o s s i b i l i t i e s that c u r r e n t l y e x i s t s w i t h i n 20 v a r i o u s c u r r i c u l a of the s c h o o l . In response to the p a u c i t y of info r m a t i o n p r o v i d e d i n the c u r r e n t l i t e r a t u r e about the nature of the o v e r a l l school h e a l t h programme, and s p e c i f i c a l l y to the Canadian s t u d i e s p e r t a i n i n g to the s t a t u s of the programme i n t h i s p r o v i n c e , a c l a i m i s made in t h i s t h e s i s that we do not have an adequate p i c t u r e of the s i t u a t i o n . As w i l l be d i s c u s s e d f u r t h e r i n t h i s study, the f i n d i n g s of the Mutter (1982, 1985) s t u d i e s and the B.C.M.A. (1984) r e s e a r c h are not i n agreement with the f i n d i n g s of t h i s t h e s i s . A major d i f f e r e n c e between these Canadian r e s e a r c h e r s r e p o r t e d i n the l i t e r a t u r e and the re s e a r c h c o n t a i n e d i n t h i s study appears to ce n t r e around the f a c t that d i f f e r e n t methodologies have been used; d i f f e r e n t q u e s t i o n s have been asked of data sources and d i f f e r e n t answers have been e l i c i t e d . T h i s divergency of f i n d i n g s w i l l be d i s c u s s e d f u r t h e r in Chapter V. T h i r d l y , there i s a b a s i c conceptual r e s e a r c h area that appears to be i n t e r t w i n e d w i t h i n the s e t t i n g of the school h e a l t h i s s u e . T h i s area concerns h e a l t h concept r e s e a r c h . In order to c l e a r l y d e f i n e the probl e m a t i c nature of the school h e a l t h programme i t appears to be u s e f u l to a l s o present a b r i e f d i s c u s s i o n of s e l e c t e d examples of h e a l t h concept r e s e a r c h . T h i s r a t i o n a l e i s based on the c l a i m , i n t h i s study, that h e a l t h i t s e l f i s a complex concept and r e p r e s e n t a t i v e of knowledge that i s s o c i a l l y c o n s t r u c t e d . The d i v e r s e , m u l t i f a c e t e d dimensions of h e a l t h b e l i e f s and understandings are i n t r i c a t e l y i n t e r t w i n e d w i t h i n the u n d e r l y i n g puzzle of the study i t s e l f . T h e r e f o r e , s e l e c t e d examples the h e a l t h concept l i t e r a t u r e are a l s o 21 i n c l u d e d i n t h i s l i t e r a t u r e review. The second area of l i t e r a t u r e addresses the t h e o r e t i c a l framework of t h i s t h e s i s . The theory that guides and anchors the r e s e a r c h i n q u i r y of the study i s drawn from the s o c i o l o g y of knowledge. The b a s i c premise of t h i s theory i s the b e l i e f that knowledge i s s o c i a l l y c o n s t r u c t e d . Knowledge, in the i n s t a n c e of t h i s r e s e a r c h study, r e f e r s to the o v e r a l l school h e a l t h programme. A d d i t i o n a l r e s e a r c h focus i s p l a c e d on the documentary i n q u i r y i n t o the e x i s t e n c e of two e p i s t e m i c groups which, in t h i s study, are the teachers and the h e a l t h p r o f e s s i o n a l s . The o b j e c t i v e s , g o a l s , r a t i o n a l e s , and b e l i e f s r e l a t e d to a d e f i n i t i o n of h e a l t h (Category I ) , the r o l e i n t e n t i o n s (Category I I ) , and the teaching/work a c t i v i t i e s (Category I I I ) , that are documentarily c o n s t r u c t e d as r e l e v a n t to the school h e a l t h programme have been s t u d i e d by means of s o c i o l o g i c a l theory. The w r i t i n g s of Holzner and Marx (1979), S c h u l t z (1962, 1967), and Smith (1974) are of p a r t i c u l a r importance to the t h e o r e t i c a l framework of t h i s study. 2.2 School H e a l t h L i t e r a t u r e The school h e a l t h l i t e r a t u r e i s s u b d i v i d e d i n t o four c a t e g o r i e s : a) l i t e r a t u r e d e f i n i n g h e a l t h education and s c h o o l s ; b) h e a l t h concept l i t e r a t u r e ; c) t r a d i t i o n a l i n t e r p r e t a t i o n s of the school h e a l t h programme; d) l i t e r a t u r e r e l a t e d to complexity i n the area under study. 22 2.2.1 H e a l t h Education and Schools The l i t e r a t u r e c o n t a i n s d e f i n i t i o n a l i n t e r p r e t a t i o n s of h e a l t h education that have d i r e c t a p p l i c a t i o n to the school s e t t i n g . However, there appears to be no consensus w i t h i n the l i t e r a t u r e of h e a l t h education as to what would c o n s t i t u t e a c l e a r d e f i n i t i o n of i t s use w i t h i n the s c h o o l . For example, Green et a l (1980) d e f i n e d h e a l t h education w i t h i n the school s e t t i n g as i n v o l v i n g a d e s i g n a t e d combination of methods f o r f a c i l i t a t i n g v o l u n t a r y a d a p t a t i o n s of behavior that i s conducive to h e a l t h . A more complex d e f i n i t i o n of h e a l t h education w i t h i n the school was p r o v i d e d by Kreuter et a l (1983). These r e s e a r c h e r s d e s c r i b e d school h e a l t h education as being an unusual phenomena of work and l e a r n i n g w i t h i n the s e t t i n g of the s c h o o l . T h e i r d e f i n i t i o n was based on the premise that t h i s p a r t i c u l a r phenomena repr e s e n t s a somewhat e c l e c t i c c o l l e c t i o n of c u r r i c u l a i n which f a c e t s of medicine, p u b l i c h e a l t h , s o c i a l s c i e n c e s and education are represented. P o l l a c k and Hamburg (1985) appear to r e i n f o r c e the Kreuter et a l d e f i n i t i o n i n t h e i r d e s c r i p t i o n of h e a l t h education i n schools as being an a p p l i e d s c i e n c e that i s b a s i c to a general education of c h i l d r e n and youth. T h e i r d e s c r i p t i o n i n c l u d e s a b e l i e f that i t i s a body of knowledge r e p r e s e n t i n g a s y n t h e s i s of f a c t s , p r i n c i p l e s and concepts, drawn from the b i o l o g i c a l , b e h a v i o r a l , s o c i o l o g i c a l and h e a l t h s c i e n c e s . T h i s body of knowledge i s d e s c r i b e d as being i n t e r p r e t e d i n terms of human needs, v a l u e s , and potent i a l . 23 2.2.2 H e a l t h Concept L i t e r a t u r e Of equal importance to the d e f i n i t i o n a l i n t e r p r e t a t i o n s of the school h e a l t h programme that e x i s t i n the l i t e r a t u r e i s the p a r a l l e l body of h e a l t h concept l i t e r a t u r e . S e l e c t e d w r i t i n g s from t h i s f i e l d are provided i n t h i s t h e s i s f o r the purpose of emphasizing the c o m p l e x i t i e s of the problematic s i t u a t i o n that i s being s t u d i e d . Within t h i s area there are s e v e r a l r e s e a r c h e r s who have attempted t o provide form and substance to our understandings about the concept of h e a l t h . Eberst (1984) proposed a m u l t i d i m e n s i o n a l model of h e a l t h t h a t i n c l u d e d the p h y s i c a l , emotional-mental, s o c i a l and s p i r i t u a l c a t e g o r i e s of h e a l t h . He contended t h a t school h e a l t h p r o f e s s i o n a l s , i n p a r t i c u l a r , have not been able to agree on one or a combination of p h i l o s o p h i c a l approaches. Eb e r s t s t a t e d that the conceptual nature of h e a l t h has h i s t o r i c a l l y been a complex phenomenon and one that has not been w e l l understood. Furthermore, he argued that s c h o o l h e a l t h p r o f e s s i o n a l s have n e g l e c t e d the t h e o r e t i c a l i s s u e s i n v o l v e d i n the ways by which we c o n c e p t u a l i z e h e a l t h . Gerhard Schaefer's res e a r c h (1980, 1984) rep r e s e n t s an e a r l i e r attempt to i n v e s t i g a t e h e a l t h concepts of school age c h i l d r e n by word a s s o c i a t i o n . When the re s e a r c h of Sc h a e f f e r (1980) i n Germany i s compared with a s i m i l a r word a s s o c i a t i o n study from the P h i l i p p i n e s ( V i l l a v i c e n z i o , 1981) the complexity of e s t a b l i s h i n g c u l t u r a l meanings f o r the word " h e a l t h " w i t h i n and between c u l t u r e s i s e v i d e n t . These two s t u d i e s r e v e a l e d both the complexity of c u l t u r a l i n t e r p r e t a t i o n s of h e a l t h and h e a l t h r e l a t i o n s h i p s , p a r t i c u l a r l y i n the students' concepts of i l l n e s s and medicine (Brumby, Garr a r d , and Auman, 1985). 24 Another c r o s s - c u l t u r a l study that attempted to look at the concept of h e a l t h , as evidenced i n s e v e r a l c o u n t r i e s i n c l u d i n g Canada, Germany, the P h i l i p p i n e s , Jordan, Japan, Barbados, and Kenya, was the I n t e r n a t i o n a l Union of B i o l o g i c a l Sciences/UNESCO study (Schaefer et a l , 1984). T h i s study of h e a l t h concepts suggested that students i n these c o u n t r i e s have d i f f e r e n t frameworks f o r c o n c e p t u a l i z i n g h e a l t h . The Canadian and German students p r i m a r i l y d e s c r i b e d h e a l t h i n p h y s i o l o g i c a l or body f u n c t i o n terminology, with the German data r e v e a l i n g a st r o n g emphasis on the students' a s s o c i a t i n g h e a l t h with the biom e d i c a l model of d i s e a s e , p r e v e n t i o n , and treatment. The P h i l i p p i n e students, on the other hand, had more p o s i t i v e a s s o c i a t i o n s with h e a l t h as a wellness concept and d i s p l a y e d a b e l i e f i n the s p i r i t u a l aspect of h e a l t h . Recent A u s t r a l i a n h e a l t h concept r e s e a r c h o r i g i n a t e d by Brumby and G a r r a r d (1982) and extended i n the j o i n t r e s e a r c h work of Brumby, Garrard and Auman (1985) i n v e s t i g a t e d student p e r c e p t i o n s of the concept of h e a l t h . A content a n a l y s i s of these students' understandings of the meaning of h e a l t h were d i s p l a y e d under the major co n c e p t u a l areas of the p h y s i c a l , mental, and s o c i a l domains of h e a l t h . They found that both secondary and t e r t i a r y students d e s c r i b e d h e a l t h p r i m a r i l y i n p h y s i c a l terms. The A u s t r a l i a n study i s of p a r t i c u l a r importance to t h i s r e s e a r c h because a Health Dimension C l a s s i f i c a t i o n scheme adapted from that study has been used as par t of the a n a l y s i s of data i n t h i s t h e s i s . Perry (1983) provided a f u r t h e r dimension to the conceptual problem of understanding h e a l t h . She s t a t e d that the notions of 25 h e a l t h and h e a l t h promotion each serve to connote a range of meanings that have d i f f e r e n t p e r s o n a l , s o c i a l and p o l i t i c a l s i g n i f i c a n c e . H e a l t h was d e s c r i b e d as encompassing at l e a s t four i n t e r r e l a t e d domains: p h y s i c a l h e a l t h ( p h y s i c a l and p h y s i o l o g i c a l f u n c t i o n i n g ) ; p s y c h o l o g i c a l h e a l t h (a s u b j e c t i v e sense of w e l l - b e i n g ) ; s o c i a l h e a l t h ( s o c i a l e f f e c t i v e n e s s and r o l e f u l f i l l m e n t ) and p e r s o n a l h e a l t h (the r e a l i z a t i o n of i n d i v i d u a l p o t e n t i a l ) . In a d d i t i o n to the h e a l t h concept l i t e r a t u r e there i s a p a r a l l e l body of r e s e a r c h that has focused on the p e r c e i v e d need to t e s t the h e a l t h knowledge that i s d i s p l a y e d by school aged c h i l d r e n . The Canada H e a l t h Knowledge Survey: 9, 12 and 15 Year  Olds (King, 1983) i s r e p r e s e n t a t i v e of t h i s r e s e a r c h . T h i s comprehensive study of h e a l t h knowledge t e s t e d 29,000 Canadian students i n Grades 4, 7, and 10. I t found that Grade 10 students i n B r i t i s h Columbia d i s p l a y e d inadequate h e a l t h knowledge in the areas of a l c o h o l , communicable d i s e a s e s , non-communicable d i s e a s e s , drugs ( i n c l u d i n g smoking), human s e x u a l i t y and f i t n e s s . The authors commented t h a t ....the r e s u l t s r e f l e c t a number of f a c t o r s ; the main f a c t o r , of course, i s the extent of h e a l t h t e a c h i n g by p a r e n t s , community and the media. (King, 1983, page 3) T h i s study i s i n c l u d e d as an example of s t u d i e s that have attempted to measure the extent of h e a l t h knowledge d i s p l a y e d by school aged c h i l d r e n . We appear to have some in f o r m a t i o n about adequate or inadequate l e v e l s of h e a l t h knowledge a t t a i n e d by some school aged c h i l d r e n , as e x e m p l i f i e d by such comprehensive t e s t i n g . 26 A d d i t i o n a l l y , there are s t u d i e s that have focused on the v a r i e t y of conceptual understandings that e x i s t about h e a l t h . However, what we appear to be l a c k i n g , p a r t i c u l a r l y w i t h i n the Canadian cont e x t , i s a base l i n e of knowledge about the fundamental nature of the school h e a l t h programme, both from a c u r r i c u l a r p e r s p e c t i v e as w e l l as the p e r s p e c t i v e of a s o c i a l c o n s t r u c t i o n of t h i s programme. In summary, the h e a l t h concept l i t e r a t u r e has been u s e f u l to the r e s e a r c h of t h i s t h e s i s . The concept of h e a l t h , as the l i t e r a t u r e i l l u s t r a t e s , i s a complex e n t i t y . I t i s a concept that changes with the i n t e r p r e t a t i o n of the i n d i v i d u a l and the group. The s o c i a l c o n s t r u c t i o n of the r e a l i t y of the school h e a l t h programme, which can be observed i n the documents of t h i s study, i s fundamentally t i e d to the d i f f e r e n t i n t e r p r e t a t i o n s of h e a l t h that appear i n these data. 2.2.3 T r a d i t i o n a l I n t e r p r e t a t i o n of School H e a l t h Programmes The body of l i t e r a t u r e t h a t has t r a d i t i o n a l l y represented school h e a l t h programme re s e a r c h has given l i t t l e n o t i c e to the complex nature of the programme. Instead, the focus has been p r i m a r i l y on s t u d i e s about the development, implementation and e v a l u a t i o n of school h e a l t h programmes. Many of these s t u d i e s have i n v o l v e d d e t a i l e d research work. Rep r e s e n t a t i v e of these s t u d i e s are the w r i t i n g s of Yager, Kabarec and Atwood (1985), Pigg (1983), the Canadian Education A s s o c i a t i o n survey (1978), and the School Health Education Study (U.S.D.H.W., 1967). Yager et a l (1985) d e s c r i b e d i n d e t a i l an e x t e n s i v e study of school h e a l t h education in Iowa in which a programme f o r d e s i g n i n g and 27 a s s e s s i n g comprehensive school h e a l t h education programmes were researched. Pigg (1983) c o n t r i b u t e d a comprehensive e v a l u a t i v e summary of school h e a l t h education i n f i v e s t a t e s of the U.S. A major recommendation of t h i s study was that a l l h e a l t h i n s t r u c t i o n at the secondary l e v e l be taught by a " c e r t i f i e d h e a l t h s p e c i a l i s t " . The School H e a l t h Education Study of 1967 i n v o l v e d a massive f e d e r a l e v a l u a t i o n of h e a l t h i n s t r u c t i o n throughout the U.S., with d e t a i l e d i n f o r m a t i o n p r o v i d e d i n t h i s r e p o r t on the development and implementation of these programmes. The Canadian Education A s s o c i a t i o n report p r o v i d e d an e x t e n s i v e survey of the s t a t u s of Canadian school h e a l t h education which i n c l u d e d the f o l l o w i n g recommendations: a) If h e a l t h education i s c o n s i d e r e d to be a separate s u b j e c t , we should ensure time and s t a t u s . b) If h e a l t h education i s i n t e g r a t e d with other s u b j e c t s , we should ensure that the coverage of h e a l t h t o p i c s i s a c t i v e l y pursued and not merely assumed. (C.E.A., 1978, page 56) Although comprehensive i n i t s d i s c u s s i o n of h e a l t h t e a c h i n g w i t h i n the c u r r i c u l a as d e f i n e d i n i t s survey q u e s t i o n s , many of the c o m p l e x i t i e s of the programme were not i n v e s t i g a t e d . S p e c i f i c a l l y , t h i s study d i d not d i s p l a y the depth and breadth of h e a l t h education t e a c h i n g p o s s i b i l i t i e s that are f o r m a l l y p r e s c r i b e d w i t h i n the c u r r i c u l a of the secondary s c h o o l s . I t a l s o f a i l e d to address the d i f f e r e n c e s i n b e l i e f s ' and understandings that e x i s t between d i f f e r e n t communities of the s c h o o l . 28 While f o c u s i n g on the t r a d i t i o n a l ways of p r e s e n t i n g s c h o o l h e a l t h r e s e a r c h the l i t e r a t u r e g e n e r a l l y appears to be d e f i c i e n t i n the area of s t u d i e s of complexity. Eberst (1984) has r a i s e d concerns about t h i s v o i d w i t h i n the l i t e r a t u r e . He has suggested t h a t school h e a l t h p r o f e s s i o n a l s put too much emphasis on the implementation phase at the expense of n e g l e c t i n g the more primary and f o u n d a t i o n a l i s s u e of the t h e o r e t i c a l c o n s t r u c t i o n of the concept of h e a l t h . The l a c k of d i s c u s s i o n as to complexity of the programme can be observed i n the more contemporary surveys and v a r i o u s r e s e a r c h r e p o r t s regarding the s t a t u s of the school h e a l t h programme i n the context of the Canadian school system. The Canada wide survey of the Canadian school aged h e a l t h programmes (Mutter, 1982) made only a p a s s i n g r e f e r e n c e to the p o s s i b l e problems of complexity. In t h i s regard the author advocated the employment of h e a l t h e d u c a t i o n c o o r d i n a t o r s f o r the purpose of f a c i l i t a t i n g b e t t e r c o o r d i n a t i o n between the v a r i o u s M i n i s t r i e s of Education and M i n i s t r i e s of H e a l t h . A follow-up survey by Mutter (1985) o f f e r e d no new i n s i g h t s i n t o the complexity of t h i s programme. A d d i t i o n a l l y , t h i s l a t e r study on the s t a t u s of Canada's school h e a l t h programmes acknowledged h e a l t h education as e x i s t i n g i n the sub j e c t areas of p h y s i c a l education and guidance, but ignored i t s e x i s t e n c e i n the s c i e n c e c u r r i c u l u m . A second contemporary r e p o r t on the s t a t u s of h e a l t h education i n the Province of B r i t i s h Columbia pres e n t s f u r t h e r evidence of the imprecise image of the school h e a l t h programme that i s found i n the l i t e r a t u r e . T h i s study i s the Report of the P r e s i d e n t i a l Task Force on Hea l t h Education i n B.C. Schools 29 ( B r i t i s h Columbia Medical A s s o c i a t i o n , 1984). I t presented f i n d i n g s of a study of h e a l t h education p r a c t i c e s i n B r i t i s h Columbia p u b l i c schools t h a t was conducted by a s p e c i a l task f o r c e of the B.C. Medical A s s o c i a t i o n . H i g h l i g h t s from the r e p o r t ' s summary i n c l u d e d : ....secondary schools i n t h i s p r o v i n c e do not demonstrate sound n u t r i t i o n a l p r a c t i c e s . P h y s i c a l f i t n e s s and p h y s i c a l education programs are adequately d i s t r i b u t e d i n the schools throughout the p r o v i n c e , but the l e v e l of i n d i v i d u a l p a r t i c i p a t i o n i s unknown. The major problem of adolescent substance abuse i s a l s o s e v e r e l y under-represented i n school c u r r i c u l a , p a r t i c u l a r l y at the secondary l e v e l . Again at the secondary s c h o o l l e v e l d i s c u s s i o n s on pregnancy c o n t r o l and sexual behaviour are a c t i v e l y avoided i n some s c h o o l s . The e d u c a t i o n system's r e l u c t a n c e to speak out on these i s s u e s i s most d i s c o u r a g i n g . (B.C.M.A., 1984, page 19) A major recommendation from t h i s study was that a mandatory h e a l t h c u r r i c u l u m f o r a l l students i n p r e - s c h o o l through grade 12 be developed and implemented i n a l l B r i t i s h Columbia s c h o o l s . The methodology for t h i s study i n v o l v e d the use of a q u e s t i o n n a i r e that was sent to a l l p u b l i c schools i n B r i t i s h Columbia i n which questions such as: what h e a l t h e d u c a t i o n s u b j e c t s ( a c c i d e n t p r e v e n t i o n , n u t r i t i o n , e t c.) are covered i n your c u r r i c u l u m . S p e c i f i c i n f o r m a t i o n r e l a t i n g to the number of minutes a l l o t e d , f o r example, to d a i l y n u t r i t i o n and f i t n e s s education was e l i c i t e d . Key informants of t h i s study were school p r i n c i p l e s or other d e s i g n a t e s . Teachers i n areas such as s c i e n c e , guidance, and p h y s i c a l education do not appear as respondents. A d d i t i o n a l l y , there i s no evidence i n t h i s study 30 to i n d i c a t e an i n t e r e s t i n f i n d i n g the ex t e n s i v e hidden c u r r i c u l u m of h e a l t h t e a c h i n g w i t h i n s u b j e c t areas that have been found t o e x i s t i n t h i s study. There are s i m i l a r i t i e s between t h i s B.C.M.A. re p o r t and the Mutter r e p o r t s (1982, 1985). In both i n s t a n c e s the r o l e of the sc i e n c e teacher as h e a l t h educator was omitted from the f i n d i n g s . A d d i t i o n a l l y , other secondary areas of h e a l t h t e a c h i n g such as home economics and consumer education were not adequately e x p l o r e d f o r f u r t h e r evidence of h e a l t h t e a c h i n g . Both the B.C.M.A. rep o r t and the Mutter r e p o r t s f a i l to r e v e a l the d i v e r s e programme of school h e a l t h that have been found to e x i s t w i t h i n the documents s t u d i e d i n t h i s t h e s i s . A recent r e p o r t from the Western Canada H e a l t h Education Interchange and Annual H e a l t h and P h y s i c a l Education Conference of May, 1986 ( s e c t i o n on B.C. by Johnson, 1986) presented a p i c t u r e of sch o o l h e a l t h education t h a t , while b r i e f and syn o p t i c i n i t s r e p o r t i n g , p o r t r a y e d f i n d i n g s both s i m i l a r and d i s s i m i l a r to those found i n t h i s study. V a l e r i e Johnson, as author of the B.C. s e c t i o n of t h i s r e p o r t , s t a t e d that at present h e a l t h education appears to lack a c o n s i s t e n t or comprehensive format w i t h i n the p u b l i c schools of B r i t i s h Columbia. She c h a r a c t e r i z e d t h i s s t a t e of h e a l t h education as being " s p o r a d i c , fragmented and i d i o s y n c r a t i c " . Commenting on the Secondary Guidance C u r r i c u l u m g u i d e l i n e s f o r teaching she observed that although there was a c o n s i d e r a b l e amount of d e s c r i p t i o n of t o p i c s and s e q u e n t i a l development provided i n t h i s document, i t lacked d i r e c t i o n s f o r implementation. Much of what Johnson found at the secondary l e v e l , i n terms of the lack 31 of c l e a r d i r e c t i v e s and uncoordinated nature of the programme, i s i n agreement with the f i n d i n g s of t h i s study. However, there are some d i s c r e p a n c i e s that appear when the f i n d i n g s of the Johnson report are compared with the f i n d i n g s of t h i s t h e s i s . For example, the Johnson r e p o r t , while acknowledging the r o l e of the p h y s i c a l education and guidance teachers as being i n v o l v e d i n school h e a l t h programmes, ignored the r o l e of the s c i e n c e teacher i n h e a l t h t e a c h i n g . In a d d i t i o n , the e x t e n s i v e hidden c u r r i c u l a of the t e a c h i n g subject areas surveyed i n t h i s t h e s i s do not appear i n t h i s r e p o r t . Furthermore, t h i s r e p o r t does l i t t l e to shed l i g h t on the complex s i t u a t i o n of teachers and h e a l t h p r o f e s s i o n a l s who are both i n v o l v e d i n t h i s programme. F i n a l l y , the s e c t i o n of t h i s r e p o r t e n t i t l e d "Future D i r e c t i o n s " r a i s e s q u e s t i o n s that are not adequately answered. For example, B.C. M i n i s t r y of Education o f f i c i a l s are repo r t e d i n t h i s document to have recognized the need f o r a complete review of h e a l t h education i n B.C. sch o o l s , f o l l o w e d by development and implementation of a comprehensive program t a r g e t e d for elementary and secondary schools (Johnson, 1986 page 13) The methodology f o r t h i s "complete review" i s not s p e c i f i e d , nor are we t o l d who i s to be i n v o l v e d i n t h i s a c t i v i t y . As the B.C.M.A. study i l l u s t r a t e s , i t i s p o s s i b l e to ask qu e s t i o n s and r e c e i v e answers that may not r e f l e c t the c o m p l e x i t i e s of such a programme. An a d d i t i o n a l unanswered q u e s t i o n that i s r a i s e d by the Johnson r e p o r t i s the referen c e to ....development and implementation of a comprehensive program t a r g e t e d f o r the elementary and secondary s c h o o l s . (Johnson, 1986, page 13) 32 If t h i s statement r e f e r s to the p o s s i b l e c r e a t i o n of a separate c u r r i c u l u m f o r the tea c h i n g of h e a l t h education i n s c h o o l s , i t would then appear that there i s a s i m i l a r i t y between the Johnson and the B.C.M.A. r e p o r t s . In summary, the Johnson r e p o r t p r o v i d e s yet another view of the B.C. school h e a l t h programme that serves to po i n t out the d i f f e r e n t kinds of p e r c e p t i o n s that can occur when re s e a r c h e r s focus t h e i r a t t e n t i o n on t h i s complex area of the work and tea c h i n g of the s c h o o l . The l a s t r e p o r t i n t h i s s e r i e s of Canadian focused s t u d i e s i s the Matters report of 1977, a r e p o r t commissioned by the B.C. M i n i s t r y of H e a l t h . In t h i s r e p o r t on the s t a t u s of sch o o l h e a l t h i n B.C., the author f a i l e d to mention any co n t a c t d u r i n g the w r i t i n g of h i s res e a r c h with the classroom teachers and t h e i r r o l e i n h e a l t h t e a c h i n g . In c o n t r a s t to the pr e v i o u s s t u d i e s , the emphasis was on the sch o o l h e a l t h programme as the domain of the p u b l i c h e a l t h nurse and other h e a l t h p r o f e s s i o n a l s under the d i r e c t i o n of the M i n i s t r y of Hea l t h as a u t h o r i z e d i n the School Act of B r i t i s h Columbia. Given the p e r s p e c t i v e of t h i s r e p o r t the reader would be l e d to conclude that h e a l t h education i s a non-event w i t h i n the classroom teaching and work a c t i v i t y of the v a r i o u s t e a c h i n g d i s c i p l i n e s represented i n the sc h o o l . A l a r g e r i s s u e appears to surround the Mutter (1982, 1985), B.C.M.A. (1984), Matters (1977), and Johnson (1986) s t u d i e s of the h e a l t h education programme w i t h i n B r i t i s h Columbia p u b l i c s c h o o l s . T h i s issue concerns the f a c t that none of these s t u d i e s appears to have addressed i n a comprehensive manner the c o m p l e x i t i e s and problematic s e t t i n g of t h i s area of work and 33 t e a c h i n g i n the s c h o o l . These s t u d i e s , while f o l l o w i n g the methodology of d e s c r i p t i v e s t u d i e s , have f a i l e d t o uncover the complex and e x t e n s i v e embedding of h e a l t h t e a c h i n g that e x i s t s i n major sub j e c t areas of the o f f i c i a l l y p r e s c r i b e d c u r r i c u l a . A d d i t i o n a l l y , they have ignored the unique s i t u a t i o n of the presence of the d i f f e r e n t communities of teachers and h e a l t h p r o f e s s i o n a l s who together s o c i a l l y c o n s t r u c t t h i s programme of school h e a l t h w i t h i n the s c h o o l . As a r e s u l t , a l i t e r a t u r e has been c r e a t e d that d i s p l a y s c e r t a i n f a c e t s of the school h e a l t h education programme while i g n o r i n g o t h e r s . These p a r t i c u l a r s t u d i e s have been i n c l u d e d f o r the purpose of f u r t h e r h i g h l i g h t i n g the unique s i t u a t i o n of t h i s programme i n the school that i s both d i f f i c u l t to d e f i n e and understand as w e l l as r e p r e s e n t a t i v e of an e n t i t y that r e q u i r e s f u r t h e r e l u c i d a t i o n . 2.2.4 L i t e r a t u r e I n d i c a t i n g Complexity Within the body of l i t e r a t u r e that i s r e l a t e d to school h e a l t h programmes there are some examples of r e s e a r c h i n which the complexity and problematic nature of t h i s area has been suggested as being an important phenomenon f o r study. Yager (1981), Doster (1985) and Garrard (In Press) are r e p r e s e n t a t i v e of r e s e a r c h e r s who have w r i t t e n about the e x i s t e n c e of h e a l t h education w i t h i n s u b j e c t areas and some of the complexity of t h i s c u r r i c u l a r embedding. Yager (1981) i n d i s c u s s i n g the problematic s i t u a t i o n of h e a l t h t e a c h i n g w i t h i n the c u r r i c u l u m of s c i e n c e touched on the nature of complexity that i s represented when these s u b j e c t areas are combined. Yager a l s o 34 observed t h a t i t appeared that more h e a l t h education was taught i n s u b j e c t s other than s c i e n c e and suggested that the s c i e n c e education community should r e f l e c t upon t h i s s i t u a t i o n i n terms of i t s own g o a l s and o b j e c t i v e s . He p r e d i c t e d that f u t u r e trends i n s c i e n c e t e a c h i n g i n the classroom would c e n t r e around a concern f o r human value s with a heightened awareness of the s u b j e c t i v e i s s u e s that surround s c i e n c e t e a c h i n g . Yager was l a t e r quoted by Doster (1985) as e x p r e s s i n g concern t h a t s c i e n c e might b e t t e r f u l f i l l i t s mandated r o l e by not attempting to subsume the r o l e of h e a l t h educator. Doster expanded f u r t h e r on the complexity of h e a l t h t e a c h i n g i n s u b j e c t areas such as s c i e n c e by contending that t e a c h e r s faced a dilemma i n t h i s a r e a. The teachers were p o r t r a y e d as having to o f t e n choose between extending t h e i r c u r r i c u l a to subsume p e r s o n a l and s o c i a l h e a l t h with attendant t e a c h i n g about a t t i t u d e s and v a l u e s aimed at h e a l t h behaviour i n s t e a d of f o c u s i n g on the more t r a d i t i o n a l views of t h e i r subject such as s c i e n c e . The q u e s t i o n of who should teach h e a l t h and where i t belonged in the c u r r i c u l a was r a i s e d as an unresolved s i t u a t i o n w i t h i n the s c h o o l . G a r r a r d (In Press) c i t e d the area of s c i e n c e as a subject in which many h e a l t h education t o p i c s a l r e a d y e x i s t e d . She observed t h a t science t e a c h e r s were i n v o l v e d i n the t e a c h i n g of h e a l t h through the medium of i n c o r p o r a t i n g h e a l t h r e l a t e d t o p i c s in g e n e r a l s c i e n c e and b i o l o g y and i n some in s t a n c e s through the t e a c h i n g of h e a l t h education as a separate s u b j e c t . G a r r a r d f u r t h e r s t a t e d that the time had a r r i v e d f o r the s h a r i n g of e x p e r t i s e to occur between s c i e n c e education and h e a l t h e d u c a t i o n . She made the p o i n t that i n s c i e n c e education there 35 appeared to be a p e r c e i v e d need to make sc i e n c e more p e r s o n a l l y and s o c i a l l y r e l e v a n t as w e l l as i s s u e based. In h e a l t h education the problem concerned where to i n c l u d e t h i s subject w i t h i n the a l r e a d y crowded c u r r i c u l a . The answer, she suggested, may l i e i n mutually b e n e f i c i a l i n t e r a c t i o n s between the two. Rohwer (1986) a l s o addressed the d i f f i c u l t i e s faced by r e s e a r c h e r s i n d e f i n i n g the p r e c i s e nature of the school h e a l t h programme. Some of the problems r e q u i r i n g s o l u t i o n s were: the lac k of agreement i n many school programmes as to what the content of h e a l t h education should be, the lack of c o o r d i n a t i o n of such programmes, and i n s u f f i c i e n t e f f o r t s at o r g a n i z i n g these programmes r e l a t i v e to agreed upon g o a l s , p h i l o s o p h i e s and course of study. H i s l o p (1986) observed that the school h e a l t h programme had been p o o r l y d e f i n e d and inadequately s t u d i e d . She d e s c r i b e d h e a l t h education as an area of the school that seemed to lack d i r e c t i o n as to what i t was and where i t should be going. E x p r e s s i n g views s i m i l a r to those of Balog (1981), she d e s c r i b e d school h e a l t h education as a d i s c i p l i n e that had been unable to c l e a r l y d e f i n e i t s boundaries. T h i s concern about the imprecise nature of boundaries appears to s u r f a c e i n s e v e r a l of the s t u d i e s about s c h o o l h e a l t h i n which the focus has been d i r e c t e d to the need to e x p l o r e the complexity of the s i t u a t i o n . Balog (1981) observed that the boundaries of school h e a l t h programmes are amorphic and p o o r l y d e f i n e d . He f u r t h e r contended that the complexity of the phenomena was d i r e c t l y r e l a t e d to the f a c t that h e a l t h as a concept i s a human c o n s t r u c t that i s s t r u c t u r e d by means of the process of s o c i a l c o n s t r u c t i o n . Auman (1982, 36 1983) a l s o observed that school h e a l t h boundaries, because they are so p o o r l y d e f i n e d , tend to impede our a b i l i t y to understand where h e a l t h teaching i s o c c u r i n g and who i s doing t h i s t e a c h i n g . T h i s present body of l i t e r a t u r e about school h e a l t h programmes i s u s e f u l i n i l l u s t r a t i n g the need f o r f u t u r e r e s e a r c h w i t h i n the area. G e n e r a l l y , there appears to have been more q u e s t i o n s r a i s e d than answered; more problems a l l u d e d to than s o l u t i o n s o f f e r e d . 2 . 3 S o c i o l o g i c a l Theory 2.3.1 I n t r o d u c t i o n In a d d r e s s i n g the p a r t i c u l a r r e s e a r c h problem of t h i s t h e s i s t hat i s e d u c a t i o n a l l y s i t u a t e d , the researcher s e l e c t e d s o c i o l o g i c a l theory that appeared to be w e l l s u i t e d to the problem. These s e l e c t e d and focused t h e o r e t i c a l viewpoints have been chosen to serve as methodological t o o l s i n a s s i s t i n g with an e x p l i c a t i o n of the f i n d i n g s and as a framework for the t h e o r e t i c a l l y informed content a n a l y s i s used in t h i s study. The theory used i s drawn from the general area of the s o c i o l o g y of knowledge. The s p e c i f i c t h e o r e t i c a l c o n s t r u c t s from w i t h i n t h i s f i e l d of i n q u i r y are those of Holzner and Marx (1979), Schutz (1962, 1967), and Smith (1974). These w r i t e r s are t h e o r i s t s w i t h i n the s o c i o l o g y of knowledge f i e l d . A p r i n c i p l e b e l i e f of these t h e o r i s t s i s that knowledge i s s o c i a l l y c o n s t r u c t e d , a term that r e f e r s to the b e l i e f that a l l knowledge i s a s o c i a l l y d e f i n e d r e a l i t y which i n d i v i d u a l s and 37 groups c o n s t r u c t i n v a r i o u s ways. Within t h i s t h e s i s the argument that w i l l u n d e r l i e a l l d i s c o u r s e i s that the two communities concerned with h e a l t h e d u c a t i o n , the e d u c a t i o n a l and the h e a l t h p r o f e s s i o n a l , represent d i v e r s e ways of understanding. T h e r e f o r e , they have developed and o p e r a t i o n a l i z e d d i f f e r e n t s o c i a l c o n s t r u c t s of the s c h o o l h e a l t h education programme. 2.3.2 Theory of Holzner and Marx Holzner and Marx (1979) c i t e d work on the s o c i a l l y c o n s t r u c t e d nature of the r e a l i t y of everyday l i f e as being a systematic extension and c o n t i n u a t i o n of i n s i g h t s from w i t h i n the c e n t r a l t r a d i t i o n of s o c i o l o g y . They r e f e r e d to the works of Schutz (1962, 1967), Beirger and Luckman (1966), and Holzner (1968, 1972) as being a major framework f o r t h e i r own t h e o r e t i c a l e x t e n s i o n s w i t h i n the area of knowledge c o n s t r u c t i o n and knowledge a p p l i c a t i o n . These authors provide a t h e o r e t i c a l framework a g a i n s t which assumptions about the everyday world can be examined. In t h e i r w r i t i n g s i n Knowledge A p p l i c a t i o n : the  Knowledge System i n S o c i e t y , Holzner and Marx (1979) observed that the o b j e c t i v e s of doing an a n a l y s i s of the s o c i a l c o n s t r u c t i o n of r e a l i t y i s both a modest as w e l l as an e m p i r i c a l p r o c e s s . The o b j e c t i v e i s the d e t e r m i n a t i o n and a n a l y s i s of the l a w f u l process that human a c t o r s use f o r the purpose of determining what i s r e a l f o r them and how they form knowledge from such e x p e r i e n c e s . The problem, as they v i s u a l i z e d i t , i s to seek to determine the s o c i a l context i n which knowledge i s formed, maintained, changed, d i s t r i b u t e d , and u t i l i z e d . Holzner 38 (1968) was c a r e f u l to c l e a r l y o u t l i n e w i t h i n h i s conceptual framework a s o c i o l o g i c a l d e f i n i t i o n of knowledge that was found to be u s e f u l to t h i s t h e s i s . He d e s c r i b e d knowledge as a communicable mapping of some aspect of an experienced r e a l i t y by the observer who conveys t h i s r e a l i t y i n symbolic terms. Holzner and Marx (1979) f u r t h e r observed that s i n c e knowledge must be s y m b o l i c a l l y represented and communicated t h i s a l s o means that i t must be s t r u c t u r e d i n terms of a p a r t i c u l a r symbol system that i s l i n k e d to the o b s e rver's stance and e x p e r i e n c e . Knowledge understood i n t h i s manner i s the c e n t r e and f o c a l p o i n t of the r e a l i t y c o n s t r u c t i o n p r o c e s s e s . The views of these t h e o r i s t s are p a r t i c u l a r l y u s e f u l i n t h e i r d e s c r i p t i o n s of the frames of r e f e r e n c e by which d i f f e r e n t groups o r i e n t themselves and i n so doing "see" the world. They suggested that our concept of knowledge i n i t s r e l a t i o n s h i p to the observer emphasizes the n e c e s s i t y to s p e c i f y the observer's p o s i t i o n and h i s p o i n t of view. Frame of r e f e r e n c e was d e f i n e d as being a s t r u c t u r e made up of t a k e n - f o r - g r a n t e d assumptions, p r e f e r e n t i a l usage of symbol systems and a n a l y t i c a l d e v i c e s with which the observer pursues h i s i n q u i r y . The frame of r e f e r e n c e d e f i n e s the r e l a t i o n s h i p of the observer to that which he knows and r e p r e s e n t s . Frames of r e f e r e n c e are u t i l i z e d i n o r i e n t i n g o u r s e l v e s to s p e c i f i c o b j e c t s , i n a s s i s t i n g with the c o n c e p t u a l i z a t i o n of what problems are and how the problems are c o n s t i t u t e d as w e l l as determining p o s s i b l e or permissable s o l u t i o n s . Of equal importance are the w r i t i n g s of Holzner and Marx con c e r n i n g e p i s t e m i c communities. E p i s t e m i c communities are 39 d e f i n e d as: ....knowledge o r i e n t e d work communities i n which c u l t u r a l standards and s o c i a l arrangements i n t e r p e n e t r a t e around a primary commitment to epistemic c r i t e r i a i n knowledge p r o d u c t i o n and a p p l i c a t i o n . (Holzner and Marx, 1979, page 108) Science was c i t e d as being an example of an e p i s t e m i c community. They f u r t h e r suggested t h a t any s p e c i a l way of knowing, in which development and e l a b o r a t i o n r e q u i r e s the establishment of an autonomous s o c i a l space, w i l l f o s t e r the c r e a t i o n of an e p i s t e m i c community. Power was d e s c r i b e d as being an i n t e g r a l p a r t of the e p i s t e m i c community because i t i s a key f a c e t of a l l s o c i a l i n t e r a c t i o n . Holzner and Marx f u r t h e r observed t h a t : Since e p i s t e m i c c r i t e r i a d e f i n e not only the nature of work w i t h i n the community, but a l s o the terms of i t s l e g i t i m a t i o n through a p p l i c a t i o n , the q u a l i t y of models f o r knowledge p r o d u c t i o n and knowledge a p p l i c a t i o n or use becomes a determinant and c o n s t r a i n t f o r both the i n t e r n a l workings of the community and t r a n s a c t i o n s across i t s boundary to p u b l i c or c l i e n t s . The e x p e r i e n t i a l base of an e p i s t e m i c community's r e f e r e n c e frame may w e l l be a major p o i n t d i f f e r e n t i a t i n g e p istemic communities. (Holzner and Marx, 1979, page 109) 2.3.3 Theory of Schutz The work of Schutz (1962, 1967) was d e s c r i b e d by Holzner and Marx (1979) as being c e n t r a l to t h e i r own r e s e a r c h . Schutz, i n h i s w r i t i n g s , o u t l i n e d a way of l o o k i n g at common-sense, ta k e n - f o r - g r a n t e d c o n s t r u c t s about knowledge that are p a r t i c u l a r l y a p p l i c a b l e to the research problem addressed i n t h i s study. The common sense world or everyday world of Schutz i s the locus of s o c i a l a c t i v i t y . Within t h i s s i t u a t i o n we experience r e l a t i o n s h i p s with one another, attempting to come to terms with each other as w e l l as with o u r s e l v e s . Because we 40 g e n e r a l l y take f o r granted t h i s on-going c o n s t r u c t i o n , we do not f u l l y apprehend or a p p r e c i a t e t h i s aspect of our d a i l y l i v e s . Schutz observed that each i n d i v i d u a l c o n t i n u a l l y i n t e r p r e t s what he encounters i n the world from the p e r s p e c t i v e of h i s p a r t i c u l a r i n t e r e s t s , motives, a s p i r a t i o n s , and i d e o l o g i c a l commitments. He observed that our b i o g r a p h i c a l , accumulated understandings as i n d i v i d u a l s have shaped the ways by which we i n t e r p r e t the everyday world around us. Schutz a l s o t h e o r i z e d about the s o c i a l d i s t r i b u t i o n of knowledge. Knowledge was d e s c r i b e d as being s o c i a l l y d i s t r i b u t e d throughout s o c i e t y with uneven p a t t e r n s of d i s t r i b u t i o n . Schutz c r e d i t e d each i n d i v i d u a l with having c e r t a i n areas of e x p e r t i s e . The i n d i v i d u a l s t r u c t u r i n g of knowledge comes from a system of p r e v a i l i n g r e l e v a n c e s and i s d i f f e r e n t f o r each i n d i v i d u a l . We may be expert i n the knowledge of some f i e l d s , but only m a r g i n a l l y acquainted with knowledge i n o t h e r s . In the i n s t a n c e of the e d u c a t i o n a l and h e a l t h p r o f e s s i o n a l communities there are obvious l i n e s of demarcation between t h e i r f i e l d s of expert knowledge and acquaintance knowledge. Schutz f u r t h e r observed that i n our d a i l y l i v e s we c o n s t r u c t what we p e r c e i v e as being the Other's f i e l d of acquaintance, of the scope and t e x t u r e of h i s knowledge. By t h i s p rocess we assume that o t h e r s are guided by p a r t i c u l a r s t r u c t u r e s that can be expressed by s e t s of constant motives l e a d i n g to p a r t i c u l a r p a t t e r n s of a c t i o n . In Schutz's theory of knowledge development and d i s t r i b u t i o n the i n d i v i d u a l and the groups to which he belongs are f o r e v e r engaged i n a process of 41 knowledge weaving i n which c e r t a i n s t r a n d s appear. T h i s process of knowledge c o n s t r u c t i o n or knowledge making i s a c o n t i n u a l process f o r the i n d i v i d u a l as w e l l as f o r the group to which he belongs. In Schutz's terms the threads f o r the process are s e l e c t e d from our everyday experience with the world around us. 2.3.4 Theory of Smith The c o n c l u d i n g author to be reviewed, from the f i e l d of the s o c i o l o g y of knowledge t h e o r i s t s , i s Dorothy Smith. Smith's 1974 a r t i c l e , The S o c i a l C o n s t r u c t i o n of Documentary R e a l i t y , p r o v i d e s a way of i l l u m i n a t i n g and i n t e r p r e t i n g documentary data that i s e s p e c i a l l y u s e f u l to t h i s study. Smith argued that our understanding of contemporary s o c i e t y i s very much mediated to us by the use of v a r i o u s kinds of documents. She observed t h a t : F a c t u a l statements i n documentary form, whether as news, data, i n f o r m a t i o n , the l i k e , stand i n f o r an a c t u a l i t y which i s not d i r e c t l y a c c e s s i b l e . S o c i a l l y o r g a n i z e d p r a c t i c e s of r e p o r t i n g and r e c o r d i n g work upon what a c t u a l l y happens or has happened to c r e a t e a r e a l i t y i n documentary form .... (Smith, 1974, page 265) Smith's w r i t i n g s appear to be congruent with the knowledge a p p l i c a t i o n t h e o r i e s of Holzner and Marx (1979), and the everyday experience grounding of i n t e r p r e t i v e understandings o u t l i n e d by Schutz (1962, 1967). In commenting s p e c i f i c a l l y about the genesis of documentary r e a l i t y from w i t h i n o r g a n i z a t i o n a l s t r u c t u r e s Smith observed that c o n t a i n e d i n the context of the formal o r g a n i z a t i o n there i s the process whereby f a c t u a l r e c o r d s , or documents, are made as a continuous end product of the e n t e r p r i s e . She s t a t e d that t h i s process depends upon and takes f o r granted a background knowledge of the way 42 t h i n g s get done; how what i s observed i s c o n s t i t u t e d as observed w i t h i n the p r a c t i c e and r e c o g n i t i o n of the members of that o r g a n i z a t i o n a l community. The l i n g u i s t i c format of the message w i t h i n the document was commented upon by Smith: In general the terminology depends upon and takes in i m p l i c i t l y p r o p e r t i e s of o r g a n i z a t i o n which i t does not e x p l i c a t e . These p r o p e r t i e s are an e s s e n t i a l context to the uses of terminology and an e s s e n t i a l resource i n how i t makes sense. (Smith, 1974, page 265) Using a Marxian framework she made the analogy that the r e l a t i o n s h i p we have to others w i t h i n s o c i e t y i s i n a sense mediated by the r u l e of s o c i a l o r g a n i z a t i o n s . Knowledge in t h i s sense i s i d e o l o g i c a l because the s o c i a l o r g a n i z a t i o n preserves the concepts and the d e s c r i p t i v e means th a t represent the world as i t i s f o r those who r u l e i t r a t h e r than f o r those who are r u l e d . For the purpose of the school h e a l t h education phenomena being s t u d i e d i n t h i s t h e s i s , Smith's summarization c o u l d be r e s t a t e d as f o l l o w s . The knowledge represented w i t h i n the concept of school h e a l t h education i s i n f a c t i d e o l o g i c a l because the s o c i a l o r g a n i z a t i o n s of both the educators and s c h o o l h e a l t h p r o f e s s i o n a l s preserve t h e i r own concepts and the d e s c r i p t i v e means whereby t h i s phenomena i s represented. Furthermore, these two d i v e r s e communities that c l a i m ownership to the area of school h e a l t h education as r e f l e c t e d i n these documents appear to have c o n s t r u c t e d a domain of knowledge i n which there are d u a l i s t i c c l a i m s to knowledge p r o d u c t i o n and knowledge ownership. The l i t e r a t u r e r e l a t e d to the r e s e a r c h of t h i s t h e s i s can be summarized as f o l l o w s . School h e a l t h l i t e r a t u r e g e n e r a l l y 43 informs the reader of the development, implementation and e v a l u a t i o n of these programmes, but does not adequately address the u n d e r l y i n g c o m p l e x i t i e s of the s i t u a t i o n . H e a l t h concept l i t e r a t u r e conveys much of the complexity of the concept of h e a l t h but does not focus on the complexity of the p r o f e s s i o n a l communities which make up the school h e a l t h programme. The body of l i t e r a t u r e r e f e r r e d to as the s o c i o l o g y of knowledge pro v i d e s a t h e o r e t i c a l b a s i s from which the complex nuances of t h i s unique s c h o o l programme can be examined. O v e r a l l the l i t e r a t u r e serves to anchor the study w i t h i n a c o n t e x t u a l framework and to provide a b a s i s f o r the c o n s t r u c t i o n of f u r t h e r i n s i g h t s i n t o the problem researched. 44 CHAPTER I I I RESEARCH METHODOLOGY 3.1 Introduct ion The r e s e a r c h methodology chosen f o r the documentary a n a l y s i s i n t h i s r e s e a r c h i s content a n a l y s i s . Content a n a l y s i s i s p a r t i c u l a r l y u s e f u l i n e d u c a t i o n a l r e s e a r c h where a c u r r i c u l u m a n a l y s i s i s the c e n t r a l focus (Borg and G a l l , 1983). Carney (1972) r e f e r s to content a n a l y s i s as being most s u i t a b l e f o r s t u d i e s i n which an aspect of s o c i a l r e a l i t y i s pursued. H o l s t i (1969) advocates i t s use i n s t u d i e s that compare messages from two or more d i f f e r e n t sources, where the i n t e n t i s to r e l a t e t h e o r e t i c a l d i f f e r e n c e s between these communications. The p a r t i c u l a r form of a n a l y s i s chosen f o r t h i s study i s t h e o r e t i c a l l y informed content a n a l y s i s . T h e o r e t i c a l l y informed content a n a l y s i s i s always t i e d to the theory that u n d e r l i e s the res e a r c h (Carney, 1972). In t h i s study the theory i s based on the S o c i o l o g y of Knowledge t h e o r i s t s whose w r i t i n g s form the framework of t h i s t h e s i s (Schutz, 1962, 1967; Holzner and Marx, 1979; and Smith, 1974). Chapter III c o n t a i n s a d e t a i l e d d i s c u s s i o n of the process of content a n a l y s i s as i t i s used i n t h i s r e s e a r c h and i t s o v e r a l l grounding to the u n d e r l y i n g theory of t h i s t h e s i s . 3.1.1 Data Base To develop the data base of t h i s r e s e a r c h study, an i n i t i a l d e c i s i o n was made concerning s e l e c t i o n and d e l i m i t a t i o n . The 45 data base f o r the teacher documents was found w i t h i n the f o r m a l l y p r e s c r i b e d and p u b l i s h e d c u r r i c u l u m guides i n the areas of Secondary P h y s i c a l Education C u r r i c u l u m and Resource Guide (B.C.M.E., 1980), Junior-Secondary Science C u r r i c u l u m and  Resource Book (B.C.M.E., 1983), Secondary School C u r r i c u l u m  Guide - Guidance (B.C.M.E., 1971), and Goal M from Guide to the  Core Cu r r i c u l u m (B.C.M.E., 1977). These s u b j e c t areas of s p e c i f i c c u r r i c u l a were chosen as being r e p r e s e n t a t i v e of courses i n which a m a j o r i t y of secondary students were e n r o l l e d . The educator data a l s o r e p r e s e n t c u r r i c u l u m documents in which a d i s c u s s i o n of the s u b j e c t area as r e l a t e d to the o v e r a l l concept of the school h e a l t h education program i s l i k e l y to occur. The second corpus of data c o n s i s t s of two o f f i c i a l l y p r e s c r i b e d and p u b l i s h e d documents that are r e l a t e d to school h e a l t h programmes. These h e a l t h p r o f e s s i o n a l documents were s e l e c t e d as being the documentary e q u i v a l e n t to the teacher data. The f i r s t document i s P u b l i c H e a l t h Nursing Program f o r  School Age C h i l d r e n (B.C.M.H., 1982). T h i s document o u t l i n e s o v e r a l l g o a l s , o b j e c t i v e s , and program g u i d e l i n e s . The second document i s e n t i t l e d School Health Program Procedures Manual ( M a r s h a l l , 1982). T h i s manual i s the f o r m a l l y p r e s c r i b e d and p u b l i s h e d procedure guide used by the M e t r o p o l i t a n H e a l t h U n i t , C i t y of Vancouver, in which o b j e c t i v e s , r o l e s , and d a i l y work procedures of school h e a l t h programmes are o u t l i n e d . D i s c u s s i o n s with M i n i s t r y of Health o f f i c i a l s i n d i c a t e that i t r e f l e c t s the c e n t r a l p o l i c y and g u i d e l i n e s throughout the p r o v i n c e . I t i s important to p o i n t out that while there are d i f f e r e n t 46 years a t t a c h e d to these documents, the documents were contemporary, in-use, o f f i c i a l l y p r e s c r i b e d guidebooks at the time t h a t t h i s study began. The year attached to the document i n d i c a t e s the year of l a s t r e v i s i o n . An o v e r a l l i n t e r e s t g u i d i n g the s e l e c t i o n of these documents was the i n t e n t of the a n a l y s t to i n v e s t i g a t e both e x p l i c i t as w e l l as i m p l i c i t documentary o r i e n t a t i o n s about school h e a l t h from r e p r e s e n t a t i v e data of teachers and h e a l t h p r o f e s s i o n a l communities. . I m p l i c i t documents i n t h i s study r e f e r s t o c u r r i c u l u m guides i n which the h e a l t h r e l a t e d work and t e a c h i n g i s presented as an i n d i r e c t or hidden aspect of the document. H e a l t h teaching w i t h i n these documents i s not g e n e r a l l y d i r e c t l y s t a t e d or expressed. E x p l i c i t documents are those i n which the h e a l t h r e l a t e d work and t e a c h i n g i s presented as the c e n t r a l aspect of the document, and as such i s c l e a r l y and p r e c i s e l y expressed and i s r e f e r r e d to g e n e r a l l y as a hidden c u r r i c u l u m . The task of a n a l y s i s i n t h i s study has not been an easy one, p r i m a r i l y because the communities are d i f f e r e n t i n t h e i r s t r u c t u r e s and o r i e n t a t i o n s . There appears to be an e x p l i c i t assumption w i t h i n the h e a l t h p r o f e s s i o n a l documents that t h i s p r o f e s s i o n a l community i s p e r c e i v e d as being a community whose work and t e a c h i n g i n the area of the school h e a l t h programme i s r e a d i l y understood and as such i s communicated i n these documents. On the other hand, these assumptions do not appear to be communicated in the teacher documents. They c o n t a i n a number of statements r e l e v a n t to the t e a c h e r ' s involvement with the o v e r a l l programme of school h e a l t h that can be c h a r a c t e r i z e d as g e n e r a l l y i n d i s t i n c t . T h i s 47 may, i n f a c t , r e f l e c t the s i t u a t i o n f o r teachers that Yaeger (1981) and Kreuter, C h r i s t e n s e n , and Davis (1983) have d i s c u s s e d . These w r i t e r s have suggested that teachers are i n f a c t i n v o l v e d with the work and t e a c h i n g of the school h e a l t h programme. However, i t i s a more i n d i r e c t , obscure involvement when compared to that of the h e a l t h p r o f e s s i o n a l . An extended d i s c u s s i o n of the d i f f e r e n c e s that e x i s t between the communities of teachers and h e a l t h p r o f e s s i o n a l s i s c o n t a i n e d i n Chapter V. 3.1.2 R a t i o n a l e and Use of Content A n a l y s i s Content a n a l y s i s has been chosen as the most a p p r o p r i a t e methodology f o r t h i s a n a l y s i s of c u r r i c u l u m documents. The methodological d i s c u s s i o n of t h i s chapter has been expanded f o r the f o l l o w i n g reasons. F i r s t l y , the author found that i t was important to d e f i n e the o p e r a t i o n a l r u l e s under which t h i s methodology was conducted. T h i s was done i n order to c l a r i f y f o r the reader the p r e c i s e c o n d i t i o n s under which content a n a l y s i s was employed. Secondly, many examples of the content a n a l y s i s methodology i n use w i t h i n t h i s study have been pr o v i d e d f o r other r e s e a r c h e r s who may wish to r e p l i c a t e or expand such a study. 3.1.3 D e f i n i n g Content A n a l y s i s Content a n a l y s i s i s a r e s e a r c h t o o l that i s f r e q u e n t l y used i n the s o c i a l s c i e n c e s , ( H o l s t i , 1969; Carney, 1972). I t i s e s p e c i a l l y s u i t a b l e f o r s t u d i e s i n v o l v i n g d e s c r i p t i v e data c o m p i l a t i o n and i n r e s e a r c h that t e s t s or extends t h e o r i e s (Borg and G a l l , 1983). I t i s a methodology that i s most a p p r o p r i a t e 48 f o r use i n i n s t a n c e s i n which v e r b a l , w r i t t e n or p i c t o r i a l data i s t o be analyzed f o r the content of u n d e r l y i n g communication. Carney (1972) d e s c r i b e d content a n a l y s i s as being a p p l i e d with maximum s u i t a b i l i t y i n the a n a l y s i s of the images which people have about c e r t a i n aspects of r e a l i t y . B e r e l s o n (1952) advocated i t s use i n i d e n t i f y i n g s p e c i f i c message c h a r a c t e r i s t i c s i n an o b j e c t i v e and systematic manner. He s t i p u l a t e d t h at a major purpose of content a n a l y s i s i s the making of i n f e r e n c e s . The i n f e r e n c e making, i n t h i s study, c o n s t i t u t e s the f i n a l phase of a n a l y s i s i n which the documentary p a t t e r n s of b e l i e f s , i n t e n t i o n s , and end products of the work and t e a c h i n g of teachers and h e a l t h p r o f e s s i o n a l s i n t h i s area are d i s c u s s e d . 3.1.4 T h e o r e t i c a l l y O r i e n t e d Content A n a l y s i s The s p e c i f i c type of content a n a l y s i s t h a t i s used i n t h i s study i s t h e o r e t i c a l l y o r i e n t e d content a n a l y s i s which appears to have c e r t a i n advantages f o r the type of r e s e a r c h that i s pursued i n t h i s study. Some form of theory always u n d e r l i e s the work of t h e o r e t i c a l content a n a l y s i s and p r o v i d e s a b a s i s of i n q u i r y . The t h e o r e t i c a l framework e s t a b l i s h e s a p a r t i c u l a r frame of re f e r e n c e and a s t a b i l i t y f o r the process of i n q u i r y . In t h i s study the t h e o r e t i c a l w r i t i n g s of the s o c i o l o g y of knowledge r e l a t e d to the s o c i a l c o n s t r u c t i o n of knowledge and the l i n k a g e of t h i s knowledge to epi s t e m i c communities serves to prov i d e a s t r o n g , t h e o r e t i c a l l y sound base f o r the a n a l y t i c a l process of content a n a l y s i s . The theory i s used to c r e a t e c a t e g o r i e s thereby c r e a t i n g a str o n g l i n k between the theory and 49 f i n d i n g s . Carney (1972) i n w r i t i n g about t h i s t h e o r e t i c a l b a s i s of i n q u i r y , d e s c r i b e d the process as p r o v i d i n g s t a b i l i t y f o r the o v e r a l l r e s e a r c h work of content a n a l y s i s . He suggested that i n order f o r a r e l i a b l e a n a l y s i s to be accomplished there must be a t h e o r e t i c a l b a s i s or body of f i n d i n g s that w i l l serve to guide the work. 3.1.5 Advantages and C o n s t r a i n t s There are c l e a r l y d e f i n e d advantages as w e l l as c o n s t r a i n t s i n the use of content a n a l y s i s . I t i s imperative that the r e s e a r c h e r be cognizant of both aspects before d e c i d i n g on the a p p r o p r i a t e n e s s of t h i s methodology. The i s s u e s of r e l i a b i l i t y , v a l i d i t y , and systematic u t i l i t y have been addressed i n t h i s study and w i l l be d i s c u s s e d as f o l l o w s . 3.1.6 The I n t e r p r e t a t i o n of V a l i d i t y T r a d i t i o n a l l y the term v a l i d i t y has been used to designate the degree to which a s p e c i f i c measurement produces data that r e f l e c t s accepted i n t e r p r e t a t i o n s about a s p e c i f i c concept. In t h i s t h e s i s the school h e a l t h programme and i t s i n t e r p r e t a t i o n i n v a r i o u s c u r r i c u l a documents has been i n v e s t i g a t e d . Whereas the broad conceptual area e x p l o r e d was the school h e a l t h programme, t h i s i n v e s t i g a t i o n a l s o focused on the c e n t r a l concept of " h e a l t h " . Because " h e a l t h " i s a concept with l i t t l e agreed upon consensus of d e f i n i t i o n , the working d e f i n i t i o n f o r e x t r a c t i o n of data depended on the most widely used d e f i n i t i o n of h e a l t h , as i n t e r p r e t e d by the World He a l t h O r g a n i z a t i o n (1978) and the more recent h e a l t h concept rese a r c h of Brumby, 50 G a r r a r d , and Auman (1985). In the f i n a l a n a l y s i s the v a l i d i t y of t h i s study i s based on the f o l l o w i n g . F i r s t l y , as p r e v i o u s l y d i s c u s s e d , a commonly used working d e f i n i t i o n of " h e a l t h " was employed i n i t i a l l y f o r the purpose of verbatim data e x t r a c t i o n of h e a l t h statements from a l l documents researched i n t h i s study. Secondly, the A u s t r a l i a n H e a l t h C l a s s i f i c a t i o n , a scheme that f u r t h e r c l a s s i f i e s h e a l t h dimensions, was used as an a d d i t i o n a l a n a l y t i c a l t o o l . T h i r d l y , the c a t e g o r i e s of a n a l y s i s d e r i v e d from the s o c i o l o g i c a l t h e o r i e s that frame t h i s study were e q u a l l y a p p l i e d to the data. F o u r t h l y , the i n f e r e n c e s drawn from the f i n d i n g s were i n t e r p r e t e d i n the context of the S o c i o l o g y of Knowledge theory, a theory whose b a s i c assumption i s p r e d i c a t e d on the b e l i e f t h a t a l l knowledge i s s o c i a l l y c o n s t r u c t e d . 3.1.7 R e l i a b i l i t y and V a l i d i t y The l i t e r a t u r e p e r t a i n i n g to c o n t e n t ' a n a l y s i s c o n t a i n s a v a r i e t y of d i r e c t i v e s about the i s s u e s of r e l i a b i l i t y and v a l i d i t y . Babbie (1986) addressed the s i t u a t i o n as f o l l o w s . He contended that the content a n a l y s t faces a fundamental c h o i c e between v a l i d i t y and s p e c i f i c i t y . In the coding of manifest content there i s a s p e c i f i c i t y s i m i l a r to that of a s t a n d a r d i z e d q u e s t i o n n a i r e . Manifest content coding has the advantages of ease and r e l i a b i l i t y ; a disadvantage of v a l i d i t y . The q u e s t i o n to be answered i s how v a l i d i s the content counted. Is there a deeper, more meaningful i n t e r p r e t a t i o n that can be made? A l t e r n a t i v e l y , Babbie recommended that communication can be 51 coded f o r i t s l a t e n t content, i t s u n d e r l y i n g meaning. T h i s method i n c r e a s e s the v a l i d i t y but decreases r e l i a b i l i t y . He suggested that the s o l u t i o n t o the problem was to i n s u r e both r e l i a b i l i t y and v a l i d i t y by u s i n g both methods whenever p o s s i b l e . In t h i s study both manifest and l a t e n t a s p e c t s of content have been analyzed. For example, the f i n d i n g s i n c l u d e t a b u l a t i o n s i n C a t e g o r i e s I and I I I of how o f t e n c e r t a i n H e a l t h Dimension C l a s s i f i c a t i o n s u b - c a t e g o r i e s , such as "drugs" and " n u t r i t i o n " , appear i n the d a t a . In a d d i t i o n , these t a b u l a t i o n s are a l s o i n t e r p r e t e d f o r t h e i r u n d e r l y i n g meanings. Berelson (1952) observed that v a l i d i t y does not seem to be a major problem f o r the content a n a l y s t . G e n e r a l l y , he suggested that a c a r e f u l d e f i n i t i o n of c a t e g o r i e s and a w e l l thought out a n a l y t i c a l scheme would take care of the problem. He a l s o s t a t e d that r e l i a b i l i t y i s enhanced through the f o l l o w i n g p r o c e s s e s : f i n d i n g simple c a t e g o r i e s and u n i t s of a n a l y s i s ; u t i l i z i n g e xperienced and w e l l t r a i n e d coders; and producing p r e c i s e and complete s e t s of coding r u l e s as w e l l as i l l u s t r a t i o n s or examples. T h i s study has attempted to address a l l these processes. The u n i t of a n a l y s i s , the theme of the category, was kept as simple as p o s s i b l e . Secondly, the r e s e a r c h e r , the s o l e coder, had used t h i s methodology i n other s t u d i e s and t h e r e f o r e had p r i o r knowledge and f a m i l i a r i t y with the technique. T h i r d l y , the d e c i s i o n r u l e s i n t h i s t h e s i s were w r i t t e n to r e f l e c t both the p r e c i s i o n and complexity of the task. F i n a l l y , the author has provided e x t e n s i v e i l l u s t r a t i o n s through the use of examples that are i n t e r s p e r s e d throughout the study. 52 Borg and G a l l (1983) d i s c u s s e d the n e c e s s i t y to c l e a r l y d e f i n e the d e c i s i o n r u l e s that are used i n the c l a s s i f i c a t i o n system of content a n a l y s i s i n order to ensure r e l i a b i l i t y . The c l e a r d e f i n i t i o n a l use of d e c i s i o n r u l e s i s p r e d i c a t e d on the assumption t h a t the o v e r a l l c l a s s i f i c a t i o n system i s i t s e l f w e l l thought out and developed to match the r e s e a r c h i n t e n t of the a n a l y s t . The d e c i s i o n r u l e s f o r the a n a l y s i s of data of t h i s study are d i s c u s s e d i n d e t a i l under D e c i s i o n Rules i n t h i s chapter. In a d d i t i o n to adhering to the o v e r a l l process of checks and balances suggested by Berelson (1952) in d i s c u s s i o n of r e l i a b i l i t y and v a l i d i t y , the f o l l o w i n g procedures were used i n t h i s study as f u r t h e r safeguards. Because the r e s e a r c h extended over a p e r i o d of s e v e r a l years there was ample time to c a r e f u l l y r e f i n e category development and i n t e r p r e t a t i o n . D i s c u s s i o n s were h e l d with informed c o l l e a g u e s concerning the r e l i a b i l i t y and v a l i d i t y of the study's category c o n s t r u c t i o n and i s s u e s such as i n c l u s i o n or e x c l u s i o n of the few unusual or a t y p i c a l statements that were found i n the c u r r i c u l a documents. I t was a l s o found u s e f u l to compare these unusual statements with the accompanying textbook for f u r t h e r c l a r i f i c a t i o n . G e n e r a l l y , the p r e v i o u s l y d i s c u s s e d process o f : c l e a r l y d e f i n e d category c o n s t r u c t i o n ; the c a r e f u l a n a l y t i c a l technique pursued by the s o l e coder; u t i l i z a t i o n of p r e c i s e coding r u l e s ; and use of e x t e n s i v e examples addressed the problem of r e l i a b i l i t y and v a l i d i t y . 53 3.1.8 Q u a n t i t a t i v e versus Q u a l i t a t i v e Aspects of the Study Much of the l i t e r a t u r e c oncerning content a n a l y s i s appears to d i v i d e t h i s methodology i n t o two d i v e r s e groups. The f i r s t of these groups can be d e s c r i b e d as c l a s s i c a l content a n a l y s i s i n which the process of q u a n t i f i c a t i o n of data i s a c e n t r a l i s s u e . The second group can be d e s c r i b e d as p r i m a r i l y q u a l i t a t i v e i n approach, with l i t t l e emphasis being p l a c e d on the need to q u a n t i f y data i n order to be able to draw i n f e r e n c e s from the f i n d i n g s . As background to the p o i n t of view that i s taken i n t h i s study, the w r i t i n g s of Berelson (1952) are p a r t i c u l a r l y u s e f u l . He s t a t e s that there can be no r i g i d dichotomy between q u a n t i t a t i v e and q u a l i t a t i v e a n a l y s i s . He a l s o observes that j u s t as q u a n t i t a t i v e a n a l y s i s a s s i g n s r e l a t i v e f r e q u e n c i e s to d i f f e r e n t q u a l i t i e s (or c a t e g o r i e s ) , q u a l i t a t i v e a n a l y s i s a l s o c o n t a i n s q u a n t i t a t i v e statements i n a rough form. In t h i s study, f o r example, although the primary focus i s q u a l i t a t i v e , there are numerical f r e q u e n c i e s p r o v i d e d f o r c a t e g o r i e s of statements that were amenable to q u a n t i f i c a t i o n . A d d i t i o n a l l y , the u t i l i z a t i o n of such terms as "more emphasis" or "no r e f e r e n c e s " provide q u a n t i t a t i v e i n f o r m a t i o n about the data that adds to the o v e r a l l a n a l y s i s of areas of r e s e a r c h pursued i n t h i s study. In g e n e r a l , the focus of t h i s study i s q u a l i t a t i v e r a t h e r than q u a n t i t a t i v e and c e n t r e s around the u t i l i z a t i o n of t h e o r e t i c a l l y informed content a n a l y s i s . Berelson suggested that the q u a l i t a t i v e a n a l y s t i s r e l a t i v e l y l e s s concerned with the content as such than with the content as r e f l e c t i n g a deeper and more complex phenomena under study. He a l s o s t a t e d that 54 q u a l i t a t i v e a n a l y s i s i s o r i e n t e d toward a methodological i n t e n t to look at a n a l y s i s u n i t s on the assumption that meanings p r e s i d e w i t h i n the t o t a l i t y of impression, the G e s t a l t , not w i t h i n an a t o m i s t i c combination of measurable u n i t s . The o v e r a l l i n t e n t i n t h i s study was to uncover and e x p l i c a t e t h i s t o t a l impression of the phenomena of the school h e a l t h programme as documentarily d i s p l a y e d . 3.1.9 Research Methodology and T h e o r e t i c a l Framework The s e l e c t i o n of the most a p p r o p r i a t e methodology f o r documentary a n a l y s i s was determined i n the f o l l o w i n g manner. F i r s t l y , the a n a l y s i s i n v o l v e d a documentary data base from which comparisons between groups were made. Secondly, the r e s e a r c h q u e s t i o n s to be asked of the data i n v o l v e d a c e n t r a l idea or theme that was to be a n a l y z e d . In both i n s t a n c e s the c h o i c e of t h e o r e t i c a l l y informed content a n a l y s i s was found to be u s e f u l . The s e l e c t i o n of t h e o r e t i c a l l y informed content a n a l y s i s i n d i c a t e s an on-going emphasis on the u n d e r l y i n g theory of the study. The theory of t h i s r e s e a r c h was b u i l t on the w r i t i n g s of s o c i o l o g y of knowledge t h e o r i s t s : Holzner and Marx (1979), Schutz (1962, 1967) and Smith (1974). These t h e o r i s t s p r o v i d e a s o c i o l o g i c a l p e r s p e c t i v e that enhances our a b i l i t y to b e t t e r understand the problematic s i t u a t i o n of the s c h o o l h e a l t h programme. Smith (1974) has s t a t e d that much of what we know about the world i s mediated to us through the use of documents. Documents r e f l e c t a s o c i a l c o n s t r u c t i o n of a p a r t i c u l a r r e a l i t y . In t h i s t h e s i s i t i s argued that the documents analyzed from the 55 communities of teachers and h e a l t h p r o f e s s i o n a l s r e f l e c t the p a r t i c u l a r ways i n which sc h o o l h e a l t h education programmes are documentarily c o n s t r u c t e d . In a d d i t i o n to the theory of documentative s u b s t a n t i a t i o n of s o c i a l r e a l i t y that i s represented i n the w r i t i n g s of Smith (1974), there i s the focus on the two communities embedded i n t h i s study, the teachers and h e a l t h p r o f e s s i o n a l s . A c e n t r a l concept that guides t h i s t h e s i s i s the b e l i e f t h a t these two communities represent two d i s t i n c t l y d i f f e r e n t e p istemic communities. As a r e s u l t of t h i s d i f f e r e n t i a t i o n between communities, the school h e a l t h programme may be understood and o p e r a t i o n a l i z e d i n d i v e r s e ways. Holzner and Marx (1979) f u r t h e r c o r r o b o r a t e t h i s view i n t h e i r w r i t i n g s on the s o c i a l c o n s t r u c t i o n of r e a l i t y that occurs between epis t e m i c communities such as that of the teachers and h e a l t h p r o f e s s i o n a l s . Schutz (1962, 1967) broadens t h i s p e r s p e c t i v e of the i n t e r p r e t a t i o n of s o c i a l r e a l i t y i n h i s w r i t i n g s p e r t a i n i n g to the b i o g r a p h i c a l c o n s t r u c t i o n of p e r s o n a l and group r e a l i t i e s . He observes that the s o c i a l b i o g r a p h i e s of such communities and the ways in which our b i o g r a p h i c a l e xperiences have culminated i n d i f f e r e n t p e r s p e c t i v e s has c r e a t e d a s i t u a t i o n whereby we have d i f f e r e n t i n t e r p r e t a t i o n s of s o c i a l r e a l i t i e s . In summary, the t h e o r i e s of Schutz (1962, 1967), Smith (1974), and Holzner and Marx ( 1979) serve to guide the a n a l y s i s in p r o v i d i n g the t h e o r e t i c a l framework upon which both the r e s e a r c h q u e s t i o n s and c a t e g o r i e s are based. The methodology of t h e o r e t i c a l l y informed content a n a l y s i s was c l o s e l y t i e d to the o v e r a l l theory of the r e s e a r c h . Both content a n a l y s i s and the 56 u n d e r l y i n g t h e o r i e s of t h i s study p r o v i d e d f o r the systematic e x t r a c t i o n of data and data a n a l y s i s which preceded the making of i n f e r e n c e s . The methodology served to guide the p r e c i s e , o b j e c t i v e b u i l d i n g of documentarily r e f l e c t e d a s p e c t s of the c u r r i c u l a from which a mosaic of s e l e c t e d f a c e t s of the school h e a l t h programme was c o n s t r u c t e d . 3.2 P r e l i m i n a r y D e c i s i o n s / D e c i s i o n S c o r i n g Rules 3.2.1 Reasons f o r Use D e c i s i o n r u l e s are used in t h i s study f o r the purpose of i n s u r i n g that the o v e r a l l goal of s y s t e m a t i c , o b j e c t i v e a p p l i c a t i o n of content a n a l y s i s i s c a r r i e d out i n a l l areas of the documentary a n a l y s i s . H o l s t i (1969) and Carney (1972) pr o v i d e d a g e n e r a l d i s c u s s i o n of d e c i s i o n r u l e s as they are to be used in the work of content a n a l y s i s . However, they d i d not address the range of complexity and problems, or more s p e c i f i c a l l y , the kinds of c o m p l e x i t i e s found in t h i s study. In order to f u r t h e r c l a r i f y the i n t r i c a t e aspects of content a n a l y s i s that were encountered in t h i s t h e s i s , the f o l l o w i n g d i s c u s s i o n of d e c i s i o n r u l e s i s p r o v i d e d . T h i s d i s c u s s i o n i s d i v i d e d i n t o two p a r t s : 1) p r e l i m i n a r y d e c i s i o n s ? and 2) d e c i s i o n s c o r i n g r u l e s . 57 3.2.2 P r e l i m i n a r y D e c i s i o n s About the Data At an e a r l y stage i n the process of data a n a l y s i s i t appeared necessary f o r the a n a l y s t to dev i s e a s e r i e s of p r e l i m i n a r y d e c i s i o n s and r u l e s concerning the systematic treatment of data. T h i s i n i t i a l p l a n n i n g f i r s t i n v o l v e d the c r e a t i o n of p r e l i m i n a r y c l a s s i f i c a t i o n d e c i s i o n s . Having a r r i v e d at the p o i n t i n the a n a l y s i s i n which the v a r i o u s documents f o r a n a l y s i s had been chosen, the f i r s t important d e c i s i o n of c l a s s i f i c a t i o n i n v o l v e d the n e c e s s i t y to decide upon a working d e f i n i t i o n of the concept of h e a l t h that was used f o r the i n i t i a l e x t r a c t i o n of data from these documents. Of equal importance was the n e c e s s i t y to c r e a t e and apply boundaries w i t h i n the documents that would guide the data e x t r a c t i o n . A d e c i s i o n was a l s o made to e x t r a c t the data verbatim i n order to d i s p l a y with f i d e l i t y the statements from these v a r i o u s documents. These verbatim data that were e x t r a c t e d from the c u r r i c u l a documents and pl a c e d i n a computer f i l e f o r the purpose of a n a l y s i s are a v a i l a b l e from the author i n p r i n t e d form or on tape. 3.2.3 D e f i n i t i o n of Health A f t e r the a p p r o p r i a t e documents had been s e l e c t e d f o r a n a l y s i s a p r e l i m i n a r y d e c i s i o n needed to be made about what d e f i n i t i o n of h e a l t h would be used to guide the e x t r a c t i o n of verbatim sentences from the documents. For t h i s purpose h e a l t h was i n t e r p r e t e d as a concept r e l a t e d to the work and te a c h i n g aspect of Category I, I I , and I I I . S p e c i f i c a l l y , a working 58 d e f i n i t i o n of h e a l t h , d e s c r i b e d below, was used to e x t r a c t statements i n s i t u a t i o n s where the document appeared to d i s c u s s h e a l t h concepts that r e l a t e d to the c a t e g o r i e s . These c a t e g o r i e s a r e : Category I ( i n s t i t u t i o n a l p o s i t i o n s taken in r e l a t i o n s h i p to s t a t e d o b j e c t i v e s , g o a l s , r a t i o n a l e s , and b e l i e f s that appear to be h e a l t h r e l a t e d ) ; Category II ( i n s t i t u t i o n a l r o l e statements that appear to be r e l a t e d to the s c h o o l h e a l t h programme); and Category III ( i n s t i t u t i o n a l end p r o c e s s r e c e i v e d by the student that appear to be r e l a t e d to the s c h o o l h e a l t h programme). The concept or d e f i n i t i o n of h e a l t h was based on a c o m p i l a t i o n of w r i t i n g s that are found in the l i t e r a t u r e . The most widely used d e f i n i t i o n of h e a l t h , i n general use, i s that of the World H e a l t h O r g a n i z a t i o n . The WHO d e f i n i t i o n d e s c r i b e s h e a l t h as being: a s t a t e of complete p h y s i c a l , mental and s o c i a l w e l l -being and not merely the absence of d i s e a s e or i n f i r m i t y . (W.H.O., 1978, page 55) Minor c o r r e c t i o n s and v a r i a t i o n s on t h i s c e n t r a l theme were added l a t e r . However, the primary areas of the p h y s i c a l , s o c i a l , and mental domains of h e a l t h remain i n t a c t . In a d d i t i o n to the e x i s t e n c e i n the l i t e r a t u r e of many d e f i n i t i o n s of h e a l t h that are r e l a t e d to the World H e a l t h d e f i n i t i o n , there are s e v e r a l that c e n t r e on the concept of school h e a l t h e d u c a t i o n . T y p i c a l of these i s the d e f i n i t i o n of Green and Iverson (1982). They d e s c r i b e school h e a l t h education as a combination of l e a r n i n g e x p e r i e n c e s i n i t i a t e d by v a r i o u s 59 personnel i n school s e t t i n g s i n which the i n t e n t i o n s are to develop b e h a v i o u r a l s k i l l s e s s e n t i a l f o r coping with d e c i s i o n s about h e a l t h as w e l l as necessary c o g n i t i v e s k i l l s . One of the problems s t u d i e d i n t h i s t h e s i s i s the f a c t t h a t the l i t e r a t u r e c o n c erning a h e a l t h d e f i n i t i o n or concept c o n t a i n s few i f any p a t t e r n s of consensus as to agreed upon understandings. Indeed, the problem of a l a c k of consensus about the d e f i n i t i o n or concept of h e a l t h i n g e n e r a l i s viewed as being c e n t r a l to the s i t u a t i o n of the o v e r a l l h e a l t h programme in schools that i s addressed i n t h i s study. The i s s u e of understandings about h e a l t h w i t h i n the s e t t i n g of the school i s a complex one and i s a s i t u a t i o n i n which there are a m u l t i p l i c i t y of d i v e r s e p a t t e r n s of understandings that appear i n the documents surveyed. In order to l o g i c a l l y and s y s t e m a t i c a l l y e x t r a c t verbatim l i n e s from the documents that were seen as being r e l a t e d to the c e n t r a l r e s e a r c h problems of t h i s study, the f o l l o w i n g working d e f i n i t i o n f o r h e a l t h statements was c o n s t r u c t e d . H e a l t h statements were any statements that r e f e r e n c e d the concept of h e a l t h as being a p h y s i c a l , mental or s o c i a l aspect of the human being's continuum between wellness and i l l n e s s (WHO, 1978). The d i s c u s s i o n s of h e a l t h were found to e x i s t i n the documents i n a l l three domains of the c o g n i t i v e , psychomotor and a f f e c t i v e areas of t e a c h i n g , l e a r n i n g and work a c t i v i t i e s . For example, the Science teacher can be d e s c r i b e d as i n v o l v e d with the work and t e a c h i n g of h e a l t h concepts in the f o l l o w i n g exerpts from the Junior-Secondary Science C u r r i c u l u m Guide and Resource Book: 60 ( c o g n i t i v e ) . . . . c l a s s i f y v a r i o u s organs i n t o body systems.... (psychomotor) . . . . p r a c t i c e safe procedures i n school l a b o r a t o r y . . . . ( a f f e c t i v e ) . . . . a s s i s t i n g the student i n d e v e l o p i n g r e s p o n s i b l e a t t i t u d e s r e l a t e d to s o c i a l / l e g a l aspects of drug use. (B.C.M.E., 1983, Teacher Reference Chart) S i m i l a r l y , the h e a l t h p r o f e s s i o n a l i s i n v o l v e d with the work and t e a c h i n g of h e a l t h as i l l u s t r a t e d i n the Vancouver Hea l t h Department's school h e a l t h g u i d e l i n e s : ( c o g n i t i v e ) I n - s e r v i c e education programs on h e a l t h s u b j e c t s f o r school p e r s o n n e l . (as p a r t of the P h y s i c i a n ' s (Medical H e a l t h O f f i c e r II) a c t i v i t i e s ) ; (page 65) (psychomotor) . . . . h e l p i n g students l e a r n to brush and f l o s s p r o p e r l y . . . . ( r e f e r e n c e d under Dental H y g i e n i s t ' s a c t i v i t i e s ) ; (page 57) ( a f f e c t i v e ) . . . . r e i n f o r c i n g h e a l t h y behaviour p a t t e r n s and d i s c o u r a g i n g negative ones.... ( l i s t e d under School Aged C h i l d Program G o a l s ) . (page 2) ( M a r s h a l l , 1982) In summary, h e a l t h i s d e f i n e d i n t h i s study as encompassing a l l areas of t e a c h i n g and work a c t i v i t y i n which c o g n i t i v e , psychomotor, and a f f e c t i v e domains of teaching and l e a r n i n g are d e s c r i b e d as o c c u r i n g i n the s c h o o l c u r r i c u l a . H e a l t h i s understood as encompassing the p h y s i c a l , mental, and s o c i a l domains of the human being i n a continuum that i n c l u d e s d e s c r i p t o r s of both w e l l being and i l l n e s s . The second p r e l i m i n a r y d e c i s i o n i n v o l v e d using t h i s working d e f i n i t i o n of h e a l t h as a g u i d e l i n e f o r the verbatim l i n e e x t r a c t i o n of documentary m a t e r i a l . T h i s part of the a n a l y s i s i n v o l v e d a lengthy process of r e a d i n g every l i n e of the documents s e l e c t e d f o r a n a l y s i s and e x t r a c t i n g s e c t i o n s that 61 seemed to belong to the broad d e f i n i t i o n a l understanding of h e a l t h . An important p a r t of the process c e n t r e s on the a b i l i t y of the a n a l y s t to make the work of l i n e e x t r a c t i o n as systematic as p o s s i b l e . In the case of the documents i n t h i s study the f o l l o w i n g parameters on the l o c a t i o n of category data was used as a g u i d e l i n e : 1) Category I data were found i n the s e c t i o n s of the document where the h e a l t h r e l a t e d o b j e c t i v e s , g o a l s , r a t i o n a l e s and b e l i e f s of the program were d i s c u s s e d as being r e l a t e d to some aspect of the o v e r a l l school h e a l t h program. 2) Category II data appeared i n s e c t i o n s of the document where a r o l e statement c o u l d be construed as r e l a t e d to the o v e r a l l s i t u a t i o n of the school h e a l t h education program. The use of " r o l e " as a category i s f u r t h e r d e f i n e d i n t h i s chapter. The category of r o l e a l s o i n c l u d e s r o l e statements from the document that serve to provide e p i s t e m i c frames of r e f e r e n c e and r a t i o n a l e s f o r r o l e u t i l i z a t i o n i n which s p e c i f i c views concerning " r o l e " w i t h i n a p a r t i c u l a r community are d i s p l a y e d . 3) Category III data appeared i n s e c t i o n s of the document where a h e a l t h r e l a t e d t e a c h i n g or work process was r e c e i v e d by the student. The use of "process" i s d i s c u s s e d i n t h i s chapter as w e l l as an expanded d i s c u s s i o n of three category d e f i n i t i o n s . To summarize Phase I of t h i s p r o c e s s , the work of the a n a l y s t p r i o r to a c t u a l category c o n s t r u c t i o n i n v o l v e d the f o l l o w i n g steps i n which p r e l i m i n a r y c l a s s i f i c a t i o n d e c i s i o n s were made: 62 a) s e l e c t i o n of a l l documentary data to be analyzed; b) development of working d e f i n i t i o n of h e a l t h f o r data e x t r a c t i o n ; c) c o n s t r u c t i o n of boundaries f o r data e x t r a c t i o n ; and d) method of e x t r a c t i o n to be used f o r verbatim l i n e e n t r i e s . A f t e r the p r e l i m i n a r y c l a s s i f i c a t i o n d e c i s i o n s were made, the next step was the f o r m u l a t i o n of d e c i s i o n s c o r i n g r u l e s f o r category placement. In t h i s second l e v e l p rocess the d e c i s i o n s c o r i n g r u l e s were a p p l i e d t o : 1) i n s t a n c e s i n which statements appeared to belong to more than one category; and 2) i n s t a n c e s i n which the t e a c h i n g / l e a r n i n g focus as h e a l t h r e l a t e d t o p i c s appeared to be u n c l e a r i n the document. In these i n s t a n c e s the i n t e n t was to c l a r i f y the data a n a l y s i s process and enhance the accuracy of the c a t e g o r i z a t i o n process. There are three major areas that appear under t h i s process of c a t e g o r y c o n s t r u c t i o n that were t r e a t e d as areas r e q u i r i n g the use of p r e c i s e d e c i s i o n s c o r i n g r u l e s . 3.2.4 D e c i s i o n S c o r i n g Rules The f i r s t of these areas i n v o l v e d the need f o r p r e c i s e r u l e s concerning s i t u a t i o n s i n which verbatim data were found to belong to more than one c a t e g o r y . For example, an e n t r y from the The School H e a l t h Program Procedures Manual of the Vancouver H e a l t h Department i n d i c a t e s t h at the Community H e a l t h Nurse and the R e g i s t e r e d Nurse are r e s p o n s i b l e f o r v i s i o n t e s t i n g i n the s c h o o l . T h i s s i n g l e , l i n e item entry t e l l s us both the job d e s c r i p t i o n (under Category I I : Role, " s u b d i v i s i o n - Job 63 D e s c r i p t i o n " ) , as w e l l as the end product r e c e i v e d by the student, (under Category I I I , End P r o d u c t ) . In these i n s t a n c e s of o v e r l a p the data i s entered as combined c a t e g o r i e s i n which the document's amalgamation of data i s d i s p l a y e d . A d d i t i o n a l l y , there are i n s t a n c e s i n which the document combined s e v e r a l "dimensions of h e a l t h " i n t o a s i n g l e sentence. For example, P h y s i c a l education aims to develop i n d i v i d u a l s who are p h y s i c a l l y , i n t e l l e c t u a l l y , e m o t i o n a l l y , and s o c i a l l y mature. (B.C.M.E., 1980, page 1) T h i s l i n e item i s repeated under the P h y s i c a l , Mental, and S o c i a l c l a s s i f i c a t i o n s of the H e a l t h Dimension C l a s s i f i c a t i o n scheme and r e f e r e n c e d a c c o r d i n g l y as "Repeated". Another area i n which a s c o r i n g r u l e had to be d e v i s e d i n v o l v e d Category I I : Role. L i k e the Health Dimension C l a s s i f i c a t i o n scheme i n which s u b d i v i s i o n s were e s t a b l i s h e d (Brumby, Garr a r d , and Auman, 1985), Category II r e q u i r e d a s i m i l a r s u b d i v i s i o n i n order that the data be s y s t e m a t i c a l l y approached. A d e f i n i t i o n a l g u i d e l i n e f o r the s u b d i v i s i o n s of the concept of r o l e were d e r i v e d from A D i c t i o n a r y of Education (Rowntree, D., 1981) and D i c t i o n a r y of Education (Good, C.V., 1959). These s u b d i v i s i o n s a r e : a) S o c i a l Role: expected s o c i a l behaviour of i n d i v i d u a l s occupying c e r t a i n p o s i t i o n s . An example of t h i s would be The p h y s i c i a n i s expected to take an advocacy r o l e on behalf of the school aged c h i l d i n regards to h e a l t h i s s u e s . ( M a r s h a l l , 1982, page 64) 64 S o c i a l r o l e i s a l s o extended to i n c l u d e the s o c i a l r o l e of a d i s c i p l i n e . For example, (the Junior-Secondary Science Programme) should a l s o attempt to show that the d i s c i p l i n e s of s c i e n c e together c o n t r i b u t e to a g r e a t e r understanding of our world. (B.C.M.E., 1983, page 3) b) Job D e s c r i p t i o n : the d e s c r i p t i o n of a job, i t s component tas k s , and the s i t u a t i o n s i n which i n d i v i d u a l s perform those jobs. An example of t h i s s u b d i v i s i o n i s ....the p u b l i c h e a l t h nurse i s r e s p o n s i b l e f o r the c o o r d i n a t i o n of h e a l t h s e r v i c e s . . . . (B.C.M.H., 1982, page 1) c) Role Set: T h i s i n v o l v e s the network or i n t e r a c t i o n of r o l e s i n d i c a t e d i n a given s e t t i n g . The s e t t i n g s t u d i e d here i s the school and i t s o v e r a l l programme of school h e a l t h . An example of t h i s s u b d i v i s i o n i s : H e a l t h personnel (Vancouver He a l t h Department) provide support s e r v i c e s to s u p e r v i s o r y a i d e s and other s c h o o l s t a f f concerned with the care of a s i c k student. ( M a r s h a l l , 1982, page 8) The f i n a l area i n which d e c i s i o n s c o r i n g r u l e s were co n s i d e r e d to be e s s e n t i a l was the s i t u a t i o n of statements e x t r a c t e d from the documents i n which r e l a t i o n s h i p s to t e a c h i n g focus and h e a l t h areas appeared to be u n c l e a r . In these i n s t a n c e s c l a r i f i c a t i o n was determined by t e x t book c r o s s -r e f e r e n c i n g . For example, the s c i e n c e c u r r i c u l u m document i n d i c a t e s that students w i l l ....be given o p p o r t u n i t i e s to grapple with wider s o c i a l c o n s i d e r a t i o n s stemming from e c o l o g i c a l and resource development i s s u e s i n t h e i r l o c a l e . (B.C.M.E., 1983, page 85) 65 In t h i s example the p r e s c r i b e d t e a c h i n g t e x t s i n d i c a t e some evidence of a human h e a l t h r e l a t e d i s s u e of man's i n t e r a c t i o n with the environment and i n such i n s t a n c e s the item was entered as r e l a t e d to the s o c i a l domain of h e a l t h . Again, i t should be p o i n t e d out that t h i s study does not i n v o l v e the teacher or h e a l t h p r o f e s s i o n a l ' s i n t e r p r e t a t i o n or a c t u a l implementation of these documents. T h i s study focuses i n s t e a d on c e r t a i n documentary aspects of the concept of h e a l t h as i t appears to be r e l a t e d to the o v e r a l l attendant work and t e a c h i n g of these communities. 3.3 Category C o n s t r u c t i o n 3.3.1 C a t e g o r i z a t i o n and Theory T h e o r e t i c a l l y informed content a n a l y s i s p r o v i d e d an on-going l i n k between the u n d e r l y i n g theory of the r e s e a r c h and the c a t e g o r i e s . In t h i s study the three c a t e g o r i e s were d e r i v e d from the theory of Holzner and Marx (1979). In t h e i r w r i t i n g s about knowledge o r g a n i z a t i o n , d i s t r i b u t i o n , and d i s s e m i n a t i o n Holzner and Marx (1979) emphasized the key areas of i n s t i t u t i o n a l i z e d p o s i t i o n s , r o l e s , and processes w i t h i n the c u r r e n t knowledge system. " I n s t i t u t i o n a l i z e d " , as i t i s used i n t h i s study, r e f e r s to the e s t a b l i s h e d , v a l i d a t e d , and f o r m a l i z e d ways by which a community c o n s t r u c t s a concept such as " p o s i t i o n " , " r o l e " , or "process". These three key areas of i n s t i t u t i o n a l i z e d p o s i t i o n s , r o l e s , and p r o c e s s e s , i n t h i s study, become C a t e g o r i e s I, I I , and III and are d e s c r i b e d below. 66 3.3.2 C a t e g o r i z a t i o n and D e c i s i o n Rules Whereas the l i n k a g e between category and theory assumes a c r u c i a l r o l e i n the process of content a n a l y s i s , the connection between d e c i s i o n r u l e s and category are a l s o an important p a r t of the work of the a n a l y s i s . As p r e v i o u s l y d i s c u s s e d the d e c i s i o n r u l e s that precede and h e l p to anchor the work of c a t e g o r i z a t i o n form an important p a r t of the on-going c o n s t r u c t i o n of content a n a l y s i s . Having formulated the p r e l i m i n a r y d e c i s i o n r u l e s and s p e c i f i c d e c i s i o n s c o r i n g r u l e s r e l a t e d to c a t e g o r i z a t i o n , the work of category c o n s t r u c t i o n entered the next phase. The t h r e e c a t e g o r i e s of t h i s a n a l y s i s are d e s c r i b e d i n d e t a i l as f o l l o w s . Category I T h i s category i n c o r p o r a t e s the n o t i o n of i n s t i t u t i o n a l i z e d  p o s i t i o n s as d i s p l a y e d i n a v a r i e t y of p o s i t i o n statements t h a t can be c o n s t r u e d as r e l e v a n t to the o v e r a l l s c h o o l h e a l t h programme. Category I i s l i m i t e d to documentary e x t r a c t s from g o a l s , o b j e c t i v e s , r a t i o n a l e s and b e l i e f statements that appear to be school h e a l t h education r e l a t e d . An example of Category I i s : Goal of the Guidance Programme: To promote w i t h i n the student an understanding of h i s own behaviour and the behaviour of o t h e r s . " (B.C.M.E., 1971, page 3) Category II T h i s c a t e g o r y i n v o l v e s the concept of i n s t i t u t i o n a l i z e d  r o l e s and i s s u b d i v i d e d as: s o c i a l r o l e , job d e s c r i p t i o n and r o l e s e t . 67 Role statements were e x t r a c t e d f o r a n a l y s i s wherever the document appeared to l i n k r o l e statements of the work and t e a c h i n g of these communities with the d e f i n i t i o n of h e a l t h as used i n t h i s study and a d d i t i o n a l l y where epi s t e m i c understandings about the concept of r o l e are d i s p l a y e d . Role i s s u b d i v i d e d i n t o s o c i a l r o l e , job d e s c r i p t i o n , and r o l e s e t , and has been d i s c u s s e d p r e v i o u s l y under D e c i s i o n Rules. An example of s o c i a l r o l e i s found in the h e a l t h p r o f e s s i o n a l documents' d e s c r i p t i o n of the p h y s i c i a n as advocate f o r the school aged c h i l d i n h e a l t h matters. Job d e s c r i p t i o n examples from these same documents r e f e r to the work of the Community Health Nurse, the R e g i s t e r e d Nurse, and the School P h y s i c i a n as being i n v o l v e d with the d e l i v e r y of f i r s t a i d and emergency care when r e q u i r e d i n the school s e t t i n g . A r o l e set example from the h e a l t h p r o f e s s i o n a l documents r e f e r s to the Community Hea l t h Nurse as i n v o l v e d with p r o v i s i o n of i n - s e r v i c e programs about School Aged C h i l d Programs to school s t a f f as requested. Category III Category II I r e f l e c t s the t h i r d key idea of Holzner and Marx (1979) in t h e i r focus on i n s t i t u t i o n a l i z e d end processes w i t h i n the paradigm of knowledge o r g a n i z a t i o n , d i s t r i b u t i o n and d i s s e m i n a t i o n . T h i s category c o n t a i n s r e f e r e n c e s from the r e p r e s e n t a t i v e documents of teacher and h e a l t h p r o f e s s i o n a l communities in which the d e t a i l s of t h e i r work and t e a c h i n g a c t i v i t i e s i n d i c a t e an i n s t i t u t i o n a l i z e d process that can be seen as being an end product r e c e i v e d by the student. Process i s d e f i n e d i n t h i s study as being a c t i o n s or o p e r a t i o n s that conclude in an end product. Examples of Category III data 68 i n c l u d e the statement of an end product of the work of the h e a l t h p r o f e s s i o n a l s r e c e i v e d by the student i n the form of v i s i o n t e s t i n g i n the s c h o o l . A p a r a l l e l end product of t h i s i n s t i t u t i o n a l process i s found i n the teacher document under c u r r i c u l u m g u i d e l i n e s f o r the P h y s i c a l Education t e a c h e r . In t h i s i n s t a n c e the student r e c e i v e s a lesson i n the f i t n e s s program as w e l l as an end product of " f i t n e s s e v a l u a t i o n " . In summary the c a t e g o r i e s provide the key to the o b j e c t i v e and systematic work of content a n a l y s i s . The c a t e g o r i e s are d i r e c t l y t i e d to the theory and the research q u e s t i o n s so that the end r e s u l t i s a s e r i e s of p r e c i s e and u t i l i z a b l e p a t t e r n s of understandings that have been documentarily d i s p l a y e d . 3.3.3 A d d i t i o n a l A n a l y s i s of Category Data An a d d i t i o n a l a n a l y t i c a l d e v i ce has been used i n t h i s study. The H e a l t h Dimension C l a s s i f i c a t i o n scheme d e r i v e d from the A u s t r a l i a n r e s e a r c h on h e a l t h concepts (Brumby, Ga r r a r d and Auman, 1985) has been a p p l i e d to C a t e g o r i e s I and I I I . T h i s c l a s s i f i c a t i o n scheme, when a p p l i e d to the data of C a t e g o r i e s I and I I I , was found to p r o v i d e e x t e n s i v e a d d i t i o n a l i n f o r m a t i o n about these areas of the data that was not r e v e a l e d with the use of a s i n g u l a r category approach. The c l a s s i f i c a t i o n technique that has been a p p l i e d to C a t e g o r i e s I and III c e n t r e s around the concept of h e a l t h o r i g i n a l l y espoused by the World H e a l t h O r g a n i z a t i o n (1978) in which the domains of the p h y s i c a l , mental and s o c i a l aspects of h e a l t h appear. The c l a s s i f i c a t i o n scheme developed i n the A u s t r a l i a n study (Brumby, G a r r a r d and Auman, 1985) used as i t s data base i n t e r v i e w s with students i n which 69 the concept of h e a l t h was i n v e s t i g a t e d . The primary d e s c r i p t i o n s of p h y s i c a l , mental, and s o c i a l , as w e l l as s u b d i v i s i o n s of these domains of h e a l t h were a r r i v e d at through a content a n a l y s i s of e x t e n s i v e i n t e r v i e w s with these students. In the r e s e a r c h presented i n t h i s t h e s i s , the A u s t r a l i a n Health Dimension C l a s s i f i c a t i o n scheme has proved to be p a r t i c u l a r l y u s e f u l i n p r o v i d i n g a c l e a r and c o n c i s e methodological t o o l that i n c r e a s e s o v e r a l l understanding of r e l e v a n t p a t t e r n s w i t h i n the document. In the present study the A u s t r a l i a n Health Dimension C l a s s i f i c a t i o n scheme has been m o d i f i e d as f o l l o w s . The s u b c l a s s i f i c a t i o n of "hygiene" has been a l t e r e d t o encompass the two s u b c a t e g o r i e s of " s a f e t y " and " p r e v e n t i o n , d i a g n o s i s , and treatment". The s u b c l a s s i f i c a t i o n of " l i f e s t y l e " has been m o d i f i e d to focus on r e l a t i o n s h i p s between the i n d i v i d u a l , s o c i e t y , and the environment as they r e l a t e to h e a l t h i s s u e s . The concepts of " w e l l - b e i n g " and "absence of d i s e a s e " r e f e r r e d to i n the 1978 World Health O r g a n i z a t i o n d e f i n i t i o n of h e a l t h do not appear i n the m o d i f i e d Health Dimension C l a s s i f i c a t i o n scheme that i s used i n t h i s study. The A u s t r a l i a n study acknowledged these concepts as being " d e s c r i p t o r s which embrace the p h y s i c a l , mental and s o c i a l dimensions of h e a l t h " . In t h i s study these d e s c r i p t o r s have been used i n a more g e n e r a l way w i t h i n the o v e r a l l d i s c u s s i o n of Chapter V r a t h e r than employed as separate c l a s s i f i c a t i o n s of data. The H e a l t h Dimension C l a s s i f i c a t i o n format f o r a n a l y s i s i s s c h e m a t i c a l l y o u t l i n e d as: 70 General r e f e r e n c e s P h y s i c a l r e f e r e n c e s , s u b d i v i d e d i n t o : (Body) (Drugs) ( N u t r i t i o n ) ( F i t n e s s ) ( S a f e t y and P r e v e n t i o n , D i a g n o s i s , and Treatment) Mental r e f e r e n c e s , no s u b d i v i s i o n s S o c i a l r e f e r e n c e s , s u b d i v i d e d i n t o : ( I n t e r p e r s o n a l ) ( L i f e s t y l e ) General The General s e c t i o n c o n t a i n s comments p r o v i d i n g background m a t e r i a l that appeared u s e f u l i n p r o v i d i n g a d d i t i o n a l context f o r the documentary r e f e r e n c e s . T h i s category r a r e l y appears i n the documents and was i n c l u d e d only i n s i t u a t i o n s r e l a t e d to c l a r i f i c a t i o n or enhancement of the data. An example of t h i s General documentary i n f o r m a t i o n i s : "The four goals of the J u n i o r Secondary Science Programme a r e . . . . " . These p a r t i c u l a r goals are not c l a s s i f i e d under the headings of P h y s i c a l , Mental or S o c i a l . However, the i n c l u s i o n of the four goals of Science was seen as r e l e v e n t to the o v e r a l l d e s c r i p t i v e d i s p l a y of t h i s document. The three primary domains of h e a l t h ( p h y s i c a l , mental, and s o c i a l ) and t h e i r s u b d i v i s i o n s are o u t l i n e d as f o l l o w s : P h y s i c a l The p h y s i c a l domain i s d i v i d e d i n t o the s u b c l a s s i f i c a t i o n s o f : body, drugs, n u t r i t i o n , f i t n e s s , s a f e t y / p r e v e n t i o n , d i a g n o s i s , and treatment. (Body) The s u b c l a s s i f i c a t i o n of (body) c o n t a i n s r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis in the data i s 71 focus s e d on body f u n c t i o n s and systems. An example of t h i s c l a s s i f i c a t i o n i s : ....demonstrate simple understanding of human body f u n c t i o n s . (B.C.M.E., 1983, Teacher Reference Chart) (Drugs) The s u b c l a s s i f i c a t i o n of (drugs) c o n t a i n s r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis i s r e l a t e d to drugs. An example of t h i s c l a s s i f i c a t i o n i s : ....be a l e r t to p o s i t i v e and negative e f f e c t s drugs have on the body. (B.C.M.E., 1983, Teacher Reference Chart) ( N u t r i t i o n ) The s u b c l a s s i f i c a t i o n of ( n u t r i t i o n ) c o n t a i n s r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis i s on n u t r i t i o n . An example of t h i s c l a s s i f i c a t i o n i s : (Students should) a p p r e c i a t e that good n u t r i t i o n i s r e l a t e d to d i e t and food a v a i l a b i l i t y . (B.C.M.E., 1983, Teacher Reference Chart) ( F i t n e s s ) The s u b c l a s s i f i c a t i o n of ( f i t n e s s ) c o n t a i n s r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis i s on f i t n e s s . An example of t h i s c l a s s i f i c a t i o n i s : ....students should be able to demonstrate a p o s i t i v e a t t i t u d e toward the value of p h y s i c a l a c t i v i t y f o r h e a l t h and f i t n e s s . . . . (B.C.M.E., 1980, page 4) (S a f e t y and Prevention, D i a g n o s i s , and Treatment) The A u s t r a l i a n s u b c l a s s i f i c a t i o n of "hygiene" has been m o d i f i e d i n t h i s study. S u b c l a s s i f i c a t i o n s of " s a f e t y " and "p r e v e n t i o n , d i a g n o s i s , and treatment" r e p l a c e t h i s previous 72 subset. Examples of these subsets a re: (Safety) ....demonstrate a concern f o r s a f e t y when using household chemicals.... (B.C.M.E., 1983, Teacher Reference Chart) ( P r e v e n t i o n , D i a g n o s i s , and Treatment) Grade 9 students should r e c e i v e a r e i n f o r c i n g immunization a g a i n s t d i p t h e r i a , tetanus and p o l i o m y e l i t i s . (B.C.M.H., 1982, page 3) Mental T h i s c l a s s i f i c a t i o n c o n t a i n s a l l r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis i s on mental, emotional and p s y c h o l o g i c a l h e a l t h . T h i s c l a s s i f i c a t i o n a l s o i n c l u d e s r e f e r e n c e s about d e c i s i o n making and value c l a r i f i c a t i o n as r e l a t e d to students i n classroom s e t t i n g s . There are no s u b d i v i s i o n s . Examples of these r e f e r e n c e s a r e : (Guidance) O b j e c t i v e I: To promote w i t h i n the student an understanding of h i s own behaviour. (B.C.M.E., 1971, page 3) Teaching t o p i c s : I d e n t i f i c a t i o n of values i n r e a l -l i f e s i t u a t i o n s . (B.C.M.E., 1971, page 20) (Health P r o f e s s i o n a l ) O b j e c t i v e 7: To i d e n t i f y and f a c i l i t a t e c o r r e c t i o n o f . . . . e m o t i o n a l h e a l t h problems which may a f f e c t the performance or general w e l l - b e i n g of the student. (B.C.M.H., 1982, page 7) 73 Soc i a l ( I n t e r p e r s o n a l ) The s u b c l a s s i f i c a t i o n of ( i n t e r p e r s o n a l ) c o n t a i n s a l l r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis i s on r e l a t i o n s h i p s with o t h e r s . An example of t h i s r e f e r e n c e i s : To promote w i t h i n the student an understanding of the behaviour of o t h e r s . (Guidance) (B.C.M.E., 1971, page 3) ( L i f e s t y l e ) T h i s s u b c l a s s i f i c a t i o n of ( l i f e s t y l e ) c o n t a i n s a l l r e f e r e n c e s i n which t e a c h i n g / l e a r n i n g / a c t i v i t y emphasis i s on r e l a t i o n s h i p s between the i n d i v i d u a l and s o c i e t y or environment. An example of t h i s r e f e r e n c e i s : . . . . a p p r e c i a t e needs and problems i n waste d i s p o s a l . (B.C.M.E., 1983, Teacher Reference Chart) 3.4 Summary of Methodology In summary, the process of content a n a l y s i s that i s used i n t h i s study can be o u t l i n e d as f o l l o w s . I. T h e o r e t i c a l Framework C o n s t r u c t i o n The i n i t i a l process f o r t h e o r e t i c a l l y informed content a n a l y s i s used i n t h i s study r e q u i r e d the s e l e c t i o n of t h e o r i e s t h a t would frame the c o n s t r u c t i o n of c a t e g o r i e s and serve to i l l u m i n a t e i n t e r p r e t a t i o n s of f i n d i n g s that were d e r i v e d from the a n a l y s i s . S e l e c t e d t h e o r i e s from the s o c i o l o g y of knowledge have been chosen f o r t h i s purpose. 74 I I . Data P r e p a r a t i o n P r i o r to C a t e g o r i z a t i o n T h i s stage i n v o l v e d s e l e c t i o n of r e p r e s e n t a t i v e data for a n a l y s i s , verbatim e x t r a c t i o n of documentary statements using working d e f i n i t i o n s of h e a l t h , d e c i s i o n s about boundaries f o r data e x t r a c t i o n , and d e c i s i o n s c o r i n g r u l e s . I I I . C a t e g o r i z a t i o n C a t e g o r i e s I, II and III were d e r i v e d from the t h e o r e t i c a l framework and d i r e c t l y t i e d to the r e s e a r c h q u e s t i o n s of t h i s study. A d d i t i o n a l l y , the H e a l t h Dimension C l a s s i f i c a t i o n scheme prov i d e d an e x t r a dimension f o r the a n a l y s i s of C a t e g o r i e s I and I I I . IV. C o n s t r u c t i o n of P a t t e r n s of F i n d i n g s The f i n d i n g s of the study d i s p l a y the v a r i o u s p a t t e r n s of meanings that were found i n the documents. The o v e r a l l p a t t e r n s were d e r i v e d from the three c a t e g o r i e s of a n a l y s i s and the a d d i t i o n a l meanings d i s p l a y e d i n the Health Dimension c l a s s i f i c a t i o n of C a t e g o r i e s I and I I I . Tables of r e s u l t s which provide t a b u l a t i o n s of C a t e g o r i e s I and III and summaries made up the f i n a l d i s p l a y of data p a t t e r n s . V. Inference Making: F i n a l Stage of A n a l y s i s The f i n a l stage of a n a l y s i s i n v o l v e d the f o r m u l a t i o n of i n f e r e n c e s , which were based on the documentary f i n d i n g s as d i s p l a y e d i n the o v e r a l l p a t t e r n s of a n a l y s i s . S p e c i f i c t h e o r i e s r e l a t e d to e p i s t e m i c communities, knowledge development and d i s s e m i n a t i o n from s o c i o l o g y of knowledge r e s e a r c h e r s were u t i l i z e d i n the f i n a l stage of i n f e r e n c e making. 75 CHAPTER IV  FINDINGS 4.1 I n t r o d u c t i o n Chapter IV presents the f i n d i n g s of t h i s t h e s i s . T h i s chapter c o n t a i n s the r e s u l t s of the a n a l y s i s of documents i n v e s t i g a t e d i n t h i s study. C a t e g o r i e s I and III have been a d d i t i o n a l l y analyzed by means of the Hea l t h Dimension C l a s s i f i c a t i o n Scheme p r e v i o u s l y d i s c u s s e d i n Chapter I I I . Ca t e g o r i e s I and I I I a l s o d i s p l a y t a b u l a t e d r e s u l t s i n the form of t a b l e s . Category II was analyzed i n a d i f f e r e n t manner, as d i s c u s s e d i n d e t a i l w i t h i n Chapter I I I . Summaries and examples of content f o r a l l c a t e g o r i e s of a n a l y s i s are a l s o p r o v i d e d i n t h i s c h a pter. Chapter V c o n t a i n s an extended d i s c u s s i o n of these f i n d i n g s . 4.2 A n a l y s i s of Junior-Secondary Science C u r r i c u l u m Guide and Resource Book (B.C. M i n i s t r y of Education, 1983) 4.2.1 Category It Health Dimension A n a l y s i s (see Table I) The s i g n i f i c a n t p a t t e r n that emerges from these data i s the unidimensional emphasis on the p h y s i c a l domain of h e a l t h as i t appears i n the documentary r e f e r e n c e s r e l a t e d to s t a t e d g o a l s , o b j e c t i v e s , r a t i o n a l e s , and b e l i e f s . S o c i a l aspects of the h e a l t h domain of sci e n c e teaching appear i n the C a t e g o r i e s II and III Combined. 7 6 TABLE I Sc i e n c e : Category I and Health Dimension C l a s s i f i c a t i o n P h y s i c a l References t o : No. References body 1 n u t r i t i o n 1 Mental No r e f e r e n c e s S o c i a l No r e f e r e n c e s Examples  General The four goals of the J u n i o r Secondary Science Programme a r e : Goal A: The J u n i o r Secondary Science Program should p r o v i d e o p p o r t u n i t i e s f o r students to develop p o s i t i v e s c i e n c e a t t i t u d e s . Goal B: The J u n i o r Secondary Science Program should p r o v i d e o p p o r t u n i t i e s f o r students to develop the s k i l l s and processes of s c i e n c e . Goal C: The J u n i o r Secondary Science Program should i n c r e a s e the students' s c i e n t i f i c knowledge. Goal D: The J u n i o r Secondary Science Program should p r o v i d e o p p o r t u n i t i e s f o r students to develop c r e a t i v e , c r i t i c a l and formal ( i . e . a b s t r a c t ) t h i n k i n g a b i l i t i e s . (B.C.M.E., 1983, pages 5-6) 77 P h y s i c a l (Body) and ( N u t r i t i o n ) The p h y s i o l o g i c a l i s s u e s l e a d i n g to adulthood and the accompanying i n c r e a s e i n self-awareness form a n a t u r a l prologue to a formal examination of the human body and of h e a l t h and n u t r i t i o n a l i s s u e s . (B.C.M.E., 1983, page 3) Mental No References S o c i a l No References 4.2.2 Category I I : Role  S o c i a l Role Sci e n c e , as a d i s c i p l i n e , i s d e s c r i b e d as p r o v i d i n g a s c i e n t i f i c p e r s p e c t i v e to students i n regards to t h e i r changing s e l v e s and world as w e l l as the impact of technology on t h i s r e l a t i o n s h i p . Role Set T h i s category d i s p l a y s teachers i n t e r a c t i n g with h e a l t h p r o f e s s i o n a l s i n a h e a l t h r e l a t e d r o l e s e t t i n g . The emphasis here i s on teacher and h e a l t h p r o f e s s i o n a l i n t e r a c t i o n i n the form of the h e a l t h p r o f e s s i o n a l being i n v i t e d i n t o the classroom s e t t i n g f o r s p e c i f i c h e a l t h t e a c h i n g purposes. Examples  S o c i a l Role . . . . s c i e n c e o f f e r s j u n i o r secondary students a p a r t i c u l a r l y s u i t a b l e p e r s p e c t i v e on t h e i r changing s e l v e s and world. (B.C.M.E., 1983, page 3) 78 Job D e s c r i p t i o n ( I t i s suggested that) the m a t e r i a l c o n t a i n e d i n t h i s guide be taught i n an i n t e g r a t e d manner.... the major i s s u e s f a c i n g s o c i e t y today - l i k e d i s e a s e , o v e r p o p u l a t i o n and resource d e p l e t i o n , cannot be completely understood through one d i s c i p l i n e of s c i e n c e . (B.C.M.E., 1983, page 97) Role Set ( l i s t e d under p o s s i b l e a c t i v i t i e s ) I n v i t e the h e a l t h nurse to t e s t the range of senses using h e a r i n g t e s t s , eye c h a r t s , and c o l o u r b l i n d n e s s c a r d s . (B.C.M.E., 1983, page 39) 4.2.3 C a t e g o r i e s II and III Combined: Role and End Product (see Table II) The i n f o r m a t i o n provided i n t h i s s e c t i o n of the document (Junior-Secondary Science Teacher Reference Chart) p r o v i d e s d e t a i l e d , d e s c r i p t i v e i n f o r m a t i o n about the embedding of h e a l t h t e a c h i n g w i t h i n the f o r m a l l y p r e s c r i b e d c u r r i c u l u m g u i d e l i n e s f o r Science and the s p e c i f i c g u i d e l i n e s f o r teachers to f o l l o w i n the e s s e n t i a l and o p t i o n a l content areas. By means of an a d d i t i o n a l a p p l i c a t i o n of the H e a l t h Dimension C l a s s i f i c a t i o n Scheme, f u r t h e r i n f o r m a t i o n i s p r o v i d e d about the te a c h i n g and l e a r n i n g p a t t e r n s w i t h i n the document. I t should be noted t h a t , concerning " e s s e n t i a l t o p i c s : drugs and n u t r i t i o n " , the t o p i c of "drugs" only appears i n Grade 8 while " n u t r i t i o n " , as a t o p i c , only appears i n Grade 9. The P h y s i c a l , subset "body", area of content d i s p l a y s a w e l l d i s t r i b u t e d documentary p a t t e r n a c r o s s Grades 8, 9, and 10. There are three times as many r e f e r e n c e s to the p h y s i c a l as to the s o c i a l domain. A p p l i c a t i o n of the Health Dimension TABLE II S c i e n c e : C a t e g o r i e s II and I I I Combined and Health Dimension C l a s s i f i c a t i o n P h y s i c a l E s s e n t i a l ( O p t i o n a l ) (Body) Grade 8 Grade 9 Grade 10 (Drugs) Grade 8 Grade 9 Grade 10 ( N u t r i t i o n ) Grade 8 Grade 9 Grade 10 ( F i t n e s s ) no r e f e r e n c e s (Safety) Grade 8 Grade 9 Grade 10 6 4 10 7 0 0 0 7 0 (Prevent i o n , Grade 8 Grade 9 Grade 10 D i a g n o s i s , 2 2 1 Treatment) 0 0 0 (1 ) (1) (2) (2) (0) (0) (0) (0) (0) (1 ) (1 ) (0) (0) (0) (3) Mental no r e f e r e n c e s Soc i a l ( I n t e r p e r s o n a l ) no r e f e r e n c e s ( L i f e s t y l e ) Grade 8 Grade 9 Grade 10 4 1 2 (0) (0) (5) 80 C l a s s i f i c a t i o n Scheme to the f i n a l products of the C a t e g o r i e s II and I I I combined a n a l y s i s p r o v i d e s a d d i t i o n a l c o n f i r m a t i o n of emphasis on the p h y s i c a l domain. In the f o l l o w i n g d i s p l a y of a n a l y s i s C a t e g o r i e s II and I I I were combined f o r these reasons. The Science document, as w r i t t e n by the M i n i s t r y of Education c u r r i c u l u m d e v e l o p e r s , presented an amalgamation of Category II (job d e s c r i p t i o n : e s s e n t i a l / o p t i o n a l t e a c h i n g a r e a s ) , Category III (end p r o d u c t s ) , and d e s i g n a t e d grade l e v e l s f o r s p e c i f i c content a r e a s . Having assessed the complexity of t h i s p o r t i o n of the document, a d e c i s i o n was made to combine these d i v i s i o n s of a n a l y s i s i n t o one c o n c i s e t a b l e of r e s u l t s . Category II when not combined with Category III i s analyzed s e p a r a t e l y and the f i n d i n g s are d i s c u s s e d under Summaries with examples pr o v i d e d . Examples (Student Outcomes) P h y s i c a l (Body) develop a resp e c t f o r the complexity and f r a g i l i t y of the nervous system. (B.C.M.E 1983, Teacher Reference Chart) (Drugs) be a l e r t to p o s i t i v e and negative e f f e c t s t h a t drugs may have on the body. (B.C.M.E 1983, Teacher Reference Chart) ( N u t r i t i o n ) a p p r e c i a t e good n u t r i t i o n and i t s r e l a t i o n s h i p to common d i e t s and a v a i l a b i l i t y of foods. (B.C.M.E 1983, Teacher Reference Chart) 81 (Safety) demonstrate a concern f o r s a f e t y when us i n g and s t o r i n g household c h e m i c a l s . (B.C.M.E., 1983, Teacher Reference Chart) ( P r e v e n t i o n , D i a g n o s i s , Treatment) i n v e s t i g a t e problems i n v o l v i n g n u t r i t i o n , e x e r c i s e or damage to a body system. (B.C.M.E., 1983, Teacher Reference Chart) Mental No References Soc i a l ( l i f e s t y l e ) develop a more r e s p o n s i b l e a t t i t u d e toward s e l f and s o c i e t y through a study of r e s o u r c e s . (B.C.M.E., 1983, Teacher Reference Chart) 4.2.4 Category I I I : C u r r i c u l u m I n t e g r a t i o n (see Table I I I ) The s c i e n c e document i s unique i n i t s p r o v i s i o n of c u r r i c u l u m i n t e g r a t i o n t e a c h i n g t o p i c s . The p a t t e r n of primary emphasis on the p h y s i c a l domain i s s i m i l a r to o v e r a l l f i n d i n g s i n the a n a l y s i s of the s c i e n c e data. Example  P h y s i c a l (body) r e l a t e body systems to symbols and r e a c t i o n s . (B.C.M.E., 1983, page 66) TABLE III S c i e n c e : Category III and H e a l t h Dimension C l a s s i f i c a t i o n (Suggestions f o r C u r r i c u l u m I n t e g r a t i o n ) No. References P h y s i c a l Body Drugs 20 2 6 2 8 N u t r i t i o n F i t n e s s Diagnosis/Prevention/Treatment Mental No r e f e r e n c e s S o c i a l L i f e s t y l e 6 4.3 A n a l y s i s of Secondary P h y s i c a l Education Curriculum and  Resource Guide (B.C. M i n i s t r y of E d u c a t i o n , 1980) I t should be noted the P h y s i c a l Education c u r r i c u l u m document f o l l o w s a d i f f e r e n t p a t t e r n from that of s c i e n c e and guidance. The d i f f e r e n c e s occur due to the f a c t that s p e c i f i c l e a r n i n g outcomes/topics as end products r e c e i v e d by the student are not l i s t e d a c c o r d i n g to grade l e v e l . Instead the document l i s t s outcomes as t i e d to the o v e r a l l g o a l . 4.3.1 Category I and H e a l t h Dimension A n a l y s i s (see Table IV) The P h y s i c a l Education c u r r i c u l u m p l a c e s emphasis on the p h y s i c a l domain with three times as many r e f e r e n c e s to p h y s i c a l as to s o c i a l aspects of h e a l t h . References to the subset of " f i t n e s s " are p a r t i c u l a r l y h i g h l i g h t e d i n t h i s s e c t i o n of the a n a l y s i s . 83 TABLE IV P h y s i c a l E d u c a t i o n : Category I and H e a l t h Dimension C l a s s i f i c a t i o n No. References P h y s i c a l Body statements 5 N u t r i t i o n 1 Drugs 0 F i t n e s s 12 S a f e t y 0 Prevention/Diagnosis/Treatment 2 Mental 6 Soc i a l U n d i f f e r e n t i a t e d 1 I n t e r p e r s o n a l 2 L i f e s t y l e 0 Examples  P h y s i c a l (Body) P h y s i c a l Education aims to develop i n d i v i d u a l s who are p h y s i c a l l y mature. (B.C.M.E., 1980, page 1) ( N u t r i t i o n ) Senior - program i m p l i c a t i o n s . Student needs to understand d a i l y h e a l t h p r a c t i c e s r e g a r d i n g a c t i v i t y , n u t r i t i o n and r e s t . (B.C.M.E., 1980, page 3) ( F i t n e s s ) (The f i t n e s s ) concept i s designed to p r o v i d e o p p o r t u n i t i e s f o r the students to develop a program which meets t h e i r own p e r s o n a l f i t n e s s needs. (B.C.M.E., 1980, page 125) 84 (Prevent ion/Diagnosis/Treatment) ( P h y s i c a l Education Programme at the J u n i o r Secondary l e v e l ) ....the student needs to understand the reasons f o r good h e a l t h h a b i t s and the problems that may be faced d u r i n g e a r l y teen and young adulthood y e a r s . (B.C.M.E., 1980, pages 1-2) Mental P h y s i c a l Education aims to develop i n d i v i d u a l s who are i n t e l l e c t u a l l y , e m o t i o n a l l y mature. (B.C.M.E., 1980, page 1) Soc i a l ( I n t e r p e r s o n a l ) Goal A: The Secondary P h y s i c a l Education Programme should a s s i s t i n d e v e l o p i n g and m a i n t a i n i n g p o s i t i v e p e r s o n a l a t t r i b u t e s and i n t e r p e r s o n a l r e l a t i o n s h i p s . . . . (B.C.M.E., 1980, page 4) 4.3.2 Category I I : Role  S o c i a l Role P h y s i c a l E ducation, as a d i s c i p l i n e w i t h i n the s c h o o l , i s po r t r a y e d as e s s e n t i a l to students' e d u c a t i o n a l experience i n terms of i n d i v i d u a l growth and development. Job D e s c r i p t i o n Teachers are d i r e c t e d to extend s k i l l s l e a r n e d at the elementary s c h o o l l e v e l . There i s an o r i e n t a t i o n toward encouraging students to maintain e x e r c i s e and n u t r i t i o n p a t t e r n s d e s c r i b e d as enhancing h e a l t h with p a r t i c u l a r emphasis on " f i t n e s s " t e a c h i n g . The " f i t n e s s " emphasis w i t h i n the domain of p h y s i c a l a s p e c t s of h e a l t h appears to e s t a b l i s h p a t t e r n s s i m i l i a r to those found i n " f i t n e s s " t o p i c emphasis that i s 85 d i s c u s s e d under Category I and Category I I I . Role Set No r o l e set i s i n d i c a t e d i n document. Examples  S o c i a l Role F i t n e s s makes a very s i g n i f i c a n t c o n t r i b u t i o n to the t o t a l w e l l - b e i n g of a l l s t u d e n t s . (B.C.M.E., 1980, page 125) Job D e s c r i p t i o n (The F i t n e s s Programme) should be i n t e g r a t e d i n t o the p h y s i c a l education c u r r i c u l u m and not taught only as an i s o l a t e d u n i t of i n s t r u c t i o n . (B.C.M.E., 1980, page 125) Role Set No r e f e r e n c e s 4.3.3 Category I I I and H e a l t h Dimension C l a s s i f i c a t i o n  End Products Received by Student (see Table V) The documentary evidence of t h i s category p r e s e n t s a p a t t e r n of emphasis on the p h y s i c a l domain of h e a l t h t o p i c s with s i g n i f i c a n t o r i e n t a t i o n s being d i s p l a y e d toward " f i t n e s s " . There i s a p a t t e r n of s i m i l a r i t y between a l l documentary c a t e g o r i e s I, I I , and I I I i n the area of p h y s i c a l domain, " f i t n e s s " subset. 86 TABLE V P h y s i c a l E d u c a t i o n : Category III and He a l t h Dimension C l a s s i f i c a t i o n No. References P h y s i c a l Body 4 N u t r i t i o n 1 Drugs 0 F i t n e s s 10 S a f e t y 1 Prevention/Diagnosis/Treatment 0 Mental 4 S o c i a l I n t e r p e r s o n a l 2 L i f e s t y l e 0 Examples  P h y s i c a l (Body) (Student w i l l a c q u i r e ) an understanding of the p h y s i o l o g i c a l concepts r e l a t e d to p h y s i c a l a c t i v i t y , such as the value of f u n c t i o n a l l y e f f e c t i v e posture and the e f f e c t s of r e g u l a r e x e r c i s e on c a r d i o v a s c u l a r f u n c t i o n . (B.C.M.E., 1980, page 5) ( n u t r i t i o n ) and ( f i t n e s s ) By the end of the Secondary P h y s i c a l Education Program students should be a b l e to demonstrate: -an understanding of concepts and methods necessary to achieve an a p p r o p r i a t e l y high l e v e l of p h y s i c a l f i t n e s s such as the s p e c i f i c i t y of a e r o b i c and . anaerobic t r a i n i n g and the importance of n u t r i t i o n as i t r e l a t e s to p h y s i c a l a c t i v i t y . (B.C.M.E., 1980, page 4) ( s a f e t y ) By the end of the Secondary P h y s i c a l Education Program students should be able to demonstrate: -an understanding of movement p r i n c i p l e s i n c l u d i n g concepts r e l a t e d to body mechanics and s a f e t y such as i n t e g r a t i n g time, weight and space i n developing a s u c c e s s f u l spike i n v o l l e y b a l l . (B.C.M.E., 1980, page 4) Mental By the end of the Secondary P h y s i c a l Education Program students should be ab l e to demonstrate: - an understanding of the p s y c h o l o g i c a l concepts r e l a t e d to p h y s i c a l a c t i v i t y such as the r e l a t i o n s h i p between p h y s i c a l a c t i v i t y and p h y s i c a l and mental s t r e s s . (B.C.M.E., 1980, page 4) Soc i a l ( I n t e r p e r s o n a l ) By the end of the Secondary P h y s i c a l Education Program students should be able to demonstrate: - a p o s i t i v e a t t i t u d e toward p h y s i c a l a c t i v i t y as a s o c i a l experience such as a p p r e c i a t i n g the r o l e of l e a d e r s h i p through experience. (B.C.M.E., 1980, page 4) 4.4 A n a l y s i s of Secondary School C u r r i c u l u m Guide - Guidance (B.C. M i n i s t r y of Education, 1971) 4.4.1 Category I and He a l t h Dimension A n a l y s i s (see Table VI) The major p a t t e r n that emerges f o r Category I i s the document's emphasis on the mental domain of h e a l t h . Mental r e f e r e n c e s are twice those of the p h y s i c a l domain. TABLE VI Guidance: Category I and He a l t h Dimension C l a s s i f i c a t i o n No. References P h y s i c a l Drugs 2 S a f e t y 1 Mental 6 Soc i a l I n t e r p e r s o n a l 1 Examples  P h y s i c a l (Drugs) The matter of drug abuse i s of grave concern. (B.C.M.E., 1971, page 5) (Safety) F i r s t A i d , under Guidance 10, to be r e v i s e d . (B.C.M.E., 1971, page 5) Mental O b j e c t i v e 1: To promote w i t h i n the student an understanding of h i s own behaviour. (B.C.M.E., 1971, page 3) 89 Soc i a l ( I n t e r p e r s o n a l ) O b j e c t i v e 3: To a s s i s t the student i n understanding the importance of community i n our s o c i e t y ; communication through the v a r i o u s media and communication among i n d i v i d u a l s . (B.C.M.E., 1971, page 3) 4.4.2 Category I I : Role  S o c i a l Role The s o c i a l r o l e of guidance, as a d i s c i p l i n e w i t h i n the s c h o o l , i s d e s c r i b e d as meeting the changing needs of s o c i e t y and the needs of secondary school students. Documentary t e n s i o n appears in the somewhat ambiguous statements of s o c i a l r o l e . In one i n s t a n c e the q u e s t i o n i s asked of the reader as to how f a r (to go) and how much r e s p o n s i b i l i t y the school should assume f o r the students' problems. T h i s statement appears i n c o n t r a s t to a r a t h e r lengthy d i s c u s s i o n of the p e r c e i v e d need f o r t h i s d i s c i p l i n e to be s i g n i f i c a n t l y i n v o l v e d with the problems of drugs and p a r t i c u l a r l y i n a s s i s t i n g the student to f i n d s o l u t i o n s to the problems of drugs at t h i s age. Job D e s c r i p t i o n I t should be noted that of the c u r r i c u l u m guides f o r the three t e a c h i n g d i s c i p l i n e s , the Guidance c u r r i c u l u m c o n t a i n s much more d i s c u s s i o n that i s r e l a t e d to o v e r a l l aspects of job d e s c r i p t i o n . The tone of the d i s c u s s i o n d i r e c t e d at the guidance teacher can be d e s c r i b e d as c a u t i o n a r y . The teacher i s f r e q u e n t l y i n s t r u c t e d to a v o i d s e n s i t i v e areas of t e a c h i n g and to apply p r o f e s s i o n a l d i s c r e t i o n as to the boundaries of subject matter that are d i s c u s s e d . T h i s unusual f a c e t of the guidance 90 document w i l l be d i s c u s s e d f u r t h e r i n Chapter V. Examples S o c i a l Role The department takes the view that the school has both r e s p o n s i b i l i t y and o p p o r t u n i t y to make a s i g n i f i c a n t c o n t r i b u t i o n to f i n d i n g s o l u t i o n s , g u i d i n g young people, p r o v i d i n g e d u c a t i o n a l experience which w i l l enable p u p i l s to cope with such problems (dr u g s ) . (B.C.M.E., 1971, page 5) Job D e s c r i p t i o n The teacher should a v o i d p l a c i n g h i m s e l f i n the p o s i t i o n of attempting to impose a set of values from above. (B.C.M.E., 1971, page 9) Role Set (Family's Role) The p u b l i c h e a l t h nurse and other p u b l i c o f f i c i a l s may be h e l p f u l . (B.C.M.E., 1971, page 6) 4.4.3 Category III and H e a l t h Dimension A n a l y s i s (see Table VII) Emphasis on the t o p i c s , as the end product, i s weighted toward the mental and s o c i a l domains. The frequent occurrence of mental t o p i c s are s i m i l a r to p a t t e r n s d e s c r i b e d f o r Category I. The most notable r e f e r e n c e s under the s o c i a l category, a c a t e g o r y which i s second i n r e f e r e n t i a l statements i n h e a l t h dimension p a t t e r n s , are the i n d i c a t i o n s of the d i s c i p l i n e ' s s t r e s s upon communication s k i l l s i n t h i s area of t e a c h i n g . T o p i c s r e f e r e n c e d under the p h y s i c a l domain, (drugs) subset, r e f l e c t a focus of t h i s content area that a l s o appears i n the (drugs) subset of Category I. TABLE VII Guidance: Category III and He a l t h Dimension C l a s s i f i c a t i o n Teaching T o p i c s No. References P h y s i c a l Body 1 Drugs 4 Mental 19 Soc i a l I n t e r p e r s o n a l 15 Examples  P h y s i c a l (Body) I n d i v i d u a l D i f f e r e n c e s Al Examination of p h y s i c a l growth r a t e s and changing body. (B.C.M.E., 1971, page 10) Mental I d e n t i f i c a t i o n of v a l u e s i n r e a l - l i f e s i t u a t i o n s (B.C.M.E., 1971, page 20) Soc i a l ( I n t e r p e r s o n a l ) Behaviour Standards Behaviour with the op p o s i t e sex (B.C.M.E., 1971 , page 10) 92 4.5 A n a l y s i s of Guide to the Core C u r r i c u l u m (Goal M) (B.C.M.E., 1977) 4.5.1 Category I: Hea l t h Dimension A n a l y s i s (no t a b u l a t i o n ) Category I c o n t a i n s a s i n g l e e n t r y , the goal i t s e l f . T h i s goal s t a t e s c l e a r l y t h a t s k i l l s and knowledge f o r h e a l t h f u l l i v i n g are to be pursued w i t h i n the s e t t i n g of the s c h o o l . Category I and Hea l t h Dimension C l a s s i f i c a t i o n The s i n g l e entry (Goal M) i s c l a s s i f i e d as Ge n e r a l . Example  General (Goal M i s ) to develop s k i l l s and knowledge f o r h e a l t h f u l l i v i n g . (B.C.M.E., 1977, page 32) 4.5.2 Category l i t Role  S o c i a l Role The s o c i a l r o l e i s the i m p l i e d r o l e of the school as s t a t e d i n t h i s g o a l . T h i s r o l e i s to develop s k i l l s and knowledge f o r h e a l t h f u l l i v i n g . Job D e s c r i p t i o n S i g n i f i c a n t documentary statements appear here i n the r e f e r e n c e s to r o l e r e s p o n s i b i l i t i e s . At the Junior-Secondary l e v e l t e a c h e r s of p h y s i c a l education and guidance are r e f e r e n c e d as i n v o l v e d with h e a l t h t e a c h i n g . Science i s r e f e r r e d to only w i t h i n the context of " b i o l o g y u n i t s of Science 8" (page 33). At the Senior-Secondary l e v e l emphasis i s given to p h y s i c a l 93 education and guidance as having a " s p e c i a l r e s p o n s i b i l i t y r e g a r d i n g outcomes" (page 33). However, i t should be noted t h a t the Guide to the Core C u r r i c u l u m (1977) was w r i t t e n p r i o r to the r e v i s e d Junior-Secondary Science C u r r i c u l u m and Resource Guide (1983) that i s analyzed i n t h i s study. T h e r e f o r e , statements concerning the Science 8 b i o l o g y are to be understood w i t h i n t h i s p a r t i c u l a r c o n t e x t . Role Set None i n d i c a t e d i n document. Examples  S o c i a l Role (Goal M i m p l i e s that the school has a r e s p o n s i b i l i t y ) to develop s k i l l s and knowledge f o r h e a l t h f u l l i v i n g . (B.C.M.E., 1977, page 32) Job D e s c r i p t i o n Teachers of p h y s i c a l education have a major r e s p o n s i b i l i t y with regards to Outcomes M.9 - M.11 ( p h y s i o l o g y , f i r s t a i d , and improving motor s k i l l s ) . (B.C.M.E., 1977, page 33) Role Set No r e f e r e n c e s 4.5.3 Category I I I : Health Dimension A n a l y s i s (see Table V I I I ) The H e a l t h Dimensions a n a l y s i s has been a p p l i e d to the student l e a r n i n g outcomes (Category III of t h i s g o a l ) . At the Junior-Secondary l e v e l , p h y s i c a l dimensions of h e a l t h dominate. Senior-Secondary r e f e r e n c e s p o r t r a y documentary emphasis on a l l three h e a l t h domains. TABLE VIII Category I I I : Student Learning Outcomes and Health Dimension C l a s s i f i c a t i o n No. References J u n i o r Secondary  P h y s i c a l Body 1 F i t n e s s 1 S a f e t y 1 Mental 1 S o c i a l 0 Senior Secondary P h y s i c a l 0 Mental 1 Soc i a l I n t e r p e r s o n a l 1 Examples  P h y s i c a l (Body) During the J u n i o r Secondary Years students should l e a r n the f u n c t i o n s of the d i g e s t i v e , r e s p i r a t o r y , c i r c u l a t o r y , r e p r o d u c t i v e , locomotor, and nervous system.... (B.C.M.E., 1977, page 3 3 ) ( F i t n e s s ) During the Junior Secondary Years students should l e a r n . . . . t o improve motor s k i l l s . . . . (B.C.M.E., 1977, page 3 3 ) 95 (Safety) During the J u n i o r Secondary Years students should l e a r n . . . . t h e fundamentals of f i r s t a i d . . . . (B.C.M.E., 1977, page 33) Mental During the J u n i o r Secondary Years students should l e a r n .... r e c r e a t i o n a l p u r s u i t s f o r adulthood .... (B.C.M.E., 1977, page 33) S o c i a l ( I n t e r p e r s o n a l ) During the Senior Secondary Years students should l e a r n . . . . t o l e a d a small group and at other times accept the l e a d e r s h i p of o t h e r s . (B.C.M.E., 1977, page 33) 4.5.4 Category I I I : Subject Summary (no t a b u l a t i o n ) An a n a l y s i s of t h i s s e c t i o n of the document d i s p l a y s a d i v e r s e p a t t e r n of s u b j e c t s that the document r e f e r e n c e s as being r e l a t e d to t h i s Goal M of h e a l t h f u l l i v i n g . Subject and grade r e f e r e n c e s d i s p l a y emphasis being p l a c e d on: P h y s i c a l Education (Grades 8-11); Guidance (Grades 10-11); Science (Grade 8). A l s o i n c l u d e d are a melange of m i s c e l l a n e o u s s u b j e c t s : drama, f i r s t a i d , a r t , music, c r a f t s , sewing, cooking, i n d u s t r i a l e d u c a t i o n . The most notable f a c e t of t h i s document i s i t s e c l e c t i c d i s p l a y of what are documentarily r e f e r e n c e d as being areas of h e a l t h t e a c h i n g w i t h i n the s c h o o l . Example (Subject areas i n which Goal M i s d e s c r i b e d as a component of content a r e ) : P h y s i c a l Education Guidance Sc ience Drama F i r s t A i d A r t Music C r a f t s Sewing Cooking I n d u s t r i a l Education (B.C.M.E., 1977, page 33) 4.6 A n a l y s i s of P u b l i c H e a l t h Nursing Program f o r School Age  C h i l d r e n (B.C. M i n i s t r y of H e a l t h , 1982) 4.6.1 Category I and H e a l t h Dimension C l a s s i f i c a t i o n (see Table IX) The emphasis in Category I a n a l y s i s of t h i s document i s on the involvement of the p u b l i c h e a l t h nurse i n the area of p r e v e n t i o n , d i a g n o s i s and treatment. Mental h e a l t h , when r e f e r e n c e d , a l s o appears r e l a t e d to the concept of p r e v e n t i o n , d i a g n o s i s and treatment. 97 Table IX P u b l i c H e a l t h Nurse: Category I and Health Dimension A n a l y s i s No. References P h y s i c a l S a f e t y 0 Prev e n t i o n 5 Mental 2 S o c i a l 0 Examples  P h y s i c a l ( P r e v e n t i o n , D i a g n o s i s and Treatment) O b j e c t i v e 3: To minimize the i n c i d e n c e of communicable d i s e a s e i n the school p o p u l a t i o n and o f f e r p r o t e c t i o n a g a i n s t s p e c i f i c d i s e a s e s . (B.C.M.H., 1982, page 3) Mental O b j e c t i v e 6: To a s s i s t students with p h y s i c a l or emotional d i s e a s e to u t i l i z e e d u c a t i o n a l o p p o r t u n i t i e s and to promote t h e i r independence i n a d u l t l i f e . (B.C.M.H., 1982, page 6) Soc i a l No r e f e r e n c e s 4.6.2 Category I I : Role  S o c i a l Role The s o c i a l r o l e of the p u b l i c h e a l t h nurse i n Category II of t h i s document emphasizes the promotion of good h e a l t h both at the school l e v e l and as f o u n d a t i o n a l to a d u l t l i f e . 98 Job D e s c r i p t i o n Job d e s c r i p t i o n s w i t h i n t h i s document are lengthy. T h i s i s a s i t u a t i o n t h a t e x i s t s i n both h e a l t h p r o f e s s i o n a l documents. The f o r m a l l y p r e s c r i b e d r o l e of the h e a l t h p r o f e s s i o n a l i n an a d j u n c t i v e r o l e to the school i s r i g o r o u s l y d e t a i l e d . The p u b l i c h e a l t h nurse i s i d e n t i f i e d as the primary h e a l t h worker. In a d d i t i o n to her h e a l t h s e r v i c e f a c i l i t a t i v e d u t i e s between the h e a l t h u n i t and the s c h o o l , the p u b l i c h e a l t h nurse i n the school i s documentarily p o r t r a y e d as an ex t e n s i v e recorder of student h e a l t h i n f o r m a t i o n . She i s a l s o c a l l e d upon to be a co n s u l t a n t on many h e a l t h i s s u e s and a d i r e c t p r o v i d e r of a v a r i e t y of h e a l t h care s e r v i c e s . Role Set The Hea l t h P r o f e s s i o n a l i s d e s c r i b e d as i n t e r a c t i n g with: - a l l i e d community agencies and d i s c i p l i n e s ; - p r i n c i p a l ; - s c h o o l p e r s o n n e l , t e a c h i n g and non-teaching; - home ( f a m i l i e s of s t u d e n t s ) ; - f a m i l y p h y s i c i a n s ; - i n t e r p r o f e s s i o n a l h e a l t h team; - school board team. Examples  S o c i a l Role (The P u b l i c h e a l t h Nursing Program f o r School Age C h i l d r e n aims to) promote a h e a l t h y l i f e s t y l e and f a c i l i t a t e the attainment of optimal h e a l t h by school age c h i l d r e n to enhance t h e i r l e a r n i n g c a p a c i t y and la y the foundations f o r h e a l t h i n ad u l t l i f e . (B.C.M.H., 1982, page 1) 99 Job D e s c r i p t i o n The H e a l t h Act ( S e c t i o n 38) prov i d e s f o r t e c h n i c a l h e a l t h s e r v i c e s and other d u t i e s to be c a r r i e d out by a h e a l t h u n i t f o r boards of school t r u s t e e s . (B.C.M.H., 1982, page 1) Role Set Meet with the p r i n c i p a l i n e a r l y September to d i s c u s s the P u b l i c Health Program f o r School Age C h i l d r e n i n order to e s t a b l i s h the h e a l t h a c t i v i t i e s t o be pr o v i d e d by h e a l t h u n i t s t a f f f o r the sch o o l year and to e s t a b l i s h an ongoing system of communication between the school and the h e a l t h u n i t . (B.C.M.H., 1982, page 2) 4.6.3 Category III and H e a l t h Dimension C l a s s i f i c a t i o n (see Table X) Category III of t h i s document d i s p l a y s an end product r e c e i v e d by the student i n the school s e t t i n g that i s s t r o n g l y weighted toward p r e v e n t i o n , d i a g n o s i s and treatment. The documentary p a t t e r n s of Category I and Category III appear to be mutually complementary i n that there i s a s i m i l a r p a t t e r n i n g of b e l i e f s , and understandings about the documentary p e r c e p t i o n s of t h i s d i s c i p l i n e and the end products that are r e c e i v e d by the student. In both i n s t a n c e s the document d i s p l a y s a h e a l t h p r o f e s s i o n a l who i s s t r o n g l y embedded w i t h i n the paradigm of p r e v e n t i o n , d i a g n o s i s , and treatment. 100 TABLE X P u b l i c Health Nurse: Category I I I and Health Dimension A n a l y s i s No. References P h y s i c a l S a f e t y 1 Prevention/Diagnosis/Treatment 13 Mental 1 S o c i a l 0 Examples  P h y s i c a l (Safety) Provide a s s i s t a n c e as r e q u i r e d to school s t a f f r e s p o n s i b l e f o r the c o n t r o l of environmental hygiene....Refer to the p u b l i c h e a l t h i n s p e c t o r as i n d i c a t e d . (B.C.M.H., 1982, page 3) (Prevention/Diagnosis/Treatment) Grade 9 students should r e c e i v e a r e i n f o r c i n g immunization a g a i n s t d i p t h e r i a , tetanus, and p o l i o m y e l i t i s . (B.C.M.H., 1982, page 3) Mental (Where r e q u i r e d , students w i l l have a v a i l a b l e ) a support system f o r each student who has an acute h e a l t h or f a m i l y problem ( p h y s i c a l or emotional) which w i l l a s s i s t them to cope with the c r i s i s and o b t a i n r e q u i r e d c a r e . (B.C.M.H., 1982, page 6) S o c i a l No r e f e r e n c e s 101 4.7 A n a l y s i s of School H e a l t h Program Procedures Manual ( M a r s h a l l , 1982) 4.7.1 Category I and H e a l t h Dimension C l a s s i f i c a t i o n (see Table XI) The o v e r a l l emphasis i s on the p h y s i c a l domain of h e a l t h . The mental domain of h e a l t h , while r e f e r e n c e d , does not r e c e i v e the emphasis that i s given to the p h y s i c a l aspects of h e a l t h . In c o n t r a s t to the P u b l i c Health Nursing Program f o r School Aged  C h i l d r e n , the School H e a l t h Program Procedures Manual, p u b l i s h e d by the Vancouver H e a l t h Department, d i s p l a y s l e s s emphasis on p r e v e n t i o n , d i a g n o s i s , and treatment statements w i t h i n the o v e r a l l c l a s s i f i c a t i o n of P h y s i c a l . TABLE XI VHD: Category I and Health Dimension C l a s s i f i c a t i o n No. References P h y s i c a l Body 3 N u t r i t i o n 1 Drugs 2 F i t n e s s 2 Prevention/Diagnosis/Treatment 5 Mental 5 Soc i a l U n d i f f e r e n t i a t e d 1 I n t e r p e r s o n a l 1 102 Examples  P h y s i c a l (Body) (a r a t i o n a l e f o r p r o v i d i n g r e h a b i l i t a t i o n t h e r a p y ) : ....to i n c r e a s e sensory awareness, sensory i n t e g r a t i o n , to i n c r e a s e c o n f i d e n c e . ( M a r s h a l l , 1982, page 22) ( n u t r i t i o n ) School Aged C h i l d Program Goals - To r e i n f o r c e h e a lthy behavior p a t t e r n s and discourage negative ones....in n u t r i t i o n . ( M a r s h a l l , 1982, page 2) (Drugs) Program Goal: R e i n f o r c e p o s i t i v e behaviour and discourage negative behaviour i n smoking, a l c o h o l i s m and drug dependence. ( M a r s h a l l , 1982, page 2) ( F i t n e s s ) (A goal f o r e n a b l i n g handicapped students to achieve whatever l e v e l s of f i t n e s s are p o s s i b l e ) : Handicapped students are encouraged and helped to i n t e g r a t e as f u l l y as p o s s i b l e i n t o school a c t i v i t i e s and to cope with d i s a b i l i t i e s . ( M a r s h a l l , 1982, page 16) (Prevention/Diagnosis/Treatment) (An o b j e c t i v e of communicable diease c o n t r o l -immunization): There w i l l be conscious e f f o r t s made toward an o f f i c i a l p o l i c y of mandatory immunization fo r the school aged c h i l d p o p u l a t i o n . ( M a r s h a l l , 1982, page 25) Mental Program Goal: Provide i n f o r m a t i o n f o r h e a l t h y l i f e t i m e l i f e s t y l e i n c l u d i n g marriage, parenthood, c a r e e r or job, aging, l o s s and death. ( M a r s h a l l , 1982, page 2) 103 S o c i a l 'Program Goal: Continue optimal s o c i a l growth and development. ( M a r s h a l l , 1982, page 2) 4.7.2 Category I I : Role  S o c i a l Role The s o c i a l r o l e s of the s e l e c t e d , r e p r e s e n t a t i v e h e a l t h p r o f e s s i o n a l s who work in the school h e a l t h program p o r t r a y these i n d i v i d u a l s as s o c i a l l y s a n c t i o n e d p r o v i d e r s of h e a l t h care knowledge and s e r v i c e to the student r e c i p i e n t . The p h y s i c i a n ' s s o c i a l r o l e i s the more d i v e r g e n t of the groups analyzed i n that the document r e f e r e n c e s h i s r o l e as t a k i n g on a s p e c i a l p o s i t i o n w i t h i n the o v e r a l l whole of the school h e a l t h program. H i s r o l e i s given primary s o c i a l s i g n i f i c a n c e w i t h i n t h i s program and w i t h i n the community i n g e n e r a l . The d i f f e r e n c e s t h a t are d i s p l a y e d w i t h i n the document's d e s c r i p t i v e r o l e o u t l i n e f o r the p h y s i c i a n , as c o n t r a s t e d with the r o l e of the community h e a l t h nurse, who i s r e f e r e n c e d i n t h i s document as the key h e a l t h p r o f e s s i o n a l f o r the school h e a l t h programme, w i l l be d i s c u s s e d f u r t h e r i n Chapter F i v e . The key s o c i a l r o l e of these h e a l t h p r o f e s s i o n a l s i s that of p r o v i d i n g h e a l t h care to school age c h i l d r e n . They appear to be s o c i a l l y s a n c t i o n e d w i t h i n t h i s document, as i l l u s t r a t e d by the H e a l t h Act and the School Act of B r i t i s h Columbia. Job D e s c r i p t i o n A l l four examples of the Vancouver h e a l t h Department h e a l t h p r o f e s s i o n a l s d e s c r i b e d as i n v o l v e d with: 104 a) D e l i v e r y of h e a l t h education and h e a l t h promotion; b) Development of l i a s o n s between home and school and h e a l t h u n i t ; c) P r o v i s i o n of c l i n i c a l s e r v i c e s ; d) Membership i n the h e a l t h p r o f e s s i o n a l team. Role Set Health P r o f e s s i o n a l s are d e s c r i b e d as i n t e r a c t i n g w i t h : - f a m i l i e s of students; - community h e a l t h agencies; - school p e r s o n n e l , teaching and non-teaching; - a d m i n i s t r a t o r s ( s c h o o l ) ; - f a m i l y p h y s i c i a n s ; - i n t e r p r o f e s s i o n a l h e a l t h team; - school board team. Examples  S o c i a l Role P h y s i c i a n : The P h y s i c i a n f u l f i l l s an advocacy r o l e on behalf of groups of c h i l d r e n and case advocacy on behalf of the i n d i v i d u a l c h i l d . ( M a r s h a l l , 1982, page 64) Job D e s c r i p t i o n R e g i s t e r e d Nurse: Functions ( s e l e c t e d ) : Screen records and c o n s u l t with students and school personnel about h e a l t h needs and h e a l t h assessments. ( M a r s h a l l , 1982, page 69) Role Set N u t r i t i o n i s t - p a r t i c i p a t e s i n Augmented School-Based team meetings as r e q u i r e d . ( M a r s h a l l , 1982, page 62) 105 4.7.3 C a t e g o r i e s II and III Combined (see Table XII) Category I l l ' s (End Product) p a t t e r n d i s p l a y i n d i c a t e s a m a j o r i t y of a c t i v i t y f a l l i n g w i t h i n the d i a g n o s i s and treatment of the p h y s i c a l domain of h e a l t h . P h y s i c a l h e a l t h appears to dominate with a predominance of a c t i v i t i e s r e l a t e d to t h i s a r e a . Mental h e a l t h a c t i v i t i e s are next i n the p a t t e r n d i s p l a y . Category I I ' s (Person Responsible) p a t t e r n d i s p l a y i n d i c a t e s a primary emphasis on the r o l e of the nurse as the primary h e a l t h care worker i n the s c h o o l . T h i s appears to be c o n s i s t e n t with the h i g h l i g h t e d statement that appears i n t h i s document which s t a t e s : The nurse i s the key Vancouver He a l t h Department worker i n the school and i s i n v o l v e d i n the a c t i v i t i e s of a l l components. ( M a r s h a l l , 1982, page 20) The second most r e f e r e n c e d h e a l t h care worker i n the school i s the school p h y s i c i a n . In summary, the f i n d i n g s of the documentary a n a l y s i s r e v e a l an e x t e n s i v e and complex composite of the s c h o o l h e a l t h programme that h e r e t o f o r e r e c e i v e d l i t t l e a t t e n t i o n i n the l i t e r a t u r e . An extended d i s c u s s i o n of some p o s s i b l e i n t e r p r e t a t i o n s and i m p l i c a t i o n s of these f i n d i n g s i s co n t a i n e d in Chapter V. 106 Table XII VHD: C a t e g o r i e s II and I I I Combined (End Products/Person Responsible) References i n d i c a t i n g a c t i v i t y i n : No. References Care of S i c k / I n j u r e d C h i l d 6 Mental Health 10 H e a l t h Education 8 Assessment 7 Nursing 4 N u t r i t i o n 4 R e h a b i l i t a t i o n Therapy 4 Speech Pathology 1 Communicable Disease 1 (Immunization) Communicable Disease 2 (General) H e a l t h Promotion 3 H e a l t h P r o t e c t i o n 3 Dental S e r v i c e s 5 Person I n d i c a t e d as Responsible f o r A c t i v i t i e s : Person No. A c t i v i t i e s Community Health Nurse 25 R e g i s t e r e d Nurse 6 School P h y s i c i a n 12 I n t e r p r o f e s s i o n a l S t a f f 1 P s y c h o l o g i s t 2 Mental Health Team 2 S o c i a l Work Consultant 2 P s y c h i a t r i s t 3 D i r e c t o r Prevention Programs 1 A l l H e a l t h Personnel 3 Personnel D i v i s i o n 1 P h y s i o t h e r a p i s t 4 O c c u p a t i o n a l T h e r a p i s t 4 C l e r k 2 N u t r i t i o n i s t 4 A u d i o l o g i s t 1 V o l u n t e e r s 1 Speech/Hearing S p e c i a l i s t s 1 P u b l i c Health I n s p e c t o r s 3 CD.A. Group 1 Dental Hygenist 3 Dental A s s i s t a n t s 5 D e n t i s t 2 107 Examples  P h y s i c a l (Prevention/Diagnosis/Treatment) F i r s t A i d , Emergency Care (Persons r e s p o n s i b l e a r e ) : Community H e a l t h Nurse, R e g i s t e r e d Nurse, School Physic i a n . Mental H e a l t h Mental H e a l t h , Medication M o n i t o r i n g , I n t e r p r e t a t i o n , Review of D i a g n o s i s (Person l i s t e d as r e s p o n s i b l e ) : P s y c h i a t r i s t . Soc i a l No r e f e r e n c e s 4.8 Summary of the F i n d i n g s A summary of the teacher and h e a l t h p r o f e s s i o n a l documents i s given i n Table XIII f o r the purpose of c o n t r a s t i n g these communities i n C a t e g o r i e s I and I I I i n which numerical t a b u l a t i o n s were compiled. As the summary i n d i c a t e s , the sc i e n c e teacher documents d i s p l a y an emphasis on the p h y s i c a l domain of h e a l t h r e l a t e d t e a c h i n g . P h y s i c a l education documents a l s o i n d i c a t e a preoccupation with p h y s i c a l f a c t o r s i n h e a l t h t e a c h i n g . In c o n t r a s t , the guidance teacher documents s t r e s s e d the mental domains of h e a l t h . The h e a l t h p r o f e s s i o n a l data i n d i c a t e s an emphasis on the p h y s i c a l aspects of h e a l t h that i s s i m i l a r i n both documents. The f o l l o w i n g p a t t e r n s , while not t a b u l a t e d , were i n d i c a t e d i n Category I I . The teacher groups i n t e r p r e t e d r o l e s w i t h i n the context of t h e i r s u b j e c t s p e c i a l i t i e s while the h e a l t h p r o f e s s i o n a l s i n t e r p r e t e d r o l e s w i t i n t h e i r s p e c i f i c medical models. There was l i t t l e acknowledgement by e i t h e r community f o r the other community's r o l e . TABLE XIII Summary T a b u l a t i o n of C a t e g o r i e s I and II-1 Teacher Documents  Science P h y s i c a l Educ. Guidance  Number of References Category I P h y s i c a l 2 20 3 Mental 0 6 6 S o c i a l 0 3 1 Category III P h y s i c a l 39(11) 16 5 Mental 0( 0) 4 19 S o c i a l 7( 5) 2 15 Heal t h P r o f e s s i o n a l Documents P u b l i c H e a l t h Vancouver He a l t h Dept.  Number of References Category I P h y s i c a l 5 18 Mental 2 5 S o c i a l 0 2 Category III P h y s i c a l 14 28 Mental 1 10 S o c i a l 0 0 109 CHAPTER V  CONCLUSIONS AND RECOMMENDATIONS 5.1 I n t r o d u c t i o n The school h e a l t h programme i s a unique and complex area of te a c h i n g and work a c t i v i t y w i t h i n the o v e r a l l c u r r i c u l a of the s c h o o l . While t h i s programme i s e d u c a t i o n a l l y s i t u a t e d w i t h i n the s e t t i n g of the s c h o o l , the focus a l s o encompasses the i n t e r e s t s of two d i s t i n c t l y d i f f e r e n t p r o f e s s i o n a l communities, that of teachers and h e a l t h p r o f e s s i o n a l s . The programme i n B r i t i s h Columbia i s d i s t i n c t from other areas of the school's t e a c h i n g and work a c t i v i t i e s i n that i t i n v o l v e s both the M i n i s t r y of He a l t h and the M i n i s t r y of Educa t i o n . The s i t u a t i o n that p r e s e n t l y e x i s t s i n which two d i s t i n c t l y d i f f e r e n t p r o f e s s i o n a l communities work together to make up the o v e r a l l programme, i s an area of study that has been v i r t u a l l y ignored by p r e v i o u s r e s e a r c h e r s . T h i s i s p a r t i c u l a r l y t r u e f o r the Canadian secondary s c h o o l . The lack of i n f o r m a t i o n i s e s p e c i a l l y e vident i n the area of h e a l t h t e a c h i n g that appears w i t h i n the f o r m a l l y p r e s c r i b e d g u i d e l i n e s f o r the tea c h i n g d i s c i p l i n e s of s c i e n c e , p h y s i c a l education and guidance. Because there i s l i t t l e i n f o r m a t i o n a v a i l a b l e as to the p r e s c r i b e d r o l e of the teacher as h e a l t h educator, i t would be p o s s i b l e f o r the impression to e x i s t that a l l school h e a l t h programming i s d i r e c t e d by the M i n i s t r y of H e a l t h . For example, at the secondary l e v e l i n the Province of B r i t i s h Columbia where t h i s study was conducted, documents e n t i t l e d "The School Health 110 Programme" are produced and d i s t r i b u t e d by the M i n i s t r y of H e a l t h . "The School Health Programme" documents are designed f o r use by h e a l t h p r o f e s s i o n a l s who work i n the school system. These documents do not i n c l u d e g u i d e l i n e s f o r the teacher who may a l s o be i n v o l v e d i n the h e a l t h t e a c h i n g c u r r i c u l u m of the s c h o o l . In a d d i t i o n , the M i n i s t r y of Health documents do not c r o s s - r e f e r e n c e any of the many l i s t i n g s of h e a l t h r e l a t e d t e a c h i n g p o s s i b i l i t i e s that were found i n t h i s study w i t h i n the c u r r i c u l u m g u i d e l i n e s f o r s c i e n c e , p h y s i c a l education, and guidance. On c l o s e r i n s p e c t i o n of t h i s programme i t would appear that the p u b l i s h e d l i t e r a t u r e to date has not looked at the complete p i c t u r e ; a p i c t u r e that should i n c l u d e the documented and o f f i c i a l l y p r e s c r i b e d work and teaching of both p r o f e s s i o n a l communities. The i n t e n t to f i n d , analyze, and e x p l i c a t e the l a r g e r p i c t u r e of the school h e a l t h programme has been a c e n t r a l focus of the study. In d i s p l a y i n g the broader mosaic of t h i s programme the researcher has been concerned with f i n d i n g and mapping the e x i s t e n c e of hidden h e a l t h c u r r i c u l a of the teache r s and a l s o e x p l o r i n g to a s i m i l a r degree the e x p l i c i t h e a l t h c u r r i c u l u m of the h e a l t h p r o f e s s i o n a l s . An e q u a l l y important concern was the n e c e s s i t y to look at the two p r o f e s s i o n a l communities who make up a s u b s t a n t i a l p o r t i o n of the programme at the secondary l e v e l and to i n v e s t i g a t e the d i f f e r e n t ways these documents have d i s p l a y e d s o c i a l c o n s t r u c t i o n s of r e a l i t y . B r i e f l y summarized, t h i s study has pursued the f o l l o w i n g areas of r e s e a r c h i n t e r e s t s . F i r s t l y , the resea r c h work i n v o l v e d a systematic attempt to look f o r the ex i s t e n c e of a 111 hidden or i m p l i c i t c u r r i c u l u m that i s found w i t h i n the secondary t e a c h i n g areas of s c i e n c e , p h y s i c a l education and guidance. A p a r a l l e l search was a l s o conducted on the e x p l i c i t c u r r i c u l u m documents of the h e a l t h p r o f e s s i o n a l s who i n t e r a c t in t h i s o v e r a l l programme. The three r e s e a r c h q u e s t i o n s that were answered i n the f i n d i n g s of t h i s study and d i s c u s s e d i n d e t a i l i n t h i s chapter a r e : 1) What do these documents d i s p l a y as being h e a l t h r e l a t e d o b j e c t i v e s , g o a l s , r a t i o n a l e s and b e l i e f s of teachers and h e a l t h p r o f e s s i o n a l s ? 2) Who i s s p e c i f i e d in the documents as r e s p o n s i b l e f o r the h e a l t h r e l a t e d teaching and work a c t i v i t y and a d d i t i o n a l l y , what are the i m p l i c i t or e x p l i c i t r o l e d e f i n i t i o n s of those delegated as being r e s p o n s i b l e ? 3) How do the documents d e s c r i b e the means by which the school h e a l t h programme should reach the intended r e c i p i e n t i n the school? In p a r t i c u l a r , what kinds of t e a c h i n g or work a c t i v i t y are s p e c i f i e d ? Secondly, t h i s study has used a s o c i o l o g i c a l framework as a b a s i s f o r the data a n a l y s i s and as the b a s i s f o r e x p l i c a t i n g c e r t a i n f a c e t s of the problem s t u d i e d . The t h e o r i e s u t i l i z e d r e present a c o m p i l a t i o n of the s e l e c t e d viewpoints of Holzner and Marx (1979), Schutz (1962, 1967) and Smith (1974) that are r e l a t e d to the s o c i a l c o n s t r u c t i o n of knowledge. The f i n d i n g s of t h i s study, p a r t i c u l a r l y those r e l a t e d to the s o c i a l c o n s t r u c t i o n of t h i s programme as r e v e a l e d through the documents analyzed from the communities of teachers and h e a l t h p r o f e s s i o n a l s , are d i s c u s s e d i n t h i s chapter. These d i v e r s e 1 1 2 communities are examined through t h e o r e t i c a l p e r s p e c t i v e s as f o l l o w s : 1. Frames of r e f e r e n c e , that take i n t o account the communities' views i n which the f o l l o w i n g are d i s p l a y e d : a) t a k e n - f o r - g r a n t e d assumptions, b) s p e c i a l i z e d language as p r e f e r e n t i a l symbol system, c) a n a l y t i c a l d e v i c e s with which the communities' work proceeds; 2. S p e c i a l i z e d knowledge that p r o v i d e s a b a s i s f o r s p e c i a l i z a t i o n and u l t i m a t e l y the l e g i t i m a c y of the r i g h t and r e s p o n s i b i l i t y to p r a c t i c e and apply the s p e c i a l i z e d work of the community; 3. Boundaries of knowledge ownership and the power that i s i m p l i e d w i t h i n domains of knowledge as p a r t i c u l a r groups l a y c l a i m s to areas of knowledge. T h i s chapter d i s c u s s e s at l e n g t h the p a t t e r n s of f i n d i n g s about h e a l t h that the documents d i s p l a y . The r e s u l t i n g p a t t e r n s i n d i c a t e an o v e r a l l programme of school h e a l t h that i s both complex and interwoven w i t h i n the m i l i e u of the secondary s c h o o l . 5.2 The E x i s t e n c e of H e a l t h Teaching i n the Documents Chapter V d i s c u s s e s the f i n d i n g s of the a n a l y s i s that are r e l a t e d to the e x i s t e n c e of h e a l t h r e l a t e d work and t e a c h i n g w i t h i n the c u r r i c u l a of s c i e n c e , p h y s i c a l education, guidance, and the h e a l t h p r o f e s s i o n a l s . The hidden c u r r i c u l u m of the teachers i s i n i t i a l l y d i s c u s s e d as a c e n t r a l f i n d i n g of t h i s study. As p r e v i o u s l y o u t l i n e d , the M i n i s t r y of H e a l t h documents 1 13 which r e f e r e n c e "The School H e a l t h Programme" p r o v i d e e x t e n s i v e , d e t a i l e d d e s c r i p t i o n s of the work of the h e a l t h p r o f e s s i o n a l i n s c h o o l h e a l t h programmes. There i s no p a r a l l e l document that i s p r o v i d e d f o r the secondary teacher who wishes to pursue h e a l t h t e a c h i n g w i t h i n a p a r t i c u l a r t e a c h i n g d i s c i p l i n e . The hidden c u r r i c u l u m of h e a l t h t e a c h i n g i n the s u b j e c t s of s c i e n c e , p h y s i c a l education, and guidance, while c l e a r l y embedded i n these c u r r i c u l u m guides i s a c u r r i c u l u m that i s both obscure and complex. 5.3 The Hidden C u r r i c u l u m 5.3.1 Sc ience The four goals of s c i e n c e do not provide c l u e s about the p o s s i b l e involvement of the s c i e n c e teacher i n h e a l t h t e a c h i n g . The goals are d i r e c t e d toward a s c i e n t i f i c approach or s c i e n t i f i c way of seeing and i n t e r p r e t i n g the world. For example, s c i e n c e i s d e s c r i b e d as p r o v i d i n g o p p o r t u n i t i e s f o r the students to develop p o s i t i v e s c i e n c e a t t i t u d e s , s k i l l s and processes of s c i e n c e ; c r e a t i v e , c r i t i c a l and formal t h i n k i n g a b i l i t i e s ; and to i n c r e a s e s c i e n t i f i c knowledge. The o b s e r v a t i o n t h a t : P h y s i o l o g i c a l changes l e a d i n g to adulthood and i n c r e a s e i n self-awareness form a n a t u r a l prologue to formal examination of human body, h e a l t h and n u t r i t i o n a l i s s u e s . (B.C.M.E., 1983, page 3) i s the only h e a l t h statement found i n Category I. The r i c h and e x t e n s i v e c a t a l o g i n g of h e a l t h t e a c h i n g p o s s i b i l i t i e s occurs l a t e r i n Category II and III (Combined) and i n Category III 1 14 (Topic i n t e g r a t i o n ) . An o v e r l a y of the H e a l t h Dimension C l a s s i f i c a t i o n Scheme r e v e a l s the f o l l o w i n g p a t t e r n s . E s s e n t i a l teaching t o p i c s under the p h y s i c a l domain of h e a l t h form the major content t e a c h i n g f o c u s . Body concept t o p i c s such as "measure some body f u n c t i o n s " and " d e s c r i b e nerve f u n c t i o n s . . . . " (B.C.M.E., 1983, Teacher Reference Chart) are examples of the more p r e v a l e n t p h y s i c a l c l a s s i f i c a t i o n s . Drugs and n u t r i t i o n are next i n order of ranking, with s a f e t y t o p i c s l a s t . The o p t i o n a l t o p i c s d i s p l a y a s i m i l a r rank order ( i n d e c r e a s i n g importance) of body t o p i c s , p r e v e n t i o n , d i a g n o s i s , treatment, drugs, and s a f e t y . The scope and sequence of content shows that drug t e a c h i n g r e f e r e n c e s are c o n f i n e d to Grade 8; N u t r i t i o n to Grade 9; P r e v e n t i o n , Diagnosis and Treatment t o p i c s ( o p t i o n a l ) are l i s t e d s o l e l y at Grade 10. T h i s one time only approach i s not found i n the t e a c h i n g t o p i c areas of body and s a f e t y where a more i n t e g r a t e d scope and sequence o c c u r s . Mental h e a l t h teaching t o p i c s are absent as are S o c i a l ( I n t e r p e r s o n a l ) t o p i c s . S o c i a l ( L i f e s t y l e ) r e f e r e n c e s d i s p l a y an i n t e g r a t e d p a t t e r n of t o p i c d i s p e r s a l with each grade having one or more r e f e r e n c e s i n d i c a t e d . With the e x c e p t i o n of the c l u s t e r i n g of drug t o p i c s at Grade 8 and n u t r i t i o n at Grade 9 the h e a l t h t o p i c d i s p l a y p a t t e r n i s more evenly d i s t r i b u t e d . A unique example of the way t h i s document i n t e g r a t e s h e a l t h t o p i c s i n t o the o v e r a l l t e a c h i n g g u i d e l i n e s i s found i n the s e c t i o n of Suggested Topic I n t e g r a t i o n . The c u r r i c u l u m guide p r o v i d e s an e x t e n s i v e l i s t i n g of p o s s i b l e t o p i c i n t e g r a t i o n f o r the s c i e n c e teacher. These c u r r i c u l u m t o p i c i n t e g r a t i o n 115 suggestions are i n t e r s p e r s e d throughout the document. He a l t h t o p i c s which r e f l e c t and repeat e s s e n t i a l / o p t i o n a l Category II and I I I data p a t t e r n s are embedded w i t h i n the t o p i c i n t e g r a t i o n l i s t i n g s . Examples of t h i s recommended i n t e g r a t i o n a r e : Suggestions f o r I n t e g r a t i o n : L i f e F u n c t i o n s i n t e g r a t e s w i t h : Changes in matter, r e l a t e body systems, n u t r i e n t s and food a d d i t i v e s to symbols and r e a c t i o n s . (B.C.M.E., 1983, page 66) The s c i e n c e document was the only one of the three teacher c u r r i c u l u m guides to l i s t e x t e n s i v e l y t h i s kind of t o p i c i n t e g r a t i o n i n which the non-health content areas are suggested for i n t e g r a t i o n with the h e a l t h r e l a t e d L i f e F u n ctions s e c t i o n s of the c u r r i c u l u m . When viewed as a whole the s c i e n c e document d i s p l a y s an e x t e n s i v e amount of h e a l t h t e a c h i n g p o s s i b i l i t i e s t h a t are e s s e n t i a l l y hidden w i t h i n the c u r r i c u l u m . Having d i s c u s s e d the e x i s t e n c e of a hidden c u r r i c u l u m of h e a l t h t e a c h i n g w i t h i n the s c i e n c e document, i t i s important to a l s o pursue some of the consequences of such a c u r r i c u l u m s t r u c t u r e . F i r s t of a l l , the document i s w r i t t e n i n such a way that the h e a l t h teaching areas have to be teased out of i t s pages. The where, what and how of h e a l t h t e a c h i n g p o s s i b i l i t i e s are not r e a d i l y a c c e s s i b l e . For example, there i s no s e c t i o n l a b e l l e d h e a l t h education or the t e a c h i n g of h e a l t h concepts in the s c i e n c e classroom. The c l o s e s t approximation to such a l a b e l i s the content area " L i f e F u n c t i o n " . In t h i s study, by means of a broader d e f i n i t i o n of h e a l t h accessed through the WHO d e f i n i t i o n (1978) and the H e a l t h Dimension C l a s s i f i c a t i o n Scheme (Brumby, G a r r a r d and Auman, 1985), other areas of h e a l t h t e a c h i n g p o s s i b i l i t i e s i n a d d i t i o n to those l i s t e d under " L i f e 116 F u n c t i o n " are found. For example, h e a l t h t e a c h i n g p o s s i b i l i t i e s appear under such content areas as: Grade 8: Ecology and Resource Management (Student l e a r n i n g outcome of ) demonstrate knowledge of b i o c i d e s : h e a l t h and environmental e f f e c t s . (B.C.M.E., 1983, Teacher Reference Chart) Grade 9: Changes in Matter (Student l e a r n i n g outcome of) demonstrate a concern f o r s a f e t y when using and s t o r i n g household c h e m i c a l s . (B.C.M.E., 1983, Teacher Reference Chart) Because t h i s J u n i o r Secondary Science C u r r i c u l u m Guide i s a primary source of both t e a c h i n g g u i d e l i n e s and resource m a t e r i a l s that are p r o v i d e d f o r the classroom teacher there appear to be s e v e r a l problems r e l a t e d to the c o n s t r u c t i o n of t h i s manual. The f a c t t h a t many h e a l t h c u r r i c u l u m t e a c h i n g p o s s i b i l i t i e s are hidden w i t h i n the document seems to send a message of low p r i o r i t y f o r t h i s content area. The s c i e n c e teacher who wishes to teach h e a l t h t o p i c s does not r e c e i v e much in the way of c l e a r l y d e f i n e d g u i d e l i n e s . The documentary p a t t e r n s of h e a l t h t e a c h i n g that are d i s p l a y e d i n the f i n d i n g s of t h i s study r e q u i r e d more e f f o r t and time to l o c a t e than can be expected of the classroom teacher who may wish to f i n d and use the h e a l t h education embedded content areas of t h i s c u r r i c u l u m . Some s p e c i f i c recommendations about p o s s i b l e ways of remedying t h i s s i t u a t i o n are d i s c u s s e d l a t e r i n t h i s c h a pter. Category II of the s c i e n c e document provides f u r t h e r evidence f o r the c l a i m that h e a l t h t e a c h i n g , while p r i m a r i l y a hidden f a c e t of t h i s c u r r i c u l u m , i s p o s s i b l e w i t h i n these p r e s c r i b e d g u i d e l i n e s . The l e a r n i n g outcomes, p r e v i o u s l y 1 17 r e f e r r e d to i n C a t e g o r i e s II and I I I (Combined), are d i s c u s s e d as: I t i s expected that the e s s e n t i a l l e a r n i n g outcomes w i l l be i n c l u d e d i n the program for a l l students while o p t i o n a l l e a r n i n g outcomes w i l l be s e l e c t e d by the teacher to extend student l e a r n i n g . (B.C.M.E., 1983, Teacher Reference Chart) The Role Set c l a s s i f i c a t i o n i n which data are d i s p l a y e d under the " P o s s i b l e A c t i v i t i e s " s e c t i o n of the guide p o r t r a y s the s c i e n c e teacher as i n t e r a c t i n g with v a r i o u s h e a l t h p r o f e s s i o n a l s who are a l l " i n v i t e d " i n t o the classroom to d i s c u s s t o p i c s such as "high blood p r e s s u r e " , " e a t i n g h a b i t s " , and " a r t i f i c i a l r e s p i r a t i o n " . The S o c i a l Role d i v i s i o n of Category II appears to m i r r o r the p r e v i o u s l y s t a t e d goals of t h i s document. The r o l e of s c i e n c e i s d e s c r i b e d as o f f e r i n g the students a p a r t i c u l a r l y s u i t a b l e s c i e n t i f i c p e r s p e c t i v e from which to understand t h e i r changing s e l v e s and the world around them. 5.3.2 P h y s i c a l Education The P h y s i c a l Education c u r r i c u l u m document t e l l s us t hat i t s g o a ls and l e a r n i n g outcomes "have i n c o r p o r a t e d and extended those of Goal M" (B.C.M.E., 1977). The four goals of the Secondary P h y s i c a l Education programme can be summarized as f o l l o w s : Goal A - d e v e l o p i n g and m a i n t a i n i n g p o s i t i v e p e r s o n a l a t t r i b u t e s , i n t e r p e r s o n a l r e l a t i o n s h i p s and p o s i t i v e a t t i t u d e s towards p a r t i c i p a t i o n i n p h y s i c a l a c t i v i t y ; 118 Goal B - d e v e l o p i n g knowledge, understanding of f a c t o r s i n competence and a p p r e c i a t i o n of p h y s i c a l a c t i v i t y ; Goal C - d eveloping e f f i c i e n t , e f f e c t i v e motor s k i l l s and a p p l y i n g them i n many p h y s i c a l s i t u a t i o n s ; Goal D - developing and m a i n t a i n i n g p h y s i c a l f i t n e s s . In a n a l y z i n g these goal statements the f o l l o w i n g p a t t e r n s emerge. A l l four goals are c l a s s i f i e d under the H e a l t h Dimension Scheme as f o l l o w s . Goal A i s l i s t e d under the mental domain and a l s o the s o c i a l ( I n t e r p e r s o n a l ) c l a s s i f i c a t i o n . Goals B, C and D belong to the p h y s i c a l (Body) c l a s s i f i c a t i o n of h e a l t h dimensions. A d d i t i o n a l l y , Category I of t h i s document p r o v i d e s numerous examples of h e a l t h - r e l a t e d o b j e c t i v e s , r a t i o n a l e s , p h i l o s o p h i e s and programme i n t e n t i o n s . For example, the document broadly d e s c r i b e s p h y s i c a l education as being: . . . . t h a t p o r t i o n of the e d u c a t i o n a l process which u t i l i z e s p h y s i c a l a c t i v i t y as a primary means f o r s t i m u l a t i n g m e n t a l - i n t e l l e c t u a l , s o c i a l - e m o t i o n a l and p h y s i c a l - g r o w t h and development. (B.C.M.E., 1977, page 1) T h i s statement i s c l a s s i f i e d under a l l three major domains of h e a l t h dimensions. "Health" statements are found under "program i m p l i c a t i o n s " such as: "student needs to understand d a i l y h e a l t h p r a c t i c e s r e g a r d i n g a c t i v i t y , n u t r i t i o n and r e s t . (B.C.M.E., 1977, page 3) The term "good h e a l t h h a b i t s " a l s o appears. The document p r o v i d e s some l e a r n i n g o b j e c t i v e g u i d e l i n e s that r e l a t e to h e a l t h t e a c h i n g under i t s " f i t n e s s " s e c t i o n . However, i t does not p r o v i d e g u i d e l i n e s f o r the " n u t r i t i o n and r e s t " s e c t i o n of t h i s Category I statement. The same c r i t i c i s m a p p l i e s to the 119 statement "good h e a l t h h a b i t s " . The teacher i s given v a r i o u s o b j e c t i v e s to work toward i n h e a l t h r e l a t e d classroom t e a c h i n g but l i t t l e i n the way of s p e c i f i c i n f o r m a t i o n as to how one goes about a c h i e v i n g them. References from the " F i t n e s s Program", a l s o r e f e r r e d to i n t h i s document as " A c t i v e H e a l t h " , d i s p l a y a r i c h p a t t e r n of h e a l t h education p o s s i b i l i t i e s . Statements such as: It i s hoped that the F i t n e s s program w i l l encourage students to maintain e x e r c i s e and n u t r i t i o n a l p a t t e r n s that w i l l a s s i s t them i n l i v i n g a h e a l t h y l i f e . . . . F i t n e s s makes a very s i g n i f i c a n t c o n t r i b u t i o n to the t o t a l w e l l - b e i n g of a l l students. (B.C.M.E., 1980, page 125) are examples of h e a l t h t e a c h i n g statements that appear i n v a r i o u s p a r t s of t h i s document. With the exception of the " F i t n e s s " s e c t i o n of t h i s document, i n which v a r i o u s student l e a r n i n g outcomes are l i s t e d as h e a l t h r e l a t e d , the r e s t of the c u r r i c u l u m guide does not provide c l e a r , c o n c i s e g u i d e l i n e s on h e a l t h t e a c h i n g f o r the p h y s i c a l education teacher. Category II of the P h y s i c a l Education document p r o v i d e s the f o l l o w i n g i n f o r m a t i o n about h e a l t h r e l a t e d g u i d e l i n e s concerning r o l e . As a s o c i a l r o l e p h y s i c a l education i s d e s c r i b e d as c o n t r i b u t i n g to the t o t a l education of the student. Job d e s c r i p t i o n statements are a l l " f i t n e s s " r e l a t e d . T h i s emphasis on " f i t n e s s " i s c o n s i s t e n t with the documentary p a t t e r n s of emphasis i n Category I and I I I . The " F i t n e s s Program" i s h i g h l i g h t e d as a p r i o r i t y i n that i t : should be i n t e g r a t e d i n t o the p h y s i c a l education c u r r i c u l u m and not taught as an i s o l a t e d u n i t of i n s t r u c t i o n . (B.C.M.E., 1980, page 125) 1 20 There i s no r o l e set i n d i c a t e d . Category III of the P h y s i c a l Education document d i s p l a y s a lengthy l i s t of student l e a r n i n g outcomes that are c a t e g o r i z e d as end products of the t e a c h i n g and work of t h i s d i s c i p l i n e . The t a b u l a t e d data of h e a l t h r e f e r e n c e s i n t h i s category p r e s e n t s a p r o f i l e of t h i s s u b j e c t area i n which the m a j o r i t y of emphasis i s on the p h y s i c a l domain with " f i t n e s s " being p a r t i c u l a r l y emphasized. There i s agreement between a l l c a t e g o r i e s of t h i s document i n that the concept of f i t n e s s appears as a p r i o r i t y t e a c h i n g t o p i c . Other p a t t e r n s of i n t e r e s t i n t h i s document i n c l u d e the frequent use of such h e a l t h r e l a t e d words as " c a r d i o v a s c u l a r " and the p r e v i o u s l y d i s c u s s e d emphasis on " f i t n e s s " . The q u e s t i o n of the hidden aspect of h e a l t h education t e a c h i n g i s s i m i l a r to the s i t u a t i o n faced by the other t e a c h i n g d i s c i p l i n e s whose c u r r i c u l u m g u i d e l i n e s were surveyed f o r t h i s study. Whereas there are numerous examples of the p o s s i b i l i t y of the p h y s i c a l education teacher a l s o f u n c t i o n i n g as an a c t i v e h e a l t h educator, the document does not present an e a s i l y f o l l o wed or i n t e r p r e t e d g u i d e l i n e f o r t h i s kind of t e a c h i n g . As p r e v i o u s l y noted, the classroom teacher would be o b l i g e d to search out and r e o r g a n i z e much of the contents of t h i s c u r r i c u l u m document i n order to plan such a programme of h e a l t h t e a c h i n g . 121 5.3.3 Guidance The f i v e g o a ls of the Guidance Programme d i s p l a y a p a t t e r n of emphasis on the mental and s o c i a l domains of h e a l t h . There are twice as many recorded r e f e r e n c e s i n Category I l i s t e d under mental as under p h y s i c a l . There i s an emphasis on a s s i s t i n g - t h e students to develop a p e r s o n a l , v i a b l e value system as w e l l as d e c i s i o n making s k i l l s . The goals a l s o s t r e s s the need f o r students to be aware of t h e i r own behaviour and that of o t h e r s , to know p o s s i b l e c h o i c e s f o r v o c a t i o n a l and e d u c a t i o n a l experiences as w e l l as the importance of communication s k i l l s . Category II f i n d i n g s r e l a t e d to r o l e and h e a l t h t e a c h i n g r e v e a l a document that i s d i f f e r e n t from a l l the other documents surveyed. One of the i n d i c a t o r s of d i s s i m i l a r i t y i s the lengthy d i s c u s s i o n about r o l e i n t h i s document. Most of the r o l e and job d e s c r i p t i o n a n a l y s i s can be c h a r a c t e r i z e d as f i n d i n g s of a c a u t i o n a r y language i n t h i s s e c t i o n . For example, the teacher i s warned about: P a r t i c u l a r care must be used....to see that embarassment i s caused to n e i t h e r student nor parent i n p u r s u i n g what must be c o n s i d e r e d p r i v a t e , p e r s o n a l d e t a i l s . Most requests f o r i n f o r m a t i o n should give the student the o p t i o n of not r e p l y i n g . The teacher should a v o i d p l a c i n g himself i n the p o s i t i o n of attempting to impose a set of value s from above. (B.C.M.E., 1971, page 9) The unusual a s p e c t s of r o l e d e l i n e a t i o n i n the guidance document are: 1) i t s tone of admonition; 2) the lengthy d i s c u s s i o n of these concerns i n the document; 122 3) the f a c t t h a t none of the other documents, i n c l u d i n g those of the h e a l t h p r o f e s s i o n a l s c o n t a i n t h i s kind of documentary d i s c o u r s e . The g u i d e l i n e s p e r t a i n i n g to p r o f e s s i o n a l d i s c r e t i o n appear to be p a r t i c u l a r l y d e f i n e d f o r t h i s s p e c i f i c t e a c h i n g d i s c i p l i n e . T h i s unusual f a c e t of the document w i l l be d i s c u s s e d f u r t h e r i n the s e c t i o n of t h i s chapter r e l a t e d to s o c i o l o g i c a l i n t e r p r e t a t i o n s of the f i n d i n g s . An a n a l y s i s of s o c i a l r o l e r e v e a l s c e r t a i n unexplained a m b i g u i t i e s i n t h i s document. The c u r r i c u l u m guide s t a t e s that guidance meets the needs of s o c i e t y and those of the secondary st u d e n t s . P a r a l l e l to t h i s statement i s the statement of s o c i a l r o l e , a l s o r e f e r e n c e d w i t h i n the job d e s c r i p t i o n d i s c o u r s e , i n which the reader i s asked: What should the p u b l i c s c h o o l be r e s p o n s i b l e f o r i n terms of students' p e r s o n a l problems? (B.C.M.E., 1971, page 2) The document f u r t h e r s t a t e s t h a t : The Department takes the view that the school has both the r e s p o n s i b i l i t y and the o p p o r t u n i t y to make a s i g n i f i c a n t c o n t r i b u t i o n to the f i n d i n g s of s o l u t i o n s to these (drug) problems and urges a l l t e a c h e r s , p a r t i c u l a r l y those i n v o l v e d i n g u i d i n g young people, to provide the kinds of e d u c a t i o n a l experiences which w i l l enable p u p i l s to cope with such problems. (B.C.M.E., 1971, page 5) One i n t e r p r e t a t i o n of these statements, which w i l l be e x p l o r e d more f u l l y i s that t h i s p a r t i c u l a r group of teachers appears to be making a c l a i m of ownership of the "drug p r o b l e m / s o l u t i o n " area of e x p e r t i s e . 123 Role set a n a l y s i s d e s c r i b e s the guidance teacher as seeking: i n t e r d i s c i p l i n a r y c o o p e r a t i o n . . . . ( f o r ) a l e s s fragmented e d u c a t i o n a l e x p e r i e n c e . (B.C.M.E., 1971, page 4) The guidance teacher a l s o i s advised to make use of i n v i t e d guest speakers such as the p u b l i c h e a l t h nurse. Category III p o r t r a y s the guidance teacher's h e a l t h r e l a t e d t e a c h i n g as weighted toward the mental and s o c i a l domains. T h i s i s a p a t t e r n s i m i l a r to that of Category I of t h i s document. Under p h y s i c a l the emphasis i s on the subset of (Drugs). The mental domain r e f l e c t s a major emphasis on such t o p i c s as: r i s k - t a k i n g , decision-making and v a l u e s . The s o c i a l ( I n t e r p e r s o n a l ) c l a s s i f i c a t i o n d i s p l a y s emphasis on communication s k i l l s . As was the case with the Science and P h y s i c a l Education teacher, t h i s c u r r i c u l u m document communicates more hidden h e a l t h c u r r i c u l u m statements than e x p l i c i t statements. In summary, a l l three teacher groups whose documents were analyzed and compared i n t h i s study appear to d i s p l a y the f o l l o w i n g p a t t e r n i n regards to t h i s hidden c u r r i c u l u m of h e a l t h r e l a t e d t e a c h i n g . The Science document, while c o n t a i n i n g examples of h e a l t h r e l a t e d teaching p o s s i b i l i t i e s , appears to c e n t r a l l y focus on the s c i e n t i f i c approach to the d i s c i p l i n e through i t s on-going d i s c o u r s e about the s k i l l s , processes and knowledge that are s c i e n t i f i c a l l y based. Health t e a c h i n g , as i t appears i n the s c i e n c e c u r r i c u l u m g u i d e l i n e s , d i s p l a y s an emphasis on the p h y s i c a l domain. The P h y s i c a l Education document s i m i l a r l y focusses on the c e n t r a l a c t i v i t y of i t s d i s c i p l i n e , the development and maintenance of optimal p h y s i c a l 124 a c t i v i t y f o r students. Where h e a l t h t e a c h i n g i s r e f e r e n c e d the major focus i s on the p h y s i c a l domain and the concept of " f i t n e s s " appears as a t e a c h i n g p r i o r i t y . The Guidance document appears to focus on the concept of "guidance" r a t h e r than the concept of " h e a l t h " per se. H e a l t h r e l a t e d t e a c h i n g i n the guidance c u r r i c u l u m s t r e s s e s the mental and s o c i a l ( i n t e r p e r s o n a l ) aspects of the domain of h e a l t h . A l l three teacher d i s c i p l i n e s are i n v o l v e d i n v a r y i n g degrees with h e a l t h r e l a t e d t e a c h i n g . However, the process and the scope and sequence of t h i s involvement with the t e a c h i n g of h e a l t h appears to be hidden r a t h e r than e x p l i c i t . 5.3.4 Goal M: Guide to the Core Cu r r i c u l u m Goal M c o n t a i n s a s i n g u l a r g o a l , as s t a t e d i n the document: To develop s k i l l s and knowledge f o r h e a l t h f u l l i v i n g . (B.C.M.E., 1977, page 32) The document i s of p a r t i c u l a r relevance to t h i s study because i t r e p r e s e n t s an o f f i c i a l l y p r e s c r i b e d view from the M i n i s t r y of Education, i n 1977, as to the s c h o o l ' s r e s p o n s i b i l i t y i n pursuing t h i s g o a l . The Guide to the Core C u r r i c u l u m handbook from which Goal M was e x t r a c t e d c l e a r l y s t a t e s that t h i s document i s intended to emphasize that core goals and l e a r n i n g outcomes are achieved and r e i n f o r c e d through the i n t e g r a t i o n of v a r i o u s s u b j e c t s or courses. A n a l y s i s of t h i s document using the Health Dimension C l a s s i f i c a t i o n d i s p l a y s an emphasis on the p h y s i c a l domain. A s o c i a l r o l e f o r the school i s i m p l i e d as i t i s d e s c r i b e d as being r e s p o n s i b l e f o r : 125 d e v e l o p i n g s k i l l s and knowledge f o r h e a l t h f u l l i v i n g . (B.C.M.E., 1977, page 32) The q u e s t i o n of who should be r e s p o n s i b l e f o r t h i s t e a c h i n g i s answered by the document as p r i m a r i l y i n v o l v i n g teachers of p h y s i c a l education and guidance. At the J u n i o r - S e n i o r Secondary l e v e l these two teacher groups are d e s c r i b e d as having "a major r e s p o n s i b i l i t y " f o r h e a l t h t e a c h i n g . Science i s r e f e r e n c e d only under Outcome M.9, an outcome r e l a t e d to the t e a c h i n g of f u n c t i o n , s t r u c t u r e and common d i s o r d e r s of the human body. T h i s s c i e n c e r e f e r e n c e i s c o n f i n e d to "the b i o l o g y u n i t s of Science 8". S t u d i e s i n "p o i s e , posture and mime" (Drama 8-10) are a l s o i n c l u d e d i n s p e c i f i c r o l e r e s p o n s i b i l i t i e s f o r su b j e c t a r e a s . R e c r e a t i o n a l a c t i v i t i e s , s a f e t y and f i r s t a i d are re f e r e n c e d as content areas without s p e c i f i c i t y of t e a c h i n g d i s c i p l i n e . At the Senior Secondary l e v e l p h y s i c a l education and guidance are h i g h l i g h t e d i n r e f e r e n c e to outcomes M.13 and M.14. These s p e c i f i c outcomes are c l a s s i f i e d under the mental and s o c i a l ( I n t e r p e r s o n a l ) domains and the gen e r a l c l a s s i f i c a t i o n . The p h y s i c a l education and guidance teac h e r s are s i n g l e d out f o r t h e i r importance as h e a l t h educators: P h y s i c a l Education and Guidance, because of the focus of t h e i r content and r e l a t e d a c t i v i t i e s , have a s p e c i a l r e s p o n s i b i l i t y r e g a r d i n g outcomes. (B.C.M.E., 1977, page 33) Science at the Senior Secondary l e v e l i s not r e f e r e n c e d as being h e a l t h r e l a t e d i n te a c h i n g focus. No r o l e set i s i n d i c a t e d i n t h i s document. 1 26 T h i s document presents a s u b j e c t l i s t i n g t h a t i n d i c a t e s the f o l l o w i n g p a t t e r n s . H e a l t h r e l a t e d t e a c h i n g occurs i n P h y s i c a l Education Grades 8-11; i n Guidance Grades 10-11; in Science Grade 8; and i n Drama Grades 8-10. Other areas of h e a l t h t e a c h i n g are l i s t e d as being: F i r s t A i d , A r t , Music, C r a f t s , Sewing, Cooking and I n d u s t r i a l E d u c a t i o n . There are s e v e r a l c o n c l u s i o n s that can be drawn from t h i s document. F i r s t , the e x i s t e n c e of Goal M i n t h i s document i s s i g n i f i c a n t . T h i s document r e p r e s e n t s an o f f i c i a l l y p r e s c r i b e d view from a m i n i s t r y that i s d i r e c t l y r e s p o n s i b l e f o r the e d u c a t i o n a l component of the work and teaching of the s c h o o l . The f a c t that Goal M was i n c l u d e d among the goals o u t l i n e d f o r the o v e r a l l c u r r i c u l a appears to lend weight to the c l a i m that h e a l t h t e a c h i n g i s o f f i c i a l l y r ecognized as o c c u r r i n g w i t h i n v a r i o u s secondary school c u r r i c u l a . The P h y s i c a l Education and Guidance r e f e r e n c e s i n Goal M bear some s i m i l a r i t y to the f i n d i n g s of t h i s study. The Science r e f e r e n c e s under Goal M, however, are not s i m i l a r . As p r e v i o u s l y d i s c u s s e d i n Chapter IV, the Goal M document predates the r e v i s e d Science c u r r i c u l u m that i s a n a l y z e d i n t h i s t h e s i s . However, the f a c t t h a t the c u r r i c u l u m ignored h e a l t h t e a c h i n g that o c c u r r e d i n Science Grades 9-12 appears to be r e l e v a n t to the o v e r a l l d i s c u s s i o n of t h i s study. The authors of t h i s Goal M document, by r e f e r r i n g only to the b i o l o g y u n i t s of Grade 8, have narrowly d e f i n e d the scope and sequence of p o s s i b l e h e a l t h teaching w i t h i n S c i e n c e . Furthermore, the r o l e of the s c i e n c e teacher as h e a l t h educator i s p o r t r a y e d as a p o s i t i o n of minor importance when compared to that of the guidance and p h y s i c a l education t e a c h e r s . 127 Another example of evidence of r e s t r i c t e d boundaries f o r the scope and sequence of h e a l t h t e a c h i n g appear i n the statements that Guidance 10 and 11 are l i s t e d to the e x c l u s i o n of Guidance 8, 9 and 12. T h i s a n a l y s i s of the d i s p l a y of understandings about the e x i s t e n c e of h e a l t h t e a c h i n g w i t h i n Goal M does not agree with the f i n d i n g s of t h i s study i n which numerous examples of h e a l t h t e a c h i n g at the grade l e v e l s of 8, 9 and 10 f o r Secondary Guidance have been found. From the standpoint of a l l teacher d i s c i p l i n e s d i s c u s s e d i n t h i s document, P h y s i c a l Education i s p o r t r a y e d as the s u b j e c t area i n which h e a l t h education i s more l i k e l y to occur, with Grades 8 through 11 emphasized. From the o v e r a l l p a t t e r n i n g t h a t appears in t h i s document there i s l i t t l e i n f o r m a t i o n given as to why c e r t a i n grades and s u b j e c t areas were c o n s i d e r e d to be h e a l t h r e l a t e d and others excluded. A d d i t i o n a l l y , there i s l i t t l e d i s c u s s i o n r e l a t e d to an u n d e r l y i n g p h i l o s o p h y that p r o v i d e d guidance f o r the c o n s t r u c t i o n of t h i s document. On the whole there are many que s t i o n s that are r a i s e d by t h i s document that do not appear to be s a t i s f a c t o r i l y answered. One of the more i n t r i g u i n g of these q u e s t i o n s i n found i n core c u r r i c u l u m document under the heading H e a l t h f u l L i v i n g ; A number of respondents to the d r a f t core c u r r i c u l u m document expressed the o p i n i o n that enough emphasis was not given to p h y s i c a l and mental h e a l t h . Compulsory d a i l y p h y s i c a l education was suggested as were s t r e s s , s e l f concept, and the a d d i t i o n to such t o p i c s as p r e p a r a t i o n f o r parenthood. The M i n i s t r y w i l l be g i v i n g f u r t h e r c o n s i d e r a t i o n to the concerns r a i s e d and the b a s i c q u e s t i o n : "What i s the r e s p o n s i b i l i t y of a p u b l i c school system with respect to these matters?" (B.C.M.E., 1977, page 5) 128 The q u e s t i o n r a i s e d i n the Guide to the Core Cu r r i c u l u m about the parameters of school r e s p o n s i b i l i t y i s s i m i l a r to that v o i c e d i n Secondary School C u r r i c u l u m Guide - Guidance. The o v e r a l l impression conveyed by these documents i s that while there i s a g e n e r a l concern about v a r i o u s student "problems", there i s a l s o an u n c e r t a i n t y as to what course the school should take i n such matters. In summary, the most important aspect of t h i s document i s the f a c t t h a t i t has been w r i t t e n and d i s t r i b u t e d as an o f f i c i a l statement of p o l i c y from the M i n i s t r y of Education, Province of B r i t i s h Columbia, and that i t s Goal M c l e a r l y e s t a b l i s h e s a precedent f o r the e x i s t e n c e and o f f i c i a l s a n c t i o n i n g of h e a l t h t e a c h i n g w i t h i n c e r t a i n s u b j e c t areas at the secondary s c h o o l l e v e l . The document i s a l s o u s e f u l as a body of data t h a t can be compared with the f i n d i n g s of t h i s study. However, there are s e r i o u s doubts that can be r a i s e d as to i t s u s e f u l n e s s to the teachers and school a d m i n i s t r a t o r s . In p a r t i c u l a r , the same problems s u r f a c e with t h i s document as with the teacher c u r r i c u l u m guides i n g e n e r a l . T h i s document i s notable i n i t s la c k of c l e a r l y d e f i n e d h e a l t h t e a c h i n g d i r e c t i v e s . G e n e r a l l y i t would be of l i t t l e use to the classroom teacher who may wish to e s t a b l i s h a programme of h e a l t h t e a c h i n g w i t h i n a s p e c i f i c t e a c h i n g d i s c i p l i n e i n the secondary s c h o o l . 129 5.4 The E x p l i c i t C u r r i c u l u m 5.4.1 I n t r o d u c t i o n The documents d i s c u s s e d here represent the h e a l t h p r o f e s s i o n a l s ' c u r r i c u l u m documents f o r the school h e a l t h programme. Both of these documents are r e f e r r e d to i n t h i s study as the e x p l i c i t c u r r i c u l u m of t h i s programme. They represent the c l e a r l y d e f i n e d , comprehensive g u i d e l i n e s f o r a programme that has been e s t a b l i s h e d i n the p u b l i c s c h o o l s of B r i t i s h Columbia f o r many decades. The use of the term e x p l i c i t r e f e r s to the f a c t that the school h e a l t h programme o u t l i n e d i n these documents i s a p r e c i s e body of h e a l t h r e l a t e d work and t e a c h i n g that i s presented as the c e n t r a l s p e c i f i c aspect of the documents. There i s no hidden aspect to t h i s c u r r i c u l u m as has been the case f o r the teacher documents p r e v i o u s l y d i s c u s s e d . The two documents that represent the h e a l t h p r o f e s s i o n a l s ' c u r r i c u l u m i n the school h e a l t h programme are: P u b l i c H e a l t h  Nursing Program f o r C h i l d r e n and the School Health Program  Procedures Manual. 5.4.2 P u b l i c H e a l t h Nursing f o r C h i l d r e n The f i r s t of the two h e a l t h p r o f e s s i o n a l documents, P u b l i c  H e a l t h Nursing f o r School Age C h i l d r e n , o u t l i n e s e i g h t o b j e c t i v e s f o r the programme. A l l these o b j e c t i v e s are h e a l t h r e l a t e d , with major emphasis p l a c e d on the p h y s i c a l subset of p r e v e n t i o n , d i a g n o s i s and treatment. The purpose of t h i s programme i s presented i n g l o b a l terms: 130 To promote a he a l t h y l i f e s t y l e and f a c i l i t a t e the attainment of optimal h e a l t h by school age c h i l d r e n to enhance t h e i r l e a r n i n g c a p a c i t y and l a y the foundation f o r h e a l t h i n a d u l t l i f e . (B.C.M.H., 1982, page 1) There i s an emphasis i n t h i s document on i l l n e s s that d i s t i n g u i s h e s i t from the p r e v i o u s l y d i s c u s s e d teacher documents. The o b j e c t i v e s , that make up the major e n t r i e s under Category I - Hea l t h Dimension A n a l y s i s , c o n t a i n words such as "communicable d i s e a s e " , " s p e c i f i c d i s e a s e s " , " d i s o r d e r s " , "impairment", " p h y s i c a l or emotional d i s e a s e " , " p h y s i c a l or emotional h e a l t h problems". While the primary i n t e n t appears to be d i r e c t e d toward the attainment of we l l n e s s , the o v e r a l l d i s c u s s i o n of wellness i s secondary to the d i s c u s s i o n of i l l n e s s . T h i s i s e s p e c i a l l y evident when the teacher documents are compared with t h i s h e a l t h document. T h i s aspect of the w e l l n e s s - i l l n e s s continuum of h e a l t h that i s d i s c u s s e d i n the documents w i l l be pursued f u r t h e r under the s o c i o l o g i c a l i n t e r p r e t a t i o n s e c t i o n of t h i s c h a pter. Category II of the P u b l i c H e a l t h Nursing f o r School Age C h i l d r e n document presents a c o n c i s e , w e l l - d e f i n e d p i c t u r e of the p u b l i c h e a l t h nurse as a promoter of a healthy l i f e s t y l e and h e a l t h f a c i l i t a t o r . The job d e s c r i p t i o n d i s p l a y s a p u b l i c h e a l t h p r o f e s s i o n a l who i s o f f i c i a l l y s a n c t i o n e d f o r t h i s r o l e by both the School Act and the H e a l t h Ac t . The document c l e a r l y d e f i n e s the e x p l i c i t r o l e of t h i s h e a l t h p r o f e s s i o n a l as: The primary h e a l t h worker i n the school i s the p u b l i c h e a l t h nurse who i s r e s p o n s i b l e f o r the c o o r d i n a t i o n of h e a l t h s e r v i c e s p r o v i d e d by a m u l t i - d i s c i p l i n a r y team. (B.C.M.H., 1982, page 1) 131 The s p e c i f i c job d e s c r i p t i o n s of t h i s h e a l t h p r o f e s s i o n a l are lengthy with many v a r i e d aspects of h e a l t h s e r v i c e p r o v i s i o n s o u t l i n e d . T h i s h e a l t h worker i s i n v o l v e d i n a long l i s t of h e a l t h care s e r v i c e a c t i v i t i e s . The m a j o r i t y of these i n v o l v e d i r e c t c l i n i c a l i n t e r v e n t i o n of a h e a l t h care nature. She i s a l s o d e s c r i b e d as a c o o r d i n a t o r - c o n s u l t a n t between the s c h o o l , the p u b l i c h e a l t h s e r v i c e and the community. Her r o l e subsumes that of a t r a d i t i o n a l r e g i s t e r e d nurse with a d d i t i o n a l p u b l i c h e a l t h q u a l i f i c a t i o n s . T h i s r o l e a l s o assumes a v a r i e t y of c l o s e l y d e l i n e a t e d a d m i n i s t r a t i v e and f a c i l i t a t i v e f u n c t i o n s as a s p e c i a l i s t i n school h e a l t h . The r o l e set f o r t h i s h e a l t h p r o f e s s i o n a l r e f l e c t s the wide focus of her r o l e d e s c r i p t i o n s g e n e r a l l y i n that she i n t e r a c t s on a broad b a s i s with the s c h o o l , the s c h o o l h e a l t h team, and the community r e l a t e d to the school as w e l l as with her primary focus, the students. The Category III - H e a l t h Dimension C l a s s i f i c a t i o n r e v e a l s the f o l l o w i n g documentary p a t t e r n s . The emphasis i s weighted toward the p h y s i c a l subset of p r e v e n t i o n , d i a g n o s i s and treatment domain as the area i n which students r e c e i v e a m a j o r i t y of the end products. Fourteen r e f e r e n c e s are l i s t e d under t h i s p h y s i c a l c l a s s i f i c a t i o n with only one statement that d i r e c t l y r e f e r e n c e s mental h e a l t h . Category I l l ' s emphasis on d i a g n o s i s , treatment and p r e v e n t i o n appears to enhance the f i n d i n g s of Category I i n which s i m i l a r p a t t e r n s occur. There are s e v e r a l phrases i n d i c a t i n g a c t i v e i n t e r v e n t i o n that appear in t h i s document. T h i s s i t u a t i o n p r o v i d e s a c o n t r a s t to the d i s c o u r s e observed in the teacher documents. Category III 1 32 c o n t a i n s d e s c r i p t o r s such as "nursing s u r v e i l l a n c e " and " i n v e s t i g a t i o n and n u r s i n g assessment". T h i s document which i n d i c a t e s an a c t i v e i n t e r v e n t i o n i s t frame of r e f e r e n c e does not c o n t a i n any of the c a u t i o n a r y p r e s c r i p t i v e s found i n the Guidance teacher document. One can assume that both of these p r o f e s s i o n a l communities work i n areas of school s e t t i n g s i n which p r o f e s s i o n a l d i s c r e t i o n i s r e q u i r e d . However, the d i s c r e t i o n a r y c a u t i o n p r e v i o u s l y d i s c u s s e d under Guidance -Category I I : Job D e s c r i p t i o n i s absent i n t h i s h e a l t h p r o f e s s i o n a l document. T h i s treatment of p r o f e s s i o n a l d i s c r e t i o n as a component of r o l e w i l l be e x p l o r e d f u r t h e r i n the s o c i o l o g i c a l d i s c u s s i o n . 5.4.3 Vancouver Health Department School Health Program  Procedures Manual The school aged c h i l d program goals and long term o b j e c t i v e s are omnibus in t h i s document. Adolescent goals cover the spectrum of r e i n f o r c i n g h e a l t h y behaviour p a t t e r n s , d i s c o u r a g i n g negative ones i n a range that i n c l u d e s d r i v i n g , smoking, and a l c o h o l as w e l l as parenthood, c h r o n i c i l l n e s s and aging. Category I - Health C l a s s i f i c a t i o n Dimension d i s p l a y s a p a t t e r n of major emphasis on the p h y s i c a l with secondary emphasis on the mental domain. Category II d e s c r i b e s r o l e s of s e l e c t e d h e a l t h p r o f e s s i o n a l workers who are the major h e a l t h p a r t i c i p a n t s i n the school programme. Under s o c i a l r o l e the documents d e s c r i b e h e a l t h p r o f e s s i o n a l s who are o f f i c i a l l y and s o c i a l l y s a n c t i o n e d p r o v i d e r s of h e a l t h s e r v i c e s . The most lengthy r o l e d e s c r i p t i o n i s that of the p h y s i c i a n . T h i s r o l e i s 133 d e s c r i b e d as assuming a s p e c i a l p o s i t i o n i n the programme. The p h y s i c i a n ' s r o l e r e f l e c t s an e l i t e or s p e c i a l s t a t u s with d e s c r i p t i o n s such as: Because of t h e i r standing i n the community and based on t h e i r medical t r a i n i n g , knowledge and experience the P h y s i c i a n s accept l e a d e r s h i p r e s p o n s i b i l i t y i n s e c u r i n g a p p r o p r i a t e c o n d i t i o n s f o r the c h i l d r e n i n the school aged c h i l d p o p u l a t i o n . ( M a r s h a l l , 1982, page 64) T h i s s i g n i f i c a t i o n of r o l e s t a t u s stands in c o n t r a s t to the document's d e s c r i p t i o n of the community h e a l t h nurse. The nurse, although i d e n t i f i e d as being the primary Vancouver H e a l t h Department worker i n the s c h o o l , i s not given the s t a t u s that i s a s c r i b e d to the school p h y s i c i a n . Job d e s c r i p t i o n s vary. The l i s t of f u n c t i o n s d e s i g n a t e d f o r the p h y s i c i a n i s twice as lengthy as that of f u n c t i o n s l i s t e d f o r the nurse. T h i s s i t u a t i o n r e v e r s e s i t s e l f i n Category II and I I I combined. In t h i s s e c t i o n under " a c t i v i t i e s " the nurse i s l i s t e d as being r e s p o n s i b l e f o r twice as many a c t i v i t i e s as the p h y s i c i a n . G e n e r a l l y , the h e a l t h p r o f e s s i o n a l s i n t h i s document are d e s c r i b e d as i n v o l v e d with the f o l l o w i n g a c t i v i t i e s : 1) enhancing the h e a l t h and l e a r n i n g environment of students; 2) p r o v i d i n g a b r i d g e between school h e a l t h s e r v i c e s and the community h e a l t h care workers; 3) h e l p i n g students and f a m i l i e s to be more r e s p o n s i b l e f o r t h e i r own h e a l t h ; 4) p r o v i d i n g e f f e c t i v e , e f f i c i e n t u t i l i z a t i o n of e d u c a t i o n a l and h e a l t h manpower reso u r c e s ; 5) a s s e s s i n g h e a l t h s e r v i c e outcomes; 134 6) p r o v i d i n g adequate i n f o r m a t i o n , r e s e a r c h and e v a l u a t i o n data f o r a n a l y s i s and m o n i t o r i n g . The r o l e set i s as d i v e r s e i n i t s focus as that d e s c r i b e d under the P u b l i c H e a l t h Nursing Program f o r School Age C h i l d r e n document. O v e r a l l t h i s h e a l t h p r o f e s s i o n a l document prese n t s a lengthy, d e t a i l e d and s p e c i f i c d i s p l a y of r o l e , p a r t i c u l a r l y r o l e i n the area of job d e s c r i p t i o n . However, as p r e v i o u s l y noted i n the p u b l i c h e a l t h document, there i s a notable omission of c a u t i o n a r y d e s c r i p t o r s . Both documents d i s p l a y h e a l t h p r o f e s s i o n a l s who are i n v o l v e d i n s e n s i t i v e , i n t e r p e r s o n a l a c t i v i t i e s f o r which there i s an absence of d i s c u s s i o n r e l a t e d to p r o f e s s i o n a l d i s c r e t i o n . Another i n t e r e s t i n g f a c e t of the two h e a l t h p r o f e s s i o n a l documents, when compared with the teacher documents, concerns the c o n t r a s t i n g p i c t u r e of the h e a l t h p r o f e s s i o n a l as the " i n v i t e d " p a r t i c i p a n t i n the classroom. The teacher documents of s c i e n c e and guidance r e f e r to the h e a l t h p r o f e s s i o n a l as being " i n v i t e d " i n t o the classroom to d i s c u s s v a r i o u s t o p i c s that are set by the t e a c h e r . The Canadian Education A s s o c i a t i o n ' s r e p o r t (1976) on school h e a l t h e d u c a t i o n , the Mutter (1985) report on Canadian school h e a l t h programmes, and the Matters (1977) study of school h e a l t h i n B r i t i s h Columbia a l s o r e f e r to t h i s image of the h e a l t h p r o f e s s i o n a l as a guest of the teacher in the classroom. However, t h i s i n v i t e d , or o u t s i d e r , image i s not d i s p l a y e d to any degree i n these h e a l t h p r o f e s s i o n a l documents. Both the P u b l i c Health Nursing Program  f o r School Aged C h i l d r e n document and the School H e a l t h Program  Procedures Manual p o r t r a y a h e a l t h p r o f e s s i o n a l who appears 135 a c t i v e l y i n v o l v e d i n classroom h e a l t h teaching a c t i v i t i e s . For example, the Vancouver He a l t h Department document d e s c r i b e s h e a l t h p r o f e s s i o n a l involvement under Job F u n c t i o n as i n c l u d i n g : Develop education programs. He a l t h o r i e n t e d s t a f f are to p a r t i c i p a t e i n planned classroom a c t i v i t i e s ( M a r s h a l l , 1982, page 31) Community H e a l t h Nurse F u n c t i o n s : I n s t r u c t i n g i n the classroom, implementing and c o o r d i n a t i n g p r e v e n t i v e h e a l t h programs. ( M a r s h a l l , 1982, page 51) In the f i r s t statement, use of the word "develop" appears to imply an a c t i v e involvement by the h e a l t h p r o f e s s i o n a l , whereas the wording " p a r t i c i p a t e i n planned classroom a c t i v i t i e s " i s more p a s s i v e i n nature. However, the phrases " i n s t r u c t i n g i n the classroom, implementing and c o o r d i n a t i n g " p o r t r a y a p o s i t i v e sense of the h e a l t h p r o f e s s i o n a l as an a c t i v e , d i r e c t p a r t i c i p a n t i n the l i f e of the classroom h e a l t h programme. T h i s p a r t i c u l a r area of the r o l e of the h e a l t h p r o f e s s i o n a l as classroom h e a l t h educator i s not w e l l d e f i n e d i n the documents. A study by the author (Auman, 1983) that touched on t h i s area of classroom r o l e found that teachers and h e a l t h p r o f e s s i o n a l s may have d i f f e r e n t understandings about t h i s q u e s t i o n of r o l e . The t e a c h e r s ' p o i n t of view i n t h i s study was that they represented the d i s c i p l i n e which knew best the methodology of t e a c h i n g i n the classroom and that h e a l t h p r o f e s s i o n a l s , while c l i n i c a l l y w e l l prepared, had not r e c e i v e d s u f f i c i e n t e d u c a t i o n a l t r a i n i n g to p r o v i d e them with h e a l t h teaching competencies r e q u i r e d f o r classroom s e t t i n g s . The h e a l t h p r o f e s s i o n a l p o i n t of view was that h e a l t h education was best taught by the h e a l t h p r o f e s s i o n a l who has a c q u i r e d an e x t e n s i v e background i n medical e x p e r t i s e . 136 Teachers were c a t e g o r i z e d as not being adequately prepared to teach about matters p e r t a i n i n g to the many complex areas of h e a l t h e d u c a t i o n . O v e r a l l t h i s h e a l t h p r o f e s s i o n a l document appears to r e f l e c t an u n c l e a r p i c t u r e of r o l e e x p e c t a t i o n s i n classroom h e a l t h education s e t t i n g s . The few e n t r i e s of c r o s s r e f e r e n c i n g i n r e l a t i o n s h i p to the r o l e of the h e a l t h p r o f e s s i o n a l w i t h i n the documents of the teachers does not provide a c l e a r or e a s i l y d e l i n e a t e d p i c t u r e of what i s a c t u a l l y expected here. T h i s problematic area of r o l e e x p e c t a t i o n s and the boundaries of knowledge w i t h i n the classroom s e t t i n g w i l l be d i s c u s s e d f u r t h e r i n t h i s c h a p t e r . Category II and III Combined T h i s f i n a l s e c t i o n of a n a l y s i s d e s c r i b e s the end products r e c e i v e d by the student and the assign e d r o l e r e s p o n s i b i l i t i e s f o r these a c t i v i t i e s . The document d i v i d e s the major areas of a c t i v i t i e s i n t o : Care of the Sick or I n j u r e d C h i l d ; Mental H e a l t h ; H e a l t h Education; Assessment; Nursing; N u t r i t i o n ; R e h a b i l i t a t i o n Therapy; Speech Pathology; Communicable Disease C o n t r o l (Immunization); Communicable Disease C o n t r o l ( G e n e r a l ) ; H e a l t h Promotion; Health P r o t e c t i o n ; and Dental S e r v i c e s . The major four areas of emphasis i n a c t i v i t i e s are, i n descending o r d e r : Mental H e a l t h , Health Education, Assessment, and Care of the S i c k / I n j u r e d C h i l d . In the corresponding area of the person r e s p o n s i b l e f o r these a c t i v i t i e s the community h e a l t h nurse i s the most f r e q u e n t l y r e f e r e n c e d with twice as many r e f e r e n c e s to the nurse as to the school p h y s i c i a n . T h i s emphasis i s c o n s i s t e n t with the document's e a r l i e r statement t h a t : 1 37 The nurse i s the key Vancouver He a l t h Department worker i n the s c h o o l . ( M a r s h a l l , 1982, page 20) The t o t a l l i s t of h e a l t h p r o f e s s i o n a l s who make up t h i s school h e a l t h team i s e x t e n s i v e . Whereas the s e c t i o n of the document that o u t l i n e s the a c t i v i t i e s and persons r e s p o n s i b l e i s lengthy, there appears to be l i t t l e i f any r o l e and a c t i v i t y o v e r l a p . The g e n e r a l impression i s t h a t t h i s document has p r o v i d e d c o n c i s e d i r e c t i o n as to what a c t i v i t i e s are p r o v i d e d and who i s r e s p o n s i b l e f o r them at the c l i n i c a l a c t i v i t y l e v e l . However, the r o l e e x p e c t a t i o n s f o r h e a l t h p r o f e s s i o n a l s i n classroom t e a c h i n g s i t u a t i o n s i s not w e l l d e f i n e d . 5.5 Summary of the Hidden and E x p l i c i t C u r r i c u l a T h i s study makes the c l a i m that there i s e x t e n s i v e and v a r i e d documentary evidence of a secondary school h e a l t h c u r r i c u l u m that i s hidden w i t h i n the teachers documents and e x p l i c i t w i t h i n the h e a l t h p r o f e s s i o n a l documents. The g e n e r a l l i t e r a t u r e about school h e a l t h programmes and the r e s e a r c h s t u d i e s aimed at i n v e s t i g a t i n g the Canadian school h e a l t h programme, and s p e c i f i c a l l y the s t u d i e s by the Canadian E d u c a t i o n a l A s s o c i a t i o n (1978), Muter (1982, 1985), Matters (1977), B r i t i s h Columbia M e d i c a l A s s o c i a t i o n (1984), and Johnson (1986) have f a i l e d to r e v e a l the amount of h e a l t h work and t e a c h i n g at the secondary l e v e l that t h i s r e s e a r c h has documented. The Science, P h y s i c a l Education, and Guidance documents d i s p l a y a wide range of h e a l t h t e a c h i n g p o s s i b i l i t i e s . The Guide to the Core C u r r i c u l u m p r o v i d e s a s p e c i f i c , e x t e n s i v e l y w r i t t e n o f f i c i a l s a n c t i o n f o r h e a l t h t e a c h i n g to 138 occur w i t h i n c e r t a i n secondary c o r e c u r r i c u l u m content a r e a s . However, the teacher documents, while c o n t a i n i n g many examples of h e a l t h education p o s s i b i l i t i e s , l a c k c o n c i s e g u i d e l i n e s or c l e a r d i r e c t i v e s f o r the would be secondary l e v e l h e a l t h educator. The e x p l i c i t c u r r i c u l u m of the school h e a l t h programmes are d e f i n e d i n the h e a l t h p r o f e s s i o n a l documents as d i s p l a y i n g a h e a l t h programme that i s broadly and c o n c i s e l y o u t l i n e d , with the e x c e p t i o n of the h e a l t h p r o f e s s i o n a l as classroom h e a l t h educator. O v e r a l l , the h e a l t h p r o f e s s i o n a l documents present a school h e a l t h programme that i s e a s i l y e x p l i c a t e d and w e l l d e t a i l e d i n i t s d i r e c t i v e s . The g e n e r a l focus of the teacher groups d i s p l a y e d i n the documents i s on the work and t e a c h i n g of the v a r i o u s s u b j e c t area. H e a l t h education t e a c h i n g , where i t does occur, i s d i s p l a y e d as a secondary concern. The general focus of the h e a l t h p r o f e s s i o n a l i s on the work of the school h e a l t h programme, p a r t i c u l a r l y i n i t s d i r e c t i v e s toward the many v a r i e d and i n t r i c a t e h e a l t h care a c t i v i t i e s that are performed by i t s community. The broad mosaic presented i n these documents i s that of a d i v e r s e h e a l t h programme w i t h i n the school that c o n t a i n s the work and tea c h i n g of both the secondary teachers i n c e r t a i n s u b j e c t areas and the h e a l t h p r o f e s s i o n a l s . 139 5.6 T h e o r e t i c a l D i s c u s s i o n 5.6.1 I n t r o d u c t i o n The p r e v i o u s l y d i s c u s s e d f i n d i n g s of t h i s study were c o n s t r u c t e d and analyzed by means of t h e o r e t i c a l l y informed content a n a l y s i s . The f i n a l stage of t h e o r e t i c a l l y informed content a n a l y s i s i s the making of i n f e r e n c e s about the f i n d i n g s . T h i s s e c t i o n of the t h e s i s concerns the process of i n f e r e n c e c o n s t r u c t i o n ; a process t h a t i s r e l a t e d to the s o c i o l o g y of knowledge t h e o r i e s that have guided the o r i g i n a l u t i l i z a t i o n of t h e o r e t i c a l l y informed content a n a l y s i s . T h i s methodology i s d i s c u s s e d i n d e t a i l i n Chapter I I I . The methodology i s based on s e l e c t e d t h e o r i e s from the s o c i o l o g y of knowledge. The s o c i o l o g i c a l t h e o r i s t s i n t h i s area of s p e c i a l i z a t i o n , whose w r i t i n g s are p a r t i c u l a r l y r e l e v a n t to t h i s r e s e a r c h are Holzner and Marx (1979), Schutz (1962, 1967) and Smith (1974). The major focus of t h i s s e c t i o n g e n e r a l l y i s on the e p i s t e m i c communities of both the t e a c h e r s and the h e a l t h p r o f e s s i o n a l s and p a r t i c u l a r l y on the f i n d i n g s of the a n a l y s i s as they p r o v i d e the b a s i s f o r the f i n a l stage of i n f e r e n c e making. S p e c i f i c a l l y , these f i n d i n g s are examined through the t h e o r e t i c a l p e r s p e c t i v e s of the e p i s t e m i c communities' use of frames of r e f e r e n c e , s p e c i a l i z e d knowledge, boundaries of knowledge and the i m p l i c a t i o n s of power that i s r e l a t e d to knowledge ownership. 1 40 5.6.2 E p i s t e m i c Communities A major focus of t h i s study has been the i n t e n t to explore the i n f l u e n c e of the epistemic communities of teachers and h e a l t h p r o f e s s i o n a l s as they appear to have been documentarily c o n s t r u c t e d i n these f i n d i n g s . Of p a r t i c u l a r i n t e r e s t to the r e s e a r c h e r has been the v a r i o u s ways that these documents s o c i a l l y c o n s t r u c t the o v e r a l l school h e a l t h programme. In d e s c r i b i n g the nature of the epistemic community Holzner and Marx (1979) have p l a c e d s p e c i a l emphasis on i t s use of frames of r e f e r e n c e . They contend that the e x p e r i e n t i a l foundation of the e p i s t e m i c community's frames of r e f e r e n c e may be a major p o i n t f o r the d i f f e r e n t i a t i o n of communities. Frames of r e f e r e n c e a s s i s t with c o n c e p t u a l i z a t i o n of problems and f a c i l i t a t e the d i s c o v e r y of p o s s i b l e s o l u t i o n s . A d i s c u s s i o n of the key p o i n t s w i t h i n t h i s concept of frames of r e f e r e n c e w i l l f o l l o w and the p a r a l l e l areas of t h e o r i e s p e r t a i n i n g to s p e c i a l i z e d knowledge, knowledge boundaries and the n o t i o n of power t h a t i s i m p l i e d by knowledge ownership w i l l be pursued in the c o n c l u s i o n of t h i s c h a p ter. 5.6.3 Frames of Reference 5.6.3.1 Taken-For-Granted Assumptions Taken-for-granted assumptions a s s i s t the community to develop a knowledge and b e l i e f framework from which i t s unique p o i n t s of view and the ways by which i t develops s p e c i f i c o r i e n t a t i o n s about i t s work and r e l a t i o n s h i p s with other communities can be formulated. Many examples of t a k e n - f o r -granted assumptions e x i s t i n the documents of t h i s study. 141 The teacher documents d i s p l a y a number of d i v e r s e taken-f o r - g r a n t e d assumptions. Beginning with the s c i e n c e documents, the o b j e c t i v e s , goals and r a t i o n a l e s of t h i s community d i s p l a y assumptions about the t a k e n - f o r - g r a n t e d knowledge and b e l i e f s that are shared by t h i s community. There i s no attempt to e x p l a i n i n t h i s document what determines " s c i e n t i f i c p e r s p e c t i v e s " or what c o n s t i t u t e s the " s k i l l s and processes of s c i e n c e " . The t a c i t understanding that appears here i s that the community's base of knowledge has i n c o r p o r a t e d these understandings somewhere w i t h i n the t r a i n i n g process experienced by s c i e n c e t e a c h e r s . There i s a l s o a t a k e n - f o r - g r a n t e d assumption, f o r example, that t h i s " s c i e n t i f i c p e r s p e c t i v e " i s s o c i a l l y s a n c t i o n e d as an a c c e p t a b l e p e r s p e c t i v e f o r the work of t h i s community i n school s e t t i n g s . T h i s shared b i o g r a p h i c a l understanding of the s c i e n c e teacher community about t a k e n - f o r -granted assumptions i s r e l a t e d to Schutz's (1967) notio n s of how we come to see and understand the world through our accumulated and shared e x p e r i e n c e s . There i s a p e r v a s i v e d i s p l a y of how the document d e f i n e s t h i s community of s c i e n c e teachers as using a " s c i e n t i f i c p e r s p e c t i v e " to o r i e n t and d e f i n e i t s work. An a n a l y s i s of r o l e and te a c h i n g t o p i c s p r o v i d e s f u r t h e r evidence of t a k e n - f o r - g r a n t e d assumptions. The c u r r i c u l u m document f o r Science, Grades 8-10, makes the assumptions that the teaching of "drug and n u t r i t i o n " education are c o n s i d e r e d to be a p p r o p r i a t e t o p i c s f o r i n c l u s i o n w i t h i n the g e n e r a l c u r r i c u l u m as w e l l as a p p r o p r i a t e work f o r t h i s community. A p a r a l l e l assumption i m p l i e d i n t h i s c u r r i c u l u m guide i s that the s c i e n c e teacher i s a q u a l i f i e d p r o f e s s i o n a l who i s capable of undertaking such 1 42 r e s p o n s i b i l i t i e s . The documents of the p h y s i c a l education teacher a l s o d i s p l a y t a k e n - f o r - g r a n t e d assumptions. For example, the document p o r t r a y s an assumption that i t i s s o c i a l l y d e s i r a b l e f o r students t o : demonstrate a p o s i t i v e a t t i t u d e toward p h y s i c a l a c t i v i t y . (B.C.M.E., 1980, page 4) S i m i l a r l y , under Category I I , S o c i a l Role, the document s t a t e s t h a t : F i t n e s s makes a very s i g n i f i c a n t c o n t r i b u t i o n to the t o t a l w e l l - b e i n g of a l l students. (B.C.M.E., 1980, page 125) As was the case of the p r e v i o u s statement, the assumption i s that ( f i t n e s s ) p h y s i c a l e d u c a t i o n i s a s o c i a l l y d e s i r a b l e aspect of the e d u c a t i o n a l p r o c e s s . Taken-for-granted assumptions i n the Guidance document demonstrate a number of unique community p e r s p e c t i v e s that can be i n f e r r e d from the f i n d i n g s . There i s an unusual d i s p l a y of ambiguity on the p a r t of t h i s document's d i s c u s s i o n of taken-f o r - g r a n t e d assumptions about the r o l e of the Guidance teacher as r e l a t e d to the r o l e of the school i n s o l v i n g personal problems of the students. On the one hand we are t o l d that Guidance f u l f i l l s a s o c i a l r o l e i n meeting the needs of secondary students and in meeting needs of s o c i e t y in g e n e r a l . The c u r r i c u l u m guide a l s o makes s e v e r a l statements about the s e r i o u s nature of the drug problem and the need f o r teachers i n Guidance t e a c h i n g areas t o : 143 p r o v i d e the kinds of e d u c a t i o n a l experiences which w i l l enable students to cope with such problems. (B.C.M.E., 1971 , page 5) However, the document q u e s t i o n s what p r e c i s e l y the p u b l i c school should be r e s p o n s i b l e f o r i n regards to students' p e r s o n a l problems. These assumptions, that s e r i o u s problems e x i s t f o r secondary students, and that the school has e x p e r t i s e that should be used to a s s i s t i n s o l v i n g these problems i s weighted a g a i n s t the assumptions that there i s u n c e r t a i n t y about the s c h o o l ' s r o l e i n t h i s matter. S i m i l a r assumptions about the s t a t e d p e r s o n a l problems of students that are p e r t i n e n t to i n t e r v e n t i o n by the school and the lack of agreement as to how i n v o l v e d the school should be i n such s i t u a t i o n s i s a l s o found i n the Guide to the Core C u r r i c u l u m document. Both documents present a l a c k of agreement in c e r t a i n of t h e i r t a k e n - f o r -granted assumptions that are not r e s o l v e d w i t h i n the general d i s c o u r s e . An e q u a l l y unique and t a k e n - f o r - g r a n t e d d i s p l a y of assumptions occurs i n the e x t e n s i v e r o l e d i s c u s s i o n of the Guidance document. These r o l e f i n d i n g s which were p r e v i o u s l y d e s c r i b e d as c a u t i o n a r y , present an e x t e n s i v e c a t a l o g u i n g of expected behaviour p a t t e r n s f o r the guidance teacher that none of the other documents c o n t a i n . T h i s teacher i s d i r e c t e d to take care to a v o i d embarassing the student i n pursuing " p r i v a t e , p e r s o n a l d e t a i l s " , and to a v o i d "imposing h i s own set of v a l u e s " , as w e l l as " g i v i n g the student the o p t i o n of not r e p l y i n g to q u e s t i o n s " . There are two b a s i c assumptions here. One i s that the guidance teacher r e q u i r e s s p e c i a l guidance about p r o f e s s i o n a l d i s c r e t i o n t h at i s e s s e n t i a l to i n c l u d e in other 1 44 teacher c u r r i c u l u m guides. In comparison, the s c i e n c e teacher, while i n v o l v e d with t e a c h i n g the s e c t i o n on l e g a l and i l l e g a l use of drugs, r e c e i v e s none of these c a u t i o n a r y g u i d e l i n e s i n the c u r r i c u l u m guide. The other t a k e n - f o r - g r a n t e d assumption d i s p l a y e d by t h i s community's document i s t h a t , while there i s u n c e r t a i n t y as to the degree or l i m i t s to the s c h o o l ' s r e s p o n s i b i l i t y f o r student's p e r s o n a l problems, there are s p e c i f i c knowledge domains such as drug education that are assumed to be an expected component of the Guidance c u r r i c u l u m . Statements such as: I t i s becoming i n c r e a s i n g l y e v i d e n t that young people in p u b l i c schools are by no means immune and i t i s not an exaggeration to d e s c r i b e them as the ' p o p u l a t i o n at r i s k ' when c o n s i d e r i n g the problems of drug dependence. (B.C.M.E., 1971, page 5) are i n d i c a t i v e of t h i s focus. A d d i t i o n a l l y , there i s a p a r a l l e l t a k e n - f o r - g r a n t e d assumption d i s p l a y e d i n the document that both t h i s community and s o c i e t y i n g e n e r a l recognizes the a b i l i t y of the guidance teacher to be i n v o l v e d with a v a r i e t y of p e r s o n a l problem s o l v i n g s i t u a t i o n s i n school s e t t i n g s . The a n a l y s i s from Goal M of the Guide to the Core  Curriculum tends to confirm the assumptions p r e v i o u s l y d i s c u s s e d for the teacher groups i n that these three t e a c h i n g d i s c i p l i n e s are a l l d e s c r i b e d to some degree as being h e a l t h work and t e a c h i n g r e l a t e d communities. However, the assumption i m p l i e d in Goal M i s t h a t p h y s i c a l education and guidance assume a g r e a t e r degree of h e a l t h t e a c h i n g " r e s p o n s i b i l i t y " than i s the case of the s c i e n c e teacher. 145 The h e a l t h p r o f e s s i o n a l documents present an e q u a l l y i n t r i g u i n g f a c e t of t a k e n - f o r - g r a n t e d assumptions that are documentarily a s c r i b e d to t h i s community. As p r e v i o u s l y d i s c u s s e d , the c u r r i c u l u m of t h i s p r o f e s s i o n a l group i s e x p l i c i t , r a t h e r than hidden, as was the f i n d i n g f o r the teacher documents. The ta k e n - f o r - g r a n t e d assumption that u n d e r l i e s the community's documents i s that the work of t h i s community i n school h e a l t h programmes i s both s o c i a l l y s a n c t i o n e d and s o c i a l l y d e s i r a b l e as an a p p r o p r i a t e a c t i v i t y w i t h i n the s c h o o l . We are t o l d i n these documents that the work of t h i s community i s a u t h o r i z e d by both the School Act and the Hea l t h A c t . U n l i k e the assumptions about the need f o r p r o f e s s i o n a l d i s c r e t i o n w i t h i n i t s c u r r i c u l u m g u i d e l i n e s , as was re v e a l e d i n the Guidance a n a l y s i s , these h e a l t h p r o f e s s i o n a l documents do not c o n t a i n t h i s concern. There are s e v e r a l s p e c u l a t i o n s that can be made about t h i s ommission. The f i r s t i s that i t c o u l d be assumed that a l l h e a l t h p r o f e s s i o n a l s have r e c e i v e d p r e v i o u s t r a i n i n g that has addressed the need f o r p r o f e s s i o n a l d i s c r e t i o n . T h e r e f o r e , they do not r e q u i r e reminding. Secondly, i t i s p o s s i b l e that the unique medical model b a s i s of t h i s community may r e i n f o r c e the assumption that there i s a r i g h t t o , under s o c i a l l y s a n c t i o n e d c o n d i t i o n s , ask the embarassing q u e s t i o n s and pursue p e r s o n a l , p r i v a t e d e t a i l s , t h a t was not sanctioned f o r the guidance teacher. T h i s notable d i f f e r e n c e between the guidance teacher and h e a l t h p r o f e s s i o n a l r o l e e x i s t s i n these documents d e s p i t e the f a c t that the h e a l t h p r o f e s s i o n a l i s most probably i n v o l v e d i n many p o t e n t i a l l y s e n s i t i v e s i t u a t i o n s . For example, the community h e a l t h nurse 1 46 i s r e s p o n s i b l e f o r keeping " s u r v e i l l a n c e " records on students with a h i s t o r y of communicable d i s e a s e s , the procedure guide a l s o c o n t a i n s a one page d e s c r i p t i o n of managing the problem of head l i c e i n the s c h o o l . A d d i t i o n a l l y the nurse i s r e f e r e n c e d as a s s i s t i n g students with emotional problems. A l l of these areas may i n v o l v e p o t e n t i a l l y embarassing s i t u a t i o n s f o r the student. In a d d i t i o n , they i n d i c a t e s p e c i f i c s i t u a t i o n s i n the school h e a l t h programme where p e r s o n a l and p r i v a t e d e t a i l s of students would most l i k e l y be pursued. However, the t a k e n - f o r -granted assumptions in the guidance and h e a l t h p r o f e s s i o n a l documents d i s p l a y d i v e r s e understandings about the n e c e s s i t y to documentarily s p e c i f y p r o f e s s i o n a l d i s c r e t i o n a r y behaviour. 5.6.3.2 S p e c i a l i z e d Languages A second dimension of the use of f r a m e s - o f - r e f e r e n c e by which the community b u i l d s i t s e x p e r i e n t i a l base i s through i t s use of s p e c i a l i z e d language as a p r e f e r e n t i a l symbol system. The teacher documents d i s p l a y three s p e c i a l i z e d language examples that represent u n i q u e l y d i f f e r e n t areas of t e a c h i n g . The s c i e n c e teacher document uses the language of s c i e n c e . There i s d i s c o u r s e about the s c i e n t i f i c p e r s p e c t i v e of the knowledge used. For example, under L i f e F unctions the student w i l l : i n v e s t i g a t e s c i e n t i f i c a l l y the l i m i t a t i o n s of the senses. (B.C.M.E., 1983, Teacher Reference Chart) The p h y s i c a l education teacher documents use terminology from the community, such as: 147 Students should develop an understanding of movement p r i n c i p l e s i n c l u d i n g concepts r e l a t e d to body mechanics and s a f e t y , such as i n t e g r a t i n g time, weight and space i n a s u c c e s s f u l v o l l e y b a l l s p i k e . (B.C.M.E., 1983, page 4) Guidance uses the language of i t s community to c o n s t r u c t t h i s g o a l : To a s s i s t the student i n understanding the p l a c e of values i n d i f f e r e n t s o c i e t i e s and i n i d e n t i f y i n g those which w i l l h e l p him develop a p e r s o n a l , v i a b l e value system. (B.C.M.E., 1971, page 3) The teacher documents c o n t a i n very l i t t l e i n the way of i l l n e s s statements. The language i s e s s e n t i a l l y one of wellness o r i e n t a t i o n r a t h e r than a focus on the concept of i l l n e s s . S p e c i a l i z e d language f o r the h e a l t h p r o f e s s i o n a l presents a s i g n i f i c a n t c o n t r a s t to that of the t e a c h e r s . Within these h e a l t h p r o f e s s i o n a l documents there i s an o r i e n t a t i o n toward the concept of i l l n e s s . D iscourse of the community i n the documents i n c l u d e s words such as "communicable d i s e a s e , s p e c i f i c d i s e a s e s , d i s o r d e r s , impairment, p h y s i c a l or emotional d i s e a s e , p h y s i c a l or emotional h e a l t h problems". The P u b l i c H e a l t h Nursing Program f o r School Age C h i l d r e n , f o r example, c i t e s a c t i v i t i e s of the programme as i n c l u d i n g : (to) i n i t i a t e and maintain a p p r o p r i a t e r e c o r d s , e.g. H e a l t h S u r v e i l l a n c e R e g i s t r y , Medical A l e r t and Chronic D i s a b i l i t y Cards, Problem O r i e n t e d Record. (B.C.M.H., 1982, page 4) The h e a l t h p r o f e s s i o n a l documents g e n e r a l l y d i s p l a y the s p e c i a l i z e d language of medicine as i t s p e r v a s i v e mode of d i s c o u r s e . 148 5.6.3.3 A n a l y t i c a l Devices The l a s t of the three s u b d i v i s i o n s of f r a m e s - o f - r e f e r e n c e d i s c u s s e d by Holzner and Marx (1979) i s that of the a n a l y t i c a l d e v i c e s with which the work of the community proceeds. T h i s f a c e t of the community's o r i e n t a t i o n to i t s work i n c l u d e s a v a r i e t y of approaches. For example, one d e v i c e that a l l the communities of t h i s study make use of i s the c a t e g o r i z a t i o n of knowledge. The s c i e n c e teacher uses the processed knowledge of the community that has determined f o r Science, Grades 8-10, such c a t e g o r i e s as: "Ecology and Resource Management", " L i f e F u n c t i o n s " and "Changes i n Matter". The p h y s i c a l education teacher works with a s i m i l a r n o t i o n of c a t e g o r i z a t i o n as i l l u s t r a t e d by the t e a c h i n g t o p i c c a t e g o r i e s o f : " F i t n e s s or A c t i v e H e a l t h " , "Dance", and "Team S p o r t s " . Guidance pursues i t s own c a t e g o r i z a t i o n of work o r i e n t a t i o n by i t s a t t e n d i n g to "Value C l a r i f i c a t i o n " , "Communication S k i l l s " , and " V o c a t i o n a l Choices". Examples of these a n a l y t i c a l d e v i c e s of c l a s s i f i c a t i o n are e q u a l l y numerous w i t h i n the h e a l t h p r o f e s s i o n a l documents. These examples i n c l u d e c a t e g o r i e s l a b e l l e d " C r i s i s I n t e r v e n t i o n " and "Communicable Disease C o n t r o l " . Another aspect of a n a l y t i c a l d e v i c e use by these communities that a s s i s t s with the e x p l i c a t i o n of the f i n d i n g s of t h i s study i s the community's sense of a problem and how s o l u t i o n s to problems are c o n c e p t u a l i z e d . For the s c i e n c e teacher the document d i s p l a y s a c o n t e x t u a l framework of problems that i s r e l a t e d to the " s c i e n t i f i c p e r s p e c t i v e " . Problems appear to be c o n s t i t u t e d as framed w i t h i n t h i s p a r t i c u l a r o r i e n t a t i o n of the community. For 149 example, the p r e s e n t a t i o n of l e g a l and i l l e g a l drugs as a t e a c h i n g t o p i c f o r Grade 8 Science d i s p l a y s an o r i e n t a t i o n that i s more c l i n i c a l i n i t s approach than that found i n the Guidance document's treatment of the drug t o p i c . Science students experience t h i s area of l e a r n i n g through such methods as i d e n t i f y i n g and c l a s s i f y i n g drugs. The Guidance approach to the t o p i c i s through a c o u n s e l l i n g p e r s p e c t i v e that i s "value c l a r i f i c a t i o n " focused. The P h y s i c a l Education document frames the p r o b l e m - s o l u t i o n with such statements as: Students need to understand the reasons f o r good h e a l t h h a b i t s and the problems that may be faced during e a r l y teen and adulthood y e a r s . (B.C.M.E., 1980, page 2) The Guidance documents present many v a r i a t i o n s on the theme of p r o b l e m - s o l u t i o n . For example, the document s t a t e s : The Department takes the view that the school has both the r e s p o n s i b i l i t y and the o p p o r t u n i t y to make a s i g n i f i c a n t c o n t r i b u t i o n to the f i n d i n g s of s o l u t i o n s to these (drug) problems and urges a l l t e a c h e r s , p a r t i c u l a r l y those i n v o l v e d i n g u i d i n g young people to provide the kinds of e d u c a t i o n a l experiences which w i l l enable p u p i l s to cope with such problems. (B.C.M.E., 1971, page 5) H e a l t h p r o f e s s i o n a l documents d i s p l a y a r i c h v a r i e t y of such a n a l y t i c a l d e v i c e s that are r e l a t e d to t h i s sense of the problem and i t s s o l u t i o n . O b j e c t i v e 7 of the P u b l i c H e a l t h Nursing f o r School Age C h i l d r e n document p o i n t s out one problem as c o n s i s t i n g of the need t o : i d e n t i f y . . . . p h y s i c a l or emotional problems which may a f f e c t the performance or g e n e r a l w e l l - b e i n g of the s t u d e n t . . . . f a c i l i t a t e c o r r e c t i o n as s o l u t i o n to the problem. (B.C.M.H., 1982, page 7) 1 50 Another example i s found i n the School H e a l t h Program Procedures Manual which r e f e r s to s p e c i f i c problems areas of " s e x u a l l y t r a n s m i t t e d d i s e a s e s " , " s u i c i d e " , " a c c i d e n t s " , and " a l c o h o l i s m -drug dependency". G e n e r a l i z e d s c h o o l aged programme goals that are i m p l i e d as p r o v i d i n g s o l u t i o n s to problems faced by t h i s age groups i n c l u d e : To r e i n f o r c e healthy behaviour p a t t e r n s and d i s c o u r a g e negative ones. ( M a r s h a l l , 1982, page 2) The w r i t i n g s of Berger and Luckman (1966) f u r t h e r c l a r i f y our understandings about the s o c i a l c o n s t r u c t i o n of knowledge that e x i s t s i n the data of t h i s study i n the form of c o n s t r u c t s such as these a n a l y t i c a l d e v i c e s of the teachers and h e a l t h p r o f e s s i o n a l s . These s o c i o l o g i s t s observed that the s o c i o l o g y of knowledge must concern i t s e l f with a l l the t h i n g s that c o n s t i t u t e knowledge w i t h i n a given s o c i e t y . They c o n c e p t u a l i z e the s o c i o l o g y of knowledge more as a s o c i o l o g y of t r u t h i n which d i f f e r e n t p e r c e p t i o n s of r e a l i t y are represented as v a r i a t i o n s of t r u t h . In t h i s sense we as i n d i v i d u a l s and as group members c o n s t r u c t the b e l i e f s and understandings that we h o l d to be t r u e . These c o n s t r u c t i o n s i n v o l v e a complexity of i n t e r p r e t a t i o n s and the end products belong to those who have c o n s t r u c t e d the r e a l i t y . A l l of these frames of r e f e r e n c e , which are evident w i t h i n the pages of the documents, a s s i s t i n the task of understanding t h i s s o c i a l c o n s t r u c t i o n of the r e a l i t y of the school h e a l t h programme. 151 5.6.4 S p e c i a l i z e d Knowledge The s p e c i a l i z e d knowledge that i s represented by these communities p r o v i d e s the b a s i s f o r t h e i r s p e c i f i c c l a i m s to the s p e c i a l i z a t i o n of that community. U l t i m a t e l y t h i s unique ownership of a p a r t i c u l a r knowledge domain a s s i s t s with the c l a i m of l e g i t i m a c y of the r i g h t and r e s p o n s i b i l i t y to p r a c t i c e and apply the s p e c i a l i z e d work of t h i s community. T h i s study focusses on the s p e c i a l i z e d knowledge of the t e a c h i n g community that i s s u b d i v i d e d i n t o areas of s c i e n c e , p h y s i c a l education and guidance, as w e l l as the community of the h e a l t h p r o f e s s i o n a l s . The work of Blau and S c o t t (1962) helped to e s t a b l i s h understandings that are u s e f u l i n the e x p l i c a t i o n of s p e c i a l i z e d knowledge domains that are represented i n t h i s study. They contend that s p e c i a l i z e d knowledge p r o v i d e s the framework from which the knowledge s p e c i a l i s t , such as the s c i e n c e teacher emerges. T h i s development of s p e c i a l i z a t i o n then f a c i l i t a t e s the establishment of e x p e r t i s e . T h e i r t h e o r i e s of s p e c i a l i z e d knowledge are a l s o p r e d i c a t e d on the understanding that p r o f e s s i o n a l s s u b s c r i b e to commonly understood and p r a c t i c e d p r o f e s s i o n a l p r i n c i p l e s . These p r i n c i p l e s i n c l u d e the f o l l o w i n g understandings. F i r s t , t h a t p r o f e s s i o n a l d e c i s i o n s and a c t i o n s are based on u n i v e r s a l c r i t e r i a . A mastery of the body of knowledge represented by the p r o f e s s i o n a l community and the a c q u i r i n g of r e l a t e d s k i l l s n e c e s s i t a t e s some form of s p e c i a l i z e d t r a i n i n g . Second, p r o f e s s i o n a l i z a t i o n as evidenced in the ep i s t e m i c communities of h e a l t h p r o f e s s i o n a l s and t e a c h e r s , assumes the dimensions of p r o f e s s i o n a l e x p e r t i s e . The h e a l t h p r o f e s s i o n a l or teacher i s understood as being a t r a i n e d 152 expert who i s q u a l i f i e d to d e a l with s p e c i f i c problems w i t h i n a l i m i t e d and s o c i a l l y r ecognized boundary. We do not, f o r example, expect the community h e a l t h nurse to be q u a l i f i e d to teach c l a s s e s i n p h y s i c a l e d u c a t i o n , nor do we recognize the s c i e n c e teacher as posses s i n g s k i l l s that are s i m i l a r to those demonstrated by the d e n t a l h y g e n i s t i n her work i n school s e t t i n g s . S p e c i a l i z a t i o n , both i n terms of the s p e c i a l knowledge base and the p r o f e s s i o n a l bonding that t i e s the community together, p r o v i d e s the key to e x p e r t i s e . Understandings about s p e c i a l i z e d knowledge appear as t a c i t assumptions i n these documents. I t i s pa r t of our everyday, common-sense knowledge about the s t r u c t u r e and meaning of these e p i s t e m i c communities which make up our world that Schutz (1962, 1967) has d i s c u s s e d . As pa r t of our everyday understandings about these communities we have a c q u i r e d a way of viewing such communities. We have come to assume that c e r t a i n kinds of knowledge a c q u i s i t i o n , p r o d u c t i o n and d i s s e m i n a t i o n belongs to p a r t i c u l a r groups that have claimed e x p e r t i s e and the r i g h t to p r a c t i c e knowledge i n s p e c i f i c a r e a s . The s c i e n c e teacher, f o r example, r e p r e s e n t s a s p e c i a l i z e d area of knowledge that has evolved over a long p e r i o d of time. T r a i n i n g f o r the s c i e n c e teacher i s community s p e c i f i c . An ownership of knowledge helps to e s t a b l i s h the r e c o g n i t i o n of e x p e r t i s e . The l e g i t i m a c y of t h i s knowledge ownership and the r i g h t to p r a c t i c e i t appears as a gi v e n w i t h i n the document. S i m i l a r l y , f o r the h e a l t h p r o f e s s i o n a l , the ownership of the s p e c i a l knowledge w i t h i n the v a r i o u s areas represented i n these documents i s a l s o t i e d to our understanding and r e c o g n i t i o n of the expert who p r a c t i c e s i t . 153 The documents t e l l us that the work of t h i s community has been e s t a b l i s h e d by the School Act and the He a l t h A c t . However, even without t h i s documented acknowledgement of s o c i a l approval we, as s o c i a l i z e d , a d u l t members of a North American c u l t u r e , would probably have a c q u i r e d t h i s knowledge p r e v i o u s l y . Part of our accumulated understandings of the school h e a l t h programme has been our awareness that h e a l t h p r o f e s s i o n a l s ' involvement i n the work of the school has been a s o c i a l l y s a n ctioned and widely accepted aspect of the o v e r a l l s t r u c t u r e of the p u b l i c s c h o o l system f o r many decades. The c o n c l u d i n g t h e o r e t i c a l p e r s p e c t i v e to be used i n examining the f i n d i n g s of t h i s study are the concepts of knowledge boundaries and the power that i s i m p l i e d w i t h i n domains of knowledge as p a r t i c u l a r groups l a y c l a i m s to s p e c i f i c areas of knowledge. 5.6.5 Knowledge Boundaries The documents analyzed f o r t h i s study have r e v e a l e d complex and unique boundaries of knowledge p e r t a i n i n g to h e a l t h work and teaching w i t h i n the secondary s c h o o l . In h i s w r i t i n g s as an e d u c a t i o n a l s o c i o l o g i s t , Musgrave (1977) observed that i n many school s i t u a t i o n s the boundaries are o f t e n b l u r r e d . He f u r t h e r s t a t e d that boundaries w i t h i n these s e t t i n g s are o f t e n p o o r l y d e f i n e d because our understandings and use of t h i s term "boundary" has been a p p l i e d i n a haphazard manner. The r e s u l t of a l l t h i s i s that l i t t l e a t t e n t i o n has been focussed on the a c t u a l problematic nature of o r g a n i z a t i o n a l boundaries. Two of the c e n t r a l documents of t h i s r e s e a r c h d i s c u s s such a problem 154 w i t h i n t h e i r documentary d i s c o u r s e . Goal M of the Guide to the  Core C u r r i c u l u m r a i s e s the i s s u e of who i s to be r e s p o n s i b l e f o r a t t e n d i n g to the p e r s o n a l problems of students. A s i m i l a r concern i s r a i s e d with the Guidance document. In both i n s t a n c e s there are more qu e s t i o n s r a i s e d than answered about boundaries of knowledge that frame the s e t t i n g f o r r o l e r e s p o n s i b i l i t y and areas of t e a c h i n g . As p r e v i o u s l y d i s c u s s e d , Goal M p l a c e s the t e a c h i n g of h e a l t h w i t h i n the p r e s c r i b e d boundaries p r i m a r i l y of P h y s i c a l Education 8-11; Guidance 10-11 and Science 8. Here the boundaries of h e a l t h teaching c l e a r l y exclude such areas as Guidance 8-9 and Science 9-10, although f u r t h e r i n v e s t i g a t i o n would r e v e a l that h e a l t h t e a c h i n g does occur i n these areas. Balog (1981) in w r i t i n g about unclear and problematic s i t u a t i o n s of knowledge boundaries has s t a t e d that the concept of h e a l t h i n p a r t i c u l a r has t r a d i t i o n a l l y had no agreed upon boundary. He f u r t h e r contended that t h i s problem of boundary i s a s o c i o l o g i c a l phenomena in that h e a l t h as a concept i s a human c o n s t r u c t . He s t a t e d that t h i s c o n s t r u c t i s c r e a t e d i n a complex, i n t e r a c t i v e f a s h i o n which takes i n t o account both i n d i v i d u a l and group c u l t u r a l v a l u e s , s o c i a l norms and i n t r i c a t e b e l i e f systems. The c r e a t i o n of the school h e a l t h programme by these two communities appears to have taken a developmental course s i m i l a r to that d e s c r i b e d .by Balog. For example, these community documents d i s p l a y ample proof of c u l t u r a l v a l u e s about h e a l t h . The i n c l u s i o n of Goal M, a goal whose aim appears to be that of promoting h e a l t h t e a c h i n g as a valued a c t i v i t y i n the school s e t t i n g , s i g n i f i e s a c u l t u r a l value that i s s o c i a l l y p r e s c r i b e d and promoted. S i m i l i a r l y , s o c i a l norms appear in the 155 data that i n d i c a t e the e x i s t e n c e of an i n t r i c a t e norm c o n s t r u c t i o n . For example, the School Health Program Procedures Manual r e f e r s to t h e i r community's concern about: s o c i a l behaviour problems with an emphasis on l e g a l d e f i n i t i o n of 'deliquency'. ( M a r s h a l l , 1982, page 3) F i n a l l y , the notion of i n t r i c a t e b e l i e f systems are a l s o embedded i n the data. The guidance community d i s p l a y s a b e l i e f p a t t e r n about "values" that i s s p e c i f i c to t h i s p a r t i c u l a r document. B e l i e f s about "values" t e a c h i n g are d i s c u s s e d at l e n g t h . The student i s d e s c r i b e d as developing an i n d i v i d u a l "method of a t t a c k " on value problems and t h i s student i s expected to "acquire h i s own set of values through i n t e r a c t i o n with other s t u d e n t s " . I n t r i c a t e s e t s of b e l i e f s appear to flow through such a d i s c u s s i o n . The f o l l o w i n g b e l i e f s appear to be i m p l i e d : 1) v a l u e s are important; 2) v a l u e s should not be imposed by o t h e r s , but r a t h e r developed by the student i n c o n s t r u c t i v e i n t e r a c t i o n with o t h e r s ; 3) value c l a r i f i c a t i o n i s a s o c i a l l y accepted and d e s i r e d a c t i v i t y to be i n c l u d e d i n the s c h o o l c u r r i c u l a . The s c i e n c e documents, in c o n t r a s t , d i s p l a y s b e l i e f systems about the s c i e n t i f i c p e r s p e c t i v e and i t s u s e f u l n e s s to students in t h e i r attempt to understand themselves and t h e i r changing world. The p h y s i c a l education documents e x h i b i t an i n t r i c a t e b e l i e f system that i s p r e d i c a t e d on the i n t e r r e l a t i o n s h i p s between p h y s i c a l h e a l t h and mental and s o c i a l h e a l t h . The h e a l t h p r o f e s s i o n a l data appear to o r i e n t t h e i r understandings 156 by means of long e s t a b l i s h e d t h e o r i e s about such phenomena as communicable d i s e a s e and mental i l l n e s s . A d d i t i o n a l l y the t a c i t b e l i e f i m p l i e d w i t h i n the documents of t h i s community i s that these s p e c i a l i z e d knowledge areas are c l e a r l y w i t h i n t h e i r boundary of e x p e r t i s e . O v e r a l l there are i n t r i c a t e boundaries of knowledge that have been c o n s t r u c t e d w i t h i n the pages of these documents. He a l t h concepts appear and disappear w i t h i n what can be d e s c r i b e d as uneven p a t t e r n s of scope and sequence. "Drugs" are taught i n Science 8 e x c l u s i v e l y , " N u t r i t i o n " at Grade 9. While the concept of n u t r i t i o n i s d i s c u s s e d by the P h y s i c a l Education document as f a l l i n g w i t h i n t h e i r boundary of knowledge ownership, i t i s excluded from the Guidance documents. The concept of t e a c h i n g about d i s e a s e i s e x c l u s i v e l y the domain of the h e a l t h p r o f e s s i o n a l with the e x c e p t i o n of " o p t i o n a l " t e a c h i n g t o p i c s f o r the s c i e n c e t e a c h e r . The h e a l t h p r o f e s s i o n a l data appears to c l a i m ownership to what can be d e s c r i b e d as a m e d i c a l l y focused approach to h e a l t h care s e r v i c e s . As p r e v i o u s l y d i s c u s s e d , the n o t i o n of the h e a l t h p r o f e s s i o n a l as classroom h e a l t h educator i s p o o r l y d e f i n e d throughout a l l of the documents. The boundaries of demarcation between the h e a l t h p r o f e s s i o n a l and the teacher r e g a r d i n g classroom h e a l t h t e a c h i n g are not adequately addressed i n these documents. The f i n d i n g s r e l a t e d to the phenomena of boundaries appears to c o n f i r m the o b s e r v a t i o n s of Balog (1983) d i s c u s s e d above. 157 5.6.6 Knowledge Domains and Power Holzner and Marx (1979) have d e s c r i b e d the concept of power as being an i n t e g r a l p a r t of the e p i s t e m i c community because i t i s a key element of a l l s o c i a l i n t e r a c t i o n s . Our i n d i v i d u a l and group experiences with the kinds of power that i s represented by communities such as t e a c h e r s and h e a l t h p r o f e s s i o n a l s have framed the ways by which we see the world that Schutz (1967) d e s c r i b e d as b i o g r a p h i c a l understandings. The work of t h i s study i n e x p l o r i n g and e x p l i c a t i n g such knowledge domains and the i m p l i c a t i o n s of power that appear w i t h i n t h i s phenomena of the school h e a l t h programme has been accomplished by means of documentary a n a l y s i s . The w r i t i n g s of Smith (1974) have been u s e f u l i n p r o v i d i n g a t h e o r e t i c a l b a s i s f o r the use of documentary a n a l y s i s as a way of p r o v i d i n g i n s i g h t i n t o the communities' c o n s t r u c t i o n s of s o c i a l r e a l i t y . Smith has observed that our understanding of contemporary s o c i e t y i s very much mediated to us by the use of v a r i o u s kinds of documents. T h i s study a l s o claims that documents such as those r e p r e s e n t i n g the o f f i c i a l l y p r e s c r i b e d c u r r i c u l a of t e a c h e r s and h e a l t h p r o f e s s i o n a l s provide evidence of unique b e l i e f s t r u c t u r e s , values and norms that may not be r e a d i l y a c c e s s i b l e elsewhere. A d d i t i o n a l l y , these documents d i s p l a y the s p e c i a l i z e d domains of knowledge and the i m p l i e d domains of •power that are r e l a t e d to s p e c i a l i z e d knowledge c l a i m s . Smith has w r i t t e n t h a t the r e l a t i o n s h i p we e s t a b l i s h with others i n s o c i e t y i s e s s e n t i a l l y mediated by the r u l e of s o c i a l o r g a n i z a t i o n s . Knowledge i n t h i s framework i s viewed as i d e o l o g i c a l i n that s o c i a l o r g a n i z a t i o n s p r e s e r v e the concepts 158 and the d e s c r i p t i v e means that represent the world as i t i s f o r those who r u l e i t rather than f o r those who are r u l e d . In terms of the phenomena s t u d i e d here, Smith's theory i s i n t e r p r e t e d i n the f o l l o w i n g way. The kinds of knowledge represented i n t h i s s c hool h e a l t h programme are i n a sense i d e o l o g i c a l because the communities of teachers and h e a l t h p r o f e s s i o n a l s have preserved t h e i r own concepts and the d e s c r i p t i v e means by which the programme i s represented. T h i s p r e s e n t a t i o n of community concepts and d e s c r i p t i v e means of p r e s e n t a t i o n appear to be r e f l e c t e d i n the broad mosaic of these documents. Furthermore, the w r i t e r s of these documents appear to have c o n s t r u c t e d a programme of school h e a l t h i n which i t can be argued that both communities c l a i m c e r t a i n f a c e t s of ownership. T h i s s i t u a t i o n of knowledge ownership and i m p l i c i t power c r e a t e s an e d u c a t i o n a l dilemma. The school h e a l t h programme, while r e p r e s e n t i n g d i f f e r e n t e p i s t e m i c communities, c o n t a i n s the problematic q u e s t i o n of what p r e c i s e l y should be the r o l e of the school i n areas of students' needs that are h e a l t h r e l a t e d . As p r e v i o u s l y d i s c u s s e d , the q u e s t i o n of h e a l t h knowledge and the domain of ownership i s o f t e n u n c l e a r i n the documents. Although v a r i o u s c l a i m s to knowledge ownership e x i s t w i t h i n these documents, there may be f u t u r e c l a i m s that are yet to be e s t a b l i s h e d . For example, the B.C.M.A. (1984) study on the s t a t u s of s c h o o l h e a l t h education i n B r i t i s h Columbia has s t r o n g l y recommended the development and implementation, with l e a d e r s h i p and d i r e c t i o n from the h e a l t h p r o f e s s i o n a l community, of a separate and mandatory h e a l t h education c u r r i c u l u m f o r Grades K-12. I f t h i s were to occur the present s t r u c t u r e of the 159 school h e a l t h programme would undergo a major t r a n s f o r m a t i o n with a c o r r e s p o n d i n g change in knowledge ownership and power. At present the documents appear to p r o v i d e knowledge ownership c l a i m s f o r both communities. The h e a l t h p r o f e s s i o n a l ownership and i m p l i e d power base i s more e x p l i c i t l y s t a t e d than i s the case f o r the t e a c h e r s . The argument of Smith (1979) that has been pursued w i t h i n t h i s r e s e a r c h study concerns both the documentation of s o c i a l r e a l i t y and the understandings of power and ideology that are i m p l i c i t w i t h i n c e r t a i n documents. The w r i t i n g s of three e d u c a t i o n a l s o c i o l o g i s t s , P h i l l i p s (1981) and Mercer and Covey (1980) are i n c l u d e d i n t h i s d i s c u s s i o n f o r the purpose of f u r t h e r i l l u m i n a t i n g the s o c i o l o g y of knowledge p e r s p e c t i v e s of Smith (1974). P h i l l i p s (1981) proposed s e v e r a l b a s i c assumptions about schools that are p e r t i n e n t to school h e a l t h programmes g e n e r a l l y . H i s f i r s t assumption i s d i v i d e d i n t o two statements of b e l i e f about o r g a n i z a t i o n a l c o n t e x t s . F i r s t l y , he suggested that s c h o o l s , as o r g a n i z a t i o n s , operate w i t h i n s p e c i f i c value and a c t i o n c o n t e x t s . Secondly, h i s n o t i o n of schools was that t h e i r s o c i a l order e x i s t s as a c r e a t i o n of i n t e r r e l a t i o n s h i p s w i t h i n and between r e l a t i o n s h i p s and c o n d i t i o n s , from both an i n t e r n a l and e x t e r n a l p e r s p e c t i v e . The w r i t i n g s of P h i l l i p s (1981) concerning value and a c t i o n c o n t e x t s are r e l e v a n t to the phenomenon of h e a l t h t e a c h i n g and work tasks i n schools that has been s t u d i e d i n t h i s t h e s i s . As p r e v i o u s l y d i s c u s s e d , " h e a l t h f u l l i v i n g " as a valued goal and an a c t i v i t y to be entered i n t o w i t h i n the context of the school has been p r e c i s e l y o u t l i n e d , i n the teacher documents, as a goal 160 (Goal M) of the Guide to the Core Curriculum. S i m i l a r l y , h e a l t h work and t e a c h i n g was a l s o found to be documented w i t h i n the h e a l t h p r o f e s s i o n a l ' s c u r r i c u l a as both valued and a c t e d upon. From an i d e o l o g i c a l standpoint, both of these communities p r o v i d e e x t e n s i v e documentary evidence as to what i s recorded as being t h e i r r i g h t and o b l i g a t i o n to t h i s area of work and t e a c h i n g w i t h i n the s e t t i n g of the s c h o o l . The i d e o l o g i c a l message i m p l i e d w i t h i n both communities' documents i s that there i s both a p e r c e i v e d need and an o b l i g a t i o n f o r some kind of h e a l t h r e l a t e d work and t e a c h i n g to occur w i t h i n the s c h o o l . The second p a r t of P h i l l i p s ' ( 1 9 8 1 ) f i r s t assumption concerned the i s s u e of s o c i a l order and r e l a t i o n s h i p s i n s c h o o l s e t t i n g s which i s i n t e r p r e t e d i n t h i s study as a q u e s t i o n of power. The i n t e r n a l and e x t e r n a l r e l a t i o n s h i p s r e f e r r e d to i n t h i s assumption are i m p l i c i t w i t h i n the documents of both communities. Both communities have been e s t a b l i s h e d w i t h i n the context of separate, autonomous m i n i s t r i e s . In B r i t i s h Columbia, the work and t e a c h i n g of h e a l t h i n s c h o o l s that i s c a r r i e d out by the teacher proceeds under the a u s p i c e s of the School A c t . The work and t e a c h i n g of the h e a l t h p r o f e s s i o n a l s in the school proceeds under the mandate of both the School Act and the H e a l t h A c t . However, there are i m p l i c i t i n e q u a l i t i e s of power p e r t a i n i n g to ownership and a u t h o r i t y to p r a c t i c e h e a l t h work and t e a c h i n g that appear as givens w i t h i n these documents. As p r e v i o u s l y d i s c u s s e d , the h e a l t h p r o f e s s i o n a l documents are the only group of documents in which the d e s c r i p t o r "School H e a l t h Program" appears. The extent of d i s c u s s i o n and d i r e c t i o n s f o r the work and t e a c h i n g of h e a l t h i n school 161 s e t t i n g s i s a primary focus of d i s c o u r s e i n the h e a l t h documents and a secondary issue w i t h i n the teacher documents. P a r a l l e l to the s i t u a t i o n of power contexts that have been r a i s e d by P h i l l i p s (1981) and w i t h i n the w r i t i n g s of Smith (1974), are the o b s e r v a t i o n s of Mercer and Covey (1980). These w r i t e r s , i n a d d r e s s i n g the work of e d u c a t i o n a l c o n f l i c t s o c i o l o g i s t s , made the f o l l o w i n g s a l i e n t p o i n t s . They g e n e r a l l y d e s c r i b e d t h i s kind of r e s e a r c h i n q u i r y as i n v o l v i n g the ways by which power r e l a t i o n s h i p s a f f e c t the e d u c a t i o n a l p r o c e s s , observing t h a t : ....the balance of power among i n d i v i d u a l s and groups i s i n a constant s t a t e of a l t e r a t i o n , r e s u l t i n g i n an e q u a l l y constant s o c i a l i n s t a b i l i t y . The s o c i a l o r g a n i z a t i o n of a s o c i e t y means that power w i l l n e c e s s a r i l y be d i s t r i b u t e d unequally, thus the powerful e x e r c i s e and determine c o n s t r a i n t . (Mercer and Covey, 1980, pages 42-43) The phenomena of uneven power d i s t r i b u t i o n and the e x e r c i s e and d e t e r m i n a t i o n of c o n s t r a i n t by the powerful may account f o r some of the d i s c r e p a n c i e s that were found to e x i s t between the documentation of the teacher and the h e a l t h p r o f e s s i o n a l communities. For example, as p r e v i o u s l y d i s c u s s e d , the guidance teacher document c o n t a i n s an e x t e n s i v e amount of c a u t i o n a r y d i s c r e t i o n g u i d e l i n e s f o r the teacher that are not found w i t h i n the h e a l t h p r o f e s s i o n a l documents. There are s e v e r a l s p e c u l a t i o n s that can be o f f e r e d as to why t h i s has o c c u r r e d . One p o s s i b i l i t y that r e l a t e s to the p o s i t i o n s t a t e d by Smith (1974), P h i l l i p s (1981) and Mercer and Covey (1980) i s that these power r e l a t i o n s h i p s are not e q u a l . The h e a l t h p r o f e s s i o n a l , because of t h e i r unique p o s i t i o n as h e a l t h s p e c i a l i s t s , may be viewed as having more power to q u e s t i o n and 162 t r e a t students i n p o t e n t i a l l y embarassing or s e n s i t i v e s i t u a t i o n s . A d d i t i o n a l l y , there may be an i m p l i c i t understanding on the pa r t of s o c i e t y that i t i s the r i g h t and o b l i g a t i o n of the h e a l t h p r o f e s s i o n a l to pursue these d i f f i c u l t areas of h e a l t h work and t e a c h i n g . I t may a l s o be that c e r t a i n i n s i t u t i o n s p r o v i d e more p r o t e c t i v e armour f o r the purpose of s h i e l d i n g i t s workers. The p u b l i c h e a l t h department, f o r example, may provide more p e r c e i v e d p r o t e c t i o n f o r i t s workers i n s e n s i t i v e areas of h e a l t h work and teaching that i s unstated i n these data. P h i l l i p s (1981) touched on t h i s area i n h i s second assumption about schools and s o c i a l order when he s t a t e d t h a t : Schools as o r g a n i z a t i o n s tend to be s u c c e s s f u l i n r e c o n c i l i n g a number of c o n t r a d i c t o r y demands or they develop responses or p r o t e c t i v e d e v i c e s f o r i n s u l a t i o n a g a i n s t some of the c o n t r a d i c t i o n s c o n f r o n t e d . ( P h i l l i p s , 1981, pages 113-114) The c a u t i o n a r y g u i d e l i n e s f o r t h i s guidance teacher would appear to be a p r o t e c t i v e d e v i c e f o r both the teacher and the m i n i s t r y . Another p r o t e c t i v e device that may be a t t r i b u t e d to t h i s same m i n i s t r y i s the p l a c i n g of the more s e n s i t i v e t o p i c s f o r t e a c h i n g , such as d i s e a s e and knowledge of p r i n c i p l e s of c o n t r a c e p t i o n , w i t h i n the " o p t i o n a l " t e a c h i n g category f o r the s c i e n c e t e a c h e r . A f u r t h e r example of a p r o t e c t i v e response or d e v i c e i s found i n the statement that appears both i n the Guide to the Core C u r r i c u l u m and i n the Secondary Guidance C u r r i c u l u m Guide. In these i n s t a n c e s the reader i s asked what the p u b l i c s c h o o l should be r e s p o n s i b l e f o r i n terms of students' p e r s o n a l problems. T h i s kind of q u e s t i o n does not appear w i t h i n the h e a l t h p r o f e s s i o n a l documents. A p o s s i b l e reason f o r these 163 d i f f e r e n c e s may be that there i s an e x p l i c i t , common understanding w i t h i n our s o c i e t y that a m a j o r i t y of h e a l t h i s s u e s , i n c l u d i n g those of "student's p e r s o n a l problems" may be i n t e r p r e t e d as subsumed under the task d e f i n i t i o n of the h e a l t h p r o f e s s i o n a l . The power of the guidance teacher to c l a i m and e x e r c i s e an equal amount of h e a l t h work and t e a c h i n g ownership in t h i s area may be l e s s than that of the h e a l t h p r o f e s s i o n a l . A d d i t i o n a l l y , the f a c t that both of these teacher documents c o n t a i n t h i s query to the reader would appear to s i g n i f y an ambiguity and l a c k of d i r e c t i o n as to the p r e c i s e r o l e and boundaries of the school i n these matters. The answer to t h i s q u e s t i o n i s not s u p p l i e d i n these documents, p r o v i d i n g a f u r t h e r form of p r o t e c t i o n f o r the c u r r i c u l u m w r i t e r s . In summary, documents such as these f r e q u e n t l y d i s p l a y a world of s o c i a l r e a l i t y that i s d i f f i c u l t to a c c e s s . They o f t e n r a i s e q u e s t i o n s without s u p p l y i n g answers. However, the documentation of i n s t i t u t i o n a l p o s i t i o n s , r o l e s and end products of these communities al l o w s us to see f a c e t s of t h i s s o c i a l r e a l i t y t h a t may otherwise go unnoticed. 5.7 The Relevance of t h i s Study to the P r a c t i c e of H e a l t h  Education School h e a l t h programmes have e x i s t e d f o r many decades in North America. While the r e s e a r c h l i t e r a t u r e about school h e a l t h has focussed on v a r i o u s aspects of these programmes, i t has f a i l e d to d i s p l a y t h e i r complexity and the meanings of that complexity. There are no other programmes in the school i n which such d i v e r s e epistemic communities e x i s t . 1 64 T h i s study has been d i r e c t e d toward d i s p l a y i n g the unique c h a r a c t e r i s t i c s of the programme from a documentary p e r s p e c t i v e and toward c o r r e c t i n g the l a c k of understanding about t h i s programme t h a t has e x i s t e d . The data r e p r e s e n t s a complexity that r e f l e c t s a microcosm of many understandings and many p o s s i b i l i t i e s . If school h e a l t h programmes are to be continued as v i a b l e e n t i t i e s , r e s e a r c h i n t o the epistemic d i v e r s i t y and the c o m p l e x i t i e s of i m p l i c i t and e x p l i c i t c u r r i c u l a p a t t e r n s must be pursued beyond the f o u n d a t i o n a l beginnings of t h i s study. I t i s hoped that other r e s e a r c h e r s w i l l continue the task of t r a c k i n g , a n a l y z i n g and e x p l i c a t i n g t h i s unique programme w i t h i n the world of the s c h o o l . 5.8 Suggestions f o r Fu r t h e r Research Both the l i t e r a t u r e and the f i n d i n g s of t h i s study i n d i c a t e that many unknowns e x i s t about t h i s complex e n t i t y of the school h e a l t h programme. T h i s study p r o v i d e s an e x p l o r a t o r y b a s i s on which other s t u d i e s of the programme c o u l d be based. I t s f i n d i n g s suggest f u t u r e q u e s t i o n s that c o u l d be researched. Some p o s s i b l e areas that c o u l d be i n v e s t i g a t e d a r e : 1) Are there s i m i l a r areas of hidden c u r r i c u l a of h e a l t h t e a c h i n g t h a t e x i s t i n the s u b j e c t s of Home Economics and Consumer Education? 2) What other e p i s t e m i c a l l y d i f f e r e n t i a t e d communities of p r o f e s s i o n a l s e x i s t i n the s e t t i n g of the school t h a t c o u l d be researched i n a s i m i l a r f a s h i o n ? 3) How are these c u r r i c u l a i n which h e a l t h t e a c h i n g e x i s t s implemented i n the classroom s e t t i n g ? 165 4) In a d d i t i o n to the te a c h i n g of h e a l t h concepts that was ex p l o r e d i n t h i s study, what other concepts are taught i n school s e t t i n g s where s i m i l a r i s s u e s of knowledge boundaries and knowledge ownership e x i s t ? 5.9 Suggestions f o r Education An e x t e n s i o n of the d i s c u s s i o n i n t h i s chapter i s o f f e r e d as suggestions about the f i n d i n g s t h a t have p a r t i c u l a r relevance to the educators of teachers and h e a l t h p r o f e s s i o n a l s , c u r r i c u l u m d e v e l o p e r s , the M i n i s t r i e s of H e a l t h and Education, and f i n a l l y to the teachers and h e a l t h educators who work w i t h i n these programmes. 5.9.1 Suggestions f o r Educators of Teachers and H e a l t h  P r o f e s s i o n a l s The f o l l o w i n g suggestions, based on t h i s r e s e a r c h , are made to educators of teachers and h e a l t h p r o f e s s i o n a l s . 1) There i s an on-going need to pro v i d e h e a l t h education t r a i n i n g f o r teachers and h e a l t h p r o f e s s i o n a l s both at the undergraduate and graduate l e v e l s . O p t i m a l l y , t h i s should occur as combined c l a s s e s f o r teachers and h e a l t h p r o f e s s i o n a l s . These c l a s s e s c o u l d provide the pedagogical e x p e r t i s e r e q u i r e d f o r h e a l t h teaching as w e l l as a pl a c e where i n t e r d i s c i p l i n a r y ideas about h e a l t h education c o u l d be exchanged. Such s p e c i a l i z e d t r a i n i n g , a l r e a d y a requirement f o r teacher c e r t i f i c a t i o n i n many s t a t e s of the U.S., would serve to strengthen the o v e r a l l programme of school h e a l t h educat i o n . 166 2) Educators of teachers and h e a l t h p r o f e s s i o n a l s at the u n i v e r s i t y and c o l l e g e l e v e l s should e s t a b l i s h an i n t e r d i s c i p l i n a r y d i a l o g u e to address the problematic s i t u a t i o n of the school h e a l t h programme, p a r t i c u l a r l y from the need to b e t t e r understand the d i v e r s e i n t e r e s t s and concerns of the p r o f e s s i o n a l communities i n v o l v e d . 5.9.2 Suggestions f o r C u r r i c u l u m Developers The f o l l o w i n g suggestions, based on t h i s r e s e a r c h , are made to c u r r i c u l u m d e v e l o p e r s . 1) I f the t e a c h i n g of h e a l t h i s seen as a s o c i a l l y d e s i r a b l e and o f f i c i a l l y mandated a c t i v i t y w i t h i n the s c h o o l , the c u r r i c u l u m developers, p a r t i c u l a r l y w i t h i n the s u b j e c t areas of S c i e n c e , P h y s i c a l Education and Guidance as w e l l as Home Economics and Consumer Education, need to r e a s s e s s the ways by which c u r r i c u l a i s developed. At present there appears to be l i t t l e d i r e c t i o n or consensus from the c u r r i c u l u m developers as to the p r i o r i t y of h e a l t h education w i t h i n the school c u r r i c u l a . 2) A separate, mandated h e a l t h education c u r r i c u l u m i s not recommended at t h i s time. The f i n d i n g s of t h i s t h e s i s i n d i c a t e a documented s h a r i n g of h e a l t h r e l a t e d work and t e a c h i n g between the communities of s c i e n c e , p h y s i c a l e d u c a t i o n , and guidance teachers and h e a l t h p r o f e s s i o n a l s . There c u r r e n t l y e x i s t s a s i t u a t i o n of s p e c i a l i z e d d i v e r s i t y . A separate c u r r i c u l u m f o r h e a l t h c o u l d e l i m i n a t e t h i s present c o n f i g u r a t i o n of s p e c i a l i z a t i o n . T h i s complex area appears to r e q u i r e f u r t h e r r e s e a r c h and d i a l o g u e between a l l p a r t i e s 167 i n v o l v e d i n the development and implementation of t h i s programme before c o n s i d e r a t i o n should be given to such a c u r r i c u l u m being developed. 5.9.3 Suggestions f o r the M i n i s t r i e s of H e a l t h and Education The f o l l o w i n g suggestions, based on t h i s r e s e a r c h , are made to the M i n i s t r i e s of Health and E d u c a t i o n . 1) I t i s imperative that some degree of d i r e c t i o n and consensus be reached about the f u t u r e of school h e a l t h programmes. There appears to have been l i t t l e forward movement toward the o p t i m a l i z a t i o n of t h i s programme. The good i n t e n t i o n s and d i r e c t i v e s o f f e r e d by Goal M of the Guide to the Core  C u r r i c u l u m do not appear to have been implemented w i t h i n the present s t a t u s of h e a l t h education programmes in t h i s p r o v i n c e , p a r t i c u l a r l y at the secondary l e v e l . 2) A review of the programme, based on a comprehensive r e s e a r c h approach i s recommended as an a d j u n c t i v e measure to the p r e v i o u s recommendation. 5.9.4 Suggestions f o r Teachers and H e a l t h Educators The f o l l o w i n g suggestions, based on t h i s r e s e a r c h , are made to t e a c h e r s and h e a l t h p r o f e s s i o n a l s . 1) The l i t e r a t u r e and the f i n d i n g s of t h i s r e s e a r c h study i n d i c a t e a degree of c o n f u s i o n and ambiguity about s c h o o l h e a l t h programmes that d i r e c t l y a f f e c t s the teacher and the h e a l t h p r o f e s s i o n a l communities. I t i s important f o r these communities to b e t t e r a r t i c u l a t e t h e i r own unique p e r s p e c t i v e s about these school h e a l t h programmes. 168 2) In c o n j u n c t i o n with the pr e v i o u s recommendation i t i s suggested that teachers and h e a l t h p r o f e s s i o n a l s work through t h e i r v a r i o u s o r g a n i z a t i o n s to d i r e c t and promote new d i r e c t i o n s f o r school h e a l t h programmes. 169 References Auman, J.T. (1982). Health e d u c a t i o n and the t e a c h i n g of human l i f e s c i e n c e i n the B.C. c u r r i c u l u m . Proceedings of the  I n t e r n a t i o n a l Union of B i o l o g i c a l Science Commission f o r  B i o l o g i c a l Education, Vancouver, B.C., Canada. (1983). The understandings of teachers and h e a l t h p r o f e s s i o n a l s about h e a l t h e d u c a t i o n . 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