Results of Telephone Interviews and Written Questionnaires
8. Results of Telephone Interviews and Written Questionnaires
This chapter presents a summary of the results of the interviews of ministries, school districts, public health units, schools, public health nurses and the written questionnaires completed by teachers. In presenting these results, we have used a health determinants approach to analyze and organize the data. The results are presented under five broad areas:
Selected, research-based criteria that were used to develop the framework for the study are presented in the introduction to each section of this chapter of the report. These criteria describe effective policies, programs, services and professional practices.
The policies, programs, services and practices of the school systems and the public health systems are reported together because these two systems share the responsibility to enable the school to help to prevent HIV/AIDS and STD and to promote sexual health. The responses from the three levels within the school and public health systems are also reported together as much as possible. This is to show how well a policy is being translated into programs, services and practices within the systems.
The degree to which the two systems are able to coordinate their efforts and the extent to which policies are implemented through sustained programs, services and professional practices will determine the potential that is achieved.
The vast amount of data presents a challenge in the writing and reading of this report. Consequently, we have tried to present the findings in as simple a format as possible. Also, we have prepared a separate table of contents for this section for the reader. Referring often to this table will assist the reader in further understanding this part of the report. We also make extensive use of tables and present several graphs to highlight certain data. Quotes from the focus groups with parents and students are used to illustrate or emphasize certain results. Also, short summaries of the results have been prepared and shown within frames with a gray background. These summaries highlight certain areas or groups of topics.
For each question the number of respondents remains constant. (The
"n" = number of respondents is outlined below.) When respondents did not record
an answer, it is shown as no response. Also the specific questions(s) are noted. For
example, (MOE -12) is question number 12 of the Ministry of Education survey. Full
technical reports will be available at:
www.schoolfile.com/AIDSreport/technical.htm
The number of respondents (n) for all of the questions reported here are:
Ministries of Education (MOE) 11
Ministries of health (MOH) 12
School Districts (SD) 92
Public Health Units (PHU) 81
School Principals (SP) 181
Public Health Nurses (PHN) 168
Teachers (T) 91
There were many times when the respondents were asked to choose between a range of options including; "never", "not our role", "at least once in last the 10 years", "at least once in the last three years", "regularly", or "planned for the future". Interviewers were asked to probe replies to those type of questions using these responses so that the most accurate and only one option would be selected by the respondent.
Sometimes, for brevity, we present only the "regularly" responses in the discussion or graphs, where it could be expected that the agency does this activity on a ongoing basis. The tables in the report, however, always include all of the data for the question specified.
For educators, it is often difficult to separate their activities and programs that address HIV, STD or sexual health. They are often treated as one topic. For health systems, there is often a separation of activities and programs for the three topics, depending on the nature of the activity. In this report, there are often times when the graphs and diagrams combine or differentiate these topics.
One key finding may be important in situating these results. Both the school systems and the public health systems are undergoing rapid change and restructuring. Almost half, (45.5%) of education ministry officials and 41.7% of health ministry officials reported that their assignment is currently under review. Similarly, 36.9% of school district officials, 32.7% of public health unit staff and 30.4% of public health nurses said that their assignments were being reviewed and that the outcome of those reviews was uncertain. These results indicate that programs, planning and practices are currently operating with a considerable degree of uncertainty.
8.1 Policy-making, Implementation and Monitoring
This section of the report examines the policy-related functions of two levels of government; provincial/territorial ministries and local authorities in both education or health. Research on policy making and implementation suggests that the following policy and accountability functions are reasonably ascribed to governments, school boards and public health authorities. The sources for these criteria for effectiveness are cited below.
Written, comprehensive policies define and describe the
expectations of the system and professionals working in those systems. Required actions
from subordinate agencies are described as well. (Canadian Association of School
Administrators, 1990; National School Boards’ Association, 1981; Health Canada, 1994;
Canadian Public Health Association, 1993)
There are explicit, written action plans to implement, monitor
and evaluate the policies. (World Health Organization, 1992; Canadian Public Health
Association, 1993; Crichton, 1987)
The
priorities of the system are explicit. (Broadfoot et al, 1994; Crighton, 1987)
Relevant
research is monitored and disseminated regularly. (MacLean, 1996; World Health
Organization, 1997; Saskatchewan Education, 1996)
There are
appropriate administrative structures and staff assignments. (Odden, 1991; Macbeth, 1980;
World Health Organization, 1997; Health Canada, 1994)
Resources,
in the form of funding, staffing or materials are linked to policy directions. (Funk,
1991; Consortium for Policy Research in Education, 1996; Canadian Public Health
Association, 1993; Health Canada, 1994)
Systematic
staff development and training occurs regularly. (MacKinnon et al, 1994; Health Canada,
1994; Canadian Public Health Association, 1993)
Cooperation
among the systems that serve youth is encouraged, supported and facilitated. (Fisher,
1990; Institute of Medicine, 1997; Canadian Association for School Health, 1994a; Capper
et al, 1996)
There are
mechanisms in place to monitor the activity and impact of the systems. (Granaheim et al,
1990; Mutchler & Pollard, 1994; Institute of Medicine, 1997)
Regular
written reports are issued that describe the performance of the systems. (Funk, 1991;
Health Canada, 1994; Institute of Medicine, 1997)
Policy-makers communicate with their publics about the progress of the system and relevant issues. (Canadian Association of School Administrators, 1990, Institute of Medicine, 1997)
Since AIDS/HIV and sexual health are part of the public mandate of the two systems studied here, these criteria on the role of government/public agencies/school boards apply to those issues and we should see data related to these results. For the convenience of the reader, we repeat the content overview of this section on policy-making, implementation and monitoring here.
Summary of Results Related to Policy
Half of the education ministries reported that they have written policy goals for HIV and sexuality education. Less than half of school districts said that they have such written goals for sexual health or STD and about half of the school districts said that they have written goals for HIV prevention.
A majority of health ministries reported that they have written policy goals for HIV prevention and STD prevention, but only about one-quarter said that they have such goals for sexual health promotion.
Most education respondents at all three levels reported that they do not have explicit action plans on HIV/STD or sexual health. Between three-quarters and one-half of health respondents at all three levels said that they have written action plans on HIV and STD. Fewer health respondents reported that they have an action plan for sexual health promotion.
Education ministry respondents reported that clear standards exist for mandatory instruction about HIV, STD and sexuality. Health ministries were less explicit in stating standards for sexual health service delivery. However, a large majority of public health nurses reported that such services are delivered regularly.
About half of education ministries stipulated a minimum time for sexuality education. School district and school principal responses indicate that these minimum times are not being met. Based on teacher responses, the amount of time spent each year on sexuality education ranges between about three and eight hours.
One-quarter of health ministries reported that they have established a ratio for the number of public health nurses relative to the population or number of schools. Almost all education ministries, school districts and school principals reported that they published or referred to an authorized list of teaching materials for sexuality education. The majority of teachers and public health nurses said that they used that list.
Two thirds of health ministries said that they required or promoted an integrated school-community approach to HIV prevention. A minority of public health units reported that they used or required this integrated or coordinated approach.
Policies to ensure that HIV-infected staff or students can continue their employment or education are widespread within school systems. Similarly, most education respondents at all levels reported that there are policies to prevent discrimination. It is not entirely clear, however, if these general prohibitions against discrimination are actively implemented to prevent homophobia. A minority of public health respondents said that they played an active role helping the school systems to implement such polices.
Most education authorities reported that they have policies stipulating that universal, hygienic and safety precautions should be taken in the school to prevent the transmission of HIV and other infectious disease. Most public health authorities also reported that they had published such guidelines. However, few respondents in both systems reported that they were monitoring compliance or education of staff in the implementation of these precautions.
Less than one-quarter of education ministries and school districts reported that they have specifically defined the qualifications required to teach sexuality education. About 30% of teachers reported that they had no pre-service in sex education. 43.9% reported that they had a minor or major in health, physical education or family studies.
About one-quarter of health ministries and about one-half of public health units said that they have defined the qualifications required of nurses to work on sexual health. Fewer respondents reported that they have defined the qualifications necessary to work with youth or schools.
A minority of public health units and public health nurses reported that they have published or use policy guidelines on the related topics of steroid use or injection drug use. About two-thirds of health ministries said they have published guidelines on injection drug use.
About one-third of education and health ministries, school districts and public health units reported that they have an explicit policy favouring a community-school health cooperative approach to school health. About two-thirds of school principals said that they tried to link school and public health programs using this type of comprehensive approach.
About one-eighth of health ministries and public health units reported that they have an explicit policy on adolescent health.
Over three-quarters of education respondents at all three levels reported that their school mission statement or mandate included the healthy, social development of the child.