RESEARCH ARTICLE
Information and Communication Technology: Students’ Health Education in 1st- to 6th-Grade South Korea Elementary Schools EUNJOO LEE, PhD, RNa HYEJIN PARK, PhD, RNb JAMES WHYTE, ND, PhD, ARNPc EUNHOE JEONG, MSN, RNd
ABSTRACT BACKGROUND: The purposes of this study were to (1) identify school nurses’ awareness of information and communication technology (ICT) use in students’ health education and (2) explore the barriers or reasons for the adoption of ICT in school nursing practice, while (3) presenting strategies to speed ICT diffusion and dissemination into practice. METHODS: For data collection, 209 primary school nurses in K province of Korea were selected and e-mailed the questionnaires. Collected data were analyzed as frequency, percentages, and chi-square tests. RESULTS: The major reasons to adopt ICT were increasing school nurses’ confidence in providing health education and improving teaching methods using diverse multimedia. The major barriers to utilization of ICT were lack of time for preparation of educational materials, lack of software availability, and lack of computer skills of school nurses and students. Several strategies were suggested to speed the diffusion of ICT into students’ health education, such as integrating a health education course into regular curriculum. CONCLUSIONS: It is important to identify barriers and reasons for adoption of ICT in school nursing. In addition, strategies should be emphasized that result in more rapid diffusion of these technologies in school nursing practice. Keywords: information and communication technology; students’ health education; elementary school; South Korea. Citation: Lee E, Park H, Whyte J, Jeong E. Information and communication technology: students’ health education in 1st- to 6th-grade South Korea elementary schools. J Sch Health. 2013; 83: 647-653. Received on March 14, 2011 Accepted on December 3, 2012
H
ealth education in elementary schools can play a vital role in establishing lifelong healthy behavior patterns due to the association between adaptive health behaviors in childhood and their positive influence on behaviors in adolescence and adulthood.1,2 According to the Joint Committee on National Health Education Standards (JCNHE), it is more difficult and complex to alter adult health behaviors than childhood behaviors, due to the extensive socialization that results in the assumption of adult behavioral patterns.3 Therefore, well-designed health education integrated into elementary school is necessary to provide the fundamental basis for instilling healthy behaviors in children. The integration of information and communication technology (ICT) strategies offers an ideal means to optimize effectiveness of students’ health
education. School nurses have the important responsibility of promoting children’s health by providing education and reducing health risks such as unintentional injury, violence, suicide, tobacco use and addiction, alcohol and other drug use, and unintended pregnancy. A minimum of 34 hours of health education in elementary school during the 5th and 6th grades is required by law in Korea.4 School nurses in Korea provide 2 distinct roles—health education and clinical health care services to students in school. In their teaching role, school nurses have to develop teaching strategies that are responsive to students’ needs and incorporate diverse teaching strategies to enhance the effectiveness of health education as well as improve learning experience of children.
a Professor, (
[email protected]), Kyungpook National University College of Nursing, Research Institute of Nursing Science, Daegu, South Korea. bAssistant Professor, (
[email protected]), Florida State University College of Nursing, 98 Varsity Way, PO Box 3064310, Tallahassee, FL 32306. c Associate Professor, (
[email protected]), Florida State University College of Nursing, 98 Varsity Way, PO Box 3064310, Tallahassee, FL 32306. dSchool Nurse, (
[email protected]), Wonho Elementary School, Daegu, South Korea.
Address correspondence to: Hyejin Park, Assistant Professor, (
[email protected]), Florida State University College of Nursing, 98 Varsity Way, PO Box 3064310, Tallahassee, FL 32306.
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As ICT has become one of the ubiquitous resources around the world, it is an essential supporting tool for well-designed health education and can enhance the effectiveness of education by delivering content using multiple modalities. There is increasing evidence that ICT-driven educational methods increase students’ attention and learning.5 However, there is a lack of research reflecting the perceived barriers or reasons for implementing ICT in students’ health education.6-8 Without the identification of current ICT utilization and the degree to which school nurses are aware of ICT adaption in health education, we cannot develop or initiate effective educational systems incorporating ICT. The purposes of this study were to identify school nurses’ awareness of ICT use in health education and barriers or reasons to adopt ICT for students’ health education. We also identified strategies for the dissemination of ICT education in school nursing practice by addressing the following research questions:
have a planned, sequenced curriculum for health education.11 The JCNHE recommends that students between pre-K to grade 2 receive a minimum of 40 hours, and students in grades 3 to 12 receive 80 hours of health education instruction per academic year.3 The JCNHE does not specify who is to provide health education to students. In the same context, many school nurses in Korea have stated that a lack of education hours allocated to school nurses has resulted in fewer opportunities for integrating ICT in students’ health education.12 The integration of ICT into students’ health education is necessary to engage students in learning and to address the unique and complex health needs of students. School nurse leaders need to integrate ICT and to become change agents for successful implementation. To facilitate ICT adoption into health education by school nurses, it is necessary to identify school nurses’ awareness, reasons for adoption of ICT, and barriers for adoption of ICT into health education. Diffusion of Innovation (DoI) theory was utilized for this study to identify dissemination factors that influence the adoption of ICT in school nursing. In the context of adoption, ICT may be viewed as an innovation—defined as ‘‘an idea, practice, or object that is perceived as new.’’13 DoI describes the innovation decision process as 5 successive stages; knowledge, persuasion, decision, implementation, and confirmation. The first 2 stages are referred to as dissemination stages and the last 3 are adoption stages.13 In the knowledge stage, individuals obtain knowledge about the existence of innovation and gain a better understanding of its use.14 In the second stage, persuasion occurs when individuals begin to form a more positive opinion about the innovation, including understanding of its relative advantage, compatibility, complexity, trialability, and observability.13 This study focuses on knowledge (awareness and understanding of the innovation) and a section of persuasion (relative advantages) because these stages influence adoption or rejection of ICT by school nurses for students’ health education.
1. What is current school nurses’ awareness status of ICT use in students’ health education in South Korea? 2. What are the perceived barriers or reasons to adopt ICT by school nurses for students’ health education in South Korea? 3. What strategies for diffusion and dissemination of ICT into students’ health education are being undertaken in South Korea? Health education in elementary schools is an essential component of school health. There are 2 keys to improve the health education provided in the nation’s schools. First, national standards guiding curriculum development focus on increasing functional health knowledge and identifying key skills that are applicable to all aspects of healthy living should be developed for comprehensive school health education programs.3 Second, adequate educational time devoted to health education by school nurses should be required statutorily to ensure the effectiveness and quality of health education programs.3 The effectiveness and quality of health education programs is linked to adequate educational time devoted to health education in the classroom.3 There is also a strong relationship between school health education and health literacy.9 According to the report of the Institute of Medicine (IOM), health education is the most effective means to improve health literacy.10 Therefore, integrating health education as a part of the curriculum in elementary school is a necessity to improve students’ health.10 The World Health Organization (WHO) has provided evidence that students’ health education should be started prior to the onset of risky behaviors; thus, both primary and secondary schools should 648
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METHODS Design and Sample A descriptive and cross-sectional design was used for this study. Of the 395 elementary school nurses working in K province of South Korea, the final sample included 209 elementary school nurses. Instruments The questionnaires used in the study were based on instruments developed by Park8 and Lee.15 Park identified the strategies and current utilization status •
© 2013, American School Health Association
of ICT in elementary schools8 and Lee identified the strategies and current utilization status of ICT by mathematics teachers in elementary school.15 These instruments were first reviewed and revised after permission obtained from Park8 and Lee15 by one of the researchers who had more than 6 years of experience as an elementary school nurse to make the questionnaire more appropriate to elementary level school nursing practice. Second, the revised questionnaire for the school nurse was reviewed by a nursing faculty member who had extensive expertise in ICT education to adapt the instrument further for use by school nurses and for health education. Extensive discussion between the school nurse and nursing faculty member was undertaken to increase the face validity of the questionnaire used in the study. The revised 52-item questionnaire was pilot-tested with 4 school nurses who had 5 to 15 years of experience and easy access to elementary-level school health settings. Fourteen questions were removed to provide clarity based on the feedback from the 4 school nurses. The final questionnaire consisted of 38 items divided into 5 sections including general characteristics, awareness of ICT, utilization status, perceived barriers and advantages, and strategies for improving utilization of ICT. A 5-point Likert scale ranging from 1 ‘‘strongly disagree’’ to 5 ‘‘strongly agree’’ was used to rate each item. Procedures An e-mail list of 395 school nurses was acquired from the Korean School Nurses’ Curriculum Development Association in K province. Approval for data collection was obtained from each school administrator of the individual school where the school nurse was working prior to sending the questionnaires. An e-mail was then sent to each potential participant. This e-mail contained a broad explanation of the study, an invitation to participate, and the questionnaire. The e-mail clearly stated that participation in the study was voluntary and that confidentiality would be maintained. Consent was implied by the return of a completed questionnaire. To increase response rates and encourage study participation, 3 reminder e-mails with an attached questionnaire were sent for 1 month in 7- to 10-day intervals. A total of 238 questionnaires were returned, reflecting a response rate of 60.25%. Of the 238 returned questionnaires, 29 questionnaires were not included in the analysis due to lack of completeness. A total 209 completed questionnaires comprised the final sample. Data Analysis Data were analyzed using SPSS for Windows, version 14 (SPSS Inc, Chicago, IL). Descriptive analysis was conducted using means and standard deviations Journal of School Health
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on normally distributed data. Categorical data were described as frequencies and percentages. The chisquare test was used to identify the differences between the level of awareness of ICT and demographics of school nurses.
RESULTS Participant Characteristics Of the 209 participants, slightly more than half (N = 123, 58.9%) reported ages from 30 to 39. Most (79%) possessed baccalaureate degrees, and 65% had worked as a school nurse from 6 to 15 years. The majority reported working in rural settings (67.5%) with fewer reporting assignment in urban schools (32.5%). A majority of participants (78%) perceived their computer skills to be average level given an option to rate as excellent, average, or poor. The majority of school nurses (63.6%) indicated their perceived need that health education using ICT is necessary and 26.3% responded that it is very necessary to adapt ICT into health education (Table 1). Awareness of ICT Utilization in Student Health Education According to Respondents’ Characteristics In general, 55% of school nurses rated their awareness of ICT utilization as moderate. Notably, the level of awareness of ICT utilization in students health education was different by education level (χ 2 = 23.602, p < .01), work experience as a school Table 1. Distribution of Demographics (N = 209) Characteristics
Ranges
Age
20-29years 30-39years 40-49years 50years and above Diploma Baccalaureate degree Master’s degree + Under 5years 6 to 10years 11 to 15years 16+ years Below 6 classes 7 to 18 classes 19 to 35 classes Above 36 classes Urban Rural Excellent Average Poor Very necessary
18 123 64 4 44 135 30 33 73 63 40 80 60 46 23 68 141 16 163 30 55
8.6 58.9 30.6 1.9 21.1 64.6 14.4 15.8 34.9 30.1 19.1 38.3 28.7 22 11 32.5 67.5 7.7 78 14.4 26.3
Necessary Less necessary Not necessary
133 19 2
63.6 9.1 1
Educational level
Work experience as a school nurse
School size
School location Computer skills
Perceived needs of ICT into health education
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%
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Table 2. ICT Awareness Status According to Respondents’ Characteristics (N = 209) ICT Awareness Characteristics
Ranges
Age
20-29 30-39 40-49 50 and above Diploma Bachelor MSN or above Under 5years 6 to 10years 11 to 15years 16+ years Below 6 classes 7 to 18 classes 19 to 35 classes Above 36 classes Urban Rural Excellent Average Poor Total
Educational level
School nurse work experience
School size
School location Computer skills
Well Known (n/%)
Moderate (n/%)
Slightly (n/%)
—
10 (56.6) 50 (32.5) 23 (35.9)
8 (44.4) 40 (32.5) 17 (26.6) 3 (75.0) 14 (31.8) 48 (35.3) 6 (20.0) 12 (36.4) 26 (35.6) 20 (31.8) 10 (25.0) 40 (50.0) 16 (26.7) 6 (13.0) 6 (26.1) 18 (26.5) 50 (35.5)
17 (13.8) 14 (21.9) 1 (25.0) 6 (13.6) 16 (13.5) 10 (33.3)
— 12 (27.3) 59 (42.9) 12 (40.0) 14 (42.4) 34 (46.6) 20 (31.8) 15 (37.5) 24 (30.0) 26 (43.3) 22 (47.8) 11 (47.8) 28 (41.2) 55 (39.0)
— 5 (6.9) 18 (28.6) 9 (22.5) 4 (5.0) 12 (20.0) 12 (26.1) 4 (17.4) 18 (26.5) 14 (9.9) 16 (100) 15 (9.2) 1 (3.3) 32 (15.3)
None (n/%) —
∗,†
16 (13.0) 10 (15.6)
—
23.602∗∗
12 (27.3) 12 (8.3) 2 (6.7) 7 (21.2) 8 (11.0) 5 (7.9) 6 (15.0) 12 (15.0) 6 (10.0) 6 (13.0) 2 (8.7) 4 (5.9) 22 (15.6)
—
—
—
77 (47.2) 6 (20.0) 83 (39.7)
60 (36.8) 8 (26.7) 68 (32.5)
11 (6.8) 15 (50.0) 26 (12.4)
χ2
23.514∗∗
27.994∗∗∗
12.877∗∗ ∗∗†
,
∗ p Value
