Training teachers for the public health workforce: systematic mapping and synthesis of effectiveness and processes

BACKGROUND: Schools are an important setting for health promotion, and teachers have an integral role in promoting children's and young people's health and wellbeing. Adequate initial teacher training and continuing professional development in health is therefore important, and trainers need sound evidence of effectiveness. However, the evidence base for teacher training is broad and has not been subjected to systematic review. The aim of this project was to assess the key characteristics of this evidence base and to investigate effectiveness and associated processes. METHODS: A novel methodological approach was used: a systematic map of the key characteristics of studies (stage 1) followed by a detailed synthesis of a subset of mapped studies (stage 2). A sensitive search was done on 20 bibliographic databases including Medline, Embase, ERIC, and PsychINFO. Reference lists of existing studies were checked and relevant websites were searched to identify unpublished work. Each study meeting the stage 1 inclusion criteria was mapped by a reviewer applying a keyword method devised for this study. Keywords described study characteristics such as country, health topic area, teaching qualification status (eg, pre-service, in-service), training content and format, and processes and outcomes examined. To be included in the map, studies had to report teacher training about health, be an outcome or process assessment or a survey, and be published after 1990. The map results were presented to a multidisciplinary advisory group. Through structured discussion, the group prioritised studies focusing on initial teacher training for stage 2. A standardised data extraction template was then applied to stage 2. Methodological quality and risk of bias was assessed unmasked with published critical appraisal criteria. Data extraction and quality assessment were done by one reviewer and checked by a second. FINDINGS: We screened 16 620 references, of which 170 were mapped (stage 1). Studies were undertaken in Europe, Africa, Asia, Australia, South America, and the Middle East, with a predominance of studies from the USA (42%). Common topics included sexual and reproductive health (22%), drugs and alcohol (18%), and mental and emotional health (16%). A range of study types were used, including outcome assessments (73%, of which 56% were controlled trials), process assessments (46%), and surveys (11%). Factual information about health (77%) and the development of skills for promoting health (66%) were common. Of the studies focusing on initial teacher training (n=20, stage 2), most were in the UK or Australia. They covered a range of topics including general health promotion, child protection, and mental health. 12 studies reported outcomes (most were before and after single cohort designs), 19 reported processes, and eight reported both. After training there were increases in trainee teachers' knowledge of health, and confidence to teach personal, social, health, and economic education. Trainees also felt better able to identify and manage child protection issues and children with mental and emotional health problems. No studies reported outcomes for pupils. In general, training was acceptable to trainees. Trainees' views on the adequacy of the training varied, with some reporting that they did not feel prepared to deal with issues such as child protection on entering the early teaching career period. The evidence suggested that for training to meet trainee teachers' needs, it may need to include practical experience and skills, be personally relevant and take into account individual needs, and relate to teachers' practice in schools. INTERPRETATION: The evidence base for teacher training in health is diverse and of variable quality. Some positive effects on teachers' knowledge and confidence are evident. However, there is a scarcity of research on school pupils' health and educational outcomes. Further assessment of health-related training spanning initial teacher training and the early career years is needed. FUNDING: National Institute for Health Research Public Health Research programme (09/3005/12).