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Conceptions of health and health education: a study of primary and lower secondary teachers


Vanessa CastanhaI; Leni Ane Muniz da SilvaII; Lays dos Santos MaiaIII; Luciane Sá de AndradeIV; Marta Angélica Iossi SilvaV; Marlene Fagundes Carvalho GonçalvesVI

INurse. Graduate with a bachelor's Degree in Nursing, University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail:
IINurse. Graduate with a bachelor's Degree in Nursing, University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail:
IIINurse. Graduate with a bachelor's Degree in Nursing, University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail:
IVProfessor of the Psychiatric Nursing and Human Sciences Department of the EERP/ USP. Ribeirão Preto, São Paulo, Brazil. E-mail:
VAssociate Professor of the Maternal-Infant and Public Health Department of the EERP/USP. Ribeirão Preto, São Paulo, Brazil. E-mail:
VIAssociate Professor of the Psychiatric Nursing and Human Sciences Department of EERP/USP. Ribeirão Preto, São Paulo, Brazil. E-mail:





Objective: to identify primary and lower secondary teachers' conceptions of health and health education, and how they figure in the subjects they teach. Method: in this qualitative-quantitative study, based methodologically on the dialectical approach, data was collected by applying an open questionnaire, comprising questions to characterize the subjects, their conceptions of health and of health education, to 13 teachers at a public school in São Paulo State, in August and September 2011. The project was approved as meeting standards of ethics and scientific rigor by the ethics and research committee of EERP/USP (CAAE No. 0107.0.153.000-11). Results: health figured as strongly related to physical activity, nutrition and well-being. Most teachers did not relate health to their disciplines, and when they did so, it was informal and unplanned. Conclusion: the conception and application of health promotion in schools is weak; accordingly, it is important to discuss ways of improving it.

Keywords: Health promotion; school health; faculty; health education.




This is a study on the conceptions of health and health education of primary education teachers, as nurses are becoming more and more involved in schools with the proposal of promoting health. The current guidelines of the Undergraduate Course in Nursing prescribe that the expected profile of those completing a nursing degree includes, among other aspects, qualification to work in primary education1. Therefore, it is necessary to understand what occurs in this respect at schools, which also involves knowing what teachers understand regarding health and how they conduct health education, so that better interaction between health/education and nurse/teacher is possible.

Thus, the following questions guided this study: What conception do primary education teachers have regarding health? How is health education conducted at school? Is there space for healthcare professionals at schools?

Therefore, the objective of this study was to identify the health and health education conceptions of teachers from the second cycle of Primary Education of a state school in São Paulo, as well as their vision on the insertion of the theme of health into the context of the discipline they teach.

This study is justified by the importance of improving knowledge on the different areas of activity of the qualified nurse, besides the possible connections between the sectors of health and education.



Health promotion is the name given to the process of empowering the community to act in improving quality of life and health, including increased participation in controlling this process. To achieve a state of complete physical, mental and social well-being, individuals and groups should know to identify aspirations, satisfy necessities and favorably modify the environment. Health should be seen as a resource for life, and not as an objective of living. As such, health is a positive concept, which emphasizes social and personal resources, as well as physical capacities. Thus, health promotion is not the exclusive responsibility of the health sector, and goes beyond a healthy lifestyle, in the direction of overall well-being2.

Health promotion, as a set of strategies established as national policy3, supposes a conception that does not restrict health to the absence of disease, but that is capable of acting on its determiners. As it concerns living conditions of the population, health promotion extrapolates to the provision of clinical care services and includes inter-sectorial actions that involve education, basic sanitation, housing, income, work, diet, the environment, access to essential goods and services and leisure; among other social determiners of health4.

The Ministry of Health understands that the school period is essential to working on health from the perspective of its promotion; developing actions for the prevention of disease and for strengthening protection factors. An important strategy in health promotion is health education, not in the sense of authoritarian transmission of information, but the empowerment of the individual to have greater control over determiners of their health5. Thus, besides school having a specific pedagogical function, it has a social and political function directed at the transformation of society, related to the exercise of citizenship and access to opportunities for development and learning, reasons that justify actions aimed at the school community, thus substantiating health promotion proposals6.

The Ministry for Education, in turn, established National Curriculum Parameters, bringing the cross-cutting theme of health and determining that every school should incorporate the principles of health promotion, recommended by the World Health Organization; fostering health and learning at all times; integrating healthcare and education workers, parents, students and members of the community in an effort to transform the school into a healthy environment; implementing practices and policies that respect individual and collective well-being and dignity, offering opportunities for growth and development in a healthy environment, with the participation of health and education sectors, families and the community7,8. However, for the development of this study, it is important to involve the teachers, to know their conceptions regarding health and the proposal of cross-cutting themes, given that this cross-cutting was aimed at establishing changes in schools9.

Therefore, schools promoting health may be seen as a highly efficient system for the production of education. In addition, the school is also seen as a community concerned with the health of all its members - teachers, students and non-teaching staff, as well as all the people related to the school community. As such, all schools may potentially promote health. So, the healthy school should be understood as a vital space generating autonomy, critical participation and creativity so that the scholar has the possibility of developing their physical and intellectual capabilities10.

For the development of this study on health promotion in schools, the connection with educators is important; "instead of specific isolated actions, the best contribution that health can offer education resides in the possibility of conducting an integrated and articulated action, which can critically and reflectively provide the opportunity to update educators"11:400.



This is a quanti-qualitative study with a dialectic approach, proposed by Minayo12, carried out at a São Paulo state primary school, not specified here for ethical reasons. This school serves an underprivileged community, with social and financial problems, located in a violent neighborhood.

The data were collected in periods of Collective Pedagogical Work, in which the regular activity of the teachers occurs, in August and September 2011. Considering the importance of the themes of this study for the school, the school directors conceded the necessary time to present the project to the teachers and collect the data.

Teachers from the second cycle of primary education (5th to 8th grade), distributed across 20 classes, being 5 classes to each grade, participated in the study. There was a total of 25 teachers, all of whom were invited to participate. Among the teachers, 13 accepted the invitation and signed the Informed Consent Form. The project was approved by the Research Ethics Committee of EERP/USP nº 1353/2011, CAAE 0107.0.153.000-11, meeting the ethical precepts and scientific rigor, as per Resolution nº 466/2012 of the National Health Council13.

A questionnaire was applied, containing questions on the profile of the subjects and open questions on concepts of health and health education. The profile characteristics of the participants were not examined in this study, with the exception of profession (teacher) and discipline taught.

Responses related to the theme were transcribed in full and the analysis was conducted based on the dialectic methodology, proposed by Minayo12, in three phases: ordering of the data, classification into empirical categories, and comprehension and interpretation of the data.

The teachers (P) were represented by letters and numbers (P1, P2...) to maintain anonymity, followed by identification of the disciplines they teach.



Data organization consisted of three analytical categories: conception of health; conception of health education; and development of health education activities.

Conception of health

Various elements were brought to this category, such as physical/mental well-being, equilibrium, healthy diet, the practice of physical activity, personal hygiene, absence of disease, life expectancy and quality of life, and were transcribed as follows:

It is the perfect state of physical, mental and social equilibrium, that is, the person should be well physically, psychologically and in harmony with the people around them, fulfilling their obligations. (P9-Sciences)

Well-being of body and mind, always maintaining a healthy diet and physical activity. (P4-Physical Education)

A body in possession of equilibrium, and well-being with physical exercise, an adequate diet and free from disease. (P12-Mathematics)

Health, for me, is having a good diet, sleeping at least 8 hours a day and enjoying a healthy environment. (P8-Portuguese/English)

Thus, it was identified that 7(61.5%) teachers strongly linked health to the practice of physical activity, the absence of disease and up-to-date vaccination.

Health is not only biology or the absence of disease, its comprehension has a high degree of subjectivity, as it depends on the moment, the reference and the values that the individuals attribute to a situation4.

The widest concept of health encompasses human completeness; that is, it considers all aspects (social, political, economic, family, environmental) that affect people's lives. It is necessary to carry out health education to achieve health promotion, working on values of democracy, citizenship, empowerment, comprehension of reality, recognition and appreciation of these principles2.

However, the conception of health demonstrated by the teachers seems to be aimed at the body, denoting a biological meaning, in detriment of a global understanding of health. This concept was formulated in 1946 by the World Health Organization, whereby in 1990, with the creation of the Integrated Health System (Sistema Único de Saúde), there was a shift in this paradigm from assistance focusing on diseases, to promotion of human care; detaching from biology and relating well-being to socio-economic and human determinations (cognitive and emotional psyche), resulting in a change in the concept of health, with politico-pedagogical orientation14,15.

Conception of health education

In relation to the way teachers conceive health education at school, the responses were organized into the following subcategories: raising awareness of the pupils, disease prevention and information based.

Raising awareness of the pupils

Health education needs to occur from birth, stimulating autonomy and personal care, in a contextualized way within the reality of the pupils and of the society in which they live. (P13-Mathematics)

Raising awareness about healthy habits, the systemic practice of different physical activities and even research (comparing people that take care of themselves with others who often don't take so much care). (P10-Physical Education)

Disease prevention

To be given as prevention, you have to raise awareness right from the first days of Primary Education. (P3-Mathematics)

Focused on prevention. (P5-Reading/Writing)

We should have prevention as the focus. (P7-Geography)

Information based

Informative and with necessary information for our day to day life. (P11-Portuguese)

Always informing, through talks, films, lectures, on well-being for everyone. (P4-Physical Education)

It can be observed that the teachers highlight that health education should happen through raising awareness of the pupils as to healthy habits, whereby 9 (76.9%) teachers put disease prevention as the main point of this orientation.

They also indicated that health education should be worked on by professionals specific to the area of health, with more orientation according to the necessity of each pupil, with informative information for day to day life, in order to improve quality of life and increase health preservation.

Health education is a learning process requiring attention throughout schooling and the contribution of school education is of a complimentary nature to family education. Establishing a relationship between systematized theoretical knowledge and real-life issues, in the educative practice, provides social meaning to the concepts worked on at school, thus going beyond learning simply aiming at passing the year6,16.

Teachers are essential to fostering students to develop attitudes of self-esteem, co-responsibility and participation in their process of teaching-learning and health promotion. Therefore, they need to develop as professionals and as critical subjects in the reality in which they are inserted; that is, situate themselves as educators and as citizens, participants in the process of constructing citizenship, of recognizing their rights and duties and their professional valorization. They should choose activities in which the pupils can offer opinions, take on responsibilities, put themselves forward, resolve problems and conflicts and reflect on the consequences of their acts; these being situations in which teachers promote learning17.

However, understanding the difference between disease prevention and health promotion is essential to changing conceptions in health education. Prevention is provisional, while promotion is permanent; that is, prevention is a repeated intervention prior to the appearance of a disease and promotion is a continuous set of measures aimed at the elimination of disease, as it seeks to effect different causes that lead to illness and not only avoid its occurrence18. Thus, the concept of health promotion has a wider scope, as it does not dispense with prevention but leads to an important way of producing health from daily actions, not only at healthcare services, but in different spaces within the community14, such as school.

Cross-cutting intends to integrate the theme of health into school, relating it to current issues and social interaction. It does not mean that teachers from different areas should stop their programs to work on cross-cutting themes, but that they should clarify the relationships between them and include them as content in their area, connecting the aims of school study with social issues, enabling pupils to use school knowledge in life outside school. Therefore, it means bringing the perspective of crosscutting themes, in this case health, to the content and methodology of the area8.

Instead of isolating and compartmentalizing teaching and learning, the relationship between cross-cutting themes and the different areas should occur so as to contemplate the objectives and content of the different areas and that at some moment the related issues are worked on. Pedagogical experiences of working with human rights, environmental education, sexual orientation and health have indicated the necessity for such issues to be worked on continuously, systematically, comprehensively and in an integrated fashion and not as separate areas or disciplines8.

Health education, as one of the strategies for health promotion, is a target for public policies and should also be conducted in appropriate environments, beyond clinical and curative treatment, with a commitment to citizenship and solidarity for the improvement of quality of life and promotion of man3,19.

Health education activities carried out by the teacher

This category was organized into two subcategories; carrying out health education and not carrying out health education. In the subcategory of carrying out health education, it is discussed whether or not the teacher relates the activity to the specific content of their subject and how these activities are developed.

Of the 13 teachers, 5 (38.4%) responded that they did not carry out health education activities and 8 (61.5%) informed that they did carry out some form of health education, emphasizing disease prevention, personal hygiene, physical exercise and a good diet. Of these 8 (61.5%) teachers, 4 (30.7%) do this without relating said activities to their subjects, as can be observed in the following transcribed statement:

I do it daily, as we always talk about cleaning up the environment, and even personal care. However, I don't specifically go into certain issues that don't fit with my subject. I've already done projects on teen pregnancy, etc... (P13-Mathematics)

Other Mathematics teachers confirm not carrying out health education as it is not related to the content of their subject. Teachers of other disciplines (Geography, Portuguese, English) demonstrate that health issues are frequently dealt with, despite not being directly related to their disciplines:

In some ways I do, as all teachers work with questions of personal hygiene a little. (P11-Portuguese)

Another Portuguese teacher, however, showed that they bring health themes to common activities in their subject:

Texts for reflection and compositions on different themes related to health. (P6-Portuguese)

In regard to Science and Physical Education teachers, 2(15.3%) of them seem to have taken responsibility for working on health issues, as they relate educational activities on this theme with specific content of their subject, linking health to the physical body and the absence of disease:

Yes. In Physical Education classes I look to work with good quality of life. I always show the importance of physical activity, a balanced and healthy diet, the importance of sleep and drinking water. (P10-Physical Education)

It is also noteworthy that the 8 (61.5%) teachers that carry out health education, even those from areas considered more pertinent to the theme, seem to develop the theme through advice and informal orientations, without a planned activity:

Not as a planned activity. However, some attention related to hygiene is always remembered. (P7-Geography)

Those that promote health education do so mainly through orientation, conversations on personal hygiene, sex education and healthy habits, understanding that it should be carried out as a form of prevention, giving information and attempting to raise awareness of the pupils.

In general, the teachers raised the issue that to better develop health education at school it is necessary for the schools to have a professional trained in the area of health to clear up doubts, offer information and raise awareness of the population on disease prevention, through films and lectures:

To be worked on according to the necessities of each person, if possible with reinforced orientations from professionals from the area, as what is worked on is not always enough. (P2-Sciences)

There should be a space for professionals trained in the area, to inform and explain things to the pupils, as they have many doubts. (P12-Mathematics)

Within what is possible, yes, clearing up doubts and providing orientation, if necessary, searching for a professional (specialist doctor), as only he can diagnose the problem that the person is going through. (P2-Sciences)

It is important to highlight that it is not because the health theme is not inserted into the content of the subject of the Mathematics teacher, for example, that he cannot conduct health education; on the contrary, the school itself is already a transforming agent by the simple fact of being the place where information and knowledge circulate. When educating in health, in a contextualized and systemic way, the teacher and the school community can contribute decisively to the formation of citizens capable of acting in favor of improving personal and collective health20.

Considering that citizenship is also the exercise of subjects in the health/disease process is essential motivation for health education and this is the concept of health providing the foundation for the National Curriculum Parameters of Education for Health21.

The health theme at school is a challenge that has been present for a long time in Brazil, the requirement of developing health programs at schools having been established in 1971. Analyses of the official documents show that, although there have been advances in intentions, there is still a lot to be done, as there is a lack of teachers, both in initial formation and continued formation, a lack of theoretical input in the area of health, as well as a lack of materials and resources for the development of this work22.

On the other hand, the school is a fundamental piece of equipment for the work of healthcare professionals, especially nurses, acting in the prevention of diseases and health promotion23. Educative work developed at school, based on the partnership between health and education, generates knowledge that reflects in the health of the young, and is of extreme importance for their development24. The nurse presents as the link between society and care programs at school, favoring the inter-sectorial integration of health-education25.

Thus, health promotion occurs when the conditions for citizens to have a dignified life are guaranteed through education, adoption of healthy lifestyles, development of individual aptitudes and capacities, production of a healthy environment, efficacy of government/society to guarantee the deployment of public policies aimed at quality of life and quality of healthcare services26.



For the participants in this study, health education appears to be localized specifically in certain disciplines at school and more connected to biology than to political, social and economic factors related to the health process.

Some teachers have difficulty conducting health education and indicate the necessity for the presence of a professional from the area at school to work on prevention and raising awareness of the population. Therefore, it is necessary to extend studies in this area, so that work proposals involving health and education in integration, can be better developed in the school environment. The teacher is an indispensable figure in the formation of citizens, of critically reflective people, so that they are not passive or remiss to social injustice or differences; working on health and promoting life expectancy, a promising future, widening the vision of children and adolescents who are forming opinions and concepts. The teacher is capable of conducting health education with their pupils but needs to be conscious of this and have information and resources for it.

The work of health promotion at school has been shown as poor, with this comes the necessity for transformation in teaching practices, which is related both to the formation of teaching staff and to the teaching itself in primary education - its structure and conditions, so that the new concept of health, coming with the creation of the Integrated Health System, permeates the understanding of the entire Brazilian population. Partnerships between municipal, state and federal public policies are essential to the promotion of public health and quality of life for society, as the laws and institutions are instruments of transformation.

Data collection, based on written responses that were not always complete, represents one of the intrinsic limitations to the methodology proposed for this work, besides the focus on only one school. However, it is recognized that these are initial studies which may contribute to knowledge on conceptions of health and health education of teachers in primary education.



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Direitos autorais 2017 Vanessa Castanha, Leni Ane Muniz da Silva, Lays dos Santos Maia, Luciane Sá de Andrade, Marta Angélica Iossi Silva, Marlene Fagundes Carvalho Gonçalves

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Esta obra está licenciada sob uma licença Creative Commons Atribuição - Não comercial - Sem derivações 4.0 Internacional.