Elementary School Personnel and Cultural Factors Affecting Health Education Implementation in the High-Stakes Testing Era

J Sch Health. 2021 Oct;91(10):846-856. doi: 10.1111/josh.13071. Epub 2021 Aug 15.


Background: Despite proven health and learning benefits, health education implementation in elementary schools is not optimal. This study investigated learning environment, leadership, and training factors that may influence elementary-level health education implementation in the current standardized testing-saturated environment.

Methods: Survey data were collected from principals of 8 Michigan elementary schools and, via focus groups, 30 teachers in their schools. Teacher groups were separated into 2 categories based on principals' understanding of state health education policies. Grounded theory analysis was used.

Results: Despite all 30 teachers' positive attitudes toward health education, numerous consistent implementation barriers were identified; competition for instructional time with tested subjects was most critical. Teachers with principals who indicated a greater understanding of state policies reported more: consistent instruction; availability of resources, and encouragement to teach select topics, especially mental health.

Conclusion: That these findings were produced in a state with strong CSHE polices, proven curricula, and expansive support systems are disheartening and accentuate the profound impact of standardized testing on elementary-level health education implementation. More promising, principals' understanding of applicable state-level policies appeared to generate stronger health education implementation. Future research should focus on the possible impact of time devoted to health instruction on standardized test scores.

Keywords: advocacy; elementary school health; school culture; school health education; school policy; standardized testing.

MeSH terms

  • Health Education*
  • Humans
  • Leadership
  • Policy
  • Schools*
  • Surveys and Questionnaires