MIDDLE SCHOOL TEACHERS’
ATTITUDES AND PERCEPTIONS ABOUT
THEIR ROLE IN PROMOTING PUPILS’
MENTAL HEALTH IN THE STATE OF
KUWAIT
Submitted by
Dalal Al Radaan
To the University of Exeter as a thesis for the degree of
Doctor Philosophy in Education (September, 2012)
E-mail: dalalpy@hotmail.com
Abstract
The aim of this study was to explore the complexity of teachers’ attitudes and perceptions
about promoting their pupils’ mental health in Kuwait middle schools. Specifically, the study
aimed to investigate teachers’ understanding of mental health and promoting mental health
concepts. Further aims were to discover more about the contextual factors that shaped
teachers’ attitudes towards promoting pupils’ mental health, and teachers’ perceptions about
barriers that might hinder the implementation of the promotion process. The study also
attempted to elicit teachers’ perceptions about the changes required to put promoting pupils’
mental health into practice in Kuwait educational context.
The study adopted a mixed-methodology approach within a pragmatic context in two stages.
Data for the first stage were obtained from participants through a systematic survey
conducted with 497 Kuwaiti middle school teachers, chosen randomly. In stage two, twelve
teachers were chosen purposely to take part in semi-structured interviews. Data were
analysed quantitatively and qualitatively.
The findings from the study suggested that Kuwaiti middle school teachers tend to hold
moderately favourable attitudes towards promoting pupils’ mental health. However, a variety
of personal, interpersonal, socio-cultural, and structural-organizational barriers were
perceived by teachers that could undermine their positive attitudes and impact on moving
towards the implementation of the promotion process. The results of the study indicated a
significant relationship between those barriers and the cognitive, affective and behavioural
components of teachers’ attitudes. The study also showed that teachers’ attitudes and
perceptions were markedly embedded within the socio-cultural and religious aspects of the
study context. Additionally, the study has theoretical implications for understanding the
values underlying the commitment to promoting pupils’ mental health in schools and
teachers’ attitudes in this area. As regards practical implications, the study provides a set of
recommendations, relating to policy, curriculum, pedagogy, methodology, and teacher
education and training in the area of pupils’ mental health. Finally, some areas for further
research investigations are suggested.
Table of Contents
Acknowledgments...................................................................................................................2
Abstract...................................................................................................................................3
Table of Contents....................................................................................................................3
List of Tables...........................................................................................................................10
List of Figures..........................................................................................................................12
Chapter 1: Exploring the Gap
13
1.1 Introduction....................................................................................................................13
1.2 Background and rationale for the study ......................................................................... 13
1.3 Aims of the study ........................................................................................................... 15
1.4 Research questions ......................................................................................................... 16
1.5 Research approach.......................................................................................................... 17
1.6 Significance of the study ................................................................................................ 18
1.7 Overview of the study .................................................................................................... 19
Chapter 2: Context of the study
21
2.1 Introduction .................................................................................................................... 21
2.2 Country profile ............................................................................................................... 21
2.3 Education system in Kuwait ........................................................................................... 21
2.4 Structure of the education system in Kuwait ................................................................. 23
2.5 Teacher education in Kuwait.......................................................................................... 25
2.6 Mental health in Kuwait ................................................................................................. 25
2.7 Mental health in the schools of Kuwait .......................................................................... 28
2.8 The historical development of counselling in Kuwaiti schools ..................................... 29
2.9 Conclusion...................................................................................................................... 31
Chapter 3: Perspectives on promoting mental health and review of
literature
33
3.1 Introduction .................................................................................................................... 33
3.2 Definition issues ............................................................................................................. 33
3.2.1 The term ‘mental health’ ......................................................................................... 33
3.2.2 Mental health problems and mental illness: points on a continuum........................ 35
3.3 Young people’s mental health: a key area of concern ................................................... 38
3.4 Promoting young people’s mental health ....................................................................... 41
3.5 Theoretical conceptualizations of promoting mental health .......................................... 42
3.5.1 Deficit model (pathogenic perspective) ................................................................... 42
3.5.2 Asset model (salutogenic perspective) .................................................................... 43
3.6 School as a protective factor .......................................................................................... 44
3.7 Rationale for promoting pupils’ mental health in schools ............................................. 49
3.7.1 The legal-legislative rationale ................................................................................. 49
3.7.2 The psychological-educational rationale ................................................................. 50
3.7.3 The social-ethical rationale ...................................................................................... 51
3.8 Overview of studies of teachers’ views of pupils’ mental health .................................. 52
3.8.1 Definitions of attitudes ............................................................................................ 52
3.8.2 Models of attitudes .................................................................................................. 53
3.8.2.1 The single component model of attitudes ............................................................. 53
3.8.2.2 The multi dimensional model of attitudes (three-component model) .................. 54
3.8.3 Empirical support for the three-component model of attitudes ............................... 57
3.8.4 The link between attitudes and behaviour ............................................................... 58
3.8.5 Attitudes measures ................................................................................................... 59
3.8.6 Justifying the use of the three-component model .................................................... 60
3.8.7 Studies of teachers’ role in and attitudes towards the area of the study .................. 61
3.8.8 Factors associated with teachers’ attitudes .............................................................. 63
3.8.8.1 Young person-related variables ............................................................................ 63
3.8.8.2 Teacher-related variables ...................................................................................... 64
3.9 Barriers to promoting pupils’ mental health .................................................................. 65
3.10 Reflection on the chapter.............................................................................................. 79
Chapter 4: Methodology and Research Design
82
4.1 Introduction .................................................................................................................... 82
4.2 Research paradigm ......................................................................................................... 82
4.3 The ontological and epistemological assumptions underpinning the study ................... 86
4.4 The justification for utilizing a mixed-methodological approach .................................. 88
4.5 Sampling of the study..................................................................................................... 90
4.5.1 Phase one: quantitative sample ................................................................................ 90
4.5.2 Phase two: qualitative sample.................................................................................. 91
4.6 Research design and data collection methods ................................................................ 91
4.6.1 Phase one: Quantitative phase (survey) ................................................................... 93
4.6.1.1 The sections of the survey .................................................................................... 94
4.6.1.2 Construction of the survey.................................................................................... 96
4.6.1.3 Translation of the survey ...................................................................................... 96
4.6.1.4 Administration of the survey ................................................................................ 97
4.6.2 Phase two: Qualitative phase (semi-structured interviews) ..................................... 97
4.6.2.1 Conducting the interviews .................................................................................. ..99
4.7 Data analysis ................................................................................................................ 100
4.7.1 Quantitative data analysis ...................................................................................... 100
4.7.2 Qualitative data analysis ........................................................................................ 100
4.8 The reliability and validity of the quantitative phase ................................................... 102
4.9 The trustworthiness of the qualitative phase ................................................................ 102
4.10 Ethical considerations ................................................................................................ 104
4.10.1 Gaining informed consent ................................................................................... 105
4.10.2 Anonymity and confidentiality ............................................................................ 106
4.10.3 Protection from harm ........................................................................................... 107
4.11 Conclusion.................................................................................................................. 107
Chapter 5: Findings of the survey
108
5.1 Introduction .................................................................................................................. 108
5.2 Descriptive data ............................................................................................................ 108
5.2.1 Gender ................................................................................................................... 109
5.2.2 Age......................................................................................................................... 110
5.2.3 Years of teaching experience ................................................................................. 111
5.2.4 Level of education ................................................................................................. 111
5.3 Factor analysis for data deduction ................................................................................ 112
5.3.1 Reliability analysis ................................................................................................ 113
5.3.2 Exploratory factor analysis .................................................................................... 113
5.4 Analysis of teachers’ attitudes towards promoting pupils’ mental health ................... 118
5.4.1 Teachers general attitudes towards promoting pupils’ mental health ................... 118
5.4.1.1 Cognitive component of attitudes ....................................................................... 119
5.4.1.2 Affective component of attitudes ....................................................................... 124
5.4.1.3 Behavioural component of attitudes ................................................................... 126
5.4.2 Correlation between the components of attitudes.................................................. 127
5.5 Factors influencing teachers’ attitudes ......................................................................... 128
5.5.1 Gender ................................................................................................................... 129
5.5.2 Age......................................................................................................................... 130
5.5.3 Level of education ................................................................................................. 131
5.5.4 Years of teaching experience ................................................................................. 132
5.6 Analysis of teachers’ perceptions about barriers to promoting pupils’ mental health . 134
5.6.1 Factor analysis for data deduction ......................................................................... 134
5.6.2 Reliability analysis ................................................................................................ 135
5.6.3 Exploratory factor analysis .................................................................................... 135
5.6.4 Analysis of teachers’ perceptions about barriers to promoting pupils’ mental health
........................................................................................................................................ 137
5.6.4.1 Personal barriers ................................................................................................. 139
5.6.4.2 Interpersonal barriers .......................................................................................... 140
5.6.4.3 Structural-organisational barriers ....................................................................... 141
5.6.4.4 Socio-cultural barriers ........................................................................................ 142
5.6.5 Correlation between barriers and attitudes ............................................................ 143
5.7 Analysis of the content of the open-ended questions ................................................... 144
5.8 Conclusion.................................................................................................................... 147
Chapter 6: Findings from the Qualitative Stage
150
6.1 Introduction .................................................................................................................. 150
6.2 Teachers’ perceptions about promoting pupils’ mental health .................................... 151
6.2.1 Perceptions of mental health (terminological issues) ............................................ 151
6.2.2 Perceptions of the philosophy of promoting pupils’ mental health ....................... 158
6.3 Teachers’ feelings about promoting pupils’ mental health .......................................... 165
6.4 Teachers’ intentional behaviours ................................................................................. 166
6.5 Perceptions of the impact of the socio-cultural context ............................................... 168
6.5.1 Contradictory religious beliefs .............................................................................. 169
6.5.2 Perceptions about different social contexts ........................................................... 171
6.6 Teachers’ perceptions of barriers to promoting pupils’ mental health......................... 173
6.6.1 Personal barriers .................................................................................................... 174
6.6.2 Interpersonal barriers ............................................................................................. 177
6.6.3 Structural-organisational barriers .......................................................................... 179
6.6.4 Socio-cultural barriers ........................................................................................... 183
6.7 Teachers’ perceptions about changes ........................................................................... 187
6.7.1 Societal awareness ................................................................................................. 188
6.7.2 Policies and regulations ......................................................................................... 190
6.7.3 Organizational and structural changes in schools.................................................. 192
6.7.4 The commitment of teachers ................................................................................. 196
6.8 Reflection on the findings, and conclusion of the chapter ........................................... 198
Chapter 7: Discussion the findings and implications of the study
200
7.1 Introduction .................................................................................................................. 200
7.2 Discussion of survey findings ...................................................................................... 200
7.2.1 Teachers’ attitudes towards promoting pupils’ mental health ............................... 200
7.2.1.1 Teachers’ beliefs (Cognitive component)........................................................... 201
7.2.1.2 Teachers’ feelings (Affective component) ......................................................... 204
7.2.1.3 Teachers’ behavioural intentions (Behavioural component) .............................. 204
7.2.2 Factors influencing teachers’ attitudes and perceptions ........................................ 204
7.2.3 Barriers to promoting pupils’ mental health and making changes ........................ 206
7.3 Discussion of the findings from the interviews ............................................................ 207
7.3.1 Themes within the socio-cultural context .............................................................. 208
7.3.2 Themes within the educational context ................................................................. 211
7.3.2.1 Teachers .............................................................................................................. 211
7.3.2.2 The educational system ...................................................................................... 216
7.4 The overall discussion of the findings.......................................................................... 224
7.5 The limitations of the study.......................................................................................... 229
7.6 Implications of the current study.................................................................................. 232
7.6.1 Theoretical implications ........................................................................................ 232
7.6.2 Practical implications ............................................................................................ 235
7.6.3 Methodological implications ................................................................................. 240
7.7 Conclusion.................................................................................................................... 242
References .........................................................................................................244
Appendices
Appendix (I): Map of Kuwait............................................................................................. 277
Appendix (II): Map of the Arabian Peninsula .................................................................... 278
Appendix (III): The study survey ....................................................................................... 279
Appendix (IV): Protocol of the Semi- Structured Interviews ............................................ 287
Appendix (V): Reliability of the scales .............................................................................. 290
Appendix (VI): An Example of testing normality of the data subjected to ANOVA ........ 294
Appendix (VII): The Ethical Approval from the University of Exeter .............................. 317
Appendix (VIII): Informed Consent Form ......................................................................... 318
Appendix (IX): Sample of analysing and coding the emerged themes from interviews ... 320
Appendix (X): Samples of interviews scripts in Arabic .................................................... 344
Appendix (XI) Arabic copy of the study survey ................................................................ 378
List of Tables
Table 5.1 Frequencies and Percentages of Participants’ Gender........................................... 109
Table 5.2 Frequencies and Percentages of Participants’ Age................................................ 110
Table 5.3 Frequencies and Percentages of Years of Teaching Experience............................111
Table 5.4 Frequencies and Percentages of Participants’ Level of Education........................ 112
Table 5.5 Attitudes Scale Factor Loadings............................................................................ 114
Table 5.6 Means and SD of the Three Components of Attitudes.......................................... 117
Table 5.7 Correlation between Means Scores of the Three Components of Attitudes Scale
and the Excluded Items.......................................................................................... 118
Table 5.8 Frequencies and Percentages of Beliefs about Health Problems........................... 120
Table 5.9 Frequencies and Percentages of Beliefs about Promoting Pupils’ Mental Health in
Schools............................................................................................................... 122
Table 5.10 Frequencies and Percentages of Beliefs about Requirements and Outcomes of
Promoting Pupils’ Mental Health....................................................................... 123
Table 5.11 Correlation between the Mean Scores of the Three Dimensions of the Cognitive
Component of Attitudes.................................................................................... 124
Table 5.12 Means and SD of the Affective Component of attitudes..................................... 125
Table 5.13 Frequencies and Percentages of the Behavioural Component of Attitudes......... 126
Table 5.14 Correlation between Mean Scores of the Three Components of Attitudes......... 128
Table 5.15 Means, SD, and Significant Differences Value for the Dimensions of Attitudes
Components and Gender Factor.......................................................................... 129
Table 5.16 Means, SD, and Significant Differences Value for the Dimensions of Attitudes
Components and the Age group Factor...............................................................130
Table 5.17 Means, SD, and Significant Differences Value for the Dimensions of Attitudes
Components and of Education Level Factor....................................................... 132
Table 5.18 Means, SD, and Significant differences Value for the Dimensions of Attitudes
Components and Years of Teaching Experience Factor..................................... 133
Table 5.19 Barriers Scale Factor Loadings............................................................................ 135
Table 5.20 Correlation between Mean Scores of the Four Dimensions of Barriers and the
Excluded Items.................................................................................................... 137
Table 5.21 Means and SD of the Barriers Dimensions.......................................................... 138
Table 5.22 Correlation between Mean Scores of the Four Groups of Barriers..................... 139
Table 5.23 Frequencies and Percentages of Personal Barriers.............................................. 140
Table 5.24 Frequencies and Percentages of Interpersonal Barriers....................................... 141
Table 5.25 Frequencies and Percentages of Structural-Organizational Barriers................... 142
Table 5.26 Frequencies and Percentages of Social-Cultural Barriers.................................... 143
Table 5.27 Correlation between Teachers’ Attitudes Components and the Four Dimensions
of Barriers to Promoting Pupils’ Mental Health.................................................144
Table 6.1 Teachers Interviewed in the Second Phase of the Study....................................... 150
List of Figures
Figure 2.1 The Structure of the Kuwaiti Education System.................................................. 23
Figure 3.1 Keyes’s Continuum Model (2002) Adapted from Health and Welfare Canada:
Striking a Balance (1988)....................................................................................37
Figure 3.2 Tiers of Promoting Mental Health (NHS Health Advisory Service,
1995)..............................................................................................................................47
Figure 3.3 The Multi-component Model of Attitudes (Eagly & Chaiken, 1993).................. 55
Figure 4.1 Research Design of the Study.............................................................................. 92
Figure 5.1 Percentage Distribution of Gender....................................................................... 109
Figure 5.2 Frequency Distribution of Participants’ Age........................................................ 110
Figure 5.3 Frequency Distribution of Participants’ Years of Teaching Experience..............111
Figure 5.4 Percentage Distribution of Level of Education.................................................... 112
Figure 5.5 Descriptive Statistics for the Three Components of Attitudes of Scale............... 117
Figure 5.6 Descriptive Statistics for the Four Dimensions of Barriers Scale........................ 138
Figure 6.1 Teachers’ Perceptions about Mental Health Concept...........................................152
Figure 6.2 Teachers’ Perceptions about the Outcomes of Promoting Pupils’ Mental
Health........................................................................................................................... 163
Figure 6.3 Different Socio-Cultural Contexts........................................................................ 169
Figure 6.4 Barriers to Promoting Pupils’ Mental Health.......................................................174
Figure 6.5 Teachers’ Perceptions about Change.................................................................. 188
Figure 7.1 Overall Core Findings of the Current Study....................................................... 228