Abstract

Background

In recent years, public health emergencies have become increasingly frequent, threatening human health. Accordingly, countries worldwide have attached great importance to optimizing their public health service systems. In China, physical education teachers are responsible for conducting health education in schools and improving students鈥� health; however, China鈥檚 health service supply is unbalanced and insufficiently developed. Therefore, this study constructed a health service competence model of Chinese physical education teachers to assess their contribution to the improvement of China鈥檚 national public health system.

Methods

The qualitative data were primarily gathered through semi-structured interviews. Physical education teachers and researchers of physical education teachers from diverse regions of China (N鈥�=鈥�48) were selected as participants using purposive sampling techniques. Grounded theory technical approach was employed to analyze the data through NVivo 11.0 software.

Results

The physical education teachers鈥� health service competence model contained three dimensions: health service beliefs, basic health knowledge, and health service skills. Health service beliefs contained two categories: health service awareness and health service cognition. Basic health knowledge contained two categories: life health knowledge and sports health knowledge. Health service skills contained seven categories: health education skills, management skills, research skills, advocacy skills, emergency skills, organization skills, and alert skills.

Conclusion

This study鈥檚 model provides a theoretical foundation for Chinese physical education teachers to transition to physical education and health teachers. Utilizing this model in teacher education can contribute to enhancing China鈥檚 national public health service system.

Introduction

Health services refer to systematic actions that promote the population鈥檚 health levels [1]. While medical services aim to cure patients [2], the main purpose of health services is to focus on disease prevention [3]. Physical education teachers鈥� health service competence refers to their ability to use health-related professional knowledge and skills to optimize students鈥� health. This definition encompasses a multi-field health service system comprising schools, families, and society, and gives full play to the role of physical education teachers in promoting the health level of students and other groups.

Many scholars have investigated the promotion of students鈥� health through education [4], as teachers are in daily contact with students and can perceive their unhealthy states [5] and assist in preventing potentially unhealthy behaviors. Many scholars have also focused on the strategies, plans, and projects for providing school mental health services [4]. For example, Cheri et al. [6] use the McGill training program in the United States as a typical case and propose that if people who intend to become school mental health teachers are provided with health consultation and health policy interpretation training, the quality of students鈥� mental health services can be improved. Weist [7] examines schools鈥� mental health service supply (from being isolated to cooperative) and suggests that the joint efforts of schools and communities can improve students鈥� mental health. Other scholars have highlighted the challenges faced by school mental health services, such as Bringewatt and Gershoff [8], who believe that schools with insufficient health service resources may negatively affect the improvement of students鈥� achievements and promotion of mental health. Cummings and Druss [9] assert that students with mental health issues are more reluctant to accept the mental health services provided by schools, which reduces the efficiency of the school mental health service supply. Regarding the current school mental health service situation, physical education teachers, as health service providers, are able to provide sufficient mental health service resources for students [10]. Regarding physical health, many scholars have explored physical education teachers鈥� role in improving students鈥� health levels through actions inside and outside the classroom. For example, Woods et al. and Macdonald [11, 12] propose physical education curriculum reform and advocated that strength training, health knowledge, and sports skills learning can improve students鈥� health levels, the intent being that school health education should be integrated with other subjects instead of being separate [13]. Further, as providers of school health education, teachers play an important role in health education courses. Benes et al. [14] review the American Department of Public Health and Human Services鈥� capability training for health education teachers, which requires these teachers to have a high level of practical ability. It also defines the characteristics of effective health education teachers as being interested in promoting healthy behaviors, having strong content knowledge, and being proficient in using various teaching strategies. This definition provides a standardized requirement for physical education teachers to provide health services, making them potentially excellent future health service providers. Although the above studies have explored the important value of physical education teachers in promoting the health of others, there is no current research on modeling health services for physical education teachers.

The aforementioned literature suggests that physical education teachers have strong significance and feasibility as health service providers owing to their professional health characteristics. However, there is a paucity of knowledge on how to develop diversified health service providers and stimulate the potential of PE teachers to become health service providers. Therefore, this study constructs a model to assess Chinese physical education teachers鈥� required competence to become qualified health service providers and improve the health levels of students and other groups. Utilizing this model in teacher education can contribute to the enhancement of China鈥檚 national public health service system.

Methods

Study design

This study mainly utilized the grounded theory methodology developed by Glaser and Strauss in 1967 [15]. It is crucial to clarify that grounded theory is a methodological framework, not a theoretical doctrine [15]. This framework offers a pathway to investigate social phenomena and to construct theoretical models from qualitative data [16]. The underlying epistemology is constructivism, influenced by the interactionism tradition [17] and pragmatic philosophy [18]. The ontology is realist, advocating that theoretical models should be embedded within the wider context of social, political, cultural, and technological environments. Furthermore, concepts across different levels of abstraction serve as the foundation for analysis [16]. Constructivists believe that researchers develop concepts and theories from narratives crafted by participants who interpret and understand their own life experiences, both for the researchers and for themselves. From these diverse narratives, analysts then compile what they refer to as knowledge. Adhering to constructivist principles, grounded theory fosters the creation of theories from the gathering and examination of primary qualitative data [16]. In this study, we obtained primary data through interviews with physical education teachers and physical education teacher researchers, and constructed a model of physical education teachers鈥� health service competencies through a three-level coding procedure (open, axical, and selective).

Data collection

The research data were obtained from interviews with 48 physical education teachers at the compulsory education, general high-school, and higher education levels. A convenience sampling method was employed and experts who met the following criteria were selected:

• Criterion 1: Interviewees need to be per-service physical education teachers, physical education teachers, or physical education teacher researchers.

• Criterion 2: Pre-service physical education teachers Physical education teachers need to have the experience of health education, whereas physical education teacher researchers need to have published at least one paper in the field of physical education and health teaching or physical education teacher education research in China National Knowledge Infrastructure (CNKI), a Chinese online academic publishing platform.

• Criterion 3: For the results of this study to be consistent with the development of physical education teachers in different regions of the country, the regions from which interviewees come should cover as much of the country as possible.

Finally, this study invited 50 experts to participate in interviews from January to March 2024, with 48 experts expressing willingness to participate (Table听1). Two other experts declined to participate due to time constraints. There were three stages of data collection: individual interviews, group interviews (the researcher organized a workshop in the form of a focus group and guided the interviewees to participate) [19], and written communications.

Table听1 Basic information of interviewees (N鈥�=鈥�48)

Fourteen experts participated in individual interviews, 28 experts (divided into 4 groups) participated in the group interviews, and six experts participated in written communication. During the interviews and exchanges, only the researcher and the interviewer participated in the dialog, and the researcher advised the interviewer that the privacy of the interviewees would be protected and that all material would be used solely for the study. In the individual interviews, group interviews, and written communication, all questions centered on the health service competence of physical education teachers, which covered the following questions: 1. 鈥淲hat do you think health education in the physical education and health curriculum consists of? In addition to health education, what other health services can physical education teachers provide for their students?鈥� 2. 鈥淚n addition to providing health services for students at school, please talk about what other health services physical education teachers can provide for parents, colleagues, the community, and other groups?鈥� 3. 鈥淲hat do you think is the current level of health service competence of physical education teachers? What factors may affect the ability of physical education teachers to develop health services?鈥�.

The interview data were summarized, sorted, and integrated through the artificial intelligence optimization tool for text transcription available on Tencent Meeting and the transcription function of the voice recorder. Through these three interview formats, 24 sets of interview material were collected (see Supplementary Material).

Coding analysis

The data were coded using NVIVO 14 software. After importing the transcribed interview text, the literature [20,21,22,23,24,25,26,27,28,29,30,31] and policy (Healthy China 2030, Guidelines for Health Education in Regular Higher Education Institutions) related to physical education teachers鈥� health service competence were captured in the analysis software in Microsoft Word and PDF formats, and the raw materials were coded using the bottom-up approach. Open coding was conducted to define the phenomena, concepts, and classify categories, and was divided into three steps: labeling, conceptualization, and categorization.

Labeling results

This study explored the specific components of physical education teachers鈥� health service competence. Therefore, when collecting the raw materials, this study took 鈥減hysical education teachers鈥� need to have skills, awareness, and so on, to carry out health services鈥� as the basis for the coding. This centered on the following questions: (1) Do the raw materials refer to the physical education teachers鈥� health service competence? (2) What aspects of the physical education teachers鈥� health service competence are reflected in the raw materials? (3) Do the raw materials go beyond the scope of this study鈥檚 conceptualization of the physical education teachers鈥� health service competence? Based on these questions, this study used the format of 鈥淓N(N is the numerical number)鈥�+鈥塴abeled statement name鈥� to name the statements (e.g., E1: Cultivate students鈥� physical activity awareness and habits) and code the data (Table听2). To avoid losing the coding鈥檚 original meaning, this study attempted to use the original statements from the literature or interview respondents鈥� original phrasing as the labeled statements in the labeling process.

Table听2 Example of raw materials labeling process

Conceptualization results

In open coding, conceptualization is used to define concepts based on the previous tagging step, and the tagged statements are condensed to form concepts. The researcher then dynamically compares the concepts and merges those with the same and similar meanings as much as possible to prevent repetition. After conceptualization, this study condensed 45 concepts from 252 labeled statements (Table听3). These concepts were named as follows: 鈥淒N(N is the numerical number)鈥�+鈥塩oncept name鈥� (e.g., D1: Conscious sharing of health knowledge).

Table听3 Example of the process from raw materials to conceptualization

Categorization results

The final open coding step is categorization, wherein the codes formed by conceptualization are analyzed, summarized, and condensed, leading to the formation and naming of categories. After the labeling, conceptualization, and categorization of the raw materials, this study obtained 11 categories (Table听4), which were presented in the form of 鈥淐N(N is the numerical number)鈥�+鈥塩ategory name鈥� (e.g., C1: Health service awareness).

Table听4 Example of the categorization process of raw materials

Based on the open coding results, axical coding comprises the second step of the grounded theory process, in which the categories formed via the open coding are condensed and summarized again. Similar to the categorization process, axical coding constantly compares the categories and analyzes their interrelationships to arrive at more scientific main categories. However, the main category connotations may be impacted by duplication. This study summarized three main categories, which were presented in the form of 鈥淏N(N is the numerical number)鈥�+鈥塩ategory name.鈥�

Finally, selective coding is conducted, which essentially condenses and summarizes the main categories formed by axical coding to form a core category. The researcher compares the interrelationships among the main categories to establish a core category that has a better explanatory degree and is more scientific and reasonable, so as to dominate all model categories and labels. In this study, the physical education teachers鈥� health service competence model was formed via repeatedly comparing the axical coding results and the categories and labels formed via the open coding.

Theoretical saturation test

A theoretical saturation test was required to ensure the physical education teachers鈥� health service competence model constructed herein covered the full range of the topic [32]. The process entails persistently gathering and examining data until there is no further identification of novel concepts, trends, or revelations, signifying that the point of theoretical saturation has been reached [33]. In this study, 80% of the raw materials were used as samples, and the remaining 20% of the samples and other related materials were used for the theoretical saturation test. By analyzing the remaining 20% of the research data using NVivo 11.0 for coding, the test results showed that no new nodes appeared, indicating that the coding content had reached saturation. Consequently, the competence model for physical education teachers is considered to be both objective and scientifically validated.

Results

Grounded in the sociocultural context of China, the physical education teachers鈥� health service competence model was formulated as follows: labeling鈥夆啋鈥塩onceptualization鈥夆啋鈥塩ategory鈥夆啋鈥塵ain category鈥夆啋鈥塩ore category. The model contained 3 main categories, 11 categories, 45 concepts, and 252 statement labels (Table听5, Fig.听1).

Table听5 Physical education teacher's health service competence model

Fig.听1

Physical education teachers鈥� health service competence model

Health service beliefs

Health service awareness

Health service awareness refers to the physical education teachers鈥� awareness of providing health services in their daily life and work. Physical education teachers with health service awareness must have a high degree of identification with their profession, understand the missions of the time in the context of frequent public health crises, put into practice their acquired health knowledge and skills, and consciously improve the health of others. Participant 1 stated the following:

鈥淩ecently, there has been a noticeable increase in the severity of influenza cases. As we navigate through the winter season, it has become evident that a significant portion鈥攁pproximately half鈥攐f my students are experiencing symptoms such as coughing or fever. During physical education classes, I've observed that many students tend to sweat profusely while engaging in physical activities. In response to this, some parents have provided their children with heavier clothing, which is not ideal for maintaining comfort and health. To address this issue, I plan to remind my students to place a towel inside their clothing during physical activities. This simple measure will help absorb sweat and prevent their clothes from becoming damp, thus ensuring they remain comfortable and reducing the risk of catching a cold.鈥� (Participant 1)

Health service cognition

Health service cognition refers to the physical education teachers鈥� understanding of their health service responsibilities and their awareness that physical education teachers should transition into physical education and health teachers. Under the active health concept, physical education teachers should realize that their daily life and work roles are not limited to instructing students in sports and dealing with sports injuries, but should also cover the promotion of students鈥� active health and the improvement of the ability to prevent health crises. Participant 2 opined:

鈥淚n our physical education and health program, the first step is to identify the key components of health education as outlined by curriculum standards. These include promoting physical activity, health knowledge, emotional management, and environmental adaptation. As a PE teacher, my role is to guide students in adopting these healthy behaviors, preparing them for a lifetime of well-being.鈥� (Participant 2)

Basic health knowledge

Life health knowledge

Life health knowledge refers to the physical education teachers鈥� health-related knowledge and covers five aspects: knowledge of healthy behavior and lifestyle, growth and adolescent health care, mental health knowledge, disease prevention and response to public health emergencies, and safety emergency and risk avoidance. The knowledge of healthy behavior and lifestyle involves healthy living habits such as having a proper diet, drinking water, and not smoking. The knowledge of growth and adolescent health care involves the awareness of sexual characteristics, prevention of sexual abuse, and the characteristics of physical development. Mental health knowledge involves the management of emotions and the regulation, identification, and cooperation with others. The knowledge of disease prevention and response to public health emergencies involves the prevention of common infectious diseases and self-protection during public health emergencies. Finally, the knowledge of safety emergency and risk avoidance involves the awareness of escape and self-protection in the event of fires, earthquakes, tsunamis, and other events. Participant 3 pointed out:

鈥淭he curriculum standards highlight five critical areas: physical health, mental health, disease prevention, public health emergencies, and evacuation procedures. Drawing from my personal and professional experiences, I am well-versed in these health-related topics.鈥� (Participant 3)

Sports health knowledge

Sports health knowledge covers two aspects: knowledge of physical fitness and knowledge of sports kinesiology. This dimension reflects the professional characteristics of physical education teachers (i.e., being able to instruct others on exercise, improving students鈥� physical fitness, and knowing how to prevent and handle sports injuries). Basic health knowledge is a prerequisite for physical education teachers to conduct health services, and the possession of rich and correct health knowledge helps physical education teachers to provide students with correct education, management, advocacy, alerts, and other services. Participant 4 concurred, stating that:

鈥淧hysical education instructors are tasked with equipping students with a comprehensive range of skills and knowledge. This includes daily physical training, sports safety education, strategies to prevent sports injuries, weight management programs, and initiatives for both physical and mental relaxation. Additionally, they are responsible for assessing and monitoring students' physical fitness levels. Consequently, there is a significant imperative for educators to possess a deep understanding in these areas.鈥� (Participant 4)

Health service skills

Health education skills

Health education is an important component of physical education teachers鈥� roles. Accordingly, physical education teachers are mainly responsible for school health education. Whether in general high-school or compulsory education, health education is an important part of the curriculum regarding physical education and health courses. In this study, health education not only refers to the transmission of health knowledge and skills to students via physical education and health courses, but also refers to the need for physical education teachers to cultivate students鈥� health literacy by establishing teaching objectives, choosing teaching contents, using innovative teaching methods, conducting teaching evaluations, and developing teaching resources. It also refers to the dissemination of health knowledge and skills to all of society (i.e., colleagues, family members, parents, neighbors, and other groups) to raise the national health literacy level. Participant 5 phrased it as follows:

鈥淧hysical education teachers are mainly responsible for the textbook content. Recently, I have been thinking about how to integrate health education into physical education or physical fitness teaching, such as how to link the knowledge of basic motor skills, physical fitness-specific motor skills, and interdisciplinary themes in the physical education curriculum with health education, and how to better design and conduct health education in terms of objectives, content, methodology, and evaluation.鈥� (Participant 5)

Health management skills

Health management skills refer to the physical education teachers鈥� ability to provide health plans and advice to others, build health platforms, and manage and analyze health data. This requires physical education teachers to have certain data management skills and information literacy to collect health information and provide management services for others鈥� health promotion. Participant 6 added the following perspective:

鈥淲e offer our teachers detailed body composition analysis through the use of specialized equipment. Each teacher receives an individual report, which they find both engaging and insightful. Armed with this data, we are able to provide personalized recommendations for healthy exercise regimens tailored to their unique needs.鈥� (Participant 6)

Health research skills

Health research skills refer to the physical education teachers鈥� ability to process and analyze students鈥� physical fitness data; investigate, analyze, and make recommendations regarding the health of different populations; and translate research results into practical application. In this study, the expression 鈥渉osting or participating in鈥� was used, meaning that not every physical education teacher was required to be able to conduct research alone, but had to be able to participate in the corresponding research. Participant 7 stated the following:

鈥淧hysical education teachers have the capability to compile and analyze student health data, which can serve as a valuable resource for informing governmental decision-making processes or for conducting research into health policies.鈥� (Participant 7)

Health advocacy skills

Health advocacy skills refer to the physical education teachers鈥� ability to disseminate health awareness, concepts, and knowledge to students, parents, colleagues, family members, neighbors, and other groups in different arenas, such as schools, homes, and communities, through presentations, lectures, leaflets, and social media. Participant 8 elucidated as follows:

鈥淚 have been privileged to deliver speeches across our school, emphasizing the critical importance of food safety. Furthermore, our school is set to initiate a health-themed handwriting and drawing campaign. The artwork will be showcased on our school bulletin board, promoting health awareness and creativity among our students.鈥� (Participant 8)

Health emergency skills

Health emergency skills refer to the physical education teachers鈥� ability to solve unexpected health crisis events, such as students鈥� classroom injuries, cardiac arrest, drowning, and so on. As professionally trained personnel, physical education teachers鈥� emergency skills can ensure students鈥� safety during unexpected crises. Participant 9 shared this point of view:

鈥淚 believe that the role of physical education teachers extends beyond the classroom; they should also be equipped to handle injuries that students might sustain during sports activities. It is essential for them to be capable of providing immediate and emergency care for a range of sports-related injuries, including but not limited to skin abrasions, muscle strains, bone fractures, and cases of fainting.鈥� (Participant 6)

Health organization skills

Health organization skills refer to the physical education teachers鈥� skills in organizing health-related activities, such as participation in sports, school health-related competitions, and earthquake drills. Expanding the impact of physical education teachers鈥� health services by organizing health-related activities is the core essence of health organization skills. Participant 10 said that:

鈥淒uring our time in the community, I was actively involved in two social media groups, frequently inviting neighbors to join in sports activities. If there was interest, we'd arrange a soccer match, and it wasn't uncommon for 20 to 30 people to show interest and register. I would then assist in organizing these games. I've always found that facilitating such recreational opportunities doesn't require a significant amount of effort, yet it can greatly enrich the community experience for everyone involved.鈥� (Participant 6)

Health alert skills

Health alert skills refer to the physical education teachers鈥� timely detection of potential health crises through data analyses and observations, as well as their use of early warnings systems to avoid the occurrence of health crises. For example, reminding students about higher body mass index statuses and the possibility of obesity, observing colleagues鈥� poorer psychological status, providing them with psychological guidance, and so on. Participant 5 shared the following modus operandi:

鈥淕iven that physical education teachers have access to comprehensive data on students' physical health, I conduct thorough health assessments for each student. Following these assessments, I issue health advisories to students who exhibit concerns and engage in dialogue with their parents. For instance, I might advise them on the importance of regular exercise. My observations have shown that students who receive these targeted warnings tend to demonstrate more notable improvements in their fitness test results.鈥� (Participant 6)

Discussion

Importance of physical education teachers鈥� health service competence model

The raw material selected for this study was derived from interviews with Chinese physical education teachers, Chinese health promotion policies, etc., and thus the theoretical model is rooted in the Chinese social context. The theoretical model reflects the requirements for the development of physical education teachers in China in the fields of education and public health. However, in terms of specific connotations, the health service competencies required of physical education teachers are both similar to and different from those of other teachers.

Health service awareness, life health knowledge, health promotion skills, and health warning skills are common to both physical education teachers and other teachers. Regarding health service awareness, all teachers should be aware of promoting healthy students. As for life health knowledge, every teacher needs to have some general life health knowledge, which is not only beneficial to help students develop healthy habits but also valuable for their own health. Regarding health promotion skills, every teacher should publicize the importance of health and disseminate health knowledge to students during the teaching process. In terms of health warning skills, every teacher needs to be able to sense if there is a potential problem psychologically or physiologically among their students during their daily interaction with them. In addition to the above four competencies that physical education teachers need to share with other teachers, all the other competencies are required for physical education teachers to specialize in, which reflects the unique expertise and skills that physical education teachers should possess that are important to develop students and others [34]. It also reflects the important value of the model in promoting the professional development of physical education teachers, facilitating the implementation of physical education and health curricula, and meeting the needs of society鈥檚 health development.

At the personal development level, the model provides clear directions for physical education teachers to transform into physical education and health teachers. The Physical Education and Health Curriculum Standards for Compulsory Education suggests that physical education teachers are responsible for conducting health education in schools and improving students鈥� health literacy. However, some scholars have pointed out that China鈥檚 physical education and health curriculum faces problems such as the extreme weakening of health education and difficulty of cultivating students鈥� health literacy. This may be because, at present, Chinese physical education teachers have less knowledge reserves of health education and weaker health education ability, making it difficult for them to conduct adequate school health education. To address this problem, this study鈥檚 physical education teachers鈥� health service competence model covers sports health knowledge, life health knowledge, and health education skills. Life health knowledge is in line with the five aspects (knowledge of healthy behavior and lifestyle, growth and adolescent health care, mental health knowledge, disease prevention and response to public health emergencies, and safety emergency and risk avoidance) of the health education curriculum standards, which point out the specific pathways needed for physical education teachers to transform into physical education and health teachers.

At the curriculum implementation level, the physical education teachers鈥� health service competence model conforms to the overall development direction of the curriculum standards. Since the founding of New China, China鈥檚 physical education curriculum standards have gone through many revisions, including the labor and health system鈥檚 emphasis on the necessity of physical development, the three fundamentals (basic knowledge, techniques, and skills) based on Kerouf鈥檚 educational theory [35], the guiding ideology of putting health first, and the emphasis on health behavioral qualities in the physical education curriculum objectives to educate people [36]. This requires physical education teachers to use a variety of means inside and outside of the classroom to provide health services to students. Accordingly, this study鈥檚 model covers skills in areas related to health education, management, research, advocacy, emergencies, alerts, and health organizations.

Finally, at the social demand level, this study鈥檚 model extends the health services provided by physical education teachers to meet all of society鈥檚 health needs. The international research on physical education teachers and public health has emphasized the need for these teachers to focus on public health [37]. For example, the comprehensive school physical activity program, implemented in the United States to solve the national health crisis and improve citizens鈥� health levels, focuses on school physical education development using physical education teachers as core personnel. Many other current international public health programs also place physical education teachers as core personnel. For example, Magner鈥檚 [38] physical fitness-based program proposes that physical education teachers should create a culture of physical activity in schools, establish physical fitness testing labs, and increase opportunities for students to be physically active so that they can develop healthy lifestyles. Jones et al. [39] call for physical education teachers to work with the community to form a collaborative children鈥檚 health promotion program. Bryan [40] calls for physical education teachers to focus on the health and well-being of their students, while Sheehan and Sheehan [41] propose a healthy active school community program. McMullen et al. [42] present a university鈥搒chool partnership regarding an out-of-class physical activity program, while Carpenter and Choi [43] propose a university鈥揾ome鈥搒chool physical education program. These public health programs assert that the physical education teachers are responsible for running the programs and requires them to provide health services both to schools and the wider community.

Physical education teachers鈥� health service competence model鈥檚 solid theoretical foundation

In this study鈥檚 model construction process, some respondents questioned why physical education teachers should be health service providers and thought that it would be difficult for teachers of other subjects to replace physical education teachers. Bourdieu鈥檚 [44] cultural capital theory can provide an explanation. Of the three types of capital (economic, social, and cultural), cultural capital has three forms: embodied, objectified, and institutionalized [44]. First, embodied cultural capital refers to the knowledge, skill, and interest that form part of the mind and body of actors through both the family environment and education. For physical education teachers, their knowledge and skills acquired during their teaching are transformed into a physical form of cultural capital through their teaching of physical and mental health. Accordingly, this study鈥檚 model asserts that physical education teachers can practice their health knowledge and skills and become health role models.

Second, objectified cultural capital refers to physical objects that carry meaning, such as books, paintings, tools, and machinery. Although this form of cultural capital has certain economic value, it cannot be obtained, so it is necessary for an individual to have a physical form of cultural capital in the sense of an object. As in this study鈥檚 model, the physical education teachers can use professional measurement tools to assess health and provide advice. Although these professional tools may have high economic value, it is difficult to maximize their effects if the teachers do not also possess rich health-related knowledge. For the physical education teachers, operating the professional health assessment tools with professional knowledge can ensure their provision of valuable health management services.

Finally, institutionalized cultural capital refers to the formal recognition of the knowledge and skills acquired by actors, and their institutionalization through the granting of diplomas and certificates of competence to qualified individuals. In short, this form of capital transforms physical cultural capital at the individual level into objective forms of cultural capital at the collective level. For the physical education teachers, institutionalized cultural capital refers to the certification of themselves as socially recognized professionals capable of instructing others in physical activity and improving their health.

Overall, the physical education teachers鈥� health service competence model has a solid theoretical foundation, and Bourdieu鈥檚 [44] cultural capital theory can be used to explain why physical education teachers, rather than teachers of other disciplines, must possess this competence.

Conclusions

Using the grounded theory technical approach, this study constructs a health service competence model for PE teachers in China. The model contains 3 dimensions (health service beliefs, basic health knowledge, and health service skills) and 11 categories based on 45 concepts and 252 labels. Among the categories, health service beliefs contain two components: health service awareness and health service cognition. Basic health knowledge contains two categories: life health knowledge and sports health knowledge. Health service skills contain seven categories: health education skills, management skills, research skills, advocacy skills, emergency skills, organization skills, and alert skills. The theoretical saturation and consistency test results reveal that the model has good reliability and validity and can comprehensively explain the health service competence of Chinese PE teachers.

Although this study constructed a health service competence model for PE teachers in China and analyzed the specific connotations and theoretical foundations of various indicators in the model, it still has limitations. First, this study did not explore the path for PE teachers to integrate health education into the national health service system. In the future, a health service management model that includes PE teachers as key figures should be developed. Second, the experts interviewed by the research institute are mainly physical education teachers and researchers on physical education tuition, and do not cover experts in other fields. Therefore, future researchers can further explore the health service competence that PE teachers should possess based on public health researchers, students, parents, and other subjects.

Limitations and听future research

This study used rooted theory and followed scientific research procedures to construct a health service competency model for physical education teachers that is valuable for future physical education teacher development. However, there are some limitations, and the following aspects deserve further consideration in the future.

First, physical education teachers and physical education teacher researchers were selected as interview subjects in this study. Although it was possible to obtain perspectives from practitioners in the field of physical education about the health service competence of physical education teachers, it was not considered from the perspective of practitioners in the field of public health. Also, the interviews did not cover physical education teachers in all regions of the country. Therefore, in the future, interviews can continue to be conducted with researchers in the field of public health and physical education teachers in all regions of the country to obtain more comprehensive primary data. In addition, in this study, two experts declined to participate in the interviews because the interviews coincided with the Chinese New Year holiday. For this reason, it is important to avoid inviting experts to participate during holidays when conducting interviews in the future.

Second, this study focused on Chinese physical education teachers鈥� health service competence and did not consider international physical education teachers鈥� development. Therefore, the physical education teacher health service competency model derived from this study may not be applicable to global physical education teacher education programs. In the future, global physical education teacher education researchers can follow this research program and use rootedness theory to construct a model of physical education teacher health service competence applicable to different countries.

Third, the term 鈥減hysical education teachers鈥� in this study refers to primary and secondary school physical education teachers, and physical education teachers were not categorized based on demographic variables such as school type, grade, gender, race, and age. In the future, one can further explore the requirements of health service competence for PE teachers with different identities and develop personalized programs for PE teachers鈥� development.

Lastly, in addition to constructing a health service competency model for physical education teachers, the topic can also be analyzed from a managerial and sociological perspective; how physical education teachers can intervene in the construction of the national public health system and how physical education teachers can gain identity in the process of providing health services are issues worth exploring.