Postural health education in schools: teachers' perspectives on well-being, inequities, and institutional constraints

PURPOSE: Postural health remains an underexamined dimension of school-based health education, despite its relevance for students' wellbeing and long-term musculoskeletal health. This study explores how Physical Education teachers conceptualise and implement postural health education, and which factors shape its enactment. METHODS: A qualitative descriptive-interpretive design was adopted. Semi-structured interviews were conducted with 30 Physical Education teachers from primary and secondary schools in Spain. Data were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis within a constructivist framework. RESULTS: Five interrelated themes captured a tension between teachers' strong valuation of postural health and its marginal curricular status. These themes reflected (i) its recognised but limited curricular integration; (ii) fragmented conceptualisations and uneven pedagogical content knowledge; (iii) predominantly sporadic and unstructured implementation; (iv) insufficiently practice-oriented training; and (v) a strong demand for practical and institutional support. Conceptualisations ranged from hygiene-oriented approaches to more integrative understandings linked to motor control and physical literacy. Implementation was shaped by limited training, scarce resources, and low institutional prioritisation. CONCLUSIONS: Findings reveal a gap between the perceived importance of postural health and the structures supporting its implementation. Addressing this gap requires context-sensitive approaches that strengthen pedagogical support and curricular alignment.