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Gallant AJ, Steenbeek A, Halperin SA, Parsons Leigh J, Curran JA. Operationalizing the Behaviour Change Wheel and APEASE criteria to co-develop recommendations with stakeholders to address barriers to school-based immunization programs. Vaccine 2024; 42:126226. [PMID: 39173194 DOI: 10.1016/j.vaccine.2024.126226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION School-based immunization programs offer an accessible route to routine vaccines for students. During the COVID-19 pandemic, school closures to comply with public health measures had a drastic effect on school-based immunization program delivery and associated vaccine uptake. We sought to integrate findings from a mixed methods study to co-develop evidence-based and theory-informed recommendations with a diverse group of stakeholders (i.e., decision makers, healthcare providers, school staff, parents and adolescent students) to address barriers to new and existing school-based immunization programs. METHODS Findings from a mixed methods study were integrated using a joint display and narrative summary. These findings were mapped through the Behaviour Change Wheel, a series of tools designed to facilitate the development of behaviour change interventions. Draft recommendations were provided to previous mixed methods study participants who consented to participating in future phases of the research study (n = 26). Feedback was captured using a Likert-scale survey of acceptability, practicality, effectiveness, affordability, safety and equity (APEASE) criteria, with feedback and additional insights captured using open-ended textboxes. Data was used to revise and finalize recommendations. RESULTS Applying the Behaviour Change Wheel, we drafted 26 evidence-based, theory-informed recommendations to address barriers to school-based immunization programs. Participants (n = 16) provided feedback, with half of the recommendations scoring 80% or higher across all six APEASE criteria. The remaining 13 recommendations received a moderate score across one or more criteria. Stakeholders identified a high level of interest in expanding the use of e-consent forms, expanding programming to offer a meningitis B vaccine, and recommendations to ease student anxiety. CONCLUSION We co-developed a range of recommendations to improve school-based immunization programs with stakeholders using data generated from a mixed methods study. Implementation of any single or combination of recommendations will need to be tailored to local clinic procedures, school system and health system resources.
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Affiliation(s)
- Allyson J Gallant
- Faculty of Health, Dalhousie University, 5968 College Street, PO BOX 15000, Halifax, Nova Scotia (NS) B3H 4R2, Canada.
| | | | | | | | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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McDonald B, Michelson D, Lester KJ. Intervention for school anxiety and absenteeism in children (ISAAC): Co-designing a brief parent-focused intervention for emotionally-based school avoidance. Clin Child Psychol Psychiatry 2024; 29:850-866. [PMID: 38130129 PMCID: PMC11188550 DOI: 10.1177/13591045231222648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Emotionally-based school avoidance (EBSA) is an important driver of persistent school absenteeism and may have worsened in the context of COVID-19. This paper describes the development of a brief parent-focused psychosocial intervention with the goal to address the lack of accessible early interventions for EBSA. The developmental process used a person-based approach with two phases. In Phase 1, qualitative data were collected about intervention preferences and priorities from N = 10 parents and N = 7 practitioners in a series of co-design workshops. Phase 2 refined an intervention blueprint based on iterative consultations with N = 4 parents and N = 3 practitioners. Framework analysis was used to organise findings around key intervention parameters, including relevant mechanisms, content, and delivery methods needed to provide effective, acceptable and feasible support for families affected by EBSA. The resulting blueprint incorporates three online modules to be delivered over three weeks with each module consisting of psychoeducational videos, self-completed learning tasks and a corresponding coaching session. Respective module content includes: (i) self-care strategies to increase parent wellbeing and self-efficacy; (ii) parenting strategies to change behavioural patterns that maintain child distress and avoidance of school; and (iii) strategic communication strategies to increase the quality of home-school relationships. The blueprint has been developed into a full prototype for a forthcoming feasibility study.
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Affiliation(s)
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, UK
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Gallant AJ, Johnson C, Steenbeek A, Parsons Leigh J, Halperin SA, Curran JA. Stakeholders' experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study. PUBLIC HEALTH IN PRACTICE 2024; 7:100505. [PMID: 38807702 PMCID: PMC11130716 DOI: 10.1016/j.puhip.2024.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Background School-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents' vaccine views. Study design Semi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February-August 2023. Methods The COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes. Results Participants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic. Conclusions We identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents' vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.
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Affiliation(s)
- Allyson J. Gallant
- Faculty of Health, Dalhousie University, 5968 College Street, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Catie Johnson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | | | | | - Scott A. Halperin
- Dalhousie University, Canadian Center for Vaccinology, Halifax, NS, Canada
| | - Janet A. Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Lester KJ, Michelson D. Perfect storm: emotionally based school avoidance in the post-COVID-19 pandemic context. BMJ MENTAL HEALTH 2024; 27:e300944. [PMID: 38580437 PMCID: PMC11021743 DOI: 10.1136/bmjment-2023-300944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/16/2024] [Indexed: 04/07/2024]
Abstract
School absences have risen following the COVID-19 pandemic and persistent absenteeism remains high in primary and secondary schools in England compared with pre-pandemic levels. This coincides with an upward trend in emotionally based school avoidance (EBSA). EBSA adversely affects children's educational attainment, health, social functioning and life prospects and warrants early intervention before a pattern of absenteeism becomes entrenched. In this article, we consider how the COVID-19 pandemic and its sequelae have created a 'perfect storm' of conditions, amplifying known school, family and child-based risk factors for EBSA while simultaneously reducing access to support services. We then outline priorities for developing new EBSA interventions and argue for a multi-component approach, which works across education, health and social care, and voluntary sectors to address the complex interplay between risk factors. Given the difficulties that families often face in obtaining timely support for EBSA, it is also essential that new interventions are accessible, resource-efficient and scalable. To this end, we specifically discuss the potential for contextually-sensitive, parent-focused interventions that can be delivered online with minimal synchronous support from a trained coach or facilitator.
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Affiliation(s)
- Kathryn J Lester
- School of Psychology, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College, London, UK
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Kim LE, Fields D, Asbury K. 'It feels like I'm back to being a teacher': A longitudinal trajectory analysis of teachers' experiences during the first 8 months of COVID-19 in England. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2023; 93:1105-1122. [PMID: 37340236 PMCID: PMC10953431 DOI: 10.1111/bjep.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Understanding teachers' experiences throughout the school closures and reopenings that have characterized large periods of the COVID-19 pandemic provides us with unique insights into what it means to be a teacher during a global public health crisis. AIM AND METHOD To investigate teachers' narratives of their experiences, we conducted 95 semi-structured interviews with 24 teachers in England across four time points between April and November 2020. We used a longitudinal qualitative trajectory analysis of participants' stories of their high-, low- and turning-points. RESULTS We derived four themes that were evident at each time point and developed over time. The themes were: (1) growing frustration at uncertainties caused by poor government leadership, (2) expanding concern for pupil learning and well-being, (3) an increasingly labour-intensive and exhausting job and (4) declining pleasure and pride in being a teacher. CONCLUSIONS The findings shed light on the impact of COVID-19 on the professional identity of these teachers and we propose ways in which teachers can be supported now and in the future.
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Affiliation(s)
- Lisa E. Kim
- Department of EducationUniversity of YorkYorkUK
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Zhao G, Wang B, Li H, Ren H, Jiao Z. The relationship between depressive and anxious symptoms and school attendance among adolescents seeking psychological services in a public general hospital in China: a cross-sectional study. BMC Psychiatry 2023; 23:456. [PMID: 37344768 DOI: 10.1186/s12888-023-04813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/23/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND School attendance problems (SAPs), whether absenteeism or dropout, are strongly associated with poor outcomes for adolescents. We examined multiple variables that influence SAPs to identify potential leverage points for improving school attendance. METHODS Self-reported SAPs and demographic information was collected from 392 adolescents in adolescents presenting to the general hospital for psychological services. PHQ-9 and GAD-7 were applied to assess the severity of depressive and anxious symptoms. We constructed logistic regression analysis and the Chi-Square Automatic Interaction Detection (CHAID) segmentation analysis via SPSS Decision Tree to identifying risk factors for the development of SAPs in adolescents. RESULTS SAPs were self-reported by 252 (64.3%) adolescents. The SAPs group and non-SAPs group showed a significant difference in age, PHQ9 total scores, GAD7 total scores, schools, siblings, residence, parental marital quality, general health, regular exercise, and regular diet. A post hoc comparison between the two groups showed that the frequency of SAPs was significantly higher in the moderately-severe and severe depressive groups compared with other three groups (none, mild, moderate). The frequency of SAPs in severe anxious groups was significantly different from the none-anxious group. According to the binary logistic regression analysis, the depressive severity, siblings, residence, marital quality of parents, general health, and regular diet were correlated with the SAPs among adolescents. The adjusted OR of SAPs according to moderately-severe depressive symptoms was 10.84 (95%CI: 1.967-59.742) and severe depressive symptoms was 6.659 (95%CI: 1.147-38.666). In the decision tree model, PHQ-9 severity was extracted as the first splitting variable, with regular exercise and residence as the second, and siblings as the third. The ROC curves for predicting SAPs showed a fair diagnostic accuracy of the model with AUCs of CHAID model (0.705,95%CI:0.652-0.759, P = 0.000) and logistic regression model (0.777,95%CI:0.729-0.824, P = 0.000). CONCLUSION Our study provides insights into the associations between depressive symptoms and poor school attendance and identifies a number of risk factors associated with SAPs. Effective intervention by mental health practitioners, more attention by policy makers, and further research in this area are urgently needed for adolescents.
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Affiliation(s)
- Guoqing Zhao
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Bin Wang
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Hui Li
- Department of Psychology, Qilu Hospital Of Shandong University Dezhou Hospital, Dezhou, 253014, Shandong, China
| | - Honghong Ren
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Zhian Jiao
- Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Department of Psychology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Weiqi Road, Huaiyin District, Jinan, 250021, Shandong, China.
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