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Sundar TKB, Sargenius H, Kvarme LG, Sparboe-Nilsen B. Norwegian pre-service teacher students' and public health nursing students' views on health - a qualitative study of students' perceptions. Int J Qual Stud Health Well-being 2024; 19:2322705. [PMID: 38431882 PMCID: PMC10911246 DOI: 10.1080/17482631.2024.2322705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE In 2020, the Norwegian school curriculum was revised, introducing a new cross-curricular subject, Public Health, and Life Skills. The curriculum emphasizes collaboration between teachers and the school health service. Subsequently, a research project, Literacies for Health and Life Skills, was initiated at Oslo Metropolitan University. The aim was to develop a new approach to the subject. A part of the research was to explore perceptions about good and poor health among teacher students and public health nursing students. METHODS This study has a qualitative design using auto-photography, group discussions and photo-elicitation interviews as methods to explore the students' views on health. RESULTS A analysis revealed three themes about good health in both student groups: Relaxation and tranquillity, belonging and relations, and enjoyment as important to health. Three themes about poor health emerged in both student groups: The ideal body and self-perception, you are as healthy as you feel, and the best in life is also the worst. The students' statements were characterized by underlying assumptions about health in society, with a focus on "healthism". No major differences between the student groups were found. CONCLUSION This study serves as a step towards increased understanding of health perceptions among future professionals working with children and adolescents.
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Affiliation(s)
- Turid Kristin Bigum Sundar
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hanna Sargenius
- Department of Psychology, section of cognition and neurosciences, University of Oslo, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bente Sparboe-Nilsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Vonk L, Eekhout I, Huijts T, Levels M, Jansen M. Does School Health Promotion Have Additional Value for Educational Performance? A Repeated Cross-Sectional Multilevel Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:767. [PMID: 38929013 PMCID: PMC11203565 DOI: 10.3390/ijerph21060767] [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: 05/01/2024] [Revised: 06/03/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
Little information is available regarding the influence of the interplay between the school context and school health promotion on educational performance. Therefore, we examined whether the variation between primary and secondary schools regarding the educational performance of students could be explained by general school characteristics, school population characteristics, and school health promotion and to what extent these factors interact. We performed multilevel analyses using existing data on 7021 primary schools and 1315 secondary schools in the Netherlands from the school years 2010-2011 till 2018-2019. Our outcomes were the final test score from primary education and the average grade of standardized final exams from secondary education. School health promotion was operationalized as having obtained Healthy School (HS) certification. For the test score, 7.17% of the total variation was accounted for by differences at the school level and 4.02% for the average grade. For both outcomes, the percentage of disadvantaged students in a school explained most variation. HS certification did not explain variation, but moderated some associations. We found small to moderate differences between schools regarding educational performance. Compositional differences of school populations, especially socioeconomic status, seemed more important in explaining variation in educational performance than general school characteristics and HS certification. Some associations were moderated by HS certification, but differences remained small in most cases.
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Affiliation(s)
- Lisanne Vonk
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Academic Collaborative Center for Public Health Limburg, Public Health Service South Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
| | - Iris Eekhout
- Expertise Center Child Health, Netherlands Organisation for Applied Scientific Research (TNO), P.O. Box 3005, 2301 DA Leiden, The Netherlands;
| | - Tim Huijts
- Research Centre for Education and the Labour Market (ROA), School of Business and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (T.H.); (M.L.)
| | - Mark Levels
- Research Centre for Education and the Labour Market (ROA), School of Business and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (T.H.); (M.L.)
| | - Maria Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Academic Collaborative Center for Public Health Limburg, Public Health Service South Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
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Ampofo AG, Mackenzie LJ, Osei Asibey S, Oldmeadow C, Boyes AW. Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana. HEALTH EDUCATION & BEHAVIOR 2024; 51:185-196. [PMID: 38105234 PMCID: PMC10981191 DOI: 10.1177/10901981231217978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. METHODS A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. RESULTS Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. CONCLUSIONS Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Shadrack Osei Asibey
- Faculty of Applied Sciences and Technology, Kumasi Technical University, Kumasi, Ghana
| | | | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Skarbek A, Endsley P, Chrisman MS, Hastert M, Stellwagen C. Exploring Wellness Through Concept Analysis. J Sch Nurs 2024; 40:86-96. [PMID: 37070135 DOI: 10.1177/10598405231165510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Modern wellness is a concept that has been discussed in the literature since the 1960's. To better understand wellness complexities in a school setting, a concept analysis was conducted using a modified version of Walker and Avant's method incorporating the nursing paradigm in the implications. A literature review was conducted and except for background information, the publication dates were limited to 2017-2022. Key search terms included "wellness," "school wellness," "wellness concept." Additional literature reviews were conducted based on data related to the definitions, attributes, antecedents, and consequences of wellness that were collected from the reviewed studies. Defining attributes of wellness included healthy habits, conscientiousness, and optimum state of health. The antecedents, consequences, and empirical referents of wellness were identified with examples from the literature and case exemplars. Wellness is a dynamic process that has unique implications for school health and school nurses. This concept analysis lays the foundation for future research incorporating nursing domains.
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Affiliation(s)
- A Skarbek
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA
| | - P Endsley
- School Nurse, Wells High School, Wells, ME, USA
| | - M S Chrisman
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA
| | - M Hastert
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - C Stellwagen
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA
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Vennegoor G, van Assema P, Molleman GRM, van Empelen P, Dieleman J, Jansen MWJ. Fidelity, adaptation and integration of whole-school health promotion within Dutch schools: a cross-sectional survey study. Health Promot Int 2023; 38:daad173. [PMID: 38124497 PMCID: PMC10733658 DOI: 10.1093/heapro/daad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Implementing comprehensive health promotion programs in the school setting can be challenging, as schools can be considered complex adaptive systems. As a first step towards understanding what works in improving implementation for which schools and under which conditions, this study aimed to examine the degree of implementation of health promoting school (HPS) programs, in terms of five dimensions of fidelity (adherence, dose, participant responsiveness, quality of delivery and program differentiation), and the dimensions of adaptation and integration. The HPS Implementation Questionnaire was distributed among ± 2400 primary, secondary, secondary vocational and special needs schools in the Netherlands. Employees of 535 schools (22.3%) filled out the questionnaire. Data were analysed by descriptive statistics and ANOVA tests. The average degree of implementation was 2.55 (SD = 0.58, range = 0.68-3.90; scaled 0-4). The lowest scores were achieved for participant responsiveness and adherence, and the highest for integration and adaptation. Schools that identified as HPS reported significantly higher overall degree of implementation, adherence, dose, participant responsiveness, program differentiation and adaptation than schools that didn't. Primary schools achieved a significantly higher degree of implementation, dose, participant responsiveness, quality of delivery and integration than other school types. In conclusion, many schools work on student health and well-being to some extent, but the vast majority have much room for improvement. Higher implementation scores for schools that identified as HPS underline the value of HPS programs. A broader perspective on health and more insight into conditions for effectiveness and implementation in secondary and secondary vocational schools are needed.
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Affiliation(s)
- Gerjanne Vennegoor
- Academic Collaborative Center for Public Health Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
- Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Patricia van Assema
- Academic Collaborative Center for Public Health Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
- Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Gerard R M Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Healthy Living, Public Health Service Gelderland-Zuid, P.O. Box 1120, 6501 BC Nijmegen, The Netherlands
| | - Pepijn van Empelen
- Expertise Center Child Health, Netherlands Organization for Applied Scientific Research (TNO), P.O. Box 3005, 2301 DA Leiden, The Netherlands
| | - Joyce Dieleman
- Public Health Service Noord- en Oost Gelderland, Academic Collaborative Center AGORA, P.O. Box 3, 7200 AA Zutphen, The Netherlands
| | - Maria W J Jansen
- Academic Collaborative Center for Public Health Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Castetbon K, Assakali W, Thiébaut I, Desbouys L. Decreasing consumption of sugar-sweetened beverages and Raising tap water consumption through Interventions based on Nutrition and sustainability for Kids: study protocol of the "DRINK" cluster randomised controlled trial. Trials 2023; 24:611. [PMID: 37752525 PMCID: PMC10521418 DOI: 10.1186/s13063-023-07643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Effectiveness of actions to reduce sugar-sweetened beverage (SB) consumption in children still needs to be improved. Furthermore, the growing concern about sustainable food systems encourages to develop sustainability-based interventions. The objective of this cluster randomised controlled trial is to evaluate the long-term effectiveness of nutrition- and environmental sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 3rd to 6th grade primary school children (8 to 11 years of age). METHODS Forty-eight French-speaking Belgian primary schools (equivalent to around 3500 pupils involved in the evaluation) are randomised using a factorial plan: (i) control, (ii) nutrition-based intervention, (iii) sustainability-based intervention, and (iv) both. The interventions (encouragement of water breaks; provision of posters, leaflets, reusable cups, and glass bottles; website; meetings at school) were undertaken from February 2022 to June 2023. Evaluation includes questionnaires for the children and their parents on various determinants of dietary behaviour, a 4-day diary to collect information on the child's beverage consumption, and audits at schools. The first evaluation was conducted in Spring 2021 before any intervention, with the two post-intervention evaluations being held in 2022 and 2023. The main quantitative judgement criterion will be the change over time in the mean SB consumption (in ml/day) in the intervention groups compared with the control group. Given the context of the research (school), the safety of the intervention, and the content of data collection, a consent was acknowledged as unnecessary by the Ethical Committee of the Faculty of Psychology (ULB; n°073/2021), but children and parents are explicitly informed of their right to refuse to fill in the questionnaires. DISCUSSION Multicomponent interventions based on nutrition and on environmental sustainability, alone or mixed, will provide an original and topical insight into health promotion at school around dietary behaviours. The dissemination plan will enable to widely inform stakeholders, school staff, and families, in addition to the scientific community through the usual medium (articles, conferences), about the research findings in 2024-2025. TRIAL REGISTRATION ISRCTN Registry ISRCTN99843102. Retrospectively registered on 25 May 2021.
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Affiliation(s)
- Katia Castetbon
- Research Center in "Epidemiology, Biostatistics and Clinical Research", School of Public Health, Université libre de Bruxelles (ULB), CP598, Route de Lennik 808, Brussels, 1070, Belgium.
| | - Wassila Assakali
- Research Center in "Epidemiology, Biostatistics and Clinical Research", School of Public Health, Université libre de Bruxelles (ULB), CP598, Route de Lennik 808, Brussels, 1070, Belgium
| | - Isabelle Thiébaut
- Club Européen des Diététiciens de L'Enfance (CEDE), Esplanade 17, Ath, 7800, Belgium
| | - Lucille Desbouys
- Research Center in "Epidemiology, Biostatistics and Clinical Research", School of Public Health, Université libre de Bruxelles (ULB), CP598, Route de Lennik 808, Brussels, 1070, Belgium
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Koch PA, Greaves-Peters N, Cadenhead JW. Nourishing Knowledge: Food Education Joins the Core Subjects in Schools. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:621-622. [PMID: 37684081 DOI: 10.1016/j.jneb.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Affiliation(s)
- Pamela A Koch
- Department of Health and Behavior Studies, Teachers College Columbia University
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Moore SE, Brennan SF, Lavelle F, Dean M, McKinley MC, Olgacher D, McCole P, Hunter RF, Dunne L, O’Connell NE, Elliott CT, McCarthy D, Woodside JV. Capturing the whole-school food environment in primary schools. Public Health Nutr 2023; 26:1671-1678. [PMID: 37272413 PMCID: PMC10410367 DOI: 10.1017/s1368980023001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations. DESIGN SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion. SETTING Primary schools. PARTICIPANTS An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16). RESULTS The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %). CONCLUSIONS The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.
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Affiliation(s)
- Sarah E Moore
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Sarah F Brennan
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Lavelle
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Moira Dean
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Michelle C McKinley
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Dilara Olgacher
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Patrick McCole
- Queen’s Management School, Queen’s University Belfast, BelfastBT9 5EE, United Kingdom of Great Britain and Northern Ireland
| | - Ruth F Hunter
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Niamh E O’Connell
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Chris T Elliott
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Danielle McCarthy
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Jayne V Woodside
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Shinde S, Raniti M, Sharma A, Sawyer SM. What happens when a whole-school health promotion research trial ends? a case study of the SEHER program in India. Front Psychiatry 2023; 14:1112710. [PMID: 37426112 PMCID: PMC10326627 DOI: 10.3389/fpsyt.2023.1112710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Health promotion interventions that are developed and evaluated by researchers and other external providers are at risk of not being sustained beyond the initial implementation period. When delivered by a lay school health worker, the SEHER study of a whole-school health promotion intervention in Bihar, India was found to be feasible, acceptable and effective in improving school climate and student health behaviors. The objective of this case study is to describe the decision-making processes, barriers, and enablers to continuing the SEHER intervention following its official closure. Methods For this exploratory qualitative case study, data were collected from four government-run secondary schools, two of which continued SEHER and two of which discontinued it after official closure. Thirteen school staff were interviewed, and 100 girls and boys (aged 15-18 years old) participated in eight focus groups discussing their experiences of the process of continuing the intervention (or discontinuing) following its official closure. Thematic analysis was conducted in NVivo 12 using grounded theory. Results No school sustained the intervention as originally delivered in the research trial. In two schools, the intervention was adapted by selecting sustainable components, whereas in two others it was discontinued altogether. We identified four interrelated themes that explained the complex decision-making process, barriers, and enablers related to program continuation: (1) understanding of the intervention philosophy among school staff; (2) school capabilities to continue with intervention activities; (3) school attitudes and motivation about implementing the intervention, and; (4) the education policy environment and governance structures. Suggestions for overcoming barriers included adequate resource allocation; training, supervision, and support from external providers and the Ministry of Education; and formal government approval to continue the intervention. Conclusion Sustaining this whole-school health promotion intervention in low-resource school settings in India depended on individual, school and government factors as well as external support. These findings suggest that health interventions will not necessarily become embedded in a school's operations merely because they are designed as a whole-school approach or because they are effective. Research should identify the resources and processes required to balance planning for future sustainability while awaiting trial results about an intervention's effectiveness.
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Affiliation(s)
- Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Center for Inquiry Into Mental Health, Pune, India
| | - Monika Raniti
- Centre for Adolescent Health, Murdoch Children’s Research Institute and Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | | | - Susan M. Sawyer
- Centre for Adolescent Health, Murdoch Children’s Research Institute and Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
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Beames JR, Werner-Seidler A, Hodgins M, Brown L, Fujimoto H, Bartholomew A, Maston K, Huckvale K, Zbukvic I, Torok M, Christensen H, Batterham PJ, Calear AL, Lingam R, Boydell KM. Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study. JMIR Pediatr Parent 2023; 6:e42349. [PMID: 37307051 DOI: 10.2196/42349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. OBJECTIVE The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). METHODS Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. RESULTS Staff perceived the FPP as a novel ("innovative approach") and appropriate way to address an unmet need within schools ("right place at the right time"). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution ("ways of working within schools"). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools ("reflecting on past experiences"). CONCLUSIONS Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-042133.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Michael Hodgins
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Lyndsay Brown
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hiroko Fujimoto
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kit Huckvale
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Isabel Zbukvic
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Vennegoor G, Van Assema P, Eekhout I, Lezwijn J, Molleman G, Jansen M. Measuring Implementation of Health Promoting School (HPS) Programs: Development and Psychometric Evaluation of the HPS Implementation Questionnaire. THE JOURNAL OF SCHOOL HEALTH 2023; 93:450-463. [PMID: 36577707 DOI: 10.1111/josh.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Implementation of Health Promoting School (HPS) programs can be challenging due to the dynamic school context. Navigating between program fidelity and adaptation, as well as integrating the program, is essential for successful implementation, and consequently, for program effects. As part of an evaluation study in the Netherlands, this study aimed to develop a measurement instrument that differentiates schools according to fidelity, adaptation, and integration of HPS implementation. METHODS This study presents the development and psychometric evaluation of the 28-item HPS Implementation Questionnaire, covering 7 dimensions: adherence, dose, participant responsiveness, quality of delivery, program differentiation, adaptation, and integration. The questionnaire, to be filled out by school employees, was developed for primary, secondary, secondary vocational, and special needs education, in close collaboration with experts (n = 54) in school health promotion. RESULTS Semi-structured interviews aimed at dimension clarification resulted in a list of 58 items. Items were revised, combined, and/or removed based on quantitative and qualitative feedback by the evaluation study's Community of Practice, 2-round expert consultation, and pre-tests. Psychometric evaluation (n = 535 schools), consisting of calculating Cronbach's α and confirmatory factor analysis (CFA), confirmed internal consistency (α > .72) and the 7-dimension framework. CONCLUSION The brief yet comprehensive HPS Implementation Questionnaire offers possibilities for research into HPS implementation in various educational sectors and contexts, as well as self-monitoring by individual schools. This study provides first evidence for internal consistency and validity of the questionnaire.
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Affiliation(s)
- Gerjanne Vennegoor
- Health Promotion, Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Center for Public Health Limburg, Heerlen, The Netherlands
| | - Patricia Van Assema
- Health Promotion, Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Center for Public Health Limburg, Heerlen, The Netherlands
| | - Iris Eekhout
- Expertise Center Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Jeanette Lezwijn
- Public Health Service Noord-en Oost Gelderland, Academic Collaborative Center AGORA, Zutphen, The Netherlands
| | - Gerard Molleman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Academic Collaborative Center AMPHI, Nijmegen, The Netherlands
- Department of Healthy Living, Public Public Health Service Gelderland-Zuid, Nijmegen, The Netherlands
| | - Maria Jansen
- Academic Collaborative Center for Public Health Limburg, Heerlen, The Netherlands
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Public Health Service Zuid Limburg, Heerlen, The Netherlands
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12
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Roux F, Chih H, Hendriks J, Burns S. Mixed Method Evaluation of My Vital Cycles ®: A Holistic School-Based Ovulatory Menstrual Health Literacy Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5964. [PMID: 37297568 PMCID: PMC10252248 DOI: 10.3390/ijerph20115964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program's impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.
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Affiliation(s)
- Felicity Roux
- Curtin Medical School, Curtin University, Bentley, WA 6102, Australia
| | - HuiJun Chih
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | | | - Sharyn Burns
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
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13
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Widnall E, Albers PN, Hatch L, Hopkins G, Kidger J, Vocht FD, Kaner E, Sluijs EMV, Fairbrother H, Jago R, Campbell R. Using systems thinking to understand how the South West - School Health Research Network can improve adolescent health and well-being: A qualitative process evaluation. Health Place 2023; 82:103034. [PMID: 37120949 PMCID: PMC7614868 DOI: 10.1016/j.healthplace.2023.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
Schools offer a valuable setting to promote good health and mental well-being amongst young people. Schools are complex systems and therefore systems interventions are needed to improve pupil health and well-being. This paper presents a qualitative process evaluation of the South West- School Health Research Network, a systems level intervention. The evaluation is based on interviews with school staff, local authorities and wider stakeholders. Given the complexity of England's educational system there is a need to intervene and monitor health at multiple levels and to ensure close partnership working to effectively improve adolescent health through schools.
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Affiliation(s)
- Emily Widnall
- Population Health Sciences, University of Bristol, UK.
| | | | - Lorna Hatch
- Population Health Sciences, University of Bristol, UK
| | | | - Judi Kidger
- Population Health Sciences, University of Bristol, UK
| | | | - Eileen Kaner
- Faculty of Medical Sciences, Newcastle University, UK
| | | | | | - Russell Jago
- Population Health Sciences, University of Bristol, UK; Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, UK
| | - Rona Campbell
- Population Health Sciences, University of Bristol, UK
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14
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Bryant M, Burton W, O'Kane N, Woodside JV, Ahern S, Garnett P, Spence S, Sharif A, Rutter H, Baker T, Evans CEL. Understanding school food systems to support the development and implementation of food based policies and interventions. Int J Behav Nutr Phys Act 2023; 20:29. [PMID: 36907879 PMCID: PMC10009978 DOI: 10.1186/s12966-023-01432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice. METHODS Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. RESULTS The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. CONCLUSIONS Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO150DD, UK
- Hull York Medical School, University of York, York, YO150DD, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO150DD, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Sara Ahern
- Bradford Institute of Health Research, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Phillip Garnett
- School for Business and Society, University of York, York, YO10 5DD, UK
| | - Suzanne Spence
- Human Nutrition Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amir Sharif
- Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, BD7, 1DP, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK
| | - Tim Baker
- Charlton Manor Primary School, Indus Road, Charlton, London, SE7 7EF, UK
| | - Charlotte E L Evans
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
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15
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Varì R, Silenzi A, d’Amore A, Catena A, Masella R, Scazzocchio B. MaestraNatura Reveals Its Effectiveness in Acquiring Nutritional Knowledge and Skills: Bridging the Gap between Girls and Boys from Primary School. Nutrients 2023; 15:nu15061357. [PMID: 36986085 PMCID: PMC10055962 DOI: 10.3390/nu15061357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
MaestraNatura (MN) is a nutrition education program developed to both enhance awareness about the importance of healthy eating behaviour and skills on food and nutrition in primary school students. The level of knowledge about food and nutritional issues was assessed by a questionnaire administered to 256 students (9–10 years old) attending the last class of primary school and was compared with that of a control group of 98 students frequenting the same schools that received traditional nutrition education based on curricular science lessons and one frontal lesson conducted by an expert nutritionist. The results indicated that students in the MN program showed a higher percentage of correct responses to the questionnaire when compared with the control group (76 ± 15.4 vs. 59 ± 17.7; p < 0.001). Furthermore, the students attending the MN program were requested to organise a weekly menu before (T0) and when finished (T1) the MN program. The results evidenced an overall significant improvement in the score obtained at T1 with respect to those at T0 (p < 0.001), indicating a strong improvement in the ability to translate the theoretical concepts of nutrition guidelines in practice. In addition, the analysis revealed a gender gap between boys and girls, with boys showing a worse score at T0 that was ameliorated after the completion of the program (p < 0.001). Overall, MN program is effective in improving nutrition knowledge amongst 9–10-year-old students. Furthermore, students showed an increased ability to organise a weekly dietary plan after completing the MN program, a result which also bridged gender gaps. Thus, preventive nutrition education strategies specifically addressed to boys and girls, and involving both the school and family, are needed to make children aware of the importance of a healthy lifestyle and to correct inadequate eating habits.
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Affiliation(s)
- Rosaria Varì
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Annalisa Silenzi
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Antonio d’Amore
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alice Catena
- Postgraduate School of Hygiene and Preventive Medicine, University of Brescia, 25123 Brescia, Italy
| | - Roberta Masella
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
- Correspondence:
| | - Beatrice Scazzocchio
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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16
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Clarke T, Platt R. Children's Lived Experiences of Wellbeing at School in England: a Phenomenological Inquiry. CHILD INDICATORS RESEARCH 2023; 16:963-996. [PMID: 37274807 PMCID: PMC9981449 DOI: 10.1007/s12187-023-10016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/07/2023]
Abstract
This phenomenological inquiry investigated children's wellbeing experiences at school, including their hedonic (feeling good) and eudaimonic (doing good) accounts, a distinction often overlooked. Further, while phenomenological inquiries of children's mental ill-health exist, wellbeing, a fundamental part of mental health, is neglected. This is at odds with positive psychology which favours strengths-based approaches to studying human development. Phenomenology provides rich detail, facilitating deeper understanding of why and how certain factors affect wellbeing, as described by children themselves. A sample of 15 children (aged 9-11), attending one English primary school broadly representative of the national socio-demographic, engaged in interviews. Children's experiences of 'feeling good' at school were characterised by: an interdependence on peers' emotional states (described as 'a domino effect'), a need to feel cared for by, and trust, adults, and desire for autonomy over their time. Children attributed mistrust in adults to adults disregarding seemingly incidental events which felt significant to children. Children experienced 'doing well' as equating to academic attainment, conveying a fixation with test scores, using language of 'correctness' and efficiency. Shame pervaded when 'correctness' was not achieved, with children describing being ridiculed for poor test scores. Recommendations for schools to support children's hedonia include prioritising wellbeing curricula and emotional literacy, greater staff reflexivity, and prioritisation of pupil voice. To foster children's eudaimonia, recommendations include the need for teachers to provide formative, personalised feedback for pupils focused on the learning process, and the need for Government to embrace a range of ways pupils can feel successful beyond academic attainment. Supplementary Information The online version contains supplementary material available at 10.1007/s12187-023-10016-2.
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Affiliation(s)
- Tania Clarke
- Faculty of Education, University of Cambridge, 184 Hills Rd, Cambridge, CB2 8PQ UK
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17
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Improving adolescents' dietary behaviours in the school-setting: challenges and opportunities. Proc Nutr Soc 2023:1-14. [PMID: 36916515 DOI: 10.1017/s0029665123002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Adolescence is a critical time of physical, psychological and social development, and thus, optimal nutritional intakes are required during this life stage. Despite this, adolescence is recognised as a period of nutritional vulnerability, with many reportedly failing to meet current dietary guidelines. The school-setting presents a favourable environment to intervene and promote positive dietary behaviours and is also inclusive regardless of socio-economic status. However, a lack of consensus exists on how best to utilise schools to facilitate improvements in dietary behaviours among this age group. Whilst previous research has focused on identifying the factors motivating dietary choices within the school-setting, less is known on the optimum strategies to enhance these dietary choices which could positively contribute to the design of future interventions. It is reported that adolescents have good nutritional knowledge, although this does not appear to be a central consideration when making their dietary choices. Alternative factors at the individual (taste, visual appeal, familiarity, food quality, price, portion size, value for money, time/ convenience), social (peer influence), physical (product placement) and macro environment (food availability) levels have been frequently cited as important influences on adolescents' dietary choices in school. Although school-based interventions have shown potential in achieving positive dietary change among adolescents, more research is needed to determine the most effective methods in improving dietary behaviours in schools. This review summarises the key factors which influence adolescents' school-based dietary choices and the effectiveness of previously conducted interventions, identifying promising components for consideration when developing future dietary interventions within the school-setting.
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18
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Laurenzi CA, Mamutse S, Marlow M, Mawoyo T, Stansert Katzen L, Carvajal-Velez L, Lai J, Luitel N, Servili C, Sinha M, Skeen S. Critical life course interventions for children and adolescents to promote mental health. Glob Ment Health (Camb) 2022; 10:e4. [PMID: 36843881 PMCID: PMC9947636 DOI: 10.1017/gmh.2022.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/08/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
Childhood and adolescence are key developmental periods in the life course for addressing mental health, and there is ample evidence to support significant, increased investment in mental health promotion for this group. However, there are gaps in evidence to inform how best to implement mental health promotion interventions at scale. In this review, we examined psychosocial interventions implemented with children (aged 5–10 years) and adolescents (aged 10–19 years), drawing on evidence from WHO guidelines. Most psychosocial interventions promoting mental health have been implemented in school settings, with some in family and community settings, by a range of delivery personnel. Mental health promotion interventions for younger ages have prioritised key social and emotional skills development, including self-regulation and coping; for older ages, additional skills include problem-solving and interpersonal skills. Overall, fewer interventions have been implemented in low- and middle-income countries. We identify cross-cutting areas affecting child and adolescent mental health promotion: understanding the problem scope; understanding which components work; understanding how and for whom interventions work in practice; and ensuring supportive infrastructure and political will. Additional evidence, including from participatory approaches, is required to tailor mental health promotive interventions to diverse groups’ needs and support healthy life course trajectories for children and adolescents everywhere.
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Affiliation(s)
- Christina A. Laurenzi
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Sihle Mamutse
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Marguerite Marlow
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Tatenda Mawoyo
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Linnea Stansert Katzen
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, NY, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Lai
- Programme Group, Health Section, UNICEF, New York, NY, USA
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
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19
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Hale FB, Mattheus D, Fletcher B, Michel A, Fontenot HB. Effects of the COVID 19 Pandemic on School Nurses' Resiliency and Ability to Cope: A Mixed Methods Study in the State of Hawaii. J Sch Nurs 2022; 39:133-142. [PMID: 36128780 PMCID: PMC9494163 DOI: 10.1177/10598405221124423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This mixed-method study examined school nurses' experiences during the Coronavirus Disease 2019 pandemic related to role change, psychological feelings, and coping/resiliency in the State of Hawaii. A total of 30 school nurses completed a Brief Resilience Coping Scale plus a series of open-ended questions in January 2022. On the coping scale, over 40% of participants scored high, 52% scored medium, and 7% scored a low resilient/coping level. We did not identify any association between coping level and participant characteristics. Three qualitative themes emerged: 1) school nurses experience chronic negative emotions related to the pandemic, 2) school nurses demonstrate attributes of resilience, and 3) school nurses utilize positive coping techniques. The pandemic created significant stresses and negative emotions among school nurses. Yet, school nurses reported effective coping strategies and demonstrated strength/resilience. Support and open communication between school nurses, their employers, and other school-based stakeholders is needed to provide continued support for school nurses.
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Affiliation(s)
- Frankie B. Hale
- University of Hawaii at
Manoa, Nancy Atmospera-Walch School of Nursing, Honolulu, HI,
USA,Frankie B. Hale, PhD, RN, University of
Hawaii at Manoa, Nancy Amosphera-Walch School of Nursing; 2528 McCarthy Mall,
Webster Hall 215, Honolulu, HI 96822, USA.
| | - Deborah Mattheus
- University of Hawaii at
Manoa, Nancy Atmospera-Walch School of Nursing, Honolulu, HI,
USA,University of Hawaii at
Manoa, Hawaii Keiki Program, Honolulu, HI, USA
| | - Betty Fletcher
- University of Hawaii at
Manoa, Hawaii Keiki Program, Honolulu, HI, USA
| | - Alexandra Michel
- University of Hawaii at
Manoa, Nancy Atmospera-Walch School of Nursing, Honolulu, HI,
USA
| | - Holly B. Fontenot
- University of Hawaii at
Manoa, Nancy Atmospera-Walch School of Nursing, Honolulu, HI,
USA
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20
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Clarke T, Hoskin S. Teaching children and adolescents about mental wellbeing: an exploratory multi-site case study in England. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2022. [DOI: 10.1080/02667363.2022.2100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tania Clarke
- Faculty of Education, University of Cambridge, Cambridge, UK
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21
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Roux F, Burns S, Chih H, Hendriks J. The Use of a Two-Phase Online Delphi Panel Methodology to Inform the Concurrent Development of a School-Based Ovulatory Menstrual Health Literacy Intervention and Questionnaire. Front Glob Womens Health 2022; 3:826805. [PMID: 35677755 PMCID: PMC9168325 DOI: 10.3389/fgwh.2022.826805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction There are a high prevalence of ovulatory-menstrual (OM) dysfunction and low levels of menstrual health literacy in adolescents, yet few evidence-based OM health education resources for schools. Method This two-phase study used an online Delphi methodology to build consensus across thirty-five purposively selected professionals from the diverse professions of health and education. The panellists were tasked to inform the development of a school-based OM health literacy resources. Results In Round One, 86% of panellists determined the scope of these resources using guided and open-ended questions. The study then split into two phases which ran concurrently. In the first phase informing the intervention's development, 57% of panellists participated in Round Two, and 29% reviewed selected lessons. In the second phase informing the questionnaire's development, 51% of panellists participated in Round Two, and 69% in Round Three. The overall consensus reached for the intervention phase and questionnaire phase were 82% and 84%, respectively. The Panel's recommendations included a strengths-based position to counter menstrual stigma, teaching accurate self-report of cycle biomarkers, addressing multiple menstrual dysfunctions and adopting a whole-school approach. Conclusion Although time-consuming and requiring a sustained interest, this two-phase Delphi methodology offered anonymity to panellists from distinct professions which facilitated their independent contribution to developing OM health literacy school resources.
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22
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Klassen D, Champion C, Montemurro G, Flynn J, Raine K, Storey K. It takes a community: exploring APPLE Schools' impact within and beyond school walls in Canada. Health Promot Int 2022:6576067. [PMID: 35486099 DOI: 10.1093/heapro/daac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood is a critical stage to develop healthy behaviours, and the school years are an important developmental period in which children are learning and growing. School-based health promotion interventions are increasingly using the comprehensive school health (CSH) approach that has been found effective at improving health behaviours, while adapting to the school and community context to create and sustain a healthy school culture. The interconnected environments of school, home and community are key to the CSH approach, however, there is minimal research that has been conducted to determine the impact at the community-level. This research used a qualitative multiple case study design to explore the influence of a school-based health promotion intervention, APPLE Schools, on the school and community environments from the perspectives of school staff in Alberta, Canada. Twenty-two participants participated in walking interviews in five schools. The walking interview approach combined interviewing and field observation and empowered participants to share their local expertise and knowledge within the context of school and community environments. Interviews were transcribed and analysed using an inductive thematic approach. Four themes were identified: APPLE schools look different, APPLE Schools build champions, APPLE Schools builds community partnerships and APPLE Schools honours community culture. Health promotion practice in schools was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. In sum, it was found that school-based health promotion reaches beyond school walls and can influence the broader community environment.
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Affiliation(s)
- Danielle Klassen
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Claudine Champion
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Genevieve Montemurro
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Jenn Flynn
- APPLE Schools Foundation, 3-50 University Terrace, 8303-112 Street, Edmonton, AB T6G 2T4, Canada
| | - Kim Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
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23
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Evans R, Bell S, Brockman R, Campbell R, Copeland L, Fisher H, Ford T, Harding S, Powell J, Turner N, Kidger J. Wellbeing in Secondary Education (WISE) Study to Improve the Mental Health and Wellbeing of Teachers: A Complex System Approach to Understanding Intervention Acceptability. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:922-933. [PMID: 35305231 PMCID: PMC9343291 DOI: 10.1007/s11121-022-01351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
Teaching staff report poorer mental health and wellbeing than the general working population. Intervention to address this issue is imperative, as poor wellbeing is associated with burnout, presenteeism, and adverse student mental health outcomes. The Wellbeing in Secondary Education (WISE) intervention is a secondary school-based programme aimed at improving the mental health and wellbeing of teachers and students. There are three components: awareness-raising for staff; a peer support service delivered by staff trained in Mental Health First Aid (MHFA); and Schools and Colleges Mental Health First Aid (MHFA) training for teachers. A cluster randomised controlled trial with integrated process and economic evaluation was conducted with 25 secondary schools in the UK (2016-2018). The intervention was largely ineffective in improving teacher mental health and wellbeing. This paper reports process evaluation data on acceptability to help understand this outcome. It adopts a complex systems perspective, exploring how acceptability is a dynamic and contextually contingent concept. Data sources were as follows: interviews with funders (n = 3); interviews with MHFA trainers (n = 6); focus groups with peer supporters (n = 8); interviews with headteachers (n = 12); and focus groups with teachers trained in Schools and Colleges MHFA (n = 7). Results indicated that WISE intervention components were largely acceptable. Initially, the school system was responsive, as it had reached a 'tipping point' and was prepared to address teacher mental health. However, as the intervention interacted with the complexities of the school context, acceptability became more ambiguous. The intervention was seen to be largely inadequate in addressing the structural determinants of teacher mental health and wellbeing (e.g. complex student and staff needs, workload, and system culture). Future teacher mental health interventions need to focus on coupling skills training and support with whole school elements that tackle the systemic drivers of the problem.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales.
| | - Sarah Bell
- Bristol Medical School, University of Bristol, Bristol, England
| | - Rowan Brockman
- Bristol Medical School, University of Bristol, Bristol, England
| | - Rona Campbell
- Department of Population Health Sciences, University of Bristol, Bristol, England
| | - Lauren Copeland
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - Harriet Fisher
- Bristol Medical School, University of Bristol, Bristol, England
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Sarah Harding
- School for Policy Studies, University of Bristol, Bristol, England
| | - Jillian Powell
- School for Policy Studies, University of Bristol, Bristol, England
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, England
| | - Judi Kidger
- Bristol Medical School, University of Bristol, Bristol, England
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Sadjadi M, Blanchard L, Brülle R, Bonell C. Barriers and facilitators to the implementation of Health-Promoting School programmes targeting bullying and violence: a systematic review. HEALTH EDUCATION RESEARCH 2022; 36:581-599. [PMID: 34312670 DOI: 10.1093/her/cyab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/20/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Health-Promoting School (HPS) interventions aim to reduce bullying and violence via curriculum, environmental and family/community-engagement components. Despite evidence of their effectiveness, factors influencing the implementation of such interventions are poorly understood. This systematic review aims to examine such factors by assessing qualitative process evaluations of HPS interventions aiming to reduce bullying, aggression or violence. A comprehensive systematic search of 12 databases was carried out, and 20 reports from 17 studies were included. Thematic synthesis was used to identify factors affecting implementation. Factors that enable implementation were related to programme characteristics and stakeholder buy-in, including support from leadership, teachers, students and parents. Good communication and staff climate were important. Interventions were better implemented when they framed health promotion as a core school business, were supported by a national policy, used local data to show need and effectiveness and provided high-quality, pragmatic and accessible staff training. The results of this review can serve to guide and facilitate the design and implementation of future bullying and violence prevention programmes. Since there is significant overlap in terms of the important pillars and guiding principles for all interventions guided by the HPS framework, the findings may apply to outcomes beyond bullying and violence.
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25
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Ampofo AG, Boyes AW, Khumalo PG, Mackenzie L. Improving knowledge, attitudes, and uptake of cervical cancer prevention among female students: A systematic review and meta-analysis of school-based health education. Gynecol Oncol 2022; 164:675-690. [PMID: 34998599 DOI: 10.1016/j.ygyno.2021.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Schools are an ideal environment for promoting cervical cancer prevention among young women. This systematic review and meta-analysis aimed to examine: 1) the effectiveness of school-based education for improving i) knowledge and perceptions of cervical cancer, HPV infection and vaccination, and cervical cancer screening; ii) attitudes and intentions toward, and uptake of HPV vaccination and cervical cancer screening among female students; and 2) the methodological quality of studies testing school-based cervical cancer education. METHODS Medline, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and ERIC literature databases were searched from inception to November 2020. English language publications describing RCTs of any form of cervical cancer education delivered to female students in a school setting were eligible for inclusion. Included studies were assessed for methodological quality using the revised Cochrane risk of bias tool for randomized trials and the GRADE approach. Standardized Mean Differences and Odds Ratios were calculated and meta-analytically pooled using random-effects models. Subgroup analysis explored heterogeneity. RESULTS Of the 13 included studies, only one study was judged overall as having a low risk of bias. School-based education improved knowledge about cervical cancer and HPV infection. It also improved knowledge of and intentions toward HPV vaccination. Although education was ineffective in improving cervical cancer and HPV infection risk perceptions, and attitudes about HPV vaccination, a subgroup analysis found printed education materials focused on HPV-related content may have significant positive effects on risk perceptions. School-based education did not significantly increase HPV vaccination uptake; however, a face-to-face active approach seemed beneficial in a subgroup analysis. Heterogeneity (I2) ranged between 0% to 93%, and the quality of evidence was rated from low to moderate. CONCLUSIONS High-quality evidence from methodologically rigorous studies is needed to provide stronger guidance regarding the benefits of school-based education in improving knowledge and behaviours toward cervical cancer prevention.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Phinda G Khumalo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Lowry C, Stegeman I, Rauch F, Jani A. Modifying the school determinants of children's health. J R Soc Med 2021; 115:16-21. [PMID: 34855534 PMCID: PMC8811324 DOI: 10.1177/01410768211051718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chloe Lowry
- UCL Institute of Education, University College London, London WC1H 0AL, UK.,EuroHealthNet, Brussels, Belgium
| | - Ingrid Stegeman
- 27256University of Klagenfurt, Klagenfurt am Woerthersee, Austria
| | - Franz Rauch
- Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
| | - Anant Jani
- Heidelberg Institute of Global Health, University of Heidelberg, 672 69120 Heidelberg, Germany
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Amudhan S, Jangam K, Mani K, Murugappan NP, Sharma E, Mahapatra P, Burma AD, Tiwari HK, Ashok A, Vaggar S, Rao GN. Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents. BMC Public Health 2021; 21:2034. [PMID: 34742284 PMCID: PMC8572074 DOI: 10.1186/s12889-021-12086-9] [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: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health. Methods Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools. Discussion This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India. Trial registration Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).
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Affiliation(s)
- Senthil Amudhan
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India.
| | - Kavita Jangam
- Department of Psychiatric Social Work, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Payel Mahapatra
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Ajit Deo Burma
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Hemant Kumar Tiwari
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Ashi Ashok
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Sangappa Vaggar
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
| | - Girish Nagaraja Rao
- Department of Epidemiology, National Institute of Mental Health And Neuro Sciences, Bangalore, Karnataka, India
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McHugh C, Lloyd J, Logan S, Wyatt K. Implementing a set of health promoting processes in English secondary schools: A comparative case study. PUBLIC HEALTH IN PRACTICE 2021; 2:100214. [PMID: 36101576 PMCID: PMC9461601 DOI: 10.1016/j.puhip.2021.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 10/27/2022] Open
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McHugh C, Lloyd J, Logan S, Wyatt K. Enablers and barriers English secondary schools face in promoting healthy diet and physical activity behaviours. Health Promot Int 2021; 37:6365860. [PMID: 34491343 PMCID: PMC9067442 DOI: 10.1093/heapro/daab148] [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] [Indexed: 11/14/2022] Open
Abstract
This study sought to understand the current challenges mainstream secondary schools in England face in creating a health promoting school culture for diet and physical activity behaviours. An in-depth qualitative case study of two purposely selected state-funded schools, including interviews with teachers, observations of school activities including meal breaks and a qualitative survey with parents was done. Inductive thematic analysis was used to explore emerging themes. Additional interviews with the leadership team from four further schools were used to develop and refine emerging themes. Four main themes emerged from the data: competing pressures, school environment, personnel and policy. Results demonstrate that schools recognize they have role to play in promoting healthy lifestyle behaviours to pupils; however, several significant barriers were identified such as lack of government support and regulation, school structures and organization, focus on core subjects, business-run canteens and lack of family and community engagement. Given the importance of maintaining a healthy weight throughout the life course, schools have an important role to play in creating healthy environments in which students can easily make a healthy choice. Future school promotion initiatives need to consider addressing the barriers that schools face by working with them and the communities in which they are embedded. There has been little research done in secondary schools to understand how to promote healthy lifestyle behaviours to adolescents (secondary schools provide secondary education for students aged 11–18 years). COVID-19 has brought the importance of maintaining a healthy weight back into sharp focus and schools are an ideal setting to educate and support young people in making healthy diet and activity choices. This research sought to understand how important school staff thought creating a health-promoting culture in schools was, how they could create such a culture and what support they had or needed to do so. From interviews with school staff, observing school activities and a questionnaire to parents, we found that schools and parents believe that schools have a role to play in supporting healthy diet and physical activity behaviours although they identified many pressures that prevent making health promotion a priority; these include time and resources as well as a lack of government policy. The importance of having a head teacher with a belief in the benefits of a healthy lifestyle was recognized. The way secondary schools are structured in England makes a joined-up approach difficult and requires central planning and coordination. More support, including resources and policy commitments, are needed to support secondary schools to create a healthy school environment.
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Affiliation(s)
- Camilla McHugh
- Department of Child Health, The University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter EX1 2LU, UK
| | - Jenny Lloyd
- Department of Child Health, The University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter EX1 2LU, UK
| | - Stuart Logan
- Department of Child Health, The University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter EX1 2LU, UK
| | - Katrina Wyatt
- Department of Child Health, The University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter EX1 2LU, UK
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30
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Michaud PA, Vervoort JPM, Visser A, Baltag V, Reijneveld SA, Kocken PL, Jansen D. Organization and activities of school health services among EU countries. Eur J Public Health 2021; 31:502-508. [PMID: 33582798 DOI: 10.1093/eurpub/ckaa200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND School health services (SHS) can be defined as health services provided to enrol pupils by health professionals and/or allied professions. The aim of this study was to explore the current state of the governance, organization and workforce of SHS and their provision of preventive activities in European countries. METHODS Observational study. Data were collected as part of the Horizon 2020-funded project 'Models of Child Health Appraised'. Only 1 expert from each of the 30 included European countries answered a closed-items questionnaire during the years 2017 and 2018. RESULTS All countries (except Spain and the Czech Republic, which do not have formal SHS) provided school-based individual screening and health-enhancing measures. The majority performed height, weight, vision and hearing checks; some integrated other assessments of limited evidence-based effectiveness. Most countries also delivered health education and promotion activities in areas, such as sexual health, substance use and healthy nutrition. Almost all countries seemed to suffer from a shortage of school health professionals; moreover, many of these professionals had no specific training in the area of school health and prevention. CONCLUSIONS Many EU countries need better administrative and legal support. They should promote evidence-based screening procedures and should hire and train more school health professionals. Overall, they need to adapt to the evolving health priorities of pupils, adopt a more holistic paradigm and extend their activities beyond traditional screening or vaccination procedures.
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Affiliation(s)
| | - Johanna P M Vervoort
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Geneva, Switzerland
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,TNO Child Health, Leiden, The Netherlands
| | - Paul L Kocken
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Danielle Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Sociology and Interuniversity for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
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Kostenius C, Nyström L. "When I feel well all over, I study and learn better" - experiences of good conditions for health and learning in schools in the Arctic region of Sweden. Int J Circumpolar Health 2021; 79:1788339. [PMID: 32663109 PMCID: PMC7480518 DOI: 10.1080/22423982.2020.1788339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A challenge facing the Arctic region is the disengagement of both education and work among its youth. Only by supporting young people who are struggling with mental and physical health challenges can we begin to address this societal challenge. Education, mental health and social inclusion are prominent factors for future employment, income and independent living for young people. The aim of this study was to describe and understand the experiences of good conditions for health and learning in schools in the Arctic region. The 5-D appreciative inquiry method was used to explore 47 students’ and professionals’ experiences and future visions of their school. A phenomenological analysis resulted in three themes: “Standing as one”, “Having an apple a day”, and “Finding the end of the rainbow”. The findings revealed the necessity of promoting health and learning simultaneously in school and viewing health holistically. Health-promoting relationships permeate the findings of good conditions for health and learning. We argue for considering mandatory health education to increase students’ health literacy and making student participation and staff collaboration a priority in schools in the Arctic region. These findings, their practical implications, and future research directions are discussed.
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Affiliation(s)
- Catrine Kostenius
- Department of Health Sciences, Luleå University of Technology , Luleå, Sweden
| | - Lena Nyström
- Norrbotten Association of Local Authorities , Luleå, Sweden
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Booth E, Halliday V, Cooper RJ. Headteachers' and chairs of governors' perspectives on adolescent obesity and its prevention in English secondary school settings. J Public Health (Oxf) 2021; 43:e213-e223. [PMID: 31832667 DOI: 10.1093/pubmed/fdz151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Secondary schools are an important setting for preventing obesity in adolescence. Headteachers and chairs of governors are identified in national guidance as crucial stakeholders for school-based preventative action. Despite this, their views remain unexplored and unrepresented. METHODS A sequential mixed method study was conducted. Semi-structured interviews were undertaken with a purposive sample of 22 secondary school headteachers and chairs of governors in England. Data were thematically analysed and informed the development of a descriptive cross-sectional survey, completed by 127 participants from the same population. RESULTS Unhealthy dietary and sedentary behaviours were viewed as a more significant problem than adolescent obesity. Obesity was perceived as complex and multi-causal, and a range of stakeholders were deemed to have responsibility for its prevention, most notably parents. Support was identified for the role of secondary schools, although this was not an explicit priority and extensive internal and external barriers exist, which hinder preventative action. CONCLUSIONS Whilst secondary school settings in England remain an important setting for the prevention of adolescent obesity, it is crucial for policy makers and public health professionals to recognize the factors affecting school leaders' ability and willingness to contribute to this agenda.
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Affiliation(s)
- E Booth
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - V Halliday
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - R J Cooper
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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Open letters about health dialogues reveal school staff and students' expectations of school health promotion leadership. HEALTH EDUCATION 2021. [DOI: 10.1108/he-06-2020-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study explores to what extent health promotion policy in practice and leadership engagement is reflected in school actors' experiences of health dialogues (HDs) and their ideas about promoting health and learning in schools.
Design/methodology/approach
The 93 participants consisted of 44 school nurses, 37 students in grades 4, 7 or the first year of high school and 12 teachers, who shared their experiences with HDs by writing open letters.
Findings
The qualitative content analysis resulted in four themes: Putting health on the agenda, Finding a common goal, Walking side by side and Pointing out a healthy direction. The participants' expectations of school health promotion leadership are revealed in suggestions on how the HDs can fulfill both the educational assignment and promote student health.
Practical implications
Based on the findings, we argue that for successful school health promotion leaders need to acknowledge the field of tension where leadership has to take place, anchor health promotion policy and administer “a Sandwich approach” – a top-down and bottom-up leadership simultaneously that facilitates school-based health promotion.
Originality/value
When different school actors (school nurses, teachers and students) are given a voice, a collective picture of HDs can emerge and help develop health promotion practices.
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Campos Nogueira R, Nonato FR, Duchene Veauvy MC, Cavin AL, Al-Anbaki M, Graz B. Head Lice at School: Traditional Medicine and Community Engagement. Health Equity 2021; 5:310-315. [PMID: 34036214 PMCID: PMC8139259 DOI: 10.1089/heq.2020.0065] [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] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The prevalence of head lice in poor rural communities and urban slums is estimated to be between 28% and 43% in Brazil, respectively. Children are among the most affected, often in clusters within schools. We launched a program intending to tackle the social stigma associated with head lice using scientific information and a local traditional remedy as a way to lower the prevalence of head lice in a low-resource community. Methods: A program involving the entire school community and the teachers addressed how to treat head lice and avoid new infestations. An affordable solution widely used in traditional Brazilian medicine was provided for the ones infested. Evaluation of the outcome was based on direct observation and was designed as a satisfaction survey. The study complied with the criteria for Standards for Reporting Qualitative Research (SRQR). Results: Two hundred and eighty participants, including parents and siblings of the school children, took part in the program. Among them, 24% (N=67) had head lice, with girls representing 85% of cases; 74.7% of participants infested with head lice were between 4 and 10 years old; 55.2% (N=37) of participants infested showed no signs of nits or adult lice after the program. Conclusions: This experience suggests that the use of playful activities associated with a well-known and accessible local product to treat head lice in low-income families gathered a high degree of community adherence and may be an important tool in overcoming health inequalities.
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Graham-DeMello A, Yusuf J, Kay-Arora M, Hancock Friesen CL, Kirk SFL. Understanding the Environment for Health-Promoting Schools Policies in Nova Scotia: A Comprehensive Scan at the Provincial and Regional School Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073411. [PMID: 33806094 PMCID: PMC8037869 DOI: 10.3390/ijerph18073411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
The World Health Organization has identified the school community as a key setting for health promotion efforts, laying out its priorities in the Health-Promoting Schools (HPS) framework. This framework offers a comprehensive approach that has been adopted in countries around the globe, with defining characteristics focused around the school curriculum and environment. Nova Scotia (NS) adopted the HPS framework at a provincial level in 2005, but it has been variably implemented. We aimed to identify, categorize, and broadly describe the environment for HPS policies in NS. Four iterative steps were employed: (1) a scan of government and regional school websites to identify publicly available policies; (2) consultations with provincial departments with respect to policy relevance and scope; (3) cross-comparison of policies by two reviewers; (4) compilation of policies into an online database. Seventy policies at the provincial level and 509 policies across eight public school regions were identified. Policies focusing on a ‘safe school environment’ were most common; those addressing mental health and well-being, physical activity, nutrition and healthy eating, and substance use were among those least commonly identified. This scan provides a comprehensive overview of HPS-relevant policies in NS, along with relative proportions and growth over time. Our findings suggest areas of policy action and inaction that may help or hinder the implementation of HPS principles and values.
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Affiliation(s)
- Anna Graham-DeMello
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, P.O. Box 15000, Halifax, NS B3H 4R2, Canada; (J.Y.); (M.K.-A.); (S.F.L.K.)
- Correspondence: ; Tel.: +1-902-229-3803
| | - Joshua Yusuf
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, P.O. Box 15000, Halifax, NS B3H 4R2, Canada; (J.Y.); (M.K.-A.); (S.F.L.K.)
- School of Health and Human Performance, Dalhousie University, 1318 Robie St, P.O. Box 15000, Halifax, NS B3H 4R2, Canada
| | - Margaret Kay-Arora
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, P.O. Box 15000, Halifax, NS B3H 4R2, Canada; (J.Y.); (M.K.-A.); (S.F.L.K.)
| | - Camille L. Hancock Friesen
- UT Southwestern Medical Center, Children’s Medical Center Dallas, 1935 Medical District Drive, Dallas, TX 75235, USA;
| | - Sara F. L. Kirk
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, P.O. Box 15000, Halifax, NS B3H 4R2, Canada; (J.Y.); (M.K.-A.); (S.F.L.K.)
- School of Health and Human Performance, Dalhousie University, 1318 Robie St, P.O. Box 15000, Halifax, NS B3H 4R2, Canada
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Gowland-Ella J, Kajons N, David M, Lewis P, Trinh K, Louis D, Kingon N, Batchelor S. Thirsty? Choose Water! Encouraging Secondary School Students to choose water over sugary drinks. A descriptive analysis of intervention components. Health Promot J Austr 2021; 33:202-215. [PMID: 33715238 DOI: 10.1002/hpja.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/04/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Childhood obesity is a significant public health issue. Sugar-sweetened beverage (SSB) consumption contributes to this and adolescents are high consumers. This paper provides a descriptive overview of a school-based intervention to address this. METHODS 61 secondary schools in New South Wales were randomised to receive a behavioural intervention (BI), a chilled water station (CWS), both interventions or neither (control). The BI was delivered through classroom lessons, school-based promotion and vaccination clinic. The CWS intervention included the installation of one CWS per school. Intervention effectiveness over time was assessed via student surveys at baseline, post-intervention and follow-up (individual-level outcomes), feedback from teachers and vaccination nurses, a school information survey, and remotely monitored CWS water usage (school-level outcomes). RESULTS Teachers reported the BI was useful in teaching students about drinking water and negative consequences of SSBs. Nurses considered the post-vaccination waiting period a good opportunity to deliver health promotion messages. Students in this group showed statistically significant changes in knowledge about SSBs, dehydration effects and changes in daily SSB consumption (T1 23.18%; T3 18.20%). Positive feedback regarding CWSs was received with an increase in water consumption reported for students in this group (T1 86.15% to T3 89.66%) and a statistically significant increase in students carrying a water bottle to school and filling it observed. CONCLUSIONS Both interventions were readily implemented with high levels of acceptability and impact on students' knowledge and SSB consumption. The study demonstrates how to promote water consumption in schools utilising two different interventions. SO WHAT?: Evidence regarding how to decrease SSB consumption amongst secondary school students has been strengthened.
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Affiliation(s)
- Justine Gowland-Ella
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
| | - Nicole Kajons
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
| | - Michael David
- School of Medicine and Public Health, The University of Newcastle, Gosford, NSW, Australia
| | - Peter Lewis
- Public Health Unit, Central Coast Local Health District, Gosford, NSW, Australia
| | - Katie Trinh
- Health Promotion Service, South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | | | - Nina Kingon
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
| | - Samantha Batchelor
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
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Neely KC, Montemurro GR, Storey KE. A Canadian-wide perspective on the essential conditions for taking a comprehensive school health approach. BMC Public Health 2020; 20:1907. [PMID: 33317496 PMCID: PMC7734767 DOI: 10.1186/s12889-020-09987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/29/2020] [Indexed: 12/22/2022] Open
Abstract
Background The primary purpose of this research was to explore Comprehensive School Health (CSH) stakeholders’ perceptions of the essential conditions for taking a CSH approach in other contexts across Canada. The secondary purpose was to examine the need for and development of an evaluative tool or resource to assess the implementation of the essential conditions. Methods Data were generated through individual semi-structured interviews (n = 38) and small group interviews (n = 3) with 45 participants across Canada involved in implementing policies or programs which take a CSH approach. Interviews were subjected to content analysis. Results There was positive support for the essential conditions and results indicated the essential conditions are relevant across Canada. Findings revealed the necessity for a new essential condition that reflected support and leadership from the school district and/or provincial/territorial governing bodies. Modifications to the description of each of the essential conditions were also suggested to provide clarity. Results also indicated that an evaluative tool that was concise, meaningful, and provided immediate feedback would be useful to school communities to establish readiness, assess, and improve ongoing implementation of CSH approaches. Conclusions This research contributes to the evidence-base of CSH by providing school communities across Canada with a set of refined and understandable essential conditions that support successful implementation. Further, the development of an evaluation tool will support school health champions, researchers, and policymakers in the optimization and implementation of policies or programs which take a CSH approach, ultimately supporting healthier school communities across the country.
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Affiliation(s)
- Kacey C Neely
- Faculty of Health Sciences and Sport, J12 Pathfoot, University of Stirling, Stirling, FK9 4LA, UK.
| | - Genevieve R Montemurro
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Kate E Storey
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
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Knight L, Atuhaire L, Allen E, Namy S, Anton-Erxleben K, Nakuti J, Mirembe AF, Nakiboneka M, Seeley J, Weiss HA, Parkes J, Bonell C, Naker D, Devries K. Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study. JMIR Res Protoc 2020; 9:e20940. [PMID: 33283762 PMCID: PMC7752527 DOI: 10.2196/20940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Violence against children in schools is a global public health problem. There is growing evidence that school-based interventions can be effective in reducing violence against children in schools. However, there is little evidence on the long-term impact of such interventions. The Good School Toolkit, developed by Raising Voices, a Uganda-based nonprofit organization, is a whole-school violence prevention intervention that aims to change the operational culture of primary schools. In 2014, the Good School Toolkit was evaluated through a cluster randomized controlled trial (Good Schools Study) and found to reduce teacher-to-student and student-to-student violence. Objective This protocol describes quantitative analyses to explore long-term outcomes of the Good School Toolkit intervention among adolescents in Uganda, including the extent to which it is associated with peer-violence victimization (primary outcome) and peer-violence perpetration, intimate-partner violence, acceptance of teacher-violence, equitable gender attitudes, agency, self-regulation, peer connectedness, social assets, psychological assets, and retention in school (secondary outcomes). Methods This is a nonrandomized quasi-experimental 4-year follow-up study of adolescents who attended the 42 Good Schools Study primary schools in 2014; 21 schools initiated the Good School Toolkit intervention during the trial from 2012, and 19 schools initiated the intervention after the trial (during the later delivery phase) from 2015; 2 schools did not implement the intervention. Students in the final school grade (Primary 7) during 2014 of the 19 primary schools in the later delivery phase are expected to have left school prior to toolkit delivery in 2015. Wave 1 data were collected in 2014 from 3431 grade Primary 5 to Primary 7 school students aged 11-14 years; these students were followed up in 2018-2019 when aged 16-19 years and invited to participate in the Wave 2 survey. Data were collected in face-to-face interviews by trained Ugandan field researchers. Toolkit exposure groups are defined as exposed during the Good Schools Study trial (from 2012), as exposed during later delivery (from 2015), or not exposed including those expected to have completed Primary 7 prior to later delivery or from the 2 schools that did not implement the toolkit. Associations between outcomes at Wave 2 and toolkit exposure groups will be analyzed using mixed-effect multivariable logistic and linear regression models for binary and continuous outcomes, respectively. This analysis is exploratory and aims to generate hypotheses on if, and under what circumstances, the toolkit influences later adolescent outcomes. Results Data collection was completed in August 2019. Conclusions To our knowledge, this is the first long-term follow-up study of adolescents exposed to a school-based violence-prevention intervention in sub-Saharan Africa. If the intervention reduces violence and improves other outcomes in later adolescence, then this study supports primary school interventions as key to achieving long-term population impacts. The pattern of effects will inform where reinforced or additional interventions are needed. International Registered Report Identifier (IRRID) DERR1-10.2196/20940
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Affiliation(s)
- Louise Knight
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lydia Atuhaire
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenny Parkes
- University College London Institute of Education, London, United Kingdom
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Karen Devries
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Reed H, Couturiaux D, Davis M, Edwards A, Janes E, Kim HS, Melendez-Torres GJ, Murphy S, Rotevatn TA, Smith J, Evans R. Co-production as an Emerging Methodology for Developing School-Based Health Interventions with Students Aged 11-16: Systematic Review of Intervention Types, Theories and Processes and Thematic Synthesis of Stakeholders' Experiences. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:475-491. [PMID: 33237552 PMCID: PMC8060205 DOI: 10.1007/s11121-020-01182-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 01/04/2023]
Abstract
Co-production affords an intervention’s target population the opportunity to participate in intervention theory decision-making during the development process. This addresses the over-reliance on developing interventions through academic theories which can be devoid of contextual understanding and result in challenges to implementing school-based health programmes. There is an emergent empirical literature on co-producing school-based health interventions, but an understanding of appropriate theoretical types and processes and stakeholders’ experiences is lacking. Through the conduct of a systematic review, this study seeks to understand the types and underlying theories and processes for co-production in school-based health interventions with students aged 11–16. A thematic synthesis explored stakeholders’ experiences of the different types of co-production. A systematic search of five electronic bibliographic databases, citation tracking of included studies, and consultation with an expert international panel were employed. Of 27,433 unique papers, 30 papers representing 22 studies were retained to describe types, and 23 papers of 18 studies used to synthesise stakeholders’ experiences. Three types were identified: external, individual-level, and system-level capacity-building. Whilst this review showed variability in co-production types, stakeholders involved and processes, shared functions were identified. Students’, school staff, facilitators’ and researchers’ experiences in terms of acceptability, feasibility and undertaking decision-making are discussed. Recommendations for conceptualising and reporting co-production and process evaluations of co-produced school-based health interventions are highlighted.
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Affiliation(s)
- Hayley Reed
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Danielle Couturiaux
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Marianne Davis
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Amy Edwards
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Edward Janes
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Hyun Sue Kim
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - G J Melendez-Torres
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Simon Murphy
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark
| | - Jesse Smith
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Rhiannon Evans
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
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Abstract
We have recently been funded by the UK Prevention Research Partnership (UKPRP) to develop a UK school food network. The overarching aim is to build a community working towards a more health-promoting food and nutrition system in UK schools (primary and secondary). Here we describe the current status of school food research, including a review of the literature supporting the health-promoting schools approach and outline the opportunities for intervention and innovation establishment of the network present. Key potential school food research themes are described, and their prioritisation within the network, as well as network activities that have been planned, with the ultimate ambition of reducing socio-economic diet-related inequalities, and, consequently, non-communicable disease risk.
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Davison J, Stewart-Knox B, Connolly P, Lloyd K, Dunne L, Bunting B. Exploring the association between mental wellbeing, health-related quality of life, family affluence and food choice in adolescents. Appetite 2020; 158:105020. [PMID: 33171225 DOI: 10.1016/j.appet.2020.105020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Young people choose energy-dense, nutrient-poor diets, yet understanding of potential determinants is limited. Associations between food choices, mental wellbeing, health-related quality of life (HRQoL) and family affluence were explored to identify targets for intervention to promote dietary health and wellbeing in young people. Adolescents were recruited via post-primary schools in the UK and surveyed at two time-points when aged 13-14 years and 15-16 years. The questionnaire enquired about mental wellbeing using the Short Warwick-Edinburgh Mental Wellbeing Scale, HRQoL using the KIDSCREEN-10, socio-economic status using the Family Affluence Scale and food choice by Food Frequency Questionnaire (FFQ). With missing and anomalous cases excluded, the sample comprised 1208 cases. Factor analysis on the FFQ indicated five food choice factors: 'Junk Food'; 'Meat'; 'Healthy Protein'; 'Fruit/Vegetables'; 'Bread/Dairy'. Multivariate regression analysis indicated that frequent consumption of Junk Food was associated with being male and lower mental wellbeing. Frequent Meat intake was associated with being male and with lower HRQoL. Frequent choice of Bread/Dairy foods was more common among males and associated with higher wellbeing and greater affluence. Those who consumed Fruit/Vegetables frequently were more likely to be female, have higher HRQoL, higher mental wellbeing, and greater family affluence. These direct associations endured between time points. The dietary factors were not mutually exclusive. Those who frequently chose Junk Food were less likely to choose Fruit/Vegetables. Frequent choice of Meat was associated with more frequent choice of Junk Food and Healthy Protein. Intervention to improve dietary and psychological health in young people should target males, those in less affluent households, seek to reduce consumption of 'junk' food, and increase fruit and vegetable intake.
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Affiliation(s)
- Jenny Davison
- Psychology Research Institute, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK.
| | - Barbara Stewart-Knox
- Division of Psychology, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Paul Connolly
- Faculty of Arts and Social Sciences, Lancaster University, FASS Building, Lancaster, LA1 4YL, UK
| | - Katrina Lloyd
- Centre for Evidence and Social Innovation, Queens University Belfast, University Road, Belfast, Northern Ireland, BT7 1NN, UK
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queens University Belfast, University Road, Belfast, Northern Ireland, BT7 1NN, UK
| | - Brendan Bunting
- Psychology Research Institute, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK
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Silva KS, da Silva JA, Barbosa Filho VC, dos Santos PC, da Silveira PM, Lopes MV, Salmon J. Protocol paper for the Movimente school-based program: A cluster-randomized controlled trial targeting physical activity and sedentary behavior among Brazilian adolescents. Medicine (Baltimore) 2020; 99:e21233. [PMID: 32756101 PMCID: PMC7402733 DOI: 10.1097/md.0000000000021233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/25/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A better understanding of how multicomponent school-based interventions work and their effects on health and education outcomes are needed. This paper described the methods of the Movimente Program, a school-based intervention that aims to increase physical activity (PA) and decrease sedentary behavior (SB) among Brazilian students. METHODS This is a cluster randomized controlled trial with adolescents from 7th to 9th grade in public schools from Florianopolis, Southern Brazil. After agreement, 6 schools were randomly selected to intervention or control groups (3 schools each), and all eligible students were invited to the study. The Movimente intervention program was performed during a school year and included 3 main components: Teacher training (including face-to-face meeting, social media platform, and handbook with lesson plans); improvements in the PA environment in school; and educational strategies. Control schools continued with their traditional schedule. Baseline (March/April 2017), postintervention (November/December 2017), and maintenance (June/July 2018) evaluations included PA and SB as primary outcomes (assessed by self-report and accelerometry). Secondary outcomes included psychosocial factors related to PA and SB (e.g., social support and self-efficacy), as well as health (e.g., quality of life and nutritional status) and education (e.g., academic achievement) outcomes. A program evaluation was performed based on the RE-AIM framework. Participants, intervention staffs, and evaluators were not blinded to group assignment, but a standardized evaluation protocol was applied independently of the trial allocation. RESULTS Statistical analyses will include a multilevel approach for repeated measurements and mediation analysis. Any side effects of the intervention will be recorded. The sample size close to that expected (n = 1090) was reached (n = 999). The results of this trial will involve valuable information about the effect and the evaluation of a multicomponent intervention carried out in a middle-income country. CONCLUSION By creating opportunities for adolescents to be active at school using multicomponent strategies, the Movimente program has the potential to enhance students health and academic performance which may encourage the school community (e.g., teachers, principals) to adopt the program. Also, this trial will provide evidence for practitioners, policy makers, and researchers on how multicomponent program may be implemented in a school setting. TRIAL REGISTRATION The trial is registered at the Clinical Trial Registry (Trial ID: NCT02944318; date of registration: 18 October 2016).
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Affiliation(s)
- Kelly Samara Silva
- Department of Physical Education, Research Centre in Physical Activity and Health, Sport Centre, Federal University of Santa Catarina, Florianopolis
| | - Jaqueline Aragoni da Silva
- Department of Physical Education, Research Centre in Physical Activity and Health, Sport Centre, Federal University of Santa Catarina, Florianopolis
| | | | - Priscila Cristina dos Santos
- Department of Physical Education, Research Centre in Physical Activity and Health, Sport Centre, Federal University of Santa Catarina, Florianopolis
| | - Pablo Magno da Silveira
- Department of Physical Education, Research Centre in Physical Activity and Health, Sport Centre, Federal University of Santa Catarina, Florianopolis
| | - Marcus V.V. Lopes
- Department of Physical Education, Research Centre in Physical Activity and Health, Sport Centre, Federal University of Santa Catarina, Florianopolis
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Victoria, Australia
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Bastos PDO, Cavalcante ASP, Pereira WMG, de Castro VHS, Ferreira Júnior AR, Guerra PH, da Silva KS, da Silva MRF, Barbosa Filho VC. Health Promoting School Interventions in Latin America: A Systematic Review Protocol on the Dimensions of the RE-AIM Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5558. [PMID: 32752119 PMCID: PMC7432100 DOI: 10.3390/ijerph17155558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 07/29/2020] [Indexed: 12/21/2022]
Abstract
Understanding the dimensions of internal and external validities (e.g., using the RE-AIM model: Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance) of school interventions is important to guide research and practice in this context. The aim of this systematic review protocol is to synthesize evidence on the RE-AIM dimensions in interventions based on the Health Promoting School (HPS) approach from the World Health Organization (WHO) in Latin America. Studies of interventions based on HPS-WHO that were carried out in Latin America involving the population of 5 to 18-year-olds will be eligible. Searches in nine electronic databases, a study repository, the gray literature, and the retrieved articles' reference lists will be performed, without year or publication language limits. Study selection and data extraction will be conducted by independent researchers. Data on intervention implementation will be summarized in categories of HPS-WHO actions: (1) school curriculum, (2) changes in the social and/or physical environment of schools, and (3) actions with families and the community. A previously validated tool will be used to summarize the information on the dimensions of the RE-AIM model. The strengths and limitations of the included studies will be evaluated using the Critical Appraisal Skills Program (CASP) tool, and the confidence level of evidence will be assessed according to the GRADE CERQual tool.
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Affiliation(s)
- Patrícia de Oliveira Bastos
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
| | - Ana Suelen Pedroza Cavalcante
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
| | - Wallingson Michael Gonçalves Pereira
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
| | - Victor Hugo Santos de Castro
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
| | - Antonio Rodrigues Ferreira Júnior
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
| | | | - Kelly Samara da Silva
- Research Center for Physical Activity and Health, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil;
| | - Maria Rocineide Ferreira da Silva
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
| | - Valter Cordeiro Barbosa Filho
- Post-graduate Program in Collective Health, Ceara State University, Fortaleza 60714-903, Brazil; (P.d.O.B.); (A.S.P.C.); (W.M.G.P.); (V.H.S.d.C.); (A.R.F.J.); (M.R.F.d.S.)
- Federal Institute of Education, Science and Technology of Ceara, Aracati 62800-000, Brazil
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Abstract
PurposeObesity in children and adolescents is a significant public health concern. The World Health Organization Health Promoting Schools (HPS) framework promotes good nutrition and physical activity in school settings. While HPS is embraced globally, effective implementation and sustainable programmes are a continued challenge. This paper aims to report on the characteristics of current school interventions based on HPS and implementation barriers and enablers.Design/methodology/approachA literature search identified peer-reviewed studies of school health interventions reflective of the HPS framework focusing on obesity prevention. Studies from all countries were included, if conducted in primary and/or secondary schools; included a sufficient amount of qualitative implementation or process evaluation data to draw conclusions regarding key barriers and enablers to implementation; and were published in English.FindingsNine interventions (n = 9) from seven countries were included. Most were implemented in primary schools and focused on specific grade levels. Engaging parents, the home environment, teacher time constraints, fun interventions, student participation, teacher training, integration with the curriculum and stakeholder engagement all emerged as strong implementation themes. Teachers as role models, establishing community partnerships and policy support also emerged as common themes.Originality/valueFuture interventions may benefit from enhancing teacher and parent health promotion. Partnerships with initiatives focusing on environmental sustainability may simultaneously benefit human and planetary health while strengthening stakeholder engagement opportunities and consistent messaging throughout the community. More comprehensive evaluation data are needed, in particular, for long-term HPS initiatives.
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Long SJ, Littlecott H, Hawkins J, Eccles G, Fletcher A, Hewitt G, Murphy S, Moore GF. Testing the "Zero-Sum Game" Hypothesis: An Examination of School Health Policies and Practices and Inequalities in Educational Outcomes. THE JOURNAL OF SCHOOL HEALTH 2020; 90:415-424. [PMID: 32128826 PMCID: PMC7187379 DOI: 10.1111/josh.12889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND Health and education are intrinsically linked, while both are significantly patterned by socioeconomic status throughout the life course. Nevertheless, the impact of promoting health via schools on education is seen by some as a "zero-sum game"; ie, focusing resources on health improvement activity distracts schools from their core business of educating pupils, potentially compromising educational attainment. There is emerging evidence that school health improvement interventions may beneficially influence both health and attainment. However, few studies have examined the relationship between school health improvement activity and socioeconomic inequalities in educational attainment. METHODS Wales-wide, school-level survey data on school health policies and practices was linked with routinely collected data on academic attainment. Primary outcomes included attendance and academic attainment at age 14 (Key Stage 3) and 16 (Key Stage 4). Linear regression models were constructed separately for high and low Free School Meal (FSM) schools, adjusting for confounders. Interaction terms were fitted to test whether there was an interaction between FSM, health improvement activity, and outcomes. RESULTS There were positive associations between almost all school health variables and KS3 attainment among high, but not low FSM schools. Similarly, for attendance, there were positive associations of several health variables among high but not low FSM schools. There were no associations for KS4 attainment. CONCLUSIONS Our findings did not support the "zero-sum game" hypothesis; in fact, among more deprived schools there was a tendency for better attendance and attainment at age 14 in schools with more embedded health improvement action.
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Affiliation(s)
- Sara J. Long
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
| | - Hannah Littlecott
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
| | - Jemma Hawkins
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
| | - Gemma Eccles
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
| | - Adam Fletcher
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15‐17 Tavistock PlaceLondonWC1H 9SHUK
| | - Gillian Hewitt
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
| | - Simon Murphy
- DECIPHer, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
| | - Graham F. Moore
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1‐3 Museum PlaceCardiffCF10 3BDUK
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McHugh C, Hurst A, Bethel A, Lloyd J, Logan S, Wyatt K. The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review. Public Health 2020; 182:116-124. [PMID: 32259722 DOI: 10.1016/j.puhe.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. STUDY DESIGN A systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. METHODS Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. RESULTS Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. CONCLUSIONS There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.
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Affiliation(s)
- C McHugh
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - A Hurst
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - A Bethel
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - J Lloyd
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - S Logan
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - K Wyatt
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
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Swain S, Pati S, Pati S. 'Health Promoting School' Model in Prevention of Vector-Borne Diseases in Odisha: A Pilot Intervention. J Trop Pediatr 2019; 65:463-473. [PMID: 30668851 DOI: 10.1093/tropej/fmy077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We tested 'Health-Promoting School model' for vector-borne diseases (VBDs) through behavioural changes among students in India for better control of the diseases in the community. A total of 1098 students from eight co-ed schools (four controls and four interventions) of Odisha participated in the study. Intervention was 12 h of class room teaching and activities on mosquito dynamics, source identification, prevention and management of VBDs. Control schools were provided with the leaflets and posters covering the objectives. Impact was assessed through change in knowledge and practice through pre- and post-test. Total mean transformed score in pre-intervention survey in both the groups was nearly 33, which increased to 38.6 and 53.9 in control and intervention group, respectively. In intervention group the mean days of absenteeism due to VBDs was reduced nearly by four times. The model can be used as effective health-promoting measures for vector control.
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Affiliation(s)
- Subhashisa Swain
- Public Health Foundation of India, Indian Institute of Public Health-Bhubaneswar (IIPH-B), Bhubaneswar, India
| | - Sandipana Pati
- Department of Health & Family Welfare, Disease Surveillance Unit, Office of Additional District Medical Officer (Public Health) Bhubaneswar, Government of Odisha, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
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Bonell C, Allen E, Warren E, McGowan J, Bevilacqua L, Jamal F, Sadique Z, Legood R, Wiggins M, Opondo C, Mathiot A, Sturgess J, Paparini S, Fletcher A, Perry M, West G, Tancred T, Scott S, Elbourne D, Christie D, Bond L, Viner RM. Modifying the secondary school environment to reduce bullying and aggression: the INCLUSIVE cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundBullying, aggression and violence among children and young people are some of the most consequential public mental health problems.ObjectivesThe INCLUSIVE (initiating change locally in bullying and aggression through the school environment) trial evaluated the Learning Together intervention, which involved students in efforts to modify their school environment using restorative approaches and to develop social and emotional skills. We hypothesised that in schools receiving Learning Together there would be lower rates of self-reported bullying and perpetration of aggression and improved student biopsychosocial health at follow-up than in control schools.DesignINCLUSIVE was a cluster randomised trial with integral economic and process evaluations.SettingForty secondary schools in south-east England took part. Schools were randomly assigned to implement the Learning Together intervention over 3 years or to continue standard practice (controls).ParticipantsA total of 6667 (93.6%) students participated at baseline and 5960 (83.3%) students participated at final follow-up. No schools withdrew from the study.InterventionSchools were provided with (1) a social and emotional curriculum, (2) all-staff training in restorative approaches, (3) an external facilitator to help convene an action group to revise rules and policies and to oversee intervention delivery and (4) information on local needs to inform decisions.Main outcome measuresSelf-reported experience of bullying victimisation (Gatehouse Bullying Scale) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale) measured at 36 months. Intention-to-treat analysis using longitudinal mixed-effects models.ResultsPrimary outcomes – Gatehouse Bullying Scale scores were significantly lower among intervention schools than among control schools at 36 months (adjusted mean difference –0.03, 95% confidence interval –0.06 to 0.00). There was no evidence of a difference in Edinburgh Study of Youth Transitions and Crime scores. Secondary outcomes – students in intervention schools had higher quality of life (adjusted mean difference 1.44, 95% confidence interval 0.07 to 2.17) and psychological well-being scores (adjusted mean difference 0.33, 95% confidence interval 0.00 to 0.66), lower psychological total difficulties (Strengths and Difficulties Questionnaire) score (adjusted mean difference –0.54, 95% confidence interval –0.83 to –0.25), and lower odds of having smoked (odds ratio 0.58, 95% confidence interval 0.43 to 0.80), drunk alcohol (odds ratio 0.72, 95% confidence interval 0.56 to 0.92), been offered or tried illicit drugs (odds ratio 0.51, 95% confidence interval 0.36 to 0.73) and been in contact with police in the previous 12 months (odds ratio 0.74, 95% confidence interval 0.56 to 0.97). The total numbers of reported serious adverse events were similar in each arm. There were no changes for staff outcomes. Process evaluation – fidelity was variable, with a reduction in year 3. Over half of the staff were aware that the school was taking steps to reduce bullying and aggression. Economic evaluation – mean (standard deviation) total education sector-related costs were £116 (£47) per pupil in the control arm compared with £163 (£69) in the intervention arm over the first two facilitated years, and £63 (£33) and £74 (£37) per pupil, respectively, in the final, unfacilitated, year. Overall, the intervention was associated with higher costs, but the mean gain in students’ health-related quality of life was slightly higher in the intervention arm. The incremental cost per quality-adjusted life year was £13,284 (95% confidence interval –£32,175 to £58,743) and £1875 (95% confidence interval –£12,945 to £16,695) at 2 and 3 years, respectively.LimitationsOur trial was carried out in urban and periurban settings in the counties around London. The large number of secondary outcomes investigated necessitated multiple statistical testing. Fidelity of implementation of Learning Together was variable.ConclusionsLearning Together is effective across a very broad range of key public health targets for adolescents.Future workFurther studies are required to assess refined versions of this intervention in other settings.Trial registrationCurrent Controlled Trials ISRCTN10751359.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 18. See the NIHR Journals Library website for further project information. Additional funding was provided by the Educational Endowment Foundation.
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Affiliation(s)
- Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer McGowan
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Leonardo Bevilacqua
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Farah Jamal
- Department of Social Science, University College London Institute of Education, London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Meg Wiggins
- Department of Social Science, University College London Institute of Education, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Mathiot
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Sara Paparini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Fletcher
- School of Social Sciences, Cardiff University, Cardiff, UK
| | | | - Grace West
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Tara Tancred
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Lyndal Bond
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Russell M Viner
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
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de Medeiros GCBS, de Azevedo KPM, Garcia DÁ, de Oliveira Segundo VH, de Sousa Mata ÁN, de Siqueira KSDP, Fernandes AKP, Santos RPD, de Brito Trindade DDB, de Oliveira Lyra C, Piuvezam G. Protocol for systematic reviews of school-based food and nutrition education intervention for adolescent health promotion: Evidence mapping and syntheses. Medicine (Baltimore) 2019; 98:e16977. [PMID: 31464944 PMCID: PMC6736443 DOI: 10.1097/md.0000000000016977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Nutrition is an important modifiable factor in combating overweight and obesity among adolescents. School has been indicated as an effective environment for influencing eating behavior; however, recent reviews assessing school-based interventions specifically for adolescents are scarce. Therefore, we propose the present systematic review with the aim to comprehensively review the quantitative and qualitative literature on the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. METHODS We will search MEDLINE/PubMed, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, and ADOLEC. We will include randomized controlled trials (RCT), non-RCT, and controlled before-after studies. Risk of bias will be assessed using the EPOC Risk of Bias Tool for RCT, Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCT or controlled before-after, as well as the Critical Appraisal Skills Program (CASP) checklist for qualitative studies. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed by the RevMan 5.3 software. We will conduct the study in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols. RESULT This review will evaluate the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. The primary outcome will be changes in adolescent food consumption. Secondary outcomes will be biological parameters (e.g., body mass index (BMI), waist circumference (WC), body composition, etc); biochemical parameters (e.g., glycemia, triglycerides, total cholesterol, etc); qualitative evidences that support or explain the effect of school-based food and nutrition education interventions on adolescent food consumption. CONCLUSION The findings of this systematic review will summarize the latest evidence of the effects of school-based food and nutrition education interventions on adolescent health promotion. The findings will be an available reference for school-based interventions and other further research. REGISTRATION PROSPERO CRD42019116520.
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Affiliation(s)
| | | | - Daniel Ángel Garcia
- Department of Physiotherapy, San Antonio de Murcia Catholic University, Spain
| | | | | | | | | | | | | | - Clélia de Oliveira Lyra
- Department of Nutrition, Federal University of Rio Grande do Norte
- Graduate Program in Public Health, UFRN, Natal, Brazil
| | - Grasiela Piuvezam
- Graduate Program in Public Health, UFRN, Natal, Brazil
- Department of Public Health, UFRN, Natal, Brazil
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Matergia M, Ferrarone P, Khan Y, Matergia DW, Giri P, Thapa S, Simões EAF. Lay Field-worker-Led School Health Program for Primary Schools in Low- and Middle-Income Countries. Pediatrics 2019; 143:peds.2018-0975. [PMID: 30872330 DOI: 10.1542/peds.2018-0975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES School health programs are frequently attempted in low- and/or middle-income countries; however, programmatic scope and reach is limited by human resource constraints. We sought to determine if trained community members could implement a school health program that improved outcomes in rural primary schools in India. METHODS This was a mixed-methods, stepped-wedge, cluster-controlled study of schools pragmatically assigned to receive a multicomponent, comprehensive school health program delivered by lay field-workers. RESULTS All students in 22 primary schools (9 government schools and 13 low-cost private schools) participated in this study. A total of 3033 student-years were included in the analysis (2100 student-years in the intervention period and 933 student-years in the control period). Qualitative feedback was collected from 38 teachers, 49 parents, and 4 field-workers. In low-cost private schools, the diarrhea incidence was lower in students receiving the intervention (incidence rate ratio 0.58; 95% confidence interval [CI] 0.47 to 0.71; P < .001). There was no difference in diarrhea incidence for students in government schools (incidence rate ratio 0.87; 95% CI 0.68 to 1.12; P = .29). Health-knowledge acquisition was higher in intervention schools (mean difference 12.6%; 95% CI 8.8 to 16.4; P < .001) and similar in both school types. Intervention coverage rates were high (mean 93.9%; SD 2.0%), and performance assessment scores indicated fidelity (mean 3.45; SD 0.69). Stakeholders revealed favorable perceptions of the field-workers and high levels of perceived impact. CONCLUSIONS Lay field-worker-led school health programs offer a promising alternative for improving school health delivery in resource-constrained settings.
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Affiliation(s)
- Michael Matergia
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado;
| | - Peter Ferrarone
- Division of Health Care Policy and Research, University of Colorado Denver, Denver, Colorado
| | - Yasin Khan
- American India Foundation, New Delhi, India
| | | | | | | | - Eric A F Simões
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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