Interventions integrating health and academic interventions to prevent substance use and violence: a systematic review and synthesis of process evaluations

Abstract

BackgroundWithin increasingly constrained school timetables, interventions that integrate academic and health education to reduce substance use and violence may hold promise as a category of intervention that can positively affect both academic and health outcomes. There are no current systematic reviews exploring the effectiveness of such interventions or factors that affect their implementation.MethodsA total of 19 bibliographic databases and 32 websites were searched. References were also extracted from the reference lists of included studies, and experts and authors were contacted to identify relevant studies.We included reports with no restrictions on language or date. References were screened on title/abstract and those not thus excluded were screened on full report. Data extraction and appraisal followed the Critical Appraisal Skills Programme, Evidence for Policy and Practice Information and Co-ordinating Centre and Cochrane tools. Extracted process data were qualitatively meta-synthesised for common themes.ResultsSeventy-eight thousand four hundred fifty-one unique references were identified, and 62 reports were included. A total of 16 reports (reporting on 15 studies of 12 interventions) evaluated process. Key facilitators of integrated academic and health curricula were supportive senior management and alignment of the intervention with school ethos; a positive teaching environment, including positive perceptions around the ability to be flexible in the adaptation and delivery of integrated academic and health curricula; positive pre-existing student and teacher attitudes towards intervention content; and parental support of interventions, largely through reinforcement of messaging at home. Important barriers were over-burdened teachers, with little time to learn and implement integrated curricula.ConclusionSeveral useful facilitating and inhibiting factors linked to the implementation of interventions that integrate academic and health education for reduced substance use and/or violence were identified, providing tentative but insightful evidence of context-specific issues that may impact intervention success. However, overall, there is still a considerable gap in our understanding of how to achieve the successful implementation of these interventions.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0886-3) contains supplementary material, which is available to authorized users.

Implementing a whole-school relationships and sex education intervention to prevent dating and relationship violence: evidence from a pilot trial in English secondary schools

“…More generally, our study provides evidence that schoolbased health interventions must ensure they do not overburden schools, particularly in contexts where school systems are stressed by budgetary or staffing problems and performance pressures (Sturgis, Smith, and Hughes 2006;Han and Weiss 2005). In line with previous research, this study raises concerns that schools struggle to deliver separate interventions for each health issue affecting their students (Tancred et al 2018), and so may be unwilling or unable to deliver an intervention focused solely on dating and relationship violence. Dating and relationship violence might best be addressed as an aspect of comprehensive relationships and sex education as suggested in recent studies (Santelli, Grilo, and Choo et al 2018;Wolfe et al 2009), with there being no clear evidence of a certain minimum dose for intervention effectiveness in reducing dating and relationship violence (Fellmeth, Heffernan, and Nurse et al 2013).…”

“…This suggests a need for prevention targeting those in early and middle adolescence informed by existing evidence. Implementing relationships and sex education and other health interventions in schools is best facilitated by committed school leaders and staff trained and supported to deliver health lessons (Pearson et al 2015;Tancred et al 2018). However, delivering health interventions in schools is challenging because of the limited incentives for schools to address students' health and the lack of training and support available on how to do this (Tancred et al 2018).…”

“…Implementing relationships and sex education and other health interventions in schools is best facilitated by committed school leaders and staff trained and supported to deliver health lessons (Pearson et al 2015;Tancred et al 2018). However, delivering health interventions in schools is challenging because of the limited incentives for schools to address students' health and the lack of training and support available on how to do this (Tancred et al 2018). Multi-component school-based health interventions depend on multiple school stakeholders (Pearson et al 2015), and public-health professionals may have little traction to promote implementation in schools (Buchanan et al 2005;Aarons, Hurlburt, and Horowitz 2011).…”

What makes multicomponent school-based health promotion interventions work? A qualitative study nested in the SEHER trial in Bihar, India.

“…Also, most of the SMs were able to generate and cultivate the support of those teachers who believed in the value of the program and were willing to participate in program activities and this also aided in successful implementation in the SM-led schools. These facilitators are consistent with studies of the implementation of school health interventions [13][14][15]. For example, a process evaluation of the Mentally Healthy Schools program in Australia reported that if the principals and teachers are passionate about the program then that sets the tone positive and supports implementation.…”

The sustainability of public health interventions in schools: a systematic review

“…There may be less political incentive to sustain health interventions; academic education is likely to be prioritised [28][29][30]. Teachers may need more support and preparation time to deliver curriculums that include health [31] and vary in their commitment to teaching health promotion [13,31]. Limited interaction between schools and the health sector might impede the identification of funding, resources and training for sustainability [30].…”