The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation

Abstract

BackgroundStudies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications.MethodsThe intervention was based on the WHO’s Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme.ResultsFeasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students’ anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the programme, as expressed by principals, parents and students. A minority of teachers complained that there was inadequate information sharing about the programme and mentioned reservations about the capacities of the lay health counsellor. Preliminary evidence of the positive effects of the programme included the correction of vision problems detected in health screening camps, and qualitative evidence of changes in health-related knowledge and behaviour of students.ConclusionA task-shifting approach of delegating school health promotion activities to lay school health counsellors rather than education or health professionals shows promise of effectiveness as a scalable model for promoting the health and well being of school based adolescents in resource constrained settings.

Interventions to improve school-based eye-care services in low- and middle-income countries: a systematic review

“…A study that conducted mass vision screenings in 51 Indian schools at the start of each academic year was identified as a cost–effective intervention 63 . Many studies noted the availability of uncomplicated referral pathways between education and health systems, and clarity regarding referral processes, as being crucial in successful follow-up, provision of spectacles and continuity of care 20 , 22 , 23 , 29 , 32 , 33 , 41 , 51 , 61 , 64 . For example, a study exploring children as potential vision screeners found that, despite being effective screeners, they were not held with sufficient credibility when referring those they screened to other health services 57 .…”

“…Inappropriate or overprescribing of spectacles was identified in studies from India and Mexico, 26 , 43 suggesting that the prescribing of spectacles for moderate vision impairment should be balanced with cost and willingness to pay 43 . Overarching factors in the provision of successful school-based eye-care interventions included communication between health services and schools, the willingness of schools to schedule sufficient time while minimizing impact, 52 , 63 and the support of principals, staff and parents 23 , 28 , 29 …”

“…An insufficient number of eye-care specialists created barriers to referrals and follow-ups in China, 62 India 22 , 23 , 64 and Peru 30 . As the availability of eye-care specialists can be limited in school settings, particularly in low- and middle-income countries, studies have investigated the use of teachers, nurses, certified medical assistants and key informants for the provision of screening and basic eye-care for children 20 , 21 , 29 , 51 – 54 , 56 , 58 , 60 , 62 .…”

“…Studies reported that the lack of facilities 20 , 23 and tools, 51 , 55 such as appropriate charts for vision screening, was a potential barrier to implementing school-based eye-care programmes. The supply of low-cost spectacles was identified as increasing spectacle acceptance in China, 24 , 39 , 45 , 46 Mexico 26 and Timor-Leste 21 .…”

“…Approaches to reduce programme costs were reported as sourcing instrumentation from local tertiary institutions, 63 and the use of cost–effective personnel (e.g. school health counsellors 23 or teachers 54 ) and appropriate spectacle correction protocols. Examples of correction protocols include only prescribing spectacles for moderate or severe refractive error, 34 , 56 and the use of ready-made spectacles 40 , 47 .…”