Variations in schools’ commitment to health and implementation of health improvement activities: a cross-sectional study of secondary schools in Wales

Abstract

BackgroundInterventions to improve young people’s health are most commonly delivered via schools. While young people attending the lowest socioeconomic status (SES) schools report poorer health profiles, no previous studies have examined whether there is an ‘inverse care law’ in school health improvement activity (i.e., whether schools in more affluent areas deliver more health improvement). Nor have other factors that may explain variations, such as leadership of health improvement activities, been examined at a population level. This paper examines variability in delivery of health improvement actions among secondary schools in Wales, and whether variability is linked to organisational commitment to health, socioeconomic status and school size.MethodsOf the 82 schools participating in the 2013/14 Health Behaviour in School-aged Children (HBSC) survey in Wales, 67 completed a questionnaire on school health improvement delivery structures and health improvement actions within their school. Correlational analyses explore associations of delivery of health improvement activity among schools in Wales with organisational commitment to health, socioeconomic context and school size.ResultsThere is substantial variability among schools in organisational commitment to health, with pupil emotional health identified as a priority by 52 % of schools, and physical health by 43 %. Approximately half (49 %) report written action plans for pupil health. Based on composite measures, the quantity of school health improvement activity was greater in less affluent schools and schools reporting greater commitment to health. There was a consistent though non-significant trend toward more health improvement activity in larger schools. In multivariate analysis deprivation (OR = 1.06; 95 % CI = 1.01 to 1.12) and organisational commitment to health were significant independent predictors of the quantity of health improvement (OR = 1.60; 95 % CI = 1.15 to 2.22).ConclusionsThere is no evidence of an ‘inverse care law’ in school health, with some evidence of more comprehensive, multi-level health improvement activity in more deprived schools. This large-scale, quantitative analysis supports previous smaller scale, qualitative studies/process evaluations that suggest that senior management team commitment to delivering health improvement, and formulating and reviewing progress against written action plans, are important for facilitating the delivery of comprehensive interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2763-0) contains supplementary material, which is available to authorized users.

Student health and well-being in secondary schools: the role of school support staff alongside teaching staff

“…The finding that the least affluent school had the most comprehensive provision of support staff dedicated to well-being is consistent with previous literature, where a higher volume of health improvement activity has been found to be implemented in more deprived schools (Moore, Littlecott, Fletcher, Hewitt, & Murphy, 2016). However, this may lead to an oversight of the more deprived students who are attending more affluent schools who report poorer relationships with school staff (Moore et al, 2017).…”

Researchers Supporting Schools to Improve Health: Influential Factors and Outcomes of Knowledge Brokering in the COMPASS Study

“…Schools with large student enrolment were more likely to be ''involved'' in knowledge brokering, consistent with findings that large schools are more committed to improving student health. 26 Larger schools may have more staff and resources to allocate toward student health compared to smaller schools.…”

“…Similarly, in school health research, developing and evaluating knowledge exchange strategies has been identified as a priority ; while initiatives are beginning to emerge, few evaluations have been published . However, 3 strategies have been recommended for youth health research: using research summaries (eg, reports, websites, newsletters) to spark conversations with knowledge users; building research‐practice‐policy partnerships; and adapting initiatives to meet specific stakeholder needs .…”

School composition, school culture and socioeconomic inequalities in young people's health: Multi‐level analysis of the Health Behaviour in School‐aged Children (HBSC) survey in Wales

“…Wales is one of 43 countries participating in the HBSC study internationally (Roberts et al ., ). In Wales, schools were also asked to complete questionnaires on the school environment and school health‐improvement actions (Moore et al ., ). Maintained and independent secondary schools in Wales were stratified by local authority and eligibility for free school meals, then selected using probability proportionate to size (and with an element of disproportionate stratification to allow analysis at Local Health Board level).…”