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Project Title: The effects of schools and school-environment interventions on health: evidence mapping and syntheses
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| Reference number: |
09/3002/08 |
| Lead: |
Dr Christopher Bonell |
| Institution: |
Senior Lecturer Social Science and Epidemiology
London School of Hygiene and Tropical Medicine |
| Protocol: |
Awaiting |
| Start date: |
1 June 2010 |
| Status: |
Research in progress |
| Methodology: |
The review will involve 3 stages: 1) a descriptive map of available evidence, plus a preliminary synthesis of intervention logic models and theories of school-level effects on health; 2) in-depth reviews and syntheses of evidence addressing our research questions; and 3) drafting of final report and other dissemination.
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| Outcome measures: |
Our syntheses of evidence will focus on the following types of health outcome (overall and by population sub-group) informed by Lee et al's existing framework: physical and emotional/mental health and wellbeing end-points; intermediate health measures (for example, health behaviours, body mass index); and health promotion outcomes (for example knowledge and attitudes relating to health). 1) What the intervention is. We will synthesise evidence on SE interventions aiming to modify the school physical, social or cultural environment via actions focused on school policies and practices relating to education, pastoral care and other aspects of school life going beyond the mere provision of health education delivered by staff or peers. These can aim to address health directly (e.g. by modifying school policies on smoking, or encouraging walking/cycling to school) or indirectly via addressing issues such as disengagement, which are established risk factors for multiple adverse outcomes (e.g. by increasing student participation in decisions, or training staff on how to re-engage disaffected students).
(2) The setting in which it will be delivered for the project and, if different, when implemented SE interventions occur in schools, i.e. educational institutions catering for those aged 4-18 (including sixth-form or other colleges for those aged 16-18).
(3) Who will deliver the intervention SE interventions are delivered by teams from the research, education and/or health sectors in collaboration with school staff, students and parents. Ultimately their actions are applied to the school through the decision of the head-teacher.
(4) Who will fund the intervention costs The project proposed is an evidence synthesis and no new intervention funding is being requested.
The following research questions will be addressed:
RQ1: What theories and conceptual frameworks are used to inform SE interventions and/or explain school-level influences on health? What testable hypotheses do these suggest regarding the effects on health?
RQ2: What are the effects of SE interventions on health and health inequalities? What are their direct and indirect costs?
RQ3: How feasible and acceptable are SE interventions? How does context affect this?
RQ4: What are the effects of other school-level factors on health?
RQ5: Through what processes might these school-level influences on health occur? |
| Sample group: |
Students, staff, parents and/or the local community of schools catering for those aged 4-18. |
| Summary: |
Research Question:
What are the effects of school environment (SE) interventions, and of school-level influences, on the health and well-being of students, staff, parents and the local community, and how can this inform the development and implementation of future interventions?
Schools can significantly affect the mental and physical health of students and staff (and perhaps parents and the local community). Some projects, called ‘school-environment’ projects try to change the way schools are run to promote health.
They do so by a variety of methods which go beyond just telling students what is healthy and what isn’t. They might involve: working with staff and students to change school policies for example on bullying or smoking; providing staff with training on how to re-engage students who don’t like school; improving catering; encouraging staff and students to walk or cycle to school; and encouraging students to take on new responsibilities such as becoming ‘mediators’ to combat bullying. Some research studies suggest these ‘school-environment’ projects can bring benefits for students such as reduced violence and drug use, increased physical activity and healthy eating. Some research also suggests that, even in the absence of these ‘school-environment’ projects, some schools simply have healthier students than others. These differences can’t be explained away simply because the schools admit different sorts of students or are in different sorts of neighbourhoods. The differences seem to reflect how the schools are run and the quality of relationships between students and staff. But we also know that the picture is complicated: some projects that try to make schools healthier places don’t work. And some health issues, like obesity, don’t always seem to vary much between schools. To decide what sorts of actions schools in the UK should take to improve health, we need to be clear about what existing research tells us. We need information on the benefits (and perhaps the harms) that specific ‘school-environment’ projects have brought about, how these projects were carried out, whether they were acceptable to students and staff, and how much they cost. We also want to know what it is about some schools that make them healthier than other schools even in the absence of a specific 'school-environment' project. This isn’t an easy task because the projects are given all sorts of different names, and published all over the world in all sorts of publications. We want to undertake a comprehensive search for these studies. We will do this using online and other computer-based methods, as well as reading through scientific journals and asking experts in this field. We will then judge which studies have been done well so that they provide the most accurate information. Finally, we will summarise what this research tells us and then recommend what actions UK schools and the government should take in the light of what we find. |
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