Health and Health Improvement in Educational Settings

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Compulsory schooling occupies much of children’s lives (estimated at over 15,000 hours), and has considerable potential to influence health, aspirations and health behaviour, at a stage when lifestyles are still formative. If educational settings – not only schools, but pre-school and tertiary educational settings - can use these opportunities effectively, they have great potential to contribute to future individual wellbeing and to the economy and society as a whole.

Although the potential benefits of interventions to school environments (‘whole school approaches’) are recognised, the evidence-base remains weak. There have been very few rigorous outcome evaluations (mostly US-based, and largely within mainstream secondary schools) and little or no evidence of the impact on health inequalities or on cost effectiveness. Despite evidence of the benefits of early intervention, there has been very little work in primary schools.

Our research builds on our strong track record in both multi-method longitudinal and cross-sectional schools-based studies, and development and evaluation. We conduct both ‘basic’ science studies aiming to describe and understand health within educational settings and how such settings impact health, and also studies focusing on development and evaluation of health-related interventions in educational settings.

Examples of more ‘basic’ science studies, aiming to describe and understand health within educational settings include:

  • A study of free school meal take-up. Scottish local authorities have a statutory duty to provide free school meals to eligible families. There has been little work to understand incomplete take-up. Analysis of Government data from 342 secondary schools found average take-up of 79%, with higher levels in schools where free meal stigma was lower, meal costs higher and eating with friends possible. These results suggest schools should encourage children paying and those receiving free meals to eat in dining halls by managing the environment in a pupil-friendly manner [Chambers 2016].
  • Oonagh Robison’s PhD explored the impact of tenure changes driven by regeneration on the pupil composition of schools in Glasgow and ultimately the impact on schools’ and pupils’ academic performance. It is known that children from poorer areas and schools in more deprived areas tend to have poorer academic outcomes than children and schools in more affluent areas. One policy approach to this is housing tenure mixing to achieve more ‘comprehensive’ schools. Analyses of Glasgow City Council data found level of owner occupation in the catchment was positively associated with both examination results at Secondary 4 (age 15) and positive destinations post-school, particularly at the more deprived end of the school spectrum. Results suggest mixed tenure policies could have positive impacts on educational outcomes in secondary schools, within a very deprived urban context [Robison 2016].
  • Our Social and Emotional Education and Development (SEED) study is an example of research focusing on development and evaluation of health-related interventions in educational settings. The SEED intervention process aimed to improve the social and emotional wellbeing of primary school pupils. The iterative process involved three components: questionnaire completion; providing benchmarked feedback to all staff; and reflexive discussion (involving all staff, led by educational psychologists) to facilitate selection and implementation of evidence-based initiatives and also some bespoke initiatives to address pupils’ needs. We conducted a stratified randomised controlled trial of SEED between 2013 and 2018. This involved 37 schools across Scotland and 2,639 pupils across two cohorts. At baseline the younger cohort were aged 4-5 and the older cohort were aged 8-9. After a one-year gap, to enable commencement of action plans, three waves of follow-up data were collected annually. The primary outcome was the Total Difficulties score from the Strengths and Difficulties Questionnaire (SDQ) at Follow-up 3, when the younger pupils were aged 8-9 and the older pupils were aged 12-13. Secondary outcomes included all five SDQ subscales. Results should be available in late 2018 or early 2019. Longer term outcomes will be explored using routine data. The Scottish Government are considering a SEED type of process for Scotland, we hope to extend that throughout the UK.
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