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

Moore, Graham ORCID:, Littlecott, Hannah ORCID:, Fletcher, Adam ORCID:, Hewitt, Gillian ORCID: and Murphy, Simon ORCID: 2016. Variations in schools’ commitment to health and implementation of health improvement activities: a cross-sectional study of secondary schools in Wales. BMC Public Health 16 , 138. 10.1186/s12889-016-2763-0

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Background Interventions 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. Methods Of 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. Results There 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). Conclusions There 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Social Sciences (Includes Criminology and Education)
Subjects: H Social Sciences > H Social Sciences (General)
Publisher: BioMed Central
ISSN: 1471-2458
Funders: MRC
Date of First Compliant Deposit: 30 March 2016
Date of Acceptance: 21 January 2016
Last Modified: 31 Oct 2022 10:55

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