Variations in schools' commitment to health and implementation of health improvement activities: a cross-sectional study of secondary schools in Wales.
Variations in schools' commitment to health and implementation of health improvement activities: a cross-sectional study of secondary schools in Wales.
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DOI：
10.1186/s12889-016-2763-0
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发表时间：
2016-02-10
影响因子：
4.5
通讯作者：
Murphy S
中科院分区：
文献类型：
--
作者：
Moore GF;Littlecott HJ;Fletcher A;Hewitt G;Murphy S
改善年轻人健康的干预措施最常见的是通过学校提供。虽然参加社会经济地位最低（SES）学校的年轻人报告了较差的健康状况，但以前的研究没有研究过学校健康改善活动中是否存在“反向护理法”（即，更富裕地区的学校是否提供更多的健康改善）。也没有在人口一级审查可能解释差异的其他因素，如改善健康活动的领导作用。本文探讨在威尔士的中学之间的健康改善行动的交付的变化，以及是否与组织的承诺，健康，社会经济地位和学校规模的变化。在威尔士参加2013/14年学龄儿童健康行为调查的82所学校中，有67所完成了关于学校健康改善交付结构和学校内健康改善行动的问卷。相关性分析探讨了威尔士学校之间的健康改善活动与组织对健康，社会经济背景和学校规模的承诺之间的关联。学校对健康的组织承诺存在很大差异，52%的学校将学生情绪健康确定为优先事项，43%的学校将身体健康确定为优先事项。约有一半（49%）报告了关于学生健康的书面行动计划。综合措施的基础上，学校健康改善活动的数量更大，在不太富裕的学校和学校报告更大的健康承诺。有一个一致的，但不显着的趋势，更多的健康改善活动在较大的学校。在多变量分析中，剥夺（OR = 1.06; 95%CI = 1.01至1.12）和组织对健康的承诺是健康改善数量的重要独立预测因素（OR = 1.60; 95%CI = 1.15至2.22）。没有证据表明在学校健康方面存在“反向保健法”，但有一些证据表明，在较贫困的学校开展了更全面、多层次的健康改善活动。这种大规模的定量分析支持了以前较小规模的定性研究/过程评价，这些研究/评价表明，高级管理团队致力于改善健康状况，并根据书面行动计划制定和审查进展情况，对于促进全面干预措施的实施非常重要。本文的在线版本（doi：10.1186/s12889-016-2763-0）包含补充材料，可供授权用户使用。
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. 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. 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). 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. The online version of this article (doi:10.1186/s12889-016-2763-0) contains supplementary material, which is available to authorized users.