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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Graham F. Moore, Hannah J. Littlecott, Adam Fletcher, Gillian Hewitt, Simon Murphy

Published in: BMC Public Health | Issue 1/2016

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Abstract

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.
Appendix
Available only for authorised users
Footnotes
1
All maintained schools in Wales are regularly assessed by Estyn, the education and training inspectorate. A publicly available report is published after each inspection. Banding was a Government system of identifying schools in need of support based on their performance and pupil attendance. All maintained secondary schools in Wales were placed in one of five bands.
 
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Metadata
Title
Variations in schools’ commitment to health and implementation of health improvement activities: a cross-sectional study of secondary schools in Wales
Authors
Graham F. Moore
Hannah J. Littlecott
Adam Fletcher
Gillian Hewitt
Simon Murphy
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-2763-0

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