The Effectiveness and Acceptability of Comprehensive and Multicomponent School Health Services: A Systematic Review

Paul Montgomery; Wendy Knerr; David A. Ross; Jacoby Patterson

doi:10.1016/j.jadohealth.2021.08.010

The Effectiveness and Acceptability of Comprehensive and Multicomponent School Health Services: A Systematic Review

Paul Montgomery^*, Wendy Knerr, David A. Ross, Jacoby Patterson

^*Corresponding author for this work

Social Policy, Sociology and Criminology

Research output: Contribution to journal › Review article › peer-review

1 Citation (Scopus)

Abstract

Purpose: Comprehensive school-based health services were reviewed as part of preparing World Health Organization guidelines.

Methods: Six databases were searched for controlled trials with schoolchildren aged 5–19 years, involving school-linked health services incorporating 4 of 7 health areas.

Results: Seventeen quasi-experimental studies conducted in high-income countries found school health services associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p < .01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p < .05), emergency department visits (odds ratio .85, 95% CI .75 to .95, p = .006), school absence (odds ratio .78, 95% CI .69 to .87, p < .0001), carrying weapons (male: 16.1% vs. 25.1%, p < .01), fighting (male: 32.6% vs. 43.1%, p < .01), sexual activity (53.5% vs. 60.5%, p < .05), drinking alcohol (60.1% vs. 70.5%, p < .001), using drugs (28.0% vs. 38.3%, p < .001), and physical activity (female: 57.4% vs. 50.4%, p < .01). They can be cost-saving, were also associated with smoking and less contraceptive use, and had no effect on depression prevalence. Acceptability/satisfaction was good. The certainty of evidence was low to moderate. Heterogeneity was high for some outcomes.

Conclusions: Results suggest moderate desirable and trivial undesirable effects of school health services in high-income countries. This article compiles evidence on effectiveness, cost-effectiveness, and acceptability into one review, enabling decision-makers to consider all essential factors.

Original language	English
Pages (from-to)	192-207
Number of pages	16
Journal	Journal of Adolescent Health
Volume	70
Issue number	2
Early online date	21 Sept 2021
DOIs	https://doi.org/10.1016/j.jadohealth.2021.08.010
Publication status	Published - Feb 2022

Bibliographical note

Funding Information:
This work was supported by Program Grant 300350 (Improving information and accountability for women's, children's and adolescents' health) from the UK Department for International Development (DFID) to the World Health Organization (WHO) and Grant 69315 “Programme development for reproductive health” awarded to WHO by the United States Agency for International Development (USAID). D.A.R. is a former staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.The authors gratefully acknowledge Dr. Sarah Dawson, Information Scientist at the University of Bristol, for help with database searching and Dr. Anders M. Bach-Mortensen, Department of Social Policy and Intervention, University of Oxford, for his work with screening and data extraction. They also acknowledge the members of the School Health Services (SHS) Guideline Steering Group within the WHO Secretariat and UNESCO Headquarters, the SHS Guideline Development Group and external reviewers, and especially Dr. Nandi Siegfried, the SHS Guideline methodologist, and Dr. Kid Kohl for valuable feedback on earlier drafts.

Funding Information:
This work was supported by Program Grant 300350 (Improving information and accountability for women's, children's and adolescents' health) from the UK Department for International Development (DFID) to the World Health Organization (WHO) and Grant 69315 “Programme development for reproductive health” awarded to WHO by the United States Agency for International Development (USAID). D.A.R. is a former staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Publisher Copyright:
© 2021 Society for Adolescent Health and Medicine

Keywords

Acceptability
Adolescent health
Child health
Effectiveness
School health services
Systematic review

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Public Health, Environmental and Occupational Health
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jadohealth.2021.08.010Licence: None: All rights reserved

Cite this

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title = "The Effectiveness and Acceptability of Comprehensive and Multicomponent School Health Services: A Systematic Review",

abstract = "Purpose: Comprehensive school-based health services were reviewed as part of preparing World Health Organization guidelines. Methods: Six databases were searched for controlled trials with schoolchildren aged 5–19 years, involving school-linked health services incorporating 4 of 7 health areas. Results: Seventeen quasi-experimental studies conducted in high-income countries found school health services associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p < .01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p < .05), emergency department visits (odds ratio .85, 95% CI .75 to .95, p = .006), school absence (odds ratio .78, 95% CI .69 to .87, p < .0001), carrying weapons (male: 16.1% vs. 25.1%, p < .01), fighting (male: 32.6% vs. 43.1%, p < .01), sexual activity (53.5% vs. 60.5%, p < .05), drinking alcohol (60.1% vs. 70.5%, p < .001), using drugs (28.0% vs. 38.3%, p < .001), and physical activity (female: 57.4% vs. 50.4%, p < .01). They can be cost-saving, were also associated with smoking and less contraceptive use, and had no effect on depression prevalence. Acceptability/satisfaction was good. The certainty of evidence was low to moderate. Heterogeneity was high for some outcomes. Conclusions: Results suggest moderate desirable and trivial undesirable effects of school health services in high-income countries. This article compiles evidence on effectiveness, cost-effectiveness, and acceptability into one review, enabling decision-makers to consider all essential factors.",

keywords = "Acceptability, Adolescent health, Child health, Effectiveness, School health services, Systematic review",

author = "Paul Montgomery and Wendy Knerr and Ross, {David A.} and Jacoby Patterson",

note = "Funding Information: This work was supported by Program Grant 300350 (Improving information and accountability for women's, children's and adolescents' health) from the UK Department for International Development (DFID) to the World Health Organization (WHO) and Grant 69315 “Programme development for reproductive health” awarded to WHO by the United States Agency for International Development (USAID). D.A.R. is a former staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.The authors gratefully acknowledge Dr. Sarah Dawson, Information Scientist at the University of Bristol, for help with database searching and Dr. Anders M. Bach-Mortensen, Department of Social Policy and Intervention, University of Oxford, for his work with screening and data extraction. They also acknowledge the members of the School Health Services (SHS) Guideline Steering Group within the WHO Secretariat and UNESCO Headquarters, the SHS Guideline Development Group and external reviewers, and especially Dr. Nandi Siegfried, the SHS Guideline methodologist, and Dr. Kid Kohl for valuable feedback on earlier drafts. Funding Information: This work was supported by Program Grant 300350 (Improving information and accountability for women's, children's and adolescents' health) from the UK Department for International Development (DFID) to the World Health Organization (WHO) and Grant 69315 “Programme development for reproductive health” awarded to WHO by the United States Agency for International Development (USAID). D.A.R. is a former staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. Publisher Copyright: {\textcopyright} 2021 Society for Adolescent Health and Medicine",

year = "2022",

month = feb,

doi = "10.1016/j.jadohealth.2021.08.010",

language = "English",

volume = "70",

pages = "192--207",

journal = "Journal of Adolescent Health",

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T1 - The Effectiveness and Acceptability of Comprehensive and Multicomponent School Health Services

T2 - A Systematic Review

AU - Montgomery, Paul

AU - Knerr, Wendy

AU - Ross, David A.

AU - Patterson, Jacoby

N1 - Funding Information: This work was supported by Program Grant 300350 (Improving information and accountability for women's, children's and adolescents' health) from the UK Department for International Development (DFID) to the World Health Organization (WHO) and Grant 69315 “Programme development for reproductive health” awarded to WHO by the United States Agency for International Development (USAID). D.A.R. is a former staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.The authors gratefully acknowledge Dr. Sarah Dawson, Information Scientist at the University of Bristol, for help with database searching and Dr. Anders M. Bach-Mortensen, Department of Social Policy and Intervention, University of Oxford, for his work with screening and data extraction. They also acknowledge the members of the School Health Services (SHS) Guideline Steering Group within the WHO Secretariat and UNESCO Headquarters, the SHS Guideline Development Group and external reviewers, and especially Dr. Nandi Siegfried, the SHS Guideline methodologist, and Dr. Kid Kohl for valuable feedback on earlier drafts. Funding Information: This work was supported by Program Grant 300350 (Improving information and accountability for women's, children's and adolescents' health) from the UK Department for International Development (DFID) to the World Health Organization (WHO) and Grant 69315 “Programme development for reproductive health” awarded to WHO by the United States Agency for International Development (USAID). D.A.R. is a former staff member of the World Health Organization. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. Publisher Copyright: © 2021 Society for Adolescent Health and Medicine

PY - 2022/2

Y1 - 2022/2

N2 - Purpose: Comprehensive school-based health services were reviewed as part of preparing World Health Organization guidelines. Methods: Six databases were searched for controlled trials with schoolchildren aged 5–19 years, involving school-linked health services incorporating 4 of 7 health areas. Results: Seventeen quasi-experimental studies conducted in high-income countries found school health services associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p < .01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p < .05), emergency department visits (odds ratio .85, 95% CI .75 to .95, p = .006), school absence (odds ratio .78, 95% CI .69 to .87, p < .0001), carrying weapons (male: 16.1% vs. 25.1%, p < .01), fighting (male: 32.6% vs. 43.1%, p < .01), sexual activity (53.5% vs. 60.5%, p < .05), drinking alcohol (60.1% vs. 70.5%, p < .001), using drugs (28.0% vs. 38.3%, p < .001), and physical activity (female: 57.4% vs. 50.4%, p < .01). They can be cost-saving, were also associated with smoking and less contraceptive use, and had no effect on depression prevalence. Acceptability/satisfaction was good. The certainty of evidence was low to moderate. Heterogeneity was high for some outcomes. Conclusions: Results suggest moderate desirable and trivial undesirable effects of school health services in high-income countries. This article compiles evidence on effectiveness, cost-effectiveness, and acceptability into one review, enabling decision-makers to consider all essential factors.

AB - Purpose: Comprehensive school-based health services were reviewed as part of preparing World Health Organization guidelines. Methods: Six databases were searched for controlled trials with schoolchildren aged 5–19 years, involving school-linked health services incorporating 4 of 7 health areas. Results: Seventeen quasi-experimental studies conducted in high-income countries found school health services associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p < .01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p < .05), emergency department visits (odds ratio .85, 95% CI .75 to .95, p = .006), school absence (odds ratio .78, 95% CI .69 to .87, p < .0001), carrying weapons (male: 16.1% vs. 25.1%, p < .01), fighting (male: 32.6% vs. 43.1%, p < .01), sexual activity (53.5% vs. 60.5%, p < .05), drinking alcohol (60.1% vs. 70.5%, p < .001), using drugs (28.0% vs. 38.3%, p < .001), and physical activity (female: 57.4% vs. 50.4%, p < .01). They can be cost-saving, were also associated with smoking and less contraceptive use, and had no effect on depression prevalence. Acceptability/satisfaction was good. The certainty of evidence was low to moderate. Heterogeneity was high for some outcomes. Conclusions: Results suggest moderate desirable and trivial undesirable effects of school health services in high-income countries. This article compiles evidence on effectiveness, cost-effectiveness, and acceptability into one review, enabling decision-makers to consider all essential factors.

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KW - Adolescent health

KW - Child health

KW - Effectiveness

KW - School health services

KW - Systematic review

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DO - 10.1016/j.jadohealth.2021.08.010

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AN - SCOPUS:85115313698

SN - 1054-139X

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JO - Journal of Adolescent Health

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IS - 2

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The Effectiveness and Acceptability of Comprehensive and Multicomponent School Health Services: A Systematic Review

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this