Use of economic evidence when prioritising public health interventions in schools: a qualitative study with school staff

Schools are an ideal setting to deliver public health interventions, yet there are competing obligations that could limit their implementation. This study aimed to examine the decision-making process and explore what evidence informs prioritisation of public health interventions in this setting. Semi-structured interviews were conducted with 14 staff in seven UK schools between November 2017 and March 2018. Participants were recruited from schools participating in The Birmingham Daily Mile trial and comprised leadership staff, teachers, and pastoral staff. Analyses used a constant comparison approach to explore the prioritisation process and schools’ use of economic evidence. Teachers felt that they had little decision-making influence in regard to public health interventions, with this falling on leadership staff. Participants perceived tension between delivering academic subjects and public health initiatives, and thought proven impact was important to justify the opportunity cost. Evidence did not appear to be routinely used, and participants were unaware of cost-effectiveness analyses, but thought it could be a useful tool. This study shows that schools face challenges in balancing the academic, health and wellbeing needs of children. There is a need for targeted evidence that includes appropriate costs and outcomes and meets school decision makers’ needs.
Keywords: Schools; economic evaluation; qualitative research; decision making; cost-effectiveness