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Improving young people's health and well-being through a school health research network: Reflections on school–researcher engagement at the national level
Abstract
The School Health Research Network is a policy–practice–research partnership established in Wales in 2013. The network aims to: provide health and well-being data for national, regional and local stakeholders, including schools; co-produce school-based health improvement
research for Wales; and build capacity for evidence-informed practice in the school health community. School-focused engagement activities include providing member schools with bespoke Student Health and Well-being Reports, hosting school health webinars, producing schoolfriendly research
briefings and holding annual events for schools. The network's model for co-producing research with schools is described and its impacts on schools is explored. These include more efficient recruitment of schools to research projects, school involvement in intervention development, schools
beginning to embed evidence-informed practice by using their Health and Well-being Reports and other network resources, and securing funding to evaluate innovative health and well-being practices identified by schools. Drawing on the transdisciplinary action research (TDAR) literature, the
article reflects on how TDAR principles have underpinned the progress of the network. The concept of reciprocity in the co-production literature, and its relevance to engagement with schools, is also explored, along with the network's contribution to our understanding of how we can build sustainable
co-production at large scale in order to generate nationallevel action and benefit.
... Amlygwyd hyn hefyd fel blaenoriaeth allweddol ar gyfer y Pwyllgor Plant Pobl Ifanc ac Addysg wrth iddo ymgynghori ar ei raglen waith yn fuan wedi'r etholiad diweddaraf yng Nghymru ym mis Mai 2016. Dengys y llenyddiaeth (Iechyd Cyhoeddus Cymru 2022;Hewitt et al. 2018) bod gan bawb sy'n ymwneud â phlant a phobl ifanc rôl i'w chwarae wrth gefnogi eu lles a'u hiechyd meddwl, a dyma'r sail i'r canllawiau statudol a amlinellir yn y Fframwaith (LlC 2021a). ...
... Fel rhan o'u hymchwil yn seiliedig ar dystiolaeth, mae disgyblion ysgol yn llenwi arolwg iechyd a lles a holiadur amgylchedd ysgol bob dwy flynedd, ac mae pob ysgol yn derbyn adroddiad ar iechyd a lles eu dysgwyr. Casglodd yr arolwg diweddaraf yn 2021-22 ddata oddi wrth 123,204 o ddysgwyr rhwng 11 ac 16 oed o 202 o ysgolion uwchradd (Hewitt et al. 2018). O'u cymharu â data blaenorol o 2019-20, dengys y data cyfredol fod dirywiad cyffredinol o safbwynt lles ac iechyd meddwl dysgwyr yng Nghymru. ...
... O'u cymharu â data blaenorol o 2019-20, dengys y data cyfredol fod dirywiad cyffredinol o safbwynt lles ac iechyd meddwl dysgwyr yng Nghymru. Dwy elfen a ddylanwadodd ar y dirywiad hwn mewn lles meddyliol oedd y cynnydd mewn dysgwyr a oedd yn profi unigrwydd a symptomau iselder clinigol sylweddol (Hewitt et al. 2018). Daeth awduron yr adroddiad ymchwil i'r casgliad bod angen monitro'r arwyddion hyn ymhellach (a rhai eraill perthnasol mewn perthynas â lles ac iechyd meddwl) nid yn unig er mwyn gwella dealltwriaeth o dueddiadau hirdymor poblogaeth Cymru ond hefyd er mwyn sicrhau bod y canllawiau statudol newydd ar sefydlu dull ysgol gyfan yn parhau i fod yn flaenoriaeth o ran polisi ac ymarfer (Hewitt et al. 2018). ...
The decline in relation to mental health issues among children and young people in Wales (School Health Research Network [SHRN] 2023) and recent curriculum reform (Welsh Government [WG] 2022) has led to the introduction of statutory guidance to promote a whole-school approach in supporting positive emotional and mental well-being among all stakeholders within the school community (WG 2021). The ‘Framework on embedding a whole-school approach to emotional and mental well-being’ (the Framework) (WG 2021) focuses on embedding the three core values of ‘belonging’, ‘efficacy’, and ‘voice’ across all aspects of school provision to create a positive social and emotional community. This integrative review explores literature that focuses on whole-school approaches to emotional and mental well-being and identifies some key facilitators and barriers in its successful implementation. Findings suggest that many schools are still not fully engaging with the Framework (WG 2021), particularly regarding the whole-school approach, and this paper concludes with some recommendations regarding the way forward.
... The 35 included articles were mainly in the United States (n = 14) [16][17][18][19][20][21][22][23][24][25][26][27][28][29], Canada (n = 5) [30][31][32][33][34], Sweden (n = 2) [35,36], and in other single locations such as Australia, Brazil, Burundi, India, Kenya, and Nigeria, among others (n = 14) [37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Of those included, 16 articles were qualitative studies [18, 20, 25, 28, 31-36, 44, 45, 47-50], nine were non-empirical papers [19,22,23,[37][38][39][41][42][43], four were quantitative studies [26,27,29,40], and six were mixed methods [16,17,21,24,30,46]. Eleven studies reported a population of interest, which were mainly Indigenous groups [31,34,48], older adults [19], patients in patient group programmes [21,27], academic faculty and researchers [40], and mental health practitioners [16], among others. ...
... The 35 included articles were mainly in the United States (n = 14) [16][17][18][19][20][21][22][23][24][25][26][27][28][29], Canada (n = 5) [30][31][32][33][34], Sweden (n = 2) [35,36], and in other single locations such as Australia, Brazil, Burundi, India, Kenya, and Nigeria, among others (n = 14) [37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Of those included, 16 articles were qualitative studies [18, 20, 25, 28, 31-36, 44, 45, 47-50], nine were non-empirical papers [19,22,23,[37][38][39][41][42][43], four were quantitative studies [26,27,29,40], and six were mixed methods [16,17,21,24,30,46]. Eleven studies reported a population of interest, which were mainly Indigenous groups [31,34,48], older adults [19], patients in patient group programmes [21,27], academic faculty and researchers [40], and mental health practitioners [16], among others. The article characteristics are summarised in Appendix 3. ...
... On the other hand, nine reports [19,22,23,[37][38][39][41][42][43], which were found in the same databases, were assessed with the AACODS checklist. The main limitations identified were the lack of methodology reporting and clear coverage limits. ...
Background
Evidence networks facilitate the exchange of information and foster international relationships among researchers and stakeholders. These networks are instrumental in enabling the integration of scientific evidence into decision-making processes. While there is a global emphasis on evidence-based decision-making at policy and organisational levels, there exists a significant gap in our understanding of the most effective activities to exchange scientific knowledge and use it in practice. The objective of this rapid review was to explore the strategies employed by evidence networks to facilitate the translation of evidence into decision-making processes. This review makes a contribution to global health policymaking by mapping the landscape of knowledge translation in this context and identifying the evidence translation activities that evidence networks have found effective.
Methods
The review was guided by standardised techniques for conducting rapid evidence reviews. Document searching was based on a phased approach, commencing with a comprehensive initial search strategy and progressively refining it with each subsequent search iterations. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.
Results
The review identified 143 articles, after screening 1135 articles. Out of these, 35 articles were included in the review. The studies encompassed a diverse range of countries, with the majority originating from the United States (n = 14), followed by Canada (n = 5), Sweden (n = 2), and various other single locations (n = 14). These studies presented a varied set of implementation strategies such as research-related activities, the creation of teams/task forces/partnerships, meetings/consultations, mobilising/working with communities, influencing policy, activity evaluation, training, trust-building, and regular meetings, as well as community-academic-policymaker engagement.
Conclusions
Evidence networks play a crucial role in developing, sharing, and implementing high-quality research for policy. These networks face challenges like coordinating diverse stakeholders, international collaboration, language barriers, research consistency, knowledge dissemination, capacity building, evaluation, and funding. To enhance their impact, sharing network efforts with wider audiences, including local, national, and international agencies, is essential for evidence-based decision-making to shape evidence-informed policies and programmes effectively.
... In education, though less extensive and developed than health, there are examples of partnerships and networks which focus on raising the profile of research and are likely to increase capacity for collaborative research. Once such example is the School Health Research Network, a policy-practice-research partnership established in Wales in (Hewitt et al., 2018). ...
... generate a greater sense of shared ownership of research, are required. The understanding of reciprocity in collaborative work is little explored, but has relevance here(Hewitt et al., 2018).A final reflection on the situation with the data analysts, relates to the discussion in earlier chapters, of the challenge in RCTs of combining flexible and 'soft' engagement processes whilst maintaining scientific integrity arising from independence and clear boundaries. The use of 'blinding' is central to the rigour of the RCT design (Akobeng, 2005). ...
Background. The past two decades have seen great interest in the development and evaluation of complex social interventions. The randomised controlled trial (RCT) is the normative research design for these evaluations and academic-practitioner collaboration in the conduct of studies is increasingly common to maximise rigour and relevance. However, gaps remain in what is known about how collaboration can be most effective in the co-production of knowledge. Practical examples of academic-practitioner collaboration can address these knowledge gaps. Aim: To demonstrate the development of academic-practitioner collaboration in the conduct of RCTs of complex health and education interventions through practical examples spanning two decades. Methods: Insider research drew on: four of my publications; experience of working on RCTs; and wider experience, gained over 20 years, working as a health visitor. Findings and conclusions: A general trend, in studies, across time is shown of: more relevant practitioners actively involved; in increasingly varied and influential study roles; with greater capacity to contribute to the research process. Improved management of the boundary between intervention and evaluation is also demonstrated. These trends have increased the potential for a more equal and effective blend of academic and practitioner knowledge and as such the co-production of more useful research. Key practitioner voices have been missing from decision-making processes in RCTs, however, which is likely to have had a negative impact on the utility of the findings. Creative approaches to collaboration, utilising skills in interpersonal relations, awareness of context and spanning of boundaries can bring these harder to reach voices into the research process. These are skills central to health visiting practice. Although health visitors are relatively new to RCTs they are well positioned to be part of the process of conducting the rigorous and relevant RCTs that are important in the development of services, including health visiting.
... Aware of the limitations of employing a standardised tool to capture impact, we set out to develop research methods in collaboration with young people that would be aligned with the nature of TCT programmes. There is a growing body of literature which supports the employment of more creative methods, especially when working with children and young people (Brady and Preston, 2020;Caslin, 2019;Hewitt et al., 2018). The importance of young people taking on the role of researcher has also been acknowledged (Elmore et al., 2019;Hopkins et al., 2017). ...
Assessing the impact of community-based programmes presents many challenges. One difficulty encountered is how to develop appropriate research methods to capture the impact of the work while also meeting the demands of external funders. For almost two decades, the charity organisation The Comedy Trust (TCT) have attempted to navigate these challenges. In 2018, TCT had the opportunity to work with a university-based researcher to develop their approaches to research. We aimed to explore what happens when you move away from quantifiable predetermined methods to take a more participatory approach to work alongside the participants of the programme. We decided to focus on their Feeling Funny Youth programme, which is aimed at young people to support their mental health and well-being. This paper is a case study of how the programme worked with a group of young people based within a youth organisation. In this paper, we offer a comparison of the standardised tool adopted by TCT with the development of more creative and participatory methods developed in collaboration with young people who participated in the programme. We offer an insight into what can be gained by adopting more creative and participatory methods to capture the experiences of young people, as this enabled us to really hear the important messages they want to share.
... Socio-economic status was identified through levels of pupil entitlement to the provision of free school meals (FSM), which have been confirmed as a reliable measure of socio-economic status (Taylor, 2018). For Wales, where 'ever-use of e-cigarette' rates by school from 2015 were available from the School Health Research Network (SHRN) survey (Hewitt, Roberts, Fletcher, Moore & Murphy, 2018), this was used to select across a range of school-level vaping rates. Group work was conducted with Year 10 students in England and Wales and S3 students in Scotland (i.e. ...
Background:
Growth of e-cigarette use among smokers has raised concerns over uptake by non-smokers, particularly young people. Legislative changes aimed in part at reducing youth exposure to e-cigarettes include the EU Tobacco Products Directive (TPD). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research.
Methods:
This paper reports results from twenty-one group interviews with 14-15 year olds in Wales, England and Scotland, conducted as part of an ongoing evaluation of the impact of the TPD on youth smoking and e-cigarette use. Interviews were conducted around the end of the transitional period for TPD implementation, and explored perceptions of e-cigarettes and tobacco, as well as similarities and differences between them.
Results:
Young people differentiated between tobacco and e-cigarettes, rejecting the term e-cigarette in favour of alternatives such as 'vapes'. Experimental or occasional use was common and generally approved of where occurring within social activity with peers. However, regular use outside of this context was widely disapproved of, unless for the purpose of stopping smoking. Increased prevalence of e-cigarettes did not challenge strongly negative views of smoking or reduce perceived harms caused by it, with disapproval of smoking remaining high. Nicotine use was variable, with flavour a stronger driver for choice of e-liquid, and interest more generally.
Conclusion:
The extent to which participants differentiated between vaping and smoking, including styles and reasons for use in adults and young people; absence of marketing awareness; and continued strong disapproval of smoking provides limited support for some of the potential mechanisms through which e-cigarettes may renormalise smoking. However caution over nicotine exposure is still necessary.
... The research network is a Welsh infrastructure for school-based health improvement research. It conducts biannual surveys with member secondary schools in Wales and provides bespoke pupil health and wellbeing reports to schools outlining statistics relating to their pupils' levels of diet, physical activity, substance use, mental health and wellbeing, as well as a broad range of other school engagement action [15,31]. In 2014, there were 69 member schools [5]. ...
Challenges in changing school system functioning to orient them towards health are commonly underestimated. Understanding the social interactions of school staff from a complex systems perspective may provide valuable insight into how system dynamics may impede or facilitate the promotion of health and wellbeing. Ego social network analysis was employed with wellbeing leads within four diverse case study schools to identify variability in embeddedness of health and wellbeing roles. This variation, as well as the broader context, was then explored through semi-structured qualitative interviews with school staff and a Healthy Schools Coordinator, sampled from the wellbeing leads’ ego-networks. Networks varied in terms of perceived importance and frequency of interactions, centrality, brokerage and cliques. Case study schools that showed higher engagement with health and wellbeing had highly organised, distributed leadership structures, dedicated wellbeing roles, senior leadership support and outside agencies embedded within school systems. Allocation of responsibility for wellbeing to a member of the senior leadership team alongside a distributed leadership approach may facilitate the reorientation of school systems towards health and wellbeing. Ego-network analysis to understand variance in complex school system starting points could be replicated on a larger scale and utilised to design complex interventions.
... Engagement with how systems work before attempting to change them, as advocated from a CAS perspective, is a key characteristic of the School Health Research Network (SHRN). SHRN (Hewitt et al. 2018) was launched in Wales in 2013 as a strategic partnership between Cardiff University, Welsh Government, Public Health Wales (part of the National Health Service in Wales) and Cancer Research UK (a research-focused charity). Network members are schools serving mainstream students aged 11 to 18 years. ...
The paper reflects on a transdisciplinary complex adaptive systems (T-CAS) approach to the development of a school health research network (SHRN) in Wales for a national culture of prevention for health improvement in schools. A T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The theory highlights the importance of establishing transdisciplinary strategic partnerships to identify and develop opportunities for system reorientation. Investment in and the linking of resources develops the capacity for key social agents to take advantage of disruption points in the re-orientated system, and engagement activities develop the network to facilitate new social interactions and opportunities for transdisciplinary activities. A focus on transdisciplinary action research to co-produce interventions, generate research evidence and inform policy and practice is shown to play an important part in developing new normative processes that act to self-regulate the emerging system. Finally, the provision of reciprocal network benefits provides critical feedback loops that stabilise the emerging adaptive system and promote the network cycle. SHRN is shown to have embedded itself in the system by securing sustainability funding from health and education, a key role in national and regional planning and recruiting every eligible school to the network. It has begun to reorient the system to one of evidence generation (56 research studies co-produced) and opportunities for data-led practice at multiple levels. Further capacity development will be required to capitalise on these. The advantages of a complex systems approach to address barriers to change and the transferability of a T-CAS network approach across settings and cultures are highlighted.
... This study used data collected from the School Health Research Network Student Health and Well-being Survey of secondary schools in Wales in 2015. 23 Out of the 113 schools invited to take part, 23% (n=26) schools did not take part and 9.7% (n=11) schools opted out of questions on drug use. These schools were excluded from the analysis. ...
Objectives
To examine whether young peoples’ risk of cannabis, mephedrone and novel psychoactive substances (NPS) use is associated with school substance-misuse policy.
Design
A cross-sectional survey of secondary school students combined with a School Environment Questionnaire and independently coded school substance-misuse policies (2015/6).
Setting
66 secondary schools in Wales.
Participants
Students aged 11–16 years (n=18 939).
Results
The prevalence of lifetime, past 30-day and daily cannabis use was 4.8%, 2.6% and 0.7%, respectively; lifetime prevalence of mephedrone use was 1.1% and NPS use was 1.5%. Across 66 schools, 95.5% (n=63) reported having a substance-misuse policy, 93.9% (n=62) reported having a referral pathway for drug using students, such that we were insufficiently powered to undertake an analysis. We found little evidence of a beneficial association between lifetime cannabis use and involving students in policy development including student council consultation (OR=1.24, 95% CI 0.89 to 1.73), other student consultation (OR=1.42, 95% CI 0.94 to 2.14) or with the use of isolation (OR=0.98, 95% CI 0.67 to 1.43), with similar results for cannabis use in past 30 days, daily and the lifetime use of mephedrone and NPS. The School Environment Questionnaires found that 39.4% (n=26) schools reported no student involvement in policy development, 42.4% (n=28) reported student council consultation, 18.2% (n=12) used other student consultations and 9.7% (n=3) mentioned isolation. The independently coded content of policies found that no school policy recommended abstinence, one mentioned methods on harm minimisation, 16.1% (n=5) policies mentioned student involvement and 9.7% (n=3) mentioned isolation.
Conclusions
Policy development involving students is widely recommended, but we found no beneficial associations between student involvement in policy development and student drug use. This paper has highlighted the need for further contextual understanding around the policy-development process and how schools manage drug misuse.
Objectives
To coproduce a school-based protocol and examine acceptability and feasibility of collecting saliva samples for genetic studies from secondary/high school students for the purpose of mental health research.
Design
Protocol coproduction and mixed-methods feasibility pilot.
Setting
Secondary schools in Wales, UK.
Participants
Students aged 11–13 years.
Primary and secondary outcome measures
Coproduced research protocol including an interactive science workshop delivered in schools; school, parental and student recruitment rates; adherence to protocol and adverse events; ability to extract and genotype saliva samples; student enjoyment of the science workshop and qualitative analysis of teacher focus groups on acceptability and feasibility.
Results
Five secondary schools participated in the coproduction phase, and three of these took part in the research study (eligible sample n=868 students). Four further schools were subsequently approached, but none participated. Parental opt-in consent was received from 98 parents (11.3% eligible sample), three parents (0.3%) actively refused and responses were not received for 767 (88.4%) parents. We obtained saliva samples plus consent for data linkage for 79 students. Only one sample was of insufficient quality to be genotyped. The science workshop received positive feedback from students. Feedback from teachers showed that undertaking research like this in schools is viewed as acceptable in principle, potentially feasible, but that there are important procedural barriers to be overcome. Key recommendations include establishing close working relationships between the research team and school classroom staff, together with improved methods for communicating with and engaging parents.
Conclusions
There are major challenges to undertaking large-scale genetic mental health research in secondary schools. Such research may be acceptable in principle, and in practice DNA collected from saliva in classrooms is of sufficient quality. However, key challenges that must be overcome include ensuring representative recruitment of schools and sufficient parental engagement where opt-in parental consent is required.
Young people's wellbeing is often lowest where they assume a relatively low position within their school's socioeconomic hierarchy, for example, among poorer children attending more affluent schools. Transition to secondary school is a period during which young people typically enter an environment which is more socioeconomically diverse than their primary school. Young people joining a school with a higher socioeconomic status intake relative to their primary school may assume a relatively lowered position within their school’s socioeconomic hierarchy, experiencing a detriment to their wellbeing as a consequence. This article draws on data from 45,055 pupils in Years 7 and 8, from 193 secondary schools in Wales, who completed the 2017 Student Health Research Network (SHRN) Student Health and Wellbeing (SHW) survey. Pupils reported which primary school they previously attended, and survey data on wellbeing were linked to publicly available data on the free school meal entitlement of schools attended. In cross‐classified linear mixed‐effects models, with primary and secondary school as levels, mental wellbeing varied significantly according to both primary and secondary school attended. A higher school‐level deprivation was associated with worse mental wellbeing in both cases. Mental wellbeing was significantly predicted by the relative affluence of a child's primary and secondary school, with movement to a secondary school of higher overall socioeconomic status associated with lowered wellbeing. These findings highlight transition to secondary school as a key point in which socioeconomic inequality in wellbeing may widen, and thus as an important focal point for intervention to reduce health inequalities.
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