Transcript SRM - AYPH

Through what processes does the school
environment influence young people’s
health?
Farah Jamal, Adam Fletcher, Angela Harden, Helene Wells, James Thomas,
Chris Bonell
Presentation by:
Farah Jamal
Research Fellow, Institute for Health & Human Development, UEL
This project was funded by the National Institute for Health Research Public Health Research
(NIHR PHR) Programme (project number 09/3002/08). Visit the PHR Programme website for more
information.
The views and opinions expressed therein are those of the authors and do not necessarily reflect
those of the PHR Programme, NIHR, NHS or the Department of Health.
Background
 Childhood and youth critical stages in the life-course
 Evidence of ‘school effects’ on health from UK and
international studies (e.g. West et al., 2004)
 This suggests ‘school environment’ approaches
needed as well as health education to promote health
 School-environment approach: promotes health by
modifying schools’ physical, social and/or cultural
environment
 However, quantitative studies of ‘school effects’
provide few insights regarding the pathways via which
they occur
Research question and methods
 Qualitative synthesis: Through what processes does the
school environment influence young people’s health?
 Qualitative studies reviewed as part of a larger mapping
and evidence synthesis project to build a more
comprehensive picture of school environment effects on
young people’s health (Bonell et al., 2013)
 Involved young people (DECIPHer’s ALPHA group),
practitioners and other researchers
• Two stages of screening to map evidence (stage 1) and
review in-depth (stage 2), including the synthesis of
qualitative studies through meta-ethnography (N=19)
Meta-ethnography approach
 Meta-ethnography treats qualitative studies as
‘data’ and ‘relates, translates and synthesizes’
these (Noblit & Hare, 1988)
 Increases the generalizability and analytic potential
of qualitative research by re-interpreting meaning
across multiple studies
 Using this approach, we developed a 4 step
method: (1) reading/re-reading included studies; (2)
grouping studies by health topic and identifying key
concepts within each topic; (3) ‘translating’ studies
across health topics to identity meta-themes; and
(4) theory development
Over-arching themes by health topic (step 2)
Aggressive
behaviours
(N=10)
(a) Performance,
collective identity, and
bonding, (b) Importance
of ‘unowned’ space, (c)
Poor staff-student
relationships, (d)
School rules and
authoritarian control
Substance use
(N=4)
(a) Performance,
collective identity, and
bonding, (b) Spaces in
the school and health
behaviours, (c) Poor
staff-student
relationships, (d) Drug
use as a source of
‘escape’
Diet (N=2)
(a) Organizational and
temporal arrangements,
(b) Importance of
physical spaces and
aesthetics, (c) The need
to ‘escape’ from school
at lunch times
Sexual health
(N=2)
(a) Poor staff-student
relationships, (b) Dis/
Empowerment
Going to the
toilets in school
(N=1)
(a) Organisational and
temporal arrangements,
(b) School rules and
authoritarian control
limit personal freedom
The school environment and health: Meta-themes (step 3)
Health-risk behaviours can be an important source of identity and bonding at school
Health-risk behaviours concentrated in unsupervised ‘hotspots’
The importance of positive staff-student relationships for promoting health
Unhappiness and stress at school can cause students to seek a means of ‘escape’
Characteristics of included studies
 Largely informed by evidence from the USA and the
UK
 Studies focused mostly on aggressive behaviours
and substance use
 Majority of studies examined views and experiences
of young people from:
– disadvantaged communities and low SES families
– Ethnic/ racial minority groups (particularly AfricanAmerican students)
– schools in urban settings
– middle-high school / secondary school
Synthesis: Themes
1) Performance, collective identity and bonding
2) The social importance of space
3) Teacher student relationships, school policies
and teacher practices
4) Ways of ‘escaping’ the school environment
Performance, collective identity &
bonding
Acting ‘tough’
 Young people (YP) often adopt ‘tough’ behaviours / ‘street’
styles at school, such as aggressive postures, smoking
cannabis and tobacco
 Such ‘performances’ can be an important source of peer
bonding and security, especially in school contexts where
YP feel educationally marginalized and/or unsafe
Gender and ‘tough’ performances
 In some cases young men showcase ‘toughness’ by playing
young women in sub-ordinate and vulnerable positions.
The social importance of space
‘Unowned’ spaces in the school
 Spaces that are unsupervised / ‘unowned’ become ‘hotspots’ for
aggressive behaviour and substance use
 These spaces are often ‘unowned’ as teachers focus only on
classroom-based instruction and not the supervision of the wider
school environment
 … which has been ‘out-sourced’ to new technologies / new
supervisory staff with little stake in the school
 This is considered by YP to be an ineffective replacement of a
caring teacher and appears only to displace problems
Chaotic and unappealing spaces
 Other spatial aspects of school canteens (e.g. crowded,
aesthetics, etc.) can limit the potential for healthy eating at
school
Teacher student relationships, school
policies and teacher practices
 Studies consistently conclude that positive teacher-student
relationships are vital for a healthy school environment,
particularly limiting ‘risky’ behaviours
 Staff-student relationships may be constrained by:
– School rules that are established and enforced by teachers
without student input or consultation
– Teachers are out of touch with the realities of young
people’s lives
– The lack of teachers supervision and support outside of the
classroom instructional environment
 Creates a vicious circle (especially for most vulnerable YP)
Ways of ‘escaping’ the school
environment
 Disengaged students often describe ‘escaping’
from their school at lunch-break to go to local
shops and/or to smoke
 Some students also report heavy alcohol and
drug use as a means of ‘escaping’ anxieties
and unhappiness about schools – either in
responses to exam stress or a constant sense
of failure and marginalisation
An extended theory and implications
 Theory of human functioning and school organisation
(Markham and Aveyard, 2003): We have extended this
theory to outline how students not only react to school
‘instructional’ and ‘regulatory’ orders but also promote
their own parallel, competing versions of these.
 Key institutional features that may be amenable to
intervention: marginalisation, lack of safety, lack of student
voice, ‘unowned’ spaces, poor student-staff relationships,
stress, etc.
 The design of interventions should be co-produced with
students so as to ensure they are appropriate and
acceptable
Published research & qualitative
studies diagram
Evidence map of
qualitative studies
n = 194
Full text not
available
n = 22
Duplicates
n= 8
Qualitative meta-ethnography
published in BMC Public
Health:
http://www.biomedcentral.com/
1471-2458/13/798
Full report published in Public
Health Research:
http://www.journalslibrary.nihr.a
c.uk/phr/volume-1/issue-1
Included
n = 58
Excluded based
on study design,
focus or language
(sift 1)
n = 106
Excluded based
on conceptual
richness/
relevance (sift 2)
n = 37
N = 21, (3 linked references)
Unique studies included for
in-depth review: n = 19
References
• Bonell C, Jamal F, Harden A, Wells H, Parry W, Fletcher A, Petticrew M,
Thomas J, Whitehead M, Campbell R, Murphy S, Moore L (2013)
Systematic review of the effects of schools and school environment
interventions on health: evidence mapping and synthesis. Public Health
Research 1(1).
• Noblit G, Hare R (1988) Meta-Ethnography: Synthesizing Qualitative
Studies. London: Sage.
• West P, Sweeting H, Leyland A (2004) School effects on pupils’ health
behaviours: evidence in support of the health promoting school.
Research Papers in Education 19: 261-291.
• Markham WA, Aveyard P: A new theory of health promoting schools
based on human functioning, school organisation and pedagogic
practice. Social Science and Medicine 2003, 56:1209-1220.
Contact details
Farah Jamal
Institute for Health and Human
Development
University of East London
UH250, Stratford
Campus
Water Lane
London
E15 4LZ
Email: [email protected]
Twitter: FarahJamal7