Background
Research questions
Methods
Semi-structured interviews
Sampling and recruitment strategy
Analysis
Theme | Sub-themes |
---|---|
School of role in health promotion | Link between health and attainment Health domains of concern – students Health domains of concern – staff Role of schools/Trusts in health promotion |
Decision-making | Health strategy or policy development Health strategy or policy implementation Locus – academy school, Trust, or MAT executive Health budget Health in strategic planning Implementing change across schools and MATs Use of research evidence (and source) Accountability for health promotion activity |
Health-promoting initiatives undertaken in schools and Trusts | Domain (e.g. student mental health; obesity, risk behaviours) Curriculum School environment Staff training Ethos Staff/pupil relationship Staff health initiatives Involvement of parents and wider community Involvement of students Facilitators to implementing initiatives Barriers to implementing initiatives Outcomes of initiatives |
Links with external agencies | Delivering initiatives in schools/Trusts Health professionals in schools/Trusts Links with Public Health teams Links with statutory health services Other health-related services Healthy schools audit |
Health data | Existing/historical health data collected by school/Trust Data from external bodies e.g. local authority, NHS, Public Health England Use of data Missing/inaccessible health data would like to have |
Networks | MAT (within and across MATs) School to school Informal networking Local authority links and networks Other networks around health promotion |
Drivers for health promotion | Motivating factors for health promotion activity Barriers to undertaking health promotion |
Undertaking health research | Experience of working with academia/public health researchers Motivation for involvement in research Barriers to undertaking research Facilitators for undertaking research |
Results
Sample
Academy school/trust participants (Denoted in quotations as AS) | Participants (N = 25) | |
Characteristic
| Category | |
Trust Size | SAT | 5 |
Small-medium MAT (≤ 20 schools) | 15 | |
Large MAT (> 20 schools) | 4 | |
Federation
| 1 | |
Role | CEO | 9 |
Deputy CEO | 1 | |
Trustee/Director | 3 | |
Other member of Executive Team | 3 | |
Head teacher | 3 | |
Assistant head teacher | 3 | |
School Wellbeing Lead | 3 | |
Non-school/trust participants (Denoted in quotations as NS) | Participants (N = 5) | |
Role | Local Authority Public health officer | 2 |
Leader of third-sector health organisation | 3 |
Key health challenges facing students
We’re talking about the mental health of children, when I think in many respects we’re talking about why schools have projected various pressures onto children over the last 15 years. And that pressure has created a particular response. And rather than talk about the pressure we’re talking about the response to the pressure, which in some ways is frustrating.(AS26).
Our most deprived areas are actually [Area A]. Now, what concerns us there is children’s nutrition but also their wellbeing – their mental health…[]…Actually, what’s quite obvious to us is when we do collaborative trips together…the physical stature of the children [from Area A] is quite marked against, maybe, the children [from other areas]. (AS13).
The one that I think [City X] education has had the most problem with is [MAT] because they are national so they’re up and down the country…[]…the thing that all [City X] schools cannot get away from is the inequality [here], heads understand that and have the joint responsibility for it. [MAT] never seem to do that. You could wave local health statistics at them but they weren’t interested. (NS28).
Research question 1: how do academy trusts in England perceive their role in health promotion amongst students?
Response category | Quotations |
---|---|
No responsibility |
Fundamentally, we are charged to educate children. Whilst we clearly have a strong interest in promoting health that is not actually our core business. It’s not that we don’t want to do it. It’s just the available time and capacity and resource. (AS1)
|
Functional approach |
Healthy children will have fewer absences and absences are linked to GSCE grades.
They have to be here to learn. (AS2)
|
Removal of barriers to learning |
Unless we can remove those barriers to learning, they are not going to access the curriculum. They’re not in an emotionally sound place, they’re not feeling secure enough. (AS7)
If you have healthy, happy children they hopefully will go on to have the better potential to attain. (AS8)
|
Duty to promote good health |
There is [no point] being successful, academically, if you have a short life span. It’s a bit of a pointless exercise, so our conclusion we have come to is that, actually, the most important thing for these children is their wellbeing. (AS13)
There is a big commitment in the trust to ensure young people are fit and healthy, because we recognise that that is a driver to them being happy and successful (AS10)
|
MAT-wide strategic approach coordinated across all member academies
MAT-wide implicit approach shared with member academies
[Initiatives around health are] decided by the school. I give the top level steer. “We need more focus on this. You need to do it through assemblies, through visiting speakers, through health education in dedicated PSHE time. And you need every adult in the school to understand it so that it can be woven into other transactions as well.” They’re the key messages. And I ask them to tell me then what they’re doing.(AS9).
MATs with no coordinated approach
We, kind of, naively thought, “Multi-academy trust, academy chains, it’s going to work exactly the same way [as local authority education departments]. We’ll go to them, we’ll explain, they’ll see the value of this, and, you know, instead of working with local authorities, we’ll work with MATs.” It just hasn’t been like that at all. We’ve had lots of meetings with academy chains that, kind of, apparently get it, are really interested. All bar one or two have then come to nothing. (NS23).
I feel that the relationship we have with our current schools, I think, is very largely based on the relationship we had with them before they became academies…[]… What’s happening [here], which is a lot of schools engaging with us doing all sorts of different things, isn’t about it coming from the [trust], it’s coming from us and the relationship we shared. (NS28).
SATs and academies within MATs with a strategic approach
SATs and academies within MATs without a strategic approach
Research question 2: how are decisions around health promotion made in academy trusts?
[The health strategy is] centrally led by the trust, without a shadow of a doubt. It comes from me, my executive team. So, things like the mental health first aid training, there is absolutely no way we would have trained [so many] teachers last year if it had been left to the individual schools to make decisions. (AS25).
This is where we differ from other trusts, I like my schools to be autonomous. I have got some superb head teachers and I don’t want to constrain them by saying, “It’s Monday and you will do this.” I want them to be free to be able to do the things they want to do. (AS22).
Mental health is something that I’m very alert to, and I have the privilege of being the CEO of a multi-academy trust, but there are other CEOs who couldn’t care less. And they’d say, “Well why should they?” You know, “We’ve got to get results.” So that contributes to a very complex landscape…[]…That’s part of the problem with MATs, you get CEOs who really kind of fancy themselves, they say they’ve got all the answers, but they don’t, they don’t test it. (AS26).
Research question 3: what factors inhibit and encourage health promotion in academy schools?
Any changes that would make a difference to health would have to be weighed against the effect it would have on the school’s standing, and how we’re perceived out there, the exam results and so on. If that could be made neutral, then we would be willing to do that, …[]… We had a couple of years before this last tranche of targets and bits and pieces where we were hovering at the base, you know, 40%, five A-Cs which, if you went below that, you were in serious trouble. …[]…. But we’re in a stronger position now where we can say, “You know what? Let’s take the hit on a couple of… Because it would be so much better for the kids. The kids will be happier, or the staff will be happier.”(AS4).
A couple of years ago, at board level we looked at whether we should have a school nurse pilot across all of our schools. That really came from our chair of the board essentially saying, “Obesity is a massive problem. What’s happening in our schools to address this?” I spoke to quite a few local authorities, and obviously the [health care professionals]… “Obviously, our kids get screened in Reception and Year 6. All of those things currently happen. But what more could we add?” At the time we didn’t move forward with that, because there were complications around funding or complications around who we would employ to do it. “Where would this sit against what the local authority…?” It was just quite murky. There is a lot of appetite at our board level to do something, but it’s just finding out the what. They would fund it, but it’s finding out where we would get the biggest bang for the investment. (AS21).
So, we get the most challenging and chaotic students in this academy. So, we know that we’re not going to get the best results, which is a shame, because we put massive amounts of work and effort in, and the teaching staff are amazing, but I think because there’s so much external issues, it has a massive impact on the students. So, we have to put a lot of nurturing, parenting in before we get anywhere close to them in achieving with them…[]…For me, our students’ emotional wellbeing, health, and their safety is paramount, over a GCSE. (AS6).
With so many services going, particularly around health and wellbeing, schools have to skill themselves up. They’re desperate [for training] because they know they’ve got to work in this area.(NS28).
There was one school I worked with that had three or maybe even four headteachers involved over the course of a year because of special measures, temporary people and so on. The staff morale around teaching PSHE [personal, social, health and economic education] and RSE [relationship and sex education] was very low. It wasn’t prioritised…[]… So, although the head teacher said they support it, they weren’t actually giving it enough attention or resource. …[]…Until they’ve got some leadership that’s helping them across the board, they’re not going to make a massive transformation. (NS29).
The barriers pupils are facing are significant. Unless we can remove those barriers to learning, they’re just not going to access the curriculum in the same way. They’re not in an emotionally sound place, they’re not feeling secure enough, their behaviour is potentially challenging, they may be suffering anxiety or concern outside of school. For us, removing the barrier to learning is absolutely essential. (AS7).
I think [this city] is one of the only areas that have the Healthy Schools team now. They are a very strong team, although very under-funded. They support us with the curriculum. They are responsible for five key areas, so things around diet and lifestyle, emotional wellbeing, mental health, sex and relationship education, drugs and alcohol. They lead, really, in terms of looking at current research, developing materials.(AS14).
We fought, myself and one of our public health consultants, yes, we did unsuccessfully fight to retain Healthy Schools [in this area]. …[]… The offer we have for schools around the public health agenda is poor…[]…I wouldn’t say there is a consistent level of input to a public health framework into our schools, nor is there a consistent knowledge of what our schools are doing because they are not accountable to us in any way, shape or form. (NS20).
Research question 4. How might public health academics and practitioners best engage with academy schools to facilitate health promotion activity and research?
Early engagement | • School input into identifying evidence gaps and research aims • School input into methodological design • Long lead time for consultation with staff, pupils and parents • Fit with school planning cycles |
Minimal impact | • Avoid or reduce disruption to student curriculum • Avoid crucial points for students e.g. exam time; pre- or post-transition • Minimise impact on staff workload • Payment for staff release if required • Avoidance of disruptive change of any type |
Tangible benefits for schools | • Contribution to curriculum, and curriculum development • Contribution to school health strategy • Continuing Professional Development (CPD) opportunities for staff • Development of resources with practical implications of use to schools e.g. staff training resources; teaching and curriculum resources • Development of data of interest to schools (benchmarking) • Avoidance of data presentation that may stigmatise communities (e.g. poor health data) • Offering widening participation opportunities to school pupils • Building an ongoing relationship between the school and University |
Outcomes of interest | • Research aims aligned with school curriculum • Research aims aligned with school health priorities or challenges • Clear links to attainment outcomes |
Stakeholder event
“In [City Y] we have a high number of MATs. Although the Trusts promote a trust-wide intention, the final decision always sits with the school. Deprivation and local inequalities drive their decisions.” (event delegate).