Background
Aim
Methods
Ethics statement
Sampling population and recruitment
Data collection
Data management and data analysis
Results
Challenges to implementation of health interventions in schools
Government-led priorities and funding
Government-led priorities and funding
| “We know that physical activity is hugely important but when we’re actually getting measured by the Welsh Assembly Government on our performance in literacy and numeracy, you can tend to push physical activities out to one side…”(Participant E - Headteacher) |
“It’s English and maths you know, we’re being hammered, English and maths, English and maths, that’s all that counts, and the Olympics come along, well sports important, or obesity comes up, sports important, it’s not really because there’s no extra funding in it you know…” (Participant N - Headteacher) | |
Initiative overload
| “We have the Welsh Assembly Government giving us initiatives, we have regional giving us, we have then our Local Authority giving us initiatives. We have then other things like we’re doing rights respect in school, we’re doing restorative practice, we do valley’s education, we do Healthy Schools, we do sustainability, we do a European schools, we do all these things, so yes, we do feel burdened.” (Participant A – Headteacher) |
“They want us to manage their agenda for them, they don’t really… they’re not terribly bothered about ours…I mean, [X] will ring up at the end of a term and say, ‘Oh, how many children have taken part in after school clubs this term? We need the figures. And you just feel… I mean, that’s it, though, isn’t it. You need the figures. It’s a data crunching exercise. It’s got very little to do with you actually coming out and seeing if there’s any quality in that activity.” (Participant J - Headteacher) | |
Autonomy v statutory approaches
| “I mean obviously there are some interventions which are statute and we’ve got to and there’s no choice I’m afraid, but I think it’s those, (coughs) excuse me, that sometimes, well it’s because of those that the more exciting, more creative activities don’t happen if you like, because of the legislative, the ones that we have to do that are statutory requirements.” (Participant H - Headteacher) |
“…we don’t have that power as a school. We’re a recipient, if you like, rather than a leader.” (Participant J - Headteacher) | |
“I think sometimes there, that’s taken away from us in terms of that expertise because I know what works in my school isn’t necessarily going to be relevant in the school next door so it’s that lack of trust really that ‘just leave us alone to do it’ and yes, of course we’re accountable and I wouldn’t want to take any of that accountability away, but just let us get on with what we’re doing because it, we’re making it work for our children and you know, we’re not the experts but we do know what we’re doing.” (Participant H - Headteacher) | |
Health and safety litigation
| “But I did have a parent come in ‘cos we had some stepping stones made out of pieces of wood and they’d have little bit of fungus growing on the side and parents saying, ‘They shouldn’t be out there, that’s a health hazard that is,’ and I’d say, ‘Well no, they’re okay’, and again you’d have to tough it out sometimes and take it like the rest of it, because if the pieces of wood get wet and the children are jumping from one to the other they get slippery, they fall off and they learn then, it’s no good trying to play stepping stones when the wood is all wet, you know, we’ll do that when it’s dried out.” (Pilot 1 – Retired Headteacher) |
“Well they can’t, they couldn’t just go into the gym break time ‘cos it’s break time, you know, it has to be supervised and you know, we don’t tend to have an after school for our infants because obviously you’re staffing ratio gets higher, you know…” (Participant K - Headteacher) | |
“We do things, we’ve taken the children to London and, you know, as long as you’re confident as a staff that you’ve risk assessed, you know exactly what you’re doing, the staff are all briefed, the ratios okay, you know, and we’ve just tried to carry on, because at the end of the day you want to enrich the children’s education, don’t you, you don’t want to sort of narrow it down, but health and safety is a nightmare, yeah.” (Participant D - Headteacher) | |
Staff and headteacher influences
| “Our football, Mr [X] you just met in there, he takes the football club and it’s basically in his own time and he is, you know, he’s fantastic, he’s a real sort of football enthusiast and that rubs off on the children because they’re very successful in football.” (Participant Q – Deputy Headteacher) |
“…the previous headteacher was a heavy smoker (laughs). So he wouldn’t even let the Healthy Schools Coordinator in through the door. So (laughs) this was like the jazz club in here, it was just smoke filled…”(Participant D - Headteacher) | |
Physical environment and facilities
| “It’s almost as if we’ve kind of got it backwards in this country because if you go to any university campus you will generally have very good sports facilities, especially if they’re offering a sports science kind of degree, you’ll have out of this world facilities. Go backwards towards the comps and you’ll kind of get reasonably good facilities, a lot of comps have got gyms, they’ve got big, you know, indoor halls. But then as you go down to primary schools you’ve got, usually the school hall, that’s usually for cooking as well and you know, for assembly and for everything else…” (Participant I – Healhy School Co-ordinator) |
“Yeah, I think you just need to be quite… you need to have a plan, basically. And what we’ve found is discipline goes, behaviour goes at play time if there isn’t anything structured. So our children, they get to play football at the front every break time, sometimes if it does go a bit too far we do have to say, ‘Well, look, you’ve had your yellow card now and if it carries on there’ll be no football tomorrow,’ and we do have to stop it sometimes.” (Participant L - Headteacher) | |
“The only thing that really, I think the barriers to that quite often are your consumable equipments so, you know, balls will go over the gardens and the skipping ropes get sort of manky and disgusting so it’s having a regular supply really of equipment because school budgets are very tight but that’s another issue for us, you know, if you’re talking about constraints.”(Participant E - Headteacher) | |
Parental engagement
| “Parents are more of a problem than the children perhaps… So it's educating parents and getting through to them because they seem to be the barrier. You know you educate the children and they seem to understand and they can sort out healthy and non-healthy foods but it doesn't, the message doesn't seem to get home so it's parents and actually getting the parents in to school. Some of them are very you know not really interested, some are some aren't, you know it's the same isn't it?” (Participant M - Headteacher) |
“If you want to effect the parents then you need to get access to the parents and you need to get access to them in an informal way, and I’m sure then they come onboard…you’ve got to go say through children to places like children’s centre, which are non-threatening, yeah, which they feel comfortable going there, it’s their choice to go there, do you see what I mean, they’re there to offer support and help and I think that is a good way of reaching them.” (Participant G - Headteacher) |
Initiative overload
Autonomy v statutory approaches
Staff and headteacher influences
Health and safety litigation
Physical environment, facilities, resources and weather
Parental engagement
Guidelines to creating successful health interventions within schools
Planning and organisation
Planning and organisation
| “Where it’s packaged and well thought out and well supported, you know, that’s when you get the benefit…" (Pilot 2 – Retired Headteacher) |
“…also that we know in advance that you’re coming in because if the class teachers plan to do something and then only two or three children are coming out, then that is destructive because one they’ve missed whatever it is the class is doing, and secondly after you are finished with them and they come back in the class teacher then has got to get them into the lesson and catch up on what they’ve missed. So it’s about organising the time that you do come in.” (Participant F - Headteacher) | |
“…what we find is that the government tend to fund something and when it’s working really well, they take the funding away…” (Participant E - Headteacher) | |
Collaboration
| “I think it’s collaborating with sports clubs. I know that rugby has got this phrase, ‘The club is the hub’, and really these days the clubs are the people who are driving physical activity, and we just give them the tasters really. I think where we do our best work we probably are linked in with clubs.” (Participant P - Headteacher) |
“I feel strongly that you need to get everybody on board so you need to have the child themselves understanding, right, this is what’s going on and this is why it’s going on, you need to have the parents on board because unless they’re on board and they understand exactly why we’re doing what we’re doing then they could potentially undo some of the hard work that’s been put in…the class teacher needs to be involved so that they can reinforce it with the children, and then whoever’s delivering it so whether that would be health professional or yourselves, somebody from the university, you know, so it’s lots of people involved in it.” (Participant C – School Health Co-ordinator) | |
Expertise
| “I think what we do tend to lack is expertise, because everybody kind of thinks ‘oh yeah, you can go and do a gym lesson, that’s not a problem at all’ but in actual fact, our staff are not experts…” (Participant E - Headteacher) |
“Well ideally it would need to be sustainable so if somebody came in and up-skilled our staff and worked alongside them for a period of time and then left so it could be maintained because we understand, you know, you can’t be every day for whatever so there would be an element of sort of training with them, modelling it to them, leaving and then having sort of visits every now and again, coming back, making sure that what was set up is still in place.” (Participant Q - Deputy) | |
Child-centred
| “…so it’s finding out what the children want so putting questionnaires out prior to starting it, to find out exactly what they would come to in terms of physical exercise so maybe giving them a choice of, I don’t know, ten different things and saying, which one would you turn up to so that they’ve got some kind of input in it and they’re far more likely to come if they think they’ve had a hand to play in it as well…” (Participant C – School Health co-ordinator) |
“…we’ve found things that the children are involved in are the most successful…it’s just part and parcel of what we do, it’s not even given a second thought and that’s the sort of thing you want isn’t it that when you move and they take it over, that it will run and be sustainable…” (Participant G-Healthy School Co-ordinator) | |
Cross-curricular
| “Coz when it snowed we were open, went out in the snow and we did like welsh describing words, you know they actually held the snow, that's the best way to do it rather than sitting here and do it so you know go out and give them firsthand experience of it. They learn better like that.” (Participant M - Headteacher) |
“…it needs to be agreed focus but also it needs to match our assessment criteria of the children because very often we have for instance, organisations come in, they’ll do like a block of activities and then they’ve gone but then we have no sort of understanding of what skills they’ve hit, how that matches our assessment of the children so then that becomes a reluctance because that’s taken up perhaps four or five weeks of our sort of PE time or games time with the children and we’ve got to go back and reassess and so on so there needs to be that link as well…" (Participant Q – Deputy Headteacher) | |
Whole school or whole class approach
| “So yeah, where it has a significant impact on children’s learning, I like, as I say, whole school and whole phase, those that are inclusive, we have two specialist teaching facilities here for children with moderate learning difficulties and we have a number of children with mobility issues or difficulties and so everything we do we’re always considering how can we include everybody in this, and that’s one of the wow factors, if you like, when you sort of stand back and reflect or observe something is seeing the children working in harmony with each other and being very accepting and supportive, excuse me, so that’s something that’s really important to us here as a school.” (Participant H - Headteacher) |
“…we will offer the children the chances to take part in a competitive way, but only if they want to. It doesn’t count. The points count for the thing everybody takes part in. Those events are just there because some children are good at it, but nobody’s gonna have to run and come last openly. I mean, you’d never do it in any other curriculum, so why would you dare humiliate kids, you know, it’s horrible isn’t it. It’s what I grew up in. I was lucky, I was quite good at athletics, but for kids who… There couldn’t have been anything worse.” (Participant J - Headteacher) | |
Adaptability
| “Can I say perhaps that academic researchers sometimes have no idea what goes on a school, at the you know, at the 200 screaming kids level.” (Pilot 2 – Retired Headteacher) |
“I think there’s a lot going on, yeah, I don’t know that there’s too many, I think there just seems to be a huge period of change if you like but the change is very quick, no sooner have you started to embed something then another thing comes along and it gets a little kind of like right, whoa we’re gonna stop, we’re gonna focus on this, this is what we’re going to do and we’re going to embed it, ‘cos it’s right for our school, and not every intervention is right for every school, you know, there are some that are more needy in some areas than others and I think it’s sort of acknowledging what is right for your school and thinking yeah, this is the path we’re going to go down.” (Participant H - Headteacher) | |
“it’s always about reinventing things and teachers are pretty good at thinking outside the box and they can be fairly creative. So I think it’s about putting new twists on things, really, to be honest, just to keep everybody into… and you can tell when things start to flag, can’t you, you know.” (Participant E - Headteacher) |