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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Socioeconomic gradients in the effects of universal school-based health behaviour interventions: a systematic review of intervention studies

Zeitschrift:
BMC Public Health > Ausgabe 1/2015
Autoren:
Graham F. Moore, Hannah J. Littlecott, Ruth Turley, Elizabeth Waters, Simon Murphy
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2244-x) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Author contributions

GM led the development and implementation of review protocols and the drafting the manuscript; HL contributed to the development and implementation of review protocols and the drafting the manuscript; RT contributed to the development of review protocols and revisions of the manuscript; EW contributed to the development of review protocols and revisions of the manuscript; SM contributed to the development of review protocols and revisions of the manuscript. All authors approved the final manuscript.

Authors’ information

Not applicable.

Abstract

Background

Socioeconomic inequalities in health behaviour emerge in early life before tracking into adulthood. Many interventions to improve childhood health behaviours are delivered via schools, often targeting poorer areas. However, targeted approaches may fail to address inequalities within more affluent schools. Little is known about types of universal school-based interventions which make inequalities better or worse.

Methods

Seven databases were searched using a range of natural language phrases, to identify trials and quasi-experimental evaluations of universal school-based interventions focused on smoking, alcohol, diet and/or physical activity, published from 2008–14. Articles which examined differential effects by socioeconomic status (N = 20) were synthesised using harvest plot methodology. Content analysis of 98 intervention studies examined potential reasons for attention or inattention to effects on inequality.

Results

Searches identified approximately 12,000 hits. Ninety-eight evaluations were identified, including 90 completed studies, of which 20 reported effects on SES inequality. There were substantial geographical biases in reporting of inequality, with only 1 of 23 completed North American studies testing differential effects, compared to 15 out of 52 completed European studies. Studies reported a range of positive, neutral or negative SES gradients in effects. All studies with a negative gradient in effect (i.e. which widened inequality) included educational components alone or in combination with environmental change or family involvement. All studies with positive gradients in effects included environmental change components, alone or combined with education. Effects of multi-level interventions on inequality were inconsistent. Content analyses indicated that in approximately 1 in 4 studies SES inequalities were discussed in defining the problem or rationale for intervention. Other potential barriers to testing effect on inequality included assumptions that universal delivery guaranteed universal effect, or that interventions would work better for poorer groups because they had most to gain.

Conclusions

Universal school-based interventions may narrow, widen or have no effect on inequality. There is a significant need for more routine testing of the effects of such interventions on inequality to enable firmer conclusions regarding types of interventions which affect inequality.

PROSPERO registration number

CRD42014014548
Zusatzmaterial
Additional file 1: Full list of studies included (including those which did and dod not examine differential effectsby SES). (RTF 1427 kb)
12889_2015_2244_MOESM1_ESM.rtf
Additional file 2: Search strategy. (DOCX 18 kb)
12889_2015_2244_MOESM2_ESM.docx
Additional file 3: Prisma checklist. (PDF 248 kb)
12889_2015_2244_MOESM3_ESM.pdf
Literatur
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