Background
Methods
Study setting
The intervention
UNIVERSAL (SCHOOL-WIDE) LEVEL | |
---|---|
School Mapping & Needs Assessment
| Mapping to assess the infrastructure, health environment and health resources available. A structured questionnaire was administered to school management, teachers, students and parents to identify health and wellbeing priorities. This information was used to tailor the intervention for each school’s needs. |
Speak-Out Box
| A letter box mounted on a wall in an easily accessible area in which school members could make anonymous submissions on any health, social or other school related concern. The SHC reviewed submissions on a weekly basis and followed these up as appropriate. |
Health Camps
| Visual Screening and BMI Assessments. SHCs were trained to take weight and height measurements and to conduct visual screening to identify possible refractory errors and colour blindness. Body Mass Index was estimated, and students identified with possible nutrition or visual problems were given appropriate advice/referral. |
CLASS LEVEL
| |
Life Skills Education
| The Life Skills classroom programme was developed using international and national resources. The programme was delivered over one period (35–40 minutes) per class per week. The sessions were designed to be interactive and activity based. They covered physiological and sexual and reproductive health; psycho-social issues/mental health; and, effective learning techniques. |
INDIVIDUAL LEVEL
| |
Individual Counselling
| Face to face counselling for students who were self-referred or referred by a teacher or principal. In the first year, a clinical psychologist conducted the counselling sessions in the presence of the SHC. In the second year, the SHC provided counselling to the students, with ongoing supervision and support from the NGO staff. |
Study design
Theme | Research Questions | Quantitative Process Indicators | Qualitative themes |
---|---|---|---|
Feasibility
| Was it possible to deliver the programme as planned? | Proportion of target activities (SHPAB meetings, health camps, and life skills sessions) delivered | Programme coordinator, SHC, school management, teacher and student perceptions of barriers and facilitators |
What were the major barriers and facilitators? | |||
Acceptability
| Were the services thought to be adding value? | number of submissions to the Speak Out Box | School management, teacher, student, and parent perceptions of need for and appropriateness of programme, and of adequacy of SHC skills |
Were the services used? | number of students accessing individual counselling | ||
Was the SHC considered capable of delivering the services? | |||
Impact
| In what ways did the programme improve the health and wellbeing of the students and influence the overall environment of the school? | Number of students who attended health camps, were identified as having problems, and sought follow up care | Qualitative evidence of impact from interviews with all stakeholders |
Quantitative programme monitoring data
Qualitative semi-structured interviews
Stakeholder Group (Sample Frame) | 2009-10 | 2010-11 | Total |
---|---|---|---|
Male student (member of SHPAB) | 9 | 4 | 13 |
Male student (from those who attended counselling sessions) | 9 | 4 | 13 |
Female student (member of SHPAB) | 9 | 4 | 13 |
Female student (from those who attended counselling sessions) | 9 | 4 | 13 |
Teacher (Teaching staff list) | 9 | - | 9 |
Teacher (member of SHPAB) | 9 | 4 | 13 |
Parent (member of SHPAB) |
-
| 4 | 4 |
Principal (all) | 9 | 4 | 13 |
SHC (all) | 9 | 4 | 13 |
Intervention coordinator (all) |
-
| 2 | 2 |
Clinical Supervisors (all) |
-
| 3 |
3
|
TOTAL
|
72
|
37
|
109
|
Results
Feasibility
School Health Promotion Advisory Board Meetings | ||||||
---|---|---|---|---|---|---|
2009–2010
|
2010–2011
| |||||
Target
|
Actual
|
Coverage
|
Target
|
Actual
|
Coverage
| |
No. of SHPAB meetings | 27 | 27 |
100%
| 30 | 30 |
100%
|
Health Camps by Sangath
| ||||||
2009–2010
|
2010–2011
| |||||
Target
|
Actual
|
Coverage
|
Target
|
Actual
|
Coverage
| |
Visual Assessment | 9 | 9 |
100%
| 10 | 10 |
100%
|
BMI | 9 | 9 |
100%
| 10 | 10 |
100%
|
Delivery of Classroom Life Skills Education sessions
| ||||||
2009–2010
|
2010–2011
| |||||
Target
|
Actual
|
Coverage
|
Target
|
Actual
|
Coverage
| |
Physiological | 428 | 326 |
76.2%
| 433 | 394 |
91%
|
Psychosocial | 735 | 661 |
89.9%
| 711 | 651 |
91.6%
|
Effective learning techniques | 350 | 324 |
92.6%
| 331 | 315 |
95.2%
|
TOTAL
| 1513 | 1311 |
86.6%
| 1475 | 1360 |
92.2%
|
School range (Total)
|
(84.6 – 98.9%)
|
(84.4 – 99.3%)
| ||||
Individual Counselling
| ||||||
2009–2010
|
2010–2011
| |||||
Number of cases | 122 | 128 | ||||
% Students who accessed counselling) | 6.2% | 6.3% | ||||
School Range (% Students who accessed counselling) | (1.8–13.1%) | (2.3–11.1%) | ||||
Number of follow ups | 251 | 323 | ||||
% Sessions led by SHC2
| 18.5% | 55% | ||||
School Range (Sessions led by SHC) | (1.8–41.2%) | (30–92.8%) |
"“Infrastructure is the problem of the school because they don’t have proper place for their own classes so we cannot demand for a class or place.”"
"“Actually some schools gave us a class and some schools did not. Some schools talked about after class. Some few schools gave us the library period or [physical education] period. You know, I think this was a lot determined by the principals. So I can’t say that across the board everybody gave us a class…it was a lot dependent on the principals and how important they thought the programme was.”"
Acceptability
"“Some students cannot afford to go to doctors for these types of health check-ups. These people are doing this in our school, and that too free of cost. That is what I like the most.”"9 th Grade Female Student, School H, 2009–10
"“I like the Speak-Out Box because students can get their problems solved without others coming to know.”"9 th Grade Male Student, School H, 2009–10"“What we cannot share with our friends we can write and share with [the school health counsellor], who will keep it a secret. I liked that.” (11th grade female student)"11 th Grade Female Student, School I, 2009–10
"“In the beginning, yes…counselling was seen as stigmatising, when teachers kept sending cases. But slowly when children started understanding that this counsellor is part of the school and they can go to her with any problem, then there was less stigma, students started coming on their own.”"Female Clinical Supervisor 3, 2010–11"“Initially counselling was a very new concept to them and they (students) may have had some misunderstanding about the things, but now the thing is they have realized the importance of it.”"Male Principal, School E, 2010–11"“Earlier we used to feel that the [counsellor] may tell others whatever we tell her so we were scared to speak. But because of counselling, our doubts were cleared and we got help in dealing with our problems. [Now] we know that [the counsellor] doesn’t share this information with anyone else.”"9 th Grade Female Student, School A, 2010–11
"“Initially, we were not telling our problems to our teachers since they would get angry, but now we are telling our [SHC].”"6 th Grade Male Student, School B, 2009–10
Impact
"“After the check up, [the SHC] did the follow up and children were given spectacles, which I had not expected. It was a really good initiative to give them spectacles because most of the students in our school are poor and they may not have been able to afford to buy the spectacles.”"Female Teacher, School C, 2010–11
"“[My son] was under weight, [the SHC] gave us a chart in which it is written what to eat and in what quantity to eat, and my son is following this. First I used to have to force him to eat, but now after this counsellor gave him a book about what to eat…he forces me to cook all the things that are there in this book for him.”"Female Parent, School C, 2010–11
"“Earlier some students used to [chew tobacco], which is no longer happening, and also gambling was there before, but this year we have not found any students with such practices…They are aware of the consequences.”"Female Teacher, School A, 2010–11
"“There has been a lot of effect on the children, earlier they would not give up their places on the bus for people to sit. Now they get up and give their seats, especially for elders. Earlier my daughter would not listen and used to back answer me, but now there is lot of improvement in her, she behaves well. Ever since [the SHC] spoke to her, she has not back answered me.”"Female Parent, School A, 2010–11
"“[the SHC] used to tell us what should be done in the exams and all so I followed that and I passed in many papers. First I had failed in two papers which I used to find difficult, but now I passed.”"6 th Grade Male Student, School F, 2009–10
"“I opened up my secret to (the SHC), which I had never done before, not even at home. She helped me to solve it and now I am fine. Now everyone is good to me they all smile at me or speak to me. I liked it.”"7 th Grade Female Student, School A, 2010–2011"“I was a repeater in the 9 th standard. [The SHC] taught me study skills and gave me a time table in writing so I followed that time table and I passed and now I am in 10 th standard.”"10 th Grade Male Student, School H, 2009–10"“[One] child was involved with a boy. Only child of the parents and she used to be very disturbed in the class also and the counsellor did help her. And this child has really come out of the problem and she has assured that she will take care of herself and her studies at this moment and not be disturbed with all this.”"Female Principal, School C, 2010–11"“My younger son was very short tempered, they spoke to him. That anger he had learned from me, because I used to get angry very quickly and he is just like me. Now my son is under control, they explained to him how to control his anger.”"Female Parent, School C, 2010–11"“There used to be complaints about my son from all teachers in all classes. Now after counselling there are no complaints about him from teachers.”"Male Parent, School E, 2010–11