Guideline evaluation and implementation mechanisms in school health services

A National Guideline for School Health Services was launched in 2017. The guideline strongly recommends individual health consultations with all 8th-grade students and collaboration with schools. The purpose is, among other things, to promote healthy lifestyle choices and life mastery among students, as well as to identify students in need of follow-up. The overarching goal of the study is to help the school health service adhere to the Guideline and achieve its objectives, as well as to increase knowledge about effective implementation of guidelines and youth's use of health and welfare services. In collaboration with users and services, we have developed Skolehelse, a toolkit consisting of three strategies to support the implementation of the Guideline, including a web-based feedback tool. A total of 25 municipalities and districts in Central and South-Eastern Norway participated in the evaluation of Skolehelse. One school participated for one school year (2022/23 or 2023/24). Participating schools (n=49) were randomly assigned to evaluate different combinations of the three strategies. Students, public health nurses, and school personnel have participated in interviews, as well as surveys at the beginning of the school-year, after consultation, and six months after consultation. Parental consent was obtained for 1,473 8th-grade students (67%), of which 1,425 (96.7%) participated. The health consultations with students were conducted by 57 public health nurses. In total, 157 teachers and school leaders and 26 leaders of the school health service participated. In Denmark, interviews have been conducted with services that have used a Danish tool equivalent to Skolehelse. We will now evaluate the extent to which the different elements of Skolehelse, both individually and in combination, contribute to the school health service working in line with the national professional guideline, as well as achieving its objectives. We will also map user experiences and compare experiences with the equivalent Danish tool in Denmark. In addition, we will combine data from Skolehelse with data from other existing health surveys and registers. We are also facilitating the continuation and scaling up of effective strategies, for instance, in the national e-infrastructure, if the results support this. Identifying effective strategies for implementing the guideline has the potential to support youth in a life phase that is crucial for future health and well-being. If successful, features of Skolehelse may contribute to health promotion work and more efficient services, as well as more systematic collaboration with schools. The study will provide valuable knowledge about effective implementation strategies and service use, increase evidence-based practice, and promote collaboration between Nordic countries.

A national guideline with best practice recommendations for school health services was launched in 2017. The guideline strongly recommended individual consultations with all 8th graders and cooperation with schools to promote healthy life skills and identify students in need of follow-up. Our overall objectives are to help the service implement this guideline, reach its goals, and increase knowledge about effective implementation strategies and service use among adolescents. Together with users and stakeholders we have developed SchoolHealth, a toolbox of three different implementation strategies including a web-based tool. We will evaluate and optimize SchoolHealth by studying the three strategies' effectiveness on guideline fidelity and the extent to which guideline fidelity helps reach the guideline goals. We will use a hybrid evaluation design with a factorial experiment where schools will be matched and randomly assigned to different combinations of the three strategies. Qualitative interviews will complement the quantitative data. Students, school nurses, and school personnel will complete interviews and questionnaires at baseline, after consultation, and 6-months post consultation. We will compare and complement SchoolHealth with a Danish equivalent and explore service use and user pathways by combining SchoolHealth data with existing health surveys and registers. We will prepare scale-up of promising SchoolHealth strategies by developing solution designs for national e-infrastructure. Identifying successful strategies for implementing the guideline can support adolescents in a life phase vital for future health and wellbeing. If successful, SchoolHealth will facilitate health promotion in schools and more effective youth services, which may increase school completion and social inclusion. The study will yield valuable knowledge about implementation mechanisms and service use, increase evidence-based practice, and promote cooperation between Nordic countries.