COMISION DE POLITICAS DE DESARROLLO ESTUDIANTIL Y CENTROS UNIVERSITARIOS

Stakeholders were asked to reflect on our hypotheses (as above). On potential benefits

Adult policy stakeholders were positive about the theorised mechanisms of the potential for reductions in violence and substance use, as were some young people. Other young people wondered whether or not interventions might be effective in reducing in-school but not out-of-school risk behaviours.

On multilevel programmes

Overwhelmingly, multilevel programmes with both a whole-school and a family component were seen as likely to be the most effective. Stakeholders suggested that a school ethos supportive of the programme’s goals and approaches would facilitate whole-school programme components. Stakeholders commenting on the Welsh experience highlighted that the Welsh Assembly Government has promoted a health-promoting schools approach that would be conducive to multilevel programming. Young people generally agreed that developing stronger relationships between staff and students would be an important element of multilevel programmes.

It was generally perceived that a whole-school approach may be more feasible in primary schools, given that there is more flexibility. In primary schools, there may be dedicated time to health themes, for example a antibullying week, during which there may be approaches beyond the classroom to extend an integrated, health-promoting curricula.

The inclusion of parents, or having a family component, was universally agreed by stakeholders to be desirable. It was suggested that parents and families play an even stronger role in influencing student behaviour than school curricula or the school environment and, as such, parents and families performing a reinforcing role around health messaging was regarded as highly valuable, if possible. However, it was also agreed that engaging parents could be very challenging, particularly parents of students in secondary school. Parents of higher-risk students who may already be working with school officials were viewed as being easier to engage.

On full integration into academic subjects

It was generally perceived that a fully integrated approach would be more likely to be feasible in primary schools, given that there may be more flexibility in the curriculum. In primary school, teachers engage with students for a full day and may teach one health topic across many academic subjects; whereas in secondary school, teachers typically see students only for specific academic subjects. Participants generally felt that some subjects (e.g. drama or art) may offer particularly appropriate platforms for practical skill development. There was also clear recognition that, if integrated programmes were able to support the achievement of academic learning objectives, receptiveness would generally be high. However, it was also pointed out that pay raises and teacher job security can hinge on their ability to support their students in achieving specific learning objectives, so it may be perceived as a personal risk to adopt a programme that may compromise core academic learning objectives. Where school leaders are judged partly on the basis of objectives concerning health and well-being, integrated programmes would be more likely to be taken up. If a school is judged largely based on academic performance then these programmes may be less likely to be taken up, despite their attempt to bridge health and academic learning objectives. Some stakeholders also suggested that some schools may prefer to implement health programmes that are clearly labelled as such, rather than engage in the more complex task of integrating health and academic education. Stakeholders agreed that all of the intervention theories of change seemed plausible within a UK context.

Chapter 5 Synthesis of process evaluations

About this chapter

Parts of this chapter are reproduced or adapted from Tancred et al.150_{This is an Open Access article}

distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text.

This chapter describes and reports on the quality of process evaluations that met our inclusion criteria. It then reports on our thematic synthesis of these studies, which focused on the factors that affected implementation and receipt in order to address research question 3.

Included studies

Sixteen empirical studies of process were included, reporting on 12 different interventions.57,84–86,89,94,107,108,117, 118,120,123,126,127,133,135_{There were two studies of KAT,}126,127_{three studies of Positive Action}85,86,118_{and two studies}

of Roots of Empathy.94,107_{The remaining interventions (i.e. 4Rs,}57_DRACON,120_{English classes,}108_{Hashish and}

Marijuana,135_I-LST,84_{Peaceful Panels,}133_PATHS,123_{Steps to Respect}117_{and the Gatehouse Project}89_{) are}

reported on by one empirical study. The included studies reported quantitative and qualitative data. Some reported on standalone process evaluations, whereas other studies also included outcome evaluations. Of the 12 interventions evaluated, four focused on primary schools,57,117,123,126,127_{five on secondary schools}84,89,108,133,135

and three on both primary and secondary schools.85,86,94,107,118,120_{A summary of all included studies of process}

and interventions is given in Appendix 18.

Quality of studies

The quality of study reports is detailed in Appendix 19, Table 24. This table presents a consolidated overview of quality after two reviewers (TT and CB) reached consensus. The original agreement rates on indicators of quality was 74%. Study reliability and usefulness varied. Only five reports were judged highly reliable and trustworthy,85,86,107,117,123_{and five reports provided insights of a high value in answering our research}

questions.57,85,86,89,118_Six57,89,118,126,127,133_{and five}84,94,108,120,135_{reports were judged}‘medium’ and ‘low’,

respectively, in terms of reliability and trustworthiness.