gms | German Medical Science

Background: Condition-generic school nursing programs (SNP), i.e. SNP targeting several health conditions simultaneously, are considered an important pillar of healthcare for school-age children. SNP have the potential to contribute to health and wellbeing of children by providing accessible and comprehensive services including care for school accidents and other acute conditions, early detection of behavioral health issues and specialized care for children with chronic health conditions. By providing low-threshold services, SNP are particularly well-placed to serve populations from lower socioeconomic backgrounds. Despite this, implementation has fallen short in Germany and internationally. Implementation is currently hindered by limited evidence on the effectiveness of condition-generic SNP on educational (e.g., absenteeism) and social outcomes (e.g., participation).

Research objectives: The primary objective of the PrimSN Study is to assess the effects of a condition-generic SNP on student absenteeism in primary schools. Further objectives are to investigate effects on secondary outcomes including health-related quality of life of students and to explore program implementation and contextual factors potentially moderating implementation and effectiveness.

Methods: The study is based on an observational stepped wedge design and is complemented by a mixed-methods process evaluation. The condition-generic SNP is delivered by nurses that receive further training in school health services and is comprised of

1.

universal nursing services covering school accidents and other acute conditions and

2.

a case management program for children with chronic health conditions.

The SNP is implemented in 18 primary schools predominantly attended by students from lower socioeconomic backgrounds in the federal state of Rhineland Palatinate. Three clusters, comprising six schools each, receive the SNP sequentially between 2022-2023. The primary outcome, the number of days absent from school per term, is assessed in routine data provided by schools. Secondary outcomes are investigated in paper-based surveys targeting parents (e.g., student health-related quality of life) and school staff (e.g., non-teaching activities due to student health issues) using validated instruments or scales adapted from prior studies. Program effects will be modelled using hierarchical regression models adjusting for potential confounders. The process evaluation will draw on data from health records kept by school nurses (e.g., reach, utilization), data from parent and staff surveys (e.g., satisfaction with the SNP) and semi-structured interviews with parents, school staff and school nurses (e.g., facilitators of program implementation).

Discussion: This is one of the first quasiexperimental studies comprehensively investigating the implementation and effectiveness of a condition-generic SNP. The SNP is anticipated to close an important gap in healthcare services for primary school students. Further, by providing a case management program for children with chronic health conditions, it has the potential to attenuate educational inequalities by, inter alia, reducing absenteeism in this vulnerable group of children.

Funding: Sonstige Förderung