School Health Research Articles

Qualitative study of the feasibility and acceptability of implementation, and potential mechanisms of Learning Together for Mental Health, a whole-school intervention aiming to promote mental health and wellbeing in secondary schools

BackgroundDespite high rates of adolescent mental-health problems, there are few effective whole-school interventions to address this. Whole-school interventions offer a feasible and sustainable means of promoting mental health. We previously evaluated the Learning Together (LT) intervention which was effective in preventing bullying (primary outcome), promoting mental well-being, psychological functioning, and reducing substance use (secondary outcomes). We adapted LT to develop Learning Together for Mental Health (LTMH) with a new menu of evidence-based actions to address mental health and an enhanced SEL curriculum.MethodsWe undertook a feasibility study of LTMH, a whole-school intervention featuring needs assessment, student and staff participation in decision-making via action groups selecting actions from an evidence-based menu, restorative practice, and a SEL and resilience skills curriculum between 2022 and 2023. This article examines the feasibility, acceptability, and potential mechanisms of LTMH, qualitatively, drawing on interviews and focus groups with 49 students in years 8 and 10, and 20 staff across four state secondary schools in southern England.ResultsThe intervention was feasible and acceptable to implement. In terms of feasibility, the SEL curriculum was the most challenging to implement and was not prioritised by schools that had existing social and emotional learning lessons. Training and external facilitation were well-rated. Some schools struggled with the resourcing and workload implications of implementing actions from the evidence-based menu. Some aspects were not clear. Some staff were not aware that the various components worked together. Needs reports were not easy to understand for all. Students were generally supportive of restorative practice and SEL lessons. Data supported a potential mechanism involving increased school belonging and developing practical knowledge and skills to manage emotions and relationships. The intervention has little potential for harm.ConclusionsThe intervention is ready for phase III trial with minor adaptations. A phase III trial of effectiveness is justified.Trial registrationISRCTN15301591 https://doi.org/10.1186/ISRCTN15301591

Musculoskeletal pain is associated with poor sleep quality and increased daytime sleepiness in dental students: a cross-sectional pilot study.

While a bidirectional relationship between sleep health and musculoskeletal (MSK)-pain have been established among chronic pain patients, few studies explored it among dental students. This cross-sectional study assessed the relationship of self-report MSK-pain with sleep health and psychological outcomes among dental students, and whether differences existed as a function of number and location of painful body-sites. Validated questionnaires were sent through REDCap to dental students at a predoctoral dental school, assessing presence, location (head, shoulder/neck, jaw, back, body), and intensity of MSK-pain, sleep health (risk of sleep apnea, insomnia severity symptoms, sleep quality, daytime sleepiness, and chronotype), and psychological outcomes (anxiety/depression). Differences between those with and without MSK-pain, and across participants with different number and location of painful sites were tested with t-tests and ANOVA, adjusting for age/gender. Out of 80 participants (82.5% females), 76.3% reported MSK-pain (68.9% in neck/shoulders). Those with MSK-pain scored significantly worse in sleep quality (7.7±3.7 vs. 4.8±2.1, p<.001), daytime sleepiness (6.1±4.2 vs. 3.3±2.7, p<.001). Those with >3 painful body-sites reported worse sleep quality (p=.006) and daytime sleepiness (p=.003) than pain-free controls. There were no differences on sleep and psychological outcomes as a function of number of painful body-sites. Those reporting back pain scored worse in insomnia (p=.037), daytime sleepiness (p=.002), and sleep quality (p=.006) than those without back pain. MSK-pain is prevalent among dental students and associated with worse sleep health. While number of painful sites may not influence sleep/psychological health, specific locations (e.g., back pain) were associated with worse sleep functioning.

Gerincferdülés szűrése mesterséges intelligenciával

Early detection of scoliosis and other locomotor disorders is critical for effective treatment and improving the quality of life of those affected. The technology enables school nurses to make a more accurate diagnosis and make timely recommendations for the necessary interventions. In this study, we present the role of nurses in school health screening and the Tartás Pajtás tool, which was created to support school nurse screening. With the involvement of several nurses, we tested this device in a real environment and analyzed its possibilities and limitations. The results presented in the study were realized in the framework of the international project IML4E.

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.

Teaching infectious diseases during and in the aftermath of the COVID-19 pandemic – middle school teachers’ choice of content and instructional approaches

ABSTRACT The COVID-19 pandemic impacted immensely in schools worldwide, emphasising the pivotal importance of infectious diseases. This study aims to delineate the teaching of diseases in middle schools, investigating how content and instruction was influenced in the aftermath of the pandemic. Semi-structured individual interviews were conducted with teachers. The analytical method involved thematic analysis. The first analysis concerned teaching content was based on the framework of contagion literacy. The second analysis investigated the teaching approaches through an inductive analysis. The findings suggest that the pandemic had an impact on the biology teaching in relation to infectious diseases. During the pandemic, teaching largely revolved around student-initiated, question-driven discussions about current events related to societal health initiatives within schools, rather than expanding the planned biology curriculum. The main finding is that teachers focused on hygiene and to influence students’ behaviours interactively. The pandemic was not fully exploited by the participating teachers to develop more curriculum-based teaching including functional and critical health literacy perspectives. The study recommends that biology teachers collaborate with school health teams and engage in interdisciplinary work. We also suggest to amend primary science teacher education to meet the need to teach the young people in the event of future pandemics.

Knowledge and uptake of contraceptive and other sexual reproductive health services among in-school adolescents in three South African townships: Baseline findings from the Girls Achieve Power (GAP Year) Trial

Background South African adolescents experience barriers to sexual and reproductive health (SRH) knowledge and uptake. This study provides insight into contraceptive and other SRH service knowledge, perceptions, and uptake among adolescents in high HIV prevalence settings. Methods A baseline cross sectional survey was conducted among 3432 grade 8s enrolled into the Girls Achieve Power (GAP Year) trial from 26 public high schools across three South African townships (Soweto, Thembisa and Khayelitsha) (2017 - 2018). An interviewer-led survey collected information on SRH knowledge and perceptions; an audio computer-assisted self-interviewing technique gathered SRH service uptake. Descriptive analysis indicates frequency distribution of socio-demographics and knowledge, uptake and perceptions of SRH services. Chi-square test tested for associations between age and sex and selected variables that measure SRH knowledge and uptake. Results In total, 2383 participants completed both survey components. Of these, 63.1% (n=1504) were female and 81.4% (n=1938) aged 12-14. Almost a fifth (18.3%, n=436) had ever had sex and less than 1% had accessed SRH services in the last year. Of the 157 females who had ever had sex, 50.9% had ever used contraception. Of those who had sex in the last three months, 59.0% reported using a contraceptive method. Condom use was inconsistent: almost all females said they had not used or could not remember if a condom was used at last sex. Conclusion This paper contributes to the evidence strengthening learner SRH education, including the national Integrated School Health Programme. Key themes include the need for age-appropriate, differentiated comprehensive sexuality education (CSE) for the range of ages found in the same grade in South African schools. Education on different contraceptive methods, informed decision-making, and emergency contraception is key. School-based interventions should embrace integrated HIV, STI, and pregnancy prevention messages. Closer links with health services need to be constantly fostered and reinforced.

Enablers and barriers of implementing a whole school approach to ovulatory menstrual health literacy: a case study of a single-sex school in Western Australia

AbstractMy Vital Cycles® is a holistic ovulatory menstrual health literacy program for adolescent females. A whole school approach was used when trialled in one single-sex secondary school in Perth Australia. This study investigated the enablers and barriers for its future implementation from the perspective of the school’s teachers, nurses and psychologists. The design was a pre-trial survey of ovulatory menstrual health knowledge and attitudes, followed by post-trial interviews and focus group discussions (FGDs). In the pre-trial survey, 12 school staff demonstrated positive attitudes to ovulatory menstrual health; sound anatomical knowledge; but limited knowledge of cycle patterns. There were two FGDs with five participants and eight post-trial semi-structured interviews, giving 13 school staff in total. Deductive thematic analysis identified 14 themes within a whole school approach framework, specifically: policies and resources; community partnerships; curriculum; social-emotional environment; and school health services. Enablers included school staff’s positive attitudes; the program’s validated materials; its curricular alignment; and address of stigma. Barriers included school staff’s need for professional development; extending the program over years; Health and Science silos; dependence on school leadership; and challenges of building community partnerships. Co-design with school leadership and staff to enhance opportunities for a whole school approach is recommended for future implementation.

Job Stress and Burnout Among School Health Teachers During the COVID-19 Pandemic: The Mediating Effect of Resilience and the Moderating Effect of School Organizational Culture.

Objectives: This study aims to examine the mediating effect of resilience and the moderating effect of school organizational culture on the relationship between job stress and burnout among school health teachers during COVID-19. Methods: The participants of the study were 223 school health teachers. The data collected included the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC), Job Stress Scale, Maslach Burnout Inventory (MBI), and School Organizational Culture Scale. Data analysis was performed using SPSS/WIN 25.0 software. Results: There was a significant positive correlation between job stress and burnout among school health teachers. Conversely, both resilience and school organizational culture were negatively correlated with burnout. The mediating effect of resilience on the relationship between job stress and burnout was significant. However, the moderating effect of school organizational culture was not significant. Conclusions: To prevent burnout in school health teachers, it is necessary to develop policy alternatives aimed at reducing job stress and to implement psychological and emotional support measures to improve resilience.

Lived Experiences of Parents of Children Having Type-I Diabetes Aged 6 to 12 Years

Type I diabetes is chronic illness which change the life styles of parents, children as well as the entire family. Parents faced many challenges such as care, management (insulin administration, diabetic diet, blood glucose monitoring) and treatment cost. Objective of the study is to explore lived experience of parents of children having type I diabetes. A qualitative phenomenological study design was adopted, and total eleven parents (8 mothers and 3 fathers) were selected as participants by using non probability purposive sampling procedure. Data was gathered by using in-depth interview. The huge information was reduced to smaller statements by grouping similar responses to get actual meaning which were coded, categorized and organized to sub themes and themes. Findings revealed that parents had experienced so many ups and downs emotional feelings during the journey of treatment. They experienced nature of type I diabetes like treatment need for the whole of life, hardship during diagnosis process, facing the diabetes complications, financial crisis and need for treatment in emergency situation. The study also revealed that parents felt permanent impact from their child’s previous health condition and disruption of family unit but they were hopeful about their children’s future consequences. They struggled for supporting and caring their children’s lives at all times in the best possible ways. They learnt to live with children having Type-I diabetes. Parents suggested to launch awareness programs to educate school teachers, staffs and health worker for early diagnosis.

Factors associated with perceived health of school-aged children in rural Rwanda: an opportunity to leverage community health workers to enhance school health promotion and primary healthcare systems linkages

BackgroundIn many low-income countries, enhancing the health of school-aged children is often impeded by insufficient or limited knowledge regarding their health status. Further, hands-on health promotion interventions are nearly non-existent due to the lack of designated health workers. The disconnection between schools and primary care facilities further exacerbates this issue. To address these challenges, the World Health Organization has introduced the Health Promoting School (HPS) framework, a comprehensive model designed to integrate health into all aspects of school life and promote physical, mental, and social well-being. We sought to assess the perceived health status of school-aged children, identify associated factors, and explore the role of community health workers (CHWs) in public schools in rural Rwanda.MethodsWe carried out a convergent mixed methods study among teachers and community members in rural areas of Musanze, Rwanda. Data collection instruments were adapted from the World Health Organization’s HPS framework and the literature. We conducted six in-depth interviews and three focus group discussions. We performed a logistic regression analysis to examine the factors associated with perceived health. Thematic analysis was used to analyze the qualitative data.ResultsA total of 479 individuals participated in this survey. Of these, 425 (89%) were community members, while 54 (11%) were employed as teachers at Nyabirehe or Rwinzovu public schools. Almost half of respondents 221 (46%) described the children’s health as poor. Many factors were associated with perceived children’s health, including having an established leadership team for school-based health promotion (OR = 1.97, 95%CI: 1.01,3,84), and being familiar with school-based health promotion (OR = 4.77, 95%CI: 2.27,10.0). Qualitative results described the CHW as a bridge between communities, schools, and primary healthcare centers.ConclusionThis study revealed that the health of schoolchildren needs particular attention. In resource-limited settings, HPS presents a promising opportunity to address the health and well-being of children at rural public schools. However, adapted policies, the establishment of health promotion teams, and hands-on orientation for teachers and community members are necessary to ensure an effective implementation of HPS. In Rwanda and other low-income countries where public schools lack nursing staff, CHWs could play a vital role in enhancing HPS and the linkage between schools and primary healthcare facilities.

‘A qualitative exploration of parent-teacher meetings in Indian schools: assessing stakeholder engagement and systemic efficacy’

ABSTRACT This study examined the effectiveness of Parent-Teacher Meetings (PTMs) and their impact on interpersonal relationships and mental health in Indian schools. Thirty participants, including 10 teachers, 10 parents, and 10 students, were purposively selected from both rural and urban areas in Assam and Delhi, ensuring equal gender representation. Data were collected through semi-structured interviews, allowing for an in-depth exploration of participants’ experiences and perceptions. Thematic analysis highlighted several challenges, such as a lack of teacher support, socioeconomic barriers, and feelings of being dismissed during PTMs. Despite these challenges, effective PTMs were found to significantly improve parent-teacher communication, enhancing support for students’ academic and emotional needs. The study emphasises the need to enhance PTMs by improving teacher receptivity, encouraging greater parental involvement, and overcoming socioeconomic challenges. However, the limited scale of the study, conducted solely in India, restricts the generalizability of findings to other contexts, highlighting the need for broader research.

Effect of Weight Loss Interventions on the Symptomatic Burden and Biomarkers of Polycystic Ovary Syndrome : A Systematic Review of Randomized Controlled Trials.

Polycystic ovary syndrome (PCOS) is common in women of reproductive age and is associated with obesity. Clinical guidelines recommend weight loss, but the impact on the clinical manifestations of PCOS is unclear. To quantify the effect of weight loss interventions on clinical features of PCOS, compared with usual care. MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, and trial registries were searched from inception through June 2024. Randomized controlled trials comparing interventions aiming to reduce weight against usual care, including lower-intensity weight loss interventions in people with PCOS. Conversations with people with PCOS informed the outcomes. Pairs of independent reviewers screened studies, extracted data, and assessed risk of bias (RoB). Outcomes included glycemic control (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR], fasting insulin and glucose), hormonal markers (free androgen index [FAI] and other sex hormones), menstrual frequency, hirsutism, and PCOS-related quality of life (QoL). Pooled mean differences were obtained from random-effects meta-analysis with Knapp-Hartung adjustment. Primary analyses included 29 comparisons with 1529 participants: 13, 12, and 4 comparisons were judged as high, some, or low RoB, respectively. Twelve used behavioral interventions, 9 used glucagon-like peptide-1 (GLP1) agonists, and 8 used other weight loss medications. Weight loss interventions were associated with significantly greater improvements in HOMA-IR (mean difference, -0.45 [-0.75 to -0.15]; I 2 = 24%), FAI (mean difference, -2.03 [-3.0 to -1.07]; I 2 = 48%), and menstrual frequency (mean difference, 2.64 [0.65 to 4.63]; I2 = 43%). There was no evidence that weight loss interventions were associated with clinically or statistically significant improvements in hirsutism, QoL, or other sex hormones, which may be due to the limited power of the available data. There was high statistical heterogeneity in the interventions, comparators, and outcomes, largely unexplained by sensitivity and subgroup analyses. Weight loss interventions were associated with improvements in some important features of PCOS and should be considered as a routine treatment option for people with PCOS. National Institute for Health and Care Research School for Primary Care Research. (PROSPERO: CRD42022367488).

National Health Education Standards: Model Guidance for Curriculum and Instruction (Third Edition).

Since the 1990s, national standards have been developed in K-12 subject areas. National standards in health education were first released in 1995 with a second set released in 2007. A third edition, the National Health Education Standards: Model Guidance for Curriculum and Instruction was developed in 2022 under the auspices of the National Consensus for School Health Education. The purpose of this article is to present an overview of the third edition including descriptions of the development process;the 8 standards and aligned performance expectations; considerations related to the translation, dissemination, and implementation of the standards; and projections for potential impact regarding teaching and student outcomes. To develop new standards, the National Consensus formed 3 groups: the Management, Development, and Expert Review Groups. These groups employed an iterative process that included the development of 3 drafts of the standards before finalization. This process included a review of each draft by the 3 groups. The second draft included additional qualitative feedback from over 500 school health education leaders, practitioners, and stakeholders. The third edition includes 8 standards with aligned performance expectations. A description and rationale are provided for each standard along with standard-specific teaching guidance. The third edition of the National Standards for School Health Education provides guidance to state departments of education and local schools in the development and implementation of health instruction that promotes meaningful learning to guide students in the promotion of their own health and the health of others.

The effect of national school health strategy components on the quality of health services: An Analytical research in Baghdad Governorate

Purpose: The research objective is to diagnose the extent to which the National School Health Strategy contributes to the quality of health services. Theoretical framework: The quality of health services can provide schools with benefits through building a healthy school community in line with the sustainable development goals, especially regarding quality education, good health, and well-being and through school health, we may be improving the health and well-being of elementary and secondary students, and the necessity of providing healthy foods reduction of fat content in school meals, and awareness to prevent the use of tobacco products and drugs. Design/methodology/approach: The research relied on the descriptive -analytical method and the research sample is a random sample of primary schools (governmental and private). The research tool is represented by using a questionnaire to collect data. Findings: Although there is a big school community represented by students compared to their society, studies in most countries of the world are still limited in discussing the quality of health services provided to them and the limited solutions. Research, Practical &amp; Social implications: We suggest future research to evaluate the national school health strategy: a comparative study between two governorates. Originality/value: The results indicate that commitment to implementing school health programs positively affects the quality of health services provided to students of school age and that any defect in their application reflects negatively on the health of students currently and society in the future.

An inter-sectoral framework for promoting and protecting mental health and psychosocial well-being in schools in low- and middle-income countries

An inter-sectoral framework for promoting and protecting mental health and psychosocial well-being in schools in low- and middle-income countries

Co-designing place-based co-located health and wellbeing infrastructure and services with high school students, educators, and health service providers

This research involved working with high school students, teachers, Guidance Officers/School Counsellors, and other stakeholders, to co-design a new Community Hub to be co-located at a high school in a high-priority community. This article describes the co-design processes undertaken to engage children and young people and adult stakeholders in the ideation and design phase of infrastructure and service development to support health and wellbeing needs of a high priority community (low service uptake/high health needs). The key insights developed from these engagement processes pointed a way forward for the next stages of infrastructure and service delivery development and led to the development of several visual depictions of the complexities of stakeholder interests. This article argues that meaningful engagement of potential future users of place-based integrated health and wellbeing services enables responsive infrastructure designs that meet future needs of both target communities and service providers.

School environment and adolescent health: Results from the HPTN 068 cohort

PurposeTo assess the relationship between school environment and health and behavior outcomes. MethodsData are from baseline and first follow-up of the HIV Prevention Trials Network (HPTN) 068 longitudinal trial established in 2012 of adolescent girls and young women in rural Mpumalanga Province, South Africa. Data from 2212 participants are included. We measured the association between four school environment domains: school resources, school safety, negative personal experiences, and school connectedness, and several health and behavior outcomes: depressive symptoms, low attendance, recent pregnancy, recent unprotected sex, transactional sex, and having an older romantic partner. We used a g-computation approach to estimate risk differences (RD) for the longitudinal relationship between the school environment (measured at the individual and school level) on individual health and behavior outcomes, controlling for baseline covariates. ResultsThe mean age of participants at baseline was 15.4; mean age at first follow-up was 16.6. Individual baseline perceptions of an unsafe school environment (RD = 3.1 %, 95 % CI: 1.3–5.2 %) and more frequent negative experiences (RD = 4.0 %, 95 % CI: 2.0–5.9 %) were associated with higher absolute risk of depressive symptoms at follow-up. There was an overall trend toward higher risk of pregnancy, unprotected sex, and having an older partner among those who reported fewer school resources, lack of school safety, more negative personal experiences, and lack of school connectedness. ConclusionsOur findings provide evidence of an overall trend toward higher risk of depression, pregnancy, unprotected sex, and having an older partner among those reporting a worse school environment across four school environment domains.

Healthier, cleaner, faster: a case study of climate action for public health in Oxfordshire

BackgroundAt a local level, climate action informs each of our current public health priorities in Oxfordshire and should enable us to deliver better health for local people faster, and more fairly. MethodsWe present Oxfordshire as a case study of climate action for public health. Delivery of climate action for public health in Oxfordshire is being informed by evidence set out in this year's Director of Public Health Annual Report which identifies the local impacts of climate change on health, across five key domains (temperature, air, water, food, nature) and provides a roadmap for how local politicians and decision-makers can act to improve health, look after our environment, and reduce emissions. FindingsIn Oxfordshire, climate action for health spans five cross-cutting themes. First, energy efficient healthy homes and buildings (initiatives include Better Housing Better Health service and Schools Energy Efficiency Loans). Second, sustainable travel and clean air (initiatives include School Streets to restrict motor traffic at pick-up/drop-off, school air quality sensors and roll-out of 159 zero-emissions buses). Third, green health and social care (initiatives include Greener Practice Oxfordshire and expansion of Council supply chain reporting of social care services). Fourth, healthy and sustainable diets (initiatives include the Oxfordshire Food Strategy in conjunction with Good Food Oxfordshire). Fifth, accessible green spaces, clean water and nature (initiatives include the Oxfordshire Local Nature Partnership and District Council programmes). InterpretationWe present clear examples of climate action for public health, at the local authority level, which have been or are currently being evaluated. In the context of a new central government, which has committed to shift the focus of the NHS into the community, to establish publicly-owned renewable energy, to reform planning and expand devolution, there are clear opportunities for local authorities to be able to deliver more and faster on climate and health. FundingLC discloses funding from the NIHR for her academic clinical fellowship, which has allowed for time to develop the abstract. The funder had no role in designing the question, the analysis or the interpretation of the results.

Experiences of Growing Up with Mothers with Schizophrenia in South Korea: A Qualitative Study

PurposeThe purpose of this study was to explore the experience of living with mothers with schizophrenia from childhood to the present from the perspective of their now-adult child. MethodsIndividual interviews were conducted with 10 adult children of mothers with schizophrenia. The data were collected in South Korea from July 2017 to March 2018 and thematic analysis was employed. Purposive sampling was used. ResultsFour themes were identified: (1) Navigating Childhood Confusion and Isolation Due to Maternal Schizophrenia, (2) Journey Through Loneliness, Resentment, and Emerging Responsibility, (3) Facing real-life difficulties as an adult child with vulnerability, and (4) Satisfaction in well-grown self. ConclusionsNotwithstanding the real-life difficulties due to unstable life with their mothers with schizophrenia, the children still had faith and confidence in themselves as well-grown thus far. Reflection on memories with their mothers served as a basis for continued maternal–child relationship and for taking on the role of guardians despite the negative experiences of their mothers’ psychotic symptoms. Mental health nurses and school health professionals should pay attention to the children of mothers with schizophrenia and their difficulties in providing appropriate mental health services.

Understanding friction points in making national active sustainable travel policy work in coastal rural local government: an in-depth qualitative policy analysis

BackgroundActive travel is a key public health focus in local authorities, and increasingly part of their ‘low carbon’ transport planning. However, much focus is on cities, while promoting walking, cycling and wheeling in rural communities is acknowledged to be a major challenge. In our policy situation analysis, we asked how local government ambitions and challenges to create sustainable and healthy transport systems in rural communities have been shaped by national agendas and local concerns. MethodsIn our in-depth qualitative policy analysis, we analysed key national (n=6) and local (n=15) policy documents, and interviewed 11 civil servants, councillors and civil society representatives in the South-West and North-East of England who developed or used these documents. Participants and documents were identified through purposive sampling. We analysed documents using the READ (Ready, Extract, Analyse, Distil) approach, and inductively and thematically analysed interview transcripts using NVivo. FindingsWe identified scarcity, volatility, and contestation as three friction points between national and local policy production and implementation. Scarcity of policies concerning rural areas in national policy and guidance documents, combined with funding mechanisms that are based on urban infrastructure, led to rural areas ‘losing out’. Volatility in national and local political agendas created vacuums of policy support concerning the roll out of schemes (eg, ‘20 is plenty’). Local contestation, alongside hostile responses to schemes via local and national media, delayed policy implementation. Opportunities were also identified, including local schemes setting national standards (eg, the integrated Transport for Cornwall). InterpretationOur analysis demonstrates the challenges that rural areas experience in the creation and implementation of active and sustainable policies. Despite this, amongst decision-makers there is a real desire for further innovation (eg, digital solutions), evidence to understand what works, and equity. In our upcoming work, we will be mapping the policy system to understand leverage points for future action. FundingThis study is funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research (grant reference number NIHR 204000). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.