Kirsi Wiss

Access to a school health nurse and adolescent health needs in the universal school health service in Finland

Universal school health services are expected to offer similar, needs‐based services to all students across schools, service providers and students’ socio‐economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students’ characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self‐reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16‐year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%–41%) and schools (0%–75%). Students with lower socio‐economic background, poorer well‐being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.

The comparative and objective measurement of health promotion capacity-building: from conceptual framework to operationalization:

The aim of this study was to analyse and test a theoretical generic health promotion capacity-building framework with empirical data on primary health care. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and other core functions. The data were collected in 2014 from all the health centres in Finland, of which 156 (99%) submitted their data. The data were scored by the quality of activities on a scale from 0 to 100, where 100 stands for desirable quality. Individual indicators were nested into subdimensions, which in turn were nested into the dimensions of the theoretical framework. Variables were clustered using the dimensions and subdimensions as initial partitions. The internal consistency of dimensions and subdimensions was tested with standardized Cronbach’s alpha both before and after the clustering analysis. The results showed that although the internal consistency of the dimensions was high in the initial classification, it is possible to get even more consistent dimensions. The internal consistency of the initial classification varied from 0.62 in participation to 0.93 in common practices. In the clustering analysis, 45 out of 203 indicators were assigned to a dimension different from the initial partition. The biggest gain in internal consistency was achieved in the subdimension of systematic mass communications by relocating two indicators. This study suggests that it is possible to assess the health promotion capacity-building of organizations in a coherent way with comparable and objective indicators. These analyses also show that the number of indicators can be reduced. It would be interesting to see how the framework works in other governmental structures or political contexts.

TEAVIISARI - A TOOL FOR BENCHMARKING SAFETY PROMOTION AND INJURY PREVENTION ON LOCAL LEVEL

Background In Finland, municipalities are responsible for promoting the health and welfare of their residents. Safety promotion and injury prevention are an integral part of health promotion on various fields of municipal action. Description of the problem Until the launch of TEAviisari, a nationwide benchmarking tool for the management, planning and evaluation of health promotion capacity building (HPCB), there has been very little accurate and comparable nationwide information on health promoting activities in different sectors in Finnish municipalities. Results Aiming to make measures taken by local authorities visible and to provide information on actions that promote better public health on local level, TEAviisari is based on a generic HPCB framework. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and core functions. Safety and injury related topics covered in TEAviisari include but are not limited to prevention of home and leisure accident injuries, inspection of health and safety at schools, home-school collaboration to promote safety, prevention and monitoring of accidents and injuries at school, compiling a local safety plan, evaluating older person’s housing safety and having expertise on health and safety technology and assistive devices. The results show that differences between municipalities and schools exist in all topics. The data can be viewed on municipal level or on various geographical or administrative levels. Data for single schools are shown with the permission of the school. Conclusions TEAviisari shows that it is possible to assess the HPCB of municipalities, serving as a tool for the local government while making it transparent to the residents. Web-based user interface provides a quick access to relevant, interpreted information for decision-makers. TEAviisari is free of charge and available at http://teaviisari.fi in Finnish, Swedish and English.

939 Accidental injury prevention in comprehensive school in Finland

Background All pupils participating in education are entitled to a safe learning environment. The Health Care Act (1326/2010) obliges comprehensive schools to monitor health and safety of school environments and well-being in learning communities every three years. Methods Health and welfare promotion in schools and educational institutions has been monitored by the National Institute for Health and Welfare and the Board of Education since 2006. In 2013 data were collected nationally using a form addressed to headmasters of Finnish comprehensive schools (N = 2734). The response rate was 74% (N = 2022). The topics covered also accidental injuries at school, accidental injury prevention, and safety promotion. Results Inspection of health and safety of school environments and well-being in learning communities provides valuable information about the safety situation in the schools and their surroundings. One in four schools (24%) reported either that they did not know whether an accidental injury risk assessment indoors had been part of the inspection or that these issues had not been considered in the inspection. About three in four schools (76%) had taken into account indoors risk locations for accidental injuries. One in three schools (33%) did not know whether an accidental injury risk assessment outdoors had been included in the most recent inspection or not. Accidental injury risks had been assessed in 68 per cent of the schools, and outdoors safety was found deficient in 28 per cent of the schools. Conclusions Multiprofessional inspection provides valuable information about school indoors and outdoors conditions, school surroundings, and safety at school trips. Most schools had paid attention to accidental injury prevention and safety both indoors and outdoors. However, a significant part of the schools did not monitor the risk of accidental injuries indoors or in the school yard.