Rebecca Langford

Hand-washing, subclinical infections, and growth: A longitudinal evaluation of an intervention in Nepali slums

We conducted a longitudinal study to assess the impact of a hand‐washing intervention on growth and biomarkers of child health in Nepali slums. This is the first study to evaluate the impact of hand‐washing on markers of subclinical, asymptomatic infections associated with childhood growth faltering.

What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences

Objectives Although sex and relationship education (SRE) represents a key strand in policies to safeguard young people and improve their sexual health, it currently lacks statutory status, government guidance is outdated and a third of UK schools has poor-quality SRE. We aimed to investigate whether current provision meets young peoples needs. Design Synthesis of qualitative studies of young peoples views of their school-based SRE. Setting Eligible studies originated from the UK, Ireland, the USA, Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden. Participants Studies of students aged 4–19 in full-time education, young adults ≤19 (not necessarily in full-time education) or adults ≤25 if recalling their experiences of school-based SRE. Results –69 publications were identified, with 55 remaining after quality appraisal (representing 48 studies). The synthesis found that although sex is a potent and potentially embarrassing topic, schools appear reluctant to acknowledge this and attempt to teach SRE in the same way as other subjects. Young people report feeling vulnerable in SRE, with young men anxious to conceal sexual ignorance and young women risking sexual harassment if they participate. Schools appear to have difficulty accepting that some young people are sexually active, leading to SRE that is out of touch with many young peoples lives. Young people report that SRE can be negative, gendered and heterosexist. They expressed dislike of their own teachers delivering SRE due to blurred boundaries, lack of anonymity, embarrassment and poor training. Conclusions SRE should be ‘sex-positive’ and delivered by experts who maintain clear boundaries with students. Schools should acknowledge that sex is a special subject with unique challenges, as well as the fact and range of young peoples sexual activity, otherwise young people will continue to disengage from SRE and opportunities for safeguarding and improving their sexual health will be reduced.

Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health

There has been increasing interest in involving the public in systematic reviews as they provide a shortcut to the evidence and arguably have greater influence over policy decisions and ultimately peoples lives. Case examples of this involvement are rare, especially for reviews focused on children and young people. This study describes the process and impact of consulting with a young peoples advisory group to inform decision making in a systematic review on the effects of schools and school environment interventions on children and young peoples health.

The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research:

The World Health Organization’s Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools’ “core business” by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children’s basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.

OP36 Individual, family and school-based interventions to prevent multiple risk behaviours in young people aged 8–25 years: a cochrane systematic review and meta-analysis

Background We aimed to undertake a Cochrane systematic review to quantify the effect of multiple risk behaviour interventions on prevention of substance use, antisocial behaviour, sexual risk, vehicle risk, self-harm, gambling, physical inactivity and unhealthy diet among individuals aged 8–25 years as little is known about their effectiveness (CD009927). Methods Eleven databases were searched to 14 November 2016. Randomised controlled trials were included that addressed two or more risk behaviours in individuals aged 0–18 years. Data were pooled in a random-effects meta-analysis in Revman 5.3. For each outcome, we included subgroups relating to study type (individual, family or school-level and universal or targeted in approach). The quality of evidence was assessed using the GRADE approach. Results We identified 34 680 titles, screened 27 691 articles and included seventy studies. We found moderate quality evidence indicating that universal school-level interventions were beneficial in relation to tobacco use (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.60–0.97, n=15 354, I2 57%), alcohol use (OR 0.72, 95% CI 0.56 to 0.92, n=8,751, I2 58%), and physical activity (OR 1.32, 95% CI 1.16 to 1.50, n=6 441, I2 0%) compared to a comparator. Lower quality evidence indicated possible benefit for drug use (OR 0.74, 95% CI 0.55 to 1.00, n=11 058, I2 69%) and antisocial behaviour (OR 0.81, 95% CI 0.66 to 0.98, n=20 756, I2 66%), while findings were less certain for sexual risk behaviour (OR 0.80, 95% CI 0.60 to 1.08, n=13 351, I2 80%; low quality evidence) and unhealthy diet (OR 0.82, 95% CI 0.64 to 1.06, n=6441, I2 49%, moderate quality evidence). Analyses indicated that family- and individual-level interventions probably have little or no effect on these outcomes, although fewer such studies were identified. The quality of studies was judged to be of moderate or low quality for most outcomes, primarily owing to concerns around selection, performance and detection bias, and heterogeneity between studies. Conclusion Available evidence is strongest for universal school-level interventions that target multiple risk behaviours demonstrating that they may be effective in preventing certain risk behaviours. However, concerns around poor reporting and study quality highlight the need to strengthen the evidence base in this field. This abstract is based on preliminary findings from a Cochrane review currently underway. Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews.

The Health Promoting Schools Framework

The World Health Organization’s Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools’ “core business” by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children’s basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.

Qualitative research methods, by Monique Hennink, Inge Hutter and Ajay Bailey

It is fair to say that both historically and currently, the dominant paradigm operating within health research has been the positivist approach that privileges the quantitative examination of outcomes of interest. Yet, recent decades have seen a growing dissatisfaction with the limits of this paradigmatic approach that focuses on the ‘who’ and ‘what’ rather than the ‘how’ and ‘why’. The valuable contribution of qualitative methods to health research – whether used on their own or in combination with quantitative methods – is now well recognised and there is increasing demand for this type of research within the health field. But with all this extra interest comes the need to ensure that researchers are adequately trained to employ these methods and analyse and interpret their results, lest qualitative research’s hard-won respectability be dented by poorly conducted research projects. This then is the aim of Hennink et al’s book: to provide good quality training to researchers ‘from many scientific disciplines who wish to learn the process of qualitative research, whether at a beginning or more advanced level’ (p. xx). This book itself is based upon the 10-year collaboration between Hennink and Hutter in delivering qualitative research training workshops to researchers in diverse academic disciplines, from different cultural backgrounds and at various academic levels. (Bailey joined as an instructor at these workshops at a later date). Perhaps not surprisingly given the authors’ backgrounds, this book has an explicitly international/developing world focus and draws heavily on examples from demography and health research. Yet, Hennink et al. argue that the approach set out in their book is equally valuable for researchers working in diverse contexts and therefore has global appeal – an assertion I would, on the whole, agree with. A key focus of this book is the cyclical, iterative nature of qualitative research. In Chapter 1 the authors set out their ‘qualitative research cycle’, made up of three further inter-linked cycles: the design cycle, the ethnographic cycle and the analytic cycle. These three cycles form the organising principle of this book. Thus, Chapters 3 and 4 are concerned with preparation for the field and discuss study design in some depth (formulating research questions, reviewing the literature, developing a conceptual framework and selecting a fieldwork approach) and ethics in qualitative research. The detail of qualitative methods is dealt with in Chapters 5–8, where the authors cover participant recruitment before going on to discuss in-depth interviews, focus groups and observations. The final chapters deal with the tricky (and seemingly mystical) task of analysing qualitative data and presenting it to others – issues that