| Authors | Jamal, F., Fletcher, Adam, Harden, A., Wells, Helene, Thomas, James and Bonell, Chris |
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| Abstract | Background
There is increasing interest in promoting young people’s health by
modifying the school
environment. However, existing research offers little guidance on how
the school context
enables or constrains students’ health behaviours, or how students’ backgr
ounds relate to
these processes. For these reasons, this paper reports on a meta-et
hnography of qualitative
studies examining: through what processes does the school environment (s
ocial and physical)
influence young people’s health?
Methods
Systematic review of qualitative studies. Sixteen databases
were searched, eliciting 62, 329
references which were screened, with included studies quality ass
essed, data extracted and
synthesized using an adaptation of Noblit and Hare’s meta-ethnographic approach.
Results
Nineteen qualitative studies were synthesised to explore processe
s through which school-
level influences on young people’s health might occur. Four over-arching
meta-themes
emerged across studies focused on a range of different health is
sues. First, aggressive
behaviour and substance use are often a strong source of status and bonding
at schools where
students feel educationally marginalised or unsafe. Second, health
-risk behaviours are
concentrated in unsupervised ‘hotspots’ at the school. Third, positive relat
ionships with
teachers appear to be critical in promoting student wellbeing and li
miting risk behaviour;
however, certain aspects of schools’ organisation and education policies c
onstrain this,
increasing the likelihood that students look for a sense of identity
and social support via
health-risk behaviours. Fourth, unhappiness at school can cause students to se
ek sources of
‘escape’, either by leaving school at lunchtime or for longer unaut
horized spells or through
substance use. These meta-themes resonate with Markham and Aveyar
d’s theory of human
functioning and school organisation, and we draw on these qualitative data to
refine and
extend this theory, in particular conceptualising more fully the rol
e of young people’s agency
and student-led ‘systems’ in constituting school environments and generating health ri
sks.
Conclusion
Institutional features which may shape student health behaviours such a
s lack of safety, poor
student-staff relationships and lack of student voice are amenable t
o interventions and should
be the subject of future investigation. Future qualitative research
should focus on health
behaviours which are under-theorised in this context such as physical
activity, sexual and
mental health. |
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