Social inequalities in availability of health-promoting interventions in Québec elementary schools

Abstract

Summary Availability of health-promoting interventions (HPIs) may vary across schools serving students with different socioeconomic backgrounds. Our objectives were to describe social inequalities across elementary schools in: (i) level of importance that school principals attribute to 13 common health-related issues among students in their school; (ii) availability of HPIs within their school addressing eight health topics and (iii) (mis)alignment between perceived importance and HPI availability. Data were collected in telephone interviews with school principals in a convenience sample of 171 elementary schools (59% of 291 schools contacted). Schools were categorized as serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health issues were among students in their schools and provided data on HPI availability for 8 health issues, 4 of which required school action under government mandates. Higher proportions of principals in schools serving disadvantaged students (36% of all 171 schools) perceived most health issues as important. The mean number of HPIs in the past year was 12.0, 12.1 and 11.7 in schools serving very advantaged, moderately advantaged and disadvantaged students, respectively. Only availability of mental health HPIs differed by school deprivation (60, 43 and 30% in very, moderately and disadvantaged, respectively). Although most schools offered oral health HPIs, dental problems were not perceived as important. Smoking was perceived as not important and smoking-related HPIs were relatively rare (9%). Given rapid evolution in public health priorities, (mis)alignment between perceived importance of specific health issues and HPI availability in elementary schools warrants ongoing reflection.

Health‐Promoting School Culture: How Do We Measure it and Does it Vary by School Neighborhood Deprivation?*

“…School‐based health promotion is an important strategy to improve the health of children; it is especially critical for students growing up in socioeconomically deprived neighborhoods, who are disproportionately affected by health issues and learning difficulties 10 . Yet in previous work, we identified a negative social gradient in student health needs and the availability of health‐promoting interventions across schools serving students from advantaged and disadvantaged backgrounds 11 . Schools serving more disadvantaged students may face additional barriers in implementing interventions such as lack of material, financial and human resources, higher workloads, and heavier student health and social needs, all of which could result in less commitment within the school community for health promotion programming 12,13 .…”

“…Data for both phases were drawn from the PromeSS Study, a cross‐sectional survey conducted in 2016‐2019, that aimed to investigate social inequalities in school‐based health‐promoting interventions 11 . The PromeSS sample of schools for this current study was selected from among all 1807 elementary schools in the province of Québec, Canada.…”

“…Data were collected across 3 academic years (2016‐2017, 2017‐2018, 2018‐2019). Questionnaire development was guided by the PromeSS conceptual model 11 . Questionnaire items were drawn/adapted from questionnaires used in previous work 19,20 or developed de novo using peer‐reviewed and gray literatures.…”

“…Although our sample of schools was similar to all eligible elementary schools in Québec, 11,27 the relatively low response proportion of eligible school boards and schools may have limited generalizability of the findings. The small sample size may have limited detection of some associations.…”

“…10 Yet in previous work, we identified a negative social gradient in student health needs and the availability of health-promoting interventions across schools serving students from advantaged and disadvantaged backgrounds. 11 Schools serving more disadvantaged students may face additional barriers in implementing interventions such as lack of material, financial and human resources, higher workloads, and heavier student health and social needs, all of which could result in less commitment within the school community for health promotion programming. 12,13 Although establishing a health-promoting school culture may be more challenging in disadvantaged schools, few studies have investigated this association.…”