Shinde Sachin, Raniti Monika, Sharma Amit, Sawyer Susan M
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Center for Inquiry Into Mental Health, Pune, India.
Front Psychiatry. 2023 Jun 23;14:1112710. doi: 10.3389/fpsyt.2023.1112710. eCollection 2023.
Health promotion interventions that are developed and evaluated by researchers and other external providers are at risk of not being sustained beyond the initial implementation period. When delivered by a lay school health worker, the SEHER study of a whole-school health promotion intervention in Bihar, India was found to be feasible, acceptable and effective in improving school climate and student health behaviors. The objective of this case study is to describe the decision-making processes, barriers, and enablers to continuing the SEHER intervention following its official closure.
For this exploratory qualitative case study, data were collected from four government-run secondary schools, two of which continued SEHER and two of which discontinued it after official closure. Thirteen school staff were interviewed, and 100 girls and boys (aged 15-18 years old) participated in eight focus groups discussing their experiences of the process of continuing the intervention (or discontinuing) following its official closure. Thematic analysis was conducted in NVivo 12 using grounded theory.
No school sustained the intervention as originally delivered in the research trial. In two schools, the intervention was adapted by selecting sustainable components, whereas in two others it was discontinued altogether. We identified four interrelated themes that explained the complex decision-making process, barriers, and enablers related to program continuation: (1) understanding of the intervention philosophy among school staff; (2) school capabilities to continue with intervention activities; (3) school attitudes and motivation about implementing the intervention, and; (4) the education policy environment and governance structures. Suggestions for overcoming barriers included adequate resource allocation; training, supervision, and support from external providers and the Ministry of Education; and formal government approval to continue the intervention.
Sustaining this whole-school health promotion intervention in low-resource school settings in India depended on individual, school and government factors as well as external support. These findings suggest that health interventions will not necessarily become embedded in a school's operations merely because they are designed as a whole-school approach or because they are effective. Research should identify the resources and processes required to balance planning for future sustainability while awaiting trial results about an intervention's effectiveness.
由研究人员和其他外部提供者开发和评估的健康促进干预措施，在初始实施期之后存在无法持续的风险。印度比哈尔邦一项针对全校健康促进干预措施的SEHER研究发现，由非专业学校健康工作者实施该干预措施在改善学校氛围和学生健康行为方面是可行的、可接受的且有效的。本案例研究的目的是描述SEHER干预措施正式结束后继续实施该干预措施的决策过程、障碍和促成因素。
对于这个探索性的定性案例研究，数据收集自四所政府开办的中学，其中两所继续实施SEHER干预措施，另外两所在正式结束后停止了该措施。对13名学校工作人员进行了访谈，100名年龄在15至18岁的男女生参加了八个焦点小组，讨论他们在干预措施正式结束后继续（或停止）实施该措施过程中的经历。在NVivo 12中使用扎根理论进行了主题分析。
没有学校维持研究试验中最初实施的干预措施。在两所学校中，通过选择可持续的组成部分对干预措施进行了调整，而在另外两所学校中，该措施则完全停止了。我们确定了得四个相互关联的主题，这些主题解释了与项目延续相关的复杂决策过程、障碍和促成因素：（1）学校工作人员对干预理念的理解；（2）学校继续开展干预活动的能力；（3）学校对实施干预措施的态度和积极性；（4）教育政策环境和治理结构。克服障碍的建议包括充足的资源分配；外部提供者和教育部的培训、监督和支持；以及政府正式批准继续实施干预措施。
在印度资源匮乏的学校环境中维持这种全校健康促进干预措施取决于个人、学校和政府因素以及外部支持。这些发现表明，健康干预措施不一定仅仅因为被设计为全校性方法或因为它们有效就会融入学校的运作中。研究应确定在等待关于干预措施有效性的试验结果时，平衡未来可持续性规划所需的资源和流程。
