Development of a School Health Policy Implementation Survey: A Delphi Study

Abstract

Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n = 378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n = 64) of questions. The remaining 15.8% (n = 12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21^st Century School Nursing Practice.

Keywords

school health policy delphi survey development

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References

Barr

E. M.

Goldfarb

E. S.

Russell

Seabert

Wallen

Wilson

K. L.

(2014). Improving sexuality education: The development of teacher-preparation standards. The Journal of School Health, 84(6), 396–415. https://doi.org/10.1111/josh.12156

Basch

C. E.

(2011). Healthier students are better learners: A missing link in school reforms to close the achievement gap. The Journal of School Health, 81(10), 593–598. https://doi.org/10.1111/j.1746-1561.2011.00632.x

Belansky

Chriqui

Schwartz

(2009). Local school wellness policies: How are schools implementing the congressional mandate? http://www.bridgingthegapresearch.org/_asset/0myri8/RWJF_Brief_WellnessPolicies_2009.pdf

Berget

Nii

Wyckoff

Patrick

Brooks-Russell

Messer

L. H.

(2019). Equipping school health personnel for diabetes care with a competency framework and pilot education program. The Journal of School Health, 89(9), 683–691. https://doi.org/10.1111/josh.12806

Best

N. C.

Oppewal

Travers

(2017). Exploring school nurse interventions and health and education outcomes: An integrative review. The Journal of School Nursing, 34(1), 14–27. https://doi.org/10.1177/1059840517745359

Bradley

B. J.

Greene

A. C.

(2013). Do health and education agencies in the United States share responsibility for academic achievement and health? A review of 25 years of evidence about the relationship of adolescents’ academic achievement and health behaviors. The Journal of Adolescent Health, 52(5), 523–532. https://doi.org/10.1016/j.jadohealth.2013.01.008

Bryan

L. N.

Brener

Barker

Underwood

J. M.

(2021). US Nationwide assessment of school health policies and practices using state-level data. Health Education Journal, 80(6), 724–733. https://doi.org/10.1177/00178969211008553

Castelli

D. M.

Centeio

E. E.

Beighle

A. E.

Carson

R. L.

Nicksic

H. M.

(2014). Physical literacy and comprehensive school physical activity programs. Preventive Medicine, 66, 95–100. https://doi.org/10.1016/j.ypmed.2014.06.007

Centers for Disease Control and Prevention (2019). School Health Index FAQs . https://www.cdc.gov/healthyschools/shi/FAQ.htm

10.

Centers for Disease Control and Prevention (2021). School Health Guidelines . https://www.cdc.gov/healthyschools/npao/strategies.htm

11.

Chicago Public Schools (2016). Healthy CPS . https://cps.edu/Programs/HealthyCPS/Pages/HealthyCPS.aspx

12.

Chriqui

J. F.

Resnick

E. A.

Schneider

Schermbeck

Adcock

Carrion

Chaloupka

F. J.

(2013). School district wellness policies: Evaluating progress and potential for improving children’s health five years after the federal mandate. School Years 2006–07 through 2010-11. (Vol. 3). Chicago, IL: Bridging the Gap Program. University of Illinois at Chicago. www.bridgingthegapresearch.org.

13.

Cicutto

Gleason

Haas-Howard

Jenkins-Nygren

Labonde

Patrick

(2017). Competency-based framework and continuing education for preparing a skilled school health workforce for asthma care: The Colorado experience. The Journal of School Nursing, 33(4), 277–284. https://doi.org/10.1177/1059840516675931

14.

Custer

R. L.

Scarcella

J. A.

Stewart

B. R.

(1999). The modified delphi technique - a rotational modification. Journal of Vocational and Technical Education, 15(2). http://doi.org/10.21061/jcte.v15i2.702

15.

Cygan

Tribbia

(2019). School health policy implementation: Facilitators and challenges. Journal of School Nursing, 36(5). https://doi.org/10.1177/19846089

16.

Cygan

Tribbia

Tully

(2019). School health policy implementation: Facilitators and challenges. The Journal of School Nursing, 36(5), 330–338. https://doi.org/10.1177/1059840519846089

17.

Davis

Maughan

E. D.

White

K. A.

Slota

(2019). School nursing for the 21st century: Assessing scope of practice in the current workforce. The Journal of School Nursing, 37(5), 374–386. https://doi.org/10.1177/1059840519880605

18.

Falzarano

Pinto Zipp

(2013). Seeking consensus through the use of the delphi technique in health sciences research. Journal of Allied Health, 42(2), 99–105.

19.

Harris

P. A.

Taylor

Minor

B. L.

Elliott

Fernandez

O'Neal

McLeod

Delacqua

Kirby

Duda

S. N.

, & REDCap Consortium (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208

20.

Hsu

Sandford

(2007). The delphi technique: Making sense of consensus. Practical Assessment, Research and Evaluation, 12(10), 1.

21.

Humphrey-Murto

Varpio

Wood

T. J.

Gonsalves

Ufholz

L. A.

Mascioli

Foth

(2017). The use of the delphi and other consensus group methods in medical education research: A review. Academic Medicine, 92(10), 1491–1498. https://doi.org/10.1097/ACM.0000000000001812

22.

Kennedy

H. P.

(2004). Enhancing delphi research: Methods and results. Journal of Advanced Nursing, 45(5), 504–511. https://doi.org/10.1046/j.1365-2648.2003.02933.x

23.

Klostermann

B. K.

Perry

C. S.

Britto

M. T.

(2000). Quality improvement in a school health program: Results of a process evaluation. Evaluation & the Health Professions, 23(1), 91–106. https://doi.org/10.1177/01632780022034507

24.

Lam

L. T.

(2014). Risk factors of internet addiction and the health effect of internet addiction on adolescents: A systematic review of longitudinal and prospective studies. Current Psychiatry Reports, 16(11), 508-014-0508-2. https://doi.org/10.1007/s11920-014-0508-2

25.

Lee

J. A.

Welk

G. J.

(2021). Association between comprehensive school physical activity program implementation and principal support. Health Promotion Practice, 22(2), 257–265. https://doi.org/10.1177/1524839919862767

26.

Linstone

Turoff

(2002). The delphi method: Techniques and applications. Addison-Wesley. https://web.njit.edu/∼turoff/pubs/delphibook/delphibook.pdf

27.

Long

S. J.

Littlecott

Hawkins

Eccles

Fletcher

Hewitt

Murphy

Moore

G. F.

(2020). Testing the “zero-Sum game” hypothesis: An examination of school health policies and practices and inequalities in educational outcomes. Journal of School Health, 90(5), 415–424. https://doi.org/10.1111/josh.12889

28.

Marshall

M. G.

Allegrante

J. P.

(2017). Achieving consensus on principles of good practice for school health in independent schools: A delphi study. The Journal of School Health, 87(10), 732–742. https://doi.org/10.1111/josh.12545

29.

Maughan

E. D.

Duff

Wright

(2016). Using the framework for 21st-century school nursing practice in daily practice. NASN School Nurse, 31(5), 278–281. https://doi.org/10.1177/1942602X16661558

30.

Michael

S. L.

Merlo

C. L.

Basch

C. E.

Wentzel

K. R.

Wechsler

(2015). Critical connections: Health and academics. The Journal of School Health, 85(11), 740–758. https://doi.org/10.1111/josh.12309

31.

Mickel

C. F.

Shanovich

K. K.

Evans

M. D.

Jackson

D. J.

(2017). Evaluation of a school-based asthma education protocol: Iggy and the inhalers. The Journal of School Nursing, 33(3), 189–197. https://doi.org/10.1177/1059840516659912

32.

National Association of School Nurses (2016). Framework for 21st century school nursing practice: National association of school nurses. NASN School Nurse, 31(1), 45–53. https://doi-org.ezproxy.rush.edu/10.1177/1942602X15618644

33.

Pinto

R. O.

Pattussi

M. P.

Fontoura Ldo

Poletto

Grapiglia

V. L.

Balbinot

A. D.

Horta

R. L.

(2016). Validation of an instrument to evaluate health promotion at schools. Revista De Saude Publica, 50, 2-8787.2016050005855. Epub 2016 Mar 8. https://doi.org/10.1590/S01518-8787.2016050005855

34.

Qualtrics (2021). Qualtrics XM. Retrieved from https://www.qualtrics.com/

35.

Rasberry

C. N.

Lee

S. M.

Robin

Laris

B. A.

Russell

L. A.

Coyle

K. K.

Nihiser

A. J.

(2011). The association between school-based physical activity, including physical education, and academic performance: A systematic review of the literature. Preventive Medicine, 52(Suppl 1), S10–S20. https://doi.org/10.1016/j.ypmed.2011.01.027

36.

Reising

Cygan

(2020). School nurse job descriptions in urban districts: Alignment with the framework for 21st-century school nursing practice. The Journal of School Nursing. E-pub ahead of print. https://doi.org/10.1177/1059840520963621

37.

S.2507 - child nutrition and WIC reauthorization act of 2004, 108 Cong (2004). https://www.congress.gov/bill/108th-congress/senate-bill/2507

38.

Schuler

B. R.

Saksvig

B. I.

Nduka

Beckerman

Jaspers

Black

M. M.

Hager

E. R.

(2018). Barriers and enablers to the implementation of school wellness policies: An economic perspective. Health Promotion Practice, 19(6), 873–883. https://doi.org/10.1177/1524839917752109

39.

Schwartz

M. B.

Henderson

K. E.

Falbe

Novak

S. A.

Wharton

C. M.

Long

M. W.

Fiore

S. S.

(2012). Strength and comprehensiveness of district school wellness policies predict policy implementation at the school level. The Journal of School Health, 82(6), 262–267. https://doi.org/10.1111/j.1746-1561.2012.00696.x

40.

Story

Nanney

M. S.

Schwartz

M. B.

(2009). Schools and obesity prevention: Creating school environments and policies to promote healthy eating and physical activity. The Milbank Quarterly, 87(1), 71–100. https://doi.org/10.1111/j.1468-0009.2009.00548.x

41.

United Sates Senate (2010). S. rept. 111-178 - HEALTHY, HUNGER-FREE KIDS ACT OF 2010. https://www.congress.gov/congressional-report/111th-congress/senate-report/178

42.

Wall

Litchfield

Carriquiry

McDonnell

E. T.

Woodward-Lopez

G. M.

(2012). Local wellness policy strength and perceived implementation of school nutrition standards across three states. Childhood Obesity, 8(4), 331–338. https://doi.org/10.1089/chi.2012.0047

43.

Weatherson

K. A.

McKay

Gainforth

H. L.

Jung

M. E.

(2017). Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: Application of the theoretical domains framework. BMC Public Health, 17(1), 835-017-4846-y. https://doi.org/10.1186/s12889-017-4846-y

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