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From complex interventions to complex systems: towards a better understanding of school health improvement

Littlecott, Hannah 2016. From complex interventions to complex systems: towards a better understanding of school health improvement. PhD Thesis, Cardiff University.
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Abstract

Interventions to improve young peoples’ health are commonly delivered via schools. Challenges in changing the functioning of complex school systems are commonly underestimated and recognition is growing that interventions cannot be described in isolation from the contexts they attempt to alter. However, school health research has typically paid less attention to understanding schools’ current orientations toward health improvement than to attempts to introduce change. This thesis analyses data from a survey of schools to explore variability in their responses to school-level health needs data in terms of its discussion, distribution and perceived likelihood of impact on health improvement. It then employs ego social network analysis, focused on Wellbeing Leads within four case study schools, to identify potential explanations for variability between schools, before undertaking semi-structured interviews with staff, students and parents within each case study school to qualitatively explore health-related system functioning. Results highlighted the potential role of staff seniority in explaining schools’ variable engagement with feedback. Highly organised structures with allocation of responsibility for wellbeing to a member of senior management, systematisation of dedicated wellbeing roles, a high level of brokerage and embeddedness of outside agencies within school systems were characteristics of the more engaged case study schools. These factors were found to contribute to the orientation of school systems towards health in terms of engaging parents, implementing Personal and Social Education and promoting a healthy school ethos. By examining system functioning through a complex systems lens, whilst layering theory within this to facilitate its practical application, and employing mixed methodology, this thesis furthers our understanding of how variance in existing school system dynamics may impede or facilitate efforts to respond to student health needs. This higher level of understanding could be utilised to design complex interventions, which work with the system to achieve change.

Item Type: Thesis (PhD)
Status: Unpublished
Schools: Social Sciences (Includes Criminology and Education)
Subjects: H Social Sciences > H Social Sciences (General)
Funders: MRC
Date of First Compliant Deposit: 25 May 2017
Last Modified: 04 Jun 2017 09:51
URI: http://orca.cf.ac.uk/id/eprint/100889

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