Linking Health to Learning: Gaps and Insights from a Rapid Review supported by the American School Health Association (ASHA)

Abstract

Purpose: In the past year, the American School Health Association (ASHA) has been updating its statement of core beliefs to align with the current evidence base. ASHA has been particularly interested in school health education following the COVID-19 pandemic. ASHA ‘s initiatives are aligned with and support the Whole School Whole Community Whole Child Model (WSCC) developed by the Centers for Disease Control. One element of the WSCC model is health education, which is most clearly related to ASHA Core Belief 1.3: “Health and learning are linked and essential to the development of healthy, resilient individuals and communities. Students’ health and well-being are foundational to achievement and serve as a primary predictor of overall outcomes across the life span.” This core belief was chosen in collaboration with ASHA as the focus of the rapid review, using a lens of health education. Specifically, ASHA leadership requested a rapid review of studies that examine the impact of health education on the relationship between health and learning from 2020 to the present.   Methods: We developed our inclusion/exclusion criteria based on our discussion with ASHA leadership, constructed a search query, and conducted a rapid literature review among three databases: PubMed, Scopus, and ERIC, yielding 665 articles. We used Covidence software to perform the review. We screened articles based on title/abstract, which resulted in 62 articles. Next, we conducted a full-text screening and applied inclusion and exclusion criteria, resulting in twenty-one articles retained for data extraction. Results: Fifteen studies focused on a specific health topic; reproductive health education was the most common research focus and appeared in six studies. Other specific health education topics include mental health in schools, school-based health centers (SBHCs), physical activity, and other specific health behaviors. Most studies were observational with descriptive outcomes. Demographic data was limited, with 18.8% of studies not including information on the race/ethnicity of participants. The authors provided recommendations for health education strategies based on their initiatives. Community-based collaborations were the most frequently recommended strategy, appearing in fourteen studies. Conclusion: We observed that most interventions recommended multiple, overlapping strategies to support health education. The two most frequent recommendations were community-Based Approaches and Focus on Specific Health Topics. The lack of reporting racial and ethnic data was a limitation of studies. Inconsistencies in study outcomes and the definition of fundamental terms such as “health” and “health education”, further limited the comparability and generalizability of study findings. Harmonizing terms and outcomes will help accelerate research to define best practices in school health and support the potential for reproducibility. This rapid review suggests that inadequate research has been done to determine how health education has impacted the relationship between health and learning from 2020 to the present, revealing a gap in the literature. This project also supports the potential value of partnerships between academic health science centers and school health organizations to strengthen evidence-based health education