HAPPEN: The Health and Attainment of Pupils in a Primary Education Network

A complex relationship exists between health and education, with evidence demonstrating the importance of childhood health and wellbeing on academic outcomes. However, prioritising health and wellbeing within the school setting has been a challenge due to curriculum pressures and a lack of collaboration. To address these shortfalls, a primary school network, HAPPEN (Health and Attainment of Pupils in a Primary Education Network) was established. The overarching aim of this thesis is to develop HAPPEN, a network combining multidisciplinary expertise through a unified system of education, health and research specialists, using an action research model. This thesis examines whether HAPPEN can act as a platform to evaluate interventions in the school setting and disseminate evidence-based learning. This is presented through published research in Study 1; a qualitative analysis of curriculum-based outdoor learning and Study 2; a mixed-methods evaluation of The Daily Mile. This thesis also examines if HAPPEN can be used for observational epidemiology by identifying the factors associated with educational attainment. Study 3 presents the association between social, lifestyle and epidemiological factors with attainment at age 10-11 using linked health, educational and survey data. The final chapter presents a critical reflection of the development, scalability and sustainability of HAPPEN. Following an annual process of observation, reflection, planning and implementation, HAPPEN has expanded to a national primary school network and knowledge exchange infrastructure for schools and health professionals in Wales. The research through HAPPEN has demonstrated local, national and international impact and demonstrates the important contribution this thesis provides to the understanding of health and education. In conclusion, HAPPEN fills an important gap in the provision of a synergistic health and education tool for primary schools

The well-being and work-related stress of senior school leaders in Wales and Northern Ireland during COVID-19 “educational leadership crisis”: A cross-sectional descriptive study

The COVID-19 pandemic caused far-reaching societal changes, including significant educational impacts affecting over 1.6 billion pupils and 100 million education practitioners globally. Senior school leaders were at the forefront and were exposed to particularly high demands during a period of “crisis leadership”. This occupation were already reporting high work-related stress and large numbers leaving the profession preceding COVID-19. This cross-sectional descriptive study through the international COVID-Health Literacy network aimed to examine the well-being and work-related stress of senior school leaders (n = 323) in Wales (n = 172) and Northern Ireland (n = 151) during COVID-19 (2021–2022). Findings suggest that senior school leaders reported high workloads (54.22±11.30 hours/week), low well-being (65.2% n = 202, mean WHO-5 40.85±21.57), depressive symptoms (WHO-5 34.8% n = 108) and high work-related stress (PSS-10: 29.91±4.92). High exhaustion (BAT: high/very high 89.0% n = 285) and specific psychosomatic complaints (experiencing muscle pain 48.2% n = 151) were also reported, and females had statistically higher outcomes in these areas. School leaders were engaging in self-endangering working behaviours; 74.7% (n = 239) gave up leisure activities in favour of work and 63.4% (n = 202) sacrificed sufficient sleep, which was statistically higher for females. These findings are concerning given that the UK is currently experiencing a “crisis” in educational leadership against a backdrop of pandemic-related pressures. Senior leaders’ high attrition rates further exacerbate this, proving costly to educational systems and placing additional financial and other pressures on educational settings and policy response. This has implications for senior leaders and pupil-level outcomes including health, well-being and educational attainment, requiring urgent tailored and targeted support from the education and health sectors. This is particularly pertinent for Wales and Northern Ireland as devolved nations in the UK, who are both implementing or contemplating major education system level reforms, including new statutory national curricula, requiring significant leadership, engagement and ownership from the education profession

Impact of school closures on the health and well-being of primary school children in Wales UK: a routine data linkage study using the HAPPEN Survey (2018–2020)

Objectives: This study aimed to explore the relationship between initial school closures and children’s health by comparing health and well-being outcomes collected during school closures (April–June 2020) via HAPPEN (the Health and Attainment of Pupils in a Primary Education Network) with data from the same period in 2019 and 2018 via the HAPPEN Survey. Setting: The study was conducted online with 161 primary schools across Wales involved in the ‘HAPPEN At Home’ Survey. Participants: Data were collected via the ‘HAPPEN At Home’ Survey capturing the typical health behaviours of children aged 8–11 years from 1333 participants across Wales. These data were compared with data in 2018 and 2019 also collected between April and June, from HAPPEN (2019 (n=1150) and 2018 (n=475)). Primary and secondary outcome measures: Primary outcomes included validated measures of physical activity, screen time, diet and dental health, as well as well-being, competency and autonomy. Free school meal (FSM) status was used as a proxy for socioeconomic deprivation. Analyses were repeated stratifying by FSM. Results: Comparing responses between April–June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general well-being for children during school closures compared with previous years. However, children on FSM ate fewer fruits and vegetables (21% less at five or more portions of fruits and vegetables (95% CI: 5.7% to 37%)) and had lower self-assessed school competence compared with 2019. Compared with those not on FSM, they also spent less time doing physical activity (13.03%, 95% CI: 3.3% to 21.7%) and consumed more takeaways (16.3%, 95% CI: 2% to 30%) during school closures. Conclusions: This study suggests that schools are important in reducing inequalities in physical health. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures

Factors influencing wellbeing in young people during COVID-19: A survey with 6291 young people in Wales

COVID-19 infection and the resultant restrictions has impacted all aspects of life across the world. This study explores factors that promote or support wellbeing for young people during the pandemic, how they differ by age, using a self-reported online survey with those aged 8–25 in Wales between September 2020 and February 2021. Open-ended responses were analysed via thematic analysis to provide further context. A total of 6,291 responses were obtained from 81 education settings across Wales (including primary and secondary schools as well as sixth form, colleges and universities). Wellbeing was highest in primary school children and boys and lowest in those who were at secondary school children, who were girls and, those who preferred not to give a gender. Among primary school children, higher wellbeing was seen for those who played with lots of others (rather than alone), were of Asian ethnicity (OR 2.17, 95% CI: 1.26 to 4.3), had a safe play area (OR: 2.4, 95% CI: 1.67 to 2.56) and had more sleep. To support their wellbeing young people reported they would like to be able to play with their friends more. Among secondary school children those who were of mixed ethnicity reported lower wellbeing (OR: 5.14, 95% CI: 1.68 to 15.79). To support their wellbeing they reported they would like more support with mental health (due to anxiety and pressure to achieve when learning online). This study found self-reported wellbeing differed by gender, ethnicity and deprivation and found younger children report the need for play and to see friends to support wellbeing but older children/young people wanted more support with anxiety and educational pressures

The Daily Mile: Whole-school recommendations for implementation and sustainability. A mixed-methods study

Regular physical activity (PA) during childhood is associated with a range of positive health outcomes and higher educational attainment. However, only 2.0% to 14.7% of girls and 9.5% to 34.1% of boys are meeting the current PA guidelines of 60 minutes of moderate to vigorous PA daily. Schools are targeted as a key setting to improve children's PA levels. The Daily Mile (TDM), a teacher-led 15 minute PA intervention was established in 2012 and has been widely adopted globally. However, the dynamic school environment generates challenges for school-based interventions to follow a uniform implementation method resulting in sustainability issues and limited evaluation. The aims of this mixed-methods study were to (1) explore whether whole-school experiences of TDM were related to implementation and (2) examine the association between TDM and CRF in children from high and low socio-economic groups. Focus groups with pupils (n = 6) and interviews with teachers (n = 9) and headteachers (n = 2) were conducted to explore factors associated with successful implementation. Pupils (n = 258 imputed) aged 9-11 from six primary schools in south Wales, United Kingdom participated in CRF assessments (20m shuttle run test) at two time-points (baseline, 6 month follow-up). Thematic analyses of qualitative measures and linear regression analyses of quantitative measures were used to assess the research questions. Qualitative findings identified implementation factors associated with a positive experience of TDM; flexible and adaptable, not replacing current play provision but delivered as an additional playtime, incorporate personal goal setting, teacher participation, whole-school delivery with community support. Both groups demonstrated equal increases in shuttles between baseline and follow-up (deprived: 4.7 ± 13.4, non-deprived: 4.8 ± 16.0). There was no significant difference in this increase for deprived compared to non-deprived children adjusted for age and gender. Findings from this study provide a set of recommendations for the future implementation and sustainability of TDM

The Effect COVID Has Had on the Wants and Needs of Children in Terms of Play: Text Mining the Qualitative Response of the Happen Primary School Survey with 20,000 Children in Wales, UK between 2016 and 2021

Play is central to children’s physical and social development. This study examines changes in children’s response to questions on play opportunities between 2016 and 2021. Primary school children aged 8–11 in Wales participated in the HAPPEN survey between 2016 and 2021. The survey captures a range of information about children’s health and wellbeing, including open-ended questions about what could make them happier. Text mining methods were used to examine how open-ended responses have changed over time in relation to play, before and, after the COVID enforced school closures. A total of 20,488 participant responses were analysed, 14,200 pre-school closures (2016 to pre-March 2020) and 6248 after initial school closures (September 2020–December 2021). Five themes were identified based on children’s open-ended responses; (a) space to play (35%), (b) their recommendations on play (31%), (c) having permission to play (20%), (d) their feelings on health and wellbeing and play (10%) and (e) having time to play (4%). Despite differences due to mitigation measures, the predominant recommendation from children after COVID is that they would like more space to play (outside homes, including gardens), more time with friends and protected time to play with friends in school and at home

Primary school staff perspectives of school closures due to COVID-19, experiences of schools reopening and recommendations for the future: A qualitative survey in Wales

School closures due to the COVID-19 global pandemic are likely to have a range of negative consequences spanning the domains of child development, education and health, in addition to the widening of inequalities and inequities. Research is required to improve understanding of the impact of school closures on the education, health and wellbeing of pupils and school staff, the challenges posed during face-to-face reopening and importantly to identify how the impacts of these challenges can be addressed going forward to inform emerging policy and practice. This qualitative study aimed to reflect on the perspectives and experiences of primary school staff (pupils aged 3–11) in Wales regarding school closures and the initial face-to-face reopening of schools and to identify recommendations for the future. A total of 208 school staff completed a national online survey through the HAPPEN primary school network, consisting of questions about school closures (March to June 2020), the phased face-to-face reopening of schools (June to July 2020) and a return to face-to-face education. Thematic analysis of survey responses highlighted that primary school staff perceive that gaps in learning, health and wellbeing have increased and inequalities have widened during school closures. Findings from this study identified five recommendations; (i) prioritise the health and wellbeing of pupils and staff; (ii) focus on enabling parental engagement and support; (iii) improve digital competence amongst pupils, teachers and parents; (iv) consider opportunities for smaller class sizes and additional staffing; and (v) improve the mechanism of communication between schools and families, and between government and schools

The well-being and work-related stress of senior school leaders in Wales and Northern Ireland during COVID-19 “educational leadership crisis”: A cross-sectional descriptive study

The COVID-19 pandemic caused far-reaching societal changes, including significant educational impacts affecting over 1.6 billion pupils and 100 million education practitioners globally. Senior school leaders were at the forefront and were exposed to particularly high demands during a period of “crisis leadership”. This occupation were already reporting high work-related stress and large numbers leaving the profession preceding COVID-19. This cross-sectional descriptive study through the international COVID-Health Literacy network aimed to examine the well-being and work-related stress of senior school leaders (n = 323)in Wales (n = 172) and Northern Ireland (n = 151) during COVID-19 (2021–2022). Findings suggest that senior school leaders reported high workloads (54.22±11.30 hours/week), low well-being (65.2% n = 202, mean WHO-5 40.85±21.57), depressive symptoms (WHO-5 34.8% n = 108) and high work-related stress (PSS-10: 29.91±4.92). High exhaustion (BAT:high/very high 89.0% n = 285) and specific psychosomatic complaints (experiencing muscle pain 48.2% n = 151) were also reported, and females had statistically higher outcomes in these areas. School leaders were engaging in self-endangering working behaviours; 74.7% (n = 239) gave up leisure activities in favour of work and 63.4% (n = 202) sacrificed sufficient sleep, which was statistically higher for females. These findings are concerning given that the UK is currently experiencing a “crisis” in educational leadership against a backdrop of pandemic-related pressures. Senior leaders’ high attrition rates further exacerbate this, proving costly to educational systems and placing additional financial and other pressures on educational settings and policy response. This has implications for senior leaders and pupil-level outcomes including health, well-being and educational attainment, requiring urgent tailored and targeted support from the education and health sectors. This is particularly pertinent for Wales and Northern Ireland as devolved nations in the UK, who are both implementing or contemplating major education system level reforms, including new statutory national curricula, requiring significant leadership, engagement and ownership from the education profession.<br/

Impact of school closures on the health and well-being of primary school children in Wales UK: a routine data linkage study using the HAPPEN Survey (2018–2020)

Objectives: This study aimed to explore the relationship between initial school closures and children’s health by comparing health and well-being outcomes collected during school closures (April–June 2020) via HAPPEN (the Health and Attainment of Pupils in a Primary Education Network) with data from the same period in 2019 and 2018 via the HAPPEN Survey. Setting: The study was conducted online with 161 primary schools across Wales involved in the ‘HAPPEN At Home’ Survey. Participants: Data were collected via the ‘HAPPEN At Home’ Survey capturing the typical health behaviours of children aged 8–11 years from 1333 participants across Wales. These data were compared with data in 2018 and 2019 also collected between April and June, from HAPPEN (2019 (n=1150) and 2018 (n=475)). Primary and secondary outcome measures: Primary outcomes included validated measures of physical activity, screen time, diet and dental health, as well as well-being, competency and autonomy. Free school meal (FSM) status was used as a proxy for socioeconomic deprivation. Analyses were repeated stratifying by FSM. Results: Comparing responses between April–June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general well-being for children during school closures compared with previous years. However, children on FSM ate fewer fruits and vegetables (21% less at five or more portions of fruits and vegetables (95% CI: 5.7% to 37%)) and had lower self-assessed school competence compared with 2019. Compared with those not on FSM, they also spent less time doing physical activity (13.03%, 95% CI: 3.3% to 21.7%) and consumed more takeaways (16.3%, 95% CI: 2% to 30%) during school closures. Conclusions: This study suggests that schools are important in reducing inequalities in physical health. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures

Changes in self-reported health and wellbeing outcomes in 36,951 primary school children from 2014 to 2022 in Wales: an analysis using annual survey data

IntroductionThis study examines the changes in childhood self-reported health and wellbeing between 2014 and 2022.MethodsAn annual survey delivered by HAPPEN-Wales, in collaboration with 500 primary schools, captured self-reported data on physical health, dietary habits, mental health, and overall wellbeing for children aged 8–11 years.ResultsThe findings reveal a decline in physical health between 2014 and 2022, as evidenced by reduced abilities in swimming and cycling. For example, 68% of children (95%CI: 67%–69%) reported being able to swim 25m in 2022, compared to 85% (95% CI: 83%–87%) in 2018. Additionally, unhealthy eating habits, such as decreased fruit and vegetable consumption and increased consumption of sugary snacks, have become more prevalent. Mental health issues, including emotional and behavioural difficulties, have also increased, with emotional difficulties affecting 13%–15% of children in 2017–2018 and now impacting 29% of children in 2021–2022. Moreover, indicators of wellbeing, autonomy, and competence have declined.DiscussionImportantly, this trend of declining health and wellbeing predates the onset of the Covid-19 pandemic, suggesting that it is not solely attributed to the pandemic’s effects. The health of primary school children has been on a declining trajectory since 2018/2019 and has continued to decline through the COVID recovery period. The study suggests that these trends are unlikely to improve without targeted intervention and policy focus