GuideMe - An evaluation project in school health services

1. Fidelity to recommendations in the guideline will be indexed by three constructs: Adherence to guidelines, adaptations to guidelines, and quality in using guidelines. Questions are tailored according to the National guideline for school health services
1.1. To measure fidelity to the recommendation of the individual 8th-grade consultation, questions on e.g., completed consultations, topics addressed, user involvement, quality, and adaptations will be answered by students and school nurses at T2 (after the consultations). School health nurses also report adaptations to guidelines through open-ended questions (free text) in the post-consultation questionnaire (T2)
1.2. To assess fidelity to the recommendation on cooperation with schools, questions on e.g., systematic cooperation, knowledge about each other’s framework conditions, nurses teaching in groups or classes and group interventions in collaboration with schools, will be answerey nurses and school personnel at the beginning of the school year (T1) and at the end of the school year (T3)
2. The school nurses' work-related self-efficacy and relations with students:
2.1. Work-related self-efficacy will be answered by nurses at T1 and T3
2.2. Nurse-student relation answered by students by an 8-item questionnaire about user satisfaction and relations at T2
2.3. Nurses by a self-developed questionnaire at T2
3. For the identification of vulnerable students a combination of several questionnaires will be used:
3.1. Students’ self-reported mental health at T1 and T3
3.2. Students’ self-reported physical health using the Children’s Somatic Symptoms Inventory (CSSI-8) at T1 and T3
3.3. Students’ self-reported health habits (see below) at T1 and T3
3.4. Students’ self-reported Quality of life measured using Kidscreen-27 at T1 and T3
3.5. Students’ self-reported trauma measured using Child and Adolescent Trauma Screen at T1
3.6. School nurses’ registration of students’ function measured using self-developed questions at T2
3.7. School nurses’ registration of student follow-up measured using self-developed questions from T2 to T3
4. Student's health literacy, general self-efficacy, health behaviour and quality of life measured using:
4.1. The Health Literacy for School-Aged Children (HLSAC) instrument at T1, T2 and T3
4.2. The General Self-Efficacy Scale, short version (GSE-5) answered by students at T1, T2 and T3
4.3. Student’s self-reported health behaviour (i.e., physical activity, sleep, nutrition, screen activities) at T1 and T3
5. School climate and student's school attendance measured using:
5.1. Self-developed questionnaire answered by students at T1 and T3

Qualitative interviews will be used to measure the experiences of school nurses, students, and school personnel with the different implementation strategies/elements in SchoolHealth

Semi-structured, individual- and focus group interviews with open-ended questions will be carried out with school nurses, students, and school personnel. Follow-up questions will be used if necessary. The interviews will take place after the individual consultations with 8th graders and at the end of the school year.

Timepoints:
T1 = The beginning of the school year
T2 = After the consultations
T3 = The end of the school year

1. Differences/similarities between SchoolHealth and the equivalent Danish dialog tool (BørnUngeLiv.dk) measured using qualitative semi-structured focus group interviews with school nurses and personnel implementing BørnUngeLiv.dk, and individual interviews with school nurses and school personnel in Denmark and Norway between timepoint T2 and T3
2. User pathways in health- and welfare services will be provided by National registry data. This includes contacts with (including time/date and diagnoses):
2.1. School health services (The Norwegian Registry for Primary Health Care)
2.2. General practitioners (The Norwegian Registry for Primary Health Care)
2.3. Physiotherapists (The Norwegian Registry for Primary Health Care)
2.4. Specialized healthcare services (including psychiatric care) (The Norwegian Patient Register (NPR))
During years before and after (to date, according to availability of data) 1) participation in SchoolHealth and 2) participation in the Young-HUNT survey.
3. Self-reported use of the school health services and self-reported health will be assessed using questionnaire data at T1 from:
3.1. The GuideMe study/SchoolHealth
3.2. Existing population studies in Norway: The youth part of The Trøndelag Health Study (The HUNT Study) - Young-HUNT 3 (2006-2008) and Young-HUNT 4 (2017-2019).
3.3. BørnUngeLiv.dk in Denmark.
4. Implementation determinants will be measured using:
4.1 The Implementation Climate Scale, ICS will be answered by nurses and their leaders at T1 and T3
4.2. The Implementation Leadership Scale, ILS will be answered by nurses and their leaders at T1 and T3
5. Implementability of guidelines will be assessed using the following three scales:
5.1. Feasibility of Intervention Measure (FIM) answered by nurses and their leaders at T1 and T3
5.2. Acceptability of Intervention Measure (AIM), answered by nurses and their leaders at T1 and T3
5.3 Intervention Appropriateness Measure (IAM) will be answered by nurses and their leaders at T1 and T3
6. Cost-effectiveness of SchoolHealth using measures of short- and long-term costs and effects of the intervention within (e.g., healthcare utilization measures and utilities) and outside (e.g. school attendance, grades, participation in extracurricular activities) the healthcare sector up to 2032. Models and measures suitable for economic evaluation in primary health care services are lacking, and development of these is planned as a part of the study.

Timepoints:
T1 = The beginning of the school year
T2 = After the consultations
T3 = The end of the school year