Background to the Healthy Schools evaluation
The Tallaght West Child Development Initiative (TWCDI) Healthy Schools (HS) programme sought to improve children’s overall health outcomes and increase their access to primary care services. The programme was developed as a result of previous research conducted by TWCDI (2004) which identified the health needs of children living in Tallaght West. The HS programme was a manualised initiative which was based upon seven primary outcomes. These were that: (1) children demonstrate age-appropriate physical development; (2) children have access to basic health care; (3) children are aware of basic safety, fitness and health care needs; (4) children are physically fit; (5) children eat healthily; (6) children feel good about themselves and; (7) parents’ involvement in their child’s health.
The principal objective of this study was to evaluate the implementation and outcome of the Healthy Schools programme. The evaluation was a longitudinal comparative study which followed the children and all key stakeholders from intervention and comparison schools throughout the implementation of the Healthy Schools Programme. The evaluation was divided into two components: (1) an examination of the health outcomes for children, and (2) a process evaluation of the programme.
The sample frame consisted of children attending junior infant class to fifth class in five intervention schools and two comparison schools. All schools were DEIS Band 1 schools. The intervention schools self-selected in liaison with Tallaght West Childhood Development Initiative (TWCDI) prior to the commencement of the evaluation study.
In each intervention school the principal was asked to complete an interview to identify their understanding and views of the implementation of the Healthy Schools programme. Interviews were also carried out with the two Healthy Schools Coordinators, the Director of Public Health Nursing as well as two members of staff from CDI to examine the rollout of the HS programme.
All participating children (from Junior to Fifth class) had their BMI measured by a qualified nurse and member of the research team during school time. Self-report questionnaires (Kidscreen 27, Health Related Behaviour Questionnaire (HRBQ) and the Childhood Depression Inventory (CDI)) were completed by children or their parent. Outcomes for all participating were measured at baseline, 12 months and 24 months follow-ups. Details of baseline findings are available from Comiskey, C. M. O’Sullivan, K., Quirke, M., Wynne, C., Hollywood, E and McGilloway, S. (2012).
Ethical and contractual challenges and solutions
The study was primarily carried out by Trinity College Dublin (TCD), however the National University of Ireland, Maynooth was subcontracted for part of the research. The signing of the main contract between TCD and TWCDI took a considerable amount of time as it was important that all matters of existing and future intellectual property were agreed. The final contract was a service agreement as opposed to a research contract and was agreed by solicitors for both parties following a face-to-face meeting. All parties were satisfied and contracts were signed after a period of approximately six months. NUI Maynooth then received an identical sub-contract from TCD and all parties were legally contracted and protected.
Prior to the initiation of any research or data collection in the study locations, the study, its design, instruments, processes, methodology and all letters of introduction, information leaflets, information posters for participating schools and consent forms received ethical approval from the Faculty of Health Sciences, Trinity College Dublin. The ethics committee of the Faculty is a legally constituted committee which reviews applications from the four constituent Schools of the Faculty. These include the Schools of Nursing and Midwifery, Medicine, Dentistry and Pharmacy and Pharmaceutical Science. As applications for ethical approval to the Faculty often involve vulnerable patient groups and new treatments the Faculty has strict legal guidelines to which it must adhere.
The Healthy Schools project received full ethical approval and the research began and was completed on schedule and within budget. Details of the main outcome results are available within Comiskey, C.M., O’Sullivan, K., Quirke, M.B., Wynne, C., Kelly, P. and McGilloway, S. (2012). Details of the process and implementation evaluation are available within Comiskey, C. M. O’Sullivan, K., Quirke, M., Wynne, C., Hollywood, E and McGilloway, S. (2015). Finally results on body mass index and health related quality of life are presented by Hollywood E., Comiskey, C.M., Snel, A., O’Sullivan, K., Quirke, M., Wynne, C. (2013); Wynne C, Comiskey C, Hollywood E, Quirke MB, O’Sullivan K, McGilloway S. (2014) and Wynne C, Comiskey C, McGilloway S. (2015).
The ethical challenges which we faced began after the study was completed and the contract successfully executed. As over 600 children were recruited and measured at baseline, 12 months and 24 months and many parents, teachers and service providers interviewed, the study team found that it had a wealth of additional detailed data that could be analysed at a more detailed level and could provide additional evidence of the health and wellbeing of the children. For example, we had data on bullying and while rates were reported on within the reports and outcome papers no detailed analysis of the bullying data was undertaken. The study team wished to open up the database for sharing with other academic professionals. When the study team returned to the Faculty ethics committee for advice on sharing the anonymised quantitative data on a national data repository we were advised that this posed an ethical dilemma as the original signed consent from parents, teachers and key stakeholders and verbal assent from children did not include notice that the data would be archived. We were advised that we may need retrospective consent as we had not planned for archiving. Given we had over 600 children who had passed through the study and many of whom had since moved on to secondary schools this was not a feasible option and data archiving could not be permitted.
To overcome this challenge and to allow additional experts to work on the anonymised data the research team expanded and additional visiting researchers were invited to join the team and work on the database within the secured internal Trinity College database. While this did mean additional resources had to be expanded by Trinity College in the form of setting up and approving visiting academics with College identity cards and these visiting academics had to travel to Trinity College to access the data, the process worked and additional analyses were conducted. A fine example of this is the additional analysis of the bullying data, which can be found within Hyland, J., Cummins, P and Comiskey, C.M. (2017).
The internal team is planning further expansion with EU collaborators who have an interest in Healthy Schools and urban disadvantage. To conclude, while we were not in a position to archive the data as we would have wished we were able to compromise and ensure that the data was accessed and used to its best advantage to ensure that the evidence continues to be mined and disseminated for the good of the children, the schools and the families that participated. The key lesson learned by the research team was to ensure that all future large research studies include within the consent form, consent to archive the anonymised data for further data mining by additional bona fide researchers after the study has ended.