Abstract
Objective
To examine perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to assess whether these barriers and strategies varied by locality.
Methods
We developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. We compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs. rural; suburban vs. rural and city vs. suburban).
Results
More than half of schools located in cities expected nine of ten potential barriers to affect the delivery of school-based health services during Fall 2021. More than 50% of responding schools located in urban, suburban and rural area indicated that external barriers outside of their control, including insufficient funding and families not able to bring students to school, were likely to be barriers to delivering care. Strategies identified as “very effective” did not vary by locality. Across all localities, more schools reported virtual strategies were less effective than in-person strategies.
Conclusions for Practice
Lessons from the early stages of the COVID-19 pandemic provide critical information for natural disaster and public health emergency preparedness. School locality should be considered in the development of plans to continue the delivery of school-based health services after natural disasters or during public health emergencies.
Significance
What is already known on this subject? Little is known about the impact of the COVID-19 pandemic on the provision of school-based health services and whether geographic locality of schools was associated with the ability of schools to continue to deliver health services on-site.
What this study adds? Geographic locality was associated with barriers to deliver school-based health services during the Fall 2021 but not strategies used to deliver services. More schools in cities reported higher rates of anticipated barriers than schools located in suburban and rural areas. Strategies used and deemed to be effective did not vary across locality. In-person strategies were more likely than virtual strategies to be reported as very effective.
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Data availability
The data are not available for public view, however the raw data from the survey and survey instrument are available upon request.
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Funding
This research was supported by grant R01HS025430-02S1 from the Agency for Healthcare Research and Quality.
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JMM: conceptualized and designed the study, acquired funding, designed the data collection instrument, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. AMK: conceptualized and designed the study, acquired funding, designed the data collection instrument, coordinated and supervised data collection, and reviewed and revised the manuscript. EDS: designed the data collection instrument, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The survey instrument and study were reviewed and approved by the Georgetown University Institutional Review Board.
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Mitchell, J.M., Kranz, A.M. & Steiner, E.D. Barriers and Strategies Used to Continue School-Based Health Services During the COVID-19 Pandemic. Matern Child Health J 28, 155–164 (2024). https://doi.org/10.1007/s10995-023-03824-z
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DOI: https://doi.org/10.1007/s10995-023-03824-z