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Open Access Study protocol

Protocol for a systematic review of the effects of schools and school-environment interventions on health: evidence mapping and syntheses

Chris Bonell1*, Angela Harden2, Helene Wells1, Farah Jamal2, Adam Fletcher1, Mark Petticrew1, James Thomas3, Margaret Whitehead4, Rona Campbell5, Simon Murphy6 and Laurence Moore6

Author Affiliations

1 Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK

2 Institute for Health and Human Development, University of East London, Water Lane, London E15 4LZ, UK

3 Social Science Research Unit, Institute of Education, University of London, 20 Bedford Way, London WC1H 0AL, UK

4 School of Population, Community and Behavioural Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK

5 Department of Social Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK

6 Cardiff Institute for Society, Health and Ethics, University of Cardiff, 1-3 Museum Place, Cardiff CF10 3BD, UK

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BMC Public Health 2011, 11:453  doi:10.1186/1471-2458-11-453

Published: 9 June 2011



Schools may have important effects on students' and staff's health. Rather than treating schools merely as sites for health education, 'school-environment' interventions treat schools as settings which influence health. Evidence concerning the effects of such interventions has not been recently synthesised.


Systematic review aiming to map and synthesise evidence on what theories and conceptual frameworks are most commonly used to inform school-environment interventions or explain school-level influences on health; what effects school-environment interventions have on health/health inequalities; how feasible and acceptable are school-environment interventions; what effects other school-level factors have on health; and through what processes school-level influences affect health.

We will examine interventions aiming to promote health by modifying schools' physical, social or cultural environment via actions focused on school policies and practices relating to education, pastoral care and other aspects of schools beyond merely providing health education. Participants are staff and students age 4-18 years.

We will review published research unrestricted by language, year or source. Searching will involve electronic databases including Embase, ERIC, PubMed, PsycInfo and Social Science Citation Index using natural-language phrases plus reference/citation checking.

Stage 1 will map studies descriptively by focus and methods. Stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by two reviewers in parallel. Evidence will be synthesised narratively and statistically where appropriate (undertaking subgroup analyses and meta-regression and where no significant heterogeneity of effect sizes is found, pooling these to calculate a final effect size).


We anticipate: finding a large number of studies missed by previous reviews; that non-intervention studies of school effects examine a greater breadth of determinants than are addressed by intervention studies; and that intervention effect estimates are greater than for school-based health curriculum interventions without school-environment components.