2 Improving public health outcomes for children and young people by involving them in health promotion initiatives in school settings

Submitting Institution

University of the West of England, Bristol

Unit of Assessment

Social Work and Social Policy

Summary Impact Type


Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services
Education: Specialist Studies In Education
Psychology and Cognitive Sciences: Psychology

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Summary of the impact

Research on health promotion in schools undertaken by UWE has demonstrated that vulnerable young people at the centre of the Government's Teenage Pregnancy Strategy can be reached via their involvement in interactive sexual health drama and further work has had direct influence on national policy in England. Following recommendations from research at UWE, Bristol, 12,000 Bristol school pupils have benefited from the introduction of sexual health clinics. UWE research demonstrated how school meal take-up and healthier eating behaviour has been increased by the work of the Food for Life Partnership. This research contributed directly into the development of the English National School Food Plan particularly into the business case for investing in increased school meal take-up.

Underpinning research

There is widespread agreement, from an ethical perspective, that children should be regarded as co-producers and not as passive recipients in health promotion initiatives. Schools play a pivotal role in promoting the health and well-being of children and their families. Yet many diet, alcohol, drug and sexual health initiatives have been found to have limited effectiveness in school settings. Orme's team researched how why and to what extent the active participation of young people can improve the credibility of health messages and can turn best practice into longer-term action in schools. Since 1999 the team, which leads the field in this area, has produced over 90 academic papers and reports related to this work.

The UWE research team includes Judy Orme (Reader in Public Health and later Professor, Public Health and Sustainability, 2011 — present); Mathew Jones (Senior Lecturer, 1998 — present) and Debra Salmon (Reader in Community Health and later Professor, Community Health, 2010 — present).

Sexual health initiatives in schools

The UWE research team led by Professor Salmon evaluated interactive sexual health drama productions in which young people participated as actors, directors or audience members e.g. Myrtle Theatre Company's `Jump' (2005-2006), `Jump Together' (2006) and `City of One' (2008) programmes. The research assessed the ability of the performing arts to improve sexual health and wellbeing of vulnerable young people to demonstrate that these young people at the centre of the Government's Teenage Pregnancy Strategy can be reached via their involvement in interactive sexual health drama (R1).

Bristol's high teenage pregnancy and sexually transmitted infection rates amongst young people before 2008 were explained in part by poor access to health services, particularly for vulnerable young people. This resulted in the introduction of the Brook Sexual Health Outreach Service in Schools, an integrated sexual health service (contraception and sexual health) in secondary schools across Bristol for young people 11-18 years. UWE's evaluation (R2) of this service demonstrated that it was successful in improving access across all groups (including those who were hard to reach e.g. boys, low educational achievers), preventing pregnancy, early identification and treatment of sexually transmitted infections and improved sexual health knowledge.

Healthier eating in schools

School meal take-up has an essential part to play in improving health and wellbeing, diet related problems, behaviour and attainment but in England only 43% of children eat school meals on a daily basis. One third of children leave primary school overweight or obese. In this context, UWE's research on effective strategies for the provision of healthy school food addressed major public policy concerns. UWE's evaluation across England of the Food for Life Partnership programme (FFLP) (2007-11) led by Professor Orme involved pre- and post- cross sectional study of 111 schools, 4,600+pupils and 1,000+ parents. The evaluation identified positive health and wellbeing programme outcomes for children and their families i.e. increased take-up of healthy school meals; increased fruit and vegetable growing, cooking, farm visits, and sustainability education activities; healthier eating for children and families; improved school performance and attainment. The findings demonstrated the role of pupil decision-making forums in directing local programme delivery and creating credible messages in school and home settings (R3). They also showed that young people actively engage with healthier eating messages when they can participate in practical food education, grasp the origins of the food they eat in a sustainability context and relate their learning to routines at home and school (R4).

References to the research

R1. Orme, J., Salmon, D. & Mages, L. (2007) Project Jump: Young People's Perspectives on a Sexual Health Drama Project for Hard to Reach Young People. Children and Society 21 (5), 352-364. ISSN 0951-0605 http://dx.doi.org/10.1111/j.1099-0860.2006.00065.x. (Supported by Grant G1)


R2. Ingram, J. & Salmon, D. (2010) Young people's use and views of a school-based sexual health drop-in service in areas of high deprivation. Health Education Journal 69 (3), 227-235. ISSN 0017-8969 http://dx.doi.org/10.1177/0017896910364566. (Supported by Grant G2)


R3. Jones, M., Dailami, N., Weitkamp, E., Salmon, D., Kimberlee, R., Morley, A. & Orme, J. (2012) Food sustainability education as a route to healthier eating: evaluation of a multi-component school programme in English primary schools. Health Education Research 27 (3), 448-458. ISSN 0268-1153 http://dx.doi.org/10.1093/her/cys016 (Supported by Grant G3)


R4. Orme, J., Jones, M., Salmon, D., Weitkamp, E. and Kimberlee, R. (2013) A process evaluation of student participation in a whole school food programme. Health Education 113 (3), 168-182. ISSN 0965-4283 http://dx.doi.org/10.1108/09654281311309819 Supported by Grant G3)


Key grants

G1.2005-2007:£40,000 awarded to J. Orme and D. Salmon. Evaluation of the development of a drama based intervention (Jump) to improve sexual health in vulnerable young people. Sponsor: Bristol and North Somerset Teenage Pregnancy Partnership.

G2.2007-2008: £20,000 awarded to D. Salmon. An Evaluation of Brook Sexual Health Outreach in Schools. Sponsor: Neighbourhood Renewal Bristol.

G3.2007-2011: £250,000 Awarded to J. Orme, M. Jones, R. Kimberlee, D. Salmon, E. Weitkamp, N. Dailami. Evaluation of the Food for Life Partnership. Sponsor: Big Lottery Fund through the Soil Association.

Details of the impact

Sexual health initiatives in schools

As a result of the work of the UWE team, young people were able to identify, discuss and analyse a range of difficult sex and relationship related situations. This led to tailored versions of the drama intervention being produced (S1). The beneficiaries of these interventions nationally since 2008 include: school pupils (1,620); health, social care and educational professionals (over 1120); arts based practitioners (55); governing bodies (207); and national politicians (30). Sexual health service design was influenced by the voices of these young people and professionals. Our underpinning research informed the Teenage Pregnancy Unit Good Practice Guidelines for arts-based work with children in the care system. Additionally it provided evidence that enabled the uptake of this approach to be broadened further as a national multi-agency training tool to address inequalities in health (T1, S2).

As a result of the research concerning `The Brook Sexual Health Outreach Service in Schools', the new schools-based service was modified and then commissioned across all nineteen secondary schools in Bristol. This resulted in 12,000 pupils using the service during 2012 for a range of contraceptive and sexual health needs and numbers have grown year on year. Bristol Young People's Public Health Manager (T1) highlights that "policy developers were able to build on a number of recommendations from the research around: the involvement of young people in service development; improving access to vulnerable groups, including young men and developing transitional pathways to enable young people to move into primary care and mainstream sexual health services".

The robustness of UWE's research was demonstrated by its inclusion in a Health Technology Assessment Systematic Review (S3) as one of only six UK-based studies meeting the criteria for inclusion in a review of effectiveness and acceptability.

Healthier eating in schools

UWE research demonstrated how the Food for Life Partnership influenced eating behaviour, e.g. by increasing school meal take-up, particularly those eligible for free school meals and increased fruit and vegetable consumption amongst pupils. The evaluation evidence is integral to key Soil Association and Garden Organic publications (S4, S5, T2). Commenting on the Soil Association's `Good Food for All' publication, the Director of the Food for Life Partnership (T3, S4) highlights the impact of UWE's research "This seminal report demonstrating the key impacts of FFLP has formed the evidence base from which we've been able to develop conversations with Public Health commissioners leading to the implementation of locally commissioned FFLP programmes that support the health strategies in local areas." Furthermore, the Head of Education, Garden Organic (T5, S5) reported that "The Department for Environment, Food and Rural Affairs supported a Food Growing in Schools Taskforce which produced a report and 6 key recommendations for helping every school become a food growing school based on the evidence demonstrated in reports like the `Good Food for All' publication". The Executive summary report of UWE's evaluation has been downloaded 1107 times and there have been 1152 downloads of the full evaluation report from UWE Research Repository (July, 2013) (S6) and the FFLP website has been accessed over 2600 times (S4).

Three key areas of impact from our research include additional funding to extend reach of the current programme, development of new commissioning models and policy level impact. Between 2011 and 2012, Professor Orme gave four key national presentations to audiences of policy makers, health and education professionals, practitioners and researchers: (i) BIG Lottery Wellbeing Research Outcomes Conference, Birmingham (March, 2011), ii) Faculty of Public Health (national professional body) conference attended by the Minister for Children and Families (S7) (June, 2011), iii) HRH Prince Charles Royal Commission consultation event (November, 2011), iv) Department for Education National School Food Plan (NSFP) consultation event (November, 2012) (T4, S8). As a result, BIG Lottery were influenced to fund FFLP to the tune of a further £4.6 million in September 2013 enabling the programme to extend its reach to additional communities. In addition, our research findings underpinned the development of a new approach that FFLP adopted to commissioning their services to support school food improvement across whole local authorities and school clusters (T3). FFLP have subsequently geared up to put in place measures to embed the programme into a wider range of settings i.e. hospitals, early years, universities, care homes and workplaces (T2). Also, our research helped to shape government public health policy. Former Deputy Director of Soil Association (T2) notes that "The [UWE] review has provided us with many opportunities to share the evidence with policy makers at the highest level". Most recently UWE's research contributed to the NSFP (S8, T2, T3, T4, T5), which provides an action plan to accelerate improvement in school food. A co-author (T4) of the NSFP comments "These [UWE] assessments were one important input into our development of a business case for investing in increased school meal take-up".

Sources to corroborate the impact

External evidence of support:

S1. Sawney, .F, Sykes, S., Keene, M., Swinden, H. & McCormack, G. (2006) It Opened My Eyes: Using theatre in Education to Deliver SRE: A Good Practice Guide. London: Teenage Pregnancy Unit.

S2. National Children's Bureau (2006) Arts in Partnership to Promote Health (2006).

S3. Owen, J., Carroll, C., Cooke, J., Formby, E., Hayter, M., Hirst, J., Lloyd Jones, M., Stapleton, H., Stevenson, M. & Sutton, A. (2010) School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities. Health Technology Assessment 2010 14 (30), 1-256. Access via http://www.hta.ac.uk/fullmono/mon1430.pdf (UWE references on pages 72; 89; 107; 161; and 172)

S4. The Good food for all. The impact of the Food for Life Partnership (2011) Soil Association
FFLP works with 4,500+ English schools and communities to transform food culture.

S5. Food Growing in Schools Taskforce 2012. Evidence from UWE research referenced throughout this report.

S6. http://eprints.uwe.ac.uk/cgi/irstats.cgi?IRS_epchoice=EPrint&page=dashboard&eprint=14456

S7. The findings of the evaluation report were disseminated at a conference held in London where the then Minister for Children and Families, Sarah Teather, spoke of the importance of the FFLP.

S8. England's National School Food Plan (June 2013) http://www.schoolfoodplan.com/ written by Henry Dimbleby and John Vincent, the co-founders of LEON restaurants. FFLP referenced on pages 61; 66; 70; 72; 73; 80; 110; 133; and 137.

Testimonials for reference:

T1. Bristol City Council. Bristol Young People's Public Health Manager can corroborate all young people's drama related work in addition to all the sexual health research impact. Testimonial available from UWE, Bristol.

T2. Chief Executive of Gloucestershire Wildlife Trust, previously Deputy Director of Soil Association during the period of the evaluation, can corroborate all information presented about the Food for Life Evaluation and its impact. Testimonial available from UWE, Bristol.

T3. Soil Association. Director of Food for Life Partnership can corroborate all information presented about the Food for Life Partnership Evaluation and its impact. Testimonial available from UWE, Bristol.

T4. Co-author of National School Food Plan can corroborate the contribution of FFLP to the NSFP as a result of the UWE research. Testimonial available from UWE, Bristol.

T5. Head of Education, Garden Organic can corroborate the impact of the FFLP evaluation and some of the policy impact events. Testimonial available from UWE, Bristol.