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Measuring school children's experiences of the school health services in Sweden: a pilot study

02 June 2022
16 min read
Volume 3 · Issue 3


This pilot study describes the initial testing of two age-matched questionnaires aiming to measure school children's experiences and satisfaction of services provided by the school health services (SHS) in Sweden. Experiences from the point of view of school children is important to improve services. The methodology followed several steps. First, an expert panel (n=8) selected items based on earlier questionnaires used in healthcare. Second, cognitive interviews with children (n=25) were performed to adjust items to be understood by school children. Finally, the questionnaires (n=144) were distributed and compared. After adjustments to items in both questionnaires the pilot study indicated overall high satisfaction, but there are differences between age groups, where younger children are more positive than older children. Involving children to evaluate and improve SHS is an important consideration. In future studies, such questionnaires need further development to increase the sensibility and reveal further insight.

Although most Swedish school children state that they have good social relationships, relatively few health problems and a high level of wellbeing, perceived school stress is increasing, especially among adolescents (László et al, 2019). Physical activity remains low, and more children and adolescents report symptoms such as headaches, stomach-aches, anxiety, depression and sleeping problems related to the use of digital media (Patton et al, 2018). Moreover, problematic relationships with friends, family and difficulties coping with schoolwork may also have an impact on young people's wellbeing (Wickström and Lindholm Kvist, 2020). Health promotion efforts directed toward this group are key to supporting them in everyday life. The school health service (SHS) in Sweden where school nurses and school physicians work, is a unique platform for providing legally required health activities (Levinson et al, 2019). The distribution of resources is different for school nurses and school physicians. School nurses are the key persons within the SHS and meet virtually all children continuously during their school time. The presence of a school physician varies significantly between different municipalities depending on resource allocation. In many municipalities most school children do not meet the school physician during the school years because the availability of school physicians is only sufficient for consultation for medical or health related difficulties in school. The Swedish government suggests limiting the number of school children to 430 per school nurse and 7 000 per school physician. Furthermore, the SHS's resources should also be allocated for existing goals and health promoting activities and not only according to the number of school children (National Association for School Nurses, 2022). The basic health programme for key ages includes promotion and prevention work and spontaneous and follow-up visits. All school children, regardless of age, have access to the SHS and there are several opportunities during a school period to build relationships between school children, school nurses and school physicians (Morberg, 2012). The prerequisite is, of course, that the school children have trust in the SHS provided. Professionals within the SHS base their work on the United Nations Convention on the Rights of the Child, which was written into Swedish law on 1 January 2020 (Regeringskansliet, 2018). The law states that all actions undertaken by public and private institutions must assure the best interest of the child, and that the child's views and rights to express those shall be a primary consideration. One way to follow the law is by inviting school children to participate in their own care and ask for school children's views of care (Gurung et al, 2020).

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