P0270 - Perspectives of Key Stakeholders Regarding School Based Health in Dhulikhel, Nepal

Background
School based health programs can be a cost effective intervention to improve the health of school children, particularly in resource-limited settings. There is limited evidence regarding the process of developing school based health programs in low and middle-income countries (LMIC), including Nepal.

Objective
The purpose of this study was to gather information to better understand the views of key stakeholders in Dhulikhel, Nepal, towards the expansion and improvement of current of school based health programs within the community.

Methods
Ours was a qualitative study and our mode of inquiry was interviews with key stakeholders. We
developed a semi-structured interview guide, which was translated into Nepali. The interview
questions explored common health problems among students, strategies for health promotion in
schools, school environments, and barriers to implementation of school based health interventions. We
interviewed government officials, school administrators, teachers,
parents and students. A total of 30 interviews were conducted, translated into English and
transcribed. The authors then divided into two groups to code the textual data. Codes were
developed based on our research questions and the two groups of coders listed the codes
and instructions on when to code and when not to code. Then two groups coded
the textual data using their codebook and then merged to compare their coding
with numerous discussion sessions leading to agreement of the final coding. The data was then
analyzed using a thematic framework, using a table of main themes and subtopics for each
theme.

Results
Interview data was categorized into broad themes (impact, barriers, priorities and strategies) with
subcategories of government, school, and community level informants
Across all levels of informants, the impact of current school based health interventions was felt to
be positive. Barriers toward health promotion included lack of funding, and disparities in
resources between schools based on nearby health infrastructure. School administrators expressed
interest in teacher training as a strategy to improve health promotion in schools—specifically
training for vision screening and health education. Teachers and students described nutrition
programs and reproductive health education as priorities for health promotion.

Conclusion:
In order to establish effective school based health programs, it is critical to understand the
perspectives of key stakeholders. This study adds to a limited but growing body of literature regarding the
development of school based health programs in LMIC.