Evaluating the cost-effectiveness of school-based public health interventions. Exploring the schools’ perspective

Breheny, Kathryn ORCID: 0000-0001-6886-4049 (2020). Evaluating the cost-effectiveness of school-based public health interventions. Exploring the schools’ perspective. University of Birmingham. Ph.D.

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Abstract

Public health interventions are widely implemented in schools, although health economics methods have predominantly developed in healthcare. This thesis explores a broader perspective in economic evaluation to better support schools’ evidence needs and decision making.

A systematic review was conducted on challenges and solutions for economic evaluation in schools. Semi-structured interviews were conducted with school staff participating in the Birmingham Daily Mile trial, to establish the decision-making process and considerations when prioritising public health interventions. A wellbeing measure (the Middle Years Development Instrument [MDI]) was validated for the first time in UK children, as a precursor to inclusion in an exploratory economic evaluation of the Daily Mile.

Interviews found that school leadership staff wanted evidence of cost-effectiveness. Health outcomes did not align with schools’ priorities and staff recognised the opportunity cost of delivering interventions. The MDI performed well in children aged 7-10, with several domains demonstrating responsiveness to changes in quality of life and self-rated health

In conclusion, this thesis demonstrates disparities between economic methods used in a healthcare context and schools. The first economic evaluation informed by school decision makers is reported, with further work required to enable comparability with other economic evaluations and estimate children’s opportunity costs.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):