Students Health Services in Israel from the Parents’ Point of View: Mixed-Methods Study

BACKGROUND: Student Health Services (SHS) are provided by school nurses to 1st to 9th-grade pupils in Israel. The nurse's role is to provide early detection and prevention services. SHS is provided by the Ministry of Health (MOH) or through outsourcing. AIM: To examine parents’ knowledge, attitudes, and satisfaction with SHS; and the differences in these measures when the services are provided by the MOH vs. outsourced organizations. METHODS: This study combines mixed methods, including a quantitative cross-sectional study among 506 parents and a qualitative study that included interviews with ten parents (upon reaching saturation). The research questionnaires were distributed via social media as well as through the National Parents’ Leadership organization. The interviewees were recruited from among the quantitative study participants. FINDINGS: The findings of the quantitative and qualitative studies support each other. Sixty-five percent of the parents responded that there is no school nurse or that they do not know whether or not there is one. Only 13.4% believe that the school nurse is available to answer their questions. The parents’ knowledge level regarding the school nurse's role was intermediate (an average of 4.44 on a scale of 0-9). However, their attitudes support the importance of the nurse's role. Age, socio-economic status, and trust significantly predict parents’ satisfaction. The older the parents and the higher their socio-economic status is, the lower their chance of being satisfied with the school nurse's role. In addition, the higher the parents’ level of trust in the nurse, the higher the chance they will be satisfied. No significant differences were found when comparing the MOH and outsourced organizations. CONCLUSIONS: Many parents are unaware of the nurse's existence and are insufficiently informed regarding her role or how to contact her. However, many feel the role is essential, necessary, and should be improved. KEY MESSAGES: • It is important to promote a public participatory process of parents, pupils, school staff and healthcare professionals in order to improve SHS and the way it's provided. • Parents-nurse-students relationship and communication must be improved in order to ensure parents’ cooperation and pupils’ health.