Secondary Outcomes (explanation)
As with the primary outcomes, the secondary outcomes comprise of a psychological dimension, a social dimension, and a cognitive dimension. The psychological dimension comprises of three subdimensions whereas the social dimensions comprise of five subdimensions. The cognitive dimension is measured by the students’ results on the Norwegian National Tests. Also, we include student absence in physical education and a measure of implementation as secondary outcomes.
The psychological dimension comprises of students perceived motivation, academic self-concept and social well-being at school. The questions tapping students’ motivation are compulsory in the Norwegian Pupil Survey and focus on interest and liking for schoolwork – a conceptualisation of motivation corresponding to the theoretical framework of self-determination theory. The theory defines intrinsic motivation as the inherent pleasure and satisfaction derived from engaging in an activity and a main postulate is that social factors promote intrinsic motivation via satisfaction of individuals’ basic needs for autonomy, competence, and relatedness (Deci & Ryan, 2000; Ryan & Deci, 2000). The measure comprises of three items and previous analyses have shown a Cronbach’s alpha of .77 – .79 (Federici et al., 2016; Wendelborg, Røe, & Caspersen, 2016) . The responses are given on a 5-point scale ranging from ‘not in any subjects/not at all’ (1) to ‘in all subjects/to a large degree’ (5). Note that this measure is a composite of questions with different response categories. Therefore, one may question to what degree it functions as a scale or an index. Previous analyses of the Norwegian Pupil Survey (Wendelborg et al., 2016; Wendelborg et al., 2014) indicate that the measure function as a scale indicative of students’ motivation.
Self-concept is measured by a four-item scale representing a short version of the subscale of a Norwegian version of the Self-Description Questionnaire SDQ II (Marsh, 1992; Skaalvik & Rankin, 1992). In general, self-concept is a multidimensional construct referring to self-perceptions in different areas or domains (Bong & Skaalvik, 2003; Marsh, Byrne, & Shavelson, 1988). Academic self-concept is often defined as students’ perceptions of doing well or poorly in school in general (general academic self-concept) or domains, for instance, mathematics self-concept. In the present study, we measure general academic self-concept. Responses are given on a five-point Likert scale ranging from 1 ‘strongly disagree’ to 5 ‘strongly agree’. Previous studies have revealed a Cronbach’s alpha of .77 (Skaalvik & Skaalvik, 2013).
The questions tapping into students’ social well-being is an index focusing on perceptions of well-being at school in general, in class, and between lessons (break/playtime). The responses are given on a 5-point scale ranging from ‘I don’t thrive at all/not at all’ (1) to ‘I always thrive/to a large degree’ (5). This measure is a composite of questions where one of the items have a different type of response categories. We will conduct confirmatory factor analyses to investigate the behaviour of this item and exclude it if it does not reach statistical significance and other measures of goodness of fit statistics (described earlier). Preliminary analyses of data from the Norwegian Pupil Survey 2016 reveals a Cronbach’s alpha of .81.
The social dimension of the secondary outcomes comprises of students’ perceptions of bullying, their work- and social environment, perceived emotional and instrumental support from teachers, and a question regarding school meals.
The Norwegian Pupil Survey includes additional items tapping into different aspects of bullying at school. The first additional item included in the present study is related to the item concerning bullying defined as a primary outcome. It asks the students whether the school provided help. Note that this question is only given to students who report that he or she experience bullying 2 or 3 times a month or more. The response categories are ‘no, no adults knew anything’, ‘the school knew, but didn’t do anything’, ‘yes, the school provided measures, but it didn’t help’, ‘yes, the school provided measures, and it helped a bit’, and ‘yes, the school provided measures and bullying stopped’. Moreover, all students are asked whether they have experienced cyberbullying or been bullied from teachers. Finally, two items ask the students whether they bully others, both at school and cyberbullying. The response categories for the latter items are ‘not at all’, ‘rare’, ‘2 or 3 times a month’, ‘about once a week’, and ‘several times a week’.
The students’ perceptions of their work environment are measured by three compulsory items in the Norwegian Pupil Survey. The questions focus on the students’ opportunities to work undisturbed, to what degree the class in general perceive working hard with school work is important, and to what degree the teachers consider mistakes to be part of the learning process. Responses are given on a five-point Likert scale ranging from 1 ‘strongly disagree’ to 5 ‘strongly agree’. Previous studies have revealed a Cronbach’s alpha of 0,66 (Wendelborg et al., 2016).
Research identifies several dimensions of teacher support, such as emotional, informational, appraisal, and instrumental support (House, Umberson, & Landis, 1988; Malecki & Demaray, 2003). The number of dimensions and the labels used for them varies. However, in general, the categories of emotional and instrumental support are typically reported (Semmer et al., 2008). Emotional support is characterised by empathy, friendliness, encouragement, esteem, and caring, whereas instrumental support is characterised by tangible support, for instance, when teachers help students solve a problem or accomplish a difficult task. In the present study, students’ perceptions of the teachers as emotionally supportive is measured by three items. The scale is a shortened and modified version of a previously tested scale of emotional support (Federici & Skaalvik, 2014b; Skaalvik & Skaalvik, 2013). Previous studies have revealed a Cronbach’s alpha of .80 and .94. The responses are given on a 5-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (5).
Three items measure the students’ perceptions of teacher instrumental support. The questions are compulsory in the Norwegian Pupil Survey and focus on tangible support and to what degree students ask for help when needed. The responses are given on a 5-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (5). Preliminary analyses of data from the Norwegian Pupil Survey 2016 reveals a Cronbach’s alpha of .71.
Finally, the social dimension includes one item concerning school meals. The question is developed for the present study and the students are asked to what degree the meal break is characterized by ‘calm and order’. The responses are given on a 5-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (5)
The cognitive dimension comprises of students results one the Norwegian National Tests. The National Tests were introduced in Norway in 2004 as part of a quality assessment system in education. These tests are run every autumn on 5th, 8th, and 9th graders and focus on core academic skills namely numeracy, literacy, and English. The main purpose of the tests is to provide educational authorities at local and national level with information on general student competency after the 4th, 7th, and 8th year of compulsory schooling.
We will use two types of test that are already implemented in schools. The national test in reading, English and mathematics for 5th grade students will be used to measure pre-intervention levels in students’ achievement. These national tests are available for the whole Norwegian student population, with a few exemptions. The cohort born in 2006 took the 5th grade test in the fall of 2016. They will take a national test in the same subjects in 8th grade in the fall of 2019 when students who attended the treatment schools have been exposed to 1.5 years of an extra school nurse resource. We will compare development in test results in 8th grade between treatment and control schools for this cohort. Depending upon additional funding, we will also conduct a study of the 2007 cohort who took the 5th grade test in 2017 and will take the 8th grade test in 2020, to measure the impact of the full two years of intervention, and studying effects on the two cohorts combined.
In addition to obtaining data of student absence in general, we wish to investigate the prevalence of absence during physical education classes. Note that there are some uncertainties about whether it is possible to get these data from the municipal authorities.
We also include a measure related to the implementation and process evaluation in the Norwegian Pupil Survey. The students are asked two questions regarding to what degree they know the school nurse and to what degree the school nurse is an ‘adult that is easy to talk with’. The main aim of these questions is to investigate possible differences in perceptions of the school health service between the treatment and control schools.