Improvements in Health-Related Quality of Life Among School-Based Health Center Users in Elementary and Middle School

Wade, Terrance J.; Mansour, Mona E.; Line, Kristin; Huentelman, Tracy; Keller, Kathryn N.

doi:10.1016/j.ambp.2008.02.004

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Volume 8, Issue 4 , Pages 241-249, July 2008

Improvements in Health-Related Quality of Life Among School-Based Health Center Users in Elementary and Middle School

From the Departments of Community Health Sciences and Child and Youth Studies, Brock University, St Catharines, Ontario, Canada (Dr Wade); Department of Pediatrics, University of Cincinnati College of Medicine, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Mansour); Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Ms Line and Ms Huentelman); and Health Foundation of Greater Cincinnati, Cincinnati, Ohio (Ms Keller)

Received 25 September 2007; accepted 18 February 2008. published online 07 April 2008.

Objective

To examine the role of school-based health centers (SBHCs) on changes in student health-related quality of life (HRQOL) over a 3-year period among elementary and middle school students.

Methods

Design: Three-year longitudinal prospective study. Setting: Four elementary schools with newly implemented SBHCs and 4 elementary comparison schools matched for rural/urban and state, percentage of nonwhite students, and percentage of free or reduced-price lunch–eligible students. Participants: Randomly selected student-parent dyads (n = 579) who responded in all 3 years from 4 intervention schools and 4 comparison schools randomly selected from school enrollment lists. Students in intervention schools were further divided into SBHC users and nonusers. Intervention: SBHC. Measures: The outcome, HRQOL, was measured annually by student self-reported and parent proxy-reported scores using the PedsQL 4.0. School covariates included region and state; individual covariates included child age, gender, race, health insurance, chronic health conditions, family income, and parental marital status.

Results

Adjusting for school- and individual-level covariates, there was a significant improvement in student-reported HRQOL over the 3 years for the SBHC user group compared with the comparison school group. Other significant predictors of student-reported HRQOL included student age, gender, health insurance, and household income. There were no differences across groups by using parent proxy reports of HRQOL.

Conclusions

The SBHC model of health care delivery improves student-reported HRQOL among younger, elementary, and middle school children. Moreover, it appears to have more influence on those children that generally have impeded access to care and who can most benefit from it, specifically those without private health insurance and with lower income levels.

Key Words: elementary school, health-related quality of life, school-based health center, school health