Adolescents’ evaluations of the quality of lifestyle counselling in school‐based health care

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Health promotion and lifestyle counselling are core elements of school nurses’ work. School nurses are well positioned to promote adolescents’ health because the most adolescents interact with a school nurse at least once a year 1. In Finland, health care services in schools are statutory. The school nurse meets a certain number of students, and health check‐ups are conducted annually 2. In junior high schools (seventh to ninth grades), extensive health check‐ups are conducted for students in the eighth grade, at which time parents are also invited to participate 3. Health promotion in schools is done on an individual basis, but it also focuses on factors at the general level, such as the environment. School nurses provide for adolescents the lifestyle counselling as part of the health check‐ups 4. Lifestyle counselling should be multiprofessional with doctors and dietitians 1, evidence‐based and of a high quality 5.
There is no generally accepted definition for good‐quality lifestyle counselling in school health care settings. The definition for quality lifestyle counselling presented in this study is based on the existing model for good‐quality counselling. Based on the model, the quality lifestyle counselling is understood as a method that is adolescent‐centred, interactive and goal‐oriented; it is implemented with sufficient counselling content and appropriate resources and has positive benefits for adolescents. The definition includes four elements: resources, content, implementation and benefits of counselling 6.
School health care should have sufficient resources for lifestyle counselling, and services should be delivered in line with quality standards. Appropriate materials must be available for providing the knowledge about healthy lifestyles for adolescents 13. However, lifestyle counselling is not always effective due to school nurses having insufficient time for counselling and a lack of evidence‐based knowledge and counselling skills 14.
Adolescents need the sufficient lifestyle counselling about the content of nutrition, physical activity and substance use and abuse. Obesity, being overweight 15, insufficient physical activity 16 and sedentary behaviour 17 are common among adolescents. Substance abuse increases with age during adolescence 1. Though adolescents’ substance abuse has declined, abuse still has serious problems among adolescents 20. Health‐related risk behaviours in adolescents contribute to many leading causes of disease and social problems experienced during adolescence as well as adulthood 21. Good‐quality counselling in school health care that targets adolescents’ lifestyles is wholly appropriate as means to helping adolescents establish healthy lifestyles as they move forward into their adult years 5.
Counselling is mainly preventative in its influence on adolescents’ health‐related behaviours, such as knowledge, beliefs, skills, attitudes, values and support 22. However, implementation of counselling should be interactive and goal‐oriented and adolescent‐centred. Counselling in the school health care setting is often implemented on individually with interaction between the school nurse and adolescent 23. Nurses use verbal interaction approaches to promote adolescent's participation 24. Confidence 25, good interaction and a positive atmosphere are core elements of implementing good‐quality lifestyle counselling. If adolescents trust in school nurse, they are more likely to discuss about their risk behaviour and sensitive issues 27. Insufficient resources, such as a lack of time 7 and the negative attitudes of adolescents towards lifestyle counselling, may impair interaction during counselling 28. Lifestyle counselling should include goal setting according to adolescents’ needs. Also, short‐ and long‐term goals should be placed together with adolescent, if behavioural change is desired, for example in weight management 29. Good lifestyle counselling should be targeted at an adolescent's particular developmental stage 28. Moreover, it should take into account an adolescent's needs 23 to be adolescent‐centred.
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