Students’ perceived sense of safety to talk about their issues in the school health examination

Abstract Background Students’ regular health examinations, common in European school health services, provide an opportunity to give support during adolescence when developmental changes and risk behavior challenge wellbeing. In Finland, universal school health services include annual health examinations for all students aged 7-16. The purpose of this study is to examine do students feel safe to talk about their issues in the health examination and whether socio-demographic background, health, wellbeing, health behavior or social relations are associated with it. Methods We used data from the School Health Promotion study, which is an anonymous and voluntary classroom survey organized biennially by the Finnish Institute for Health and Welfare. The 2023 data included 70 per cent of all 8th and 9th grade students (aged 15-16), of whom 61 per cent (N = 53466) reported they had undergone a health examination by a school nurse during the past school year. They were asked if they felt safe talking about their issues in the health examination (5-point Likert scale: fully agree - fully disagree). Preliminary analyses used crosstabs and the χ2-test. Results 66 per cent of the students (girls 58%, boys 76%) had felt safe talking about their issues during the health examination. Challenges related to wellbeing or social relationships were associated with this perception. For instance, the feeling of security was less common among those who had discussion difficulties with parents (girls 26%, boys 40%), loneliness (41%; 55%), average or poor health (42%; 59 %) or moderate or severe anxiety (43%; 54%) (p < .001). The student's origin was associated with the perceived safety only for boys (foreign background 66%, Finnish background 77%, p <.001). Conclusions Several challenges to wellbeing were associated to the fact that students did not feel safe talking about their own issues. The importance of an open and safe atmosphere for discussion needs to be emphasized in school health services. Key messages • Students may not feel safe talking about their issues in the school health examination. More attention needs to be given to how students suffering from different health challenges are met in services. • School health services have an opportunity to support adolescents’ health and wellbeing by offering an open and safe atmosphere for discussions.