Improving school attendance through health support: A test-of-change project in a deprived Scottish primary school

School attendance is a significant determinant of educational attainment and affects the health and wellbeing of children and young people (CYP) across the life course. Poor school attendance, especially when related to ill-health, is closely linked with reduced literacy and numeracy skills, which can negatively affect long-term health and employment outcomes for CYP. A test-of-change project was undertaken in collaboration with education services to identify CYP whose poor attendance was recorded as due to medical reasons and to explore whether health-led support could improve attendance. Some 30 CYP were identified, with 25 completing the 16-week project. Interventions included family contact, assessment of unmet health needs, signposting, and a CBT-informed anxiety-management programme. Results demonstrated a mean attendance improvement in 23 of 25 CYP, with average attendance rising from 74% to 80% (a 6% increase, equating to 18 additional hours in school over the course of 4 months). Common barriers identified included poor sleep hygiene, emotionally based school avoidance (EBSA) and challenges with family routines. This project suggests that early health intervention could address barriers to attendance, particularly in areas of deprivation where educational and health inequalities are more prevalent, promoting improved educational outcomes. This project is aligned with the Scottish Government's Getting it Right for Every Child framework, which promotes early intervention and holistic support. Although the sample size and scope of the study were limited, the results suggest that implementing a school nurse-led health approach to school attendance may improve academic outcomes for CYP. Additional research is required to assess the long-term impact and scalability of this project across a variety of schools.