Establishing children and adolescents’ engagement in self-care is crucial to ensure their health in adulthood and ultimately reduce global health inequality [1
]. Earlier studies have provided evidence that risky behaviors established during adolescence can continue into adulthood, thereby becoming several leading causes of mortality and morbidity [2
]. Attention has been directed toward adolescence in low-and middle-income countries (LMICs) as part of their commitment to achieve the 2030 Sustainable Development Goals (SDGs) of ensuring healthy lives and promoting well-being for all, at all ages, and decreasing the incidence of non-communicable diseases, which represents the leading cause of preventable mortality [3
]. As schools provide care and education for students for long periods, school is an important setting within which to promote adolescents’ health [1
]. Well-designed school-based health interventions enable students to build competencies to prevent disease and promote health [4
]. However, the school health staff (SHS) members responsible for school health service and education in LMICs have limited capacity. Therefore, global collaborative efforts are essential to improve key human resources on the frontline of ensuring students’ health; implementation of best practices across countries could represent an improved strategy.
SHS members play a key role in identifying unmet health needs of school-aged children and promoting health in schools. It is essential to strengthen the ability of SHS members to perform their roles adequately. SHS members in LMICs rarely have opportunities to engage in systematic education and training, and there is considerable variation in their competency [6
]. In many countries, school nurses play an important role in promotion and prevention programs for school health, but in LMICs, the proportion of SHS members who are skilled health professionals is low [7
]. In Vietnam, SHS members, including assistant doctors or nurses, are assigned to individual schools and usually attend a 1-day training session annually, but this does not occur regularly (Tien Le Thi Huong, personal communication, 26 July 2018). The role of SHS members in Vietnam is specified as “health records management of students and teachers, health education, first aid, care of general illness, and management of health equipment” [8
]. However, systematic school health education and activities would likely be inadequate for students unless the practical competencies of SHS members are developed through continuing training. Thus, it is necessary to identify SHS members’ training needs prior to the development of training programs to improve their capacity. Accordingly, the purpose of this study was to identify SHS members’ training needs in a province of Vietnam through a global collaboration project.
This was a nurse-led global health project that aimed to identify the priority of training needs to strengthen the capacity of SHS members, who rarely have opportunities to continue professional development. It is worth mentioning that the cooperation of researchers from both countries was beneficial in conducting this needs assessment prior to designing a Vietnam-specific training program, as integrating the needs and circumstances of SHS members in Vietnam and would benefit from evidence accumulated pertaining to Korean school health teachers. As part of a global commitment to achieve SDG 3, the findings provide data to help establish training programs for SHS members, who play key roles in providing quality school health service and improving health knowledge and healthy behaviors of students in LMICs. The TNAQ will be useful in future research in LMICs to provide valid and reliable assessments of the performance and importance of SHS members’ activities.
The domain of “controlling infectious diseases” was identified as a top priority area for SHS members’ training, as lower performance than average was reported while the domain was considered of higher than average importance for all competency items but one. Specifically, “building a system of infectious disease control” and “monitoring and managing students with infectious diseases” represented the highest priority training needs. As suggested by Kim and colleagues [16
], it is important to establish systems and action plans in schools that address outbreaks of pandemic diseases. In Korea, school health teachers plan and take action in response to infectious diseases in schools appropriately according to the situation, by following an infectious disease manual [17
] distributed by the Ministry of Education. For example, in general cases of infectious disease, school health teachers confirm vaccination completion of students and encourage vaccination for unvaccinated students; provide preventive education regarding infectious disease for students, parents, and school personnel; and monitor students at-risk of infectious disease and report infected students to public health centers [17
]. During infectious disease outbreaks such as the Middle East Respiratory Syndrome (MERS), school health teachers are required to coordinate school health services, develop plans for distributing infection-control supplies, construct referral systems to public health centers and local clinics for screening, and provide health education for both parents and students for preventing infectious disease [18
]. In resource-limited communities in LMICs, SHS members are expected to play a vital role in responding to both infectious diseases in general and outbreaks, which highlights the need for training programs.
Providing emergency care (Domain 1) included the three top-ranking items requiring priority training. According to recommendations on the role of school nurses during emergencies by the National Association of School Nurses (NASN) [19
], training content for school nurses should include identifying hazards, serving on planning groups, building emergency response plans, and coordinating first aid response teams; these were identified in the current study as items that should be prioritized in SHS members’ training. Where resources and accessibility of medical facilities are limited in LMICs, it would be necessary to strengthen the capacity of SHS members to appropriately manage medical emergencies in schools. NASN emphasized SHS members as key persons to act as liaisons between community resources [19
]. Thus, SHS members should be trained to organize community networks and link community transportation resources for urgent patient transfers. In a previous study [20
], school nurses who were well-trained in medical emergency response plans were confident when managing head/neck injury of students and determining the availability of emergency equipment. Note that more than half of the SHS members in the current study were non-professionals who reported low competency in several skills. Therefore, considerable education regarding how to address emergencies should be provided to SHS members.
In addition to infectious and emergency care, the SHS participants in this study exhibited high training needs in the areas of health screening, counseling students with mental or psychological trauma, and protecting children from danger from road traffic, animals, and fire. According to the American Academy of Pediatrics on School Health [21
], schools should provide regular and developmental health screening for vision, oral health, hearing, height, and weight for secondary prevention in schools. It is interesting to consider counseling students with mental or psychological trauma and protecting children from danger from road traffic, animals, and fire. In a recent study of Vietnamese adults, 46.9% had been exposed to a traumatic event in their life [22
]. Children of parents who have experienced traumatic events are likely to experience psychological problems, as evidenced by findings that children of war veterans with post-traumatic stress disorder (PTSD) experience more psychological issues than do children of veteran fathers without PTSD [23
]. In addition, motorcycles are a major form of transportation in Vietnam, and mortality of children and adolescents due to motorcycle accidents is high [24
]. Further, road traffic injuries are common among older adolescents and those who consume alcohol before riding motorcycles [24
]. This suggests that training for SHS members should include strategies to educate adolescents regarding the risks associated with motorcycling.
No items were identified as being of high priority in “implementing health promotion programs” (Domain 8) in the current study. The results are consistent with low levels of awareness of the importance of health promotion [25
] and promoting healthy behaviors among adolescents [26
] in LMICs. However, the WHO has emphasized that schools are of strategic value for guiding preventive health behaviors as a key to health promotion [27
]. The WHO has further stated that children and adolescents are the most important population for fostering the adoption of healthy lifestyles in the future [28
]. In addition, as school-based health promotion programs exert positive effects on children’s and adolescents’ health [29
], consideration should also be given to efforts to increase awareness about these issues among SHS members in the process of developing the training program.
Providing continuous training for health professionals in areas with shortages of, and low accessibility to, medical resources is crucial [31
] and would ultimately exert a significant effect on children’s and adolescents’ health [21
]. The current study showed that non-health professionals (e.g., accountants and librarians) in charge of school health demonstrated significantly poorer performance than did health professionals, indicating an urgent need to develop the capacity of the former to provide school health. It is noteworthy that increased training and opportunities for continuous professional development could reduce variation in competency among types of SHS professional [7
The study was subject to some limitations. It is difficult to generalize the results regarding training needs to all SHS members in LMICs because the study was conducted in a single province of Vietnam. In addition, training needs were examined only via an online survey. Further research involving qualitative needs assessment is required to explore the training context in-depth.
The current findings support the need for a policy of mandatory training for school health professionals, including nurses. Training needs for health promotion were of low priority, but there is a need for political support for long-term health promotion programs for young people and efforts to increase awareness regarding the importance of this issue. This study was conducted to identify training needs of all SHS members of a province in Vietnam, one of the LMICs, in close cooperation with a local college and provincial education department. Therefore, this study’s strength is that the results can be practically applied to training programs for SHS members in the future. It is important to assess SHS members’ performance in each country at a local level and provide them with needs-based appropriate training. The current findings could be of utility for other developing countries in research and policy pertaining to SHS members.