Kouluterveydenhuollon suunnitelmallisuus ja saatavuus Suomessa 2000-luvulla

Hanne Kivimäki

Research output: Book/ReportDoctoral thesisCollection of Articles


Statutory school health services have an opportunity to reach most children and adolescents and promote their health and well-being. The aim of this dissertation was to study the planning activity and availability of Finnish school health services, emphasizing the perspective of equality. The study comprises four publications which focus on activity plans and annual reports, visiting rates of school health services, perceived access to services by adolescents, and parental participation in health examinations. The topics were examined at the level of service providers, health centers and comprehensive schools, as well as at the student level. The data used were national and regional health center surveys, action plans and annual reports made by health centers, the statistics of school health care visits, data collection for comprehensive schools and the nationwide School Health Promotion study, which was targeted to adolescents.

According to the results, one third (33%) of the health centers (N=227) implemented activity planning according to recommendations in 2005. Small health centers made, and revised, activity plans the least. The analysed documents were mainly quite brief. Planning activity was not equal between different areas. According to the study concerning visits to school health services in 1994–2005, visiting rates to doctor per thousand 7–18-year-olds decreased until the beginning of the 21st century, and the change in other visits was small. The variation in visiting rates between health centers was large and increased for visits to school doctor. Preventive services were decreased by several professionals simultaneously.

The guidance for school health services was strengthened by governmental decree (2009/380; 2011/338) and the Student Welfare Act (2013/1287). Service providers were obliged to ensure a uniform level and availability of services. According to the results, about one sixth (13%) of adolescents (N=71 865) perceived accessing school health nurse appointments as difficult in 2013. In 2017, less than half (44%) of the adolescents (N=58 232) reported parental participation in a health examination during grades 7–9. The share of adolescents who perceived difficult access or reported parental participation in health examinations varied greatly between health centers and schools. A school health nurse resource below national recommendation was associated with difficult access among boys. School health nurse resource or parents’ invitation to a comprehensive health examination were not associated with parental participation.

Socio-demographic factors, such as parents’ low education level or immigrant background, were associated with perceived difficult access or parents’ non-participation in health examinations. Parental unemployment had no association here. Factors related to adolescent’s wellbeing, for example daily health complaints or discussion difficulties with parents, were also associated with perceived difficult access and parental non-participation. Challenges in perceived health and school-related well-being had an association with perceived difficult access. Adolescents who had a long-term illness or were bullied weekly reported more frequent parental participation.

The results of this study enlighten both the state of the planning activity and availability of Finnish school health services and differences between service providers. Although most adolescents perceived easy access to a school health nurse, there were probably unmet service needs, and health examinations did not reach parents extensively. These deficiencies in services were noticed before challenges to availability arose during the COVID-19 epidemic. The results indicate that the availability of services, especially open-door clinics, should be strengthened for students with different needs for support. Parental participation in health examinations can be promoted by, e.g., sending invitations in several languages, describing the meaning of the appointment and services, and enabling parents to impact the time of the appointment. In addition, the plans describing school health services should be written and openly available for both professionals and families.

The equality of school health services should be monitored at national and service provider levels. In particular, equal availability, a uniform level of services, and the population’s needs for services should be considered. Future research should focus on how planning activity and management guides school health services and is associated with service quality and resources. Information is needed on the development of school health visiting rates in relation to children and adolescents’ other services and wellbeing. The distribution of school health nurse working hours, share of open appointment and online services, and their association with perceived access and parents’ participation in health examinations should be studied more. Likewise, more research is needed on information provided about services to both adolescents and parents, and on inviting parental participation in health examinations.
Original languageFinnish
Place of PublicationTampere
ISBN (Electronic) 978-952-03-2604-3
Publication statusPublished - 2022
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028

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