Background and aims
Life checks have been proposed by the English Department of Health (DH) as a personalised service providing support and advice at key stages throughout the lifespan to help people to maintain and improve their health. A set of transitional stages has been identified as the most appropriate for life checks to take place, and, for young people, the proposed key stage for a life check is the transition between primary and secondary school at the ages 11 to 12 years. This report is the result of a scoping review commissioned by the DH. The review aimed to identify the size and scope of the available research evidence relevant to the life check proposal for young people. Of particular interest was evidence about the effectiveness of life checks within and outside school settings, evidence about the acceptability of life checks to young people, and evidence about optimising uptake of the life check.
We identified three bodies of literature in which we might find relevant evidence: health promotion and public health; resilience and wellbeing; and youth transitions. When searching, we also considered the concepts of ‘health literacy’ and ‘health trainers’. We searched for relevant studies published in the last 10 years within a range of bibliographic databases, specialist registers and websites across the health and social sciences. Eligible studies were those that (a) focused on the provision of a health and/or emotional wellbeing check-up followed by feedback, advice, support, referral and/or the development of personal health plans; and (b) focused on young people aged 9 to 14 years. Relevant studies were coded using a standardised strategy on the basis of information presented in abstracts. This strategy covered study design, country, health focus, study population, intervention setting, intervention provider, and type of intervention.
We identified a total of 70 relevant studies from 13 different countries around the world. Just under half the total number of studies identified (N=34) were evaluations of the impact of interventions on health and other outcomes, suggesting a small but significant body of literature which could potentially provide evidence on the likely effects of the life-check proposal. The body of evidence was spread evenly according to effectiveness in school settings and effectiveness outside school settings. We identified a small number of surveys (N=12) which offered either evidence about the acceptability of the life check to young people or how to optimise uptake of the life check. This smaller amount of evidence on acceptability and uptake was supplemented by a number of outcome evaluations which had also studied acceptability and uptake issues. We also found several studies which had developed and/or evaluated screening tools for young people (N=15). These may have relevance for the assessment stage of the proposed life check. The remainder of the 70 studies were reviews which looked as though they might offer relevant information (N=9). While five of these reviews appeared to be systematic reviews, none exactly matched the topic, intervention and population focus of this scoping review.
The scope of the interventions reported in the outcome evaluations ranged from a fairly narrow focus on single issues (such as physical activity or asthma) to more broad-ranging assessments of health behaviours and/or emotional health and wellbeing. Many of the interventions involved nurses who undertook some form of assessment and/or provided follow-up guidance and advice. Other providers were family doctors and specialists, such as school counsellors or dentists. The location of the interventions was fairly evenly split between schools and health-care settings. Where the information was available, it appeared that most young people were offered tailored advice or individual health plans following their health check. Most of the studies targeted young people in general, although a small number focused on young people from disadvantaged groups or reported their results stratified by age, gender or socio-economic group. There was limited evidence available from the UK, as only four outcome studies evaluated interventions implemented in this country.
The kinds of interventions evaluated varied in terms of how closely they matched the proposed life check. Some studies evaluated interventions in which young people were invited to take part in ‘one-off’ assessments to assess their physical health, health behaviours and/or emotional health and wellbeing. These took place in schools or in health-care settings, usually in primary care. Other studies evaluated periodic health check-ups offered to all children in a particular school, area or country. It was not always clear what these periodic health checks covered. In some studies, the health check was used as an opportunity to screen for more specific health problems or behaviours, such as diabetes or oral health behaviour; while, in other studies, the health check was used as an opportunity to discuss health behaviours, lifestyle and/or emotional health more generally. A variation on this theme was a check-up for young people before they participated in school sports. Again, in some of these studies, the ‘pre-participation’ exam was used to screen for specific problems, such as asthma; in others, it was used as an opportunity for health-promoting activities. Despite searching the transitions literature, we only identified one study which offered a life-check style intervention to help young people negotiate the transition between primary and secondary school.
The results of this scoping review suggest a small, but nonetheless substantive, body of research evidence relevant to the life-check proposal for young people. Although searches were systematic and comprehensive, they were not exhaustive, so the results of this scoping review may represent an underestimate of the total body of relevant literature. On the other hand, because the review is based on titles and abstracts of study reports only, we may have deemed some studies as relevant which may on inspection of the full report turn out to be irrelevant. The scoping review has highlighted that the available research evidence can address questions about the effectiveness, acceptability and uptake of the life check. It was not in the remit of this review to assess the quality of this evidence and synthesise the findings. A full systematic review would be required for this task. The commissioning of such a review would need to consider supplementary searching methods and the relevance to the life-check proposal of the different types of interventions identified in this scoping exercise. Since we found studies evaluating life check style interventions in a variety of settings and according to a range of outcomes, such a review could also consider where the life checks might be best located (school, health services, community or the home) and the most relevant outcomes of interest. Such a review would also need to appraise both the potential benefits and harms of intervening in young people’s lives during their transition years.