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School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders' perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child's wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other's expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child.

Inleiding: De M@ZL-methodiek (Medische Advisering van de Ziekgemelde Leerling) is een methodiek die gericht is op het vroegtijdig identificeren van ziekteverzuim en het reduceren ervan door het tijdig en proactief aanbieden van ondersteuning. Dit onderzoek had tot doel de M@ZL-methodiek te evalueren onder leerlingen van het middelbaar beroepsonderwijs (mbo) en jeugdartsen. Methode: Mbo-leerlingen met ‘zorgwekkend’ ziekteverzuim in zowel interventiescholen als controlescholen vulden op twee momenten (een nulmeting en na zes maanden) een zelfrapportagevragenlijst in. Voor de analyse werden lineaire en logistische regressieanalyses toegepast. Ook vulden mbo-leerlingen op interventiescholen en jeugdartsen een evaluatieformulier in. Resultaten: Deelnemende mbo-leerlingen (n = 200) hadden een gemiddelde leeftijd van 18,6 jaar (sd = 2,0) en 78,5% was vrouw. De M@ZL-methodiek liet positieve resultaten zien op het verminderen van ziekteverzuim in dagen (β = −1,13, 95%-BI = −2,22–−0,05, p 0,05). Een significante interactie liet een afname van het ziekteverzuim zien bij mannen (p 0,05). De jeugdartsen die M@ZL uitvoerden, vonden de methodiek zinvol en verklaarden dat het consult bijna altijd verliep zoals bedoeld. Leerlingen beoordeelden het consult met een 8,3. Conclusie: De M@ZL-methodiek kan positieve effecten hebben op het verminderen van zowel ziekteverzuim als depressieve symptomen bij mbo-leerlingen. De jeugdartsen en de leerlingen waardeerden de methodiek.

Inleiding: Ziekteverzuim in het voortgezet onderwijs heeft negatieve gevolgen voor degezondheid en ontwikkeling van jongeren. Bij de methodiek M@ZL (Medische Advisering Ziekgemelde Leerling) werken school, jeugdarts en leerplicht samen aan de signalering en begeleiding van scholieren met ziekteverzuim. Wij onderzochten hoe jongerenhun ziekteverzuim en de ziekteverzuimbegeleiding volgens M@ZL ervaren, en in hoeverre hun perspectieven daarover aansluiten bij de programmatheorie. Methode: Het betreft een kwalitatief onderzoek door middel van semigestructureerde interviews. Er vonden dertien interviews plaats waarop een inductieve thematische analyse werd uitgevoerd. De resultaten werden vergeleken met de programmatheorie.Resultaten: Jongeren vinden het niet fijn om te verzuimen en zien voor hun ouders een ondersteunende rol en een rol als intermediair tussen henzelf en de school of jeugdarts. Ziekteverzuimbegeleiding door de school en jeugdarts wordt als aandacht en interesse ervaren, maar jongeren vinden het ook logisch dat hun afwezigheid wordt gecontroleerd. Ze vindenuitleg van de school over verwijzing naar de jeugdarts en uitleg van de jeugdarts over de terugkoppeling naar de school belangrijk. Opvolging van het consult bij dejeugdarts door de school vond volgens jongeren niet altijd plaats.Conclusie: M@ZL wordt door jongeren gewaardeerd. Verbeterpunten zijn communicatie door de school en jeugdarts met jongeren en hun ouders, en opvolging na het consult bij de jeugdarts.

School attendance is crucial for the development of a child. Sickness absence is the most common type of absenteeism and can be a red flag for underlying problems. To address sickness absence, the intervention Medical Advice for Sick-reported Students for Primary School (MASS-PS) was recently developed. It targets children at risk and is a school-based child and youth health care intervention. The present study is a process evaluation of the intervention. MASS-PS was implemented and evaluated in 29 schools in the West-Brabant region of the Netherlands, during three school years (2017–2020). Attendance coordinators (ACs) from the different schools were interviewed in six focus group interviews as well as in over 200 individual conversations, of which logbooks were kept. Content analysis was used based on a framework of implementation elements. During the first year of the study, the uptake was low. Changes were made by the project group to improve the uptake. The ACs generally considered the MASS-PS as compatible and relevant, but suggested improvements by adding a medical consultation function with a child and youth healthcare physician and increasing the threshold for selecting children at risk. They saw several personal benefits, although time was necessary to learn to use the intervention. An organisational barrier was the lack of teaching staff. A strength in the organisational structure was the appointment of ACs. A major event in the sociological structure was the COVID-19 pandemic. ACs felt that the intervention helped them keep track of sickness absence during the pandemic. The Medical Advice for Sick-reported Students for Primary School intervention was implemented successfully, and the process evaluation gave insight into possible improvements.

The Netherlands has a unique system for promoting child and youth health, known as the preventive Child and Youth Healthcare service (CYH). The CYH makes an important contribution to the development and health of children and young people by offering (anticipatory) information, immunisation, and screening, identifying care needs and providing preventive support to children and their families from birth up to the age of 18 years. The CYH is offered free of charge and offers basic preventive care to all children and special preventive care to children who grow up in disadvantaged situations, such as children growing up in poverty or in a family where one of the members has a chronic health condition. Basic care is supported by 35 evidence-based guidelines and validated screening tools. Special care is supported by effective interventions. The impact of the CYH is high. It is estimated that every EUR 1 spent on the CYH provides EUR 11 back. Although the Dutch CYH is a solid public health system with a reach of up to 95% among young children, the access to this service could be further improved by paying more attention to health literacy, making special care available to all children in need and improving transmural and integrated care coordination. In addition, the generation of nationwide data could help to demonstrate the impact of the CYH and will direct and prioritise the necessary care. By continuously developing care on the basis of new (scientific) insights and (societal) issues, the CYH will continue to offer all children in the Netherlands the best preventive healthcare.

Background Absence from school can lead to lower educational achievement and poor health. Little is known about school absence in primary education. This study’s first aim was to examine the prevalence of school absence in primary schools and differing types of absence, including sickness absence. The second aim was to determine which pupil characteristics and types of absence were associated with extensive sickness absence. Methods The school absence registries for the school year 2015–2016 were analysed retrospectively in eight mainstream primary schools with 2216 pupils, and six schools for special primary education with 1000 pupils in the West-Brabant region of the Netherlands. Descriptive analyses, χ2-tests, Mann-Whitney U tests and logistic regression analyses were performed. Results The one-year prevalence of school absence was 85% in mainstream primary schools and 79% in special schools. Sickness absence was the most prevalent type of absence, occurring in 75 and 71% of pupils, respectively The prevalence of extensive sickness absence was 13 and 23%, respectively. In mainstream schools, extensive sickness absence was associated with a young age, low parental educational level, more doctor’s visits and unauthorised absence, and in special schools with more doctor’s visits, other authorised absence, tardiness and unauthorised absence. Conclusions The prevalence of extensive sickness absence was high, and as this was associated with other types of absence, these pupils missed even more days of school. Public health research, policy and practice should address sickness absence among primary school pupils, to prevent adverse effects on children’s development.

BACKGROUND To limit students’ medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students’ autonomy regarding their situation. OBJECTIVE This study aimed to identify professionals’ and students’ perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. METHODS Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. RESULTS Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. CONCLUSIONS Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism.

Background Certain factors, such as depressive symptoms and binge drinking, may be linked to young adults’ ability to attain an acceptable level of functioning on specific life-domains (i.e. self-sufficiency). We studied the association of contextual factors and health indicators with self-sufficiency in young adults. Methods We used both baseline (n = 755) and 6-months follow-up (n = 200) self-reported questionnaire data of intermediate vocational education students (16–26 years). The questionnaire included the adapted Dutch self-sufficiency matrix (SSM-D), which addresses self-sufficiency regarding 11 life-domains (e.g. finances and housing). The questionnaire also included potentially associated contextual factors (e.g. socio-demographic characteristics) and health indicators (e.g. sickness absence from school). Ordinal (overall self-sufficiency: self-sufficient on 11, 10, 9 or ≤ 8 life-domains), and logistic (self-sufficiency per life-domain: self-sufficient yes/no) regression models were applied. Results The studied population was 18.6 years on average (SD 2.04), and 73.6% were female. Cannabis use was associated with a lower overall self-sufficiency category at baseline (OR = 0.57, 95% CI = 0.33–0.99), as were an increase in sick days (OR = 0.94, 95% CI = 0.91–0.98) and an increase on the scale of depressive symptoms (OR = 0.87, 95% CI = 0.85–0.89). An increase in sick days and an increase on the scale of depressive symptoms were associated with lower odds of being self-sufficient on three and ten life-domains, respectively (p Conclusions Our findings underline the importance of addressing self-sufficiency, sickness absence, and depressive symptoms, preferably before the transition from adolescence to young adulthood has begun.

This study examines the association between school absenteeism, health-related quality of life (HRQOL) and happiness among young adults aged 16&ndash, 26 years attending vocational education. Cross-sectional data from a survey among 676 young adults were analyzed. School absenteeism was measured by the self-reported number of sick days in the past eight weeks and hours of truancy in the past four weeks. HRQOL was measured by the 12-item Short Form Health Survey, physical and mental component summary scores were calculated. General happiness was assessed on a scale of 0&ndash, 10, higher scores indicating greater happiness. Linear regression analyses were performed. The study population had a mean age of 18.5 years (SD 2.2), 26.1% were boys. Young adults with &ge, 5 sick days or &ge, 6 h of truancy reported lower mental HRQOL compared to young adults without sickness absence or truancy (p &lt, 0.05). Young adults with 1&ndash, 4 and &ge, 5 sick days reported lower physical HRQOL compared to young adults who had not reported to be sick (p &lt, 5 h and &ge, 6 h of truancy reported higher physical HRQOL compared to young adults who were not truant (p &lt, 0.05). No associations were observed between school absence and happiness. Lower self-reported mental HRQOL was observed among young adults with more school absenteeism due to sickness or truancy. Sickness absence was additionally associated with lower physical HRQOL.

An adequate approach to reducing school absenteeism should focus on medical absenteeism as this is the most prevalent form of school absenteeism. The objective of this study is to explore the health condition of pre-vocational secondary students with extensive medical absenteeism from a biopsychosocial perspective. Data were obtained from medical assessments and Strengths and Difficulties Questionnaires (SDQs) of students with medical absence above threshold criteria (i.e. reported sick four times in 12 school weeks or more than six consecutive school days) who were referred to a youth health care physician. The results showed that the students had a mean absence rate of 14% in 12 school weeks. Of all students, 43.5% had a diagnosed disease and 81.5% had problems such as physical complaints not yet diagnosed, psychosocial problems, lifestyle problems and sleeping difficulties. Four groups could be distinguished: 13.4% with a diagnosed disease and no problem, 30.1% with a diagnosed disease and a problem, 51.5% with a problem and no diagnosed disease and 5.1% without a diagnosed disease or problem. Significantly higher scores of the Total difficulties-scale on the SDQ were found (mean 10.5; SD 5.8) in the study group, compared to a reference group (mean 9.1; SD 4.9). In conclusion, this study shows that when using the aforementioned criteria for extensive medical absenteeism to intervene with the absence, students with a mean absence rate of 14% in 12 school weeks are identified. If there was a diagnosed disease, it was accompanied by problems about twice as often. More than half of the students’ absence was caused by problems rather than a disease. The great diversity of these problems calls for a personalized approach. A broad perspective, including medical expertise, is needed to distinguish between emerging mental and physical diseases, psychosocial and lifestyle problems.Keywords: Adolescent Health, Preventive Pediatric Primary Care, School Absenteeism, Public Health, Psychosocial Problems

Background School absenteeism, including medical absenteeism, is associated with early school dropout and may result in physical, mental, social and work-related problems in later life. Especially at intermediate vocational education schools, high rates of medical absenteeism are found. In 2012 the Dutch intervention ‘Medical Advice for Sick-reported Students’ (MASS), previously developed for pre-vocational secondary education, was adjusted for intermediate vocational education schools. The aim of the study outlined in this paper is to evaluate the effectiveness of the MASS intervention at intermediate vocational education schools in terms of reducing students’ medical absenteeism and early dropping out of school. Additionally, the extent to which biopsychosocial and other factors moderate the effectiveness of the intervention will be assessed. Methods A controlled before-and-after study will be conducted within Intermediate Vocational Education schools. Schools are allocated to be an intervention or control school based on whether the schools have implemented the MASS intervention (intervention schools) or not (control schools). Intervention schools apply the MASS intervention consisting of active support for students with medical absenteeism provided by the school including a consultation with the Youth Health Care (YHC) professional if needed. Control schools provide care as usual. Data will be collected by questionnaires among students in both groups meeting the criteria for extensive medical absenteeism (i.e. ‘reported sick four times in 12 school weeks or for more than six consecutive school days’ at baseline and at 6 months follow-up). Additionally, in the intervention group a questionnaire is completed after each consultation with a YHC professional, by both the student and the YHC professional. Primary outcome measures are duration and cumulative incidence of absenteeism and academic performances. Secondary outcome measures are biopsychosocial outcomes of the students. Discussion It is hypothesized that implementing the MASS intervention including a referral to a YHC professional on indication, will result in a lower level of medical absenteeism and a lower level of school drop outs among intermediate vocational education students compared to students receiving usual care. The study will provide insight in the effectiveness of the intervention as well as in factors moderating the intervention’s effectiveness. Trial registration Nederlands Trial Register NTR5556. Date of clinical trial registration: 29-Oct-2015.

BackgroundStudents’ health and school absenteeism affect educational level, with adverse effects on their future health. This interdependence is reflected in medical absenteeism. In the Netherlands, a public health intervention has been developed to address medical absenteeism in pre-vocational secondary education. This study aims to investigate the effectiveness of this intervention on students’ medical absenteeism, compared to “medical absenteeism policy as usual”.MethodsA quasi-experimental design with an intervention group (493 students) and a control group (445 students) was applied. Multilevel analysis was used to study differences in the development of the level of a student’s medical absence over time (after 3 and 12 months).ResultsIn the intervention group, the level of absenteeism decreased from 8.5 days reported sick in 12 school weeks to 5.7 days after 3 months, and to 4.9 days after 12 months. The number of absence periods fell from 3.9 in 12 school weeks to 2.5 after 3 months, and to 2.2 after 12 months. In the control group, the absence days initially decreased from 9.9 days reported sick in 12 school weeks to 8.4 days after 3 months, after which an increase to 8.9 days was measured. The number of absence periods initially decreased from 4.5 in 12 school weeks to 3.5, after which an increase to 3.7 was measured. The number of absence days per period remained about the same in both groups.ConclusionsThe study provides first indications for the intervention to be effective for Dutch pre-vocational secondary students with increased medical absence rates. The intervention, which consists of personalised management of medical absenteeism by systematic identification of students with extensive medical absenteeism and consistent referral to youth health care physicians, appears to reduce the absence rates more effectively than “medical absenteeism policy as usual”. The effectiveness of the intervention is shown primarily by a decrease in the number of periods reported sick.

Introductieomvangrijk schoolverzuim kan leiden tot uitstroom naar een lager onderwijsniveau of voortijdig schoolverlaten. Beiden hangen sterk samen met gezondheidsproblemen en hogere sterftecijfers. In het huidige onderzoek werd nagegaan hoe studieloopbaanbegeleiders (slb’ers) de begeleiding bij ziekteverzuim van mbo’ers inhoud en vorm geven en waarom ze dat zo doen.methodekwalitatief onderzoek met semigestructureerde interviews, afgenomen bij elf slb’ers werkzaam op drie mbo-scholen in west-brabant.resultatenvolgens slb’ers zijn er drie vormen van ziekteverzuim: verzuim vanwege ziekte, vanwege psychosociale problemen en vanwege ‘niet naar school willen komen’. In de verzuimbegeleiding hanteren slb’ers drie soorten rollen: een controlerende, een structurerende en een empathische rol. Omdat er volgens de slb’ers vaak sprake is van ziekteverzuim vanwege ‘niet naar school willen komen’, wat ze niet legitiem verzuim vinden, hanteren ze vooral een controlerende rol, terwijl ze met deze rol weinig affiniteit hebben. De slb’ers benoemen de randvoorwaarden die volgens hen nodig zijn om de rollen bij ziekteverzuimbegeleiding goed in te kunnen vullen. Deze randvoorwaarden zijn niet specifiek voor bepaalde rollen.conclusieshoewel slb’ers in hun visie op ziekteverzuim onderscheid maken in drie vormen van ziekteverzuim, blijken ze in hun werkwijze vooral onderscheid te maken tussen legitiem en niet legitiem verzuim. Door deze focus op legitimiteit hanteren ze vooral een controlerende rol. Ze voelen zich echter niet prettig bij deze rol en nemen liever een structurerende of een empathische rol op zich. Hierdoor ervaren slb’ers ziekteverzuimbegeleiding als een ambigue taak.

BackgroundReducing school absenteeism benefits the health and educational opportunities of young people. The Dutch intervention Medical Advice for Sick-reported Students (abbreviated as MASS) was developed to address school absenteeism due to sickness reporting, also called medical absenteeism. This study is part of a research project on the effectiveness of MASS and explores factors that influence the implementation and dissemination of the intervention, from schools' perspectives. The research questions include reasons schools have to implement MASS, their experiences in the implementation of MASS and their views on what is needed to ensure sustainable implementation.MethodsA qualitative research method was used. Semi-structured interviews were held with nine principals and eight special education needs coordinators, working in nine secondary schools that apply MASS. Inductive content analysis was carried out.FindingsThe main reasons for schools to address medical absenteeism were their concerns about students' well-being and future prospects and their wish to share these concerns with students' parents. Participants also mentioned the wish to raise the threshold for reporting sick. According to the participants, MASS makes it easier for teachers to enter into conversation with students and their parents about medical absence. MASS prevents damage to the relationship with parents and medical problems being missed. In implementing MASS the main obstacles are teachers' dialogue about medical absence with students and their parents, teachers' follow-up of the feedback of the youth health care physicians (YHCPs), and correct registration. The participants were convinced that MASS also improves collaboration with parents regarding the optimization of care for students.ConclusionsMASS allows schools to identify students at risk of dropout at an early stage and to optimise guidance of these students. The intervention matches schools' need to address medical absenteeism by providing a clear framework, an approach from concern rather than control, and socio-medical expertise through the collaboration with YHCPs. MASS can support schools to maximize the number of students graduating and to improve parental involvement in school. These outcomes may help to put the subject of addressing medical absenteeism on the agenda of all schools, and contribute to prioritization, support adoption and secure sustainable implementation and dissemination of MASS.

Sociaal economische gezondheidsverschillen kunnen worden gereduceerd door het verminderen van gezondheidsrisico’s en het verhogen van onderwijskansen. Bij dit laatste is omvangrijk schoolverzuim een risicofactor. Door aandacht te besteden aan schoolverzuim wegens ziekte levert de jeugdgezondheidszorg een bijdrage aan de gezondheid, het welbevinden en de onderwijskansen van jongeren en daarmee aan het terugdringen van sociaal economische gezondheidsverschillen. De GGD West-Brabant heeft in een pilot de interventie M@ZL (Medische Advisering Ziekgemelde Leerling) voor de aanpak van ziekteverzuim door scholieren in het voortgezet onderwijs ontwikkeld. In dit artikel worden methodiek en pilotresultaten beschreven. Van de leerlingen met omvangrijk ziekteverzuim werd 98% bereikt door de jeugdarts of de leerplichtambtenaar; 50% had lichamelijke klachten, veel leerlingen hadden psychosociale problemen. Bij 63% van de leerlingen die in het begeleidingstraject kwamen nam de verzuimomvang af. Het ziekteverzuim op schoolniveau nam af met gemiddeld 1,1 ziektedagen per leerling per schooljaar. Uit de pilot wordt voorlopig geconcludeerd dat de interventie M@ZL veelbelovend is voor het terugdringen van ziekteverzuim op het voortgezet onderwijs. Er worden aanknopingspunten voor verdere ontwikkeling gegeven.