research paper on student health

Student mental health is in crisis. Campuses are rethinking their approach

Amid massive increases in demand for care, psychologists are helping colleges and universities embrace a broader culture of well-being and better equipping faculty to support students in need

Vol. 53 No. 7 Print version: page 60

• Mental Health

By nearly every metric, student mental health is worsening. During the 2020–2021 school year, more than 60% of college students met the criteria for at least one mental health problem, according to the Healthy Minds Study, which collects data from 373 campuses nationwide ( Lipson, S. K., et al., Journal of Affective Disorders , Vol. 306, 2022 ). In another national survey, almost three quarters of students reported moderate or severe psychological distress ( National College Health Assessment , American College Health Association, 2021).

Even before the pandemic, schools were facing a surge in demand for care that far outpaced capacity, and it has become increasingly clear that the traditional counseling center model is ill-equipped to solve the problem.

“Counseling centers have seen extraordinary increases in demand over the past decade,” said Michael Gerard Mason, PhD, associate dean of African American Affairs at the University of Virginia (UVA) and a longtime college counselor. “[At UVA], our counseling staff has almost tripled in size, but even if we continue hiring, I don’t think we could ever staff our way out of this challenge.”

Some of the reasons for that increase are positive. Compared with past generations, more students on campus today have accessed mental health treatment before college, suggesting that higher education is now an option for a larger segment of society, said Micky Sharma, PsyD, who directs student life’s counseling and consultation service at The Ohio State University (OSU). Stigma around mental health issues also continues to drop, leading more people to seek help instead of suffering in silence.

But college students today are also juggling a dizzying array of challenges, from coursework, relationships, and adjustment to campus life to economic strain, social injustice, mass violence, and various forms of loss related to Covid -19.

As a result, school leaders are starting to think outside the box about how to help. Institutions across the country are embracing approaches such as group therapy, peer counseling, and telehealth. They’re also better equipping faculty and staff to spot—and support—students in distress, and rethinking how to respond when a crisis occurs. And many schools are finding ways to incorporate a broader culture of wellness into their policies, systems, and day-to-day campus life.

“This increase in demand has challenged institutions to think holistically and take a multifaceted approach to supporting students,” said Kevin Shollenberger, the vice provost for student health and well-being at Johns Hopkins University. “It really has to be everyone’s responsibility at the university to create a culture of well-being.”

Higher caseloads, creative solutions

The number of students seeking help at campus counseling centers increased almost 40% between 2009 and 2015 and continued to rise until the pandemic began, according to data from Penn State University’s Center for Collegiate Mental Health (CCMH), a research-practice network of more than 700 college and university counseling centers ( CCMH Annual Report , 2015 ).

That rising demand hasn’t been matched by a corresponding rise in funding, which has led to higher caseloads. Nationwide, the average annual caseload for a typical full-time college counselor is about 120 students, with some centers averaging more than 300 students per counselor ( CCMH Annual Report , 2021 ).

“We find that high-caseload centers tend to provide less care to students experiencing a wide range of problems, including those with safety concerns and critical issues—such as suicidality and trauma—that are often prioritized by institutions,” said psychologist Brett Scofield, PhD, executive director of CCMH.

To minimize students slipping through the cracks, schools are dedicating more resources to rapid access and assessment, where students can walk in for a same-day intake or single counseling session, rather than languishing on a waitlist for weeks or months. Following an evaluation, many schools employ a stepped-care model, where the students who are most in need receive the most intensive care.

Given the wide range of concerns students are facing, experts say this approach makes more sense than offering traditional therapy to everyone.

“Early on, it was just about more, more, more clinicians,” said counseling psychologist Carla McCowan, PhD, director of the counseling center at the University of Illinois at Urbana-Champaign. “In the past few years, more centers are thinking creatively about how to meet the demand. Not every student needs individual therapy, but many need opportunities to increase their resilience, build new skills, and connect with one another.”

Students who are struggling with academic demands, for instance, may benefit from workshops on stress, sleep, time management, and goal-setting. Those who are mourning the loss of a typical college experience because of the pandemic—or facing adjustment issues such as loneliness, low self-esteem, or interpersonal conflict—are good candidates for peer counseling. Meanwhile, students with more acute concerns, including disordered eating, trauma following a sexual assault, or depression, can still access one-on-one sessions with professional counselors.

As they move away from a sole reliance on individual therapy, schools are also working to shift the narrative about what mental health care on campus looks like. Scofield said it’s crucial to manage expectations among students and their families, ideally shortly after (or even before) enrollment. For example, most counseling centers won’t be able to offer unlimited weekly sessions throughout a student’s college career—and those who require that level of support will likely be better served with a referral to a community provider.

“We really want to encourage institutions to be transparent about the services they can realistically provide based on the current staffing levels at a counseling center,” Scofield said.

The first line of defense

Faculty may be hired to teach, but schools are also starting to rely on them as “first responders” who can help identify students in distress, said psychologist Hideko Sera, PsyD, director of the Office of Equity, Inclusion, and Belonging at Morehouse College, a historically Black men’s college in Atlanta. During the pandemic, that trend accelerated.

“Throughout the remote learning phase of the pandemic, faculty really became students’ main points of contact with the university,” said Bridgette Hard, PhD, an associate professor and director of undergraduate studies in psychology and neuroscience at Duke University. “It became more important than ever for faculty to be able to detect when a student might be struggling.”

Many felt ill-equipped to do so, though, with some wondering if it was even in their scope of practice to approach students about their mental health without specialized training, Mason said.

Schools are using several approaches to clarify expectations of faculty and give them tools to help. About 900 faculty and staff at the University of North Carolina have received training in Mental Health First Aid , which provides basic skills for supporting people with mental health and substance use issues. Other institutions are offering workshops and materials that teach faculty to “recognize, respond, and refer,” including Penn State’s Red Folder campaign .

Faculty are taught that a sudden change in behavior—including a drop in attendance, failure to submit assignments, or a disheveled appearance—may indicate that a student is struggling. Staff across campus, including athletic coaches and academic advisers, can also monitor students for signs of distress. (At Penn State, eating disorder referrals can even come from staff working in food service, said counseling psychologist Natalie Hernandez DePalma, PhD, senior director of the school’s counseling and psychological services.) Responding can be as simple as reaching out and asking if everything is going OK.

Referral options vary but may include directing a student to a wellness seminar or calling the counseling center to make an appointment, which can help students access services that they may be less likely to seek on their own, Hernandez DePalma said. Many schools also offer reporting systems, such as DukeReach at Duke University , that allow anyone on campus to express concern about a student if they are unsure how to respond. Trained care providers can then follow up with a welfare check or offer other forms of support.

“Faculty aren’t expected to be counselors, just to show a sense of care that they notice something might be going on, and to know where to refer students,” Shollenberger said.

At Johns Hopkins, he and his team have also worked with faculty on ways to discuss difficult world events during class after hearing from students that it felt jarring when major incidents such as George Floyd’s murder or the war in Ukraine went unacknowledged during class.

Many schools also support faculty by embedding counselors within academic units, where they are more visible to students and can develop cultural expertise (the needs of students studying engineering may differ somewhat from those in fine arts, for instance).

When it comes to course policy, even small changes can make a big difference for students, said Diana Brecher, PhD, a clinical psychologist and scholar-in-residence for positive psychology at Toronto Metropolitan University (TMU), formerly Ryerson University. For example, instructors might allow students a 7-day window to submit assignments, giving them agency to coordinate with other coursework and obligations. Setting deadlines in the late afternoon or early evening, as opposed to at midnight, can also help promote student wellness.

At Moraine Valley Community College (MVCC) near Chicago, Shelita Shaw, an assistant professor of communications, devised new class policies and assignments when she noticed students struggling with mental health and motivation. Those included mental health days, mindful journaling, and a trip with family and friends to a Chicago landmark, such as Millennium Park or Navy Pier—where many MVCC students had never been.

Faculty in the psychology department may have a unique opportunity to leverage insights from their own discipline to improve student well-being. Hard, who teaches introductory psychology at Duke, weaves in messages about how students can apply research insights on emotion regulation, learning and memory, and a positive “stress mindset” to their lives ( Crum, A. J., et al., Anxiety, Stress, & Coping , Vol. 30, No. 4, 2017 ).

Along with her colleague Deena Kara Shaffer, PhD, Brecher cocreated TMU’s Thriving in Action curriculum, which is delivered through a 10-week in-person workshop series and via a for-credit elective course. The material is also freely available for students to explore online . The for-credit course includes lectures on gratitude, attention, healthy habits, and other topics informed by psychological research that are intended to set students up for success in studying, relationships, and campus life.

“We try to embed a healthy approach to studying in the way we teach the class,” Brecher said. “For example, we shift activities every 20 minutes or so to help students sustain attention and stamina throughout the lesson.”

Creative approaches to support

Given the crucial role of social connection in maintaining and restoring mental health, many schools have invested in group therapy. Groups can help students work through challenges such as social anxiety, eating disorders, sexual assault, racial trauma, grief and loss, chronic illness, and more—with the support of professional counselors and peers. Some cater to specific populations, including those who tend to engage less with traditional counseling services. At Florida Gulf Coast University (FGCU), for example, the “Bold Eagles” support group welcomes men who are exploring their emotions and gender roles.

The widespread popularity of group therapy highlights the decrease in stigma around mental health services on college campuses, said Jon Brunner, PhD, the senior director of counseling and wellness services at FGCU. At smaller schools, creating peer support groups that feel anonymous may be more challenging, but providing clear guidelines about group participation, including confidentiality, can help put students at ease, Brunner said.

Less formal groups, sometimes called “counselor chats,” meet in public spaces around campus and can be especially helpful for reaching underserved groups—such as international students, first-generation college students, and students of color—who may be less likely to seek services at a counseling center. At Johns Hopkins, a thriving international student support group holds weekly meetings in a café next to the library. Counselors typically facilitate such meetings, often through partnerships with campus centers or groups that support specific populations, such as LGBTQ students or student athletes.

“It’s important for students to see counselors out and about, engaging with the campus community,” McCowan said. “Otherwise, you’re only seeing the students who are comfortable coming in the door.”

Peer counseling is another means of leveraging social connectedness to help students stay well. At UVA, Mason and his colleagues found that about 75% of students reached out to a peer first when they were in distress, while only about 11% contacted faculty, staff, or administrators.

“What we started to understand was that in many ways, the people who had the least capacity to provide a professional level of help were the ones most likely to provide it,” he said.

Project Rise , a peer counseling service created by and for Black students at UVA, was one antidote to this. Mason also helped launch a two-part course, “Hoos Helping Hoos,” (a nod to UVA’s unofficial nickname, the Wahoos) to train students across the university on empathy, mentoring, and active listening skills.

At Washington University in St. Louis, Uncle Joe’s Peer Counseling and Resource Center offers confidential one-on-one sessions, in person and over the phone, to help fellow students manage anxiety, depression, academic stress, and other campus-life issues. Their peer counselors each receive more than 100 hours of training, including everything from basic counseling skills to handling suicidality.

Uncle Joe’s codirectors, Colleen Avila and Ruchika Kamojjala, say the service is popular because it’s run by students and doesn’t require a long-term investment the way traditional psychotherapy does.

“We can form a connection, but it doesn’t have to feel like a commitment,” said Avila, a senior studying studio art and philosophy-neuroscience-psychology. “It’s completely anonymous, one time per issue, and it’s there whenever you feel like you need it.”

As part of the shift toward rapid access, many schools also offer “Let’s Talk” programs , which allow students to drop in for an informal one-on-one session with a counselor. Some also contract with telehealth platforms, such as WellTrack and SilverCloud, to ensure that services are available whenever students need them. A range of additional resources—including sleep seminars, stress management workshops, wellness coaching, and free subscriptions to Calm, Headspace, and other apps—are also becoming increasingly available to students.

Those approaches can address many student concerns, but institutions also need to be prepared to aid students during a mental health crisis, and some are rethinking how best to do so. Penn State offers a crisis line, available anytime, staffed with counselors ready to talk or deploy on an active rescue. Johns Hopkins is piloting a behavioral health crisis support program, similar to one used by the New York City Police Department, that dispatches trained crisis clinicians alongside public safety officers to conduct wellness checks.

A culture of wellness

With mental health resources no longer confined to the counseling center, schools need a way to connect students to a range of available services. At OSU, Sharma was part of a group of students, staff, and administrators who visited Apple Park in Cupertino, California, to develop the Ohio State: Wellness App .

Students can use the app to create their own “wellness plan” and access timely content, such as advice for managing stress during final exams. They can also connect with friends to share articles and set goals—for instance, challenging a friend to attend two yoga classes every week for a month. OSU’s apps had more than 240,000 users last year.

At Johns Hopkins, administrators are exploring how to adapt school policies and procedures to better support student wellness, Shollenberger said. For example, they adapted their leave policy—including how refunds, grades, and health insurance are handled—so that students can take time off with fewer barriers. The university also launched an educational campaign this fall to help international students navigate student health insurance plans after noticing below average use by that group.

Students are a key part of the effort to improve mental health care, including at the systemic level. At Morehouse College, Sera serves as the adviser for Chill , a student-led advocacy and allyship organization that includes members from Spelman College and Clark Atlanta University, two other HBCUs in the area. The group, which received training on federal advocacy from APA’s Advocacy Office earlier this year, aims to lobby public officials—including U.S. Senator Raphael Warnock, a Morehouse College alumnus—to increase mental health resources for students of color.

“This work is very aligned with the spirit of HBCUs, which are often the ones raising voices at the national level to advocate for the betterment of Black and Brown communities,” Sera said.

Despite the creative approaches that students, faculty, staff, and administrators are employing, students continue to struggle, and most of those doing this work agree that more support is still urgently needed.

“The work we do is important, but it can also be exhausting,” said Kamojjala, of Uncle Joe’s peer counseling, which operates on a volunteer basis. “Students just need more support, and this work won’t be sustainable in the long run if that doesn’t arrive.”

Further reading

Overwhelmed: The real campus mental-health crisis and new models for well-being The Chronicle of Higher Education, 2022

Mental health in college populations: A multidisciplinary review of what works, evidence gaps, and paths forward Abelson, S., et al., Higher Education: Handbook of Theory and Research, 2022

Student mental health status report: Struggles, stressors, supports Ezarik, M., Inside Higher Ed, 2022

Before heading to college, make a mental health checklist Caron, C., The New York Times, 2022

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• Research article
• Open access
• Published: 03 September 2013

The school environment and student health: a systematic review and meta-ethnography of qualitative research

• Farah Jamal 1 ,
• Adam Fletcher 2 ,
• Angela Harden 1 , 3 ,
• Helene Wells 4 ,
• James Thomas 5 &
• Chris Bonell 6  

BMC Public Health volume  13 , Article number:  798 ( 2013 ) Cite this article

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There is increasing interest in promoting young people’s health by modifying the school environment. However, existing research offers little guidance on how the school context enables or constrains students’ health behaviours, or how students’ backgrounds relate to these processes. For these reasons, this paper reports on a meta-ethnography of qualitative studies examining: through what processes does the school environment (social and physical) influence young people’s health?

Systematic review of qualitative studies. Sixteen databases were searched, eliciting 62, 329 references which were screened, with included studies quality assessed, data extracted and synthesized using an adaptation of Noblit and Hare’s meta-ethnographic approach.

Nineteen qualitative studies were synthesised to explore processes through which school-level influences on young people’s health might occur. Four over-arching meta-themes emerged across studies focused on a range of different health issues. First, aggressive behaviour and substance use are often a strong source of status and bonding at schools where students feel educationally marginalised or unsafe. Second, health-risk behaviours are concentrated in unsupervised ‘hotspots’ at the school. Third, positive relationships with teachers appear to be critical in promoting student wellbeing and limiting risk behaviour; however, certain aspects of schools’ organisation and education policies constrain this, increasing the likelihood that students look for a sense of identity and social support via health-risk behaviours. Fourth, unhappiness at school can cause students to seek sources of ‘escape’, either by leaving school at lunchtime or for longer unauthorized spells or through substance use. These meta-themes resonate with Markham and Aveyard’s theory of human functioning and school organisation, and we draw on these qualitative data to refine and extend this theory, in particular conceptualising more fully the role of young people’s agency and student-led ‘systems’ in constituting school environments and generating health risks.

Institutional features which may shape student health behaviours such as lack of safety, poor student-staff relationships and lack of student voice are amenable to interventions and should be the subject of future investigation. Future qualitative research should focus on health behaviours which are under-theorised in this context such as physical activity, sexual and mental health.

Peer Review reports

Childhood and youth are critical stages in the life-course for improving population-level health and reducing health inequalities. Multiple health-risk behaviours such as smoking, drinking, drug use (hereafter described collectively as ‘substance use’), violence and sexual risk are known to cluster together among the most disadvantaged groups of young people [ 1 ], suggesting the need for new common intervention strategies in schools [ 2 ]. This paper reports on a meta-ethnography of qualitative studies examining the processes by which schools’ social and physical environments influence young people’s health. This qualitative review was undertaken as part of a larger systematic review which also included theories and evidence from outcome and process evaluations and multi-level model (MLM) studies in order to build a comprehensive picture on how the school environment influences health [ 3 ]. Systematic reviews have consistently suggested that health education aiming to address these concerns by improving young people’s knowledge about health risks and modifying peer norms have relatively small and inconsistent results [ 4 ]. Socio-ecological approaches which address multiple-levels and contexts offer a complementary approach to changing behaviour via addressing upstream determinants [ 5 ]. These have the potential to ameliorate health inequalities [ 6 ]. One example of a socio-ecological approach is via interventions which change the school environment alongside curriculum-based education. This approach is supported by the World Health Organisation’s (WHO) framework for’Health Promoting Schools’ [ 7 ].

Markham and Aveyard [ 8 ] developed a theory of human functioning and school organisation, integrating theoretical conceptions of parenting [ 9 ] and cultural transmission in education [ 10 ]. Their theory focuses on how schools can promote health by enabling students to fulfil their capacity for autonomy, practical reasoning and affiliation through, what Bernstein termed, its ‘instructional’ and ‘regulatory’ orders. The instructional order is the way in which a school enables students to learn, both formally and informally. The regulatory order is the way in which a school aims to encourage norms of good behaviour and students’ sense of belonging. The theory suggests that schools in which many students become detached (from the regulatory order), disengaged (from the instructional order), and/or alienated (from both) will report poorer health outcomes. Schools can maximise student commitment to the instructional and regulatory orders by eroding unnecessary boundaries, for example between staff and students, and between different areas of learning; and by ensuring that both learning and decision-making in schools is student-centred.

Subsequent empirical research has aimed to test this theory. Three English studies [ 11 – 13 ] and one American study [ 14 ] found consistent evidence that schools with higher academic attainment and attendance than would be expected judging from the social profile of their students (which is an indirect measure termed ‘value-added’) had lower rates of substance use. For example, a longitudinal study by Tobler and colleagues [ 14 ] found that ‘value-added’ American high-school institutional environments have significantly lower rates of substance use and violence. These studies support a ‘school environment’ approach for reducing youth substance use and other risk behaviours [ 15 ]. However, these MLM studies of ‘school effects’ on student health only provide relatively weak evidence in support of a theory of human functioning and school organisation for several reasons. First, they rely on quite a crude measure of the school social environment based on a school-level summary score of the extent to which the students in the school achieved higher academic attainment and lower rates of truancy after accounting for their socio-demographic profile [ 16 ]. Second, the statistical correlations observed between higher value-added scores and lower rates of risk behaviours do not equate to direct evidence that students were more committed to the instructional and regulatory orders at these schools, nor what organisational factors influenced this. None of the MLM studies examined causal pathways.

Furthermore, these quantitative studies only offer very limited guidance on how the school context enables or constrains students’ health behaviours, or how students’ family backgrounds relate to these processes. For these reasons, qualitative evidence was included as part of the larger project to build a comprehensive picture on the effects of the school environment on young people’s health. Qualitative research is useful for exploring students’ lived experiences of schooling and how this may influence their health. This review reports the first meta-ethnography to address the question: through what processes does the school environment (social and physical) influence student health outcomes?

The study adheres to PRISMA guidelines for systematic reviews. A PRISMA checklist is provided in an Additional file 1 .

Searching and evidence map

The review was undertaken in two stages. In stage 1, sixteen bibliographic databases were searched between July and September 2010. A comprehensive approach to database searching was used in order to identify theory, outcome and process evaluations of school environment interventions, ecological and MLM studies of school effects as well as qualitative research on accounts of how school environment influences are implicated in health behaviours and outcomes (refer to Additional file 2 ). References (n = 82,775) were retrieved and screened to identify relevant studies (n = 1,144). Relevant studies were mapped (based on their titles and abstracts) to describe the types of question(s), setting(s) and population(s) they focused on. A diagram of the flow of literature through the review is provided in Figure  1 and the published protocol describes search strategies and exclusion criteria for stage 1 in detail [ 3 ]. An evidence map was produced and academic/policy stakeholders and young people were consulted to inform priorities for in-depth reviews (stage 2), which included the synthesis of qualitative research through meta-ethnography reported here. In-depth reviews focused on student (but not staff) health and were limited to studies which examine school environments in terms of: organisation and management; teaching, pastoral care and discipline; student attitudes and relationships with teachers; and physical environment.

Flowchart of qualitative studies from evidence map to in-depth review.

Exclusion criteria

Prior to the in-depth synthesis, references to qualitative research studies (n = 194) included in the evidence map were screened using the full text and excluded if they: were found to be not relevant on retrieval of the full paper; did not provide an account of how student health is influenced by features of the school environment; did not report on the aspects of school environment listed above; were not a qualitative study; or were not reported in English. Reports were double screened by two reviewers and any discrepancies were discussed until agreement was reached. A second set of criteria was then applied to all included reports in order to limit the review to relevant reports which provide findings conceptually rich enough to facilitate meta-ethnography. A scale of ‘high’, ‘medium’ and ‘low’ was used to rate: conceptual richness (i.e. do authors go beyond a description of the findings and interprets them to develop concepts, theories or metaphors?); relevance in terms of research aims; and relevance of findings for addressing our research question.

Data extraction

We adopted an inclusive approach to data extraction [ 17 ] whereby reviewers extracted all relevant data presented in a study according to a standard proforma. Relevant data were: a) the study context (e.g. country, participant characteristics, sample size, research methods); and b) findings of the paper, highlighting themes or concepts which the study authors report and including author interpretation. Four reviewers extracted data, using the guidelines, on a randomly selected sample of two study reports to ensure thoroughness and consistency. All other reports were split between two reviewers and were checked by another reviewer and any disagreements were resolved by discussion. The data extracted provided a broad overview of the included studies, which is summarized in Additional file 3 : Table S1. Reviewers however returned to reading full-text papers during the synthesis process in order to immerse themselves in the data. This is common in qualitative reviews where authors move between reading primary studies, data extraction, synthesis and interpretation in several cycles [ 17 ].

Quality assessment

Studies that met the above criteria for inclusion were assessed for methodological quality using criteria from EPPI-Centre health promotion reviews [ 18 ]. The quality criteria addressed the rigour of: sampling; data collection; data analysis; the extent to which the study findings are grounded in the data; whether the study privileges the perspectives of children and young people; the breadth of findings; and depth of findings. The tool was piloted by four reviewers to ensure consistency and all remaining reports were assessed by two reviewers and checked by a third reviewer. Based on this assessment, reviewers rated the study overall on a ‘low’, ‘medium’ and ‘high’ scale. Reports were not excluded based on these quality assessment ratings; instead they were intended to inform our interpretation of findings.

Studies were synthesized using a meta-ethnographic method adapted from Noblit and Hare’s [ 19 ] approach. This method involves treating interpretations and explanations in original studies as data and relating, translating and synthesising these ‘data’ sources via four steps.

Step 1: Reading and re-reading the studies to gain a detailed understanding of their findings, theories and concepts. To preserve the meaning of, and relationships between, concepts within an individual study, memos were used to describe ‘second order constructs’ (i.e. authors’ interpretation of the data) regarding how school-level influences on behaviour and health outcomes may occur.

Step 2: In order to determine how the studies were related they were grouped according to health topics which the included studies were mostly concerned with (aggressive behaviours, substance use, diet, sexual health, and rules for going to the toilet) and the key concepts from individual studies within each health topic were synthesised, which resulted in lists of overarching themes for each of the five health topics (see ‘Figure  2 ’).

Reciprocal translation of included studies to develop meta-themes.

Step 3: Translating studies into one another to produce ‘meta-themes’ across the different health topics (see ‘Figure  2 ’). To draw out the findings under each meta-theme, studies rated ‘high’ in terms of their quality and/or conceptual richness were chosen as ‘index’ papers from which we extracted findings, and then compared and contrasted these findings with the findings of a second study, and the resulting synthesis of these two studies were then contrasted with a third study, and so forth. Noblit and Hare [ 19 ] refer to this as ‘reciprocal translation’.

Step 4: Synthesizing the (step 3) translation across health topics via interpretive reading of these meta-themes to develop a ‘line of argument’ regarding the process by which schools might influence health. This is presented in the discussion.

Nineteen studies were included in the meta-ethnography (summarised in Additional file 3 : Table S1). Studies were conducted in the USA (n = 10), UK (n = 6), Australia (n = 1), South Africa (n = 1) and Sweden (n = 1). The majority of studies were conducted in high-school/secondary-school settings. A range of different socio-economic contexts and ethnic-minority groups were represented, although a disproportionate number of studies were conducted in disadvantaged urban contexts (n = 13) and none focused on rural settings. The results are presented below according to the four meta-themes based on the ‘reciprocal translations’ of studies (step 3).

Performance, identity construction and bonding: acting ‘tough’

Several studies developed this concept and suggested young people often need to adopt ‘tough’ identities at school via acting aggressively and violently, and/or by engaging in substance use. Through such performances young people can foster close relationships with ‘tough’ peers and achieve ‘safety in numbers’. Students described as ‘geeky’ and who chose not to adopt ‘tough’ identities were vulnerable and isolated in disadvantaged, urban school contexts. This process of identity construction based on aggression and substance use thus appears to be an important source of bonding, social support and security, especially where young people feel educationally marginalised and/or unsafe [ 20 – 25 ].

“You smoke it [cannabis] for fun [but also] you wanna look bad. People think you’re a bad boy or bad girl… with me they are cool and I’m safe with the boys here” – female student, UK [ 25 ], p. 247.

One study explicitly developed the concept of violent incidents in schools as group performances through which the norms of acting ‘tough’ are collectively entrenched. This was evident in the way in which bystanders create a spectacle and space for violent behaviour:

“[They] were throwing punches at each other, trying to push each other’s head against the floor with all the strength that they could muster as they twisted their bodies together like twine. They were encircled by a ring of students locked arm-in-arm as they chanted in unison to the rhythm of the fighters” – ethnographic notes, USA [ 21 ], p. 51.

Through the diffusion of these norms, acting ‘tough’ often becomes entrenched in certain ‘high risk’, urban school environments [ 21 , 22 , 25 ]. This appears to reinforce existing patterns of health-risk behaviours, poor educational outcomes and teacher-student conflict in these schools, and both reflecting and exacerbating wider social and racial inequalities.

Reciprocal translation also led us to conclude that the norms around showcasing toughness may reflect the way in which the school environment maintains masculine conventions. Two studies found that young women were subjected to sexualized name calling (e.g. ‘slag’) and physical abuse (e.g. inappropriate touching) in schools [ 26 , 27 ]. This suggests that young men assert their power and reproduce existing gender inequalities in schools via such showcases of toughness.

The social importance of space at school: health impacts

School spaces that are un-supervised appear to be ‘hotspots’ for certain health-risk behaviours. For example, aggressive behaviours and substance use were often associated with areas such as hallways, staircases, toilets, changing-rooms and empty classrooms [ 20 , 24 , 26 , 28 ]. Astor and colleagues [ 26 ] used the term ‘unowned’ to refer to these areas. In their study of five high schools, all 166 violent events reported by students could be mapped onto these ‘unowned’ spaces where few or no adults were present.

Several studies suggested that the large number of ‘unowned’ spaces in schools was the result of teachers focusing on classroom-based instruction and not the supervision of the wider school environment, which was considered beyond their professional responsibility [ 20 , 25 , 26 , 28 ]. Some school staff also reported avoiding potentially aggressive, ‘unowned’ spaces because of: fear of harm; the ambiguity of procedures; and inadequate support systems [ 26 ]. Where security guards, metal detectors and closed-circuit television cameras (CCTV) were used as alternative surveillance mechanisms in these ‘unowned’ spaces, students reported they were inappropriate and ineffective. For example:

“All the cameras are gonna do is videotape, you know what I’m saying? They’ll fight right in front of the camera too… some of them they’ll be asking, ‘Can I get that tape?” –male student, USA [ 26 ], p. 29.

Students reported that CCTV at best merely displaced risk behaviours to new ‘hotspots’ [ 25 ]. In some American high schools the deployment of security guards in such spaces was reported to facilitate new health-risk behaviours:

“Although the guards are discouraged by their superiors from ‘fraternizing’ with the students, they do often develop strong emotional relationships with them; we have known some guards who encourage students to study and to go to class; we have also known others who take drugs, sell drugs to students, have sex with them, and dispense favours” – ethnographic field notes, USA [ 20 ], p. 176.

Reciprocal translation also revealed connections between the spatial and social dynamics of school dining areas and student diet [ 24 , 29 – 31 ]. It appears that young people’s food choices are often constrained by the chaotic and unappealing aesthetic features of school dining areas [ 30 , 31 ]. For example, a study in Scotland described students’ frustrations at policies which organised lunch breaks by year-group and whether students want hot or cold food, which prevented them from eating lunch with friends and limited choice [ 30 ]. Aesthetically unappealing environments (e.g. no natural light, ‘cheap moulded chairs’, etc.) were also implicated in poor school meal uptake [ 31 ].

Another factor which seemed to influence lunchtime experiences was the presence (or non-presence) of teachers in dining halls. Multiple studies reported that teachers used lunch periods to prepare for afternoon lessons or have ‘breathing space’ away from students and that the lunch supervisors who ‘policed’ the dining halls did not make students feel safe, supported or comfortable, often eating quickly (if at all) to escape this environment [ 24 , 30 ].

Teacher-student relationships influence on health

Studies consistently report that positive relationships between students and school staff, particularly teachers, are likely to be crucial to creating a healthy school environment [ 20 , 21 , 25 , 26 , 32 – 36 ] and that this may be particularly important for fostering students’ resiliency regarding substance use [ 37 , 38 ]. However, poor staff-student relationships were widely reported and this appeared to be a product of three inter-related features of the school environment.

First, young people consistently suggested that teachers were disconnected from the realities of their lives, especially urban Black youth [ 20 , 25 , 26 ] and students from the most disadvantaged and chaotic family backgrounds [ 27 , 34 ]. Teaching practices rarely engaged these young people, who then had fewer reasons not to engage in health-risk behaviours once disengaged from school:

“I think, if you’ve got no hope, if you’re surrounded by despair, then you don’t see that following the rules, that good work and good deed will get you anywhere” – teacher, USA [ 26 ], p. 26.

Furthermore, once students felt that staff did not understand them, this appeared to limit the extent to which staff could provide credible health messages and support them to make healthy transitions to adulthood – a theme which was reciprocated across studies of student diet and substance use [ 25 , 32 ]. Students also felt that ‘caring’ or ‘respectful’ teachers who defined their role beyond classroom based instruction were more effective in preventing and managing ‘risky’/‘problem’ behaviours [ 25 , 26 , 29 ].

Second, school rules to maintain discipline were usually said to be established without student input or consultation. This approach may be counter-productive as students recognize their lack of ‘voice’ and challenge the rules they feel are unfair and which disadvantage them [ 22 , 29 , 39 , 40 ], sometimes specifically through adopting health-risk behaviours, such as drug use [ 34 ]. Students also reported frustration at being treated as passive and child-like especially when already taking on adult-like responsibilities at home:

“I’ve had to be an adult for, like, my whole life really but oh no, they just think they always know best ‘cos they are the teacher and we are the students and we’ve gotta listen to them” – female student, UK [ 34 ], p. 555.

Third, teachers’ inconsistent application of rules was a recurring theme, which appeared to contribute to the poor student-staff relationships described above and also influence student health directly through a failure to prevent specific health-risk behaviours such as smoking and bullying on the school site [ 22 , 32 ].

Finally, the wider education system appeared partly to structure these poor institutional relationships and their adverse health consequences. In particular, high staff turnovers, a highly-divided market-orientated school system and target-based education policies focused on academic attainment were implicated in limiting the capacity for teachers to develop more supportive relationships [ 22 , 34 ].

“I can’t make anything happen here. I have no power… There’s nothing I can do. I have no voice” – teacher, USA [ 26 ], p. 25.

The market-orientated system whereby schools effectively compete for the ‘best’ students may also encourage teachers to keep problems such as aggression or drug use ‘hush-hush’ to maintain the reputation of the school, even if this meant that issues related to student health are never adequately addressed [ 22 ].

‘Escaping’ the school environment

Disengaged students often ‘escaped’ the school environment, which was implicated in their account of unhealthy habits. For example, students often reported that lunch-time provided a time of ‘relief’, to ‘hang out’ with friends and ‘escape’. Fast food was often eaten on the walk back to school or in local spaces surrounding the school that young people claimed as their own:

“Just usually run to try and beat all the queues for the food and then like we go down to the wee pigeon bit, sit, ate our lunch and then probably have a fag or two and then go back up the school” – student, UK [ 30 ], p. 462.

The need to escape the school environment at lunch periods had multiple implications for young people’s health: they were less likely to purchase healthy foods provided at school; more likely to visit local shops selling ‘junk’ food and high-calorie drinks; and more likely to smoke tobacco.

Using cannabis and other drugs was also reported as a potential means of escaping anxieties about school and as source self-medication in response to exam stress or a constant sense of academic failure [ 38 ]. A British female secondary-school student explained:

“If someone can’t be bothered about school, like you’re having a bad day then have a spliff in the morning and then it’s a good day. Pressure and stress can make people take drugs. If people don’t like the environment they’re in they are not going to be comfortable and getting on at school” – female student, UK [ 38 ], p. 131.

Our qualitative synthesis suggests complex pathways via which the school environment may shape health harms at a young age. Qualitative research forms a useful complement to quantitative studies on the health effects of the school environment. It illuminates how the school environment is understood by students from different backgrounds, and explores both students’ accounts of their actions and how these are enabled and constrained by the immediate school environment, and how wider structural forces such as education policies and students’ family backgrounds are implicated in this. Qualitative research can thus unpick how agency and structure are mutually constitutive and underlie social processes operating within schools which shape school effects on health.

Through an interpretation of the synthesis, below we present a ‘line of argument’ (step 4 in the meta-ethnography) about how schools might influence health. We refine Markham and Aveyard’s [ 8 ] theory of human functioning and school organisation to elaborate the importance of young people’s agency in constituting school structures, and the importance not merely of the instructional and regulatory orders of the school but also student social structures and networks. We argue that these two ‘systems’ are likely to interact in shaping school practices and influencing student health.

Line of argument: the structuration of school organisation and student health

In line with Giddens’ [ 41 ] notion of structuration, two systems operate in the school environment: first, the student system (comprising peer-led processes and structures); and second, the school institutional system (comprising structures and processes involving school management, teachers, school staff and technologies such as CCTV). Students not only react to schools’ institutional systems for ordering instructional and regulatory practices, but they also promote their own parallel, competing versions of these instructional and regulatory ‘orders’ which Markham and Aveyard’s theory largely ignores. As well as their symbiotic relationship in shaping health, these systems are also both influenced by common social and structural factors beyond the boundaries of the school, such as students’ family backgrounds, which may constrain their sources of identity and social support, and education policies which constrain teachers’ time and responses.

We found that one of the most consistent and harmful effects of the student-led institutional system on health outcomes occurs via a process of normative social ‘instruction’ and the diffusion of highly-symbolic ‘regulatory’ styles based on practices such as intimidation, violence and drug use to (paradoxically) facilitate a sense of safety and security. Once these performative rituals permeate extended networks of students and become the norm, their social and symbolic importance reproduces the institutional ‘order’ through student-led social control, in extreme cases, in opposition to teachers and the schools institutional processes. Consider the rigid rules students reported following when confronted with a violent incident, such as linking arms around a ‘one-on-one-fight’: this collective performance helps establish bonding and collective identity.

Thus, risk arises from students developing the autonomy to engage in behaviour which is often regarded as anti-social but which is thoroughly social in its origins, rather than stemming from an absence of students’ practical reasoning, affiliation and autonomy as Markham and Aveyard suggest. This resonates with other ethnographically-driven theories explaining young people’s ‘street culture’ [ 42 ] and ‘tough fronts’ in inner city high schools [ 43 ], which conceptualise young people not merely as the victims of poverty and violence but as agents struggling for meaning and survival, and ultimately reinforcing existing educational, social and health inequalities.

‘Institutional authority’ [ 8 ] is also shaped by broader, cross-cutting socio-cultural structures which influence the process of localised, institutional structuration. For example, where students’ family and/or community culture is immersed in urban ‘street culture’, with relatively little hope of conventional social advancement, this will permeate the local student-network and thus shape both students’ actions and, in turn, the institutions’ regulatory response. State educational policies also provide an additional cross-cutting ‘structure’ that determine instructional and regulatory practices and, in turn, students’ health. For example, it appears that incentive structures such as ‘league tables’ in the UK and No Child Left Behind monitoring systems in the USA can create perverse incentives for schools to focus on more ‘academic’ students and neglect students’ general health and welfare. In the most extreme cases, the pressure of public exams or a constant sense of monitoring and surveillance can lead young people to seek sources of ‘escape’, either by engaging in substance use or by physically leaving school at lunchtime or for longer unauthorized spells.

Limitations

We acknowledge that the way we have refined and extended Markham and Aveyard’s [ 8 ] theory is not without its problems. There is an apparent bias in the range and nature of qualitative research synthesised here. For example, the strong emphasis on a ‘disconnection’ between the top-down, school institutional regulatory and instructional ‘orders’ and the creative, student-led systems for social regulation and instruction could partly reflect the urban and disadvantaged context of the majority of the studies, where students and teachers may have the least in common. Nonetheless, the strength of the meta-ethnographic approach is that it combines evidence from multiple sources to increase validity and moves beyond merely providing a narrative review of individual studies and instead develops higher-order explanations. The value of this meta-ethnographic approach is also supported by the remarkable consistency in the findings of studies of variable quality undertaken in a wide range of settings, which differed by school system, deprivation level and ethnic make-up. However, some of these differences may have been masked in our review in the process of translating studies.

Another limitation is that we may have lost some of the meaning and depth of key concepts and themes during ‘step 2’ of the synthesis in order to translate themes across studies and identify meta-themes. However, we attempted to preserve individual authors’ interpretations by ensuring that all key concepts extracted from individual papers were accompanied by a narrative memo regarding how they were developed and connected in order to refer back to, and report, these relationships when synthesizing the findings across studies. Also, reports were not excluded based on ‘low quality’ scores as this could bias the review according to certain methodological approaches (e.g. interviews/focus groups rather than ethnographic approaches) and certain academic disciplines (e.g. anthropology) where methods may be less transparently reported. Studies, often from anthropology, that were rated as ‘low quality’ due to poor transparency in reporting of research procedure also provided the most conceptually rich data and thus contributed more substantively to the synthesis. Furthermore, the themes emerging in our review inevitably reflect the range of health topics covered in the primary qualitative studies. Most qualitative researchers exploring and theorising school level influences have focused mainly on how schools might shape risk behaviours, particularly aggressive behaviours and substance use and thus this review may be less useful for understanding how schools can support positive health and well-being, which should be the focus of future research.

The exclusion criteria were designed to identify those qualitative studies that were the most relevant to our review question and conceptually rich enough to facilitate a meta-ethnography approach which requires the presence and clarity of concepts for translation. Studies were excluded that did not examine how features of the school-environment (specifically, school type, physical environment, school management, teaching, support and discipline, student attitudes to school or relations with teachers) influences student health. We thus did not include a major body of work from sociology of education [ 44 – 46 ] including some studies that focused primarily on mental health. However, issues of self-esteem, anxiety and depression emerge prominently among the studies we’ve included in the context of substance use or aggressive behaviours for example, and this is in turn reflected in our synthesis.

Implications for future research

There have been few conceptually rich qualitative studies focused on how the school environment as defined in this review might influence student diet and sexual health and none have passed our exclusion criteria that focus specifically on physical activity and mental health. While there is a body of research related to these topics, particularly from the field of sociology of education, further qualitative work oriented towards public health is needed. The bias in the literature towards young people in the most disadvantaged and extreme environments reflect the sociological research and theory more broadly and future studies should explore a range of contexts in order to include more ‘ordinary kids’ [ 45 ] who still represent the ‘missing middle’ [ 47 ]. The refined theory of human functioning and school organisation presented here should also be examined via quantitative and qualitative research in differing contexts (e.g. religious, rural/sub-urban, high SES and alternative schools).

The synthesis suggests how the school environment might be transformed to promote student health in future intervention studies. First, schools may promote student safety and health by ensuring teachers spend more time with students outside the classroom and by giving students more ‘voice’ regarding how schools are run. Second, interventions such as enhanced supervision and monitoring of school spaces that are ‘hot spots’ for student risk behaviour might be the focus for intervention. Third, policies could be developed to improve the social aspects of school food environments and to ensure students feel safe eating in school dining places where healthy eating is being promoted, for example by creating aesthetically appealing food environments where teachers eat with students, and where students have sufficient time and space to eat, as well as take a break with friends. The design of these programmes should be co-produced with students themselves so as to ensure they are appropriate and acceptable. However, such interventions should be examined in randomised controlled trials before being scaled up.

In-depth qualitative studies suggest common pathways via which the school environment might shape young people’s health. Building on Markham and Aveyard’s [ 8 ] theory, our synthesis suggests that the student population not only reacts to the institutionally-directed instructional and regulatory ‘orders’, but is also an active agent in constituting its own instructional and regulatory structures. The separation of these two systems represents a lack of cooperative functioning, shared norms and understanding between students and the institutional ‘orders’; a condition most pervasive in urban contexts of disadvantage. In this context, students protect themselves and develop relationships by means of their own intervention: to build on Markham and Aveyard [ 8 ], the ways in which schools ‘order’ behaviour and learning indeed directly influences students’ reasoning, affiliation and ‘capacity’ for health but this is highly constrained, and not just by the organisation of the school, but also simultaneously by the organisation, norms and behaviours of the students themselves and their peers. The creative strategies students adopt also appear to produce a vicious circle whereby acting ‘tough’ or ‘escaping’ the school may lead to even more aggressive behaviours and higher rates of substance use, which in turn further reinforces and reproduces the boundaries between student-led and institutional social systems in new ways – an example of structuration in action.

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Acknowledgments

We would like to thank Val Hamilton, Carol Vigurs, Dr Rebecca Langford, Jeff Brunton, Sergio Graziosi, Dr Alison O’Mara-Eves, Zahida Suleman and Juan Daniel Kennedy for their contribution to the project.

This project is funded from a grant by the National Institute for Health Research Public Health Research Programme (grant 09/3002/08).

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute for Health Research Public Health Research Programme or the Department of Health.

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FJ conducted the review of qualitative research and led on the meta-ethnography synthesis. AF contributed to the design of the study and meta-ethnography synthesis. AH co-directed the project, contributed to planning the project and oversaw the meta-ethnography. HW contributed to screening and data extraction. JT advised on qualitative review methods, information management and commented on the report. CB conceived and directed the study, contributed to the meta-ethnography and commented on and contributed to the manuscript. The manuscript was drafted by FJ and AF. All authors read and approved the final manuscript.

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Jamal, F., Fletcher, A., Harden, A. et al. The school environment and student health: a systematic review and meta-ethnography of qualitative research. BMC Public Health 13 , 798 (2013). https://doi.org/10.1186/1471-2458-13-798

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School educational models and child mental health among K-12 students: a scoping review

1 The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030 China

Yining Jiang

Xiangrong guo.

2 MOE-Shanghai Key Laboratory of Children’s Environmental Health, Department of Child and Adolescent Healthcare, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China

Associated Data

The data analysed in this review are available from the corresponding author upon request.

The promotion of mental health among children and adolescents is a public health imperative worldwide, and schools have been proposed as the primary and targeted settings for mental health promotion for students in grades K-12. This review sought to provide a comprehensive understanding of key factors involved in models of school education contributing to student mental health development, interrelationships among these factors and the cross-cultural differences across nations and societies.

This scoping review followed the framework of Arksey and O’Malley and holistically reviewed the current evidence on the potential impacts of school-related factors or school-based interventions on student mental health in recent 5 years based on the PubMed, Web of Science, Embase and PsycExtra databases.

Results/findings

After screening 558 full-texts, this review contained a total of 197 original articles on school education and student mental health. Based on the five key factors (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) identified in student mental development according to thematic analyses, a multi-component school educational model integrating academic, social and physical factors was proposed so as to conceptualize the five school-based dimensions for K-12 students to promote student mental health development.

Conclusions

The lessons learned from previous studies indicate that developing multi-component school strategies to promote student mental health remains a major challenge. This review may help establish appropriate school educational models and call for a greater emphasis on advancement of student mental health in the K-12 school context among different nations or societies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13034-022-00469-8.

Introduction

In recent years, mental health conditions among children and adolescents have received considerable attention as a public health concern. Globally about 10–20% of children and adolescents experience mental health problems [ 1 , 2 ], and mental health problems in early life may have the potential for long-term adverse consequences [ 3 , 4 ]. In 2019, the World Health Organization has pointed out that childhood and adolescence are critical periods for the acquisition of socio-emotional capabilities and for prevention of mental health problems [ 5 ]. A comprehensive multi-level solution to child mental health problems needs to be put forward for the sake of a healthier lifestyle and environment for future generations.

The school is a unique resource to help children improve their mental health. A few generations ago, schools’ priority was to teach the traditional subjects, such as reading, writing, and arithmetic. However, children are now spending a large amount of time at school where they learn, play and socialize. For some students, schools have a positive influence on their mental health. While for others, schools can present as a considerable source of stress, worry, and unhappiness, and hinder academic achievement [ 2 ]. According to Greenberg et al., today’s schools need to teach beyond basic skills (such as reading, writing, and counting skills) and enhance students’ social-emotional competence, characters, health, and civic engagement [ 6 ]. Therefore, universal mental health promotion in school settings is recognized to be particularly effective in improving students’ emotional well-being [ 2 , 7 ].

Research evidence over the last two decades has shown that schools can make a difference to students’ mental health [ 8 ]. Previous related systematic reviews or meta-analyses focused on the effects of a particular school-based intervention on child mental health [ 9 , 10 ] and answered a specific question with available research, however, reviews covering different school-related factors or school-based interventions are still lacking. An appropriate model of school education requires the combination of different school-related factors (such as curriculum, homework, and physical activities) and therefore needs to focus on multiple primary outcomes. Thus, we consider that a scoping review may be more appropriate to help us synthesize the recent evidence than a systematic review or meta-analysis, as the wide coverage and the heterogeneous nature of related literature focusing on multiple primary outcomes are not amenable to a more precise systematic review or meta-analysis [ 11 ]. To the best of our knowledge, this review is among the first to provide a comprehensive overview of available evidence on the potential impacts of multiple school-related factors or school-based interventions on student mental health, and identify school-related risk/protective factors involved in the development of mental health problems among K-12 students, and therefore, to help develop a holistic model of K-12 education.

A scoping review was systematically conducted following the methodological framework of Arksey and O'Malley [ 12 ]: defining the research question; identifying relevant studies; study selection; data extraction; and summarizing and reporting results. The protocol for this review was specified in advance and submitted for registration in the PROSPERO database (Reference number, CRD42019123126).

Defining the research question (stage 1)

For this review, we sought to answer the following questions:

• What is known from the existing literature on the potential impacts of school-related factors or school-based interventions on student mental health?
• What are the interrelationships among these factors involved in the school educational process?
• What are the cross-cultural differences in K-12 education process across nations and societies?

Identifying relevant studies (stage 2)

The search was conducted in PubMed, Web of Science and Embase electronic databases, and the dates of the published articles included in the search were limited to the last 5 years until 23 March 2021. The PsycExtra database was also searched to identify relevant evidence in the grey literature [ 13 ]. In recent 5 years, mental disorders among children and adolescents have increased at an alarming rate [ 14 , 15 ] and relevant policies calling for a greater role of schools in promoting student mental health have been issued in different countries [ 16 – 18 ], making educational settings at the forefront of the prevention initiative globally. Therefore, limiting research source published in the past 5 years was pre-defined since these publications reflected the newest discoveries, theories, processes, or practices. Search terms were selected based on the eligibility criteria and outcomes of interest were described as follows (Additional file 1 : Table S1). The search strategy was peer-reviewed by the librarian of Shanghai Jiao Tong University School of Medicine.

Study selection (stage 3)

T.Y. and Y.J. independently identified relevant articles by screening the titles, reviewing the abstracts and full-text articles. If any disagreement arises, the disagreement shall be resolved by discussion between the two reviewers and a third reviewer (J. X.).

Inclusion criteria were (1) according to the study designs: only randomized controlled trials (RCT)/quasi-RCT, longitudinal and cross-sectional studies; (2) according to the languages: articles only published in English or Chinese; (3) according to the ages of the subjects: preschoolers (3.5–5 years of age), children (6–11 years of age) and adolescents (12–18 years of age); and (4) according to the study topics: only articles examining the associations between factors involved in the school education and student mental health outcomes (psychological distress, such as depression, anxiety, stress, self-injury, suicide; and/or psychological well-being, such as self-esteem, self-concept, self-efficacy, optimism and happiness) in educational settings. Exclusion criteria: (1) Conference abstracts, case report/series, and descriptive articles were excluded due to overall quality and reliability. (2) Studies investigating problems potentially on a causal pathway to mental health disorders but without close associations with school education models (such as problems probably caused by family backgrounds) were excluded. (3) Studies using schools as the recruitment places but without school-related topics were also excluded.

Data extraction (stage 4)

T.Y. and Y.J., and X.G., Y. Z., H.H. extracted data from the included studies using a pre-defined extraction sheet. Researchers extracted the following information from each eligible study: study background (name of the first author, publication year, and study location), sample characteristics (number of participants, ages of participants, and sex proportion), design [intervention (RCT or quasi-RCT), or observational (cross-sectional or longitudinal) study], and instruments used to assess exposures in school settings and mental health outcomes. For intervention studies (RCTs and quasi-RCTs), we also extracted weeks of intervention, descriptions of the program, duration and frequency. T.Y. reviewed all the data extraction sheets under the supervision of J. X.

Summarizing and reporting the results (stage 5)

Results were summarized and reported using a narrative synthesis approach. Studies were sorted according to (a) factors/exposures associated with child and adolescent mental health in educational settings, and (b) components of school-based interventions to facilitate student mental health development. Key findings from the studies were then compared, contrasted and synthesized to illuminate themes which appeared across multiple investigations.

Search results and characteristics of the included articles

The search yielded 25,338 citations, from which 558 were screened in full-text. Finally, a total of 197 original articles were included in this scoping review: 72 RCTs (including individually randomized and cluster-randomized trials), 27 quasi-RCTs, 29 longitudinal studies and 69 cross-sectional studies (Fig.  1 for details). Based on thematic analyses, the included studies were analyzed and thematically grouped into five overarching categories based on the common themes in the types of intervention programs or exposures in the school context: curriculum, homework and tests, interpersonal relationships, physical activity and after-school activities. Table ​ Table1 1 provided a numerical summary of the characteristics of the included articles. The 197 articles included data from 46 countries in total, covering 24 European countries, 13 Asian countries, 4 American countries, 3 African countries, and 2 Oceanian countries. Most intervention studies were conducted in the United States of America (n = 16), followed by Australia (n = 11) and the United Kingdom (n = 11). Most observational studies were conducted in the United States of America (n = 19), followed by China (n = 15) and Canada (n = 8). Figure  2 illustrated the geographical distribution of the included studies. Further detailed descriptions of the intervention studies or observational studies were provided in Additional file 1 : Tables S2 and S3, respectively.

Study selection process

Summary of the included articles

Geographical distribution of included studies: A intervention studies; B observational studies

The association between school curriculum and student mental health was investigated in four cross-sectional studies. Mathematics performance was found to be adversely associated with levels of anxiety or negative emotional responses among primary school students [ 19 ]. However, in middle schools, difficulties and stressors students may encounter in learning academic lessons (such as difficulties/stressors in taking notes and understanding teachers’ instructions) could contribute to lowered self-esteem [ 20 ] and increased suicidal ideation or attempts [ 21 ]. Innovative integration of different courses instead of the traditional approach of teaching biology, chemistry, and physics separately, could improve students’ self-concept [ 22 ].

To promote student mental health, 64 intervention studies were involved in innovative curricula integrating different types of competencies, including social emotional learning (SEL), mindfulness-intervention, cognitive behavioral therapy (CBT)-based curriculum, life skills training, stress management curriculum, and so on (Fig.  3 ). Curricula focusing on SEL put an emphasis on the development of child social-emotional skills such as managing emotions, coping skills and empathy [ 23 ], and showed positive effects on depression, anxiety, stress, negative affect and emotional problems [ 23 – 37 ], especially in children with psychological symptoms [ 24 ] and girls [ 23 , 27 ], as well as increased prosocial behaviors [ 38 ], self-esteem [ 39 – 42 ] and positive affect [ 43 ]. However, four programs reported non-significant effects of SEL on student mental health outcomes [ 44 – 47 ], while two programs demonstrated increased levels of anxiety [ 48 ] and a reduction of subjective well-being [ 49 ] at post-intervention. Mindfulness-based curriculum showed its potential to endorse positive outcomes for youth including reduced emotional problems and negative affect [ 50 – 56 ] as well as increased well-being and positive emotions [ 51 , 52 , 57 – 60 ], especially among high-risk children with emotional problems or perceived stress before interventions [ 50 , 53 ]. However, non-significant effects were also reported in an Australian study in secondary schools [ 61 ]. Curricula based on CBT targeted children at risk or with early symptoms of mental illness [ 62 – 67 ], or all students regardless of symptom levels as a universal program [ 68 – 70 ], and could impose a positive effect on self-esteem, well-being, distress, stress and suicidality. However, a universal CBT trial in Swedish primary schools found no evidence of long-term effects of such program on anxiety prevention [ 71 ]. Five intervention studies based on life-skill-training were found to be effective in promoting self-efficacy [ 72 , 73 ], self-esteem [ 73 , 74 ], and reducing depression/anxiety-like symptoms [ 72 , 75 , 76 ]. Courses covering stress management skills have also been reported to improve life satisfaction, increase happiness and decrease anxiety levels among students in developing countries [ 77 – 79 ]. In practice, innovative teaching forms such as the game play [ 67 , 80 , 81 ] and outdoor learning [ 82 , 83 ] embedded in the traditional classes could help address the mental health and social participation concerns for children and youth. Limited evidence supported the mental health benefits of resilience-based curricula [ 84 – 86 ], which deserve further studies.

Harvest plots for overview of curriculum-based intervention studies, grouped by different types of curriculum-based interventions. The height of the bars corresponded to the sample sizes on a logarithmic scale of each study. Red bars represented positive effects of interventions on student mental health outcomes, grey bars represented non-significant effects on student mental health outcomes, and black bars represented negative effects on student mental health outcomes

Large cluster-randomized trials utilizing multi-component whole-school interventions which involves various aspects of school life (curriculum, interpersonal relationships, activities), such as the Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) program in India and the Together at School program in Finland, have been proved to be beneficial for prevention from depression [ 87 – 89 ] and psychological problems [ 90 ].

Homework and tests

The association between homework and psychological ill-being outcomes was investigated in four cross-sectional studies and one longitudinal study. Incomplete homework and longer homework durations were associated with a higher risk of anxiety symptoms [ 91 , 92 ], negative emotions [ 93 – 95 ] and even psychological distress in adulthood [ 96 ].

Innumerable exams during the educational process starting from primary schools may lead to increased anxiety and depression levels [ 97 , 98 ], particularly among senior students preparing for college entrance examinations [ 99 ]. Students with higher test scores had a lower probability to have emotional and behavioral problems [ 100 ], in comparison with students who failed examinations [ 93 , 101 ]. Depression and test anxiety were found to be highly correlated [ 102 ]. In terms of psychological well-being outcomes, findings were consistent in the negative associations between student test anxiety and self-esteem/life-satisfaction levels [ 103 , 104 ]. Regarding intervention studies, adolescent students at a high risk of test anxiety benefited from CBT or attention training by strengthening sense of control and meta-cognitive beliefs [ 105 , 106 ]. However, more knowledge about the criteria for an upcoming test was not related to anxiety levels during lessons [ 107 ].

Interpersonal relationships

School-based interpersonal (student–student or student–teacher) relationships are also important to student mental health. Low support from schoolmates/teachers and negative interpersonal events were reported to be associated with psychosomatic health complaints [ 108 – 113 ]. In contrast, positive interpersonal relationships in schools could promote emotional well-being [ 114 – 117 ] and reduce depressive symptoms in students [ 118 – 120 ].

Student–teacher relationships

Negative teaching behaviors were associated with negative affect [ 121 , 122 ] and low self-efficacy [ 123 ] among primary and high school students. Student–teacher conflicts at the beginning of the school year were associated with higher anxiety levels in students at the end of the year, and high-achieving girls were most susceptible to such negative associations [ 124 ]. Higher levels of perceived teachers’ support were correlated with decreased risks of depression [ 125 ], mental health problems [ 126 ] as well as increased positive affect [ 127 , 128 ] and improved mental well-being [ 129 , 130 ]. Better student–teacher relationships were positively associated with self-esteem/efficacy [ 131 ], while negatively associated with the risks of adolescents’ externalizing behaviors [ 132 ] among secondary school students. Longitudinal studies demonstrated that high intimacy levels between students and teachers were correlated with reduced emotional symptoms [ 133 ] and increased life-satisfaction among students [ 134 ]. In addition, more respect to teachers in 10th grade students was associated with higher self-efficacy and lower stress levels 1 year later [ 135 ].

A growing body of research focused on the issue of how to increase positive interactions between teachers and students in teaching practices. Actually, interventions on improving teaching skills to promote a positive classroom atmosphere could potentially benefit children, especially those experiencing a moderate to high level of risks of mental health problems [ 136 , 137 ].

Student–student relationships

Findings were consistent in considering the positive peer relationship as a protective factor against internalizing and externalizing behaviors [ 138 – 142 ], depression [ 143 – 145 ], anxiety [ 146 ], self-harm [ 147 ] and suicide [ 148 ], and as a favorable factor for positive affect [ 149 , 150 ], increased happiness [ 151 ], self-efficacy [ 152 ], optimism [ 153 , 154 ] and mental well-being [ 155 ]. In contrast, peer-hassles, friendlessness, negative peer-beliefs, peer-conflicts/isolation and peer-rejection, have been identified in the development of psychological distress among students [ 141 , 143 , 149 , 156 – 165 ].

As schools and classrooms are common settings to build peer relationships, student social skills to enhance the student–student relationship can be incorporated into school education. Training of interpersonal skills among secondary school students with depressive symptoms appeared to be effective in decreasing adolescent internalizing and externalizing symptoms [ 166 ]. In addition, recent studies also identified the effectiveness of small-group learning activities in the cognitive development and mental health promotion among students [ 87 – 90 , 167 ].

Physical activity in school

Moderate-to-high-intensity physical activity during school days has been confirmed to benefit children and adolescents in relation to various psychosocial outcomes, such as reduced symptoms of depression [ 168 ], emotional problems [ 169 ] and mental distress [ 170 ] as well as improved self-efficacy [ 171 ] and mental well-being [ 172 , 173 ]. In addition, participation in physical education (PE) at least twice a week was significantly associated with a lower likelihood of suicidal ideation and stress [ 174 ].

A variety of school‐based physical activity interventions or lessons have been proposed in previous studies to promote physical activity levels and psychosocial fitness in students, including integrating physical activities into classroom settings [ 175 – 178 ], assigning physical activity homework [ 178 ], physically-active academic lessons [ 179 , 180 ] as well as an obligation of ensuring the participation of various kinds of sports (such as aerobic exercises, resistance exercises, yoga) in PE lessons [ 181 – 192 ]. Although the effectiveness of these proposed physical activity interventions was not consistent, physical education is suggested to implement sustainably as other academic courses with special attention.

After-school activities

Several cross-sectional studies have synthesized evidence on the positive effects of leisure-time physical activity against student depression, anxiety, stress, and psychological distress [ 193 – 199 ]. Extracurricular sport participation (such as sports, dance, and martial arts) could foster perceived self-efficacy, self-esteem, improve mental health status [ 200 – 203 ], and reduce emotional problems [ 204 ] and depressive symptoms [ 205 ]. Participation in team sports was more strongly related to beneficial mental health outcomes than individual sports, especially in high school girls [ 199 ]. Other forms of organized activities, such as youth organizations and arts, have also been demonstrated to benefit self-esteem [ 201 ], self-worth [ 206 ], satisfaction with life and optimism [ 207 , 208 ].

However, different types of after-school activities may result in different impacts on student mental health. Previous studies demonstrated that students participating in after-school programs of yoga or sports had better well-being and self-efficacy [ 209 ], and decreased levels of anxiety [ 210 ] and negative mood [ 211 ], while another study showed that the after-school yoga program induced no significant changes in levels of depression, anxiety and stress among students [ 212 ]. Inconsistent findings on the effects of participation in art activities on student mental health were also reported [ 213 , 214 ]. Another study also highlighted the benefits of after-school clubs, demonstrating an improvement in socio-emotional competencies and emotional status, and sustained effects at 12-month follow-up [ 215 ].

Based on the potential importance of the five school-based factors identified in student mental development, a multi-component school educational model is therefore proposed to conceptualize the five school-based dimensions (including curriculum, homework and tests, interpersonal relationships, physical activity, and after-school activities) for K-12 students to promote their mental health (Fig.  4 ). The interrelationships among the five dimensions and cross-cultural comparisons are further discussed as follows in a holistic way.

The multi-component school educational model is proposed to conceptualize the five school-based dimensions (including curriculum set, homework and tests, physical activity, interpersonal relationships and after-school activities) for K-12 students to promote student mental health

Comprehensive understanding of K-12 school educational models: the reciprocal relationships among factors

Students’ experiences in the school educational context are dynamic processes which englobe a variety of educational elements (such as curriculum, homework, tests) and social elements (such as interpersonal relationships and social activities in schools). Based on the educational model proposed in this review, these educational/social elements are closely related and interact with each other, which play an important role in students’ psychosocial development.

Being aware of this, initiatives aimed to improve student social and emotional competencies may certainly impact student psychological well-being, at least in part, in a way of developing supportive relationships between teachers-students or between peers [ 35 , 89 ]. On the other hand, the enhancement of interpersonal relationships at school could serve as a potent source of motivation for student academic progress so as to further promote psychological well-being [ 131 , 132 ]. In addition, school education reforms intended to provide pupils with more varied teaching and learning practices to promote supportive interpersonal relationships between students and teachers or between peers, such as education programs outside the classroom [ 82 ], cooperative learning [ 167 ] and adaptive classroom management [ 136 , 137 ], have also been advocated among nations recently.

Our findings also suggested that participation in non-academic activities was an important component of positive youth development. Actually, these school-based activities in different contexts also require teacher–student interactions or peer interactions. Social aspects of physical activities have been proposed to strengthen relationship-building and other interpersonal skills that may additionally protect students against the development of mental health problems [ 130 , 203 ]. Among various types of sports, team sports seemed to be associated with more beneficial outcomes compared with individual sports due to the social aspect of being part of a team [ 194 , 199 ]. Participation in music, student council, and other clubs/organizations may also provide students with frequent connections with peers, and opportunities to build relationships with others that share similar interests [ 201 ]. Further, frequent and supportive interactions with teachers and peers in sports and clubs may promote student positive views of the self and encourage their health-promoting behaviors (such as physical activities).

However, due to increasing academic pressure, children have to spend a large amount of time on academic studies, and inevitably displace time on sleep, leisure, exercises/sports, and extracurricular activities [ 92 ]. Although the right amount of homework may improve school achievements [ 216 ] and higher test scores may help prevent students from mental distress [ 100 – 102 ], over-emphasis on academic achivements may lead to elevated stress levels and poor health outcomes ultimately. The anxiety specifically related to academic achievement and test-taking at school was frequently reported among students who felt pressured and overwhelmed by the continuous evaluation of their academic performance [ 98 , 103 , 104 ]. In such high-pressure academic environments, strategies to alleviate the levels of stress among students should be incorporated into intervention efforts, such as stress management skill training [ 77 – 79 ], CBT-based curriculum [ 62 , 64 , 66 , 105 ], and attention training [ 106 ]. Therefore, school supportive policies that allow students continued access to various non-academic activities as well as improve their social aspect of participation may be one fruitful avenue to promote student well-being.

Cross-cultural differences in K-12 educational models among different nations and societies

As we reviewed above, heavy academic burden exists as an important school-related stressor for students [ 91 , 92 , 94 – 96 ], probably due to excessive examinations [ 97 – 99 ] and unsatisfactory academic performance [ 100 – 102 ]. Actually, extrinsic cultural factors significantly impact upon student academic burden. In most countries, college admission policies affect the entire ecological system of K-12 education, because success in life or careers is determined by examination performance to a large extent [ 217 ]. The impacts of heavy academic burden may be greatest in Asian cultures where more after-school time of students is spent on homework, exam preparations, and extracurricular classes for academic improvement (such as in Korea, Japan, China and Singapore) [ 92 , 95 , 218 ]. As a consequence, the high proportion of adolescents fall in the “academic burnout group” in Asian countries [ 219 ], which highlights the need to take further measures to combat the issue. As an issue of concern, the “double reduction” policy has been implemented nationwide in China since 2021, being aimed to relieve students of excessive study burden, and the effects of the policy are anticipated but remain unknown up to now.

Other factors such as school curriculum and extra-curricular commitments, vary among societies and nations and may explain the cross-cultural differences in educational models [ 220 ]. For example, in Finland, the primary science subject is as important as mathematics or reading, while Chinese schools often lack time to arrange a sufficient number of science courses [ 221 ], which could be explained by different educational traditions of the two countries. In addition, approximately 75% of high schools in Korea failed to implement national curriculum guidelines for physical education (150 min/week), instead replacing that time with self-guided study to prepare for university admission exams [ 174 ]. In terms of the arrangement of the after-school time, Asian students spend most of their after-school time on private tutoring or doing homework [ 222 ], 2–3 times longer than the time spent by adolescents in most western countries/cities [ 92 ]. However, according to our analyses and summaries, most intervention studies targeting the improvement of mental health of students by school education were conducted in western countries (Fig.  2 ), suggesting that special attention needs to be paid to the students’ mental health issue on campus, especially in countries where students have heavy study-loads. Merits of the different educational traditions also need to be considered in the designs of educational models among different countries.

Strengths and limitations

This study focuses on an interdisciplinary topic covering the fields of developmental behavioral pediatrics and education, and the establishment of appropriate school educational models is teamwork involving multiple disciplines including pediatrics, prevention, education, services and policy. Although there are lots of studies focusing on a particular factor in school educational processes to promote student mental health, comprehensive analysis/understanding on multi-component educational model is lacking, which is important and urgently needed for the development of multi-dimensional educational models/strategies. Therefore, we included a wide range of related studies, summarized a comprehensive understanding of the evidence base, and discussed the interrelationships among the components/factors of school educational models and the cross-cultural gaps in K-12 education across different societies, which may have significant implications for future policy-making.

Some limitations also exist and are worth noting. First, this review used the method of the scoping review which adopted a descriptive approach, rather than the meta-analysis or systematic review which provided a rigorous method of synthesizing the literature. Under the subject (appropriate school education model among K-12 students) of this scoping review, multiple related topics (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) were included rather than one specific topic. Therefore, we consider that the method of the scoping-review is appropriate, given that the aim of this review is to chart or map the available literature on a given subject rather than answering a specific question by providing effect sizes across multiple studies. Second, we limited the study search within recent 5 years. Although we consider that the fields involved in this scoping review change quickly with the acquisition of new knowledge/information in recent 5 years, limiting the literature search within recent 5 years may make us miss some related but relatively old literature. Third, we only included studies disseminated in English or Chinese, which may limit the generalizability of our results to other non-English/Chinese speaking countries.

This scoping review has revealed that the K-12 schools are unique settings where almost all the children and adolescents can be reached, and through which existing educational components (such as curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) can be leveraged and integrated to form a holistic model of school education, and therefore to promote student mental health. In future, the school may be considered as an ideal setting to implement school-based mental health interventions. Our review suggests the need of comprehensive multi-component educational model, which involves academic, social and physical factors, to be established to improve student academic achievement and simultaneously maintain their mental health.

However, questions still remain as to what is optimal integration of various educational components to form the best model of school education, and how to promote the wide application of the appropriate school educational model. Individual differences among students/schools and cross-cultural differences may need to be considered in the model design process.

Acknowledgements

We thank the librarian of Shanghai Jiao Tong University School of Medicine for their help.

Abbreviations

Author contributions

JX conceived the scoping review, supervised the review process and reviewed the manuscript. TY conducted study selection and data extraction, charted, synthesized the data, and drafted the manuscript. YJ conducted study selection and data extraction. XG, YZ and HH conducted data extraction. All authors read and approved the final manuscript.

This study was supported by the National Natural Science Foundation of China (NSFC, 81974486, 81673189) (to Jian Xu), Shanghai Jiao Tong University School of Medicine Gaofeng Clinical Medicine Grant Support (20172016) (to Jian Xu), Shanghai Sailing Program (21YF1451500) (to Hui Hua).

Availability of data and materials

Declarations.

Not applicable.

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

How to Write a Research Proposal Paper

Table of Contents

What is a research proposal paper, why write a research proposal paper.

• How to Plan a Research Proposal Paper

Components of a Research Proposal Paper

Research proposal examples, help & additional resources, this resource page will help you:.

• Learn what a research proposal paper is.  
• Understand the importance of writing a research proposal paper. 
• Understand the steps in the planning stages of a research proposal paper.  
• Identify the components of a research proposal paper.  

A research proposal paper:   

• includes sufficient information about a research study that you propose to conduct for your thesis (e.g., in an MT, MA, or Ph.D. program) or that you imagine conducting (e.g., in an MEd program). It should help your readers understand the scope, validity, and significance of your proposed study.  
• may be a stand-alone paper or one part of a larger research project, depending on the nature of your assignment. 
• typically follows the citation format of your field, which at OISE is APA .    

Your instructor will provide you with assignment details that can help you determine how much information to include in your research proposal, so you should carefully check your course outline and assignment instructions.  

Writing a research proposal allows you to  

• develop skills in designing a comprehensive research study; 

learn how to identify a research problem that can contribute to advancing knowledge in your field of interest; 

further develop skills in finding foundational and relevant literature related to your topic; 

critically review, examine, and consider the use of different methods for gathering and analyzing data related to the research problem;  

see yourself as an active participant in conducting research in your field of study. 

Writing a research proposal paper can help clarify questions you may have before designing your research study. It is helpful to get feedback on your research proposal and edit your work to be able to see what you may need to change in your proposal. The more diverse opinions you receive on your proposal, the better prepared you will be to design a comprehensive research study. 

How to Plan your Research Proposal

Before starting your research proposal, you should clarify your ideas and make a plan. Ask yourself these questions and take notes:  

What do I want to study? 

Why is the topic important? Why is it important to me? 

How is the topic significant within the subject areas covered in my class? 

What problems will it help solve? 

How does it build on research already conducted on the topic? 

What exactly should I plan to do to conduct a study on the topic? 

It may be helpful to write down your answers to these questions and use them to tell a story about your chosen topic to your classmates or instructor. As you tell your story, write down comments or questions from your listeners. This will help you refine your proposal and research questions. 

This is an example of how to start planning and thinking about your research proposal assignment. You will find a student’s notes and ideas about their research proposal topic - "Perspectives on Textual Production, Student Collaboration, and Social Networking Sites”. This example is hyperlinked in the following Resource Page: 

A research proposal paper typically includes: 

• an introduction  
• a theoretical framework 
• a literature review 
• the methodology  
• the implications of the proposed study and conclusion 
• references 

Start your introduction by giving the reader an overview of your study. Include:  

• the research context (in what educational settings do you plan to conduct this study?) 
• the research problem, purpose (What do you want to achieve by conducting this study?) 
• a brief overview of the literature on your topic and the gap your study hopes to fill 
•  research questions and sub-questions 
• a brief mention of your research method (How do you plan to collect and analyze your data?) 
• your personal interest in the topic. 

 Conclude your introduction by giving your reader a roadmap of your proposal. 

 To learn more about paper introductions, check How to write Introductions .  

A theoretical framework refers to the theories that you will use to interpret both your own data and the literature that has come before. Think about theories as lenses that help you look at your data from different perspectives, beyond just your own personal perspective. Think about the theories that you have come across in your courses or readings that could apply to your research topic. When writing the theoretical framework, include 

• A description of where the theories come from (original thinkers), their key components, and how they have developed over time. 
• How you plan to use the theories in your study / how they apply to your topic. 

The literature review section should help you identify topics or issues that will help contextualize what the research has/hasn’t found and discussed on the topic so far and convince your reader that your proposed study is important. This is where you can go into more detail on the gap that your study hopes to fill. Ultimately, a good literature review helps your reader learn more about the topic that you have chosen to study and what still needs to be researched 

To learn more about literature reviews check What is a Literature Review . 

The methods section should briefly explain how you plan to conduct your study and why you have chosen a particular method. You may also include  

• your overall study design (quantitative, qualitative, mixed methods) and the proposed stages 
• your proposed research instruments (e.g. surveys, interviews)  
• your proposed participant recruitment channels / document selection criteria 
• a description of your proposed study participants (age, gender, etc.). 
• how you plan to analyze the data.  

You should cite relevant literature on research methods to support your choices. 

The conclusion section should include a short summary about the implications and significance of your proposed study by explaining how the possible findings may change the ways educators and/or stakeholders address the issues identified in your introduction. 

Depending on the assignment instructions, the conclusion can also highlight next steps and a timeline for the research process. 

To learn more about paper conclusions, check How to write Conclusions . 

List all references you used and format them according to APA style. Make sure that everything in your reference list is cited in the paper, and every citation in your paper is in your reference list.  

To learn more about writing citations and references, check Citations & APA . 

These are detailed guidelines on how to prepare a quantitative research proposal. Adapted from the course APD2293 “Interpretation of Educational Research”. These guidelines are hyperlinked in the following Resource Page:  

Related Resource Pages on ASH

• What is a Literature Review?
• How to Prepare a Literature Review
• How to Understand & Plan Assignments
• Citations and APA Style
• How to Integrate Others' Research into your Writing
• How to Write Introductions
• How to Write Conclusions

Additional Resources

• Writing a research proposal– University of Southern California   
• Owl Purdue-Graduate-Specific Genres-Purdue University  
• 10 Tips for Writing a research proposal – McGill University  

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