School Absenteeism Surveillance Program: Evaluation...
Transcript of School Absenteeism Surveillance Program: Evaluation...
2012
Wellington-Dufferin-Guelph Public Health
Health Analytics, Melissa Horan
School Absenteeism Surveillance Program: Evaluation Report
School Health Absenteeism Program Evaluation Report Page 2
ACKNOWLEDGEMENTS
Authors
Lead Author
Melissa Horan Health Promotion Specialist, WDGPH
Dr. Lise Trotz-Williams Epidemiologist, WDGPH
Contributors
Mai Miner Program Assistant, WDGPH
Wellington-Dufferin-Guelph Public Health would like to thank our school board partners from the Upper
Grand District School Board and the Wellington Catholic District School Board for their permission to
conduct this work and for their help implementing this evaluation.
We would also like to thank the office coordinators and principals for their responses to this evaluation
and for the time they provide to supply information to the school absenteeism surveillance program.
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TABLE OF CONTENTS ACKNOWLEDGEMENTS .................................................................................................................................................. 2
TABLE OF CONTENTS ..................................................................................................................................................... 3
EXECUTIVE SUMMARY ................................................................................................................................................... 4
Evaluation Description .............................................................................................................................................. 4
Recommendations .................................................................................................................................................... 4
Next Steps ................................................................................................................................................................. 5
INTRODUCTION ............................................................................................................................................................. 6
Program History ........................................................................................................................................................ 6
Description of the School Health Monitoring System ............................................................................................... 7
School Orientation and Communication with Schools .............................................................................................. 7
EVALUATION OBJECTIVES AND METHODOLOGY ........................................................................................................... 8
SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM EVALUATION RESULTS ................................................................ 10
CHARACTERISTICS OF RESPONDENTS ..................................................................................................................... 10
PARTICIPATING SCHOOLS ................................................................................................................................... 10
NON-PARTICIPATING SCHOOLS .......................................................................................................................... 11
SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: PARTICIPATING SCHOOLS .................................... 12
SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: NON-PARTICIPATING SCHOOLS ........................... 19
KEY FINDINGS AND CONCLUSIONS .............................................................................................................................. 23
WEB-FORM .............................................................................................................................................................. 23
Recommendation #1 ........................................................................................................................................... 23
Recommendation #2 ........................................................................................................................................... 23
PROGRAM EMAILS, PHONE CALLS, AND YEAR-END REPORTS ................................................................................ 23
Recommendation #3 ........................................................................................................................................... 24
Recommendation #4 ........................................................................................................................................... 24
Recommendation #5 ........................................................................................................................................... 24
PROGRAM OVERALL ................................................................................................................................................ 24
Recommendation #6 ........................................................................................................................................... 24
Recommendation #7 ........................................................................................................................................... 24
TIME REQUIRED FOR PARTICIPATION IN THE PROGRAM ....................................................................................... 25
Recommendation #8 ........................................................................................................................................... 25
ADDITIONAL ANALYSIS ............................................................................................................................................ 25
Recommendation #9 ........................................................................................................................................... 25
NEXT STEPS .................................................................................................................................................................. 25
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EXECUTIVE SUMMARY
Evaluation Description In winter of 2012, Wellington-Dufferin-Guelph Public Health conducted an evaluation of its School
Absenteeism Surveillance Program of secondary and elementary schools in both the Upper Grand
District School Board and the Wellington Catholic District School Board.
The goals of the school absenteeism surveillance program are:
To monitor and collect information about illness in the community, using school absenteeism as
a possible early indicator of illness in school-aged children in order to improve early detection of
outbreaks before they reach their peak level of infection (“syndromic surveillance”).
To utilize the information collected to identify unusual trends or clusters of illness within the
community, including enteric and/or respiratory illnesses.
To utilize school absenteeism data to target prevention strategies (i.e. proper coughing and
hand washing practices) and/or deploy treatment resources.
The goal of the evaluation was to answer the question “How can the delivery of Wellington-Dufferin-
Guelph Public Health’s School Absenteeism Surveillance Program be improved to better serve the needs
of schools and Wellington-Dufferin-Guelph Public Health (WDGPH)?”
To accomplish this goal, two separate surveys were designed for participating and non-participating
schools using Fluid Surveys software. Participants in the survey self-identified whether they belonged to
a participating or non-participating school and filled out the corresponding survey.
Recommendations As a result of analysis of the survey responses Public Health will consider implementing the following
changes to the program:
Public Health will investigate how to make the response emails and phone calls, and the year-
end report, more helpful to schools.
At the beginning of the 2012-2013 school year, principals will be asked to indicate whether they
would like to receive a customized report on their school’s attendance at the end of the school
year. Public Health will provide these reports based on interest.
Public Health will review their response protocol for the program to ensure that:
o The submitted data on illness from schools are closely examined prior to the
distribution of emails to schools with reported absenteeism rates of 10% or over. If a
school has indicated that most of their absenteeism is not due to illness, but rather class
trips or vacations, Public Health will not send the school an email.
o No more than one email a week is sent to a school with repeated daily absenteeism
rates of 10%.
Public Health will consider providing school boards, office coordinators and principals with more
information on syndromic surveillance and its importance in disease prevention. To make the
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program more meaningful to schools, it may also be helpful to share any success stories that the
system has had to date in local schools, or examples of successes from other syndromic
surveillance systems in schools.
Since principals and office coordinators change schools frequently, it is important to inform
schools about the program and the processes involved on an annual basis. In order to ensure
that this is done, Public Health will consider sending the end-of-year reports directly to
principals of participating schools.
Public Health may contact schools that have ceased participation in the program to help
determine how to better support office coordinators with respect to the time required to
participate in the program.
To meet the needs of an effective syndromic surveillance system and to respect the time of
school office coordinators, Public Health will discuss the feasibility of making the following
changes to the web-form used for absenteeism reporting:
o Introducing an autofill function for the ‘total school population’ field
o Adding a field or fields that will allow schools to indicate whether increased
absenteeism is mainly due to illness or not, to the current optional fields reporting exact
number of students absent due to gastrointestinal, respiratory, and other illness.
o Removing the section on the web-form that asks office coordinators to report on staff
illnesses. Office coordinators have indicated that it is difficult to gather the reasons for
staff illness. Because of this and the low numbers of staff compared to students in
schools, it is difficult to use the numbers of staff absent for the purpose of syndromic
surveillance.
Next Steps Public Health also intends to take the following next steps:
Public Health will share the results of the evaluation with external stakeholders, including
the Upper Grand District School Board and the Wellington-Catholic District School Board
and principals and office coordinators from both school boards.
Public Health will share the results of the evaluation with relevant internal staff.
Public Health will, in consultation with the School Boards, and if feasible, implement the
changes listed above prior to or during the 2012-2013 school year.
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INTRODUCTION
In winter, 2012, Wellington-Dufferin-Guelph Public Health conducted an evaluation of its School
Absenteeism Surveillance Program of secondary and elementary schools in both the Upper Grand
District School Board and the Wellington Catholic District School Board.
The goals of the school absenteeism surveillance program are:
To monitor and collect information about illness in the community, using school absenteeism as
a possible early indicator of illness in school-aged children, in order to improve early detection
of outbreaks before they reach their peak level of infection.
To utilize the information collected to identify unusual trends or clusters of illness within the
community, including enteric and/or respiratory illnesses.
To utilize school absenteeism data to target prevention strategies (i.e. proper coughing and
hand washing practices) and/or deploy treatment resources.
Program History Figure 1. A Historical Timelines of the School Absenteeism Surveillance Program
School Absenteeism Surveillance Program Timeline
Abbreviations WDGPH Wellington-Dufferin-Guelph Public Health UGDSB Upper Grand District School Board
WCDSB Wellington Catholic District School Board MOHLTC Ministry of Health and Long-Term Care
2002 2008
2002
2004
2002
2006
2002
2010
2002
2012 2002
2014 2002
SARS Outbreak Occurs
which resulted in the
recognition of a need
for increased
surveillance, including
early warning
systems. (2003)
(2003)
WDGPH pilots a Syndromic Surveillance
Project. 15 elementary schools from
UGDSB participate.
(January, 2008)
After the H1N1
pandemic,
participation in
the program
declines from
both school
boards, leaving
only 38 schools
from both school
boards
participating.
(2011)
WDGPH initiates an
evaluation to give schools
an opportunity to provide
feedback and suggest how
to make the program more
user-friendly.
(2012)
H1N1 Outbreak occurs. MOHLTC requests school absenteeism
data weekly from Public Health. WDGPH expands the Sentinel
Elementary School Health Monitoring Project. (Fall 2009)
67 UGDSB and 14 WCDSB schools participate in the newly
named School Absenteeism Surveillance Program in the 2009-
2010 school year. (Fall 2009 - 2010)
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Description of the School Health Monitoring System Submission of absenteeism data by schools is done via a secure customized web form created by the
WDG Information Technology (IT) department. Upon submission, data from the schools is automatically
saved in a secure, Microsoft Access database.
Required fields on the form include:
Name of School
Total Student Population
Report Date
Completed by
Number of students absent due to all causes
Total number of staff expected
Number of staff absent
Optional fields include:
Number of students absent due to illness only
Number of students ill with mainly respiratory symptoms (e.g. fever, cough, runny nose, sore
throat)
Number of students ill with mainly gastrointestinal symptoms (e.g. diarrhea, vomiting, stomach
cramps)
Number of students ill with other symptoms or symptoms not reported (e.g. malaise, lethargy,
anything that does not fit into above categories)
The same database that was created for the pilot project was used for the expanded surveillance
system. The optional fields were created for the pilot project so the Health Unit could differentiate
between absenteeism due to symptoms of respiratory or enteric illness, and absence due to other
illnesses or reasons. However, when the expansion of the program occurred, the decision was made
that schools would only be asked to report on all cause absenteeism (i.e. absences for any reason) for
both students and teachers, to limit the time required by school staff to collate and submit the
information. However, many of the pilot schools and some other schools continue to report numbers
absent broken down by illness/other, and by syndrome (enteric vs. respiratory).
School Orientation and Communication with Schools In general, school office coordinators are responsible for collating student absenteeism information and
submitting it to the secure web form daily. Upon joining the program, schools are provided with an
orientation package that includes the following:
Access to the secure web-form to report absenteeism to Public Health
Hands on familiarization with the web form for data submission
A data-sharing agreement form to establish the commitment of the school and the specific
office coordinator-public health unit liaison
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Summary reports of school absenteeism provided to the Upper Grand District School Board and
the Wellington-Catholic School Board at the end of the school year.
In addition, schools who wish to submit absenteeism information broken down by syndrome are
provided with:
A newsletter article for parents to familiarize them with the need to report their children’s
symptoms when reporting their absence for the day and to notify parents that the privacy of
their children would be protected
Voice mail script for the automated prompt message on the absenteeism reporting phone line
of each school to enhance the practice among parents of reporting their child’s symptoms
The database is then monitored daily by a public health unit program assistant. If more than 10% of
students from a school are absent, the program assistant sends the school principal and office
coordinator an alert email, asking the school to contact Public Health if the increased absenteeism is
related to illness. A list of schools with absenteeism rates over 10% is send daily by the program
assistant to the Control of Infectious Diseases team at Public Health. If over 20% of students are
absent at a school, a Public Health Nurse calls the school to investigate the alert, and may suggest
infection control measures to prevent illness.
At the end of each school year, a summary report is prepared for schools of each school board. This
report is sent to participating school boards, as well as principals and office coordinators of participating
schools. Individual school absenteeism data summaries are also made available to schools on request.
EVALUATION OBJECTIVES AND METHODOLOGY
The goal of the evaluation was to answer the question “How can the delivery of Wellington-Dufferin-
Guelph Public Health’s School Absenteeism Surveillance Program be improved to better serve the needs
of schools and Wellington-Dufferin-Guelph Public Health (WDGPH)?”
Based on this evaluation goal, several objectives were created. These objectives included:
To determine the perceived benefits and challenges of participating in the program
To determine the helpfulness and usefulness of the program’s features
To determine how Public Health can improve the program to better support schools
To identify any program processes that either support or impede involvement in the program
To gather feedback from both principals and office coordinators.
To gather feedback from both schools that participate in the program and schools that stopped
participating in the program.
To make changes to the program based on evaluation feedback
To accomplish these goals and objectives, two separate surveys were designed for participating and
non-participating schools using Fluid Surveys software. Survey participants self-identified whether they
belonged to a participating or non-participating school, and filled out the corresponding survey. Before
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being launched, draft copies of both surveys were submitted to both the Upper Grand District School
Board and the Wellington Catholic District School Board for approval. The surveys were pre-tested by
five Health Promotion Specialists, one Epidemiologist, a Public Health Inspector and an Office
Coordinator from the Upper Grand District School Board to ensure the questions were understandable,
had face validity and could be accessed in the school environment. Following approval and pretesting,
the Upper Grand District School Board posted both surveys on the School Board’s conference systems
for principals and office coordinators, while Public Health emailed the surveys directly to principals from
the Wellington Catholic District School Board.
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SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM EVALUATION
RESULTS
CHARACTERISTICS OF RESPONDENTS
PARTICIPATING SCHOOLS
For a school to be considered to be participating, Wellington-Dufferin-Guelph Public Health must have
received at least one data submission for the school absenteeism surveillance program, in the fall of
2011. Fifty-three schools from both the Upper Grand District School Board and the Wellington Catholic
District School Board met this
criterion. Assuming each
school has one principal and
one office coordinator that
contributes to the program,
the total number of responses
that could have been received
was 106. Thirty one responses
were received from both
principals and office
coordinators, which amounts
to a response rate of 29%.
For the survey of the
participating schools, the
majority of responses were received from elementary school office coordinators. Twenty-seven (87%)
of the 31 total responses were
from office coordinators, while
4 (13%) were from principals.
Of the surveys from office
coordinators, 85% were from
elementary schools and 15%
were from secondary schools.
Of the surveys received from
principals, 100% were from
elementary schools. (See Figure
2).
From the participating school
responses, 27 (87%) were from
the Upper Grand District
School Board (UGDSB) and 4
23 (85%)
4 (15)
27 (100%)
4 (100%) 0 (0%)
4 (100%)
27 (87%)
4 (13%)
31 (100%)
0
5
10
15
20
25
30
35
Off
ice
Co
ord
inat
ors
Pri
nci
pal
s
Tota
l
Off
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Co
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inat
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Pri
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pal
s
Tota
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Off
ice
Co
ord
inat
ors
Pri
nci
pal
s
Tota
l
Elementary School Respondents
Secondary School Respondents
Total Respondents
# o
f re
spo
nd
en
ts
Figure 2. Participating Schools:Number of Survey Respondents by School Type and Job Title
23
4
27
4
0
4
27
4
31
0
5
10
15
20
25
30
35
UGDSB WCDSB Total UGDSB WCDSB Total UGDSB WCDSB Total
Office Coordinator Responses
Principal Responses Total Responses
# o
f re
spo
nd
en
ts
Figure 3. Participating Schools: Number of Survey Respondents by School Board and Job Title
School Health Absenteeism Program Evaluation Report Page 11
(13%) were from the Wellington Catholic District School Board (WCDSB). All four of the respondents
from the Wellington Catholic District School Board were office coordinators, thus all feedback received
from principals will reflect the views of Upper Grand District School Board Principals only. (See Figure 3).
Concerning the length of time involved with the program, the majority of respondents 19 (62%) had
been involved with the program for over 2 years. Nine (29%) had been involved with the program for 1-
2 years and 3 (10%) had been involved for 6 months to 1 year.
NON-PARTICIPATING SCHOOLS
If Wellington-Dufferin-Guelph
Public Health has not received
a data submission to the school
absenteeism surveillance
program in the fall of 2011, the
school was considered to be
non-participating. Forty-one
schools from both the Upper
Grand District School Board
and the Wellington-Catholic
District School Board met this
criterion. Assuming each
school has one principal and
one office coordinator, the
total number of responses that
could have been received was
82. Seventeen responses were
received from both principals
and office coordinators, which
amounts to a response rate of
21%.
For the survey of the non-
participating schools, 16 (94%)
of the 17 total respondents
were office coordinators. Of
these 16 respondents, 14 (88%)
were from elementary schools and 2 (12%) were from secondary school. The one principal that
responded (6% of total respondents) was from an elementary school. (See Figure 4).
From the non-participating school responses, the majority, 16 (94%), were from the Upper Grand
District School Board. Of these responses, 15 (94%) were from office coordinators and 1 (6%) was from
a principal. The one (6%) response from the Wellington Catholic District School Board was from an
office coordinator. Additionally, when asked if the school currently participated in the program, 2
2 (12%)
12 (70%)
3 (18%)
0
5
10
15
Yes No No response
# o
f re
spo
nd
en
ts
Figure 5. Current Participation in the School Health Absenteeism Program, from Non-Participating Schools
14 (93%)
1 (7%)
15 (100%)
2 (100%) 0
2 (100%)
16 (94%)
1 (6%)
17 (100%)
0 2 4 6 8
10 12 14 16 18
Off
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Co
ord
inat
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Pri
nci
pal
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Tota
l
Off
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Co
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inat
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Tota
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Off
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inat
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Pri
nci
pal
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Tota
l
Elementary School Respondents
Secondary School Respondents Total Respondents
# o
f re
spo
nd
en
ts
Figure 4. Non-Participating Schools: Number of Survey Respondents by School Type and Job Title
School Health Absenteeism Program Evaluation Report Page 12
indicated they do currently participate. (See Figure 5), and one of these responses was from a principal.
Thus, their responses were excluded from the analysis, leaving 15 responses to analyze from office
coordinators only. Of the 15 responses, the majority 12 (80%) had participated in the program
previously. 3 (20%) were not sure if they had.
SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: PARTICIPATING
SCHOOLS Question: The time it takes to participate in the program is acceptable.
Eighty-five percent of all respondents from participating schools either agreed or strongly agreed that
the length of time required to participate in the program is acceptable.
Question: How easy is it to log into the program’s web-form? How easy is it to complete the
program’s web-form?
Ninety-six percent of office coordinators indicated that logging into the web-form was either easy or
very easy. 100% responded that completing the web-form was easy or very easy and that none of the
questions on the web-form were easy to understand.
0 1 0
10
16
0 0 0
12
15
0
5
10
15
20
not at all easy
not easy neutral easy very easy
# o
f re
spo
nse
s
level of agreement
Ease of logging into and ease of completing the program's web-form, level of agreement for participating schools
Ease of logging into the web-form
Ease of completing the web-form
0% 7%
0%
48% 37%
0%
20%
40%
60%
strongly disagree
disagree neutral agree strongly agree % o
f re
spo
nd
en
ts
response
Participating Schools Question: Is the time required to participate in the
program acceptable?
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Question: Have you received an email from Public Health for having an absenteeism rate greater than
10%? Have you received a call from a Public Health Nurse or Public Health Inspector for having a
school absenteeism rate of greater than 20%? Have you received a copy of Public Health’s year-end
report on the School Absenteeism Surveillance Program?
Of the total sample of principals and office coordinators, the majority 23 (74%) recalled receiving an
email from Public Health. However, most of the respondents had not received a phone call from Public
Health for having an absenteeism rate over 20%. The majority 23 (74%) of respondents either did not
know or had not received a copy of the year-end report 27 (87%).
Question: Are the emails you received from Public Health when your school had an absenteeism rate
of greater than 10% helpful? Are the phone call(s) you received from Public Health when your school
had an absenteeism rate of greater than 20% helpful? Have you received a copy of Public Health’s
year-end report on the School Absenteeism Surveillance Program?
Seven (30%) of all respondents either strongly disagreed or disagreed that the emails were helpful and
an additional 10 (43%) were neutral. The majority of respondents 5 (80%) were neutral on the
helpfulness of the phone calls. Of the 4 possible respondents to the question on the helpfulness of the
year-end reports, 3 (75%) were neutral and 1 (25%) agreed. However, the responses to the questions
on the phone calls and year-end reports must be interpreted with caution, as the sample size was very
small.
23
6 2
5
23
3 4
15 12
0
5
10
15
20
25
Yes No I don't know
# o
f re
spo
nse
s
response options
Respondents from participating school that had received emails, phone calls and year-end reports from Public Health
# Receiving Email from Public Health
# Receiving Phone Call from Public Health # Receiving Year-end Report from Public Health
3 4
10
6
0 0 0
4
1 0 0 0
3 1 0
0
5
10
15
strongly disagree
disagree neutral agree strongly agree
# o
f re
spo
nse
s
Level of Agreement
Level of Agreement on the Helpfulness of Public Health's
Emails, Phone Calls and Year-end Reports, from Participating Schools
The Emails were helpful
The Phone Calls were Helpful
The Year-end Reports were Helpful
School Health Absenteeism Program Evaluation Report Page 14
Question: The number of emails I receive from Public Health for the program are:
The majority of survey participants agreed that the number of emails received from Public Health was
‘just right’ 27 (90%).
Question: Would you be interested in receiving a separate year-end report on your specific school’s
absenteeism trends?
The majority of office coordinators 20 (74%) were not interested in receiving a separate year-end report
while half of principals were interested.
0 3 (10%)
27 (90%)
0
5
10
15
20
25
30
not enough too many just right
# o
f re
pso
nse
s
Level of Agreement
Acceptability of the Frequency of Emails from Public Health, from Participating Schools
7 (23%)
20 (65%)
2 (50%) 2(50%)
9 (29%)
22 (71%)
0
5
10
15
20
25
Yes No Yes No Yes No
Office Coordinators Principals Total
# o
f re
spo
nd
en
ts
Interest in receiving year-end report customized to the individual school level, participating schools
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Question: On a scale of 1 to 5, please select your response to the following statement: “Preventing
disease at my school is important.”
Thirty-one (100%) respondents either agreed or strongly agreed that preventing disease in schools is
important.
Question: On a scale of 1 to 5, please select your response to the following statement: “Participating
in the School Absenteeism Surveillance Program could prevent disease at my school.”
Two (6%) respondents either agreed or strongly agreed that participating in the program helps prevent
diseases in schools, and 14 (45%) respondents were neutral.
4
9
13
1 0 0
2 1 1
0
4
11
14
2
0 0
2
4
6
8
10
12
14
16
strongly disagree
disagree neutral agree strongly agree
# o
f re
spo
nse
s
Level of agreement
Level of Agreement with the Statement "Participating in the Program Helps Prevent
Diseases in Schools."
Office Coordinators
Principals
Total
0 0 0
15
12
0 0 0 1 3
0
5
10
15
20
strongly disagree
disagree neutral agree strongly agree
# o
f re
spo
nse
s
Level of agreement
Preventing Disease in Schools is Important, participating schools
Office Coordinators
Principals
School Health Absenteeism Program Evaluation Report Page 16
Question: On a scale of 1 to 5, please select your response to the following statement: “The Program
is helpful.”
Nearly half of all respondents were neutral on whether they perceived the program to be helpful, while
8 (29%) respondents disagreed, and 7 (23%) agreed with the statement.
Question: What do you think are the benefits to participating in the program?
The main perceived benefit of the program was that it “alerts Public Health of outbreaks” 26 (84%),
followed by “the program informs schools of absenteeism rates” 15 (48%), and “the program prevents
diseases from spreading in schools” 9 (29%).
0
7
14
5
1 0
1 1 2
0 0
8
15
7
1
0 2 4 6 8
10 12 14 16
strongly disagree
disagree neutral agree strongly agree
# o
f re
spo
nse
s
Level of agreement
Level of Agreement with the Statement "The Program is Helpful"
Office Coordinators
Principals
Total
15 (48%)
26 (84%)
9 (29%)
4 (13%) 1 (3%) 0 (0%)
4 (13%)
0
5
10
15
20
25
30
Informs schools of
absenteeism rates
Alerts Public Health of outbreaks
Prevents diseases from spreading in
schools
Education on disease
prevention from Public
Health
Year-end summary reports
Other (please specify)
I do not think there are
benefits to participating
in the program
# o
f re
spo
nse
s
Possible Benefits
Perceived Program Benefits of Principals and Office Coordinators from Participating Schools
School Health Absenteeism Program Evaluation Report Page 17
Question: What do you find challenging about participating in the program?
The majority of respondents 18 (58%) indicated that participating in the program wasn’t challenging.
Challenges that were identified were time 9 (29%), having to report the same information to multiple
sources 3 (10%), and “other” 3 (10%). Some of the qualitative responses to the other option, included:
forgetting to do the reporting and not feeling like Public Health properly examines the absenteeism
rates, resulting in the school receiving emails when it has indicated that most of the students are on
vacation, rather than ill.
Question: How can Public Health better support schools in reporting absenteeism data to the
program?
Below is a summary of the responses:
Two responses indicated that an autofill function for the form that would self-populate the
fields that remain the same each time (for example, school name and size) would be helpful and
would save time.
Two responses noted that schools will indicate on the web-form that while there are a large
number of absences, most are due to vacation or schools trips. However, Public Health often
sends schools an email for having high absenteeism rates, despite the warning of students not
being absent due to illness. This can be frustration for office coordinators.
One respondent suggested a month-end summary report detailing the dates the school
reported absenteeism information.
One respondent noted that the program focuses mainly on gasto-intestinal and respiratory
illness; however, other health concerns may also be important (for example, chicken pox, eye
infections).
One respondent expressed confusion over the reasons for requesting staff absenteeism
information. The respondent noted that there is not a place on the form for information on the
9 (29%)
2 (84%) 0 (0%)
3 (10%) 3 (10%)
18 (58%)
0 2 4 6 8
10 12 14 16 18 20
Time Technical difficulties
Not enough support
from Public Health
Having to report the
same information to multiple
sources
Other I do not find participating
in the program to
be challenging
# o
f re
spo
nse
s
Possible Challenges
Perceived Program Challenges of Principals and Office Coordinators from Participating Schools
School Health Absenteeism Program Evaluation Report Page 18
cause of staff absenteeism. It was expressed that office coordinators don’t always know the
details of staff illness.
Question: How can Public Health better support schools in preventing communicable diseases, other
than the school absenteeism surveillance program?
Responses include:
Distributing information via school newsletters or via the school board website on specific
problems or outbreaks that parents need to be aware of.
Sending out an information flyer to parents at the start of the school year stating the amount of
time children should stay at home until medications become active, as well as signs parents can
use to recognize illness.
Send out the newest information to schols so they can update their binders, particularly the
information on whether specific diseases need to be reported or not.
Have a Public Health Nurse visit the school regularly to discuss issues or health concerns.
Communicate with the schools via the Public Health Nurse assigned to the school.
Provide information sessions for staff and students on communicable diseases and prevention.
School Health Absenteeism Program Evaluation Report Page 19
SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: NON-
PARTICIPATING SCHOOLS Question: Why does your school no longer participate in the program? (Please check all that apply).
Overall, time for participation in the program did appear to be a factor, with 6 (50%) of respondents
indicating this as a reason for discontinuing participation in the program. Three (25%) did not see the
benefit of participating in the program. Seven (58%) chose the “other” option. Some of the qualitative
(other) responses include:
Four respondents indicated they either were not aware that the program was still continuing,
they forgot their password to log in, or participation “just did not happen this year.”
Two respondents noted that parents calling in to report their child’s illness often do not
indicate the kind of illness (respiratory or gastro-intestinal).
One school noted that it generally doesn’t have a lot of absences, thus they aren’t sure about
the purpose of reporting.
6 (50%)
3 (25%)
1 (8%)
7 (58%)
0
1
2
3
4
5
6
7
8
Time Did not see benefit to
participating in the program
Difficulty filling out the online
form
Other (please specify)
# o
f re
spo
nse
s
response options
Reasons for ceasing participation in the School Health Absenteeism Program
School Health Absenteeism Program Evaluation Report Page 20
Question: Did your school ever receive an email from Public Health for having an absenteeism rate
greater than 10%? Did your school ever receive a phone call from a Public Health Nurse or Public
Health Inspector for having a school absenteeism rate greater than 20%? Have you ever received a
copy of Public Health’s year-end report on the School Absenteeism Surveillance Program for your
School Board?
The majority of respondents had not received an email (7 [58%]), phone call (10 [83%]), or year-end
report (10 [67%]) from Public Health.
The participants that had not previously received a copy of Public Health’s year-end report on school
absenteeism trends were asked if they would be interested in receiving a separate year-end report on
their specific school’s absenteeism trends. The majority (11 [73%]) responded no.
Question: On a scale of 1 to 5, please select your response to the following statement: “Preventing
disease at my school is important.”
The majority of respondents 12 (85%) either agreed or strongly agreed that preventing disease in
schools is important.
3
7
2 1
10
1 0
10
5
0
2
4
6
8
10
12
Yes No I don't know
# o
f re
spo
nse
s
response options
Non-participating Schools: Number that had received emails, phone calls and year-end reports from Public
Health
# Receiving Email from Public Health
# Receiving Phone Call from Public Health
# Receiving Year-end Report from Public Health
1 (7%) 0 (0%)
1 (7%)
10 (71%)
2 (14%)
0
2
4
6
8
10
12
Strongly disagree
Disagree Neutral Agree Strongly Agree
# o
f re
spo
nse
s
Level of agreement
Preventing Disease in Schools is Important, level of agreement from non-participating schools
School Health Absenteeism Program Evaluation Report Page 21
Question: On a scale of 1 to 5, please select your response to the following statement: “Participating
in the School Absenteeism Surveillance Program could prevent disease at my school.”
The majority (10 [71%]) neither agreed nor disagreed with the statement while 3 (21%) strongly
disagreed or disagreed that participating in the program could prevent disease at their school.
Question: What do you think would be the benefits of participating in the Program?
Perceived benefits of participating in the program included: the program alerting Public Health of
outbreaks (10 [71%]), the program informing schools of absenteeism rates (2 [21%]), the program
preventing diseases from spreading in schools (2[14%]), education on disease prevention from Public
Health (2 [14%]), and the year-end summary reports (2 [14%]).
2 (14%) 1 (7%)
10 (71%)
1 (7%) 0
0
5
10
15
Strongly disagree
Disagree Neutral Agree Strongly Agree
# o
f re
spo
nse
s
Level of agreement
Level of Agreement with the Statement "Participating in the Program Helps Prevent
Diseases in Schools," Non-participating Schools
3 (21%)
10 (71%)
2 (14%) 2(14%) 12(14%) 1(7%)
2 (14%)
0
2
4
6
8
10
12
Informs schools of
absenteeism rates
Alerts Public Health of outbreaks
Prevents diseases
from spreading in
schools
Education on disease
prevention from Public
Health
Year-end summary reports
Other (please specify)
There would not be
benefits
# o
f re
spo
nse
s
Possible Benefits
Perceived Program Benefits from Non-Participating Schools
School Health Absenteeism Program Evaluation Report Page 22
Question: What do you think would be challenging about participating in the Program?
Potential challenges to participating in the program included time (11[78%]), having to report the same
information to multiple sources (5 [35%]), technical difficulties (3 [21%]), and “there would not be any
challenges” (3 [21%]).
Question: How can Public Health better support schools in reporting absenteeism data to the
program?
Below is a summary of the responses:
Schools enter absences on a daily basis into “Maplewood.” There School Board could provide
the absenteeism data that Public Health is wanting from the Maplewood database.
The Upper Grand District School Board needs to recognize that reporting data to Public Health is
an additional duty that needs time to summarize and report.
Question: How can Public Health better support schools in preventing communicable diseases, other
than the school absenteeism surveillance program?
Responses include:
Making information on reportable disease more accessible on their website.
Coming to schools to teach about the importance of hand washing and/or suggesting to
teachers to have scheduled hand-washing times.
Producing monthly inserts for newletters, providing presentations by Public Health Nurses to
students and staff, and providing presentations to staff on P.D. days.
Informing the Public on how important it is for parents to communicate with the school.
11 (78%)
3 (21%)
0 (0%)
5 (35%)
0 (0%)
3 (21%)
0
2
4
6
8
10
12
Time Technical difficulties
Not enough support from Public Health
Having to report the
same information to multiple
sources
Other There would not be any challenges
# o
f re
spo
nse
s
Possible Challenges
Perceived Program Challenges of Principals and Office Coordinators from Participating Schools
School Health Absenteeism Program Evaluation Report Page 23
KEY FINDINGS AND CONCLUSIONS
WEB-FORM Survey respondents from participating schools overwhelmingly indicated that the secure web-form
for the program is easy to login to as well as to complete. Additionally, only one non-participating
school indicated that a reason for discontinuing with the program was due to the web-form.
Qualitative feedback related to the web-form indicated that the possibility of an autofill function
that would self-populate the fields that remain the same each time (for example, school name and
student population) would be helpful and would save time for office coordinators. Also, one
respondent expressed confusion over the reasons for requesting staff absenteeism information.
The respondent noted that there is no place on the form for information on the cause of staff
absenteeism. It was expressed that office coordinators do not always know the details of staff
illness.
Recommendation #1
It is recommended that Public Health look into the possibility of an autofill function; however, the
implementation of this feature is not crucial to the success of program.
Recommendation #2
Because the web-form doesn’t ask for the cause staff absences, Public Health should consider
removing the section on staff absenteeism from the web-form. Without information on illness type,
it is difficult to apply this information.
PROGRAM EMAILS, PHONE CALLS, AND YEAR-END REPORTS The majority of respondents from participating schools did recall receiving an email from Public
Health for having an absenteeism rate more than 10%, but most did not find the email to be helpful.
However, most respondents also indicated that the frequency of emails from Public Health for the
program was just right. A large percentage of respondents (likely those whose schools had not
exceeded the alert thresholds) did not recall receiving a phone call or year-end report from Public
Health and were therefore neutral on the helpfulness of these features.
From non-participating schools, most respondents did not recall receiving an email, phone call or
year-end report from Public Health. Overwhelmingly, office coordinators were not interested in
receiving a year-end report on their school’s absenteeism trends. However, some principals did
indicate an interest for this feature.
Qualitatively, two respondents appeared frustrated that they often receive emails from Public
Health in response to having a high absenteeism rate, even when they have noted in the web-form
that most students are absent due vacations or class trips, rather than being ill.
School Health Absenteeism Program Evaluation Report Page 24
Recommendation #3
Concerning the helpfulness of the program’s features, Public Health may want to consider having
the schools or the school boards provide input on how to make these emails, phone call and year-
end report features more helpful to schools.
Recommendation #4
At the beginning of next year’s surveillance program, ask principals to indicate whether they would
like a customized report for their school at the end of the year, and provide these reports based on
interest.
Recommendation #5
Currently, Public Health automatically sends emails to all schools that have an absenteeism rate
equal to or greater than 10%. However, Public Health should revisit their response protocol to
ensure that any submitted data from schools on numbers of students ill are reviewed prior to the
distribution of emails. If a school has indicated that most of their absenteeism is not due to illness,
Public Health should not send the school an email. Additionally, Public Health should only send one
email to an individual school on having a high absenteeism rate each week to not overwhelm office
coordinators.
PROGRAM OVERALL Respondents from both participating and non-participating schools overwhelmingly indicated that
preventing disease in schools is important. However, the majority of survey participants from both
groups selected ‘neutral,’ ‘disagree’ or ‘strongly disagree’ for their response to the statement
“participating in the [school absenteeism surveillance] program helps prevent diseases in schools.”
Additionally, when asked about the benefits of the program, the majority of respondents indicated
that the main benefit is that it alerts Public Health of outbreaks. Few respondents indicated that it
prevents diseases from spreading in schools.
Effective syndromic surveillance of school absenteeism data requires regular data from the majority
of schools in order to be successful. If participants in the program do not feel the program could be
helpful in preventing disease, this puts the future of the program as risk, particularly since data
submission is not mandatory.
Recommendation #6
It is recommended that Public Health provide school boards, office coordinators and principals with
information on syndromic surveillance and its importance in disease prevention. It would also be
helpful to share any success stories that the system has had to date in local schools or examples of
successes from other syndromic surveillance systems in schools to make the program more
meaningful to participants.
Recommendation #7
Since principals and office coordinators change schools frequently, it is important to continue to
inform schools about the program and the processes involved on an annual basis.
School Health Absenteeism Program Evaluation Report Page 25
TIME REQUIRED FOR PARTICIPATION IN THE PROGRAM Schools that continue to participate in the program felt that the length of time required to
participate in the program is acceptable; however, for schools that no longer participate in the
program, time was the main reason for ceasing participating in the program.
Recommendation #8
Public Health should contact schools that have ceased participation in the program to help
determine how to better support staff with respect to the time required for participation in the
program. Also contact some of the participating schools that do not feel the program takes a great
deal of time to see if they have any suggestions for non-participating schools.
ADDITIONAL ANALYSIS Public Health has noticed that many schools are not indicating the number of students absent due
to gastrointestinal, respiratory, or other symptoms on the web-form. For a syndromic surveillance
system to be truly effective, it is imperative to gather some information on the cause of
absenteeism, rather than simply the total number of students absent. However, Public Health
suspects that it is often quite difficult and time consuming for office coordinators to track and
gather all this information.
Recommendation #9
To meet the needs of an effective syndromic surveillance system and to respect the time of school
office coordinators, it is recommended that changes should be made to the program’s web-form. In
addition to the current optional fields for the reporting of the number of students away to
gastrointestinal, respiratory, and other illness, a field could be added for office coordinators to
indicate whether they feel any unusual absenteeism is due to illness, along with an associated
qualitative field where more details on illness could be provided.
NEXT STEPS
In response to the results of the evaluation, Public Health should take the following actions:
Public Health should share the results of the evaluation with external stakeholders,
including the Upper Grand District School Board and the Wellington Catholic District School
Board and principals and office coordinators from both school boards.
Public Health should share the results of the evaluation internally with the Communicable
Infectious Diseases (CID) program staff, the school health team, and the program assistants
involved with the program.
Public Health should consider all proposed recommendations and, in consultation with the
School Boards, implement them, if feasible, prior to or during the 2012-2013 school year.