Health Professions · Research topic

Open research questions in School Health and Nursing Education

125 unresolved questions extracted from the limitations and future-work sections of 2,956 School Health and Nursing Education papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Soliciting recommendations from youth who have direct experience with an intervention is a dynamic method of assessing acceptability and moves beyond the binary check- box of whether the student enjoyed the intervention (Bri- esch & Chafouleas, 2009). Both SMH participants and non-participants shared their recommendations for partici- pation. Common themes across all students pertained to the timing, frequency, and activities of the SMH group. Some students were dissatisfied with the scheduling of the group, citing missed academic classes and lost opportunities to go outside during lunch. Charlotte shared how she needed to self-advocate in order to attend class and participate in the SMH group (see Table 2). Though Charlotte was able to advocate for herself, other students may not realize their options, which may ultimately keep them from participat- ing, as Andres mentioned earlier. Another aspect of sched- uling was how it intersected with confidentiality. Kasey shared that scheduling the SMH group in the middle of the day drew unwanted attention from peers and threatened her anonymity in the group: Alynda’s experience demonstrates how naming, processing, and gaining perspective on racial stressors is a valuable cop- ing strategy for multiple marginalized students to support I also didn’t like how it was in the middle of the day, because it’s grief group. I know I’m going to cry. I’m 1 3School Mental Health a sensitive person. And I’m going to leave the group with tears running down my face, mascara, whatever, blah blah blah. I don’t like that it was in the middle of the day and then I had to go back into the hallway, walk past a whole bunch of people and have them look at me like, “Yo, why’s she crying?” With confidentiality as a salient factor for youth accessing mental health services, Kasey’s experience highlights how scheduling plays an important role in ensuring confidential- ity and preventing embarrassment (Ijadi-Maghsoodi et al., 2018; Wang et al., 2020). Increased frequency of intervention sessions was another improvement recommended by students in the SMH groups. Nia, a Black, female high school student expressed her desire for more sessions given the nature of the topic: “And I feel like it wasn’t long enough for it to be a grief group. Grief takes time.” Healing and processing do not occur on a set schedule, nor does it happen for all youth simultane- ously. This is at odds with the nature of a SMH group, which is often a planned, scripted intervention with a specific timeline and set goals. Other students also shared they were unable to meet their personal goals within the short number of sessions (see Table 2). Students’ reflections illustrate the tension between students’ personal goals and the goals and timeline of the planned intervention. Continual check-ins with students may help guide the direction of the group so that session and student goals may be met. Similarly, students also reported on the tension between their expectations and the SMH group, particularly as it dealt with intervention activities. Kasey shared that her group’s art activities fell short of her expectations, while Chen advo- cated for more art activities (see Table 2). Kasey and Chen’s experiences illustrate the variance of students’ preferences, underscoring the importance of adjusting interventions to respond to the needs of students. Most importantly, students also experienced a disconnect between their own needs and the content of the SMH curriculum. Desiree, a Black and Latiné female middle school student, shared how the SMH intervention did not address the lived experiences of the group: “It didn’t adapt to what we were feeling. […] they read off a paper.” Desiree’s disappointment highlights the importance of selecting and facilitating SMH interventions and curriculum that are relevant and responsive to the needs and experiences of the participants (Fazel & Hoagwood, 2021; Ungar, 2008). Overall, youth collectively agreed that SMH groups must adapt in timing, frequency, and activi- ties to align with their needs and lived experiences. These recommendations from youth reveal that when SMH ser- vices do not accommodate student schedules, privacy, and lived experiences, they can become barriers to engagement; on the other hand, when groups are flexible and responsive, they can facilitate engagement and sustained participation.

    “I Just Thought it Would Help Me”: A Qualitative Exploration of Youth’s Experiences with School Mental Health Services · 2026 · DOI
  • Exemplary Quotes “I think it’s really helpful for those who haven’t gotten a voice like myself.” (Chen, HS, NB, A, P) “The only thing I didn’t like was when […] the group lined up with a test I had […] and I care about my grades. So, a couple of times, I told [adult group facilitator], I was like, I have a test this period. I can’t do the group. I want to do the test. And she was totally fine with it and there was no problem (Charlotte, HS, F, W, P) “I thought we were going to have more time to share and to have other people trying to actually under- stand how we felt.” (Margot, MS, F, W, P) “I feel like we were doing more art projects than anything. And when we would, it would just be the same questions over and over again and it just, it wasn’t enough, I guess.” (Kasey, HS, F, W, P) “But I think if people who joined hear that there’s activities, there’s things you can physically do, very tactile things–I think that’d be really fun to have more interactive activities in [the intervention] other than just talking. Not many people really like talking.” (Chen, HS, NB, A, P) MS = Middle school student; HS = high school student; F = Female; M = Male; NB = non-binary; B = Black; W = White; A = Asian; L = Latiné; MR= Multiracial; DNI = did not indicate; P = participant in school mental health group; DNP = Did not participate in school mental health group.

    “I Just Thought it Would Help Me”: A Qualitative Exploration of Youth’s Experiences with School Mental Health Services · 2026 · DOI
  • In addition to these recommendations for practice, we offer some important future directions for researchers to build upon this work. The current study focused on student deci- sions to participate in small group SMH interventions. Future work should examine student perceptions of barri- ers and facilitators to accessing SMH individual and group services more broadly in order to better understand the decision-making process involved in engaging with SMH services generally. It could be the case that there are dis- tinct barriers and facilitators to participating in building or district-wide services specific to the context in which the study was conducted. Additional studies from rural or sub- urban communities, for example, or with students and fami- lies with varying cultural and linguistic identities other than the current sample would offer additional important insights into how to improve SMH services. Finally, the current study engaged youth in the research process by seeking their input during focus groups. Feed- back from youth led to changes in local school and district- level SMH programming, as well as several broader policy and practice recommendations for SMH professionals as part of the current research-practice partnership. Future research can further center youth voice by including a mem- ber checking step or by having students take part in data analysis and change to improve SMH interventions (see Vaughn & Jacquez, 2020).

    “I Just Thought it Would Help Me”: A Qualitative Exploration of Youth’s Experiences with School Mental Health Services · 2026 · DOI
  • Although global models, such as the WHO framework and THEnet, provide clear guidance, the extent to which Caribbean offshore medical schools (OMS) incorporated these principles remains unclear.

    Social Accountability Across Caribbean Offshore Medical Schools: A Qualitative Study · 2026 · DOI
  • 2022). The Pennsylvania-specific included examining how New York created their policies, developing a stakeholder coalition, writing policy briefs, and creating a Pennsylvania-specific state-wide curriculum (Elliott, 2022). More broad suggestions were provided by Hoover and Bostic (2021) and Slease et al. (2024) who sug- gested that the federal government should play a role either by passing a resolution encouraging states to act or creat- ing national learning standards for mental health education. Both articles also suggested that federal departments need to provide funding for programs and related training. Hoover and Bostic (2021) specified that mental health education should be required in all 50 U.S. states, and Slease et al. (2024) noted the importance for policies to include informa- tion about implementation and programming processes, as well as developing evaluation mechanisms to understand if school districts are following policies. Gorman (2024) took the opposite approach, recommending that mental health education be neither required nor funded, and, if it occurs at all, only in high school. Policy Recommendations-International The four international articles that provided policy rec- ommendations were focused on China, Ireland, Canada, and Scotland. In qualitative interviews, Davidson et al. (2015) heard feedback from Chinese counseling students Policy as a Determinant of Mental Health Education Imple- mentation Only four articles focused on how policy plays a role in mental health education, besides describing the actual policy. All four articles emphasized the importance of fund- ing and policy to ensure implementation of mental health education (Gorman, 2024; Han & Weiss, 2005; Hoare et al., 2020; Reaves et al., 2025). However, Gorman (2024) was against compulsory mental health education while the other three articles were in favor. Gorman (2024) argued that pre- ventative and universal supports are not needed, and that schools should only target supporting children with existing mental health issues. (More detailed policy characteristics are in the appendix).

    Mental Health Education in Schools: A Scoping Review of Policies, Implementation Factors, and Recommendations · 2026 · DOI
  • MHL: mental health literacy, MHE: mental health education 13 (81.3) 8 (50.0) 4 (25.0) 7 (17.1) 8 (19.5) 9 (22.0) 8 (19.5) 3 (7.3) 9 (22.0) 21 (51.2) 10 (24.4) 30 (73.2) for an increased focus in mental health literacy in schools (Rosenbaum et al., 2023; Slease et al., 2024), with Slease et al. noting that Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare & Medicaid Services (CMS), and the Centers for Disease Control and Prevention (CDC) have also recommended increasing mental health literacy to assist student-wellbeing. Gorman (2024) also noted that these programs expanded following the federal Every Student Succeeds Act passed in 2015, and additional funding came from bills passed during COVID-19. Policy Descriptions–International Three articles focused on mental health education policies in China. Both Davidson et al. (2015) and Deng and Fang (2015), explored the history of mental health education in China, which was first noted in policy in 1988. Mental health education policy in China is incorporated into “moral education” (defined as a Confucian concept about morality, values, and being responsible citizens; Tang (唐汉卫) & Wang (王阳), 2021). Policy guidelines noted that mental health education in China should be adapted differently for rural and urban schools and for different ages (Davidson, 2015). All three articles mentioned the 2012 government document “Guidelines of Mental Health Education in Schools,” which requires schools to educate students about mental health and hire specific teachers or counselors to implement the program (Davidson, 2015; Deng & Fang, 2015; Guo et al., 2020). Two articles mentioned that mental health education is required in England, but neither provided any description of policy (Goodwin et al., 2023; Mansfield et al., 2021). One article noted that Ireland has the “Wellbeing Policy Statement and Framework and Practice” which is intended 1 3School Mental Health to foster wellbeing in young people, but the authors determined that the policy was not sufficiently specific (Goodwin et al, 2023). Two articles focused on Australia. One detailed that, following a government review of mental health programs and services for youth, the government found a gap in mental health education and funded Beyond Blue, a national mental health organization, to create the national mental health education program Be You (Hoare et al., 2020). The other article noted that the Australian National Mental Health Commission believes that there needs to be a continued increase in mental health literacy (Marinucci, 2023). Ojio et al. (2019) described Japan’s policy, School of Education Act, which was updated in 2017 to require a new course of study on mental health and mental illness in schools.

    Mental Health Education in Schools: A Scoping Review of Policies, Implementation Factors, and Recommendations · 2026 · DOI
  • may be behind countries such as China in mandating mental health education, it is clear that, for the most part, mental health education policies have not been widely evaluated on an international scale. Globally, there are few policies that mandate mental health education, and even in countries that mandate it, implementation varies widely (Slease et al. As New York’s policy was one of the first statewide mental health education laws to come into existence, and imple- mentation is lacking years post-policy effective date, it is clear there is more work to do to evaluate mental health edu- cation policy implementation.

    Mental Health Education in Schools: A Scoping Review of Policies, Implementation Factors, and Recommendations · 2026 · DOI
  • While the findings give insight into challenges many teachers School Mental Health (2026) 18:658–6711 3 experience, future research should investigate other inter- vention programs like Everest that aim to improve teacher wellness. This was outside of the parameters of our study, but future research should focus on documenting the impact of in-school teacher wellness programs on student outcomes to help understand this relationship.

    Addressing Teacher Mental Health Knowledge and Skills: An Exploration of Teacher Wellness Supports in Two High Schools · 2026 · DOI
  • Understanding how schools continue to deliver CBT and other mental health services in the aftermath of COVID-19 related disruptions can provide insights into the resilience and effectiveness of these interventions, and overall school operations. As schools expand delivery offerings to meet the evolving needs of learners, learnings from this research can help inform the delivery of virtual learning, teletherapy, and other deviations from in-person mental health delivery. Future research efforts could examine the aspects that con- tribute to the sustained use of CBT, including ongoing train- ing and support for SPs, organizational factors, and resource allocation. While this study focused on the perspectives of SPs, it is also critical to assess the effect of modified mental health service delivery on student outcomes, ideally on both academic and mental health outcomes. By evaluating the effectiveness of the modified interventions, researchers can identify adaptation strategies and mechanisms that have the greatest positive outcomes for student well-being and aca- demic success. These avenues of inquiry can further advance the understanding of effective and adaptable approaches to 255 supporting the mental health needs of students during times of crisis. This research initially focused on how CBT delivery in schools changed during COVID-19. However, broader con- versations regarding mental health emerged during inter- views with SPs. Enhancing school-based mental health supports can benefit from a more comprehensive imple- mentation approach, considering how various facets of implementation strategies affect mental health outcomes in school settings. The shift from modification of existing practices to planned adaptation highlights the importance of tailoring interventions to diverse contexts and needs. By translating adaptive strategies from other spaces (i.e., clini- cal settings) to the school setting, researchers and practitio- ners can enhance schools’ ability to address student mental health challenges more holistically. This broader perspec- tive can not only improve effectiveness of mental health interventions but also ensure that future approaches are more inclusive and responsive to the complex realities faced by students and educators.

    Meeting Student Mental Health Needs in Survival Mode: A Qualitative Analysis of School Professional Mental Health Delivery at Michigan High Schools in Response to COVID-19 · 2026 · DOI
  • Mitey’s strength lies in its structured, evidence-based framework. However, schools require some flexibility to adapt the approach to their unique contexts. Findings suggest that some schools are integrating Mitey alongside other mental health pro- grammes or approaches. The SJKF will need to continue collaborating with other providers, developing protocols and processes that help schools adhere to Mitey’s core elements while still allowing for contextual adaptations. More specifically, strat- egies could include: ● providing support materials that illustrate how Mitey can be integrated with other mental health education initiatives without compromising its integrity. ● conducting periodic fidelity checks or audits to ensure consistent implementation while identifying opportunities for flexible adaptation. Another important step is to adopt a research-based approach to supporting school self-sufficiency. Sustainability remains a key challenge for Mitey, particularly in managing school staff turnover, navigating shifting government priorities, and addressing implementation time constraints. Schools need more robust systems to help them become self-sufficient in delivering Mitey effectively. The SJKF could consider developing a sustainability framework that includes: ● leadership development – providing training and resources to help school lead- ers embed Mitey within their strategic goals and maintain momentum despite competing demands. ● time management support – providing practical tools to help schools plan and allocate time for Mitey (e.g. lesson planning templates, scheduling tools, and case study examples of how Mitey has been successfully integrated within the curriculum). The SJKF and the university team are very aware of the need to adapt the Mitey learning progression plus the curriculum and planning tools to align with the new Health and Physical Education curriculum. This learning area will be formally issued under the Education and Training Act and released to the education sector in Term 1, 2026, with initial planning, teaching, and learning resources, alongside implementa- tion tools and professional learning and development resources (Te Kāwanatanga o New Zealand Journal of Educational Studies (2026) 61:215–2311 3 229 Aotearoa–New Zealand Government, Te Tāhuhu o te Mātauranga–Ministry of Edu- cation, Te Poutāhū Curriculum Centre, 2025). The revised Health and Physical Edu- cation learning area will be mandated for use from Term 1, 2027. The long-term success of Mitey will likely depend on its ability to demonstrate lasting impact while continuing to adapt to the evolving needs of schools. The SJKF and the university team are mindful of the significant upscaling of Mitey to date and are committed to retaining its quality and the integrity of the approach, while maintaining ongoing curriculum support and professional development for schools. Continued research is essential to refine Mitey and provide evidence of its effective- ness. This could include: ● longitudinal studies – conducting research to track outcomes for school students, staff, and cultures over time to better understand Mitey’s long-term impact. ● evidence-based refinements – using research findings to continually improve Mit- ey, incorporating new insights and addressing emerging challenges, such as sup- porting diverse student populations, or adapting to shifting educational priorities.

    Mitey: The Inception, the Development, the Implementation, the Evaluation · 2026 · DOI
  • This is one of the first studies to examine a whole-school approach to mental health education in Aotearoa New Zealand. The mixed methods design offers a comprehen- New Zealand Journal of Educational Studies (2026) 61:215–2311 3 228 sive view of Mitey’s implementation, strengthens the study’s inferences, and pro- vides a nuanced understanding of Mitey’s impact. There are several limitations to this evaluative study. The online survey relied on participants self-selecting to take part. The survey was not designed to test for con- struct validity or reliability. However, the close alignment between open- and closed- ended responses suggests good face validity. Interview participants were selected by individual schools. Given the qualitative approach’s focus on gathering detailed insights, it was essential to include those most engaged in Mitey’s implementation process.

    Mitey: The Inception, the Development, the Implementation, the Evaluation · 2026 · DOI
  • • Create evidence-based policies: Adapt school health policies to Namibia’s unique health challenges via empirical data. • Equity in resource allocation: Increase funding for rural schools and enhancing access to basic health infrastructure, such as water and sanitation. • Enhance capacity building: Train educators and health professionals to enhance school health interventions. • Monitoring and evaluation: Robust M&E systems should be implemented to track and assess school health policies, enabling timely adjustments. • Stakeholder engagement: Involve learners, parents, educators and communities in policy development and implementation for relevance and sustainability.

    Strengthening school health in Namibia: A framework for policy development, implementation and evaluation · 2026 · DOI
  • Credibility, dependability, confirmability, and trans- ferability are aspects of trustworthiness in qualitative research [52]. To achieve credibility, school nurses with experience working with students with gender dyspho- ria were recruited, since credibility is strengthened by the participants having experiences of the phenomenon. The sample could be considered small, but credibility in the findings cannot be judged by the number of partici- pants [52]. Rather, participants were perceived to have varied and deep experiences, which contributed to the study findings. The participants were also from different geographic areas, both urban and rural, which contrib- uted to a broader perspective. Some of the school nurses had longer careers working as school nurses than others, who had only been school nurses for a short time. All participants had several experiences of the phenomenon. Qualitative research exists in a paradigm of a value-based process, characterized by multiple realities and multi- faceted perceptions of a phenomenon [52]. While the participation number could be considered low, the expe- riences and descriptions of the school nurses were rich and varied and therefore suitable for analysis. The school nurses were from different areas in the country, rural and urban, from different municipalities, from differ- ent grades, with different specialist educations and years as nurses and school nurses. Furthermore, there was no goal of reaching saturation or in the data collection. Rather, the approach of Graneheim and Lundman of data richness and relevance to the aim was the goal during the data collection. During the analysis, the phase of choosing which codes and supporting quotes will be included in each category relates to the dependability of the study. To strengthen the dependability of the study, all authors discussed the steps taken during the research process to reach con- sensus. Among the research group, there were different experiences in school nursing-three of the researchers have experience in school health services, and one researcher had experience teaching higher education in gender and sexuality. The researchers are the instrument in qualitative studies, since their development of self- awareness is important for promoting thoroughness and integrity in assessing the findings [53]. Bias on the sub- ject was discussed within the research group thorough the analysis process to minimize the influence of the results. Presenting these pre-understandings strength- ens the dependability of the study, as does using more than one researcher to analyse the material [52]. To what extent the result can be transferable to another popula- tion must be decided by the reader [52]. It is strength- ened by the descriptions of the participants and setting in the background and method section. The study results may be transferable to other contexts with a similar sys- tem for school health care. Transferability would be greater in contexts which have similar cultural views as Sweden. Confirmability is achieved when credibility, dependability, and transferability are achieved. This is achieved through thorough descriptions in the methods section and the discussion of the study’s strengths and limitations.

    A qualitative content analysis study on Swedish school nurses’ experiences of meeting students with gender dysphoria · 2026 · DOI
  • Despite the limited research on supervision, its potential benefits are noteworthy, hence this study shares the impact of a peer clinical supervision (PCS) trial on Australian principals’ occupational health and wellbeing.

    Supporting wellbeing of Australian school leaders through peer supervision · 2025 · DOI
  • Although two sequential TIES pilot studies found significantly positive outcomes in cultivating a trauma-sensitive school climate and culture, the program has been limited to a few schools and has not yet been assessed for broader impact on primary stakeholders.

    Exploring Public Schools as a Primary Setting for Early Prevention in Rural Areas: A Qualitative Approach to Strengthening the Trauma-Informed Elementary Schools (TIES) Program · 2024 · DOI
  • Informed by prior work, interviews (n = 12) with parents and elementary school employees showed that (1) a vast array of non-Migrant Advocate school employees, mostly Latinx women, directly brokered physical and psychosocial MSF health care access, often through developing deep social relationships and (2) barriers to brokerage included language inaccessibility, school employee gaps in knowledge of MSF health care needs, and transportation and related structural issues.

    Health Care Access Brokerage by School Employees for Immigrant Mexican and Indigenous Guatemalan Farmworking Families in a Connecticut Elementary School · 2022 · DOI
  • Originality/value Although researchers have identified the stressors and reactions of principals during the early months of the COVID-19 pandemic, little is known on how principals engaged in self-care practices.

    Responsibility, stress and the well-being of school principals: how principals engaged in self-care during the COVID-19 crisis · 2022 · DOI
  • Purpose Though the benefits of social-emotional competence (SEC) are well-recognized, measuring it and designing appropriately matched interventions remains elusive and methodologically challenging.

    A biblioguidance approach to understanding and developing adolescents' social-emotional competence in the health education classroom: a formative research study · 2021 · DOI
  • As greater emphasis is placed on addressing critical school issues such as school-based mental health, violence prevention, and the effects of trauma, the utilization of school counselors should be examined to ensure that these uniquely-trained professionals are mobilized by school administrators to engage these issues.

    A Clear and Consistent Focus on Students: Principals’ Perceptions of the Role of School Counselors · 2020 · DOI
  • However, despite these efforts, access to adequate nutrition among children in poverty remains insufficient, with only 11% of newly unemployed families reporting access to “grab-and-go” meals.

    Advocating for Children During the COVID-19 School Closures · 2020 · DOI
  • While an immediate post-test showed only inconsistent results, a 20-month follow-up resulted in clear positive outcomes for experimental students on measures of cigarette smoking and improved food choices, and ambiguous but positive results on rates of intercourse.

    An Outcome Evaluation of Project Model Health: A Middle School Health Promotion Program · 1990 · DOI
  • The courses of action, presented below, are recommended for consideration by school personnel in each of the 48 states.

    GUIDANCE SERVICES: <i>in Indiana Public High Schools</i> · 1951 · DOI
  • Future research may investigate what factors account for setting differences in the frequency with which clinician competencies are applied during sessions.

    Adherence and Competence in Delivering Evidence-Based Practices to Children and Adolescents Across Clinic- and School-Based Clinicians · 2026 · DOI
  • Further, an examination of ratio data alone does not account for the roles and responsibili- ties that school psychologists actually take on within the public school.

    Using ArcGIS Pro to Increase Advocacy Efforts Around School Psychologist Shortages · 2026 · DOI
  • Future research should address these limitations by incorporating more robust statistical methods, minimizing errors in the survey instrument tool, considering a different recruitment scheme to ensure…

    Analyzing School-Based Behavioral Health Services Across HRSA-Defined Regions in the United States · 2026 · DOI

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125 open questions have been extracted from the limitations and future-work passages of 2,956 School Health and Nursing Education papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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