First Advisor

Sherril B. Gelmon

Term of Graduation

Summer 2021

Date of Publication


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Health Systems and Policy


Health Systems and Policy




School health services, School attendance, Health services accessibility, Academic achievement, Secondary education



Physical Description

1 online resource (xv, 237 pages)


A student's ability to attend school regularly can be profoundly affected by poor health-related behaviors, illnesses, and chronic diseases that are left unaddressed and unattended. The delivery of health services in the school environment is uniquely positioned to interrupt the effects these health barriers to learning (HBLs) can have on subsequent diminished educational and health outcomes. The literature widely acknowledges the intersectionality between health and education, but no comprehensive overview exists of how different structures and processes within a school work (or do not work) together to lead to higher or lower student absenteeism. This research sought to fill that gap by exploring how the structural elements of the school system and the process elements of school-based health services (SBHS) delivery can mitigate the ways in which HBLs affect a student's ability to attend school regularly.

Secondary data from multiple publicly available data sources and from the 2018 administration of the Centers for Disease Control and Prevention's School Health Profiles Surveys were used to describe characteristics of a subset of secondary schools in Oregon. These data were utilized to create a unique characterization of the structural elements of the secondary school system and the process elements of SBHS delivery, which in combination lead to the absenteeism outcome. This categorization aided in the identification of elements that may influence the availability, delivery, and quality of health services in secondary schools. Using a comparative configurational method known as coincidence analysis, configurations with different combinations of the structural and process elements (solution pathways) were identified and compared to examine their contributions to both higher and lower rates of chronic absenteeism.

This research found that the combination of elements needed for both higher and lower student absenteeism varied by a school's grade level. This finding suggests that despite grade level being a nonmodifiable element, giving attention to the grades served by a school can inform where and how programs and resources are targeted. Additionally, SBHS delivery that was more comprehensive, coordinated and consistent was found to actively support students by addressing the effects various health problems and issues can have on school attendance. Finally, purposeful coordination of comprehensive in-school health services delivery can also decrease the barriers and problems associated with seeking care off-site.

Most recent efforts to address the academic achievement gap have largely focused on educational reform that target in-classroom activities, teacher preparation, and test preparation. An increased emphasis on student health and well-being may be complementary to those efforts, by supporting rather than detracting from academics. Opportunities can be created for new collaborations among players in both the health services and educational systems, which may need to be supported by policy reforms in either or both sectors. The process by which well-designed, coordinated health services are provided within the structure of the school environment can synergistically improve student academic achievement and health outcomes in the short-term, as well as employment, health, and wellness opportunities over the life course.


©2021 Kelly Elizabeth Coates

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