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Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory

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Abstract

Purpose

Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes.

Method

This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation.

Results

We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students’ wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students’ trust underpins the whole activity system.

Conclusions

Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.

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Availability of data and materials

The datasets are available upon reasonable request by contacting the corresponding author.

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Acknowledgements

The authors wish to thank Ms Yasmin Lynda Munro, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, for her contribution to the search strategy and database searches.

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Authors and Affiliations

  1. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

    Emmanuel Tan & Jennifer Cleland

  2. Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands

    Emmanuel Tan, Janneke Frambach & Erik Driessen

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  1. Emmanuel Tan
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  2. Janneke Frambach
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  4. Jennifer Cleland
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Contributions

The idea for this study came from ET and evolved through discussions involving all four authors (ET, JF, ED, and JC). ET conducted the literature search and analysis. JC undertook a second review of papers where there was uncertainty as to an article’s inclusion status. All authors met regularly to discuss the data, discuss and resolve any discrepancies. ET prepared the first draft of the manuscript and worked with JC to generate a working draft. All authors contributed to the revision of the manuscript. All authors read and approved the final paper for submission.

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Correspondence to Emmanuel Tan.

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No applicable. This was a review of previously published literature. Ethical approval was not required.

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Tan, E., Frambach, J., Driessen, E. et al. Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory. Adv in Health Sci Educ (2023). https://doi.org/10.1007/s10459-023-10261-8

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