Background. Many of New Zealand's children are entering school with low oral language ability. Many are also experiencing health concerns that impact the development of academic skills critical to school success. Mitigating adverse impacts of poor health are likely to improve children's academic achievement and overall well-being. Early intervention is particularly necessary to improve outcomes for children who are experiencing significant health or learning challenges. Early intervention will allow targeted support so children can overcome challenges before they significantly fall behind their peers. However, sharing health information for early intervention strategies is often delayed, with the responsibility to share this information being placed solely on the caregiver. Teachers are thus unaware of the health profile of their classrooms and are unable to introduce early intervention strategies or support the whole child.

The extended capability for collaborative, multi-sector practice, along with the rise of digital systems, suggests a digital student health information sharing system (DSHISS) may facilitate sharing of student health information between health professionals and educators (Cunningham & Wodrich, 2006). A DSHISS may allow for earlier intervention, resulting in timely and targeted support that empowers children to overcome health challenges and reach their full potential. Despite the potential gains of a DSHISS, the real and perceived risks of such a system require significant buy-in from key stakeholders and must also consider the legal and ethical implications. It is essential to consider the appetite of teachers and parents and establish the support or opposition for sharing health information before implementing a DSHISS.

Aims. This doctoral research had three broad aims: establish a health profile of children who enter school with known challenges for their school success and investigate the need for integration of health data in New Zealand schools; understand teacher perceptions toward sharing student health information, including the perceived benefits and risks; and, understand parent perceptions toward sharing student health information, including the perceived benefits and risks.

Methodology and Methods. Three phases characterised this research. Using quantitative research methods, phase 1 established a health profile of 85 children entering school with low oral language ability, then utilised a convergent mixed method design to understand parent’s beliefs on health information sharing. Quantitative data prompted participants to think about sharing health information, with qualitative data allowing participants to explain their answers and understand the drivers for their opinions. These findings informed the questionnaire development for phase 2 and 3.

Phases 2 and 3 utilised an explanatory sequential mixed methods design. Teachers (n = 26) and parents (n = 99) of 5 to 7-year-old children completed a questionnaire regarding their views of sharing student health information and the roles of key players within the education system. The questionnaire utilised quantitative research methods to look at the similarities and differences in views around health information sharing between schools and other demographic areas. In the second stage of each phase, teacher (n = 7) and parent (n = 10) participants attended a focus group session, utilising qualitative research methods, via thematic analysis, to clarify questionnaire findings and develop themes pertinent to considering a DSHISS.

Findings. Phase 1 found that of children entering school with low oral language ability, 55% of participants expressed at least one concern with their child’s health, with 29% identifying over one health concern. One in five children had experienced asthma, eczema/dermatitis and ear infections in the past 12 months. Sixty-one percent of participants thought teachers should have access to student medical records, with 62% believing that consent should be given only when a request is made for health information to be released (rather than automatically at enrolment).

In phases 2 and 3, parents and teachers displayed generally positive attitudes towards sharing student health information giving similar explanations for their attitudes. The focus group thematic analysis identified four key themes: The roles within health and education need flexibility: the roles of educators and parents must be flexible and reflective on community need to share health information to improve children’s academic performance and holistic well-being. There are significant benefits to sharing student health information: these benefits to sharing children’s health information with educators include the ability to provide greater targeted and tailored support as well as safer learning environments. If sharing health information is done carelessly, there is potential for harm: the risks of sharing health information include the potential for misuse and misinterpretation of health data. Taking a solution-focused, collaborative approach to implementation: A range of strategies could reduce the perceived risks of health data sharing, including clear policies, practices, prioritizing trusting relationships between home and school, and limiting what data is shared.

Conclusion. The findings suggest that children who enter school with low oral language ability are experiencing health concerns that could result in these children missing out on further teaching that builds vital foundational learning skills for learning success. Yet, the majority of these children’s parents would be happy to share health data with the child’s teacher, which could lessen the impact of health issues on learning. By sharing health information, teachers can offer targeted early interventions to children that consider both their oral language ability and health concerns. The findings from this thesis support the need to investigate multi- disciplinary approaches to health information sharing, especially given the frequent occurrence of health issues in children who enter school with a higher risk for educational challenges.

Parent and teacher participants were able to discuss their perceptions of sharing children’s health information and the development of a DSHISS. They acknowledged that schools and teachers must reflect the needs of their community. Participants highlighted their perceived benefits by discussing the opportunity for triangulation with sectors outside education, more efficient and targeted early intervention in schools, and greater school safety. Conversely, participants considered the risks of sharing information, discussing fears of privacy and confidentiality breaches. Ultimately, participants recognised the potential for a DSHISS to have significant value if these risks are mitigated. Real-time access to health information and tailored support strategies could have a considerable impact on reducing adverse effects on children’s school success from health concerns. Participants desire to minimise risks associated with student health data sharing highlight the value of the perceived benefits.

While the New Zealand education sector is beginning to take a child-centric approach in the classroom, there is room for improvement, especially around how to manage health in schools. This research highlights the potential for integration of health in schools and justifies greater cross-sector collaboration. Through facilitation from digital technology, greater integration and cooperation between health and education sectors could see the improvement of both health and education outcomes. The extent of this improvement, along with the legal frameworks surrounding information sharing, requires future research. However, the general openness of participants in this study towards a DSHISS calls for further exploration.