Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the South West of England

Study setting

The study was conducted during the school summer holidays immediately following school campus closures and the first week of the new academic year (between July and September 2020), with 11–16 years, parents and school staff recruited via secondary schools and local community organisations in the South West of England.

Sampling and recruitment

Because lower socioeconomic and Black, Asian and Minority Ethnic (BAME) populations are disproportionately affected by COVID-19, we contacted 21 secondary schools with relatively higher levels of these populations (based on school-level data from local Public Health departments) to ensure we captured their specific concerns. Participating schools sent study information to potential participants (eg, by email/newsletter). We included staff (teachers, senior leaders/headteachers, Special Educational Needs Coordinators (SENCOs), or those with a role in infection control), students and their parents/carers, at Bristol secondary state schools. We focused student/parent recruitment on year 8 (age 12–13; most had no face-to-face teaching since March) and year 10 (age 14–15; had briefly returned to school campus prior to the summer holidays; faced key exams next year). We also advertised the study via community organisations (eg, BAME support groups, youth groups) in areas of higher BAME groups/deprivation (newsletters, social media and direct contact with members) and used snowball sampling (including families inviting friends to be interviewed with them or separately). Individuals interested in participating contacted the researcher directly to arrange an interview. All eligible volunteers were interviewed (none refused or dropped out).

Interviews

Participants chose to be interviewed on their own, with a friend and/or parent (students) or with colleagues (staff). AL (an experienced qualitative researcher) led interviews by phone or video, with JMK or JK present for group interviews/student interviews without a parent present. Interviews were 30–60 min and audio recorded. Participants provided audio-recorded verbal informed consent (or assent and parent consent for those under 16 years).

Students and school staff provided input into the study design and topic guides.

Topic guides (see online supplemental materials) were tailored for staff or families, but both covered attitudes towards UK recommendations at the time (social distancing, school hand hygiene and infection control strategies) and acceptability of school COVID-19 testing, and were used flexibly, allowing exploration of issues raised by participants. We offered participants a shopping voucher as thanks for their time (£10 for each family member; £20 for staff).

Data collection was informed by the concept of information power15 and pragmatic considerations of the project timeline.

Patient and public involvement

The National Institute for Health Research Applied Research Collaboration West Young Peoples Advisory Group provided feedback on study design and interview topic guides.

Analysis

Producing timely reports for local and national stakeholders necessitated rapid analysis (reports available at https://arc-w.nihr.ac.uk/research/projects/the-back-to-school-study). The framework method16 was used to analyse the data. AL used anonymised interview notes to develop an initial coding framework in Microsoft EXCEL. Codes reflecting the topic guide headings and inductive coding were combined to produce overarching themes. Data within each code were summarised. The framework was further developed using verbatim anonymised interview transcripts. Each author independently read through a subset of interviews and added new codes and quotes to the existing framework, discussing these additions as a team. Framework analysis was appropriate for the specific a priori questions and limited time frame.

Participants

Three of the 21 contacted schools participated by sending information to potential participants, with participants from an additional 11 schools recruited via other methods. We did not record how participants heard about the study. Participants were 15 school staff (heads/assistant heads, teachers, SENCOs) from 7 schools, and 20 families from 10 schools (12 with a BAME child/parent)—17 students (9 females; 8 males; 6 years 7 s, 4 years 8 s, 2 years 9 s, 5 years 10 s) and 20 parents (19 mothers, 1 father) (table 1). For family interviews, nine were one parent and one child (one where child was interviewed alone so an additional researcher was present), six one parent only, three one parent and two children, and one was two families together (friends and one parent each). All 5 years 10 students had attended school for a few days, and all staff participants had been working during lockdown (some of whom had worked within the school environment).

COVID-19 risk concerns

Most staff and around half of students and parents (hereafter referred to as families where there is agreement in views) were not concerned about personal/family COVID-19 risk from returning to school (table 2). However, many staff anticipated increased cases describing schools as ‘petri dishes’. Some staff worried about being a potential ‘spreader’ (table 2). Staff also had concerns about higher risk staff and students, including those from BAME backgrounds, those who were pregnant or who had health conditions.

Many families were more concerned about the negative educational consequences of students not being at school, accepting that home schooling cannot continue indefinitely. However, families did note the risk to vulnerable family members (due to health or age) (table 2). Concern was more common in families with BAME members, although a minority explicitly cited ethnicity-related risk, with some noting the lack of scientific understanding around this risk.

School risk reduction measures

Outside school, most students had accepted social distancing, wearing masks and handwashing, understanding their necessity, with minor negative comments such as social distancing being ‘not nice’. Most aimed to socially distance and some had almost no social contact outside their household during the first lockdown, some enjoying staying home.

Interviewees highlighted a wide variety of school COVID-19 risk reduction measures (see box 1). Participants agreed such measures were needed, although staff were frustrated with the lack of detail in government guidance, meaning each school had to develop their own plans. Staff were generally happy with schools’ plans but had reservations about feasibility and how they would ‘play out in practice’.

Barriers/concerns regarding risk reduction measures

All participants agreed student social distancing was impossible and ‘pointless’ given the numbers of people and lack of space (table 3). Year ‘bubbles’ (see Box 1) were seen as a ‘pragmatic solution’, although there was concern about crossover via siblings or groups leaving school together, and teachers (though less commonly reported). In terms of compliance with risk reduction measures, of most concern among families was forgetting, and a desire to ‘be normal’. A few staff were concerned about rule enforcement methods.

Staff and family concerns about hand-hygiene/infection control were mostly practical, including: availability of resources (sanitiser/soap, sinks, cleaners)—one school estimated a £40 k cost of hand sanitiser; bathroom cleanliness; time for handwashing and effective use of measures, for example, hand sanitiser versus washing, or proper use of masks. Some were concerned about ventilation for example, windows not opening.

A minority of staff were worried about behavioural issues arising from students having to stay in the same classroom for example, unsupervised lesson changeovers, student boredom and lack of movement. Other concerns included risk of using public transport and reduced range of lessons/activities. An important concern for staff was the impact of these measures on learning and pastoral care, especially social distancing measures, for example, fewer interactive lessons and less opportunity to support individual students.

Staff were concerned social distancing measures would particularly affect students with special educational needs (SEN) or mental health issues. Particular issues for students with SEN included (table 3): struggling to understand and comply with the changes; finding less interactive lessons challenging; SEN staff being unable to work physically closely with students (and lack of Personal Protective Equipment (PPE) for this); physical needs for example, personal care or feeding; and removal of ‘safe spaces’ (due to bubbles and infection risk from soft furnishing).

Facilitators/suggestions regarding risk reduction measures

The main suggestion from staff for facilitating the new rules was educating students about their importance, and encouraging a ‘we culture’ of collective responsibility through a supportive, considerate approach (table 3), although a minority of families thought handwashing should be compulsory and enforced.

Staff and parents suggested clear consistent messaging and daily reminders, both verbal and visual. Clear and regular communication from schools about the measures would also reassure parents (table 3).

Other staff suggestions to support the mitigation measures included:

• Funding for cleaning products, PPE and hand-sanitiser; additional classroom equipment to ensure no sharing.

• Government guidance on PPE and students with SEN.

• Staff training on how to work within the new measures.

• Risk assessments for vulnerable students/staff.

• Shorter lessons to allow time for handwashing.

• Students bringing their own hand-sanitiser.

• Encouraging staff to stay home if displaying symptoms (a culture shift from presenteeism common in schools) (table 3).

School management of COVID-19 cases

Limitations

This study was conducted in a limited time frame in response to an urgent need to understand attitudes towards school COVID-19 mitigation measures and views on managing infections in schools. As a result, we took a pragmatic approach, capturing one time point in a rapidly changing field. Several limitations must be acknowledged. During the study, the community COVID-19 transmission rates in the research setting were relatively low; this context may have influenced participants risk perceptions. Furthermore, the sample lacks those with English as an additional language (recruitment materials were translated); those disengaged from school (recruitment was mainly via schools); and those without internet access/computers (due to COVID-19 restrictions we mainly used online recruitment). In addition, the majority of parents interviewed were mothers. Our findings have identified useful insights with important implications for schools, but should be interpreted with these limitations in mind.

Implications

Due to lack of detailed school guidance, our interviews highlighted a wide variety of school COVID-19 mitigation measures, meaning comparison of effectiveness of mitigation measures will be difficult.

More could be done to reduce school transmission, such as reducing crowding to improve social distancing (eg, using other community spaces) and introducing effective school COVID-19 testing.30–33 These actions are even more vital as the pandemic progresses and family and staff opinions about the benefits of schools remaining open may shift. Even with the implementation of such measures, as demonstrated in the UK in early 2021, stopping face-to-face teaching may be a necessary last resort to reduce COVID-19 transmission.

Barriers to mitigation measure compliance may be addressed through clear, consistent information and reminders,24 33 and engendering a sense of collective responsibility.34 This applies both to communication from schools to families and from government to schools—our findings demonstrate that government have provided ambiguous recommendations rather than clear instructions which has left schools having to interpret them. Clear communication is needed from government based on latest scientific evidence. Our findings also demonstrate the importance of emphasising to students the collective good, benefits for their family or wider community, and a sense of collective identity and responsibility.35–37 This conflicts with UK government use of police and fines to enforce measures in wider society,38 for which behavioural scientists have expressed concern.39 40 Schools may need policies, rules and reward systems, and discipline22 35 but should consider a compassionate approach to COVID-19 mitigation measures, which seeks to promote collective identity and social norms, as well as being sensitive to potential stigma of COVID-19.41

Although our findings support schools returning to face-to-face teaching for all (risks from school closure outweigh those of COVID-19,18 policy-makers must consider potential unintended consequences of measures, and ways to help schools support vulnerable individuals and those with additional needs and avoid widening inequalities.24 This may include additional funding and resources to ensure that staff and pupils can adhere to the current government advice,42 and access to home learning resources for the most vulnerable. It may also involve training staff to meet the emotional and mental health needs of students6; for example, many organisations are suggesting a trauma informed approach for schools during this period.

Future research

Further research is needed to understand the welfare and morale of staff and students as the pandemic continues to disrupt schools, including the mental and physical impact of self-isolation of groups of students, and the impact on learning and disruption to schools. Further research to identify the ongoing disproportionate impact of the COVID-19 pandemic, both within and outside schools, on vulnerable and deprived groups is vital. There is also a need for research to understand how to address BAME families’ particular concerns relating to COVID-19 transmission within schools.