The COVID-19 HL School Principal Survey (Wales) linked to routinely collected anonymised health data

Abstract Background Evidence before the pandemic suggests that school headteachers report high work-related stress and psychological/physical burden compared to other professional groups (1). There is an evidence gap exploring the effects of the COVID-19 pandemic on senior leaders in schools who have experienced high demands as a result of COVID-19. This is important because in the UK, teacher retention is policy priority. Methods The COVID-19 HL: School Leadership Survey aimed to explore the burden and stress that school leaders in Wales, UK experienced during COVID-19, part of a global study with the COVID-HL network (3). 172 school leaders (62% female) from 130 primary (age 3-11) and 30 secondary schools (age 11-16) completed an online survey between July-Nov 2021, exploring topics such as work-related stress and mental health. A unique aspect is the use of data linkage using the SAIL (Secure Anonymised Information Linkage) Databank. SAIL is data repository containing individual-level, anonymised population-scale data for Wales. Results Initial descriptive findings show 54% of senior leaders have depression (WHO-5), and lower wellbeing scores compared to other UK professions. 83% report moderate-high perceived stress (Perceived Stress Scale) and physical (38%) and mental (57%) work exhaustion. The next stage of this study is to perform data linkage of survey responses to health records and administrative data. Logistic regression analyses will examine wellbeing and work-related stress with outcomes including mental health (e.g. anxiety/depression) diagnosis and time off work. Conclusions Preliminary results show high levels of stress, exhaustion and low wellbeing amongst school leaders in Wales. The next part of this study will examine this in greater detail using data linkage of routine records. Data linkage allows this sample to be extrapolated to population level to theorise work-related stress for all school leaders in Wales.


Background:
The health crisis caused by the COVID-19 pandemic has severely affected the education sector and its whole community. Due to their responsibility for organizing schoolwork, school managers were in an extremely challenging position. The main objective of the present study is to reveal the extent to which school principals in Poland put aside their own needs in favor of fulfilling their professional duties during the COVID-19 pandemic.

Methods:
The results come from an online survey among school principals in Poland, which is part of the international COVID-19 Health Literacy School Principals Survey. The survey was conducted in 8 out of 16 provinces in Poland between June 2021 and December 2021. 1899 school principals participated in the survey, of which 928 completed the questionnaire.

Results:
The study revealed that 68,3% of school principals often and very often worked longer than contractually agreed and 71,3% reported to be available for their colleagues, pupils, and parents in their free time. Most of them also had to give up leisure activities in favor of work (67,9%), work extra hours in their spare time (60%), waive breaks during working hours (57,3%), and did not get sufficient sleep in favor of work (50,5%). Devoting more time to work and high stress levels during the pandemic were associated with somatic complaints among respondents (e.g. muscle pain (neck, shoulder, or back) and headache).

Conclusions:
The results suggest that Polish school principals worked at the expense of their free time and health during the COVID-19 pandemic. As such, findings emphasized a lack of life-work balance and the need to raise their awareness of the consequences of self-exploitation in work in challenging times. The ability to set healthy boundaries between work and private life among managers is one of the health promotion tasks in demanding times.

Background:
School leaders are credited with an important role when it comes to school health promotion. During the COVID-19 pandemic, much health-related information was available and had to be interpreted and acted upon by school leaders. Therefore, it is crucial that they have sufficient health literacy as the ability to gain access to, understand and use healthrelated information. A study in Germany showed that limited health literacy among school principals was associated with low levels of health promotion activities. This paper explores the association between school leaders' health literacy and school health promotion in Switzerland, addressing the following questions: 1. What is the relationship between health literacy of school leaders and the implementation of school health promotion? 2. Does health literacy explain variance above and beyond other antecedents, such as principals individual mental health and attitudes?

Methods:
The quantitative analysis is based on an online survey conducted among school leaders in the German-and French speaking parts of Switzerland in June 2021 as part of the project ''COVID-19 health literacy school principals survey''. The final sample comprised N = 339 school leaders. The data were analyzed using stepwise regression with health literacy, stress, wellbeing and attitudes toward school health promotion as antecedents and COVID-19 related school health promotion as the outcome.

Results:
The results show that health literacy of school principals has played an important role in the implementation of school health promotion during the COVID-19 pandemic. It explains additional variance beyond other antecedents.

Conclusions:
One way to promote implementation of school health promotion is to strengthen the health literacy of school leaders.
physical burden compared to other professional groups (1). There is an evidence gap exploring the effects of the COVID-19 pandemic on senior leaders in schools who have experienced high demands as a result of COVID-19. This is important because in the UK, teacher retention is policy priority.

Methods:
The COVID-19 HL: School Leadership Survey aimed to explore the burden and stress that school leaders in Wales, UK experienced during COVID-19, part of a global study with the COVID-HL network (3). 172 school leaders (62% female) from 130 primary (age 3-11) and 30 secondary schools (age 11-16) completed an online survey between July-Nov 2021, exploring topics such as work-related stress and mental health. A unique aspect is the use of data linkage using the SAIL (Secure Anonymised Information Linkage) Databank. SAIL is data repository containing individual-level, anonymised population-scale data for Wales.

Results:
Initial descriptive findings show 54% of senior leaders have depression (WHO-5), and lower wellbeing scores compared to other UK professions. 83% report moderate-high perceived stress (Perceived Stress Scale) and physical (38%) and mental (57%) work exhaustion. The next stage of this study is to perform data linkage of survey responses to health records and administrative data. Logistic regression analyses will examine wellbeing and work-related stress with outcomes including mental health (e.g. anxiety/depression) diagnosis and time off work.

Conclusions:
Preliminary results show high levels of stress, exhaustion and low wellbeing amongst school leaders in Wales. The next part of this study will examine this in greater detail using data linkage of routine records. Data linkage allows this sample to be extrapolated to population level to theorise work-related stress for all school leaders in Wales.

10.L. Round table: Health literacy in health professionals -conceptualising and piloting a new measuring instrument
Abstract citation ID: ckac129.661

Background:
Studies have shown that the population's health literacy is low in many countries, including Austria, Germany, and Switzerland. In order to improve the health literacy of patients and the population, health professionals have an essential role to play. However, as most studies have been conducted either outside of Europe or among health professionals in training, there is a lack of a clear definition, clear-cut concept, and reliable data on the professional health literacy of the healthcare workforce in Europe so far.

Approach of the Pilot Study:
The present study is a pilot study that aims to remedy this shortcoming. The underlying notion of health literacy is based on the definition by the HLS-EU Consortium and the HLS19study. Following these definitions, a joint concept of professional health literacy was developed. It is comprised of the following complexes: a) communication with patients and users, b) dissemination of health related information with patients in a comprehensible manner, and c) dealing with relevant professional knowledge by health professionals. Based on this conceptual reflections, a quantitative survey was developed and conducted among health professionals in Austria, Germany, and Switzerland. This process revealed some challenges and limitations of a standardised questionnaire, as national discourses vary and different professions require distinctive vocabulary and frameworks of reference. Moreover, differences in professional qualifications and training challenge the comparability of both sample and results.

Objectives of the Workshop:
The objective of this workshop is threefold. a. The first is to present the working group's concept, its experience with, and reflections on this first of its kind study in Europe -all before the backdrop of previous endeavours to examine professional health literacy. This is the more important as interest in professional and organisational health literacy is growing. b. The second objective includes the presentation of the survey instrument, its development, and preliminary results (the analysis of the study's data will not be completed by the time of the workshop). c. The third objective is to provide a platform for discussion about the study as well as the challenges and potential limitations of a wider international comparison across a larger variety of health professions. Added Value of the Workshop: The workshop will provide an overview of the general context, the approaches in the field of professional health literacy, and the concept. This combination offers a unique opportunity to discuss the study, its questionnaire, and preliminary results, while considering aspects and issues in this field of research in general. This discussion is essential, as it supports identifying opportunities and limitations in order to develop solutions in this field of research -and contribute to the possible progress in the development of the role of health professionals.

Key messages:
Professional health literacy is essential to improve patients' health literacy. This workshop discusses potentials, challenges, and potential limitations examining this field.