Measurement of school health
We used a comprehensive school health checklist (Table 1) to evaluate the important aspects of school health based on the context of an HPS program for Burmese migrant schools in Thailand. The checklist was modified from a checklist used in a program in Laos (Yoshimura et al., 2009). Training and pre-testing were conducted to adapt the checklist to the situation of the migrant schools and to ensure its quality.
The checklist consisted of five components: component 1 (personal health and life skills, 12 items); component 2 (healthy school environment, 22 items); component 3 (health and nutrition services, 13 items); component 4 (common disease control and prevention, 7 items) and component 5 (partnership with community, 6 items).
Each item scored from observations and questions asked to students, school staff or teachers was evaluated by research staff using a score from 0 to 3 points. For example, in an observation of 16 students, if eight or more students (≥50%) met the criteria (e.g. had nails clipped), the overall score for the item was 1. If 10 or more (≥60%) or 12 or more (≥70%) students had a positive score, the overall scores were 2 or 3, respectively. Conversely, item 21 of component 2 determined the students' experience of physical punishment in the past year. Scores were −1, −2 and −3 if physical punishment was given to ≥50, ≥60 and ≥70% of students, respectively. Each school was evaluated by calculating the mean of the total score and the means of the individual scores for the five components.
Although our checklist included items related to cooking and hygiene of school lunches, several schools did not provide school lunches or only received a pre-cooked meal from non-governmental organizations (NGOs). In those schools, several items related to cooking of school lunches were omitted because the meals were delivered from the kitchen of the NGO or students had lunch at home. In the 2008 survey, five schools omitted items 6–13 in component 3 and in 2009, seven schools omitted item 10 in component 3; 11 schools skipped items 6–9 and 11–13 and one school skipped item 2 in component 1. For these items, the mean scores were calculated from the eligible schools.