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HEALTH EDUCATION RESEARCH Vol.21 no.

5 2006
Theory & Practice Pages 633–642
Advance Access publication 1 June 2006

School well-being in Grades 4–12

Anne I. Konu1* and T. P. Lintonen1,2

Abstract being evaluation tool for schools to use. The


idea is that schools evaluate their well-being,
The World Health Organization has encour- make positive changes and perform the evalua-
aged a whole-school approach when trying to tion again to see if progress has been made.
promote mental health and well-being in
schools. The Internet-based School Well-being
Profile aims to be a holistic well-being evalua- Introduction
tion tool for schools. Well-being is divided into
four categories: ‘school conditions’, ‘social The World Health Organization (WHO) has en-
relationships’, ‘means for self-fulfillment’ and couraged a whole-school approach when trying to
‘health status’. The questionnaires for the promote mental health and well-being in schools. In
School Well-being Profile were developed for WHO, they use the concept of creating an environ-
school personnel and for pupils at three levels: ment for emotional and social well-being [1]. The
primary, lower secondary and upper secondary two already well-known holistic approaches to
schools. The present data consisted of the school health promotion are the Health Promoting
responses from 8285 participants from pri- School [2] and the Comprehensive School Health
mary, lower and upper secondary school pupils Program [3, 4]. The settings approach—the shift
in the school year 2004–05 in Finland. School from monocausal risk factor interventions to focus
well-being was compared between gender, on the whole-school change—has many advocates
school levels and grades. Pupils in primary [5–7]. Lister-Sharp et al. [8] have also called for
school experienced school conditions, social a theoretical basis or explicated assumptions un-
relationships and means for self-fulfillment to derpinning the health promotion interventions in
be better than pupils in secondary schools. schools. Recently, Deschesnes et al. [9] noted that
When comparing gender and grades, the main despite the tremendous potential of these two
finding was that girls and younger students comprehensive approaches to school health pro-
within each school level rated school well-being motion mentioned above, only rarely are they put
more positively, except the fact that boys had into practice. However, Mũkoma and Flisher [10]
fewer symptoms than girls did. The aim of the showed that it is possible to integrate health
School Well-being Profile is to provide a well- promotion into the school curriculum and policies
successfully.
Health promotion interventions could also ben-
1
efit from the action research practice of feeding
Tampere School of Public Health, University of Tampere, back the data to schools [11]. Furthermore, the
FIN-33014, Finland and 2University of Tampere Centre for
Advanced Study, FIN-33014, Finland
school organization needs to be motivated to get the
*Correspondence to: A. I. Konu. most out of health promotion interventions [12]. A
E-mail: anne.konu@uta.fi good example of feeding back the data to schools

Ó The Author 2006. Published by Oxford University Press. All rights reserved. doi:10.1093/her/cyl032
For permissions, please email: journals.permissions@oxfordjournals.org
A. I. Konu and T. P. Lintonen

is the School Health Index (SHI) (http://apps.nccd. to homework, attentiveness in the classroom and
cdc.gov/shi), which is a theory-based (the Coordi- academic self-concept. The results showed that the
nated School Health Program [3, 4]) and holistic relative influence of classes and schools on a pupil’s
school health evaluation tool. In SHI, schools can achievement was higher than the influence on his
fill in the questionnaires either on the Internet or in or her well-being.
paper format. The present indicator, the well-being profile,
Lister-Sharp et al. [8] recommended new out- aims to be a holistic well-being evaluation tool for
come measures for school health promotion inter- schools. It is based on theoretical work on school
ventions in their systematic review of school health well-being, which produced a well-being model for
promotion. Deschesnes et al. [9] state that the schools [19–22]. In the model, well-being is di-
fundamental goal is to evaluate the effectiveness vided into four categories: ‘school conditions’,
of holistic school health promotion programs; that ‘social relationships in school’, ‘means for self-
is, their ability to produce the desired effects on fulfillment in school’ and ‘health status’. The well-
health, well-being or academic achievements. Ac- being theory and model are discussed more deeply
cording to St Leger [13], the evaluation of school in separate articles mentioned above, especially in
health programs should include cognitive and social the article of Konu and Rimpelä [19].
outcomes and comprehensive and holistic pro- Health promotion evaluation should help the
grams. The evaluation of health promotion inter- schools to develop their current practices and give
ventions reveals many difficulties; for example, them relevant information to make plans for the
how to evaluate different types of schools in future. Evaluation research should bring informa-
different areas with different health promotion tion to a broader audience: what kind of interven-
foci [10]. In both planning and evaluating health tions and practices were successful in improving
promotion interventions, cooperation between health and well-being in schools. The aim of the
health and education sectors is essential [14]. present paper is to present a holistic, Internet-based
Well-being in the school context has been evaluation method of school well-being and to
studied by Knuver and Brandsma [15], Samdal compare the well-being in different grades in
[16] and Opdenakker and Van Damme [17]. primary, lower secondary and upper secondary
Knuver and Brandsma [15] studied both cognitive schools in Finland. The School Well-being Profile’s
and affective outcomes in school. Affective out- main purpose is to aid an individual school in its
comes referred to attitudes the student had towards development process in an easy and effective way.
school and learning. They measured school well-
being by Stoel’s [18] questionnaire about the
pupils’ experience (positive or negative) of their Methods
school and its organization, their teachers and their
classmates. The schools’ cognitive and affective Development of the well-being evaluation
outcomes were relatively independent [15]. tool
Samdal [16] measured pupils’ subjective well- For the School Well-being Profile, new question-
being with one single item: ‘In general, how do you naires were developed on the basis of the Well-being
feel about your life at present?’ Student support, Model and the empirical findings of the School
adequate expectations and teacher support were the Health Promotion Survey in Finland [19–22] and two
most important predictors of subjective well-being. international school surveys conducted in Finland:
Opdenakker and Van Damme [17] used a well- Health Behaviour in School-aged Children [23] and
being questionnaire consisting of eight indicators: School Environment 2000 Questionnaire [24]. The
well-being at school, social integration in the class, well-being profile questionnaires were tested during
relationships with teachers, interest in learning the years 2002–04 in the Koulumiete Project [25],
tasks, motivation towards learning tasks, attitude which was a part of the Pirkanmaa Mental Health

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School well-being

project (www.pmh.info). The region of Pirkanmaa, upper secondary schools. The means for self-fulfill-
which has a city of about 200 000 inhabitants as well ment category included questions on work appreci-
as other smaller towns, is situated in southern ation, attitudes towards studies, getting help in
Finland. The Koulumiete Project’s main aims were studying, participation, spurring on and commend-
to support pupils’ mental health, prevent marginali- ing. The number of questions was 17 in primary
zation and support the whole school so that it could schools, and 24 in lower and upper secondary
promote positive development. The Koulumiete schools. The health status category had questions
Project worked with seven schools (two primary mostly on symptoms: neck and shoulder pains, lower
and five lower secondary schools) in the region. One back pains, stomach aches, tension or nervousness,
school was in an urban area, and others were in irritability and temper tantrums, difficulties falling
smaller towns. There were two main strategies for asleep or awakenings during night, headache, feeling
achieving the project’s aims, which were to produce tired or weak, feeling downhearted, feeling fear,
a well-being profile for each school and thus to find common cold, flu and cough. The number of
out the most important development areas from the questions was nine in primary schools, and 11 in
well-being and mental health viewpoints and to pay lower and upper secondary schools [25].
special attention to school absenteeism and develop
a model for early recognition and prompt help for Data and analysis
pupils with high absence rates. The well-being profile has not yet been publicly
The questionnaires for the School Well-being advertised. Schools which have heard about it in
Profile were developed for school personnel and for seminars or by word of mouth or found it them-
pupils at three levels: primary (Grades 4–6, aged selves on the Internet have used it. It is located in
10–12 years), lower secondary (Grades 7–9, aged the Finnish National Board of Education Web
13–15 years) and upper secondary (Grades 10–12, pages (www2.edu.fi/hyvinvointiprofiili). Some ac-
aged 16–18 years). The topics of the questions were tive schools have found the profile by searching for
the same at each level, only wording was suited for something new in those Web pages. The present
each grade and for personnel. In the questionnaires data consisted of participants from active and
for primary schools, the answering options were voluntary schools. This is likely to cause some
decreased to three (agree, neither agree nor dis- bias when using it for research purposes. However,
agree, disagree) instead of the five in others the selection process was the same in each school
(completely agree, agree, neither agree nor dis- level, and the comparison was made between
agree, disagree, completely disagree). There were school levels and within school grades. In Finland,
also fewer questions in each well-being category for every school has access to the Internet (M. Suvanen,
primary schools to make it more suitable for pupils personal communication), over 80% through
aged 10–13 years. a high-speed connection. However, there may be
The school conditions category included questions differences between schools on how this technol-
on physical conditions like ventilation, desks, class- ogy is used and managed. This may affect which
rooms, safety; organizational conditions like sched- schools use this kind of an evaluation tool. This has
ules, working in peace, rules and regulations, haste, also been a technical test period for the tool itself
lunch break and services like lunches, access to a and it has worked well.
school nurse and counselor. The number of questions After the schools asked for and received their
was 15 in primary, and 26 in lower and upper username and password, the primary user, usually
secondary schools. The social relationships category a teacher, in each school instructed the pupils and
had questions on relationships between personnel personnel on how to complete the questionnaires
and pupils, among pupils themselves and cooperation on the Internet. The schools were advised to fill
between homes and school. The number of questions in the questionnaires during school hours under
was 15 in primary, 19 in lower secondary and 17 in a teacher’s supervision. The researchers were not

635
A. I. Konu and T. P. Lintonen

present. The administration of the instrument may statistical significances of differences between the
have varied between schools, which may have mean values of the four well-being categories by
affected the results. To ensure confidentiality, explanatory variables. The internal consistency of
each pupil and a member of personnel got a ran- each well-being category was calculated using Cron-
domly assigned password for the questionnaire. bach’s alpha. The correlations between categories
These passwords were not saved in the database. were analyzed using Pearson correlation. SPSS 11.0
Seventy schools completed the well-being profile for Windows was used for the analysis.
(33 primary schools, 28 lower secondary schools, 9
upper secondary schools and personnel from 46
schools) from a total of around 4000 primary and Results
secondary schools in Finland. The total number of
9169 questionnaires was completed during October The internal consistencies of the four well-being
2004–May 2005 (2381 pupils from primary, 5280 categories were very good at each school level: in
from lower secondary, 624 from upper secondary the school conditions category, Cronbach’s alpha
schools and 884 people from school personnel). was 0.84 in primary school (0.92 in lower second-
The present data consisted of pupils from all ary and 0.89 in upper secondary), in the social
participating schools from three levels: primary relationships category, it was 0.78 in primary
school (Grades 4–6), lower secondary school school (0.89 and 0.89, respectively), in the means
(Grades 7–9) and upper secondary school (Grades for self-fulfillment category, 0.87 in primary school
10–12). The results from personnel data will be (0.94 and 0.92, respectively) and in the health status
discussed in a separate article. In all, 49.3% of category, it was 0.79 in primary school (0.90 and
participating pupils was male, 10.4% 4th, 6.7% 5th, 0.89, respectively). As expected, the correlations
11.6% 6th, 27.7% 7th, 18.8% 8th, 17.3% 9th, 4.5% between well-being categories were moderate [22]
10th, 1.8% (151 students) 11th and 1.1% (93 at each school level. The highest correlation was
students) 12th Graders. Six students studied fourth found between the means for self-fulfillment and
year in upper secondary school and were not social relationships categories (0.74 primary, 0.74
included in comparing the grade data. lower secondary, 0.71 upper secondary), means for
In the School Well-being Profile, means for each self-fulfillment correlated also with the school
well-being category (school conditions, social re- conditions category (0.71, 0.69, 0.64, respectively).
lationship, means for self-fulfillment and health The lowest correlation was found between the
status) were calculated. The proportion of missing school conditions and health status categories
responses within variables varied between 0 and (0.32, 0.31, 0.31, respectively).
4%. Most missing responses concerned questions The differences in school well-being between
on counselors—not all schools had them. The school levels are presented in Fig. 1. Pupils in
percentage of agreement (completely agree or primary school experienced school conditions and
agree) was calculated for each variable. Bullying means for self-fulfillment to be better than pupils in
was indicated by the percentage of those being lower and upper secondary schools, but there was
bullied/bullied others at least once a week during no difference between lower and upper secondary
the school term (percentage of those being bullied school pupils. There was a significant difference
many times during this school term among primary between each school level on social relationships
school pupils). In the health status category, the category; lower secondary school pupils rated their
indicators present the percentage never experienc- social relationships the lowest. Pupils in upper
ing these symptoms. secondary schools had more symptoms than pupils
One-way analysis of variance with Bonferroni post in lower secondary and pupils in primary schools;
hoc test in the cases of more than two explanatory there was no significant difference between lower
variable categories was used for analyzing the secondary and primary school pupils.

636
School well-being

The differences in school well-being between well-being more positively, except the fact that
gender and between grades (Grades 4–6 in primary boys had fewer symptoms than girls did.
school, Grades 7–9 in lower secondary school and Selected single questions from each well-being
Grades 10–12 in upper secondary school) within category are presented in Fig. 2. School was rated
each school level are presented in Tables I and II. quite safe. Almost 65% from lower and upper
The main finding was that girls and younger secondary school pupils thought that there was too
students within each school level rated school much time pressure in school. Over 90% of pupils

social relationships
a,b,c

means for self-fulfillment


a,c

school conditions
a,c

primary
health status
lower sec.
b,c
upper sec.

0 0.5 1 1.5 2 2.5 3 3.5 4


Note: Statistically significant differences (p < .05): a primary to lower secondary, b lower secondary to upper secondary,
c primary to upper secondary school levels

Fig. 1. The differences in school well-being between school levels. (0 = completely disagree, 4 = completely agree, except in the health
status category: 0 = symptoms almost every day and 4 = never experiencing these symptoms.)

Table I. Differences in school well-being between the genders within each school level

Primary Lower secondary Upper secondary

Girls Boys Girls Boys Girls Boys

Mean SD Mean SD Significance Mean SD Mean SD Significance Mean SD Mean SD Significance

School 3.07 0.64 2.92 0.78 ** 2.40 0.56 2.33 0.64 ** 2.32 0.46 2.36 0.58 NS
conditions
Social 3.39 0.47 3.23 0.60 ** 2.93 0.50 2.83 0.56 ** 3.02 0.47 2.93 0.62 NS
relationships
Means for 3.22 0.58 3.04 0.70 ** 2.63 0.54 2.60 0.61 NS 2.62 0.49 2.59 0.58 NS
self-fulfillment
Health 2.61 0.78 2.77 0.82 ** 2.52 0.80 2.91 0.76 ** 2.33 0.75 2.78 0.88 **
status

**P < 0.001.

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A. I. Konu and T. P. Lintonen

Table II. Differences in school well-being between grades within each school level

Mean SD Significance Mean SD Significance Mean SD Significance

Primary school Fourth (4–5) Fifth (5–6) Sixth (4–6)


School conditions 3.21 0.61 ** 2.99 0.71 ** 2.80 0.76 **
Social relationships 3.39 0.49 NS 3.33 0.54 ** 3.22 0.57 **
Means for self-fulfillment 3.29 0.56 * 3.16 0.64 ** 2.97 0.70 **
Health status 2.78 0.81 * 2.63 0.81 NS 2.65 0.79 *
Lower secondary school Seventh (7–8) Eighth (8–9) Ninth (7–9)
School conditions 2.46 0.61 ** 2.34 0.57 ** 2.24 0.60 **
Social relationships 2.96 0.53 ** 2.85 0.50 * 2.79 0.56 **
Means for self-fulfillment 2.72 0.56 ** 2.57 0.54 * 2.50 0.60 **
Health status 2.79 0.78 NS 2.73 0.80 ** 2.60 0.83 **
Upper secondary school Tenth (10–11) Eleventh (11–12) Twelfth (10–12)
School conditions 2.40 0.44 NS 2.28 0.51 NS 2.25 0.59 NS
Social relationships 3.06 0.41 NS 2.97 0.61 NS 2.80 0.62 **
Means for self-fulfillment 2.67 0.45 NS 2.56 0.54 NS 2.50 0.61 *
Health status 2.54 0.79 NS 2.37 0.86 NS 2.54 0.91 NS

*P < 0.05, **P < 0.001.

School conditions Social relationships


rules and regulations na. I have friends in school
are sensible c
b
na.
punisments are fair easy to get along with
b teachers
a, b
not too much time na. teachers treat pupils
pressure fairly
a, b, c
na. most tearchers are
ventilation is good
friendly
a, b, c
school is safe pupils in class get along
a, b, c well a, c
primary primary
there is a good chance lower sec. classmates intervene in lower sec.
to work in peace upper sec. bullying upper sec.
a, b, c a, b, c
0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100
% agree or fully agree % agree or fully agree

Means for self-fulfillment Health status


irritability or temper tantrums na.
I get help from teachers b
a, c neck or shoulder pains na.
b
I am able to follow feeling fear
teaching a, b, c
feeling downhearted
teachers commend work a, b, c
lower back pains
well done a, b, c
a stomach aches
pupils' views are taken a, c
being tense and nervous
into account a, b, c
a, c
feeling tired or weak
my work is appreciated in a, b, c
school flu, common cold etc.
a, c primary a, c primary
pupils take part in lower sec. trouble with sleep lower sec.
a, b, c
making rules upper sec. headache upper sec.
a, b, c a, c
0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100
% agree of fully agree % rarely or never

Note: Statistically significant differences (p < .05): a primary to lower secondary, b lower secondary to upper secondary, c primary to upper secondary school levels

Fig. 2. Selected single questions from each well-being category at primary, lower and upper secondary schools.

had friends in school, but only a third reported that ary and 72% in primary school) thought that
classmates intervened in bullying. In all, 53% of teachers treated pupils fairly. Around 80% of pupils
lower secondary school pupils (60% upper second- thought that they could follow teaching and got

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School well-being

help from teachers, but only a quarter of pupils (a lower secondary and upper secondary) and grade
third in primary school) took part in making rules in (from 4 to 12). However, even the grade with the
school and 45–56% of pupils felt that their views least participants had 93 respondents. In most
were taken into account in school development. schools, all their pupils used the system; in some
Around two-thirds of pupils never felt fear in schools, only a certain grade completed it. Even
school. In primary schools, fewer pupils had any pupils absent during the survey could easily
symptoms. Headache, stomach ache and common complete the questionnaire when they returned to
cold were the most commonly reported symptoms school. We do not know how many pupils in each
at all school levels. In secondary schools, feeling school did not answer the questionnaire. However,
tired or weak and being tense and nervous were also we do know that the schools were motivated and
common symptoms. wanted their pupils to complete the questionnaire.
In all, 5.3% of pupils were bullied once a week or In addition, the fact that the most active schools
more often in lower secondary and 2.4% in upper participated in the system may introduce some bias
secondary school. In all, 3.9% bullied others once in the results. To the above-mentioned limitations
a week or more often in lower secondary and 2.7% had to be added the fact that not every school could
in upper secondary school. In primary school, the participate in the system, because it is in the
response options for this question were ‘never’, Internet. Although every school has had access to
‘rarely’ and ‘many times’ during this school term. the Internet since the year 2000 (M. Suvanen,
In all, 6.9% of pupils were bullied many times and personal communication), in practice, the use of
3.2% bullied others many times. the Internet varies considerably among schools.
Despite these limitations, the School Well-being
Profile provided a decent data set for studying well-
Discussion being in schools.
The wording of the questionnaires had minor
Health promotion interventions should feed back variations according to school level. The primary
data to schools [11]. This was the main aim of the school questionnaire differed the most from the
development of the Internet-based well-being eval- others. Some questions were removed to make it
uation system for schools (the School Well-being shorter and more easily understandable for children
Profile; www2.edu.fi/hyvinvointiprofiili). Most aged 10–13 years. The theoretical basis of school
probably, the schools that utilize the system are well-being [19] was the same in each questionnaire
motivated for development, because they have and the topics of the questions were the same. The
actively chosen to use it. Those schools may also internal consistencies of the school conditions,
be the most motivated and get the most out of social relationships, means for self-fulfillment and
a health promotion intervention, as Reynolds and health status categories were very good in lower
Teddie [12] called for. The School Well-being and upper secondary schools and good in primary
Profile acts as a health promotion intervention by school.
a careful, theory-based planning of the question- The data were gathered entirely via Internet. The
naire giving instant feedback. Answering the ques- feedback concerning the answering mode has been
tionnaire (open questions included) gives the pupils very positive. An open question on the ease of use
a possibility to get their voice heard. was included at the end of the questionnaires. Over
The data analyzed in this paper were gathered 90% of the answers were like the following: very
from pupils who answered the well-being profile easy, easy, easily, easy of course, much easier than
questionnaire during the school year 2004–05. in paper format, piece of cake, etc. McCabe et al.
Some questions on the qualities of the research [26] have found that among young children, there
data should be noted. It consisted of different were minimal differences between survey modes
numbers of pupils from each school level (primary, (Web form versus paper form) in data quality.

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A. I. Konu and T. P. Lintonen

Pupils in primary school experienced school changes experienced during puberty [31]. In pri-
conditions, social relationships and means for mary schools, we usually have one teacher per
self-fulfillment to be better than pupils in lower class, whereas in secondary schools there is a dif-
and upper secondary schools. Pupils in secondary ferent teacher in every school subject. Recently,
school are going through their period of puberty, schools with Grades 1–9 have been introduced
during which they construct their identity and self- to reduce the gap between Grades 6 and 7.
image. Their opinions towards adults at home and Bullying was not very common in participating
school vary. In adolescence, pupils’ cogitation schools compared with the School Health Pro-
gradually approaches the level of abstraction and motion Survey in Finland, where 8% of 8th and 9th
logic, which is typical of adults [27]. These changes Graders were bullied and 6% bullied others once
may affect the way they assess the settings they a week or more often [32]. Still, the finding that
study in. Whatever the reason, pupils’ assessments classmates do not intervene when others are being
of school at each level should be noted. This could bullied is alarming. Salmivalli et al. [33] see
also be a sign of pupils’ views being ignored in bullying as a group phenomenon, where there are
school. Less than half of the pupils thought that more players involved than only the one who
their views were taken into account and only a third bullies others and the one being bullied. School
reported that pupils could take part in making rules. personnel should take action to educate pupils to
Primary school pupils ranked these questions intervene when their classmates are being bullied.
higher than others. This is surprising; it would Promising results have been seen when the whole-
seem natural that older pupils had more say in school policy approach [34] and participant role
school. That might increase their responsibility as approach in school classes [35] have been used.
students, too. School well-being could also be Comparing gender and grades, the main finding
improved by appreciating each member’s work was that girls and younger students within each
in school more. The appreciation is seen also in school level rated school well-being more posi-
offering possibilities for pupils’ participation. The tively. However, girls had more symptoms than
school environment has a major impact on behavior boys at every school level, even in primary school.
and emotional well-being, so we should ensure that This result is in line with other studies [20, 36].
young people feel valued at school by providing The differences between gender and grade tend
them with opportunities for positive participation to diminish in upper secondary school.
[28]. Simovska [29] calls for schools to provide Primary school pupils’ responses concerning
space for the voices and choices of young people. single questions on school well-being were gener-
In the lower secondary schools, pupils experi- ally more positive than corresponding responses
enced social relationships to be worse than pupils in secondary schools. Interesting exceptions were
in primary and upper secondary schools. The period noted. Only one-third of primary school pupils
between Grades 7 and 9 (from 13- to 15-year old thought that there was a good chance to work in
pupils) is very challenging. During puberty, school peace, whereas many more secondary school pupils
motivation may diminish, difficulties in concentrat- thought so. Less than half of primary school pupils
ing may affect studying and pupils need continuing thought that their work was appreciated in school,
feedback about themselves [30]. This calls for whereas this percentage was ;60 among secondary
special efforts to enhance social relationships be- school pupils. Work appreciation would be an
tween pupils and personnel, and among pupils interesting topic for further research at all school
themselves. The transition from primary to second- levels.
ary school (between Grades 6 and 7) is quite a big Early prevention programs for younger children
change for pupils in Finland. Many children, of are more effective as well as programs which
course, manage the transition well, but it may be develop protective factors compared with those
a stressful situation when they are undergoing the which try to reduce existing negative behavior [37].

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School well-being

The current intervention tried to influence schools Acknowledgement


as a whole—starting from primary school. Its basis
was positive development—well-being in school. This study was financially supported by the Foun-
Schools get both pupils’ and personnel’s results, so dation of Juho Vainio in Finland.
they are able to see a holistic picture of well-being
in their own school. They can see the ratings of the
four well-being categories as well as single ques-
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