Barriers and Strategies Used to Continue School-Based Health Services During the COVID-19 Pandemic

Matern Child Health J. 2024 Jan;28(1):155-164. doi: 10.1007/s10995-023-03824-z. Epub 2023 Nov 16.


Objective: To examine perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to assess whether these barriers and strategies varied by locality.

Methods: We developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. We compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs. rural; suburban vs. rural and city vs. suburban).

Results: More than half of schools located in cities expected nine of ten potential barriers to affect the delivery of school-based health services during Fall 2021. More than 50% of responding schools located in urban, suburban and rural area indicated that external barriers outside of their control, including insufficient funding and families not able to bring students to school, were likely to be barriers to delivering care. Strategies identified as "very effective" did not vary by locality. Across all localities, more schools reported virtual strategies were less effective than in-person strategies.

Conclusions for practice: Lessons from the early stages of the COVID-19 pandemic provide critical information for natural disaster and public health emergency preparedness. School locality should be considered in the development of plans to continue the delivery of school-based health services after natural disasters or during public health emergencies.

Keywords: Barriers to delivery during COVID-19 pandemic; Effective strategies for delivery; School-based health services.

MeSH terms

  • COVID-19* / epidemiology
  • Humans
  • Pandemics
  • Rural Population
  • School Health Services
  • Schools