What school-based interventions work to improve attendance in secondary school students with persistent absence? A systematic review.

Alice Middleton^1*Martha Watson²Joanna Anderson³

• ¹Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
• ²West Suffolk NHS Foundation Trust, Bury St Edmunds, United Kingdom
• ³Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom

Background Absence from school is an increasing concern internationally, with significant consequences for children's mental health, academic achievement, and future opportunities. The multifaceted causes of absenteeism, including factors like emotionally based school avoidance (EBSA), have prompted a variety of interventions aimed at addressing this complexity. These efforts include recent plans from the UK government. This systematic review evaluates the effectiveness of school-based interventions targeting persistently absent secondary school students, to inform evidence-based strategies. Methods A systematic search was conducted across six electronic databases in health and education for studies published up to April 2024. Eligible studies assessed school-based interventions aimed at improving attendance among persistently absent secondary school students. The Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Programme (CASP) tools were used to assess study quality. A bioecological framework was applied to map interventions to influence levels and evaluate their impact on attendance. Results Sixteen studies, mostly from the United States with one from Australia, were included. Study designs varied, including randomised controlled trials, quasi-experimental designs, and cohort studies, with quality ratings from weak to moderate. Interventions demonstrated variable effectiveness, reflecting the challenges of addressing persistent absenteeism. Favourable outcomes were reported for mentoring schemes, family involvement initiatives, school counselling, incentive programmes, school-based healthcare, and a police partnership strategy. However, inconsistencies in significance and impact were observed across studies. Conclusion The evidence base for interventions to improve attendance among persistently absent secondary school students remains limited. High-quality research is needed to build robust evidence, incorporating comprehensive attendance metrics alongside academic and health outcomes. Future studies should document and analyse demographic subgroups and include qualitative approaches to address the needs of diverse at-risk groups and guide intervention design.