Application of Standard Tools and Medication Management Situation in Schools in Satun Province

Abstract

Background: Medication management in schools is a critical component of School Health Services (SHS) and has the potential for long-term health promotion among children and adolescents. However, previous studies have revealed chronic systemic problems, including the lack of standard medication lists, presence of expired or inappropriate medications, improper storage conditions, and a lack of health-related training among designated school personnel. Developing and applying a standardized assessment tool is therefore essential to improve medication safety and establish concrete guidelines.

Objectives: To evaluate the appropriateness and validity of a standardized assessment tool for medication management in schools, to investigate the current situation and critical defects of school medication management in Satun Province, and (3) to measure the inter-rater reliability and evaluation consistency between pharmacists and school personnel.

Methods: This study employed a mixed-methods approach with an exploratory sequential design, conducted in two phases. Phase 1 involved a qualitative evaluation of a 51-item assessment tool using a purposive sampling of 12 experts, and practitioners, including primary care pharmacists, nurse-teachers, and a representative from the Provincial Education Office. Semi-structured in-depth interviews were conducted using the concurrent think-aloud technique based on 8 guiding questions, and data were analyzed via thematic analysis. Phase 2 consisted of a quantitative survey where the improved tool was deployed to all 220 schools in Satun Province. Completed questionnaires were returned by 42 schools (a 19.09% response rate). Additionally, on-site evaluations were conducted simultaneously by both a pharmacist and a nurse-teacher across 9 sampled schools to perform a reliability test using Cronbach’s alpha. Quantitative data were analyzed using descriptive statistics. Data collection was conducted between May and July 2025.

Results: Phase 1 results revealed a highly positive outlook towards the tool, with participants agreeing that the content was explicit, uncomplicated, and effective in identifying critical defects for urgent improvement. Nevertheless, recommendations were made to simplify technical jargon and integrate the tool into existing school health evaluation systems to reduce paper-work burdens. Resource constraints were also highlighted as major challenges for smaller schools. Phase 2 survey demonstrated that while schools performed well in physical infrastructure (85.7% having an infirmary) and patient data screening (95.2% recording patient histories), serious critical defects persisted. Specifically, 66.7% of nurse-teachers worked completely alone, 85.7% had received no medication-related training within the past year, and only 59.5% maintained the storage temperature below 30°C. Regarding the reliability test within the 9 schools, the inter-rater agreement yielded excellent to perfect consistency, with Cronbach’s alpha coefficients ranging between 0.82 and 1.00 (with 4 schools scoring a perfect 1.00).

Conclusion: The findings confirm that this standard assessment tool exhibits high quality, validity, and exceptional reliability, successfully reflecting the actual situation of school medication management. Relevant educational and public health authorities should officially integrate this tool into policy and prioritize reinforcing nurse-teachers' capacities alongside physical resource support to ensure sustainable medication safety for students.