The SIODO study aims to contribute to the reduction of school dropout and socioeconomic health differences using an integrative approach that is both broadening and deepening. This study has several unique characteristics. First, the case–control trial will be followed by a qualitative study with the aim of further interpreting and understanding the acquired information. Second, the determinants of school dropout will be viewed from a life-course perspective. The PCYH files providing longitudinal data from birth to adolescence will enable us to gain insight into the life-course pathways leading to school dropout. This information is not affected by retrospective bias. Third, all of the stakeholders involved will participate, including the young adults and their parents. This will create a better understanding of the pathways leading to dropout and will contribute to a prevention tool. PCYH professionals working in the field of school dropout and unauthorised school absence will be able to learn from the valuable experiences shared by the dropouts, their parents and professionals in other fields. Fourth, this study will explore self-assigned masculine and feminine characteristics and gendered beliefs and their association with dropout in more depth. The subject of gender is still underrepresented in public health research. Fifth, our study will specifically address socioeconomic status and its relation to school dropout and health. This study will particularly provide more in-depth information on how health and developmental problems in early life contribute to adolescent school dropout, thus adding to the knowledge about the under-studied selection perspectives on the (persisting and widening) socioeconomic inequalities in health. Finally, the availability of information on the non-responders in the PCYH files allows for a detailed analysis of possible selection biases.
The PCYH system is well-suited for detecting and monitoring youths and families at risk for dropout . Rather than looking at early life symptoms from a dichotomous perspective (poor, good), we will assess symptoms that vary along a continuum from normal variations to problems, and finally disorders (with diagnoses) . The focus on symptoms, rather than on diagnoses, may require a shift in the current medical model, in which therapy is only followed after a diagnosis has been given. Even without a diagnosis, certain symptoms have a great impact on the child’s development and quality of life [15, 63]. School dropout is not an abrupt event, but a gradual process that often begins early in life. It is important that Dutch PCYH professionals, who offer routine health examinations and anticipatory guidance from birth, monitor social participation at each consultation, because joining sports, playing with friends or going to school is considered important for a healthy development. As school dropout has such a profound impact on an adolescent’s life and increases the risks of social exclusion, it is important that PCYH professionals are able to detect and monitor youths and families at risk for dropout, also in cases where no disorder has been diagnosed. SIODO aims to contribute to effective early childhood interventions for preventing young people from dropping out of school.
This study also has some limitations that need to be addressed. First, the data described in the PCYH files were not collected for the purpose of this study, so important information might be missing. However, the information in the PCYH files is not retrospectively biased, which means that this disadvantage is also one of the study’s strengths. Secondly, not all data in the PCYH files will be complete and these files will have been compiled by many different PCYH professionals, each with their own interpretations and descriptions of certain situations, symptoms and life-course determinants. However, because the PCYH professionals work with this information in their daily practice, the ecological validity of our findings will likely be high and provide added value for developing the prevention tool. The collaboration between research, practice and policy will certainly enhance the study’s use for optimising daily practice. Finally, participants in both the case and control groups had already been brought under the attention of the municipal CED. This may be why we had difficulties including participants who returned the completed questionnaire. We therefore included another Dutch region to increase the number of participants. For financial reasons, we proceeded with online questionnaires only.
The SIODO study will use a life-course perspective, the ICF-CY model to group the determinants and a mixed-methods design. In this respect, the SIODO study is innovative because it both broadens and deepens the study of the health-related determinants of school dropout. It examines how these determinants contribute to socioeconomic and gender differences in health and contributes to the development of a tool that can be used in public health practice to tackle the problem of school dropout at its roots.
Approval for conducting this study was granted by the Medical Ethics Committee of Maastricht University.