The authors concluded that evidence was severely limited and equivocal on the effectiveness of school-based healthcare for sexual, reproductive and mental health outcomes. Despite some concerns about the search, the authors' conclusions reliably reflect the limited evidence presented.

To evaluate the effects of school-based healthcare services on the sexual, reproductive and mental health of adolescents. The review also assessed factors that influenced the uptake of services, and contextual issues that affected their provision; these do not form part of this abstract.

PubMed, PsycINFO, APA PsycNET, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science were searched for articles published in English between January 1990 and March 2012. Search terms and strategies were reported.

Eligible for inclusion were all studies that evaluated health centres, health clinics or healthcare primarily based in schools. Services had to target adolescents and focus on sexual, reproductive and mental health outcomes.

All included studies (for the purposes of this abstract) were conducted in the United States. Outcomes included knowledge and use of hormonal contraception, condom use, emergency contraception, receipt of testing for sexual transmitted disease/infection, care related to pregnancy and HIV prevention, pregnancy rate, age at first sexual experience, suicide attempt and ideation, substance use and educational outcomes.

At least two reviewers were involved in the selection of studies.

The authors stated that they did not carry out a formal quality assessment of selected studies.

Data were extracted on proportions to demonstrate the direction of intervention effect. Adjusted odds ratios and 95% confidence intervals were also presented.

Two independent reviewers extracted the data.

A narrative synthesis was presented.

Three studies that focused on sexual, reproductive and mental health outcomes were included (27 studies were represented in the wider review). There were two controlled before and after studies (one study included 5,930 participants; the other included six intervention and four comparison groups); and one cohort study (3,909 participants).

Results were generally mixed and inconsistent between and within studies. There was some evidence to suggest an intervention effect in terms of increased use of pregnancy prevention care, disease prevention/screening services and contraceptive use.

Further results were reported in the article.

The evidence was severely limited and equivocal on the effectiveness of school-based healthcare for sexual, reproductive and mental health outcomes in adolescents.

The review question and inclusion criteria were (of necessity) broad. The search strategy included several appropriate data sources. The inability to access CINAHL (acknowledged by the authors), with the exclusion of unpublished material and articles in other languages, meant that relevant studies might have been overlooked. The processes of study selection and data extraction were carried out with sufficient attempts to minimise error and bias. As the authors pointed out, the absence of measures to assess the quality of included studies represented a limitation. However, it was unlikely (given the nature of included study designs) that such an assessment would have significantly influenced the authors' conclusions. There was little detail on study participants and intervention characteristics so generalisability of the evidence was unclear. The chosen method of synthesis was appropriate. Despite some concerns about the search, the authors' conclusions reliably reflect the limited evidence presented.

Practice: The authors did not state any implications for practice.

Research: The authors stated that high-quality research on the effects of school-based healthcare on sexual, reproductive and mental health outcomes was urgently needed. Clearer definitions of school-based healthcare were also required.

University of York; South African Medical Research Council; EC Health Research Programme (7th Framework).

Mason-Jones AJ, Mathews C, Kagee A, Lombard C. Clinical effectiveness of school and mixed school and community based interventions for STI and HIV prevention in adolescents (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD006417. DOI: 10.1002/14651858.CD006417.pub2.