Beyond budgets: a qualitative study exploring how opportunity cost considerations shape schools’ decisions to adopt and implement interventions

Background. Within the context of limited financial resources, economic evaluations are frequently conducted in health care and compare the costs and benefits of alternative ways of treating or diagnosing health conditions. Such evaluations are then used by decision-makers who plan the provision of health care to make judgements on what interventions constitute the best value for money. In education, economic evaluations are much less frequently conducted, and as such, the conceptual approach is underdeveloped. Nevertheless, in the context of an increase in the use of evidence-based policy making in education, there are increased calls to also evaluate the cost-effectiveness of interventions. The purpose of this research was to explore how fundamental concepts within economics (value, cost) can elucidate school decision-making in the context of the adoption and implementation of universal social-emotional learning interventions. Methods. Ten semi-structured interviews were conducted with teachers and senior leaders from the intervention arm of a parallel cluster randomised controlled trial of a social-emotional learning intervention (Passport: Skills for Life), implemented in mainstream primary schools across Greater Manchester. Data were analysed using thematic framework analysis, underpinned by implementation and health economic principles and theory. Findings. Three themes were generated, revealing how intervention adoption is governed by a complex calculus involving multidimensional costs (e.g., curriculum time), weighted against multidimensional benefits (e.g., academic achievement, emotional wellbeing) and contextualised by student need. Critically, these costs and benefits were not objective or static but are constructed differently by different stakeholders and fluctuate over time. All themes were underpinned by ethical tension between resource efficiency and equity. Differences in goals and values between stakeholders at national and local levels may explain why research on intervention effectiveness and cost-effectiveness is underutilised by the audience it intends to support. These findings will inform a contextually grounded and mixed-method economic evaluation of Passport. Conclusions. Adopting a mixed methods approach to economic evaluations that recognises context and integrates practice expertise can enhance interpretation and application of findings for local level decision makers. Trial registration . ISRCTN12875599