Determinants of School Attendance in 6841 Elementary School Students in Japan: a Structural Equation Model

Hiromi Nakamura-Thomas (  nakamura-hiromi@spu.ac.jp ) Saitama Prefectural University Faculty of Health Science and Welfare: Saitama Kenritsu Daigaku Hoken Iryo Fukushi Gakubu Daigakuin Hoken Iryo Fukushigaku Kenkyuka https://orcid.org/0000-0002-3878-6729 Nobuyuki Sano Fukuoka International College of Health and Welfare: Fukuoka Kokusai Iryo Fukushi Gakuin Donald Maciver Queen Margaret University Edinburgh

developed. Therefore, we developed a new model and questionnaire that described the potential determinants of positive perceptions towards attending school among elementary school students in state-run schools and explored the model in this research.

Methods
The current study was a cross-sectional study of elementary school children in the 5th year in state-run schools in Saitama, Japan. The research protocol was reviewed and approved by the Research Ethics Committee at Saitama Prefectural University (No. 19078).

Procedures
This study was conducted collaboratively between Saitama Prefectural University and the Saitama educational board. The measures described below were distributed to the children between April and December 2019. Each school district chose the periods for administration. Prior to distribution, school district o cers visited the schools, described the aim of this survey to school teachers, and obtained agreement to conduct the survey. School district o cers explained the aim and asked children to participate in a homeroom session while the school teachers facilitated students' group activities that were not relevant to the subjects or teaching. Data collection was completed by teachers in each classroom.

Participants
The educational board manages 802 state-run elementary schools (99% of total elementary schools) in Saitama. Those state-run elementary schools are grouped into 72 school districts matched to municipalities. We targeted 8 school districts (selecting 2 school districts from the southern, northern, western, and eastern areas). Chairpersons of the school districts provided permission to implement the survey.
Children begin elementary education at six years of age in Japan. Thus, elementary school children in the 5th year were either 10 or 11 years old during the data collection period. There were 8045 eligible children who were in the 5th year for this survey (Supplemental material Table). The district with small school numbers employed no school counselors. Unlike European countries with inclusive policies, children who require special support in school because of physical, psychological, and intellectual issues attend segregated special schools [4]. No school providing special education was included in this survey.

Hypothesized model
We hypothesized that a positive perception towards attending school was in uenced by positive relationships with friends and school teachers, positive perceptions of current circumstances, positive subjective health, and having someone to share experiences and thoughts with (Fig. 1). To examine the model, an original questionnaire was developed through a collaboration between members of the Saitama educational board and faculty whose specialty was education. Several meetings took place between the members of the development team to nalize the questionnaire. Items were developed based on the literature, national guidelines and the expertise of the development team. It was strongly felt by the development team, given their experience working in and around schools, that a large number of questions would be a burden to the participants; thus, a shorter tool was desirable.

Data collection
There were 14 items in the original questionnaire. The rst 13 items targeted intrapsychic and interpersonal determinants of positive perceptions towards attending school. The 14th item listed potential persons who were accessible for the participants to share their experiences.
To capture how children felt about attending school, the item wording was "I am looking forward to going to my school." The responses were 4 = strongly agree, 3 = agree, 2 = disagree, and 1 = strongly disagree.
To capture positive relationships with friends and school teachers, the following ve items were positively worded: "I play with friends a lot," "I get along well with friends," "Other kids like me," "School teachers approve of my efforts" and "I am happy when talking to school teachers." For the ve items, the responses were 3 = very much, 2 = a little bit, and 1 = not at all.
To capture the positive perceptions of current circumstances, the following four items were positively worded: "I am able to prepare for classes by my own," "I am proud of myself," "I am helpful to others" and "I believe my efforts will be rewarded." For the item about being able to prepare for classes independently, the responses were 4 = very well, 3 = fairly, 2 = poorly, and 1 = not at all. For other items, the responses were 3 = very much, 2 = a little bit, and 1 = not at all.
To capture subjective health, the following three items were employed: "My health status," "I get tired easily" and "I have anxieties and/or worries." For the general health status, the responses were 4 = good, 3 = fair, 2 = not very good, and 1 = not good at all. For the item for tiredness, the responses were 3 = not tired at all, 2 = sometimes tired, and 1 = frequently tired. For the item about anxieties and/or worries, the responses were 3 = no anxiety/worry at all, 2 = a little bit of anxiety/worry, and 1 = a lot of anxiety/worry.
To capture the persons with whom the children shared their experiences and thoughts as the 14th item, the following eight responses were selected: (a) my mother, (b) my father, (c) my siblings, (d) other family members/relatives, (e) school teachers, (f) a school counselor, (g) instructors of extracurricular activities, and (h) friends. The item also asked the participants the frequency of accessing those persons. The responses were 3 = frequently, 2 = sometimes, 1 = rarely, and 0 = there is no such person.

Data analysis
The statistical data analysis included descriptive statistics, Cramer's V, Spearman's rank correlation coe cient, and a structural equation model (SEM). The analysis was conducted with HAD 17.0 [29], SPSS v.26 for Japanese (IBM, Japan), and Mplus version 7.3 [30].
Before conducting the SEM, we observed the data characteristics. Because the data were collected from 8 school districts, we explored individual-level variance and group-level (school district-level, in this study) variance [31]. Group homogeneity was identi ed with intraclass correlation coe cient (ICC). A high ICC results in a biased error variance in conventional regression models, overestimating the relationship between variables. An ICC of 0.25 and higher indicates that much of the variation in the dependent variables is due to the features of groups rather than the characteristics of individuals [32]. In our study, we employed a more conservative value of 0.05 [33] because we collected data from a large sample.
After con rming the ICC values, we observed sample descriptive data with individual-level variance. We compared boys and girls according to the survey items. For the comparisons, we used Cramer's V, which indicates how strongly two categorical variables are associated, with 1 indicating a strong association and 0 indicating no association. Values of 0.1, .03, and 0.5 are considered to be small, medium, and large effect sizes, respectively [34]. We also used Spearman's rank correlation coe cient between the variables. Coe cients were interpreted as limited (0.00 to 0.25), fair 0(.25 to 0.50), moderate (0.50 to 0.75) and excellent (0.75 to 1.0) [35].
SEM with ordinal data was conducted using the modi ed weighted least squares method (WLSMV). We examined the hypothesized model using all data obtained by the original questionnaire and then, modi ed the model. The model t indices were comparative t index (CFI), Tucker Lewis index (TLI), and root mean square error of approximation (RMSEA). For CFI and TLI, a value higher than 0.9 is the best model t. For RMSEA, a value of 0.05 and smaller is a close t, a value of 0.08 and smaller is a reasonable t, and a value of 0.1 and higher is a poor t [36]. The RMSEA value was supplemented with a 90% con dence interval (90% CI).

Demographic characteristics of children
The average response rate was 85% (between 78.9% and 95.4% in school districts) (Supplemental material Table). In total, 6860 children completed the questionnaire. Among the collected data from 6860 children, 19 children were excluded due to missing data. As a result, data from 6841 children were analyzed. Among them, 2995 (43.78%) were boys, 3169 (46.32%) were girls, and 677 (9.9%) were children of uncategorized gender. Across the school district, no signi cant difference was observed in percentages between boys and girls (0.032 for Cramer's V, p = 0.521). Every student was either 10 or 11 years old.
Response characteristics Table 1 shows the values for the valid sample number, interclass correlation, and p-value for each question item. Across the question items, the valid data rates were 95% and higher. No question item showed an ICC value of 0.05 or higher, indicating that all data could be described with individual-level variance.  Tables 2, 3, 4 and 5 show the responses and comparison of the responses between boys and girls according to the survey items. All question items indicated an ignorable level or no association in the comparison, indicating no difference in responses between boys and girls (all p < 0.01). Table 2 shows the items of attending school and the positive relationships with friends and school teachers. For the item "I am looking forward to going to my school," 45% of the children responded "agree," followed by "strongly agree" (35%), "disagree" (14%) and "strongly disagree" (5%). Regarding the positive relationships with friends and school teachers, 70% of the children indicated "very much" for "playing with friends a lot," and 80% of the children indicated "very much" for "getting along well with friends." More than 85% of the children perceived that other children liked them ("very much" and "a little bit"), school teachers approved of their efforts ("very much" and "a little bit"), and they were happy when talking to school teachers ("very much" and "a little bit").  Table 3 shows the items of the positive perceptions of current circumstances and their subjective health. More than 80% of the children perceived that they were being able to prepare for classes independently ("very well" and "fairly"), were proud of themselves ("very well" and "a little bit"), and were helpful to others ("very well" and "a little bit"). More than 95% of the children believed their efforts would be rewarded ("very well" and "a little bit").
For the items on health status, 95% of the children perceived their subjective health status positively ("good" and "fair"). Only 20% of the children "did not get tired at all" while 80% of the children perceived becoming tired ("sometimes" and "frequently"). Only 30% of the children "had no anxiety/worry at all" while 70% of the children perceived having anxieties/worries ("a little bit" and "a lot"). Subtotal Tables 4 and 5 shows the items of the persons the children talked to when sharing experiences and thoughts. More than 90% of the children indicated doing so with their mother ("frequently" and "sometimes"). More than 70% of the children indicated doing so with their father ("frequently" and "sometimes"). More than 60% of the children indicated doing so with siblings, other family members/relatives, and school teachers ("frequently" and "sometimes"). For school counselors, nearly 50 % of the children indicated "rarely" and more than 40% of the children indicated "no one such person". For instructors of extracurricular activities, more than 40% of the children indicated "rarely." More than 80% of the children indicated doing so with friends ("frequently" and "sometimes").  Spearman's rank correlation coe cient between variables The following variables showed signi cant and positive correlations with how children felt about attending school ("I am looking forward to going to school") at a fair level (all p < 0.01): "getting along well with friends" (r = 0.303), "other kids like me" (r = 0.306), "school teachers approve of my efforts" (r = 0.339), "being happy when talking to school teachers" (r = 0.428), "being able to prepare for classes by own" (r = 0.254), "being proud of oneself" (r = 0.320), "being helpful to others" (r = 0.314), "believing one's efforts will be rewarded" (r = 0.306), and subjective health status (r = 0.273). One signi cant and positive correlation at a moderate level was observed between "being proud of oneself" and "being helpful to others" (r = 0.526) ( Table 6). The initial model examination

Discussion
This study identi ed the structural relations among positive perceptions towards attending school for elementary school students in the 5th year in state-run schools in Saitama, Japan. The latent variable of positive relationships with friends and school teachers was positively and directly associated with children's feelings towards attending school. This study con rms the importance of positive relationships with friends and teachers. The relationships have previously been identi ed as key to overcoming school nonattendance [9][10][11][12]24]. Positive health status and a positive perception of current circumstances were also related to how children felt about attending school, but not strongly. The latent variable of having someone to share experiences and thoughts did not impact the outcome of interest. The presence or absence of a school counselor was not found to be important.
Current guidance emphasizing the importance of understanding, acceptance and social support [4] seem to be re ected in the results obtained in this study. The items in the latent variable of positive relationship with friends and school teachers included "I get along well with friends," "other kids like me," and "school teachers approve of my efforts." In previous research, peer acceptance in school was associated with subjective health [37]. Support from school teachers and classmates has also been found to be signi cantly and positively related to "school satisfaction" [38] and emotional stability [39] among elementary school students.
The present study identi ed a moderate correlation between "school teachers approve of my efforts" and "I am happy when talking to school teachers." Moreover, sharing experiences with school teachers correlated with sharing experiences with mothers, fathers, siblings, and other family members or relatives.
Feelings of being supported by adults have been identi ed as important for children with social, emotional and mental health-related di culties to ourish in the school environment [40]. School teachers may be perceived as accessible adults who are available at schools. In fact, more than 60% of the children in this study indicated that school teachers were the people to whom the children talked when sharing experiences and thoughts, a frequency that was equivalent to siblings and other family members.
Teachers and the school environment have the potential to improve and intervene in students' mental health [41]. School counselors have previously been recommended. The presence or absence of school counselors, however, was not an important aspect in this study. The employment system of counselors, i.e., being employed directly by school district o ces but not in schools may account for the result. For elementary school students, specialist counsellors were not as accessible as other staff, such as teachers. School teachers therefore have more potential to improve students' well-being and mental health in Japan. A range of interventions have been tested for mental health promotion in schools with varying degrees of success [42]. Evidence-based strategies to improve positive emotions and well-being may be useful in supporting children who have issues with attendance [43][44][45][46].
Strengths and limitations of the study A large sample size, obtained by collaboration with the educational board in Saitama, Japan, enabled us to examine our hypothesized model. A high collection rate was supported by the school teachers who distributed and collected the original questionnaire.
However, this study has some limitations. First, our questionnaire was developed speci cally for this study. There may be variables that were not included that account for some of the variance in the outcomes. Additionally, the generation of items was based on a rigorous development process; however, children were not included in development. Future studies may replace the current variables or add variables to improve the model t indices. Methods including students may be used to improve the questionnaire. Second, we do not know whether students with a non-school attendance history were included in this study. Thus, we were unable to compare responses between students with poor versus good attendance.

Conclusions
This study examined children's perspectives on school attendance and related variables through a survey of 6841 elementary school students. This study found that positive relationships with friends and school teachers were signi cantly and positively associated with children looking forward to attending school. Positive health status and a positive perception of current circumstances were also signi cant, but the relationship was not as strong. This study reported a large-scale exploration of school nonattendance in Japan and presented a novel questionnaire and model. The rst examination using a SEM Numbers are path coe cients, **p < 0.05, *p < 0.001