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A pandemic year

How the pandemic is reshaping education

[ Parents and teachers: How are your kids handling school during the pandemic? ]

School by screen

Remote learning keeps going.

[ Do you have questions about how D.C.-area school systems are returning kids to the classroom? Ask The Post. ]

— Donna St. George

The great catch-up, schools set to attack lost learning.

[ 'A lost generation’: Surge of research reveals students sliding backward, most vulnerable worst affected ]

— Laura Meckler

When students struggle

More support for mental health.

[ Partly hidden by isolation, many of the nation’s schoolchildren struggle with mental health ]

— Donna St. George and Valerie Strauss

Teachers tested

Educators draw lessons from a challenging year.

[ Dispatches from education’s front lines: Teachers share their experiences as school returns during the pandemic ]

[ For locked-down high-schoolers, reading ‘The Plague’ is daunting, and then comforting ]

Connected at home

Laptops and hotspots likely to stick around.

[ A look back one year after the WHO declared the coronavirus a pandemic and changed how we live ]

D-plus school buildings

Pandemic spotlight offers real chance for reform, — hannah natanson, rethinking attendance, who attends, who is absent.

Funding schools

Changing the ‘butt-in-seats’ formula.

[ Answer Sheet: This is what inadequate funding at a public school looks and feels like — as told by an entire faculty ]

— Valerie Strauss

Wanted: new ways to assess students.

[ Answer Sheet: One month in, Biden angers supporters who wanted him to curb standardized testing ]

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COVID-19 has fuelled a global ‘learning poverty’ crisis

The pandemic saw empty classrooms all across the world. Image:  REUTERS/Marzio Toniolo

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• Before the pandemic, the world was already facing an education crisis.
• Last year, 53% of 10-year-old children in low- and middle-income countries either had failed to learn to read with comprehension or were out of school.
• COVID-19 has exacerbated learning gaps further, taking 1.6 billion students out of school at its peak.
• To mitigate the situation, parents, teachers, students, governments, and development partners must work together to remedy the crisis.

Even before COVID-19 forced a massive closure of schools around the globe, the world was in the middle of a learning crisis that threatened efforts to build human capital—the skills and know-how needed for the jobs of the future. More than half (53 percent) of 10-year-old children in low- and middle-income countries either had failed to learn to read with comprehension or were out of school entirely. This is what we at the World Bank call learning poverty . Recent improvements in Learning Poverty have been extremely slow. If trends of the last 15 years were to be extrapolated, it will take 50 years to halve learning poverty. Last year we proposed a target to cut Learning Poverty by at least half by 2030. This would require doubling or trebling the recent rate of improvement in learning, something difficult but achievable. But now COVID-19 is likely to deepen learning gaps and make this dramatically more difficult.

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3 things we can do reverse the ‘covid slide’ in education, this indian state is a model of how to manage education during a pandemic, covid-19 is an opportunity to reset education. here are 4 ways how.

Temporary school closures in more than 180 countries have, at the peak of the pandemic, kept nearly 1.6 billion students out of school ; for about half of those students, school closures are exceeding 7 months. Although most countries have made heroic efforts to put remote and remedial learning strategies in place, learning losses are likely to happen. A recent survey of education officials on government responses to COVID-19 by UNICEF, UNESCO, and the World Bank shows that while countries and regions have responded in various ways, only half of the initiatives are monitoring usage of remote learning (Figure 1, top panel). Moreover, where usage is being monitored, the remote learning is being used by less than half of the student population (Figure 1, bottom panel), and most of those cases are online platforms in high- and middle-income countries.

COVID-19-related school closures are forcing countries even further off track from achieving their learning goals. Students currently in school stand to lose $10 trillion in labor earnings over their working lives. That is almost one-tenth of current global GDP, or half the United States’ annual economic output, or twice the global annual public expenditure on primary and secondary education.

In a recent brief I summarize the findings of three simulation scenarios to gauge potential impacts of the crisis on learning poverty. In the most pessimistic scenario, COVID-related school closures could increase the learning poverty rate in the low- and middle-income countries by 10 percentage points, from 53% to 63%. This 10-percentage-point increase in learning poverty implies that an additional 72 million primary-school-age children could fall into learning poverty , out of a population of 720 million children of primary-school age.

This result is driven by three main channels: school closures, effectiveness of mitigation and remediation, and the economic impact. School closures, and the effectiveness of mitigation and remediation, will affect the magnitude of the learning loss, while the economic impact will affect dropout rates. In these simulations, school closures are assumed to last for 70% of the school year, there will be no remediation, mitigation effectiveness will vary from 5%, 7% and 15% for low-, middle- or high-income countries, respectively. The economic channel builds on macro-economic growth projections , and estimates the possible impacts of economic contractions on household income, and the likelihood that these will affect primary school age-school-enrollment.

Most of the potential increase in learning poverty would take place in regions with a high but still average level of learning poverty in the global context pre-COVID, such as South Asia (which had a 63% pre-pandemic rate of learning poverty), Latin America (48%) , and East Asia and the Pacific (21%). In Sub-Saharan Africa and Low-income countries, where learning poverty was already at 87% and 90% before COVID, increases would be relatively small, at 4 percentage points and 2 percentage points, respectively. This reflects that most of the learning losses in those regions would impact students who were already failing to achieve the minimum reading proficiency level by the end of primary—that is, those who were already learning-poor.

To gauge at the impacts of the current crisis in Sub-Saharan Africa and the Middle East and Northern Africa we need to examine other indicators of learning deprivation. In these two regions children are on average the furthest below the minimum proficiency level, with a Learning Deprivation Gap (the average distance of a learning deprived child to the minimum reading proficiency level) of approximately 20%. This rate is double the global average (10.5%), four times larger than the East Asia and Pacific Gap (5%), and more than tenfold larger the Europe and Central Asia average gap (1.3%). The magnitude of learning deprivation gap suggests that on average, students on those regions are one full academic year behind in terms of learning, or two times behind the global average.

In the most pessimistic scenario, COVID-19 school closures might increase the learning deprivation gap by approximately 2.5 percentage points in Sub-Saharan Africa, Middle East and North Africa, and Latin America. However, the same increase in the learning deprivation gap does not imply the same impact in qualitative terms. An indicator of the severity of learning deprivation, which captures the inequality among the learning deprived children, reveals that the severity of learning deprivation in the Middle East and Sub-Saharan Africa could increase by approximately 1.5 percentage points, versus an increase of 0.5 percentage points in Latin America. This suggests that the new learning-deprived in Latin America would remain closer to the minimum proficiency level than children in Middle East and Sub-Saharan Africa. As a consequence, the range of options required to identify students’ needs and provide learning opportunities, will be qualitatively different in these two groups of countries— more intense in Sub-Saharan Africa and the Middle East than in Latin America.

In absolute terms, Sub-Sharan Africa and the Middle East and Northern Africa would remain the two regions with the largest number of learning-deprived children. The depth of learning deprivation in Sub-Saharan Africa will increase by three times more than the number of children who are learning-deprived. This is almost three times the global average, and four times more than in Europe and Central Asia. This suggests an increase in the complexity and the cost of tackling the learning crisis in the continent.

Going forward, as schools reopen , educational systems will need to be more flexible and adapt to the student’s needs. Countries will need to reimagine their educational systems and to use the opportunity presented by the pandemic and its triple shock—to health, the economy, and the educational system—to build back better . Several policy options deployed during the crisis, such as remote learning solutions, structured lesson plans, curriculum prioritization, and accelerated teaching programs (to name a few), can contribute to building an educational system that is more resilient to crisis, flexible in meeting student needs, and equitable in protecting the most vulnerable.

The results from these simulations are not destiny. Parents, teachers, students, governments, and development partners can work together to deploy effective mitigation and remediation strategies to protect the COVID-19 generation’s future. School reopening, when safe, is critical, but it is not enough. The simulation results show major differences in the potential impacts of the crisis on the learning poor across regions . The big challenge will be to rapidly identify and respond to each individual student’s learning needs flexibly and to build back educational systems more resilient to shocks, using technology effectively to enable learning both at school and at home.

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Subscribe to the center for universal education bulletin, daphna bassok , daphna bassok nonresident senior fellow - governance studies , brown center on education policy @daphnabassok lauren bauer , lauren bauer fellow - economic studies , associate director - the hamilton project @laurenlbauer stephanie riegg cellini , stephanie riegg cellini nonresident senior fellow - governance studies , brown center on education policy helen shwe hadani , helen shwe hadani former brookings expert @helenshadani michael hansen , michael hansen senior fellow - brown center on education policy , the herman and george r. brown chair - governance studies @drmikehansen douglas n. harris , douglas n. harris nonresident senior fellow - governance studies , brown center on education policy , professor and chair, department of economics - tulane university @douglasharris99 brad olsen , brad olsen senior fellow - global economy and development , center for universal education @bradolsen_dc richard v. reeves , richard v. reeves president - american institute for boys and men @richardvreeves jon valant , and jon valant director - brown center on education policy , senior fellow - governance studies @jonvalant kenneth k. wong kenneth k. wong nonresident senior fellow - governance studies , brown center on education policy.

March 12, 2021

• 11 min read

One year ago, the World Health Organization declared the spread of COVID-19 a worldwide pandemic. Reacting to the virus, schools at every level were sent scrambling. Institutions across the world switched to virtual learning, with teachers, students, and local leaders quickly adapting to an entirely new way of life. A year later, schools are beginning to reopen, the $1.9 trillion stimulus bill has been passed, and a sense of normalcy seems to finally be in view; in President Joe Biden’s speech last night, he spoke of “finding light in the darkness.” But it’s safe to say that COVID-19 will end up changing education forever, casting a critical light on everything from equity issues to ed tech to school financing.

Below, Brookings experts examine how the pandemic upended the education landscape in the past year, what it’s taught us about schooling, and where we go from here.

In the United States, we tend to focus on the educating roles of public schools, largely ignoring the ways in which schools provide free and essential care for children while their parents work. When COVID-19 shuttered in-person schooling, it eliminated this subsidized child care for many families. It created intense stress for working parents, especially for mothers who left the workforce at a high rate.

The pandemic also highlighted the arbitrary distinction we make between the care and education of elementary school children and children aged 0 to 5 . Despite parents having the same need for care, and children learning more in those earliest years than at any other point, public investments in early care and education are woefully insufficient. The child-care sector was hit so incredibly hard by COVID-19. The recent passage of the American Rescue Plan is a meaningful but long-overdue investment, but much more than a one-time infusion of funds is needed. Hopefully, the pandemic represents a turning point in how we invest in the care and education of young children—and, in turn, in families and society.

Congressional reauthorization of Pandemic EBT for  this school year , its  extension  in the American Rescue Plan (including for summer months), and its place as a  central plank  in the Biden administration’s anti-hunger agenda is well-warranted and evidence based. But much more needs to be done to ramp up the program–even  today , six months after its reauthorization, about half of states do not have a USDA-approved implementation plan.

In contrast, enrollment is up in for-profit and online colleges. The research repeatedly finds weaker student outcomes for these types of institutions relative to community colleges, and many students who enroll in them will be left with more debt than they can reasonably repay. The pandemic and recession have created significant challenges for students, affecting college choices and enrollment decisions in the near future. Ultimately, these short-term choices can have long-term consequences for lifetime earnings and debt that could impact this generation of COVID-19-era college students for years to come.

Many U.S. educationalists are drawing on the “build back better” refrain and calling for the current crisis to be leveraged as a unique opportunity for educators, parents, and policymakers to fully reimagine education systems that are designed for the 21st rather than the 20th century, as we highlight in a recent Brookings report on education reform . An overwhelming body of evidence points to play as the best way to equip children with a broad set of flexible competencies and support their socioemotional development. A recent article in The Atlantic shared parent anecdotes of children playing games like “CoronaBall” and “Social-distance” tag, proving that play permeates children’s lives—even in a pandemic.

Tests play a critical role in our school system. Policymakers and the public rely on results to measure school performance and reveal whether all students are equally served. But testing has also attracted an inordinate share of criticism, alleging that test pressures undermine teacher autonomy and stress students. Much of this criticism will wither away with  different  formats. The current form of standardized testing—annual, paper-based, multiple-choice tests administered over the course of a week of school—is outdated. With widespread student access to computers (now possible due to the pandemic), states can test students more frequently, but in smaller time blocks that render the experience nearly invisible. Computer adaptive testing can match paper’s reliability and provides a shorter feedback loop to boot. No better time than the present to make this overdue change.

A third push for change will come from the outside in. COVID-19 has reminded us not only of how integral schools are, but how intertwined they are with the rest of society. This means that upcoming schooling changes will also be driven by the effects of COVID-19 on the world around us. In particular, parents will be working more from home, using the same online tools that students can use to learn remotely. This doesn’t mean a mass push for homeschooling, but it probably does mean that hybrid learning is here to stay.

I am hoping we will use this forced rupture in the fabric of schooling to jettison ineffective aspects of education, more fully embrace what we know works, and be bold enough to look for new solutions to the educational problems COVID-19 has illuminated.

There is already a large gender gap in education in the U.S., including in  high school graduation rates , and increasingly in college-going and college completion. While the pandemic appears to be hurting women more than men in the labor market, the opposite seems to be true in education.

Looking through a policy lens, though, I’m struck by the timing and what that timing might mean for the future of education. Before the pandemic, enthusiasm for the education reforms that had defined the last few decades—choice and accountability—had waned. It felt like a period between reform eras, with the era to come still very unclear. Then COVID-19 hit, and it coincided with a national reckoning on racial injustice and a wake-up call about the fragility of our democracy. I think it’s helped us all see how connected the work of schools is with so much else in American life.

We’re in a moment when our long-lasting challenges have been laid bare, new challenges have emerged, educators and parents are seeing and experimenting with things for the first time, and the political environment has changed (with, for example, a new administration and changing attitudes on federal spending). I still don’t know where K-12 education is headed, but there’s no doubt that a pivot is underway.

• First, state and local leaders must leverage commitment and shared goals on equitable learning opportunities to support student success for all.
• Second, align and use federal, state, and local resources to implement high-leverage strategies that have proven to accelerate learning for diverse learners and disrupt the correlation between zip code and academic outcomes.
• Third, student-centered priority will require transformative leadership to dismantle the one-size-fits-all delivery rule and institute incentive-based practices for strong performance at all levels.
• Fourth, the reconfigured system will need to activate public and parental engagement to strengthen its civic and social capacity.
• Finally, public education can no longer remain insulated from other policy sectors, especially public health, community development, and social work.

These efforts will strengthen the capacity and prepare our education system for the next crisis—whatever it may be.

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March 26, 2024

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• Published: 30 January 2023

A systematic review and meta-analysis of the evidence on learning during the COVID-19 pandemic

• Bastian A. Betthäuser   ORCID: orcid.org/0000-0002-4544-4073 1 , 2 , 3 ,
• Anders M. Bach-Mortensen   ORCID: orcid.org/0000-0001-7804-7958 2 &
• Per Engzell   ORCID: orcid.org/0000-0002-2404-6308 3 , 4 , 5  

Nature Human Behaviour volume  7 ,  pages 375–385 ( 2023 ) Cite this article

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To what extent has the learning progress of school-aged children slowed down during the COVID-19 pandemic? A growing number of studies address this question, but findings vary depending on context. Here we conduct a pre-registered systematic review, quality appraisal and meta-analysis of 42 studies across 15 countries to assess the magnitude of learning deficits during the pandemic. We find a substantial overall learning deficit (Cohen’s d  = −0.14, 95% confidence interval −0.17 to −0.10), which arose early in the pandemic and persists over time. Learning deficits are particularly large among children from low socio-economic backgrounds. They are also larger in maths than in reading and in middle-income countries relative to high-income countries. There is a lack of evidence on learning progress during the pandemic in low-income countries. Future research should address this evidence gap and avoid the common risks of bias that we identify.

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The coronavirus disease 2019 (COVID-19) pandemic has led to one of the largest disruptions to learning in history. To a large extent, this is due to school closures, which are estimated to have affected 95% of the world’s student population 1 . But even when face-to-face teaching resumed, instruction has often been compromised by hybrid teaching, and by children or teachers having to quarantine and miss classes. The effect of limited face-to-face instruction is compounded by the pandemic’s consequences for children’s out-of-school learning environment, as well as their mental and physical health. Lockdowns have restricted children’s movement and their ability to play, meet other children and engage in extra-curricular activities. Children’s wellbeing and family relationships have also suffered due to economic uncertainties and conflicting demands of work, care and learning. These negative consequences can be expected to be most pronounced for children from low socio-economic family backgrounds, exacerbating pre-existing educational inequalities.

It is critical to understand the extent to which learning progress has changed since the onset of the COVID-19 pandemic. We use the term ‘learning deficit’ to encompass both a delay in expected learning progress, as well as a loss of skills and knowledge already gained. The COVID-19 learning deficit is likely to affect children’s life chances through their education and labour market prospects. At the societal level, it can have important implications for growth, prosperity and social cohesion. As policy-makers across the world are seeking to limit further learning deficits and to devise policies to recover learning deficits that have already been incurred, assessing the current state of learning is crucial. A careful assessment of the COVID-19 learning deficit is also necessary to weigh the true costs and benefits of school closures.

A number of narrative reviews have sought to summarize the emerging research on COVID-19 and learning, mostly focusing on learning progress relatively early in the pandemic 2 , 3 , 4 , 5 , 6 . Moreover, two reviews harmonized and synthesized existing estimates of learning deficits during the pandemic 7 , 8 . In line with the narrative reviews, these two reviews find a substantial reduction in learning progress during the pandemic. However, this finding is based on a relatively small number of studies (18 and 10 studies, respectively). The limited evidence that was available at the time these reviews were conducted also precluded them from meta-analysing variation in the magnitude of learning deficits over time and across subjects, different groups of students or country contexts.

In this Article, we conduct a systematic review and meta-analysis of the evidence on COVID-19 learning deficits 2.5 years into the pandemic. Our primary pre-registered research question was ‘What is the effect of the COVID-19 pandemic on learning progress amongst school-age children?’, and we address this question using evidence from studies examining changes in learning outcomes during the pandemic. Our second pre-registered research aim was ‘To examine whether the effect of the COVID-19 pandemic on learning differs across different social background groups, age groups, boys and girls, learning areas or subjects, national contexts’.

We contribute to the existing research in two ways. First, we describe and appraise the up-to-date body of evidence, including its geographic reach and quality. More specifically, we ask the following questions: (1) what is the state of the evidence, in terms of the available peer-reviewed research and grey literature, on learning progress of school-aged children during the COVID-19 pandemic?, (2) which countries are represented in the available evidence? and (3) what is the quality of the existing evidence?

Our second contribution is to harmonize, synthesize and meta-analyse the existing evidence, with special attention to variation across different subpopulations and country contexts. On the basis of the identified studies, we ask (4) to what extent has the learning progress of school-aged children changed since the onset of the pandemic?, (5) how has the magnitude of the learning deficit (if any) evolved since the beginning of the pandemic?, (6) to what extent has the pandemic reinforced inequalities between children from different socio-economic backgrounds?, (7) are there differences in the magnitude of learning deficits between subject domains (maths and reading) and between age groups (primary and secondary students)? and (8) to what extent does the magnitude of learning deficits vary across national contexts?

Below, we report our answers to each of these questions in turn. The questions correspond to the analysis plan set out in our pre-registered protocol ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249944 ), but we have adjusted the order and wording to aid readability. We had planned to examine gender differences in learning progress during the pandemic, but found there to be insufficient evidence to conduct this subgroup analysis, as the large majority of the identified studies do not provide evidence on learning deficits separately by gender. We also planned to examine how the magnitude of learning deficits differs across groups of students with varying exposures to school closures. This was not possible as the available data on school closures lack sufficient depth with respect to variation of school closures within countries, across grade levels and with respect to different modes of instruction, to meaningfully examine this association.

The state of the evidence

Our systematic review identified 42 studies on learning progress during the COVID-19 pandemic that met our inclusion criteria. To be included in our systematic review and meta-analysis, studies had to use a measure of learning that can be standardized (using Cohen’s d ) and base their estimates on empirical data collected since the onset of the COVID-19 pandemic (rather than making projections based on pre-COVID-19 data). As shown in Fig. 1 , the initial literature search resulted in 5,153 hits after removal of duplicates. All studies were double screened by the first two authors. The formal database search process identified 15 eligible studies. We also hand searched relevant preprint repositories and policy databases. Further, to ensure that our study selection was as up to date as possible, we conducted two full forward and backward citation searches of all included studies on 15 February 2022, and on 8 August 2022. The citation and preprint hand searches allowed us to identify 27 additional eligible studies, resulting in a total of 42 studies. Most of these studies were published after the initial database search, which illustrates that the body of evidence continues to expand. Most studies provide multiple estimates of COVID-19 learning deficits, separately for maths and reading and for different school grades. The number of estimates ( n  = 291) is therefore larger than the number of included studies ( n  = 42).

Flow diagram of the study identification and selection process, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The geographic reach of evidence is limited

Table 1 presents all included studies and estimates of COVID-19 learning deficits (in brackets), grouped by the 15 countries represented: Australia, Belgium, Brazil, Colombia, Denmark, Germany, Italy, Mexico, the Netherlands, South Africa, Spain, Sweden, Switzerland, the UK and the United States. About half of the estimates ( n  = 149) are from the United States, 58 are from the UK, a further 70 are from other European countries and the remaining 14 estimates are from Australia, Brazil, Colombia, Mexico and South Africa. As this list shows, there is a strong over-representation of studies from high-income countries, a dearth of studies from middle-income countries and no studies from low-income countries. This skewed representation should be kept in mind when interpreting our synthesis of the existing evidence on COVID-19 learning deficits.

The quality of evidence is mixed

We assessed the quality of the evidence using an adapted version of the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool 9 . More specifically, we analysed the risk of bias of each estimate from confounding, sample selection, classification of treatments, missing data, the measurement of outcomes and the selection of reported results. A.M.B.-M. and B.A.B. performed the risk-of-bias assessments, which were independently checked by the respective other author. We then assigned each study an overall risk-of-bias rating (low, moderate, serious or critical) based on the estimate and domain with the highest risk of bias.

Figure 2a shows the distribution of all studies of COVID-19 learning deficits according to their risk-of-bias rating separately for each domain (top six rows), as well as the distribution of studies according to their overall risk of bias rating (bottom row). The overall risk of bias was considered ‘low’ for 15% of studies, ‘moderate’ for 30% of studies, ‘serious’ for 25% of studies and ‘critical’ for 30% of studies.

a , Domain-specific and overall distribution of studies of COVID-19 learning deficits by risk of bias rating using ROBINS-I, including studies rated to be at critical risk of bias ( n  = 19 out of a total of n  = 61 studies shown in this figure). In line with ROBINS-I guidance, studies rated to be at critical risk of bias were excluded from all analyses and other figures in this article and in the Supplementary Information (including b ). b , z curve: distribution of the z scores of all estimates included in the meta-analysis ( n  = 291) to test for publication bias. The dotted line indicates z  = 1.96 ( P  = 0.050), the conventional threshold for statistical significance. The overlaid curve shows a normal distribution. The absence of a spike in the distribution of the z scores just above the threshold for statistical significance and the absence of a slump just below it indicate the absence of evidence for publication bias.

In line with ROBINS-I guidance, we excluded studies rated to be at critical risk of bias ( n  = 19) from all of our analyses and figures, except for Fig. 2a , which visualizes the distribution of studies according to their risk of bias 9 . These are thus not part of the 42 studies included in our meta-analysis. Supplementary Table 2 provides an overview of these studies as well as the main potential sources of risk of bias. Moreover, in Supplementary Figs. 3 – 6 , we replicate all our results excluding studies deemed to be at serious risk of bias.

As shown in Fig. 2a , common sources of potential bias were confounding, sample selection and missing data. Studies rated at risk of confounding typically compared only two timepoints, without accounting for longer time trends in learning progress. The main causes of selection bias were the use of convenience samples and insufficient consideration of self-selection by schools or students. Several studies found evidence of selection bias, often with students from a low socio-economic background or schools in deprived areas being under-represented after (as compared with before) the pandemic, but this was not always adjusted for. Some studies also reported a higher amount of missing data post-pandemic, again generally without adjustment, and several studies did not report any information on missing data. For an overview of the risk-of-bias ratings for each domain of each study, see Supplementary Fig. 1 and Supplementary Tables 1 and 2 .

No evidence of publication bias

Publication bias can occur if authors self-censor to conform to theoretical expectations, or if journals favour statistically significant results. To mitigate this concern, we include not only published papers, but also preprints, working papers and policy reports.

Moreover, Fig. 2b tests for publication bias by showing the distribution of z -statistics for the effect size estimates of all identified studies. The dotted line indicates z  = 1.96 ( P  = 0.050), the conventional threshold for statistical significance. The overlaid curve shows a normal distribution. If there was publication bias, we would expect a spike just above the threshold, and a slump just below it. There is no indication of this. Moreover, we do not find a left-skewed distribution of P values (see P curve in Supplementary Fig. 2a ), or an association between estimates of learning deficits and their standard errors (see funnel plot in Supplementary Fig. 2b ) that would suggest publication bias. Publication bias thus does not appear to be a major concern.

Having assessed the quality of the existing evidence, we now present the substantive results of our meta-analysis, focusing on the magnitude of COVID-19 learning deficits and on the variation in learning deficits over time, across different groups of students, and across country contexts.

Learning progress slowed substantially during the pandemic

Figure 3 shows the effect sizes that we extracted from each study (averaged across grades and learning subject) as well as the pooled effect size (red diamond). Effects are expressed in standard deviations, using Cohen’s d . Estimates are pooled using inverse variance weights. The pooled effect size across all studies is d  = −0.14, t (41) = −7.30, two-tailed P  = 0.000, 95% confidence interval (CI) −0.17 to −0.10. Under normal circumstances, students generally improve their performance by around 0.4 standard deviations per school year 10 , 11 , 12 . Thus, the overall effect of d  = −0.14 suggests that students lost out on 0.14/0.4, or about 35%, of a school year’s worth of learning. On average, the learning progress of school-aged children has slowed substantially during the pandemic.

Effect sizes are expressed in standard deviations, using Cohen’s d , with 95% CI, and are sorted by magnitude.

Learning deficits arose early in the pandemic and persist

One may expect that children were able to recover learning that was lost early in the pandemic, after teachers and families had time to adjust to the new learning conditions and after structures for online learning and for recovering early learning deficits were set up. However, existing research on teacher strikes in Belgium 13 and Argentina 14 , shortened school years in Germany 15 and disruptions to education during World War II 16 suggests that learning deficits are difficult to compensate and tend to persist in the long run.

Figure 4 plots the magnitude of estimated learning deficits (on the vertical axis) by the date of measurement (on the horizontal axis). The colour of the circles reflects the relevant country, the size of the circles indicates the sample size for a given estimate and the line displays a linear trend. The figure suggests that learning deficits opened up early in the pandemic and have neither closed nor substantially widened since then. We find no evidence that the slope coefficient is different from zero ( β months  = −0.00, t (41) = −7.30, two-tailed P  = 0.097, 95% CI −0.01 to 0.00). This implies that efforts by children, parents, teachers and policy-makers to adjust to the changed circumstance have been successful in preventing further learning deficits but so far have been unable to reverse them. As shown in Supplementary Fig. 8 , the pattern of persistent learning deficits also emerges within each of the three countries for which we have a relatively large number of estimates at different timepoints: the United States, the UK and the Netherlands. However, it is important to note that estimates of learning deficits are based on distinct samples of students. Future research should continue to follow the learning progress of cohorts of students in different countries to reveal how learning deficits of these cohorts have developed and continue to develop since the onset of the pandemic.

The horizontal axis displays the date on which learning progress was measured. The vertical axis displays estimated learning deficits, expressed in standard deviation (s.d.) using Cohen’s d . The colour of the circles reflects the respective country, the size of the circles indicates the sample size for a given estimate and the line displays a linear trend with a 95% CI. The trend line is estimated as a linear regression using ordinary least squares, with standard errors clustered at the study level ( n  = 42 clusters). β months  = −0.00, t (41) = −7.30, two-tailed P  = 0.097, 95% CI −0.01 to 0.00.

Socio-economic inequality in education increased

Existing research on the development of learning gaps during summer vacations 17 , 18 , disruptions to schooling during the Ebola outbreak in Sierra Leone and Guinea 19 , and the 2005 earthquake in Pakistan 20 shows that the suspension of face-to-face teaching can increase educational inequality between children from different socio-economic backgrounds. Learning deficits during the COVID-19 pandemic are likely to have been particularly pronounced for children from low socio-economic backgrounds. These children have been more affected by school closures than children from more advantaged backgrounds 21 . Moreover, they are likely to be disadvantaged with respect to their access and ability to use digital learning technology, the quality of their home learning environment, the learning support they receive from teachers and parents, and their ability to study autonomously 22 , 23 , 24 .

Most studies we identify examine changes in socio-economic inequality during the pandemic, attesting to the importance of the issue. As studies use different measures of socio-economic background (for example, parental income, parental education, free school meal eligibility or neighbourhood disadvantage), pooling the estimates is not possible. Instead, we code all estimates according to whether they indicate a reduction, no change or an increase in learning inequality during the pandemic. Figure 5 displays this information. Estimates that indicate an increase in inequality are shown on the right, those that indicate a decrease on the left and those that suggest no change in the middle. Squares represent estimates of changes in inequality during the pandemic in reading performance, and circles represent estimates of changes in inequality in maths performance. The shading represents when in the pandemic educational inequality was measured, differentiating between the first, second and third year of the pandemic. Estimates are also arranged horizontally by grade level. A large majority of estimates indicate an increase in educational inequality between children from different socio-economic backgrounds. This holds for both maths and reading, across primary and secondary education, at each stage of the pandemic, and independently of how socio-economic background is measured.

Each circle/square refers to one estimate of over-time change in inequality in maths/reading performance ( n  = 211). Estimates that find a decrease/no change/increase in inequality are grouped on the left/middle/right. Within these categories, estimates are ordered horizontally by school grade. The shading indicates when in the pandemic a given measure was taken.

Learning deficits are larger in maths than in reading

Available research on summer learning deficits 17 , 25 , student absenteeism 26 , 27 and extreme weather events 28 suggests that learning progress in mathematics is more dependent on formal instruction than in reading. This might be due to parents being better equipped to help their children with reading, and children advancing their reading skills (but not their maths skills) when reading for enjoyment outside of school. Figure 6a shows that, similarly to earlier disruptions to learning, the estimated learning deficits during the COVID-19 pandemic are larger for maths than for reading (mean difference δ  = −0.07, t (41) = −4.02, two-tailed P  = 0.000, 95% CI −0.11 to −0.04). This difference is statistically significant and robust to dropping estimates from individual countries (Supplementary Fig. 9 ).

Each plot shows the distribution of COVID-19 learning deficit estimates for the respective subgroup, with the box marking the interquartile range and the white circle denoting the median. Whiskers mark upper and lower adjacent values: the furthest observation within 1.5 interquartile range of either side of the box. a , Learning subject (reading versus maths). Median: reading −0.09, maths −0.18. Interquartile range: reading −0.15 to −0.02, maths −0.23 to −0.09. b , Level of education (primary versus secondary). Median: primary −0.12, secondary −0.12. Interquartile range: primary −0.19 to −0.05, secondary −0.21 to −0.06. c , Country income level (high versus middle). Median: high −0.12, middle −0.37. Interquartile range: high −0.20 to −0.05, middle −0.65 to −0.30.

No evidence of variation across grade levels

One may expect learning deficits to be smaller for older than for younger children, as older children may be more autonomous in their learning and better able to cope with a sudden change in their learning environment. However, older students were subject to longer school closures in some countries, such as Denmark 29 , based partly on the assumption that they would be better able to learn from home. This may have offset any advantage that older children would otherwise have had in learning remotely.

Figure 6b shows the distribution of estimates of learning deficits for students at the primary and secondary level, respectively. Our analysis yields no evidence of variation in learning deficits across grade levels (mean difference δ  = −0.01, t (41) = −0.59, two-tailed P  = 0.556, 95% CI −0.06 to 0.03). Due to the limited number of available estimates of learning deficits, we cannot be certain about whether learning deficits differ between primary and secondary students or not.

Learning deficits are larger in poorer countries

Low- and middle-income countries were already struggling with a learning crisis before the pandemic. Despite large expansions of the proportion of children in school, children in low- and middle-income countries still perform poorly by international standards, and inequality in learning remains high 30 , 31 , 32 . The pandemic is likely to deepen this learning crisis and to undo past progress. Schools in low- and middle-income countries have not only been closed for longer, but have also had fewer resources to facilitate remote learning 33 , 34 . Moreover, the economic resources, availability of digital learning equipment and ability of children, parents, teachers and governments to support learning from home are likely to be lower in low- and middle-income countries 35 .

As discussed above, most evidence on COVID-19 learning deficits comes from high-income countries. We found no studies on low-income countries that met our inclusion criteria, and evidence from middle-income countries is limited to Brazil, Colombia, Mexico and South Africa. Figure 6c groups the estimates of COVID-19 learning deficits in these four middle-income countries together (on the right) and compares them with estimates from high-income countries (on the left). The learning deficit is appreciably larger in middle-income countries than in high-income countries (mean difference δ  = −0.29, t (41) = −2.78, two-tailed P  = 0.008, 95% CI −0.50 to −0.08). In fact, the three largest estimates of learning deficits in our sample are from middle-income countries (Fig. 3 ) 36 , 37 , 38 .

Two years since the COVID-19 pandemic, there is a growing number of studies examining the learning progress of school-aged children during the pandemic. This paper first systematically reviews the existing literature on learning progress of school-aged children during the pandemic and appraises its geographic reach and quality. Second, it harmonizes, synthesizes and meta-analyses the existing evidence to examine the extent to which learning progress has changed since the onset of the pandemic, and how it varies across different groups of students and across country contexts.

Our meta-analysis suggests that learning progress has slowed substantially during the COVID-19 pandemic. The pooled effect size of d  = −0.14, implies that students lost out on about 35% of a normal school year’s worth of learning. This confirms initial concerns that substantial learning deficits would arise during the pandemic 10 , 39 , 40 . But our results also suggest that fears of an accumulation of learning deficits as the pandemic continues have not materialized 41 , 42 . On average, learning deficits emerged early in the pandemic and have neither closed nor widened substantially. Future research should continue to follow the learning progress of cohorts of students in different countries to reveal how learning deficits of these cohorts have developed and continue to develop since the onset of the pandemic.

Most studies that we identify find that learning deficits have been largest for children from disadvantaged socio-economic backgrounds. This holds across different timepoints during the pandemic, countries, grade levels and learning subjects, and independently of how socio-economic background is measured. It suggests that the pandemic has exacerbated educational inequalities between children from different socio-economic backgrounds, which were already large before the pandemic 43 , 44 . Policy initiatives to compensate learning deficits need to prioritize support for children from low socio-economic backgrounds in order to allow them to recover the learning they lost during the pandemic.

There is a need for future research to assess how the COVID-19 pandemic has affected gender inequality in education. So far, there is very little evidence on this issue. The large majority of the studies that we identify do not examine learning deficits separately by gender.

Comparing estimates of learning deficits across subjects, we find that learning deficits tend to be larger in maths than in reading. As noted above, this may be due to the fact that parents and children have been in a better position to compensate school-based learning in reading by reading at home. Accordingly, there are grounds for policy initiatives to prioritize the compensation of learning deficits in maths and other science subjects.

A limitation of this study and the existing body of evidence on learning progress during the COVID-19 pandemic is that the existing studies primarily focus on high-income countries, while there is a dearth of evidence from low- and middle-income countries. This is particularly concerning because the small number of existing studies from middle-income countries suggest that learning deficits have been particularly severe in these countries. Learning deficits are likely to be even larger in low-income countries, considering that these countries already faced a learning crisis before the pandemic, generally implemented longer school closures, and were under-resourced and ill-equipped to facilitate remote learning 32 , 33 , 34 , 35 , 45 . It is critical that this evidence gap on low- and middle-income countries is addressed swiftly, and that the infrastructure to collect and share data on educational performance in middle- and low-income countries is strengthened. Collecting and making available these data is a key prerequisite for fully understanding how learning progress and related outcomes have changed since the onset of the pandemic 46 .

A further limitation is that about half of the studies that we identify are rated as having a serious or critical risk of bias. We seek to limit the risk of bias in our results by excluding all studies rated to be at critical risk of bias from all of our analyses. Moreover, in Supplementary Figs. 3 – 6 , we show that our results are robust to further excluding studies deemed to be at serious risk of bias. Future studies should minimize risk of bias in estimating learning deficits by employing research designs that appropriately account for common sources of bias. These include a lack of accounting for secular time trends, non-representative samples and imbalances between treatment and comparison groups.

The persistence of learning deficits two and a half years into the pandemic highlights the need for well-designed, well-resourced and decisive policy initiatives to recover learning deficits. Policy-makers, schools and families will need to identify and realize opportunities to complement and expand on regular school-based learning. Experimental evidence from low- and middle-income countries suggests that even relatively low-tech and low-cost learning interventions can have substantial, positive effects on students’ learning progress in the context of remote learning. For example, sending SMS messages with numeracy problems accompanied by short phone calls was found to lead to substantial learning gains in numeracy in Botswana 47 . Sending motivational text messages successfully limited learning losses in maths and Portuguese in Brazil 48 .

More evidence is needed to assess the effectiveness of other interventions for limiting or recovering learning deficits. Potential avenues include the use of the often extensive summer holidays to offer summer schools and learning camps, extending school days and school weeks, and organizing and scaling up tutoring programmes. Further potential lies in developing, advertising and providing access to learning apps, online learning platforms or educational TV programmes that are free at the point of use. Many countries have already begun investing substantial resources to capitalize on some of these opportunities. If these interventions prove effective, and if the momentum of existing policy efforts is maintained and expanded, the disruptions to learning during the pandemic may be a window of opportunity to improve the education afforded to children.

Eligibility criteria

We consider all types of primary research, including peer-reviewed publications, preprints, working papers and reports, for inclusion. To be eligible for inclusion, studies have to measure learning progress using test scores that can be standardized across studies using Cohen’s d . Moreover, studies have to be in English, Danish, Dutch, French, German, Norwegian, Spanish or Swedish.

Search strategy and study identification

We identified relevant studies using the following steps. First, we developed a Boolean search string defining the population (school-aged children), exposure (the COVID-19 pandemic) and outcomes of interest (learning progress). The full search string can be found in Section 1.1 of Supplementary Information . Second, we used this string to search the following academic databases: Coronavirus Research Database, the Education Resources Information Centre, International Bibliography of the Social Sciences, Politics Collection (PAIS index, policy file index, political science database and worldwide political science abstracts), Social Science Database, Sociology Collection (applied social science index and abstracts, sociological abstracts and sociology database), Cumulative Index to Nursing and Allied Health Literature, and Web of Science. Second, we hand-searched multiple preprint and working paper repositories (Social Science Research Network, Munich Personal RePEc Archive, IZA, National Bureau of Economic Research, OSF Preprints, PsyArXiv, SocArXiv and EdArXiv) and relevant policy websites, including the websites of the Organization for Economic Co-operation and Development, the United Nations, the World Bank and the Education Endowment Foundation. Third, we periodically posted our protocol via Twitter in order to crowdsource additional relevant studies not identified through the search. All titles and abstracts identified in our search were double-screened using the Rayyan online application 49 . Our initial search was conducted on 27 April 2021, and we conducted two forward and backward citation searches of all eligible studies identified in the above steps, on 14 February 2022, and on 8 August 2022, to ensure that our analysis includes recent relevant research.

Data extraction

From the studies that meet our inclusion criteria we extracted all estimates of learning deficits during the pandemic, separately for maths and reading and for different school grades. We also extracted the corresponding sample size, standard error, date(s) of measurement, author name(s) and country. Last, we recorded whether studies differentiate between children’s socio-economic background, which measure is used to this end and whether studies find an increase, decrease or no change in learning inequality. We contacted study authors if any of the above information was missing in the study. Data extraction was performed by B.A.B. and validated independently by A.M.B.-M., with discrepancies resolved through discussion and by conferring with P.E.

Measurement and standardizationr

We standardize all estimates of learning deficits during the pandemic using Cohen’s d , which expresses effect sizes in terms of standard deviations. Cohen’s d is calculated as the difference in the mean learning gain in a given subject (maths or reading) over two comparable periods before and after the onset of the pandemic, divided by the pooled standard deviation of learning progress in this subject:

Effect sizes expressed as β coefficients are converted to Cohen’s d :

We use a binary indicator for whether the study outcome is maths or reading. One study does not differentiate the outcome but includes a composite of maths and reading scores 50 .

Level of education

We distinguish between primary and secondary education. We first consulted the original studies for this information. Where this was not stated in a given study, students’ age was used in conjunction with information about education systems from external sources to determine the level of education 51 .

Country income level

We follow the World Bank’s classification of countries into four income groups: low, lower-middle, upper-middle and high income. Four countries in our sample are in the upper-middle-income group: Brazil, Colombia, Mexico and South Africa. All other countries are in the high-income group.

Data synthesis

We synthesize our data using three synthesis techniques. First, we generate a forest plot, based on all available estimates of learning progress during the pandemic. We pool estimates using a random-effects restricted maximum likelihood model and inverse variance weights to calculate an overall effect size (Fig. 3 ) 52 . Second, we code all estimates of changes in educational inequality between children from different socio-economic backgrounds during the pandemic, according to whether they indicate an increase, a decrease or no change in educational inequality. We visualize the resulting distribution using a harvest plot (Fig. 5 ) 53 . Third, given that the limited amount of available evidence precludes multivariate or causal analyses, we examine the bivariate association between COVID-19 learning deficits and the months in which learning was measured using a scatter plot (Fig. 4 ), and the bivariate association between COVID-19 learning deficits and subject, grade level and countries’ income level, using a series of violin plots (Fig. 6 ). The reported estimates, CIs and statistical significance tests of these bivariate associations are based on common-effects models with standard errors clustered by study, and two-sided tests. With respect to statistical tests reported, the data distribution was assumed to be normal, but this was not formally tested. The distribution of estimates of learning deficits is shown separately for the different moderator categories in Fig. 6 .

Pre-registration

We prospectively registered a protocol of our systematic review and meta-analysis in the International Prospective Register of Systematic Reviews (CRD42021249944) on 19 April 2021 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249944 ).

Reporting summary

Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.

Data availability

The data used in the analyses for this manuscript were compiled by the authors based on the studies identified in the systematic review. The data are available on the Open Science Framework repository ( https://doi.org/10.17605/osf.io/u8gaz ). For our systematic review, we searched the following databases: Coronavirus Research Database ( https://proquest.libguides.com/covid19 ), Education Resources Information Centre database ( https://eric.ed.gov ), International Bibliography of the Social Sciences ( https://about.proquest.com/en/products-services/ibss-set-c/ ), Politics Collection ( https://about.proquest.com/en/products-services/ProQuest-Politics-Collection/ ), Social Science Database ( https://about.proquest.com/en/products-services/pq_social_science/ ), Sociology Collection ( https://about.proquest.com/en/products-services/ProQuest-Sociology-Collection/ ), Cumulative Index to Nursing and Allied Health Literature ( https://www.ebsco.com/products/research-databases/cinahl-database ) and Web of Science ( https://clarivate.com/webofsciencegroup/solutions/web-of-science/ ). We also searched the following preprint and working paper repositories: Social Science Research Network ( https://papers.ssrn.com/sol3/DisplayJournalBrowse.cfm ), Munich Personal RePEc Archive ( https://mpra.ub.uni-muenchen.de ), IZA ( https://www.iza.org/content/publications ), National Bureau of Economic Research ( https://www.nber.org/papers?page=1&perPage=50&sortBy=public_date ), OSF Preprints ( https://osf.io/preprints/ ), PsyArXiv ( https://psyarxiv.com ), SocArXiv ( https://osf.io/preprints/socarxiv ) and EdArXiv ( https://edarxiv.org ).

Code availability

All code needed to replicate our findings is available on the Open Science Framework repository ( https://doi.org/10.17605/osf.io/u8gaz ).

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Carlsberg Foundation grant CF19-0102 (A.M.B.-M.); Leverhulme Trust Large Centre Grant (P.E.), the Swedish Research Council for Health, Working Life and Welfare (FORTE) grant 2016-07099 (P.E.); the French National Research Agency (ANR) as part of the ‘Investissements d’Avenir’ programme LIEPP (ANR-11-LABX-0091 and ANR-11-IDEX-0005-02) and the Université Paris Cité IdEx (ANR-18-IDEX-0001) (P.E.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Betthäuser, B.A., Bach-Mortensen, A.M. & Engzell, P. A systematic review and meta-analysis of the evidence on learning during the COVID-19 pandemic. Nat Hum Behav 7 , 375–385 (2023). https://doi.org/10.1038/s41562-022-01506-4

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COVID-19 and education: The lingering effects of unfinished learning

As this most disrupted of school years draws to a close, it is time to take stock of the impact of the pandemic on student learning and well-being. Although the 2020–21 academic year ended on a high note—with rising vaccination rates, outdoor in-person graduations, and access to at least some in-person learning for 98 percent of students—it was as a whole perhaps one of the most challenging for educators and students in our nation’s history. 1 “Burbio’s K-12 school opening tracker,” Burbio, accessed May 31, 2021, cai.burbio.com. By the end of the school year, only 2 percent of students were in virtual-only districts. Many students, however, chose to keep learning virtually in districts that were offering hybrid or fully in-person learning.

Our analysis shows that the impact of the pandemic on K–12 student learning was significant, leaving students on average five months behind in mathematics and four months behind in reading by the end of the school year. The pandemic widened preexisting opportunity and achievement gaps, hitting historically disadvantaged students hardest. In math, students in majority Black schools ended the year with six months of unfinished learning, students in low-income schools with seven. High schoolers have become more likely to drop out of school, and high school seniors, especially those from low-income families, are less likely to go on to postsecondary education. And the crisis had an impact on not just academics but also the broader health and well-being of students, with more than 35 percent of parents very or extremely concerned about their children’s mental health.

The fallout from the pandemic threatens to depress this generation’s prospects and constrict their opportunities far into adulthood. The ripple effects may undermine their chances of attending college and ultimately finding a fulfilling job that enables them to support a family. Our analysis suggests that, unless steps are taken to address unfinished learning, today’s students may earn $49,000 to $61,000 less over their lifetime owing to the impact of the pandemic on their schooling. The impact on the US economy could amount to $128 billion to $188 billion every year as this cohort enters the workforce.

Federal funds are in place to help states and districts respond, though funding is only part of the answer. The deep-rooted challenges in our school systems predate the pandemic and have resisted many reform efforts. States and districts have a critical role to play in marshaling that funding into sustainable programs that improve student outcomes. They can ensure rigorous implementation of evidence-based initiatives, while also piloting and tracking the impact of innovative new approaches. Although it is too early to fully assess the effectiveness of postpandemic solutions to unfinished learning, the scope of action is already clear. The immediate imperative is to not only reopen schools and recover unfinished learning but also reimagine education systems for the long term. Across all of these priorities it will be critical to take a holistic approach, listening to students and parents and designing programs that meet academic and nonacademic needs alike.

What have we learned about unfinished learning?

As the 2020–21 school year began, just 40 percent of K–12 students were in districts that offered any in-person instruction. By the end of the year, more than 98 percent of students had access to some form of in-person learning, from the traditional five days a week to hybrid models. In the interim, districts oscillated among virtual, hybrid, and in-person learning as they balanced the need to keep students and staff safe with the need to provide an effective learning environment. Students faced multiple schedule changes, were assigned new teachers midyear, and struggled with glitchy internet connections and Zoom fatigue. This was a uniquely challenging year for teachers and students, and it is no surprise that it has left its mark—on student learning, and on student well-being.

As we analyze the cost of the pandemic, we use the term “unfinished learning” to capture the reality that students were not given the opportunity this year to complete all the learning they would have completed in a typical year. Some students who have disengaged from school altogether may have slipped backward, losing knowledge or skills they once had. The majority simply learned less than they would have in a typical year, but this is nonetheless important. Students who move on to the next grade unprepared are missing key building blocks of knowledge that are necessary for success, while students who repeat a year are much less likely to complete high school and move on to college. And it’s not just academic knowledge these students may miss out on. They are at risk of finishing school without the skills, behaviors, and mindsets to succeed in college or in the workforce. An accurate assessment of the depth and extent of unfinished learning will best enable districts and states to support students in catching up on the learning they missed and moving past the pandemic and into a successful future.

Students testing in 2021 were about ten points behind in math and nine points behind in reading, compared with matched students in previous years.

Unfinished learning is real—and inequitable

To assess student learning through the pandemic, we analyzed Curriculum Associates’ i-Ready in-school assessment results of more than 1.6 million elementary school students across more than 40 states. 2 The Curriculum Associates in-school sample consisted of 1.6 million K–6 students in mathematics and 1.5 million in reading. The math sample came from all 50 states, but 23 states accounted for 90 percent of the sample. The reading sample came from 46 states, with 21 states accounting for 90 percent of the sample. Florida accounted for 29 percent of the math and 30 percent of the reading sample. In general, states that had reopened schools are overweighted given the in-school nature of the assessment. We compared students’ performance in the spring of 2021 with the performance of similar students prior to the pandemic. 3 Specifically, we compared spring 2021 results to those of historically matched students in the springs of 2019, 2018, and 2017. Students testing in 2021 were about ten points behind in math and nine points behind in reading, compared with matched students in previous years.

To get a sense of the magnitude of these gaps, we translated these differences in scores to a more intuitive measure—months of learning. Although there is no perfect way to make this translation, we can get a sense of how far students are behind by comparing the levels students attained this spring with the growth in learning that usually occurs from one grade level to the next. We found that this cohort of students is five months behind in math and four months behind in reading, compared with where we would expect them to be based on historical data. 4 The conversion into months of learning compares students’ achievement in the spring of one grade level with their performance in the spring of the next grade level, treating this spring-to-spring difference in historical scores as a “year” of learning. It assumes a ten-month school year with a two-month summer vacation. Actual school schedules vary significantly, and i-Ready’s typical growth numbers for a “year” of learning are based on 30 weeks of actual instruction between the fall and the spring rather than on a spring-to-spring calendar-year comparison.

Unfinished learning did not vary significantly across elementary grades. Despite reports that remote learning was more challenging for early elementary students, 5 Marva Hinton, “Why teaching kindergarten online is so very, very hard,” Edutopia, October 21, 2020, edutopia.org. our results suggest the impact was just as meaningful for older elementary students. 6 While our analysis only includes results from students who tested in-school in the spring, many of these students were learning remotely for meaningful portions of the fall and the winter. We can hypothesize that perhaps younger elementary students received more help from parents and older siblings, and that older elementary students were more likely to be struggling alone.

It is also worth remembering that our numbers capture the “average” progress by grade level. Especially in early reading, this average can conceal a wide range of outcomes. Another way of cutting the data looks instead at which students have dropped further behind grade levels. A recent report suggests that more first and second graders have ended this year two or more grade levels below expectations than in any previous year. 7 Academic achievement at the end of the 2020–2021 school year , Curriculum Associates, June 2021, curriculumassociates.com. Given the major strides children at this age typically make in mastering reading, and the critical importance of early reading for later academic success, this is of particular concern.

While all types of students experienced unfinished learning, some groups were disproportionately affected. Students of color and low-income students suffered most. Students in majority-Black schools ended the school year six months behind in both math and reading, while students in majority-white schools ended up just four months behind in math and three months behind in reading. 8 To respect students’ privacy, we cannot isolate the race or income of individual students in our sample, but we can look at school-level demographics. Students in predominantly low-income schools and in urban locations also lost more learning during the pandemic than their peers in high-income rural and suburban schools (Exhibit 1).

In fall 2020, we projected that students could lose as much as five to ten months of learning in mathematics, and about half of that in reading, by the end of the school year. Spring assessment results came in toward the lower end of these projections, suggesting that districts and states were able to improve the quality of remote and hybrid learning through the 2020–21 school year and bring more students back into classrooms.

Indeed, if we look at the data over time, some interesting patterns emerge. 9 The composition of the fall student sample was different from that of the spring sample, because more students returned to in-person assessments in the spring. Some of the increase in unfinished learning from fall to spring could be because the spring assessment included previously virtual students, who may have struggled more during the school year. Even so, the spring data are the best reflection of unfinished learning at the end of the school year. Taking math as an example, as schools closed their buildings in the spring of 2020, students fell behind rapidly, learning almost no new math content over the final few months of the 2019–20 school year. Over the summer, we assume that they experienced the typical “summer slide” in which students lose some of the academic knowledge and skills they had learned the year before. Then they resumed learning through the 2020–21 school year, but at a slower pace than usual, resulting in five months of unfinished learning by the end of the year (Exhibit 2). 10 These lines simplify the pattern of typical learning through the year. In a typical year, students learn more in the fall and less in the spring, and only learn during periods of instruction (the chart includes the well-documented learning loss that happens during the summer, but does not include shorter holidays when students are not in school receiving instruction).

In reading, however, the story is somewhat different. As schools closed their buildings in March 2020, students continued to progress in reading, albeit at a slower pace. During the summer, we assume that students’ reading level stayed roughly flat, as in previous years. The pace of learning increased slightly over the 2020–21 school year, but the difference was not as great as it was in math, resulting in four months of unfinished learning by the end of the school year (Exhibit 3). Put another way, the initial shock in reading was less severe, but the improvements to remote and hybrid learning seem to have had less impact in reading than they did in math.

Before we celebrate the improvements in student trajectories between the initial school shutdowns and the subsequent year of learning, we should remember that these are still sobering numbers. On average, students who took the spring assessments in school are half a year behind in math, and nearly that in reading. For Black and Hispanic students, the losses are not only greater but also piled on top of historical inequities in opportunity and achievement (Exhibit 4).

Furthermore, these results likely represent an optimistic scenario. They reflect outcomes for students who took interim assessments in the spring in a school building 11 Students who took the assessment out of school are not included in our sample because we could not guarantee fidelity and comparability of results, given the change in the testing environment. Out-of-school students represent about a third of the students taking i-Ready assessments in the spring, and we will not have an accurate understanding of the pandemic’s impact on their learning until they return to school buildings, likely in the fall. —and thus exclude students who remained remote throughout the entire school year, and who may have experienced the most disruption to their schooling. 12 Initial results from Texas suggest that districts with mostly virtual instruction experienced more unfinished learning than those with mostly in-person instruction. The percent of students meeting math expectations dropped 32 percent in mostly virtual districts but just 9 percent in mostly in-person ones. See Reese Oxner, “Texas students’ standardized test scores dropped dramatically during the pandemic, especially in math,” Texas Tribune , June 28, 2021, texastribune.org. The Curriculum Associates data cover a broad variety of schools and states across the country, but are not fully representative, being overweighted for rural and southeastern states that were more likely to get students back into the classrooms this year. Finally, these data cover only elementary schools. They are silent on the academic impact of the pandemic for middle and high schoolers. However, data from school districts suggest that, even for older students, the pandemic has had a significant effect on learning. 13 For example, in Salt Lake City, the percentage of middle and high school students failing a class jumped by 60 percent, from 2,500 to 4,000, during the pandemic. To learn about increased failure rates across multiple districts from the Bay Area to New Mexico, Austin, and Hawaii, see Richard Fulton, “Failing Grades,” Inside Higher Ed , March 8, 2021, insidehighered.com.

The harm inflicted by the pandemic goes beyond academics

Students didn’t just lose academic learning during the pandemic. Some lost family members; others had caregivers who lost their jobs and sources of income; and almost all experienced social isolation.

These pressures have taken a toll on students of all ages. In our recent survey of 16,370 parents across every state in America, 35 percent of parents said they were very or extremely concerned about their child’s mental health, with a similar proportion worried about their child’s social and emotional well-being. Roughly 80 percent of parents had some level of concern about their child’s mental health or social and emotional health and development since the pandemic began. Parental concerns about mental health span grade levels but are slightly lower for parents of early elementary school students. 14 While 30.7% percent of all K–2 parents were very or extremely concerned, a peak of 37.6% percent of eighth-grade parents were.

Parents also report increases in clinical mental health conditions among their children, with a five-percentage-point increase in anxiety and a six-percentage-point increase in depression. They also report increases in behaviors such as social withdrawal, self-isolation, lethargy, and irrational fears (Exhibit 5). Despite increased levels of concern among parents, the amount of mental health assessment and testing done for children is 6.1 percent lower than it was in 2019 —the steepest decline in assessment and testing rates of any age group.

Broader student well-being is not independent of academics. Parents whose children have fallen significantly behind academically are one-third more likely to say that they are very or extremely concerned about their children’s mental health. Black and Hispanic parents are seven to nine percentage points more likely than white parents to report higher levels of concern. Unaddressed mental-health challenges will likely have a knock-on effect on academics going forward as well. Research shows that trauma and other mental-health issues can influence children’s attendance, their ability to complete schoolwork in and out of class, and even the way they learn. 15 Satu Larson et al., “Chronic childhood trauma, mental health, academic achievement, and school-based health center mental health services,” Journal of School Health , 2017, 87(9), 675–86, escholarship.org.

In our recent survey of 16,370 parents across every state in America, 35 percent of parents said they were very or extremely concerned about their child’s mental health.

The impact of unfinished learning on diminished student well-being seems to be playing out in the choices that students are making. Some students have already effectively dropped out of formal education entirely. 16 To assess the impact of the pandemic on dropout rates, we have to look beyond official enrollment data, which are only published annually, and which only capture whether a child has enrolled at the beginning of the year, not whether they are engaged and attending school. Chronic absenteeism rates provide clues as to which students are likely to persist in school and which students are at risk of dropping out. Our parent survey suggests that chronic absenteeism for eighth through 12th graders has increased by 12 percentage points, and 42 percent of the students who are new to chronic absenteeism are attending no school at all, according to their parents. Scaled up to the national level, this suggests that 2.3 million to 4.6 million additional eighth- to 12th-grade students were chronically absent from school this year, in addition to the 3.1 million who are chronically absent in nonpandemic years. State and district data on chronic absenteeism are still emerging, but data released so far also suggest a sharp uptick in absenteeism rates nationwide, particularly in higher grades. 17 A review of available state and district data, including data released by 14 states and 11 districts, showed increases in chronic absenteeism of between three and 16 percentage points, with an average of seven percentage points. However, many states changed the definition of absenteeism during the pandemic, so a true like-for-like comparison is difficult to obtain. According to emerging state and district data, increases in chronic absenteeism are highest among populations with historically low rates. This is reflected also in our survey results. Black students, with the highest historical absenteeism rates, saw more modest increases during the pandemic than white or Hispanic students (Exhibit 6).

It remains unclear whether these pandemic-related chronic absentees will drop out at rates similar to those of students who were chronically absent prior to the pandemic. Some students could choose to return to school once in-person options are restored; but some portion of these newly absent students will likely drop out of school altogether. Based on historical links between chronic absenteeism and dropout rates, as well as differentials in absenteeism between fully virtual and fully in-person students, we estimate that an additional 617,000 to 1.2 million eighth–12th graders could drop out of school altogether because of the pandemic if efforts are not made to reengage them in learning next year. 18 The federal definition of chronic absenteeism is missing more than 15 days of school each year. According to the Utah Education Policy Center’s research brief on chronic absenteeism, the overall correlation between one year of chronic absence between eighth and 12th grade and dropping out of school is 0.134. For more, see Utah Education Policy Center, Research brief: Chronic absenteeism , July 2012, uepc.utah.edu. We then apply the differential in chronic absenteeism between fully virtual and fully in-person students to account for virtual students reengaging when in-person education is offered. For students who were not attending school at all, we assumed that 50 to 75 percent would not return to learning. This estimation is partly based on The on-track indicator as a predictor of high school graduation from the UChicago Consortium on School Research, which estimates that up to 75 percent of high school students who are “off track”—either failing or behind in credits—do not graduate in five years. For more, see Elaine Allensworth and John Q. Easton, The on-track indicator as a predictor of high school graduation , UChicago Consortium on School Research, 2005, consortium.uchicago.edu.

Even among students who complete high school, many may not fulfill their dreams of going on to postsecondary education. Our survey suggests that 17 percent of high school seniors who had planned to attend postsecondary education abandoned their plans—most often because they had joined or were planning to join the workforce or because the costs of college were too high. The number is much higher among low-income high school seniors, with 26 percent abandoning their plans. Low-income seniors are more likely to state cost as a reason, with high-income seniors more likely to be planning to reapply the following year or enroll in a gap-year program. This is consistent with National Student Clearinghouse reports that show overall college enrollment declines, with low-income, high-poverty, and high-minority high schools disproportionately affected. 19 Todd Sedmak, “Fall 2020 college enrollment update for the high school graduating class of 2020,” National Student Clearinghouse, March 25, 2021, studentclearinghouse.org; Todd Sedmak, “Spring 2021 college enrollment declines 603,000 to 16.9 million students,” National Student Clearinghouse, June 10, 2021, studentclearinghouse.org.

Unfinished learning has long-term consequences

The cumulative effects of the pandemic could have a long-term impact on an entire generation of students. Education achievement and attainment are linked not only to higher earnings but also to better health, reduced incarceration rates, and greater political participation. 20 See, for example, Michael Grossman, “Education and nonmarket outcomes,” in Handbook of the Economics of Education, Volume 1 , ed. Eric Hanushek and Finis Welch (Amsterdam: Elsevier, 2006), 577–633; Lance Lochner and Enrico Moretti, “The effect of education on crime: Evidence from prison inmates, arrests, and self-reports,” American Economic Review , 2004, Volume 94, Number 1, pp. 155–89; Kevin Milligan, Enrico Moretti, and Philip Oreopoulos, “Does education improve citizenship? Evidence from the United States and the United Kingdom,” Journal of Public Economics , August 2004, Volume 88, Number 9–10, pp. 1667–95; and Education transforms lives , UNESCO, 2013, unesdoc.unesco.org. We estimate that, without immediate and sustained interventions, pandemic-related unfinished learning could reduce lifetime earnings for K–12 students by an average of $49,000 to $61,000. These costs are significant, especially for students who have lost more learning. While white students may see lifetime earnings reduced by 1.4 percent, the reduction could be as much as 2.4 percent for Black students and 2.1 percent for Hispanic students. 21 Projected earnings across children’s lifetimes using current annual incomes for those with at least a high school diploma, discounting the earnings by a premium established in Murnane et al., 2000, which tied cognitive skills and future earnings. See Richard J. Murnane et al., “How important are the cognitive skills of teenagers in predicting subsequent earnings?,” Journal of Policy Analysis and Management , September 2000, Volume 19, Number 4, pp. 547–68.

Lower earnings, lower levels of education attainment, less innovation—all of these lead to decreased economic productivity. By 2040 the majority of this cohort of K–12 students will be in the workforce. We anticipate a potential annual GDP loss of $128 billion to $188 billion from pandemic-related unfinished learning. 22 Using Hanushek and Woessmann 2008 methodology to map national per capita growth associated with decrease in academic achievement, then adding additional impact of pandemic dropouts on GDP. For more, see Eric A. Hanushek and Ludger Woessmann, “The role of cognitive skills in economic development,” Journal of Economic Literature , September 2008, Volume 46, Number 3, pp. 607–68.

This increases by about one-third the existing hits to GDP from achievement gaps that predated COVID-19. Our previous research indicated that the pre-COVID-19 racial achievement gap was equivalent to $426 billion to $705 billion in lost economic potential every year (Exhibit 7). 23 This is the increase in GDP that would result if Black and Hispanic students achieved the same levels of academic performance as white students. For more information on historical opportunity and achievement gaps, please see Emma Dorn, Bryan Hancock, Jimmy Sarakatsannis, and Ellen Viruleg, “ COVID-19 and student learning in the United States: The hurt could last a lifetime ,” June 1, 2020.

What is the path forward for our nation’s students?

There is now significant funding in place to address these critical issues. Through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act); the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA); and the American Rescue Plan (ARP), the federal government has already committed more than $200 billion to K–12 education over the next three years, 24 The CARES Act provided $13 billion to ESSER and $3 billion to the Governor’s Emergency Education Relief (GEER) Fund; CRRSAA provided $54 billion to ESSER II, $4 billion to Governors (GEER II and EANS); ARP provided $123 billion to ESSER III, $3 billion to Governors (EANS II), and $10 billion to other education programs. For more, see “CCSSO fact sheet: COVID-19 relief funding for K-12 education,” Council of Chief State School Officers, 2021, https://753a0706.flowpaper.com/CCSSOCovidReliefFactSheet/#page=2. a significant increase over the approximately $750 billion spent annually on public schooling. 25 “The condition of education 2021: At a glance,” National Center for Education Statistics, accessed June 30, 2021, nces.ed.gov. The majority of these funds are routed through the Elementary and Secondary School Emergency Relief Fund (ESSER), of which 90 percent flows to districts and 10 percent to state education agencies. These are vast sums of money, particularly in historical context. As part of the 2009 American Recovery and Reinvestment Act (ARRA), the Obama administration committed more than $80 billion toward K–12 schools—at the time the biggest federal infusion of funds to public schools in the nation’s history. 26 “The American Recovery and Reinvestment Act of 2009: Saving and Creating Jobs and Reforming Education,” US Department of Education, March 7, 2009, ed.gov. Today’s funding more than doubles that previous record and gives districts much more freedom in how they spend the money. 27 Andrew Ujifusa, “What Obama’s stimulus had for education that the coronavirus package doesn’t,” Education Week , March 31, 2020, www.edweek.org.

However, if this funding can mitigate the impact of unfinished learning, it could prevent much larger losses to the US economy. Given that this generation of students will likely spend 35 to 40 years in the workforce, the cumulative impact of COVID-19 unfinished learning over their lifetimes could far exceed the investments that are being made today.

Furthermore, much of today’s federal infusion will likely be spent not only on supporting students in catching up on the unfinished learning of the pandemic but also on tackling deeper historical opportunity and achievement gaps among students of different races and income levels.

As districts consider competing uses of funding, they are juggling multiple priorities over several time horizons. The ARP funding needs to be obligated by September 2023. This restricts how monies can be spent. Districts are balancing the desire to hire new personnel or start new programs with the risk of having to close programs because of lack of sustained funds in the future. Districts are also facing decisions about whether to run programs at the district level or to give more freedom to principals in allocating funds; about the balance between academics and broader student needs; about the extent to which funds should be targeted to students who have struggled most or spread evenly across all students; and about the balance between rolling out existing evidence-based programs and experimenting with innovative approaches.

It is too early to answer all of these questions decisively. However, as districts consider this complex set of decisions, leading practitioners and thinkers have come together to form the Coalition to Advance Future Student Success—and to outline priorities to ensure the effective and equitable use of federal funds. 28 “Framework: The Coalition to Advance Future Student Success,” Council of Chief State School Officers, accessed June 30, 2021, learning.ccsso.org.

These priorities encompass four potential actions for schools:

• Safely reopen schools for in-person learning.
• Reengage students and reenroll them into effective learning environments.
• Support students in recovering unfinished learning and broader needs.
• Recommit and reimagine our education systems for the long term.

Across all of these actions, it is important for districts to understand the changing needs of parents and students as we emerge from the pandemic, and to engage with them to support students to learn and to thrive. The remainder of this article shares insights from our parent survey of more than 16,000 parents on these changing needs and perspectives, and highlights some early actions by states and districts to adapt to meet them.

1. Safely reopen schools for in-person learning

The majority of school districts across the country are planning to offer traditional five-days-a-week in-person instruction in the fall, employing COVID-19-mitigation strategies such as staff and student vaccination drives, ongoing COVID-19 testing, mask mandates, and infrastructure updates. 29 “Map: Where Were Schools Required to Be Open for the 2020-21 School Year?,” Education Week , updated May 2021, edweek.org. The evidence suggests that schools can reopen buildings safely with the right protocols in place, 30 For a summary of the evidence on safely reopening schools, see John Bailey, Is it safe to reopen schools? , CRPE, March 2021, crpe.org. but health preparedness will likely remain critical as buildings reopen. Indeed, by the end of the school year, a significant subset of parents remain concerned about safety in schools, with nearly a third still very or extremely worried about the threat of COVID-19 to their child’s health. Parents also want districts to continue to invest in safety—39 percent say schools should invest in COVID-19 health and safety measures this fall.

2. Reengage and reenroll students in effective learning environments

Opening buildings safely is hard enough, but encouraging students to show up could be even more challenging. Some students will have dropped out of formal schooling entirely, and those who remain in school may be reluctant to return to physical classrooms. Our survey results suggest that 24 percent of parents are still not convinced they will choose in-person instruction for their children this fall. Within Black communities, that rises to 34 percent. But many of these parents are still open to persuasion. Only 4 percent of parents (and 6 percent of Black parents) say their children will definitely not return to fully in-person learning—which is not very different from the percentage of parents who choose to homeschool or pursue other alternative education options in a typical year. For students who choose to remain virtual, schools should make continual efforts to improve virtual learning models, based on lessons from the past year.

For parents who are still on the fence, school districts can work to understand their needs and provide effective learning options. Safety concerns remain the primary reason that parents remain hesitant about returning to the classroom; however, this is not the only driver. Some parents feel that remote learning has been a better learning environment for their child, while others have seen their child’s social-emotional and mental health improve at home.

Still, while remote learning may have worked well for some students, our data suggest that it failed many. In addition to understanding parent needs, districts should reach out to families and build confidence not just in their schools’ safety precautions but also in their learning environment and broader role in the community. Addressing root causes will likely be more effective than punitive measures, and a broad range of tactics may be needed, from outreach and attendance campaigns to student incentives to providing services families need, such as transportation and childcare. 31 Roshon R. Bradley, “A comprehensive approach to improving student attendance,” St. John Fisher College, August 2015, Education Doctoral, Paper 225, fisherpub.sjfc.edu; a 2011 literature review highlights how incentives can effectively be employed to increase attendance rates. Across all of these, a critical component will likely be identifying students who are at risk and ensuring targeted outreach and interventions. 32 Elaine M. Allensworth and John Q. Easton, “What matters for staying on-track and graduating in Chicago Public Schools: A close look at course grades, failures, and attendance in the freshman year,” Consortium on Chicago School Research at the University of Chicago, July 2007, files.eric.ed.gov.

Chicago Public Schools, in partnership with the University of Chicago, has developed a student prioritization index (SPI) that identifies students at highest risk of unfinished learning and dropping out of school. The index is based on a combination of academic, attendance, socio-emotional, and community vulnerability inputs. The district is reaching out to all students with a back-to-school marketing campaign while targeting more vulnerable students with additional support. Schools are partnering with community-based organizations to carry out home visits, and with parents to staff phone banks. They are offering various paid summer opportunities to reduce the trade-offs students may have to make between summer school and summer jobs, recognizing that many have found paid work during the pandemic. The district will track and monitor the results to learn which tactics work. 33 “Moving Forward Together,” Chicago Public Schools, June 2021, cps.edu.

In Florida’s Miami-Dade schools, each school employee was assigned 30 households to contact personally, starting with a phone call and then showing up for a home visit. Superintendent Alberto Carvalho personally contacted 30 families and persuaded 23 to return to in-person learning. The district is starting the transition to in-person learning by hosting engaging in-person summer learning programs. 34 Hannah Natanson, “Schools use home visits, calls to convince parents to choose in-person classes in fall,” Washington Post , July 7, 2021, washingtonpost.com.

3. Support students in recovering unfinished learning and in broader needs

Even if students reenroll in effective learning environments in the fall, many will be several months behind academically and may struggle to reintegrate into a traditional learning environment. School districts are therefore creating strategies to support students  as they work to make up unfinished learning, and as they work through broader mental health issues and social reintegration. Again, getting parents and students to show up for these programs may be harder than districts expect.

Our research suggests that parents underestimate the unfinished learning caused by the pandemic. In addition, their beliefs about their children’s learning do not reflect racial disparities in unfinished learning. In our survey, 40 percent of parents said their child is on track and 16 percent said their child is progressing faster than in a usual year. Black parents are slightly more likely than white parents to think their child is on track or better, Hispanic parents less so. However, across all races, more than half of parents think their child is doing just fine. Only 14 percent of parents said their child has fallen significantly behind.

Even if programs are offered for free, many parents may not take advantage of them, especially if they are too academically oriented. Only about a quarter of parents said they are very likely to enroll their child in tutoring, after-school, or summer-school programs, for example. Nearly 40 percent said they are very likely to enroll their students in enrichment programs such as art or music. Districts therefore should consider not only offering effective evidence-based programs, such as high-dosage tutoring and vacation academies, but also ensuring that these programs are attractive to students.

In Rhode Island, for example, the state is taking a “Broccoli and Ice Cream” approach to summer school to prepare students for the new school year, combining rigorous reading and math instruction with fun activities provided by community-based partners. Enrichment activities such as sailing, Italian cooking lessons, and Olympic sports are persuading students to participate. 35 From webinar with Angélica Infante-Green, Rhode Island Department of Education, https://www.ewa.org/agenda/ewa-74th-national-seminar-agenda. The state-run summer program is open to students across the state, but the Rhode Island Department of Education has also provided guidance to district-run programs, 36 Learning, Equity & Accelerated Pathways Task Force Report , Rhode Island Department of Education, April 2021, ride.ri.gov. encouraging partnerships with community-based organizations, a dual focus on academics and enrichment, small class sizes, and a strong focus on relationships and social-emotional support.

In Louisiana, the state has provided guidance and support 37 Staffing and scheduling best practices guidance , Louisiana Department of Education, June 3, 2021, louisianabelieves.com. to districts in implementing recovery programs to ensure evidence-based approaches are rolled out state-wide. The guidance includes practical tips on ramping up staffing, and on scheduling high-dosage tutoring and other dedicated acceleration blocks. The state didn’t stop at guidance, but also flooded districts with support and two-way dialogue through webinars, conferences, monthly calls, and regional technical coaching. By scheduling acceleration blocks during the school day, rather than an add-on after school, districts are not dependent on parents signing up for programs.

For students who have experienced trauma, schools will likely need to address the broader fallout from the pandemic. In southwest Virginia, the United Way is partnering with five school systems to establish a trauma-informed schools initiative, providing teachers and staff with training and resources on trauma recovery. 38 Mike Still, “SWVA school districts partner to help students in wake of pandemic,” Kingsport Times News, June 26, 2021, timesnews.net. San Antonio is planning to hire more licensed therapists and social workers to help students and their families, leveraging partnerships with community organizations to place a licensed social worker on every campus. 39 Brooke Crum, “SAISD superintendent: ‘There are no shortcuts’ to tackling COVID-related learning gaps,” San Antonio Report, April 12, 2021, sanantonioreport.org.

4. Recommit and reimagine our education systems for the long term

Opportunity gaps have existed in our school systems for a long time. As schools build back from the pandemic, districts are also recommitting to providing an excellent education to every child. A potential starting point could be redoubling efforts to provide engaging, high-quality grade-level curriculum and instruction delivered by diverse and effective educators in every classroom, supported by effective assessments to inform instruction and support.

Beyond these foundational elements, districts may consider reimagining other aspects of the system. Parents may also be open to nontraditional models. Thirty-three percent of parents said that even when the pandemic is over, the ideal fit for their child would be something other than five days a week in a traditional brick-and-mortar school. Parents are considering hybrid models, remote learning, homeschooling, or learning hubs over the long term. Even if learning resumes mostly in the building, parents are open to the use of new technology to support teaching.

Edgecombe County Public Schools in North Carolina is planning to continue its use of learning hubs this fall to better meet student needs. In the district’s hub-and-spoke model, students will spend half of their time learning core content (the “hub”). For the other half they will engage in enrichment activities aligned to learning standards (the “spokes”). For elementary and middle school students, enrichment activities will involve interest-based projects in science and social studies; for high schoolers, activities could include exploring their passions through targeted English language arts and social studies projects or getting work experience—either paid or volunteer. The district is redeploying staff and leveraging community-based partnerships to enable these smaller-group activities with trusted adults who mirror the demographics of the students. 40 “District- and community-driven learning pods,” Center on Reinventing Public Education, crpe.org.

In Tennessee, the new Advanced Placement (AP) Access for All program will provide students across the state with access to AP courses, virtually. The goal is to eliminate financial barriers and help students take AP courses that aren’t currently offered at their home high school. 41 Amy Cockerham, “TN Department of Education announces ‘AP Access for All program,’” April 28, 2021, WJHL-TV, wjhl.com.

The Dallas Independent School District is rethinking the traditional school year, gathering input from families, teachers, and school staff to ensure that school communities are ready for the plunge. More than 40 schools have opted to add five additional intercession weeks to the year to provide targeted academics and enrichment activities. A smaller group of schools will add 23 days to the school year to increase time for student learning and teacher planning and collaboration. 42 “Time to Learn,” Dallas Independent School District, dallasisd.org.

It is unclear whether all these experiments will succeed, and school districts should monitor them closely to ensure they can scale successful programs and sunset unsuccessful ones. However, we have learned in the pandemic that some of the innovations born of necessity met some families’ needs better. Continued experimentation and fine-tuning could bring the best of traditional and new approaches together.

Thanks to concerted efforts by states and districts, the worst projections for learning outcomes this past year have not materialized for most students. However, students are still far behind where they need to be, especially those from historically marginalized groups. Left unchecked, unfinished learning could have severe consequences for students’ opportunities and prospects. In the long term, it could exact a heavy toll on the economy. It is not too late to mitigate these threats, and funding is now in place. Districts and states now have the opportunity to spend that money effectively to support our nation’s students.

Emma Dorn is a senior expert in McKinsey’s Silicon Valley office; Bryan Hancock and Jimmy Sarakatsannis are partners in the Washington, DC, office; and Ellen Viruleg is a senior adviser based in Providence, Rhode Island.

The authors wish to thank Alice Boucher, Ezra Glenn, Ben Hayes, Cheryl Healey, Chauncey Holder, and Sidney Scott for their contributions to this article.

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New Data Show How the Pandemic Affected Learning Across Whole Communities

• Posted May 11, 2023
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• Disruption and Crises
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Today, The Education Recovery Scorecard , a collaboration with researchers at the Center for Education Policy Research at Harvard University (CEPR) and Stanford University’s Educational Opportunity Project , released 12 new state reports and a research brief to provide the most comprehensive picture yet of how the pandemic affected student learning. Building on their previous work, their findings reveal how school closures and local conditions exacerbated inequality between communities — and the urgent need for school leaders to expand recovery efforts now.

The research team reviewed data from 8,000 communities in 40 states and Washington, D.C., including 2022 NAEP scores and Spring 2022 assessments, COVID death rates, voting rates, and trust in government, patterns of social activity, and survey data from Facebook/Meta on family activities and mental health during the pandemic.

>> Read an op-ed by researchers Tom Kane and Sean Reardon in the New York Times .

They found that where children lived during the pandemic mattered more to their academic progress than their family background, income, or internet speed.  Moreover, after studying instances where test scores rose or fell in the decade before the pandemic, the researchers found that the impacts lingered for years.  

“Children have resumed learning, but largely at the same pace as before the pandemic. There’s no hurrying up teaching fractions or the Pythagorean theorem,” said CEPR faculty director Thomas Kane . “The hardest hit communities — like Richmond, Virginia, St. Louis, Missouri, and New Haven, Connecticut, where students fell behind by more than 1.5 years in math — have to teach 150 percent of a typical year’s worth of material for three years in a row — just to catch up. That is simply not going to happen without a major increase in instructional time.  Any district that lost more than a year of learning should be required to revisit their recovery plans and add instructional time — summer school, extended school year, tutoring, etc. — so that students are made whole. ”

“It’s not readily visible to parents when their children have fallen behind earlier cohorts, but the data from 7,800 school districts show clearly that this is the case,” said Sean Reardon , professor of poverty and inequality, Stanford Graduate School of Education. “The educational impacts of the pandemic were not only historically large, but were disproportionately visited on communities with many low-income and minority students. Our research shows that schools were far from the only cause of decreased learning — the pandemic affected children through many ways — but they are the institution best suited to remedy the unequal impacts of the pandemic.”

The new research includes:

• A research brief that offers insights into why students in some communities fared worse than others. 
• An update to the Education Recovery Scorecard, including data from 12 additional states whose 2022 scores were not available in October. The project now includes a district-level view of the pandemic’s effects in 40 states (plus D.C.). 
• A new interactive map that highlights examples of inequity between neighboring school districts. 

Among the key findings:

• Within the typical school district, the declines in test scores were similar for all groups of students, rich and poor, white, Black, Hispanic. And the extent to which schools were closed appears to have had the same effect on all students in a community, regardless of income or race. 
• Test scores declined more in places where the COVID death rate was higher, in communities where adults reported feeling more depression and anxiety during the pandemic, and where daily routines of families were most significantly restricted. This is true even in places where schools closed only very briefly at the start of the pandemic. 
• Test score declines were smaller in communities with high voting rates and high Census response rates — indicators of what sociologists call “institutional trust.” Moreover, remote learning was less harmful in such places. Living in a community where more people trusted the government appears to have been an asset to children during the pandemic.
• The average U.S. public school student in grades 3-8 lost the equivalent of a half year of learning in math and a quarter of a year in reading.

The researchers also looked at data from the decade prior to the pandemic to see how students bounced back after significant learning loss due to disruption in their schooling. The evidence shows that schools do not naturally bounce back: Affected students recovered 20–30% of the lost ground in the first year, but then made no further recovery in the subsequent three to four years.   

“Schools were not the sole cause of achievement losses,” Kane said. “Nor will they be the sole solution. As enticing as it might be to get back to normal, doing so will just leave the devastating increase in inequality caused by the pandemic in place. We must create learning opportunities for students outside of the normal school calendar, by adding academic content to summer camps and after-school programs and adding an optional 13th year of schooling.”

The Education Recovery Scorecard is supported by funds from Citadel founder and CEO Kenneth C. Griffin, Carnegie Corporation of New York, and the Walton Family Foundation.

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A Better Education for All During—and After—the COVID-19 Pandemic

Research from the Abdul Latif Jameel Poverty Action Lab (J-PAL) and its partners shows how to help children learn amid erratic access to schools during a pandemic, and how those solutions may make progress toward the Sustainable Development Goal of ensuring a quality education for all by 2030.

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By Radhika Bhula & John Floretta Oct. 16, 2020

Five years into the Sustainable Development Goals (SDGs), the world is nowhere near to ensuring a quality education for all by 2030. Impressive gains in enrollment and attendance over recent decades have not translated into corresponding gains in learning. The World Bank’s metric of "learning poverty," which refers to children who cannot read and understand a simple text by age 10, is a staggering 80 percent in low-income countries .

The COVID-19 crisis is exacerbating this learning crisis. As many as 94 percent of children across the world have been out of school due to closures. Learning losses from school shutdowns are further compounded by inequities , particularly for students who were already left behind by education systems. Many countries and schools have shifted to online learning during school closures as a stop-gap measure. However, this is not possible in many places, as less than half of households in low- and middle-income countries (LMICs) have internet access.  

Many education systems around the world are now reopening fully, partially, or in a hybrid format, leaving millions of children to face a radically transformed educational experience. As COVID-19 cases rise and fall during the months ahead, the chaos will likely continue, with schools shutting down and reopening as needed to balance educational needs with protecting the health of students, teachers, and families. Parents, schools, and entire education systems—especially in LMICs—will need to play new roles to support student learning as the situation remains in flux, perhaps permanently. As they adjust to this new reality, research conducted by more than 220 professors affiliated with the Abdul Latif Jameel Poverty Action Lab (J-PAL) and innovations from J-PAL's partners provide three insights into supporting immediate and long-term goals for educating children.

1. Support caregivers at home to help children learn while schools are closed . With nearly 1.6 billion children out of school at the peak of the pandemic, many parents or caregivers, especially with young children, have taken on new roles to help with at-home learning. To support them and remote education efforts, many LMICs have used SMS, phone calls, and other widely accessible, affordable, and low-technology methods of information delivery. While such methods are imperfect substitutes for schooling, research suggests they can help engage parents in their child’s education and contribute to learning , perhaps even after schools reopen.

Preliminary results from an ongoing program and randomized evaluation in Botswana show the promise of parental support combined with low-technology curriculum delivery. When the pandemic hit, the NGO Young 1ove was working with Botswana's Ministry of Education to scale up the  Teaching at the Right Level approach to primary schools in multiple districts. After collecting student, parent, and teacher phone numbers, the NGO devised two strategies to deliver educational support. The first strategy sent SMS texts to households with a series of numeracy “problems of the week.” The second sent the same texts combined with 20-minute phone calls with Young 1ove staff members, who walked parents and students through the problems. Over four to five weeks, both interventions significantly improved learning . They halved the number of children who could not do basic mathematical operations like subtraction and division. Parents became more engaged with their children's education and had a better understanding of their learning levels. Young 1ove is now evaluating the impact of SMS texts and phone calls that are tailored to students’ numeracy levels.

In another example, the NGO Educate! reoriented its in-school youth skills model to be delivered through radio, SMS, and phone calls in response to school closures in East Africa. To encourage greater participation, Educate! called the students' caregivers to tell them about the program. Their internal analysis indicates that households that received such encouragement calls had a 29 percent increase in youth participation compared to those that did not receive the communication.

In several Latin American countries , researchers are evaluating the impact of sending SMS texts to parents on how to support their young children who have transitioned to distance-learning programs. Similar efforts to support parents and evaluate the effects are underway in Peru . Both will contribute to a better understanding of how to help caregivers support their child’s education using affordable and accessible technology.

Other governments and organizations in areas where internet access is limited are also experimenting with radio and TV to support parents and augment student learning. The Côte d’Ivoire government created a radio program on math and French for children in grades one to five. It involved hundreds of short lessons. The Indian NGO Pratham collaborated with the Bihar state government and a television channel to produce 10 hours of learning programming per week, creating more than 100 episodes to date. Past randomized evaluations of such “edutainment” programs from other sectors in Nigeria , Rwanda , and Uganda suggest the potential of delivering content and influencing behavior through mass media, though context is important, and more rigorous research is needed to understand the impact of such programs on learning.

2. As schools reopen, educators should use low-stakes assessments to identify learning gaps. As of September 1, schools in more than 75 countries were open to some degree. Many governments need to be prepared for the vast majority of children to be significantly behind in their educations as they return—a factor exacerbated by the low pre-pandemic learning levels, particularly in LMICs . Rather than jumping straight into grade-level curriculum, primary schools in LMICs should quickly assess learning levels to understand what children know (or don’t) and devise strategic responses. They can do so by using simple tools to frequently assess students, rather than focusing solely on high-stakes exams, which may significantly influence a child’s future by, for example, determining grade promotion.

Orally administered assessments—such as ASER , ICAN , and Uwezo —are simple, fast, inexpensive, and effective. The ASER math tool, for example, has just four elements: single-digit number recognition, double-digit number recognition, two-digit subtraction, and simple division. A similar tool exists for assessing foundational reading abilities. Tests like these don’t affect a child’s grades or promotion, help teachers to get frequent and clear views into learning levels, and can enable schools to devise plans to help children master the basics.

3. Tailor children's instruction to help them master foundational skills once learning gaps are identified. Given low learning levels before the pandemic and recent learning loss due to school disruptions, it is important to focus on basic skills as schools reopen to ensure children maintain and build a foundation for a lifetime of learning. Decades of research from Chile, India, Kenya, Ghana, and the United States shows that tailoring instruction to children’s’ education levels increases learning. For example, the Teaching at the Right Level (TaRL) approach, pioneered by Indian NGO Pratham and evaluated in partnership with J-PAL researchers through six randomized evaluations over the last 20 years, focuses on foundational literacy and numeracy skills through interactive activities for a portion of the day rather than solely on the curriculum. It involves regular assessments of students' progress and is reaching more than 60 million children in India and several African countries .

Toward Universal Quality Education

As countries rebuild and reinvent themselves in response to COVID-19, there is an opportunity to accelerate the thinking on how to best support quality education for all. In the months and years ahead, coalitions of evidence-to-policy organizations, implementation partners, researchers, donors, and governments should build on their experiences to develop education-for-all strategies that use expansive research from J-PAL and similar organizations. In the long term, evidence-informed decisions and programs that account for country-specific conditions have the potential to improve pedagogy, support teachers, motivate students, improve school governance, and address many other aspects of the learning experience. Perhaps one positive outcome of the pandemic is that it will push us to overcome the many remaining global educational challenges sooner than any of us expect. We hope that we do.

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The state of the global education crisis, a path to recovery.

The global disruption to education caused by the COVD-19 pandemic is without parallel and the effects on learning are severe. The crisis brought education systems across the world to a halt, with school closures affecting more than 1.6 billion learners. While nearly every country in the world offered remote learning opportunities for students, the quality and reach of such initiatives varied greatly and were at best partial substitutes for in-person learning. Now, 21 months later, schools remain closed for millions of children and youth, and millions more are at risk of never returning to education. Evidence of the detrimental impacts of school closures on children’s learning offer a harrowing reality: learning losses are substantial, with the most marginalized children and youth often disproportionately affected.

The State of the Global Education Crisis: A Path to Recovery charts a path out of the global education crisis and towards building more effective, equitable and resilient education systems.

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Remote learning turned spotlight on gaps in resources, funding, and tech — but also offered hints on reform

“Unequal” is a multipart series highlighting the work of Harvard faculty, staff, students, alumni, and researchers on issues of race and inequality across the U.S. This part looks at how the pandemic called attention to issues surrounding the racial achievement gap in America.

The pandemic has disrupted education nationwide, turning a spotlight on existing racial and economic disparities, and creating the potential for a lost generation. Even before the outbreak, students in vulnerable communities — particularly predominately Black, Indigenous, and other majority-minority areas — were already facing inequality in everything from resources (ranging from books to counselors) to student-teacher ratios and extracurriculars.

The additional stressors of systemic racism and the trauma induced by poverty and violence, both cited as aggravating health and wellness as at a Weatherhead Institute panel , pose serious obstacles to learning as well. “Before the pandemic, children and families who are marginalized were living under such challenging conditions that it made it difficult for them to get a high-quality education,” said Paul Reville, founder and director of the Education Redesign Lab at the Harvard Graduate School of Education (GSE).

Educators hope that the may triggers a broader conversation about reform and renewed efforts to narrow the longstanding racial achievement gap. They say that research shows virtually all of the nation’s schoolchildren have fallen behind, with students of color having lost the most ground, particularly in math. They also note that the full-time reopening of schools presents opportunities to introduce changes and that some of the lessons from remote learning, particularly in the area of technology, can be put to use to help students catch up from the pandemic as well as to begin to level the playing field.

The disparities laid bare by the COVID-19 outbreak became apparent from the first shutdowns. “The good news, of course, is that many schools were very fast in finding all kinds of ways to try to reach kids,” said Fernando M. Reimers , Ford Foundation Professor of the Practice in International Education and director of GSE’s Global Education Innovation Initiative and International Education Policy Program. He cautioned, however, that “those arrangements don’t begin to compare with what we’re able to do when kids could come to school, and they are particularly deficient at reaching the most vulnerable kids.” In addition, it turned out that many students simply lacked access.

“We’re beginning to understand that technology is a basic right. You cannot participate in society in the 21st century without access to it,” says Fernando Reimers of the Graduate School of Education.

Stephanie Mitchell/Harvard file photo

The rate of limited digital access for households was at 42 percent during last spring’s shutdowns, before drifting down to about 31 percent this fall, suggesting that school districts improved their adaptation to remote learning, according to an analysis by the UCLA Center for Neighborhood Knowledge of U.S. Census data. (Indeed, Education Week and other sources reported that school districts around the nation rushed to hand out millions of laptops, tablets, and Chromebooks in the months after going remote.)

The report also makes clear the degree of racial and economic digital inequality. Black and Hispanic households with school-aged children were 1.3 to 1.4 times as likely as white ones to face limited access to computers and the internet, and more than two in five low-income households had only limited access. It’s a problem that could have far-reaching consequences given that young students of color are much more likely to live in remote-only districts.

“We’re beginning to understand that technology is a basic right,” said Reimers. “You cannot participate in society in the 21st century without access to it.” Too many students, he said, “have no connectivity. They have no devices, or they have no home circumstances that provide them support.”

The issues extend beyond the technology. “There is something wonderful in being in contact with other humans, having a human who tells you, ‘It’s great to see you. How are things going at home?’” Reimers said. “I’ve done 35 case studies of innovative practices around the world. They all prioritize social, emotional well-being. Checking in with the kids. Making sure there is a touchpoint every day between a teacher and a student.”

The difference, said Reville, is apparent when comparing students from different economic circumstances. Students whose parents “could afford to hire a tutor … can compensate,” he said. “Those kids are going to do pretty well at keeping up. Whereas, if you’re in a single-parent family and mom is working two or three jobs to put food on the table, she can’t be home. It’s impossible for her to keep up and keep her kids connected.

“If you lose the connection, you lose the kid.”

“COVID just revealed how serious those inequities are,” said GSE Dean Bridget Long , the Saris Professor of Education and Economics. “It has disproportionately hurt low-income students, students with special needs, and school systems that are under-resourced.”

This disruption carries throughout the education process, from elementary school students (some of whom have simply stopped logging on to their online classes) through declining participation in higher education. Community colleges, for example, have “traditionally been a gateway for low-income students” into the professional classes, said Long, whose research focuses on issues of affordability and access. “COVID has just made all of those issues 10 times worse,” she said. “That’s where enrollment has fallen the most.”

In addition to highlighting such disparities, these losses underline a structural issue in public education. Many schools are under-resourced, and the major reason involves sources of school funding. A 2019 study found that predominantly white districts got $23 billion more than their non-white counterparts serving about the same number of students. The discrepancy is because property taxes are the primary source of funding for schools, and white districts tend to be wealthier than those of color.

The problem of resources extends beyond teachers, aides, equipment, and supplies, as schools have been tasked with an increasing number of responsibilities, from the basics of education to feeding and caring for the mental health of both students and their families.

“You think about schools and academics, but what COVID really made clear was that schools do so much more than that,” said Long. A child’s school, she stressed “is social, emotional support. It’s safety. It’s the food system. It is health care.”

“You think about schools and academics” … but a child’s school “is social, emotional support. It’s safety. It’s the food system. It is health care,” stressed GSE Dean Bridget Long.

Rose Lincoln/Harvard file photo

This safety net has been shredded just as more students need it. “We have 400,000 deaths and those are disproportionately affecting communities of color,” said Long. “So you can imagine the kids that are in those households. Are they able to come to school and learn when they’re dealing with this trauma?”

The damage is felt by the whole families. In an upcoming paper, focusing on parents of children ages 5 to 7, Cindy H. Liu, director of Harvard Medical School’s Developmental Risk and Cultural Disparities Laboratory , looks at the effects of COVID-related stress on parent’ mental health. This stress — from both health risks and grief — “likely has ramifications for those groups who are disadvantaged, particularly in getting support, as it exacerbates existing disparities in obtaining resources,” she said via email. “The unfortunate reality is that the pandemic is limiting the tangible supports [like childcare] that parents might actually need.”

Educators are overwhelmed as well. “Teachers are doing a phenomenal job connecting with students,” Long said about their performance online. “But they’ve lost the whole system — access to counselors, access to additional staff members and support. They’ve lost access to information. One clue is that the reporting of child abuse going down. It’s not that we think that child abuse is actually going down, but because you don’t have a set of adults watching and being with kids, it’s not being reported.”

The repercussions are chilling. “As we resume in-person education on a normal basis, we’re dealing with enormous gaps,” said Reville. “Some kids will come back with such educational deficits that unless their schools have a very well thought-out and effective program to help them catch up, they will never catch up. They may actually drop out of school. The immediate consequences of learning loss and disengagement are going to be a generation of people who will be less educated.”

There is hope, however. Just as the lockdown forced teachers to improvise, accelerating forms of online learning, so too may the recovery offer options for educational reform.

The solutions, say Reville, “are going to come from our community. This is a civic problem.” He applauded one example, the Somerville, Mass., public library program of outdoor Wi-Fi “pop ups,” which allow 24/7 access either through their own or library Chromebooks. “That’s the kind of imagination we need,” he said.

On a national level, he points to the creation of so-called “Children’s Cabinets.” Already in place in 30 states, these nonpartisan groups bring together leaders at the city, town, and state levels to address children’s needs through schools, libraries, and health centers. A July 2019 “ Children’s Cabinet Toolkit ” on the Education Redesign Lab site offers guidance for communities looking to form their own, with sample mission statements from Denver, Minneapolis, and Fairfax, Va.

Already the Education Redesign Lab is working on even more wide-reaching approaches. In Tennessee, for example, the Metro Nashville Public Schools has launched an innovative program, designed to provide each student with a personalized education plan. By pairing these students with school “navigators” — including teachers, librarians, and instructional coaches — the program aims to address each student’s particular needs.

“This is a chance to change the system,” said Reville. “By and large, our school systems are organized around a factory model, a one-size-fits-all approach. That wasn’t working very well before, and it’s working less well now.”

“Students have different needs,” agreed Long. “We just have to get a better understanding of what we need to prioritize and where students are” in all aspects of their home and school lives.

“By and large, our school systems are organized around a factory model, a one-size-fits-all approach. That wasn’t working very well before, and it’s working less well now,” says Paul Reville of the GSE.

Already, educators are discussing possible responses. Long and GSE helped create The Principals’ Network as one forum for sharing ideas, for example. With about 1,000 members, and multiple subgroups to address shared community issues, some viable answers have begun to emerge.

“We are going to need to expand learning time,” said Long. Some school systems, notably Texas’, already have begun discussing extending the school year, she said. In addition, Long, an internationally recognized economist who is a member of the  National Academy of Education and the  MDRC board, noted that educators are exploring innovative ways to utilize new tools like Zoom, even when classrooms reopen.

“This is an area where technology can help supplement what students are learning, giving them extra time — learning time, even tutoring time,” Long said.

Reimers, who serves on the UNESCO Commission on the Future of Education, has been brainstorming solutions that can be applied both here and abroad. These include urging wealthier countries to forgive loans, so that poorer countries do not have to cut back on basics such as education, and urging all countries to keep education a priority. The commission and its members are also helping to identify good practices and share them — globally.

Innovative uses of existing technology can also reach beyond traditional schooling. Reimers cites the work of a few former students who, working with Harvard Global Education Innovation Initiative,   HundrED , the  OECD Directorate for Education and Skills , and the  World Bank Group Education Global Practice, focused on podcasts to reach poor students in Colombia.

They began airing their math and Spanish lessons via the WhatsApp app, which was widely accessible. “They were so humorous that within a week, everyone was listening,” said Reimers. Soon, radio stations and other platforms began airing the 10-minute lessons, reaching not only children who were not in school, but also their adult relatives.

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The changes we need: Education post COVID-19

1 Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia

2 School of Education, University of Kansas, 419 JRP, Lawrence, KS 66049 USA

Jim Watterston

The COVID-19 pandemic has caused both unprecendented disruptions and massive changes to education. However, as schools return, these changes may disappear. Moreover, not all of the changes are necessarily the changes we want in education. In this paper, we argue that the pandemic has created a unique opportunity for educational changes that have been proposed before COVID-19 but were never fully realized. We identify three big changes that education should make post COVID: curriculum that is developmental, personalized, and evolving; pedagogy that is student-centered, inquiry-based, authentic, and purposeful; and delivery of instruction that capitalizes on the strengths of both synchronous and asynchronous learning.

Introduction

The impact of the COVID-19 pandemic on education is both unprecedented and widespread in education history, impacting nearly every student in the world (UNICEF 2020 ; United Nations 2020 ). The unexpected arrival of the pandemic and subsequent school closures saw massive effort to adapt and innovate by educators and education systems around the world. These changes were made very quickly as the prevailing circumstances demanded. Almost overnight, many schools and education systems began to offer education remotely (Kamanetz 2020 ; Sun et al. 2020 ). Through television and radio, the Internet, or traditional postal offices, schools shifted to teach students in very different ways. Regardless of the outcomes, remote learning became the de facto method of education provision for varying periods. Educators proactively responded and showed great support for the shifts in lesson delivery. Thus, it is clear and generally accepted that “this crisis has stimulated innovation within the education sector” (United Nations 2020 , p. 2).

However, the changes or innovations that occurred in the immediate days and weeks when COVID-19 struck are not necessarily the changes education needs to make in the face of massive societal changes in a post-COVID-19 world. By and large, the changes were more about addressing the immediate and urgent need of continuing schooling, teaching online, and finding creative ways to reach students at home rather than using this opportunity to rethink education. While understandable in the short term, these changes will very likely be considered insubstantial for the long term.

The COVID-19 pandemic has the potential to be a once in a generation opportunity for real change a number of reasons. First, the pandemic was global and affected virtually all schools. As such, it provides the opportunity for educators and children to come together to rethink the education we actually need as opposed to the inflexible and outdated model that we are likely to feverishly cling to. Second, educators across the world demonstrated that they could collectively change en masse. The pandemic forced closure of schools, leaving teachers, children and adults to carry out education in entirely different situations. Governments, education systems, and schools offered remote learning and teaching without much preparation, planning, and in some cases, digital experience (Kamanetz 2020 ; Sun et al. 2020 ). Third, when schools were closed, most of the traditional regulations and exams that govern schools were also lifted or minimally implemented. Traditional accountability examinations and many other high stakes tests were cancelled. Education was given the room to rapidly adapt to the prevailing circumstances.

It is our hope that as we transition out of the COVID-19 pandemic and into an uncertain future that we can truly reimagine education. In light of this rare opportunity, we wish to urge scholars, policy makers, and educators to have the courage to make bold changes beyond simply changing instructional delivery. The changes that we advocate in this paper are not new but they never managed to gain traction in the pre-COVID-19 educational landscape. Our most recent experience, however, has exacerbated the need for us to rethink what is necessary, desirable, and even possible for future generations.

Changes we need

It is incumbant upon all educators to use this crisis-driven opportunity to push for significant shifts in almost every aspect of education: what, how, where, who, and when. In other words, education, from curriculum to pedagogy, from teacher to learner, from learning to assessment, and from location to time, can and should radically transform. We draw on our own research and that of our colleagues to suggest what this transformation could look like.

Curriculum: What to teach

It has been widely acknowledged that to thrive in a future globalized world, traditionally valued skills and knowledge will become less important and a new set of capabilities will become more dominant and essential (Barber et al. 2012 ; Florida 2012 ; Pink 2006 ; Wagner 2008 ; Wagner and Dintersmith 2016 ). While the specifics vary, the general agreement is that repetition, pattern-prediction and recognition, memorization, or any skills connected to collecting, storing, and retrieving information are in decline because of AI and related technologies (Muro et al. 2019 ). On the rise is a set of contemporary skills which includes creativity, curiosity, critical thinking, entrepreneurship, collaboration, communication, growth mindset, global competence, and a host of skills with different names (Duckworth and Yeager, 2015 ; Zhao et al. 2019 ).

For humans to thrive in the age of smart machines, it is essential that they do not compete with machines. Instead, they need to be more human. Being unique and equipped with social-emotional intelligence are distinct human qualities (Zhao 2018b , 2018c ) that machines do not have (yet). In an AI world individual creativity, artistry and humanity will be important commodities that distinguish us from each other.

Moreover, given the rapidity of changes we are already experiencing, it is clear that lifelong careers and traditional employment pathways will not exist in the way that they have for past generations. Jobs and the way we do business will change and the change will be fast. Thus there are almost no knowledge or skills that can be guaranteed to meet the needs of the unknown, uncertain, and constantly changing future. For this reason, schools can no longer preimpose all that is needed for the future before students graduate and enter the world.

While helping students develop basic practical skills is still needed, education should also be about development of humanity in citizens of local, national, and global societies. Education must be seen as a pathway to attaining lifelong learning, satisfaction, happiness, wellbeing, opportunity and contribution to humanity. Schools therefore need to provide comprehensive access and deep exposure to all learning areas across all years in order to enable all students to make informed choices and develop their passions and unique talents.

A new curriculum that responds to these needs must do a number of things. First, it needs to help students develop the new competencies for the new age (Barber et al. 2012 ; Wagner 2008 , 2012 ; Wagner and Dintersmith 2016 ). To help students thrive in the age of smart machines and a globalized world, education must teach students to be creative, entrepreneurial, and globally competent (Zhao 2012a , 2012b ). The curriculum needs to focus more on developing students’ capabilities instead of focusing only on ‘template’ content and knowledge. It needs to be concerned with students’ social and emotional wellbeing as well. Moreover, it needs to make sure that students have an education experience that is globally connected and environmentally connected. As important is the gradual disappearance of school subjects such as history and physics for all students. The content is still important, but it should be incorporated into competency-based curriculum.

Second, the new curriculum should allow personalization by students (Basham et al. 2016 ; Zhao 2012b , 2018c ; Zhao and Tavangar 2016 ). Although personalized learning has been used quite elusively in the literature, the predominant model of personalized learning has been computer-based programs that aim to adapt to students’ needs (Pane et al. 2015 ). This model has shown promising results but true personalization comes from students’ ability to develop their unique learning pathways (Zhao 2018c ; Zhao and Tavangar 2016 ). That is, students can follow their passions and strengths. This not only requires the curriculum to be flexible so that students can choose what they wish to learn, but also requires students to come up with their own learning pathway without being overly constrained by the pre-determined curriculum. Thus national curriculum or curriculum for all students should be a minimal suite of essential knowledge and skills, sufficient for all students to develop the most basic competences and learn the most common norms, expectations, and the societal organizations of a jurisdiction.

Enabling students to co-develop part of the curriculum is not only necessary for them to become unique but also gives them the opportunity to exercise their right to self-determination, which is inalienable to all humans (Wehmeyer and Zhao 2020 ). It provides the opportunities for students to make choices, propose new learning content, and learn about consequences of their actions. Furthermore, it helps students to become owners of their learning and also develop life-long learning habits and skills. It is to help them go meta about their learning—above what they learn and understand why they learn.

Third, it is important to consider the curriculum as evolving. Although system-level curriculum frameworks have to be developed, they must accommodate changes with time and contexts. Any system-level curriculum should enable the capacity for schools to contextualize and make changes to it as deemed necessary. Such changes must be justifiable of course but a system-level curriculum framework should not use national or state level accountability assessments to constrain the changes.

Pedagogy: How to teach

There is increasing call for learners to be more actively engaged in their own learning. The reasons for students to take a more significant role in their own learning are multiple. First, students are diverse and have different levels of abilities and interests that may not align well with the content they are collectively supposed to learn in the classroom. Teachers have been encouraged to pursue classroom differentiation (Tomlinson 2014 ) and students have been encouraged to play a more active role in defining their learning and learning environments in collaboration with teachers (Zhao 2018c ). Second, the recent movement toward personalized learning (Kallick and Zmuda 2017 ; Kallio and Halverson 2020 ) needs students to become more active in understanding and charting their learning pathways.

To promote student self-determination as both a self-evident, naturally born right and an effective strategy for enhanced learning (Wehmeyer and Zhao 2020 ), we need to consider enabling students to make informed decisions regarding their own learning pathway. This generation of learners are much more active and tech-savvy. They access information instantly and have been doing so throughout their daily life. They have different strengths and weaknesses. They also have different passions. Thus, schools should use discretion to start relaxing the intense requirements of curriculum. Schools could start by allowing students to negotiate part of their curriculum instead of requiring all students learn the same content, as discussed earlier. Students should be enabled to have certain levels of autonomy over what they want to learn, how they learn, where they learn and how they want to be assessed (Zhao 2018c ). When students have such autonomy, they are more likely to be less constrained by the local contexts they are born into. The impact of their home background and local schools may be less powerful.

Students should exercise self-determination as members of the school community (Zhao 2018c ). The entire school is composed of adults and students, but students are the reason of existence for schools. Thus, schools and everything in the school environment should incorporate and serve the students, yet most schools do not have policies and processes that enable students to participate in making decisions about the school—the environment, the rules and regulations, the curriculum, the assessment, and the adults in the school. Schools need to create these conditions through empowering students to have a genuine voice in part of how they operate, if not in its entirety. Students’ right to self-determination implies that they have the right to determine under what conditions they wish to learn. Thus, it is not unreasonable for schools to treat students as partners of learning and of change (Zhao 2011 , 2018c ).

It should not be unique to see school practices co-developed with students (Zhao 2018c ). Students not only will be co-owners (with parents and teachers) of their own learning enterprise, but also co-owners of the school community. It is likely to see students having their own personal learning programs and also acting as fully functioning members of the entire school community, contributing to fundamental decisions regarding the curriculum for all, the staff, the students, and the entire environment.

Moreover, with ubiquitous access to online resources and experts, students do not necessarily need teachers to continually and directly teach them. When students are enabled to own their learning and have access to resources and experts, the role of the teacher changes (Zhao 2018a ). Teachers no longer need to serve as the instructor, the sole commander of information to teach the students content and skills. Instead, the teacher serves other more important roles such as organizer of learning, curator of learning resources, counselor to students, community organizer, motivator and project managers of students’ learning. The teacher’s primary responsibility is no longer simply just instruction, which requires teacher education to change as well. Teacher education needs to focus more on preparing teachers to be human educators who care more about the individual students and serve as consultants and resource curators instead of teaching machines (Zhao 2018a ).

Pedagogy should change as well. Direct instruction should be cast away for its “unproductive successes” or short-term successes but long term damages (Bonawitza et al. 2011 ; Buchsbauma et al. 2011 ; Kapur 2014 , 2016 ; Zhao 2018d ). In its place should be new models of teaching and learning. The new models can have different formats and names but they should be student-centered, inquiry-based, authentic, and purposeful. New forms of pedagogy should focus on student-initiated explorations of solutions to authentic and significant problems. They should help students develop abilities to handle the unknown and uncertain instead of requiring memorization of known solutions to known problems.

Organization: Where and when to teach

Technology has made it possible for schools to offer online education for quite some time and the number of students taking online courses has been on the rise, but not until the arrival of COVID-19 has the majority of education been offered through this mode. While there are many good reasons for schools to return to what was refrred to as “normal,” the normalcy may not be easily achieved because of the uncertainty of the virus, and as discussed above, may not even be desirable.

Moving teaching online is significant. It ultimately changed one of the most important unwritten school rules: all students must be in one location for education to take place. The typical place of learning has been the classroom in a school and the learning time has been typically confined to classes. This massive online movement changed the typical. It has forced teachers to experience remote teaching without proximity to the students. It has also given many teachers the opportunity to rethink the purpose of teaching and connecting with students.

When students are not learning in classes inside a school, they are distributed in the community. They can interact with others through technologies. This can have significant impact on learning activities. If allowed or enabled by a teacher, students could be learning from online resources and experts anywhere in the world. Thus, the where of learning changes from the classroom to the world.

Furthermore, the time of learning also changes. When learning goes online and students are not or do not need to be in schools, their learning time vastly expands beyond the traditional school time. They can learn asynchronously at anytime. Equally important is that their learning time does not need to be synchronous with each other or with that of the teacher.

There are many possible ways for schools to deliver remote learning (Zhao 2020 ). The simplest is to simulate that schools are open with traditional timetables with the default model being that all students attend lessons on screen at the same time as they do in schools. In this case, nothing changes except for the fact that students are not in the same location as their classmates and the teacher. While it has been perhaps the most common approach that has been taken by many schools, this approach has not been very effective and successful, resulting in distress, disengagement, and much less personal interaction and learning than traditional face-to-face situations (Darby 2020 ; Dorn et al. 2020 ).

As schools continue to explore online learning, new and more effective models are being explored, innovatively developed, and practiced. The more effective models of online learning have a well-balanced combination of both synchronous and asynchronous sessions that enable more desirable ways of learning. Instead of teaching online all the time, it is possible, for example, to conduct inquiry-based learning. Students receive instructions from online resources or synchronous meetings, conduct inquiry, create products individually or within small groups, and make presentations in large class synchronous meetings. Instead of lecturing to all students, teachers could create videos of lectures or find videos made by others and share them with students. They would also be meeting with small groups of individuals for specific advice and support. The fundamental pursuit is that there is minimal benefit or student engagement for teachers to lecture all the time when more interesting and challenging instructional models can be developed.

Today, being disconnected physically can result in being more broadly connected virtually. Students have been traditionally associated with their schools and schools have typically served local communities. Thus, students typically are connected and socialize with their peers from restricted catchment areas. Despite the possibility to connect globally with people from other lands, most schools’ activities are local. Today, when local connections become less reliable and students are encouraged to have social distancing, it is possible to encourage more global connections virtually. Students could join different learning communities that involve members from different locations, not necessarily from their own schools. Students could also participate in learning opportunities provided by other providers in remote locations. Furthermore, students could create their own learning opportunities by inviting peers and teachers from other locations.

The ideal model of organizing students, based on the COVID-19 experiences, is perhaps a combination of both online and face-to-face learning opportunities. Many schools have already reopened, but when schools reopen it is unnecessary to undo the online aspect of learning developed during COVID-19. Online learning can be effective (Means et al. 2013 ; Rudestam and Schoenholtz-Read 2010 ; Zhao et al. 2005 ), but a well-designed mixed mode delivery of online and face-to-face education should be more effective for learning in general but especially so should there be future instances of virtual learning (Tucker 2020 ). The idea of blended learning or flipped classrooms (Bishop and Verleger 2013 ) has been promoted and researched in recent years as very effective models of teaching. COVID-19 should have made the convincing much easier since many teachers have been forced to move online.

When learning is both online and face-to-face, students are liberated from having to attend classes at specific times. They are also no longer required to be in the same place to receive instruction from teachers. They could work on their own projects and reach out to their teachers or peers when necessary. When students are no longer required to attend class at the same time in the same place, they can have much more autonomy over their own learning. Their learning time expands beyond school time and their learning places can be global.

Education will undoubtedly go through major changes in the next decade as the combined result of multiple major forces. These changes include curricular changes that determine what is to be learned by learners. It is likely that more students will be moving toward competency-based learning that has an emphasis on developing unique skills and abilities. Learning has to become more based on strengths and passions and become personalized. In response, education providers will need to make student autonomy and student agency key to transforming pedagogy and school organizations. Students will prosper by having more say in their own learning and their learning communities. Moreover, schools will have a unique opportunity to positively and proactively change as a result of COVID-19 and the need for global connections. It is possible to see schools rearrange their schedules and places of teaching so that students can at the same time take part in different and more challenging learning opportunities regardless of their physical locations. Relevant online learning will be on the rise and perhaps becomes a regular part of the daily routine for many students.

Of course, we cannot forget that not all students have equal access to technology, both in terms of hardware and digital competency. The issue of digital divide remains a significant issue around the globe. It is important for us to reimagine a better education with technology and find creative ways to make education more equitable, including wiping out the digital divide.

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Contributor Information

Yong Zhao, Email: ude.uk@oahzgnoy .

Jim Watterston, Email: [email protected] .

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How the Pandemic Has Changed Us—and Higher Education

Explore more.

• Digital Learning
• Education Strategy
• Perspectives

THREE UNIQUE PERSPECTIVES

Maria de Fátima Carioca , dean at AESE Business School in Portugal, began her career in education with 20 years in the software industry, working in various business management and people management functions. After getting her doctorate degree at the University of Manchester, she joined AESE as a professor of Human Factor in 2005 and became a dean in 2014.

When the pandemic arrived, Carioca oversaw the closing of the school in a matter of days, accounting for the needs of faculty, staff, students, and even alumni, whom AESE is dedicated to supporting. Almost all programs were moved online except for high-level management programs dependent on in-person networking.

Wendy Stahl , a professor in the School of Professional Studies at New York University, had a somewhat easier time transitioning to online learning—her courses for Spring 2020 were already digital by design.

Driven by a passion for education, Stahl began teaching over 20 years ago, while still an executive in the media technology industry. She continued to follow that passion by taking a teaching position at NYU after retiring from the corporate sector. About seven years ago, Stahl had the opportunity to begin developing asynchronous online courses for NYU, and she has continued to teach some of her courses online ever since. Over the past year, she had the opportunity to observe the transition to online learning from a position of knowledge and experience.

Nour Khalil , a student pursuing a BA in business administration at the American University in Cairo, spent her early school years in several different countries, gaining a multicultural worldview from her travels. Her passions include the natural world and sustainability.

Khalil was on campus for only a semester and a half before having to switch to online learning. While learning online has been quite tough, she says her school did a great job facilitating a smooth transition to digital learning and maintaining a quality educational program.

But our individual paths have also been markedly different— much rougher for some than others . To better understand this past year’s impact on individuals in education, Inspiring Minds spoke to a dean, a professor, and a student from different business schools globally. While reading their reflections, consider how this time of trial has reshaped boundaries and played out differently among their roles.

Q: What was your experience early in the pandemic?

Maria de Fátima Carioca, dean, AESE Business School in Portugal: In March 2020, in a matter of days, we closed the school. In doing so, we had to consider what being closed meant to the whole AESE community—to our staff, our faculty, and our alumni.

We switched most of our programs to an online format. I say “most of our programs” because we realized very quickly that some executive education programs, namely those that rely heavily on networking, cannot be accomplished online. Moving programs online changed the way we delivered classes—and even the way we encouraged our students to prepare for those classes. We invested in creating virtual classrooms that are basically TV studios. And we trained our faculty to make the most of the technology, to reinvent themselves, and to deliver the best possible learning experience tailored to a live online format. We also trained our staff, because doing all of the administrative processes online and from home was a completely different way of working.

Wendy Stahl, adjunct assistant professor in the School of Professional Studies, New York University: At NYU, tremendous resources are dedicated to supporting faculty in their online teaching skills. A few years ago, when everyone started looking at online learning, I was asked to develop a course for the asynchronous online mode, which was quite new back then. I have taught both in the asynchronous online mode and in the classroom for the last seven years. So this year was not the first time that I taught online.

As it turned out, for this past winter semester [2020], I was already scheduled to teach an asynchronous online course. During the pandemic, I taught the courses that I would have taught. So for me, unlike for many, the scramble to quickly drop what you were doing for classroom teaching and convert it all instantly to online was not an issue.

Nour Khalil, BA student, American University in Cairo: I experienced only a semester and a half on campus, and the rest has been online. So, unfortunately, the primary university experience I know has been online.

I have to say—the American University in Cairo did an amazing job at shifting online very quickly. Around the end of February [2020], the university had started teaching faculty how to use Zoom and how to use online platforms. The school made a big effort to smooth things out for us and not make us even more stressed than we already were.

The school’s quality did not decline at all. They truly did an amazing job staying true to their promise, which is providing students with high-quality education. And from my personal experience, the quality of my education did not really change during the pandemic. For that, I’m grateful. I’d like to say thank you to all those who made a huge effort and to all the professors who were very understanding.

In terms of my day-to-day experiences, though, there were tougher times than others. I would be remiss if I didn’t mention mental health and burnout, which is something I’m sure we all felt. The pandemic definitely had a big toll on mental health in the sense that, even if you worked very hard and were very organized, your mental health could suffer. I experienced a lot of Zoom fatigue, and the lack of normal physical activity was a strain, as well. I did reach points of burnout where I was overworking myself too much to be able to stay at a certain level. It has definitely been a tough time.

Q: What bright spots have emerged for you during the past year?

Carioca : Since the first week of confinement, we began delivering an article a day to our alumni, sharing thoughts, stories, solutions, and pioneering ideas to move forward. It was very good for our alumni to feel that we were together in the same boat, on the same journey. The intention was to help our community get through the challenges that the pandemic brought upon their organizations, and to see this moment as a great opportunity to take risks while doing things differently in order to come out of the crisis stronger than ever.

We also confirmed that online learning has great advantages. One is that we have been able to expand to new markets by bringing our programs to other Portuguese-speaking countries. Now we are seeking to reach all those countries, and that is something that is only possible with all the knowledge gained from the past year. It turned out to be an amazing opportunity.

“The school is changing its processes, some of its culture, and its programs, but the mission is the same. We prepare our participants and our alumni throughout their lives to be leaders to whom we can entrust the future. That mission, our mission, must—and will—continue.” Maria de Fátima Carioca

Amidst these challenging times, AESE celebrated a landmark moment—its 40th anniversary. Previous anniversaries have been times to network and to share knowledge, innovative approaches, and disruptive ideas. For the past year and a half, the challenge was to reimagine everything, maintaining the standards but in an online format. By now, I am proud to share that our Alumni Assembly took place online on June 25 and gathered more than 800 participants from our 7,500 alumni throughout a whole day. It was a virtual learning experience with relevant networking, supported by quality technological means. It received overwhelmingly positive feedback.

Stahl : Last summer, I participated in a development program that NYU put together to purposefully convert several courses in our core program to a fully online modality. We had access to resources such as instructional designers, videographers, and others. There was a tremendous amount of pedagogical review and curriculum alignment that went on.

I found, and I think my colleagues found, that for each lesson, we had to really rethink: What is it that I’m trying to do, and what’s the best way to do that when you’re not in the classroom? We experimented with a lot of different ways to do things, some of them related to pedagogical structures and some of them experimenting with various activities.

I think it’s very exciting that we have this opportunity to work in all these new ways to further make an impact on our students and engage with them. And I think that the progress in the next couple years should be awesome.

Khalil : We had some professors who were amazing people, who were really understanding. This removed a big bulk of the stress we would get from other professors who unfortunately weren’t that understanding.

Some professors were very innovative, as well. For example, Dr. Nellie El Enany was able to make class time as engaging and as interactive as it would be on campus. She was open to discussion and would cover really interesting topics. Also, the way she assessed us was all about projects, and each one was a hands-on experience. I feel like I really gained information from the field that I want to work in in the future. I would wake up in the morning excited to attend her class. So even with all the hard things going on, professors like her made this online experience bearable.

Q: What did you learn over the past year that you want to carry with you going forward?

Carioca : Through the time of the pandemic, we have changed and greatly enriched our learning offerings. But I think all of us realized that the culture of the school has been reinforced. Our values have been reinforced. Change ignited us. We understood very quickly that no matter what format or channel we are using, we must continue to have a unique way of educating leaders and accomplishing our mission.

The school is changing its processes, some of its culture, and its programs, but the mission is the same. We prepare our participants and our alumni throughout their lives to be leaders to whom we can entrust the future. That mission, our mission, must—and will—continue.

Stahl : Never underestimate what your students can do if you motivate them well. They are digital natives, so this is not a strange world for them. Doing school in this space is not all that unusual.

Additionally, I became even more committed to hybrid models of teaching that take the best of all of our tools and platforms and let us really engage with the students in as many ways as possible.

“Teachers need to remember that we have to become a person to our students. We have to find a personal way to engage them, so that they’re comfortable coming to us if something’s on their mind.” Wendy Stahl

Khalil : There were three things that I had to deal with: I had to become much more independent in my work, I had to be much more organized, and I had to manage my time efficiently. When I was at the university, if I had any questions, I would just go see my professor. But now if I have any questions, I have to send an email and wait for a response, which can be another burden. So instead, I try to first understand by myself. And if I really don’t understand, then I ask. I’ve had to learn to be a bit more independent.

Second, organization is so crucial because you have so many things to deal with at the same time. So if you’re not organized, you can forget deadlines. I know many people who suffered from that. You have to stay organized and even do work in advance.

And lastly, time management, which goes with organization. We have so many courses to deal with at the same time, and many projects, which can be a really big burden because they demand lots of groupwork. When you have to deal with other people’s schedules and yours, and you still have a lot of other schoolwork to handle, you really need to know how to manage your time or you just won’t be able to finish everything.

Q: How do you think business education will change as a result of the pandemic?

Carioca : In the near future, I believe that the option of either online or face-to-face training will no longer be a mandatory choice; it will become a corporate or personal decision. The choice will be made by evaluating the learning experience offered by the school and considering the individual and corporative training objectives. But I trust all the formats will be used, albeit oriented to accomplishing different learning objectives.

I also think business schools were already changing before the pandemic. I say that because of forces such as the digital revolution, globalization, innovative business models, and even the vast discussion around the future of work—all those forces were already driving the reimagination of education. With the pandemic, we just had to change at an accelerated pace and on several fronts—modalities, curricula, etc.

Stahl : I think changes had been coming, but what happened last year pushed people who weren’t that interested in using online tools to jump right into it. And there’s no going back now.

With online teaching part of the new normal, we as educators have more work to do to make sure we are using technology effectively and that there’s some rigor to what online tools can offer the learning experience. Now that we have more experience with it broadly—some great and some not so great—we can learn from that.

I think there will always be completely online classes because there are definitely some students for whom that’s a great benefit. Will it move everybody to 100 percent online degrees? No, I don’t think so. The social component of the education process is important. If we’re teaching business, business is about people’s relationships. And in today’s business world, we have both in-person relationships and digital relationships. So I think that as the workplace also evolves post-pandemic, with more remote working and more collaboration, we will also see that flow back into education.

“I don’t know why it has taken an entire pandemic for us to realize this, but I’m happy that it has made professors realize that they need to be more innovative to make sure all that information actually gets stuck in our brains.” Nour Khalil

Khalil : I think that, in the future, universities will try to incorporate more online courses into the way they deliver education, just because I think we’ve all gotten the hang of it. Online learning is something that will definitely not disappear, and it also makes some things easier.

However, what I want, and what many of my friends want, is to go back to our old life on campus. So I think it’s eventually going to be a combination of both.

Q: After what you witnessed last year, what advice do you have for educators?

Carioca : First, think of what must not change. When I think about it, I realize that the human side of our school—caring about each other, standing by our alumni, reinforcing our shared values, engaging the faculty and staff—has not changed.

Secondly, think of what we can and must change. We all have proven that our adaptability is enormous and that is why we can and should dare to innovate.

Ten years from now, we will be offering different programs and learning initiatives in different ways and dealing with different business and societal challenges, but the ethos of the school shall remain. We will be, as we are now, forging leaders for the present and for the future.

Balancing these two dimensions, and in the correct order, is the equation that will keep us resilient and bring success to our schools. I think that is the most important lesson learned from the pandemic: understanding what is perennial while gaining the ability to adapt and innovate creatively.

Stahl : I see four key takeaways. First, as you’re preparing your online lessons, ask yourself the hard questions: Why am I putting this in the lesson? How does this particular element support what we’re doing? In the online world, content has to really earn its place rather than fill time.

The second thing is to innovate and try things to make meaningful engagement. Online learning is not naturally engaging, but it can be.

Third, remember that students today live in the digital world, and to them it’s perhaps not as unusual to do things digitally as it would be to some of us. So check your own paradigms.

And finally, I think the really important one for us as teachers is to remember that you have to become a person to your students. That means that you have to find a personal way to engage with them so that they’re comfortable coming to you if something is on their minds.

“Change ignited us. We understood very quickly that no matter what format or channel we are using, we must continue to have a unique way of educating leaders and accomplishing our mission.” Maria de Fátima Carioca

Khalil : One thing we’ve learned is that there’s so much information all around us, and we’re all so overwhelmed, that we can no longer make education a burden. It can very easily become this thing that students want to get over with. But nowadays, we’re having conversations about making things more interactive and more fun to lock students’ interests. I don’t know why it has taken an entire pandemic for us to realize this, but I’m happy that it has made professors realize that they need to be more innovative to make sure all that information actually gets stuck in our brains.

I don’t think this is something we should omit from the equation. Fun should be included in learning to make students more engaged, so we actually come out of university having learned something and being qualified for jobs.

Maria de Fátima Carioca has been dean of AESE since 2014 and professor in the Human Factor area of the school since 2005. She coordinates initiatives and studies in the areas of people management, talent, future of work, family-work balance, family businesses, leadership, and business ethics.

Wendy Stahl is an adjunct assistant professor at New York University. She teaches leadership and strategic marketing in the MS Marketing Program. She also assists in adapting course content for digital delivery.

Nour Khalil is a student at the American University in Cairo. She is currently pursuing a BA in business administration.

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UChicago Class Visits

Top stories, national study finds in-school, high-dosage tutoring can reverse pandemic-era learning loss, ethan bueno de mesquita appointed dean of the harris school of public policy, course on afrofuturism brings together uchicago students and community members, uchicago education lab study finds in-school, high-dosage tutoring leads to meaningful math gains.

Results from a study by the University of Chicago Education Lab and the nonprofit MDRC  have shown promise in reducing the pandemic-era learning loss in students.

The preliminary results from the Personalized Learning Initiative (PLI) show that in-school high-dosage tutoring can lead to large and positive effects on student learning in math – even when delivered in the aftermath of the pandemic and in diverse academic settings.

High-dosage tutoring has been used in education for centuries, but lack of funding has poised a barrier to wide implementation. In this approach, one instructor works with one or two students at a time for several hours per week.

In this study, approximately 2,000 students in Chicago Public Schools in Illinois and Fulton County Schools in Georgia who participated in district-wide, in-school tutoring during the 2022-23 school year saw meaningful improvement in math learning. (The results for reading scores are not yet conclusive.)

Delivering tutoring during the school day – as opposed to ad-hoc, “on demand,” or after school – seems critical to realizing large gains in student learning, the Education Lab said.

These results are among the first indications that in-school high-dosage tutoring, done at scale, can effectively counteract pandemic-era learning setbacks.

‘A once-in-a-generation opportunity’

Research has highlighted the promise of high-dosage tutoring and earned the endorsement of U.S. Education Secretary Cardona . In addition, President Biden’s recently launched Improving Student Achievement Agenda centered the UChicago Education Lab’s research to announce expanded support for high-dosage tutoring.

Prior research from the University of Chicago Education Lab, in partnership with Saga Education , found that high-dosage tutoring can double or even triple student learning in a single academic year.

High-dosage tutoring also helps address what teachers report in surveys to be the two most difficult challenges of classroom teaching: variability in students’ academic levels (and hence their needs); and classroom management.

But challenges such as cost and hiring have made it difficult for school districts to implement and scale high-dosage tutoring – even with an influx of federal funding.

To overcome these barriers, the PLI works with partners to launch, scale, and evaluate high-dosage tutoring programs. To date, the PLI has allocated more than $5 million to fund the delivery of tutoring in partner sites. This includes funding outside providers that help address implementation challenges, such as scheduling tutoring sessions and optimizing the use of educational technology.

“We’ve seen firsthand the incredible impact of high-dosage tutoring on Chicago students,” said Pedro Martinez, CEO of Chicago Public Schools. “We are proud to be a founding partner of the Personalized Learning Initiative and look forward to helping other school systems across the country follow in our footsteps.”

“As our students and policymakers continue to struggle with pandemic-era learning loss, the PLI represents a once-in-a-generation opportunity to boost learning and close longstanding gaps in student achievement,” said Jens Ludwig, faculty co-director of the University of Chicago Education Lab. “The Education Lab is proud to work alongside our partners in determining how to cost-effectively deliver one of the most promising learning interventions to a student population in urgent need of support.”

The data used in this study to determine the preliminary results only covers a portion of the expected final study sample, which will be available after this school year. The Education Lab and MDRC are actively learning from these data to better inform implementation and ultimately accelerate student learning.

As a testament to these promising results, the PLI is continuing partnerships with sites in Illinois, Georgia, and New Mexico and has launched new partnerships during the 2023-2024 school year with school districts in California, Florida, North Carolina, and South Carolina. The expansion of the PLI will allow for continued analysis of different types of tutoring programs, including varied student-to-tutor ratios, management practices, and student time with technology as schools work to expand high-dosage tutoring programs. The PLI will also create a ‘playbook’ for districts nationwide, detailing how tutoring can be scaled up in different settings and at the lowest cost possible for each student while maintaining effectiveness.

“We are excited to see growing evidence supporting the effectiveness of high-dosage tutoring,” said Kevin Huffman, CEO of Accelerate , a partner in this study. “While this research is ongoing, it is important for school leaders and school system leaders to have access to interim reports as they continue to make hard decisions about how to address disparities in learning outcomes. We appreciate the leadership of the Education Lab and MDRC in this important and timely initiative and look forward to learning more from the future years of this project.”

The PLI receives substantial support from Accelerate – The National Collaborative for Accelerated Learning, which is supported by Citadel founder and CEO Kenneth C. Griffin and Griffin Catalyst; Arnold Ventures; the Bill & Melinda Gates Foundation; the Overdeck Family Foundation; and the Walton Family Foundation. Additional funding comes from the AbbVie Foundation, Crown Family Philanthropies, Citadel founder and CEO Kenneth C. Griffin and Griffin Catalyst, IMC Chicago Charitable Foundation, and Vivo Foundation.

Read the full report.

—Adapted from an article first published by the University of Chicago Education Lab.

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​Why School Absences Have ‘Exploded’ Almost Everywhere

The pandemic changed families’ lives and the culture of education: “Our relationship with school became optional.”

By Sarah Mervosh and Francesca Paris

Sarah Mervosh reports on K-12 education, and Francesca Paris is a data reporter.

In Anchorage, affluent families set off on ski trips and other lengthy vacations, with the assumption that their children can keep up with schoolwork online.

In a working-class pocket of Michigan, school administrators have tried almost everything, including pajama day, to boost student attendance.

And across the country, students with heightened anxiety are opting to stay home rather than face the classroom.

In the four years since the pandemic closed schools, U.S. education has struggled to recover on a number of fronts, from learning loss , to enrollment , to student behavior .

But perhaps no issue has been as stubborn and pervasive as a sharp increase in student absenteeism, a problem that cuts across demographics and has continued long after schools reopened.

Nationally, an estimated 26 percent of public school students were considered chronically absent last school year, up from 15 percent before the pandemic, according to the most recent data, from 40 states and Washington, D.C., compiled by the conservative-leaning American Enterprise Institute . Chronic absence is typically defined as missing at least 10 percent of the school year, or about 18 days, for any reason.

Source: Upshot analysis of data from Nat Malkus, American Enterprise Institute. Districts are grouped into highest, middle and lowest third.

The increases have occurred in districts big and small, and across income and race. For districts in wealthier areas, chronic absenteeism rates have about doubled, to 19 percent in the 2022-23 school year from 10 percent before the pandemic, a New York Times analysis of the data found.

Poor communities, which started with elevated rates of student absenteeism, are facing an even bigger crisis: Around 32 percent of students in the poorest districts were chronically absent in the 2022-23 school year, up from 19 percent before the pandemic.

Even districts that reopened quickly during the pandemic, in fall 2020, have seen vast increases.

“The problem got worse for everybody in the same proportional way,” said Nat Malkus, a senior fellow at the American Enterprise Institute, who collected and studied the data.

Victoria, Texas reopened schools in August 2020, earlier than many other districts. Even so, student absenteeism in the district has doubled.

Kaylee Greenlee for The New York Times

The trends suggest that something fundamental has shifted in American childhood and the culture of school, in ways that may be long lasting. What was once a deeply ingrained habit — wake up, catch the bus, report to class — is now something far more tenuous.

“Our relationship with school became optional,” said Katie Rosanbalm, a psychologist and associate research professor with the Center for Child and Family Policy at Duke University.

The habit of daily attendance — and many families’ trust — was severed when schools shuttered in spring 2020. Even after schools reopened, things hardly snapped back to normal. Districts offered remote options, required Covid-19 quarantines and relaxed policies around attendance and grading .

Source: Nat Malkus, American Enterprise Institute . Includes districts with at least 1,500 students in 2019. Numbers are rounded. U.S. average is estimated.

Today, student absenteeism is a leading factor hindering the nation’s recovery from pandemic learning losses , educational experts say. Students can’t learn if they aren’t in school. And a rotating cast of absent classmates can negatively affect the achievement of even students who do show up, because teachers must slow down and adjust their approach to keep everyone on track.

“If we don’t address the absenteeism, then all is naught,” said Adam Clark, the superintendent of Mt. Diablo Unified, a socioeconomically and racially diverse district of 29,000 students in Northern California, where he said absenteeism has “exploded” to about 25 percent of students. That’s up from 12 percent before the pandemic.

U.S. students, overall, are not caught up from their pandemic losses. Absenteeism is one key reason.

Why Students Are Missing School

Schools everywhere are scrambling to improve attendance, but the new calculus among families is complex and multifaceted.

At South Anchorage High School in Anchorage, where students are largely white and middle-to-upper income, some families now go on ski trips during the school year, or take advantage of off-peak travel deals to vacation for two weeks in Hawaii, said Sara Miller, a counselor at the school.

For a smaller number of students at the school who qualify for free or reduced-price lunch, the reasons are different, and more intractable. They often have to stay home to care for younger siblings, Ms. Miller said. On days they miss the bus, their parents are busy working or do not have a car to take them to school.

And because teachers are still expected to post class work online, often nothing more than a skeleton version of an assignment, families incorrectly think students are keeping up, Ms. Miller said.

Sara Miller, a counselor at South Anchorage High School for 20 years, now sees more absences from students across the socioeconomic spectrum.

Ash Adams for The New York Times

Across the country, students are staying home when sick , not only with Covid-19, but also with more routine colds and viruses.

And more students are struggling with their mental health, one reason for increased absenteeism in Mason, Ohio, an affluent suburb of Cincinnati, said Tracey Carson, a district spokeswoman. Because many parents can work remotely, their children can also stay home.

For Ashley Cooper, 31, of San Marcos, Texas, the pandemic fractured her trust in an education system that she said left her daughter to learn online, with little support, and then expected her to perform on grade level upon her return. Her daughter, who fell behind in math, has struggled with anxiety ever since, she said.

“There have been days where she’s been absolutely in tears — ‘Can’t do it. Mom, I don’t want to go,’” said Ms. Cooper, who has worked with the nonprofit Communities in Schools to improve her children’s school attendance. But she added, “as a mom, I feel like it’s OK to have a mental health day, to say, ‘I hear you and I listen. You are important.’”

Experts say missing school is both a symptom of pandemic-related challenges, and also a cause. Students who are behind academically may not want to attend, but being absent sets them further back. Anxious students may avoid school, but hiding out can fuel their anxiety.

And schools have also seen a rise in discipline problems since the pandemic, an issue intertwined with absenteeism.

Dr. Rosanbalm, the Duke psychologist, said both absenteeism and behavioral outbursts are examples of the human stress response, now playing out en masse in schools: fight (verbal or physical aggression) or flight (absenteeism).

“If kids are not here, they are not forming relationships,” said Quintin Shepherd, the superintendent in Victoria, Texas.

Quintin Shepherd, the superintendent in Victoria, Texas, first put his focus on student behavior, which he described as a “fire in the kitchen” after schools reopened in August 2020.

The district, which serves a mostly low-income and Hispanic student body of around 13,000, found success with a one-on-one coaching program that teaches coping strategies to the most disruptive students. In some cases, students went from having 20 classroom outbursts per year to fewer than five, Dr. Shepherd said.

But chronic absenteeism is yet to be conquered. About 30 percent of students are chronically absent this year, roughly double the rate before the pandemic.

Dr. Shepherd, who originally hoped student absenteeism would improve naturally with time, has begun to think that it is, in fact, at the root of many issues.

“If kids are not here, they are not forming relationships,” he said. “If they are not forming relationships, we should expect there will be behavior and discipline issues. If they are not here, they will not be academically learning and they will struggle. If they struggle with their coursework, you can expect violent behaviors.”

Teacher absences have also increased since the pandemic, and student absences mean less certainty about which friends and classmates will be there. That can lead to more absenteeism, said Michael A. Gottfried, a professor at the University of Pennsylvania Graduate School of Education. His research has found that when 10 percent of a student’s classmates are absent on a given day, that student is more likely to be absent the following day.

Absent classmates can have a negative impact on the achievement and attendance of even the students who do show up.

Is This the New Normal?

In many ways, the challenge facing schools is one felt more broadly in American society: Have the cultural shifts from the pandemic become permanent?

In the work force, U.S. employees are still working from home at a rate that has remained largely unchanged since late 2022 . Companies have managed to “put the genie back in the bottle” to some extent by requiring a return to office a few days a week, said Nicholas Bloom, an economist at Stanford University who studies remote work. But hybrid office culture, he said, appears here to stay.

Some wonder whether it is time for schools to be more pragmatic.

Lakisha Young, the chief executive of the Oakland REACH, a parent advocacy group that works with low-income families in California, suggested a rigorous online option that students could use in emergencies, such as when a student misses the bus or has to care for a family member. “The goal should be, how do I ensure this kid is educated?” she said.

Relationships with adults at school and other classmates are crucial for attendance.

In the corporate world, companies have found some success appealing to a sense of social responsibility, where colleagues rely on each other to show up on the agreed-upon days.

A similar dynamic may be at play in schools, where experts say strong relationships are critical for attendance.

There is a sense of: “If I don’t show up, would people even miss the fact that I’m not there?” said Charlene M. Russell-Tucker, the commissioner of education in Connecticut.

In her state, a home visit program has yielded positive results , in part by working with families to address the specific reasons a student is missing school, but also by establishing a relationship with a caring adult. Other efforts — such as sending text messages or postcards to parents informing them of the number of accumulated absences — can also be effective.

Regina Murff has worked to re-establish the daily habit of school attendance for her sons, who are 6 and 12.

Sylvia Jarrus for The New York Times

In Ypsilanti, Mich., outside of Ann Arbor, a home visit helped Regina Murff, 44, feel less alone when she was struggling to get her children to school each morning.

After working at a nursing home during the pandemic, and later losing her sister to Covid-19, she said, there were days she found it difficult to get out of bed. Ms. Murff was also more willing to keep her children home when they were sick, for fear of accidentally spreading the virus.

But after a visit from her school district, and starting therapy herself, she has settled into a new routine. She helps her sons, 6 and 12, set out their outfits at night and she wakes up at 6 a.m. to ensure they get on the bus. If they are sick, she said, she knows to call the absence into school. “I’ve done a huge turnaround in my life,” she said.

But bringing about meaningful change for large numbers of students remains slow, difficult work .

Nationally, about 26 percent of students were considered chronically absent last school year, up from 15 percent before the pandemic.

The Ypsilanti school district has tried a bit of everything, said the superintendent, Alena Zachery-Ross. In addition to door knocks, officials are looking for ways to make school more appealing for the district’s 3,800 students, including more than 80 percent who qualify for free or reduced-price lunch. They held themed dress-up days — ’70s day, pajama day — and gave away warm clothes after noticing a dip in attendance during winter months.

“We wondered, is it because you don’t have a coat, you don’t have boots?” said Dr. Zachery-Ross.

Still, absenteeism overall remains higher than it was before the pandemic. “We haven’t seen an answer,” she said.

Data provided by Nat Malkus, with the American Enterprise Institute. The data was originally published on the Return to Learn tracker and used for the report “ Long COVID for Public Schools: Chronic Absenteeism Before and After the Pandemic .”

The analysis for each year includes all districts with available data for that year, weighted by district size. Data are sourced from states, where available, and the U.S. Department of Education and NCES Common Core of Data.

For the 2018-19 school year, data was available for all 50 states and the District of Columbia. For 2022-23, it was available for 40 states and D.C., due to delays in state reporting.

Closure length status is based on the most in-person learning option available. Poverty is measured using the Census Bureau’s Small Area Income and Poverty Estimates. School size and minority population estimates are from NCES CCD.

How absenteeism is measured can vary state by state, which means comparisons across state lines may not be reliable.

An earlier version of this article misnamed a research center at Duke University. It is the Center for Child and Family Policy, not the Center of Child and Family Policy.

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Why Oregon schools rank among lowest in education gains following COVID disruptions

Katia Riddle

Students around the country are starting to rebound from the COVID era's massive learning disruptions. But students lag in Oregon, where some advocates say districts had too much leeway during the pandemic.

MICHEL MARTIN, HOST:

The pandemic may seem like it's in the rearview mirror, but students and teachers continue to feel its impact. The federal government has invested billions of dollars in recent years to address learning loss. And a recent study from Harvard and Stanford shows that while students have made gains, those gains have been uneven. Katia Riddle reports from Oregon, where many school districts ranked among the lowest on this measure.

KATIA RIDDLE, BYLINE: Meet future rock star Judah Moisan. He plays bass.

JUDAH MOISAN: So it's called Siblings of War. It's a punk rock band that I made up with some kids at school.

RIDDLE: They want to be kind of like Green Day, he says, except their band will be made up of 10-year-olds instead of old guys. He's written out the names of their future songs on a Post-It note.

JUDAH: The first song on it is going to be named "Priority," and the second one is "Feeding Frenzy."

RIDDLE: Making up these song names seems like a small thing, but just the act of writing them down shows progress for Judah. His mom, Jane Moisan, says during the pandemic, they abandoned the online learning platform the school gave them.

JANE MOISAN: We had, you know, the little red dot that said 157 at one point (laughter).

RIDDLE: Missing assignments?

MOISAN: Yes, yes.

RIDDLE: Judah was still reading and doing math at home. His mom wasn't too worried. But she didn't realize he wasn't writing enough. When he got back to school, he really struggled.

MOISAN: The worksheets were going back to his teacher with these kind of flippant answers, because Judah wasn't feeling maybe confident in writing out his thinking. So he was sort of like having this attitude of this is dumb anyway, right, Judah?

JUDAH: And it was kind of sad. Like, I couldn't express my ideas like Mom was saying.

RIDDLE: Judah started to get defiant in school. He was self-conscious around his peers. Then this year, his parents hired a tutor. He's made a lot of progress. High-dosage tutoring - it's one thing experts say works to catch kids up. But what about kids here who don't have parents who can pay for it?

AMARA LAVATO: Something that I notice is that they have a very hard time focusing.

RIDDLE: Amara Lavato teaches in a Portland suburb called Gresham. Other states invested in programs to provide widespread tutoring for kids who need it. That happened in some places in Oregon, but not all. Many of her students are low income.

LAVATO: They don't know how to handle frustration.

RIDDLE: Lovato teaches second grade. The kids she has this year were preschool age in the pandemic. She says even with kids this young, she can still see significant delays in their social and emotional development. That leads to academic delays.

LAVATO: One-to-one tutoring - it could be very effective. But we don't have enough staff to do that.

RIDDLE: Unlike some other states, Oregon gave individual school districts a lot of latitude to decide how to spend federal recovery money. Thomas Kane is a researcher at Harvard. He worked on the study, evaluating different states' efforts.

THOMAS KANE: It's almost as if - like, just imagine if during the pandemic, the federal government had just distributed dollars to local public health departments and said to them, OK, you guys figure out your own solution to the pandemic.

RIDDLE: Schools had to juggle a lot during the pandemic - figuring out remote learning, monitoring students' emotional well-being, thinking about their safety. Kane says Oregon didn't give its schools firm directives on how much they should set aside to address learning loss, or the best practices for doing so.

KANE: Like, there would have been some communities, you know, implemented more effective strategies than others.

RIDDLE: Teacher training is another thing that experts say helped to catch kids up in other states. That was also less consistent here. Jackie Ayalya is a second grade teacher. She points to a board of sticky notes in her classroom. After that day's math lesson, each student had to rate one addition problem and put it on the wall.

JACKIE AYALYA: This kind of helps me to see who gets it.

RIDDLE: It's a quick assessment, but it gives her invaluable information that helps her make sure kids don't slip through the cracks. She didn't learn this strategy in Oregon, though. She learned it when she was working in another state. She says her colleagues here just haven't had the same opportunities.

AYALYA: I knew this math program because I used it in my last district, but I was told that because it was a pandemic that there wasn't that training.

CHARLENE WILLIAMS: It was a tough time for folks.

RIDDLE: Dr. Charlene Williams is the director of the Oregon Department of Education. She says educators everywhere struggled to figure out how to prioritize spending with lots of needs during the pandemic.

WILLIAMS: They had to make some hard decisions.

RIDDLE: There was a lot of guesswork. But she says, like the rest of the country, the state has learned from this stress test.

WILLIAMS: While we know that our data does not tell a good story, we also know what it takes in order to start getting students what they need.

RIDDLE: Oregon has started a new statewide summer learning program as well as an early literacy initiative. Williams says it's an effort by the state to reach not just some students - all students.

For NPR News, I'm Katia Riddle in Portland, Ore.

Copyright © 2024 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

• Open access
• Published: 06 April 2024

Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model

• Eneyew Talie Fenta   ORCID: orcid.org/0000-0002-3710-7990 1 ,
• Atitegeb Abera kidie   ORCID: orcid.org/0000-0002-3010-0438 2 ,
• Misganaw Guadie Tiruneh 3 ,
• Tadele Fentabel Anagaw   ORCID: orcid.org/0000-0002-0312-4119 4 ,
• Eyob ketema Bogale   ORCID: orcid.org/0000-0002-0010-3750 4 ,
• Amanuel Addisu Dessie 1 ,
• Nigus Kassie worku 5 ,
• Mastewal Giza Amera 2 ,
• Hiwot Tesfa   ORCID: orcid.org/0000-0003-2533-339X 1 ,
• Liknaw Workie Limenh 6 ,
• Amare Mebrate Delie 1 &
• Birtukan Gizachew Ayal 2  

BMC Public Health volume  24 , Article number:  971 ( 2024 ) Cite this article

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Health literacy is the important for the prevention of non-communicable disease to make informed health decisions, and practice healthy and protective behaviours. Therefore, application of socioecological model to this study aimed to identify multilevel factors on health literacy among patients and develop scientific health communication interventional strategies to improve health literacy on non-communicable disease prevention and care.

To explore barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public Hospitals, Northeast Ethiopia, 2023.

In this study phenomenological study design was conducted from February 5 to 30/2023.We have used purposive sampling technique to select study participants from chronic follow up clinics. Data were collected using in-depth interview and focused group discussion in which audio was recorded, transcribed verbatim and translated to English. Thematic analysis was performed with atlas ti. 7 software.

In this study four main themes with seven subthemes were developed. The main themes were factors at the organizational, community, interpersonal, and intra-personal factors. The poor knowledge, lack of enough money for transportation and medication at the hospital were identified as barrier to get early diagnosis and treatment. Some participants explored that they have no any support from family or others. The cultural norms like weeding and funeral ceremonies enforce patients to consume prohibited substances like alcohol and salty foods.

In this study different barriers of health literacy were explored. Lack of knowledge, economic problems, lack of social support, poor communication with health care providers, cultural influences, lack of regular health education, lack of access to health care services and poor infrastructure were main barriers of health literacy in patients with NCD. Therefore, we recommended all concerned bodies to work on social and behavioral change communication intervention focusing on awareness creation, supply of drugs and create supportive environment to get accessible and affordable health care service to decrease the impact of non-communicable disease at personal, community and national level.

Peer Review reports

Introduction

Non -communicable diseases (NCD), such as cardiovascular diseases, cancer, diabetes, chronic respiratory diseases are the leading global cause of death and are responsible for over 71% of deaths worldwide, with 85% of these occurring in developing countries. These NCDs share key modifiable behavioural risk factors like tobacco use, unhealthy diet, lack of physical activity, and the harmful use of alcohol, which in turn lead to overweight and obesity, raised blood pressure, and raised cholesterol, and ultimately disease [ 1 , 2 ]. World health organization ( WHO) developed an action plan from 2013–2020 to address population based risk factors and integrated management of NCDs at the primary health care level and, in Ethiopia 42% deaths and 27% are premature deaths before 70 age is cause by NCDs [ 3 , 4 ].

Health literacy (HL) is the degree to which an individual have the capacity to obtain,process and understand basic health information’s to make appropriate health decisions [ 5 , 6 ]. WHO positioning HL as one of pillars for achieving sustainable development and health equity [ 7 ]. HL is used to get reliable information, and empowers people to make informed health decisions, practice healthy and protective behaviours [ 8 , 9 ]. The social ecological model (SEM) targets five levels of influence for health related behaviours which are: Intrapersonal factors, Institutional; community factors; and finally public policy level factors [ 10 ].

It has been shown that HL levels was lower among those who had low social status, have poor education and income levels, older population, gender groups, the level of medication adherence, higher BMI, increased systolic blood pressure, poor financial status, being, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol has association with low health literacy [ 11 , 12 , 13 ]. High level of health literacy is associated with improved preventive care, early detection of diseases, ability to access health care and management of chronic disease, use proper nutrition, avoidance of smoking and good medication adherence and also it shapes people’s health and the safety and quality of health care [ 14 ].

The studies also showed that structural barriers, such as insurance, transportation issues and limited information with in communities affect health literacy [ 15 , 16 ]. Another study conducted in United Kingdom revealed that health literacy had association with lack of access to the Internet [ 17 ]. The study in Myanmar showed that watching medical-related TV series, accessibility to education were detected as significant determinants of health literacy. Cultural beliefs may also impact communication between patients and providers and affect a patient’s ability to follow a physician’s instructions [ 16 , 18 , 19 , 20 ].

Health literacy is a social determinant of health, and poor HL is associated with poor education, poverty, unemployment, and low socioeconomic status, yet those with higher levels of education and income can have low health literacy. Studies have revealed that people with poor HL had lower health outcomes, and higher costs, and people of all ages, races, income levels, and educational levels are affected. Good vaccine HL is important to alter societal norms in promoting vaccine uptake and establishing a foundation for herd immunity at a level appropriate for each individual's age, mental capacity, gender, and environment [ 21 , 22 , 23 , 24 , 25 ].

The studies revealed that HL should improve especially in adult and elderly population, in those with a lower level of education for better disease prevention and adequate health literacy improved health outcomes and efficacy among older patients with chronic diseases [ 26 , 27 ]. Health literacy interventions for chronic diseases include a range of strategies, such as education, self-management training, counselling, consultations, and other techniques, that are intended to improve the health-related knowledge, attitudes, abilities, and behaviours of people living with chronic illnesses [ 28 , 29 ].

Even though, there are studies done regarding health literacy on non-communicable disease, that could not focus on exploring health literacy qualitatively for better interventional strategy development and the approach is not guided by the use of SEM to identify the levels of interventions. The application of social ecological model in health literacy could lead to more sustainable changes over time by creating supportive environments for people as they access and seek to understand health information, interact with health professionals, and move through their community and organizational contexts. Therefore, the application of socio ecological model to this study identified multilevel factors and provide information to develop scientific health communication interventional strategies to improve health literacy among patients in non-communicable disease.

Methods and materials

Study design, area and period.

North Wollo is located in Amhara region with the capital city of Woldia found 521 km away from Addis Ababa and 360 km from Bahirdar. According to the 2007 census conducted by central statistics agency of Ethiopia it has a total population of 1,500,303. There are six governmental hospitals in North Wollo. These are Woldia Hospital, Kobo Hospital, Lalibela Hospital, Mekiet Hospital, Wadila Hospital, and Mersa Hospital. Institution based Phenomenological study design was used to explore barriers of health literacy among chronic patients in chronic care follow up clinics, north wollo zone three public hospitals, Northeast Ethiopia from February 5–30/2023 with the use of socio ecological model. The approach helps to describe particular phenomena, or the appearance of things, as lived experience and find meaning or is used in cases about which there is little knowledge available. Phenomenological study assists in looking at change processes over time, adjusting to new issues and ideas as they emerge among chronic disease patients in selected hospitals [ 30 , 31 ].

Study population and sampling procedure

The study population were all adult chronic patients receiving follow-up care in three selected public hospitals of north wollo. All chronic patients age above 18 years from selected public hospital were included in this study whereas participant who were seriously ill or not able to communicate, required emergency care, who had mental or cognitive impairment in the data collection period were not include in the study. In this study twenty-six in-depth interviews with 3 focus group discussions were conducted. A total of 22 individuals with chronic diseases follow up were participated in FGD. The participants were 9 DM patients (kobo 4, Meket 3, woldia 2), 11 HTN (5 kobo,2 Meket, 4 woldia), 3 Epilepsy (2 meket,1 kobo), 3 CHF patients (woldia 2, Meket 1). Three hospital managers, and 7 health care providers who work in chronic follow up clinic were participated for key informant interview. Purposive sampling was used in phenomenology; which focuses on particular characteristics of a population, which would be enabled to answer this research questions. Heterogonous purposive sampling was used to select people who had experienced the phenomenon [ 32 ].

Data collection tool and procedure

The data was collected through face-to-face In-depth interview, key informant interview, and focus group discussion by experienced 4 masters holder health professionals. IDI, KII, and FGD guides were drafted through reviewing different related literatures. Written informed consent was obtained from each study participants. Each interview was audiotaped using digital voice recorder and filed notes were taken. The English version semi-structured open-ended question and were translated in to Amharic and again translated back to English. The length of the interview is guided by the process of information saturation, when the narratives become repetitive and no new data is revealed which lasts from 9 to 18 min for in-depth interview and 1 h to 1:40 h for FGD for patients, and health care and hospital manager key informant interview lasts 8 to 23 min.

Data quality control

To maintain the credibility of the research findings, the study participants was observed persistently at the time of the interview. Peer-debriefing was done for the questioner and transcripts was given to my colleagues. Member checking was conducted by returning the preliminary findings to some participants to correct errors and challenge what they perceive as wrong interpretations. Dependability was attained through accurate documentation by minimizing spelling errors through frequently observing data and including all documents in the final report, such as including the notes written during the interview and ensuring that the details of the procedures was described to allow the readers to see the basis upon which conclusions was made. The data analysis, interpretations, and conclusions were continuously peer reviewed [ 33 , 34 ].

To achieve confirmability of the study findings: raw data, interview and observation notes, documents and records collected from the field, and others was documented for crosschecking and to conduct an audit trial, where triangulation was used. To maintain the transferability of the finding, appropriate probes was used to obtain detailed information on responses, and study participants was selected based on their specific purpose to answer study questions and to get greater in-depth findings.

Data processing and analysis

We have used consolidated Criteria for Reporting Qualitative Research (COREQ), a 32-item checklist that is used to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations. After data collection, the investigators transcribing the audio-record data in to Amharic, local language, translated into English, and then read and re-read the several times to code the data, to detect emerging themes and sub-themes. The translated document was coded line-by-line and grouped into themes based on the concepts they contain. Responses was categorized under each theme and sub-theme. Interpretations of the qualitative data was dependent upon patients’ descriptions of their experiences and perceptions, which the researchers check against the verbatim transcripts for accuracy and consistency.

Lastly, investigators interpret the theme to reveal core meanings of the experiences and presenting the discoveries of the study specifically, thematic analysis technique was used to analysed the data. Quotes was used to highlight each category and show association with each theme. The principal investigator reads and re-read the transcriptions several times to coding the data, then 32 categories were extracted from 128 codes by combination similar meaning then 7 sub-themes 4 major themes were identifying, and thematic approach was used for analysis, which could emphasize identifying, analyzing, and interpreting patterns of meaning [ 35 ].

Socio-demographic information of the participants

In this study ten key informant interview, twenty-six in-depth interviews with 3 focus group discussions were conducted. A total of 22 individuals with chronic diseases follow up were participated in FGD. The most frequently reported diseases were hypertension, diabetes, chronic heart disease and epilepsy. The participants were 9 DM patients, 11 HTN, 3 Epilepsy 3 CHF patients totally 26 in-depth interviews were conducted. Also 22 FGD were conducted in three hospitals from Meket hospital,7 chronic disease patients (3 HTN, DM, bronchial asthma, Epilepsy, CHF 1 each) were participated. In woldia referral hospital totally 6 participants (3 HTN, 2 DM, and 1 CHF), in kobo hospital 9 NCD patients (DM4, HTN 3, Bronchial asthma 1, and 1 CHF) were included in the study. For key informant interview 4 medical doctors and 6 nurse professionals were participated (Tables 1 and 2 ).

Thematic findings

The findings that emerged from the analysis of the in-depth interview and focus group discussion were presented and arranged as major themes, sub-themes and categories. There are four (4) main themes and seven (7) subthemes (Fig.  1 ).

Representation of the key themes emerged from study participants

Theme 1: intra-personal (patient level) factors

In this study most of the study participants described that lack of formal education, poor knowledge on non-communicable disease, and economic problems were raised as the main barrier to health literacy on chronic disease. This theme has 2 subthemes, which are poor knowledge, and economic problems.

Poor knowledge

The study's participants talked about their inability to comprehend, their inability to get health information on non-communicable diseases, their lack of knowledge about their condition, their inability to take their medication, and their inability to adopt preventive measures for better disease control.

A 49 years old male epileptic patient having a chronic follow up for 10 years said that : “I did not know how to take the medicine before which made it difficult for me to control the disease”.

Health care providers also concluded that most patients don’t have awareness on the cause, treatment and prevention mechanisms of their disease before diagnosed for their diseases. This is explained as: A 27 years old male nurse working in the hospital for 4 years said that: “ Patients get information from health professionals. They know while they come to check themselves, most people with non-communicable diseases get information from a professional when they come for treatment. They have no awareness on their disease, almost 90% get information from health care professional ”.

Similarly, a 26 years old female doctor working for 2 years in NCD OPD explained that: “Usually patients’ source of information on NCD is when they are told about the disease from the specialist. Occasionally they may have their own sources depending on their level of education, but usually from the professionals”.

Regarding source of information, they heard about non-communicable disease from health care providers, using media like television or radio, other chronic disease patients, family, friends, and health care institutions. The following participant stated the same thing as:

“Before I had screened the disease, I did not have any health information on my disease since I have no any education, and my source of information was from the community and television”. (61 years, male, Diabetic patient).

Economic problems

The study participants reported that economic problems like, shortage of money for transportation to reach hospital, and to buy medication are barriers to early diagnosis and get treatment for their diseases.

“I find it difficult to take more than one medication at once for my HIV, blood pressure, renal, and asthma. I also don't have access to the hospital pharmacy and don't have the money to buy all of my medications in private drug store”. (60 years Female, FGD participant).

Another study participant explained as “ It is very difficult to buy the drug in private pharmacy. It is very expensive……… ”. (48 years, Male diabetic patient participated in FGD).

A 26 years old female doctor working for 2 years in NCD OPD also expressed as: “Most of the obstacles for controlling disease and using preventive methods in chronic patients is the economic problems. There may be edible foods for some diseases that their economy does not allow to get the proper nutrition for their disease…….”

Theme two: interpersonal level factors

This theme has two subthemes which are lack of social support, and poor communication with health care providers.

Lack of social support

Even if most chronic disease patients have good family and social support some participants explored that they have no any support from family or others. The participants also explained that since no one remind them, they forget their appointment and taking medication regularly. The following participant stated the same thing as:

“I am tired of taking the medicine, the lack of support from the family, government, and the lack of money has become a severe problem for me”. (61 years male, DM patient).

Another 49 years male, epileptic patient having a chronic follow up for 10 years explained that: “ It's hard for me to come, because of I am alone I’m afraid to fail, I used to forget my follow-up appointment. Now I come to hospital by calling”.

In addition to this lack of social support, absence of functional patients’ association like diabetes association, is a barrier for patients to control and care their diseases. As explained by male NCD focal nurse having greater than 12 years’ work experience: “ Currently, there is also a recently established Diabetes Association but not going as expected. Even though its role is to support our patients by some medicines especially for young ( <  25 years of age), it is intermittent and should be strengthen ”.

Poor communication with health care providers

The study participants discussed that even if health care professionals provide health information about their disease status, they didn’t listen carefully, understand their need and give time to ask questions and get feedback for their disease.

Hypertensive, Female, 60 years, patient with one year duration described as: “The health care professionals don’t give fair service to all equally, they don’t give enough health information for my disease, it is better if they give full information on the disease and then written medicine information than oral”.

Another HIV and hypertensive female participant reported as: “Since health care providers are busy, they did not care about me, except prescribing medication in my follow up, did not want to listen my complain and give advice by giving time is the main problem that I have to tell you”.

Theme three: community level factors

Cultural influences.

Even though, most of the participants are committed to take their medication timely and take the recommended prevention practices, some participants explored that cultural traditions with in the family and social ceremonies enforce them to drink and eat the forbidden things that worsen their health condition. Another participant also described that when there were special ceremonies around their home, they had forgotten to take their medication, not take timely, and use alcohol and other foods not allowed for NCD patients.

The study participant explained as

“In our society, there are pressures to consume salty foods and alcoholic beverages at social events; there are occasional drug shortages; there is currently a shortage of laboratory resources; in my own negligence that I sometimes forget to take on time and at all”. (77 years male DM patient).

Another female diabetic patient patient participated in FGD also said: “……………. for example, when there was a wedding, I increased the amount of fat and sugar intake and my blood sugar became 400 in the last month. But now my blood sugar is 78 since I avoid taking these kinds of diet”.

A 30 years old female nurse working for 5 years as BSC nurse also reported as “There are social ceremonies that the people enforce patients to use the forbidden food and drink since most of the society did not understand the disease very well, for example, people around the hypertensive patient said that what is the problem if you eat salt for today…”.

Theme four: organizational level factors

This theme has two subthemes, Lack of regular health education, poor infrastructure and access to health care were explored as barriers of health literacy on non- communicable disease prevention and care.

Lack of regular health education

The study participants reported that they had try to teach their patients about chronic disease when they come for appointment at clinics, but it is not continuous heath information provision by using different health education method like Television radio in most hospitals. The participant explained that they couldn’t organize drug information centre that can provide information for general education about medication on chronic diseases at the pharmacy level.

A 29 years old female working as a nurse for 4 years in the hospital reported as: “To increase patient’s knowledge, we provide health education for chronic patients at waiting area together. Still, we didn’t use media”.

32 years. Male participant nurse expressed as: There are many written leaflets, so we distribute them to every patient who comes here, give health education, but did not use television; radio and did not keep the schedule. We also conduct a screening for hypertension and diabetes in clinics and at community level”.

“In the previous year, before patients enter to OPD health education was given 2 times a week. But now it has stopped, we prepare, and distribute leaflets, most of the patients were understand and apply what we said”. (33 years old female, Nurse).

Poor infrastructure and access to health care

The study participants described that distance of home from the hospitals, and absence of comfortable roads to get hospital were the major obstacles in getting health information for early treatment . male participant 54 years, diabetic and hypertensive patient explored as : “I travelled on foot from a remote rural area and arrived too late to take medication for my follow-up appointment”. Similarly, male NCD focal nurse working for greater than12 years also expressed as: “ patients usually come from far place. So, they don’t come on time, especially diabetic patients who are expected to screen for fasting blood glucose before 8 h, are usually tested after 8 h and the result is not that much believable…. The cases are loaded and the hospital far for patients.”

Almost all participants also described that the examination rooms were not comfortable to get health information and treatment appropriately. They explored that the buildings are narrow, no waiting area to get care and support easily.

A 27 years old male nurse working for 4 years said: “The main problem is that our patients with non-communicable diseases have only one chronic OPD. So, since there are many NCD patients and the lack of class and trained professionals is a problem”.

Health literacy includes all of the skills required to receive, interpret, and process basic health information and services in order to make significant health decisions [ 36 , 37 ]. HL enhances individuals’ ability to participate in decision-making processes in various aspects of life concerning individual and community health [ 38 , 39 ]. Our study identified four main themes with seven subthemes. These were patient level, Interpersonal level, Community level, and organizational level factors.

The participants explored poor knowledge on non-communicable disease, and economic problems were the main barrier to get health related information and health services for their chronic disease. This was comparable with study done in Nepal which stated that health literacy was affected by education, knowledge of health services and health problems, access to good quality information [ 40 ]. The study in Bangladesh supported that unawareness of the severity, lack of knowledge on NCDs and low health literacy were barriers to change in behaviour on chronic disease prevention and care [ 41 ]. Another study in Brazil described that poor and less accessible education, lower knowledge about the disease, and difficulties in understanding the medical instructions were factors associated with limited health literacy [ 42 ]. This might be lack of education leads to poor knowledge and understanding on NCD prevention and care.

The study's participants talked about that despite giving patients health information regarding their disease status, medical professionals didn't pay close attention, or allow enough time for their patients to ask questions. This is consistent with the study discussed that access to good quality information, communication skills of staff, health worker’s attitudes have effect on health literacy on non-communicable disease patients [ 40 ]. The communication between medical professionals and patients have an impact on the patients' knowledge, motivation, decision-making, participation [ 43 ]. Another study also described that medical mistrust was associated with poorer communication with providers and patients’ health literacy level [ 44 ]. The study in Australia revealed that inadequate understanding, poor support from family and friends, conflicting advice from and poor communication among specialists were barriers to get the recommended care for NCD patients [ 45 ]. The possible reason might be because of good communication with health care providers may help to get appropriate health information on NCD prevention.

The study's participants complained about how financial issues, such as a lack of enough money to travel to the hospital for treatment prohibit them from receiving an early diagnosis and treatment. This is comparable with other studies which reported that low social status, financial deprivation were barriers to health literacy [ 46 , 47 ], and Low health literacy was associated with living in poverty, lacking consistent health insurance [ 48 ]. Another the studies showed that those groups more at risk of socioeconomic deprivation had low the health literacy status [ 49 , 50 , 51 ]. One plausible explanation could be that those with better financial standing find it easier to pay for the medications they are prescribed.

Even though most the study participants with chronic diseases have strong family and social networks, some participants mentioned that they don't have any support from their families or others. This was consistent with the studies which explains education, income, perceived health and social isolation have effect on health literacy [ 52 , 53 ]. The studies discussed that social support in which the help of relatives and friends is important in assessing the information on chronic disease to increase health literacy of patients on their chronic disease [ 54 , 55 ]. One explanation could be that patients who receive support from their families find it easier to remember when to follow up, and they may also be eligible for financial assistance to help pay for their medical expenses.

The participants explored that cultural norms enforce the consumption of prohibited substances at social events and family gatherings, which worsens their health. This is comparable with the study done in Kenya showed that culture and misinformation were determinates of health literacy on non-communicable disease [ 56 ] and the study in Germany revealed that family and peer influences within the different societies and cultures has effect on health literacy [ 57 ]. The studies also examined that cultural beliefs have impact on communication between patients and providers and affect a patient’s ability to follow a physician’s instructions [ 58 , 59 , 60 ]. This implies that cultural mis information on drinking and eating habits during social ceremony have impact on health literacy level of NCD patients.

In this study poor access of health care and poor infrastructure were the main barriers in getting care for chronic disease patients. This was consistent was the study in Bangladesh reported inadequate laboratory facilities, and logistics were barriers in chronic disease prevention and care [ 61 ] another study also examined infrastructure problems like bad road network, unreliable electricity supplies, living far from health centres were barriers to get NCD treatment [ 62 ]. The study in Nigeria also described that poor road and weak transportation infrastructure limit health education and awareness programs to communities [ 63 ]. This might be because good infrastructure and access to health care improves timely care for NCD patients.

The strength of this study was that the use of phenomenology study design with the application of socio ecological model that could explore multilevel barriers of health literacy on non-communicable disease prevention and care. These results cannot be automatically generalized to the entire population of patients with chronic non-communicable disease.

Conclussion

The finding of this study showed barriers to health literacy on non-communicable disease prevention and care with four major themes and seven subthemes. These were patient level, interpersonal level, Community, and organizational level factors. Most of the study participants discussed that they have no awareness and knowledge on non-communicable disease prevention and care. The participants stated that lack knowledge, and economic problems were the main barrier to get health information and on their chronic disease. The study participants discussed that health care providers didn’t listen carefully, understand their need and give time to ask questions and get feedback for their disease, and some participants mentioned that they don't have any support from their families or others. The participants reported that poor access of health care, and poor infrastructure were the main barriers in getting care. The participants explored that cultural norms enforce the consumption of prohibited substances at social events and family gatherings, which worsens their health. Therefore, we recommended all the concerned bodies should work to avoid barriers of health literacy on chronic disease patients at each level of influence to decrease the impact of chronic disease at personal, community and national level.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

World health Organization

Non communicable diseases

• Health literacy

Health literacy level

Diabetes mellitus

Cerebrovascular disease

Chronic obstructive pulmonary disease

Social ecological model

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Acknowledgements

We would like to acknowledge Woldia University, data collectors and study participants.

This study was funded by Woldia University.

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Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia

Eneyew Talie Fenta, Amanuel Addisu Dessie, Hiwot Tesfa & Amare Mebrate Delie

Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia

Atitegeb Abera kidie, Mastewal Giza Amera & Birtukan Gizachew Ayal

Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Misganaw Guadie Tiruneh

Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

Tadele Fentabel Anagaw & Eyob ketema Bogale

Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia

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“ETF, AAK, MGT, and BGA design the main concept, and manuscript, TFA, EKB, HTM, MGA and AMD review, and revise the manuscript, LWL, MGA, ADD, NKW, prepare figures and tables. All authors reviewed the manuscript.”

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Fenta, E.T., kidie, A.A., Tiruneh, M.G. et al. Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model. BMC Public Health 24 , 971 (2024). https://doi.org/10.1186/s12889-024-18524-8

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Received : 04 November 2023

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DOI : https://doi.org/10.1186/s12889-024-18524-8

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BMC Public Health

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Bringing dental care to kids in schools is helping take care of teeth neglected in the pandemic

CONCORD, N.H. (AP) — Tucked away inside the teachers lounge at a New Hampshire elementary school, Amber Warner was having her teeth checked out for the first time.

The 5-year-old sat back on what looked like a beach chair and wore a pair of dark sunglasses as certified public health dental hygienist Mary Davis surveyed Amber's teeth and then with a tiny syringe applied traditional dental sealants, which had the consistency of nail gel.

“Close down and bite your teeth together, bite down like you are biting down on a hot dog or a cheeseburger," Davis told Amber, to ensure the sealants were done properly. After that, Davis flossed all of the “popcorn and the chicken, pizza between your teeth.” The whole visit took 15 minutes.

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“Look at you. You are a pro on your first dental visit. I am so proud of you,” Davis said to the kindergartener, who got up from the chair and was hugged by a teacher's assistant.

The portable clinic is part of a cavity prevention program developed by NYU College of Dentistry and being rolled out in Concord and two other New Hampshire districts. CariedAway New Hampshire hopes to expand to Maine and Vermont — and eventually nationwide — as part of a growing effort to improve pediatric oral health, especially in children from lower-income families.

There isn't a good national estimate of dental programs in schools but many larger school districts have them. Boston University’s program operates in 20 schools and 30 preschools in Boston and eight other cities in Massachusetts and covers 3,000 children from 6 months to 21 years. In New York City, 81,000 students across 820 schools — a little over half of all public schools — were treated last school year.

Nationwide Children’s Hospital has seen 1,700 children in central Ohio since 2021 with its roving school-based dental clinics, while Minnesota nonprofit Ready, Set, Smile is in 44 schools in the Twin Cities, serving 2,225 children.

“Dental care typically is looked at as an extra or an add-on,” said Terri Chandler, who is the founder and executive director of Future Smiles in Clark County, Nevada, which includes Las Vegas and serves 7,500 kids in 75 schools. “It is not part of medical care.”

Intermittent dental care, if at all

Nearly half of all U.S. children don’t receive regular dental care, according to a 2022 report from the National Institute of Dental and Craniofacial Research, which is a federal agency.

That can lead to cavities quickly: More than half of children ages 6 to 8 had a cavity in at least one baby tooth and more than half adolescents ages 12 to 19 have a cavity in at least one of the permanent teeth, according to the U.S. Centers for Disease Control and Prevention.

Too many children fail to see a dentist before they enter school — forcing them to go to the hospital to get treatment for a mouthful of cavities, Harvard School of Dental Medicine's Catherine Hayes said.

“If their parents aren’t getting any kind of oral health education in the physician’s office, these kids develop extensive decay,” she said, noting it can take a month or more to fix. She added: "... It's completely preventable. We know how to prevent it.”

At Boston Children’s Hospital, there's a waiting list of eight to nine months for the dental clinic, said Man Wai Ng, the dentist-in-chief. Ng points in part to worsening dental care during the pandemic.

“I have patients who were going to bed without brushing their teeth. They ate and drank at all hours of the day because those normal daily routines weren’t there,” Ng said. “They weren’t able to get in for ... preventive dental care. Kids were developing more dental disease without the ability to get timely care.”

Ruth Langwell struggled to find a dentist for her granddaughter Lola, a 10-year-old who has autism. She recently was able to get the girl into the clinic.

“She needs somebody who is very patient, obviously ... We've tried two other dentist and they have been reluctant because of Lola's challenges," said Langwell, who added she wanted Lola to see a dentist at age 2, but didn't until she was five.

Funding programs to build habits

The challenge for many programs, especially mobile and school-based clinics, is sustainability, said Richard Niederman, a professor of epidemiology and health promotion at NYU Dentistry and founder of CariedAway. That's because school-based programs like Neiderman's lean heavily on donations because they often serve low-income populations who are either uninsured or on Medicaid.

Niederman has spent two decades developing his program. Other ones he tried in the Bronx and Boston ended due to a lack of funding, but this time, Niederman has $1 million from Northeast Delta Dental, which ensures his New Hampshire program will remain in place for at least three years.

“It breaks my heart that kids don’t get effective care that they could get ... and the system doesn't support it,” he said.

But the picture for pediatric oral health is improving — even outside of school programs.

Untreated tooth decay in preschool children is down 50% since 2000, according to the federal dental research agency's report. It pointed to an increased use of sealants, which prevent cavities.

Jane Grover, the senior director of the American Dental Association’s Council on Advocacy for Access and Prevention, said there has been “tremendous growth” of dental programs in community health centers, as well as efforts to deploy dental hygienists in pediatric offices.

Some states are also better coordinating pediatric and dental care. MassHealth, the Medicaid program in Massachusetts, started requiring physicians last year to ensure a child has two fluoride varnish applications and refer them to a dentist, Hayes said.

“I remember my first dental cleaning and and that left a lasting impression,” Grover said. “We want to have children understand that, but we want their families to understand that sugar-sweetened beverages all day on primary teeth where the enamel is a little thinner than it is on adult teeth, it doesn’t take long ... to go from a potentially serious situation to a very serious situation.”

Neiderman's team treated more than 60 students over a week at the Concord school. Among them was softspoken 10-year-old Evette Sesay, who dutifully detailed how she brushes twice a day and flosses.

She wondered aloud whether the treatment would “hurt,” only to be assured by Davis that it shouldn't — but that she could raise a hand if she felt pain. Evette, who went to the clinic because she “wanted to check” on her teeth, never did.

She said it felt like a typical exam at her dentist’s office: “They cleaned my teeth very well. The bubble gum flavor was good, too.”