Introduction

The significant increase in the migratory flow represents a huge challenge and at the same time a great opportunity in terms of public policies in countries in key areas such as health and education (^{World Health Organization [WHO], 2022}).

The contribution of youth migration to the economic and social development of host countries is undeniable, and it is essential to promote a positive integration process, for which the health of young people is an essential condition, developing policies and programs that consider and safeguard access to healthcare, with particular attention to reducing inequalities (^{WHO, 2022}).

The School is strongly influenced by Education and Health policies, social and community values ​​in the context in which it operates. The school reality appears to be very variable between educational establishments, both due to the school groups it hosts and the origin and expectations of the population that attends them (^{Direção-Geral da Saúde [DGS], 2015}). Currently, events of great educational complexity are observed in schools, representing great multiculturalism (^{Conselho Nacional da Educação, 2023}).

According to the National Health Plan for 2030 (DGS, 2021), leaving no one behind implies identifying the most vulnerable or most at-risk groups in which young migrants fall. This Plan highlights strategies such as reducing inequalities and boosting partnerships, as well as promoting literacy and health-promoting environments aimed at enhancing health gains in the school community (^{DGS, 2021}).Strengthening health literacy is a fundamental concept in the school community (WHO, 2019) and, according to Sorensen et al. (2012), knowledge, competence and motivation, to access, understand, evaluate and apply health information. Health Promotion is associated with Health Literacy, due to its influence on behaviors and results and, according to the WHO (^{Nutbeam, 1998}), it is the process that aims to empower individuals and communities with the aim of improve health and well-being.

The mission of school health is to promote collective awareness that health is a valuable asset and everyone's responsibility for the formation of healthy adults (^{Martins & Borges, 2023}; ^{Ramos & Barbieri-Figueiredo, 2020}). Combining professional responsibility with the potential contribution to building a better society with more literate citizens, the concept of empowerment will be present (Ramos & Barbieri-Figueiredo, 2020), while associated with skills, behaviors and health gains, the concept of Health Literacy emerges (^{Okan et al., 2020}).

From this perspective, it is necessary to create strategies that favor inclusion, promoting enriching diversity. Therefore, results will be better if school systems promote integration, providing them with additional support, guaranteeing accessibility and school quality (^{Banco Internacional, 2023}).

The agents that make up the school community, including teachers and non-teaching staff, nurses and other health professionals, (^{Hockenberry & Wilson, 2014}), are part of the educational strategies and resources, essential for the development of health literacy among young migrants. and autochthonous (^{Dadaczynski et al., 2020}).

Investment in the production of studies within the scope of empowering the school community to promote health literacy among young people allows for a more evidence-based practice, converting knowledge into new practices and improving the quality of care provided to the community.

Carrying out this scope aims to support an empirical study towards improving the quality of care for the community, so the lack of evidence in the context of empowering the school community to promote health literacy among young people was evident, which determines the need for more research that allows us to clearly identify what we understand about the topic and the strategies we use. It is understood that in relation to community empowerment, ^{Melo (2020}), created a Community Nursing Assessment and Intervention Model (MAIEC), to understand the health needs of communities, which is why some studies derived from it have emerged, such as examples: “Alto Minho + Inclusive and Community Diagnosis” (^{Melo et al., 2023}); “Assessing Community Empowerment for an Innovative Epidemiologic” (^{Melo et al., 2020}) and “Focuses of attention in community nursing and community empowerment: a qualitative study” (^{Melo, 2018}).

This Scoping Review will follow the recommendations proposed by the Joanna Briggs Institute (JBI), based on the principle that research constitutes a central practice in Nursing and is decisive for its affirmation and recognition as a profession and discipline (^{Nené & Sequeira, 2022}). The objective is to map the evidence relating to the school community in the health decision-making process of indigenous and migrant young people in a school context.

1. Methods

This scoping review was conducted based on the method proposed by the Joanna Briggs Collaboration (^{Peters et al., 2020}) and was written in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (^{Tricco et al., 2018}). The protocol for this systematic review was registered on OSF.

The methods proposed by the Joanna Briggs Collaboration have been widely used and recognized in multiple areas of knowledge and by experienced reviewers, representing a primordial approach to support decision-making based on the best available evidence (^{Khalil et al., 2021}).

The PRISMA for Searching extension provides a reporting checklist for this specific type of review proposed by JBI (^{Aromataris et al., 2024}). The steps that must be followed are formulate the review question, define inclusion and exclusion criteria, locate studies through search, select studies for inclusion, extract, analyze and synthesize relevant studies (Aromataris et al., 2024). In this way, the following research question was formulated: “How does the empowerment of the school community influence the health literacy of indigenous and migrant young people?”.

According to the JBI method, it proposes the following eligibility criteria: population, concept and context - PCC method (^{Peters et al., 2020}). Regarding the population, all studies that include the school community, namely teaching/non-teaching staff, were considered. In terms of concept, all studies that address the concept of health literacy were considered. Regarding the context, all studies in a school context were considered, namely in the 3rd cycle of basic education.

The specific objectives are: Identify the school community in health decision-making for migrant and indigenous young people; Characterize the health decision-making process of indigenous and migrant young people in a school context.

1.2 Study Selection Process

Regarding the type of study, all existing studies were considered. Quantitative studies include any experimental study designs (including randomized controlled trials, non-randomized controlled studies, or other quasi-experimental studies, including before and after), and observational designs (descriptive studies, cohort studies, cross-sectional studies, cases and case series studies). Qualitative studies include any studies that focus on qualitative data, among others, phenomenology, grounded theory, and ethnographic studies. Abstracts and posters published at conferences, as well as opinion articles, were excluded. No time limits were applied to the research as the aim was to have an integrated view of all available evidence on the topic under consideration. The studies were selected by three independent reviewers, according to the inclusion criteria, with a third reviewer evaluating, in case of disagreement, using the Rayyan® platform (Qatar Computing Research Institute, Doha, Qatar). This analysis of the full text was carried out by two independent reviewers (JM and CA). Any disagreements between reviewers at each stage of the selection process were mitigated through constructive discussion or by using a third reviewer (AS). In the first phase, articles were included based on the information provided by the title and abstract. All studies that meet the inclusion criteria have full text analysis.

Figure 1, PRISMA-ScR diagram, highlights the detailed article selection process, outlining three crucial steps: identification, analysis and inclusion (^{Page et al., 2021}).

In the first phase of PRISMA, the number of articles found in the database was identified, 924 articles. 181 duplicates were removed. Totaling 745 articles.

The analysis constitutes the second phase of PRISMA, where, after analyzing the title of the article and the abstract, those that do not meet the previously defined inclusion criteria must be rejected, in accordance with the PCC method, namely the inclusion criteria relating to to the participants. Thus, of the 735 articles in the second phase, 725 articles were rejected, 18 articles were read in full. 13 articles were rejected, taking into account the exclusion criteria: Non-teaching/non-teaching population and other teaching cycles other than the 3rd cycle. Thus, the third phase of PRISMA “Included” appears. At this stage, 5 articles remained, of which 2 were qualitative, 2 were quantitative and 1 was mixed.

Figure 1 Prisma Flow Diagram. Adapted: ^{Page et al., 2021}  

2. Results

In order to guarantee a logical and descriptive organization of the data extracted from the 5 articles under analysis and address the initial question comprehensively, a table was created which included, for each of the articles, the name of the authors, objectives, methodology, results and conclusions (Table 3) (^{Peters et al., 2020}).

3. Discussion

Current society reflects school contexts with events of great educational complexity representing great multiculturalism (CNE, 2023). The school reality can be very variable between educational establishments, either due to the school groups it hosts, or due to the origin and expectations of the population that attends them (DGS, 2015).

The five selected studies point to the school as a privileged place for health promotion (^{Bichoualne et al., 2023}; ^{Dadaczynski et al., 2020}; ^{Moynihan et al., 2015}; ^{McDiarmid et al., 2021}; ^{Desmée & Ceborati, 2023}). For DGS (2021), inequalities should be reduced as well as the promotion of healthy behaviors, cultures and communities through the promotion of health literacy and health-promoting environments.

In this aspect, it is necessary to create strategies that favor inclusion, promoting enriching diversity. Results will be better if school systems promote integration, providing them with additional support, ensuring school accessibility and quality (^{Banco Internacional para a Reconstrução e Desenvolvimento, 2023}). There is an urgent need for the school to be an inclusive place, regardless of personal, social or cultural condition and to be a space that allows the acquisition of skills, strengthening health literacy (^{Dadaczynski, et al., 2020}).

The definition of guidelines, the development of health promotion activities and the integration of the school community in its holistic form will be preponderant (^{Bichoualne et al., 2023}; ^{Dadaczynski et al., 2020}; ^{Moynihan et al., 2015}; ^{McDiarmid et al., 2021}; ^{Desmée & Ceborati, 2023}). Therefore, there must be an alignment, from a holistic perspective, of the incorporation of health literacy in schools, to enable students, teachers, directors, coordinators, assistants and school technicians to implement and seek, within schools, measures and objectives according to their own needs and adapt the skills acquired to daily life (^{Okan et al., 2020}).

The school should be a space that promotes an environment favorable to learning where teachers have responsibilities in establishing a relationship of trust that allows the development of literacy and the transformation of migrants into informed and civically engaged citizens (^{Bichoualne et al., 2023}; ^{McDiarmid et al., 2021}; ^{Desmée & Ceborati, 2023}).

The involvement of teaching/non-teaching staff in the decision-making process is a deliberate and relational process involving their involvement and self-awareness of their capabilities in each situation which means that teachers' skills and early professionalization cannot be disregarded (^{Bichoualne et al., 2023}; ^{Dadaczynski et al., 2020}; ^{Moynihan et al., 2015}; ^{McDiarmid et al., 2021}; ^{Desmée & Ceborati, 2023}). Empowering the community of indigenous and migrant young people is fundamental to strengthening health literacy WHO (2019) and the evidence tells us that teachers/non-teachers have influence in this process (Bichoualne et al., 2023; Dadaczynski et al., 2020¸Desmée & Ceborati, 2023). Empowering communities is assumed as a premise, in the context of community empowerment, from a systemic perspective (^{Melo, 2020}). In this context, the Nurse Specialist in Community Nursing and Public Health has the community as its main focus and its main pillars are the Health Planning methodology and the MAIEC (Melo, 2020; Ordem dos Enfermeiros, 2018).

MAIEC is a model that integrates a prescriptive clinical decision system and constitutes a fundamental role for the practice of nurses specializing in Community Nursing (^{Melo, 2020}). Community management is the central focus according to the MAIEC clinical decision matrix and integrates three diagnostic dimensions: community participation, community process and community leadership (^{Melo, 2020}).

The focuses of community process and community participation, associated with the interaction of community members, are associated with the dimensions of community empowerment. Since community empowerment allows us to obtain more effective results as a process in community intervention (^{Melo, 2020}), the figure below (Figure 2) presents the relationship between the categories (diagnosis dimensions of the model), the subthemes emerging from the articles analyzed (cataloging) and interventions from the MAIEC clinical decision matrix.

In the literature, it is consistent that the school community is increasingly aware and aware of the needs of migrant children (^{Bichoualne et al., 2023}; ^{Dadaczynski et al., 2020}; ^{Moynihan et al., 2015}; ^{McDiarmid et al., 2021}; ^{Desmée & Ceborati, 2023}). However, there is still a need to develop the areas of knowledge of teachers and school directors and overcome existing barriers (Bichoualne et al., 2023; Dadaczynski et al., 2020; Moynihan et al., 2015; McDiarmid et al., 2021; Desmée & Ceborati, 2023). Therefore, in this context, Health Diagnosis is extremely important, as it allows us to obtain knowledge of the community by identifying its problems, needs, risk groups and available resources. Consequently, Health Planning will allow the promotion of healthy behaviors and lifestyles and promote the correct use of health services (^{Melo, 2020}; ^{Imperatori & Giraldes, 1982}). Community nursing is responsible for transforming the school community's power of participation and decision-making, so that the community responses developed are appropriate to the real needs and interests.

Figure 2 Relationship between the nurses' main focus of attention with the diagnostic dimensions, interventions in the MAIEC clinical decision matrix - articles emerging from the scoping review. Adapted from ^{Melo (2020}). 

There is a need for more studies, research needs to be focused on evidence of interventions and, evaluating the different educational strategies used to promote the health decision-making process in young people, thus reparing young people to become civically aware decision-making adults in health.

Conclusion

This review highlights the potential for empowering teaching/non-teaching staff among young migrants. The evidence found corroborates that teachers play a preponderant role in the decision-making of young natives and migrants, making it necessary to build an educational environment providing the construction of a partnership relationship with students, in order to provide them with knowledge and skills to effectively manage health/illness processes. On the other hand, non-teaching staff, as a source of support and cultural support network, where family members should also be part of the process. In this context, community health teams have a fundamental and privileged role in: understanding the knowledge and skills of teaching/non-teaching staff and enabling teaching/non-teaching staff to mobilize their knowledge and skills, raising awareness for the promotion of health, contributing to increasing health literacy.

For young migrants, in particular, these influences are fundamental for integration and adaptation to new social and cultural contexts. Interactions with these figures provide a sense of belonging and identity, helping them to balance cultural expectations of origin with the host country.

In short, the synergy between the influences of teachers and non-teachers is essential to empower young people, promoting more informed and conscious decision-making. Recognizing and valuing these dynamics can contribute to more inclusive and effective educational and social policies, which respect diversity and promote the integral development of young migrants.

Authors' contribution

Conceptualization, J.M., C.A. and A.S.; data curation, J.M., C.A. and A.S.; formal analysis, J.M., C.A. and A.S.; investigation, J.M., C.A. and A.S.; methodology, J.M., C.A. and A.S.; project administration, J.M., C.A. and A.S.; resources, J.M., C.A. and A.S.; software J.M., C.A. and A.S.; supervision, J.M., C.A. and A.S.; validation, J.M., C.A. and A.S.; visualization, J.M., C.A. and A.S.; writing-original draft, J.M., C.A. and A.S.; writing-review and editing, J.M., C.A. and A.S.

Conflict of interest

The authors declare no conflicts of interest.