American School Health Association Membership Survey: Leading the Way Into the Next Century

The American School Health Association (ASHA) is a nearly 100-year-old multidisciplinary, professional member association that provides the Journal of School Health in collaboration with its publishing partner, Wiley. Over the course of its long history, ASHA has addressed health issues among primary and secondary students that impact learning and student success. ASHA has long advocated for a coordinated school health approach involving a team composed of various school health professionals—including health and physical educators, school nurses, counselors/social workers, and dietitians—as well as families and the wider community. ASHA envisions healthy students who learn and achieve in healthy environments, nurtured by caring adults, functioning within coordinated school and community support systems [1].

As ASHA prepares for its centennial celebration, a look backward is helpful in paving the way for success in the next hundred years. A 1990 survey of ASHA members revealed that most respondents had been a member for 5 years or less, belonged to more than one professional association, and felt that the activities and operations of ASHA were average with the journal and annual conference being the most well-regarded though less than half had attended the conference [2]. A 1993 survey of ASHA members revealed an even greater proportion of respondents were members for 5 years or less, highlighting the loss of longer-term members of the Association within a 3-year period. The majority of respondents belonged to more than one association while 10% were exclusively ASHA members [3]. As was the case in 1990, respondents felt that the activities and operations of ASHA were average with the journal and annual conference being the most well-regarded though less than half had attended the conference [3].

An examination of the ASHA membership database in 2020 revealed a significant decline in membership. In 1990, ASHA had approximately 2800 members. As of 2021, ASHA had fewer than 800 members, half of which had been members for 5 years or less. This marked decline in ASHA membership underscores the need to understand the needs of the professionals served by ASHA. Rominiecki encourages associations to engage in extensive data analysis to fully understand those who renew their membership and those who do not renew [4]. Not only are membership and engagement rates on the decline, but financial resources are also waning. Since the “Great Recession” from late 2007 to mid 2009, funding and contributions have declined more than in past recessions. According to Morreale [5], this was particularly true for education- and health-related nonprofits and was even more pronounced for small nonprofit organizations. This may be contributing to a trend of professionals joining local- and state-level professional associations [6], which often have lower membership dues than a national association. As such, member associations—especially smaller associations, which are the majority—are struggling to survive and adapt to the new normal. For any member association, it is important to identify the most influential factors for a loss of members and funding and respond quickly [6].

In 2021, ASHA designed and distributed a survey questionnaire via the Association's social media platforms, website, and newsletter using a snowball sampling method. The purpose of the survey was to develop a full picture of the benefits of membership, barriers to membership, incentives for engagement, and perceptions of ASHA. Results of this survey informed the types of programs, services, and member benefits offered to school health professionals through the Association. As ASHA approaches the 100th anniversary of its founding in 1926, the following insights will help guide ASHA into the next century of the Association.

Respondents (n = 414) included 183 current ASHA members (150 professional members, 12 student members, 11 retired members, and 10 lifetime members), 93 former ASHA members, and 138 non-members (i.e., never a member). Approximately 80% of respondents indicated that they were established professionals (i.e., 5+ years into their careers) representing a variety of settings, areas of responsibility, and professional disciplines though the most represented groups were nurses (36%) and health educators (25%). The top settings within which respondents worked were elementary schools (n = 76), higher education (n = 68), and government agencies (n = 47). Most respondents identified areas of responsibility as health education and health services (58%). The majority spoke English as their primary language (80%) and identified as LGBTQIA+ allies (65%). The make-up of the membership pointed to a lack of workplace diversity in the Association. As such, ASHA implemented a recruitment plan with the goal of reaching more school health professionals who work in primary and secondary school settings. Systemic adjustments included changing committee meeting times and moving the annual conference date to allow for greater participation of classroom educators and other school professionals. The annual conference was moved to the summer in 2022 (Albuquerque, New Mexico) and 2023 (Minneapolis, Minnesota) to determine whether this time period was more conducive for classroom educators. Due to record low attendance and feedback provided from conference attendees and members, the conference was moved back to the fall (Pittsburgh, Pennsylvania) in 2024.

There were 183 respondents who identified as members of the Association. Half of ASHA members reported paying for their memberships themselves (51%) and most members found the benefits to be in line with the cost (83%). The price of membership dues was the main contributor to lapsed memberships. Membership fees have not increased in over 5 years and more opportunities for no cost or reduced membership fees have been provided, including those provided through the annual scholarship award and membership campaign promotional offers.

For respondents who have never been an ASHA member (n = 138), the primary reasons provided were the cost of ASHA membership and their involvement in another association more closely aligned to their professional role. ASHA continues to prioritize outreach and relationship building with other national organizations. The Association launched an “Ambassadors Initiative,” focused on membership recruitment among state and national non-member organizations versus from other membership organizations.

The majority of all respondents (68%) perceived ASHA to be an inclusive association (e.g., with diverse values, perspectives, roles, and opinions). ASHA staff recently completed the Culturally and Linguistically Appropriate Services (CLAS) Standards Assessment and implemented strategies to expand diversity, equity, inclusion, and accessibility efforts. Examples of ASHA's efforts include a commitment to providing living wages to ASHA staff and interns, ethical consumerism and investments, and environmental sustainability.

The most utilized professional development opportunities included webinars (46%), the annual conference (35%), and journal self-studies (10%). ASHA has continued to grow its webinar offerings and self-study options and now provides an increasing number of continuing education hours, for a variety of professionals, as an extension of the annual conference.

The top two initiatives or member benefits respondents would like to see ASHA add are a school health training/leadership program and virtual workshops. ASHA has designed and is seeking funding to offer a school health team leadership academy in addition to its established Future Leaders Academy (FLA). In addition, ASHA has added comprehensive e-learning courses and workshops to the learning management system.

Opportunities to provide direct support to K-12 students is the top motivator for donating to ASHA. The ASHA Gives Back initiative benefits a school or school-aged youth-supporting nonprofit organization in the city where the annual conference is held. With member support, ASHA donates items identified by the local school/organization leadership as a priority need for the students they serve. Additionally, the ASHA Board of Directors has designated donations collected through conference and year-end fundraisers to support the ASHA scholarship award, which increases access to the virtual and in-person conferences for individuals working in school settings.

The top two reasons why people continue to be a member of ASHA are the annual conference and belief in ASHA's mission. As such, the annual conference continued through the pandemic using a virtual platform and a virtual option has continued to be an added component of the conference schedule through 2024. Respondents indicated that they prefer to hold the ASHA conference in the summer in a location that is easily accessible. In response, the ASHA Board of Directors moved the conference to the summer (in 2022 and 2023) to locations easily accessible via air travel. To make the conference more affordable, ASHA collaborated with a university to further reduce expenses and registration fees were reduced and remain lower than pre-pandemic rates. However, due to low turnout and negative conference evaluations, the conference was moved back to the fall in 2024 and rebounded from low participation rates in 2022 and 2023. The virtual conference continued to be offered through 2024 to meet the needs of classroom educators with limited time off and reduced travel funds.

In conclusion, ASHA firmly believes that understanding the needs of professionals in the field—members and non-members alike—is crucial for the success of the Association in the next 100 years. Even more important is to be responsive to the needs of those professionals when they are shared with the Association. ASHA has taken great care to make use of the information provided by survey respondents. As ASHA approaches its centennial year, the Association will continue to request feedback and will be responsive to and responsible with the shared ideas and information.

The authors declare no conflicts of interest