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The article presents the results of a survey on the perception of the psychosocial school environment and school functioning of lower secondary school students with and without chronic conditions. Students of grades 1–3 (N = 4,058) from randomly selected 234 public lower secondary schools from all voivodships participated in the survey. In this group 3,232 (80%) students were healthy and 798 (20%) had different chronic conditions. The anonymous “Health and school” questionnaire was used as the instrument for data collections with questions from HBSC study (Health Behaviour in School-aged Children) and from CHIP–AE Questionnaire (Child Health and Illness Profile: Adolescent Edition). Based on Urie Bronfenbrenner’s ecological model, dimensions of psychosocial school environment were analysed on the individual level (microsystem) and the social relations level (mesosystem). It was found that healthy students, in comparison with those with chronic conditions, perceived school environment and their functioning at school better. They have: a larger sense of school belonging, higher level of school competencies and achievements, larger sense that their grades are adequate to the results, a higher social position in the class and a higher level of support from peers, teachers and parents. Students with chronic conditions have higher level of workload, stress and problems associated with the school, and they also spend more time on homework. These students (about 20% of the population of school age) have special educational needs which depend on the specificity and the course of the disease. Identification of difficult areas in the functioning of chronically ill students in the school and knowledge of their perception of their school’s psychosocial environment will allow teachers to provide them with appropriate support.
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