Conditions for implementation of whole school health promotion in the Netherlands

Abstract

Abstract Background Around 35 years ago, the Health Promoting School (HPS) framework was introduced to promote student health behaviors. It is an integrated approach, including education, school health policy, health services, and a stimulating social and physical environment. Implementation of such whole school HPS programs often remains challenging due to the dynamic school system. In order to strengthen implementation and reduce heterogeneity in effects, the present study aimed to understand what works, for which schools and under which conditions. Methods In 2020, 535 schools filled out the HPS Implementation Questionnaire to determine the degree of HPS implementation, showing considerable variety. Based on their implementation scores, 21 ‘lower HPS’ and 22 ‘higher HPS’ schools (16 primary; 15 secondary; 12 secondary vocational) were recruited by Public Health Services for a visit in 2022 to examine differences. Data on implementation and 35 contextual factors (related to individuals, the school organization, HPS framework, and socio-political environment) were collected by observations, a semi-structured group interview, a questionnaire, document analysis, and field notes. Data were analyzed thematically in Nvivo, and will be followed up by Qualitative Comparative Analysis in R. Preliminary results Most evident conditions for degree of implementation were: 1) capacity (time), 2) employee attitude (mainly at primary schools), 3) program champion (mainly at secondary schools), 4) professional implementation support, 5) turbulence (e.g. merger), and 6) management support (mainly at secondary schools). Activity budgets and social support among employees were key factors as well, but did not explain differences in implementation. Conclusions In order to strengthen implementation of HPS programs, more efforts are needed to: 1) intensify support for schools in terms of time and professional advice, and 2) achieve a positive school climate among employees and management. Key messages • Implementation of HPS programs is challenging due to the dynamic nature of schools. • Offering support and achieving a positive school climate are crucial to strengthen HPS implementation in schools.