School communities’ expectations of a school-based health promotion intervention in South Africa

Introduction: School-based health promotion interventions (SHPI) have been introduced extensively over the last decades, but their implementation and evaluation still present challenges. Among these, the complexity of the environments in which SHPI are implemented, and intersectoral collaboration to promote more sustainable change, must be better addressed within evaluation processes. Objectives: The objectives of this study were to (1) identify pertinent scientific literature on the implementation processes for intersectoral SHPI and (2) develop a programme theory that maps potential elements of context and underlying mechanisms that may influence intersectoral SHPI. Method: A critical interpretative synthesis was performed of elements of context and underlying situational and transformational mechanisms. These were identified based on the scientific literature published between 1997 and 2017 addressing intersectoral SHPI. Results: Six potential elements of context, seven potential situational mechanisms and seven potential transformational mechanisms that can explain SHPI outcomes were identified from 28 articles. The results were integrated into a framework to pinpoint elements that facilitate or impede intersectoral SHPI implementation. Conclusion: The results of this synthesis support a more comprehensive approach to evaluating SHPI, and improved consideration of intersectoral collaboration and the complexity associated with this type of intervention.

Background: Interventions to promote health have been implemented in some urban settings. However, school-based health promotion interventions in at-risk urban schools have not been thoroughly investigated. Objective: This article investigates teachers’ perceptions regarding health promotion interventions with the main goal of establishing social change in at-risk school communities. Design: The study used phenomenology as a theoretical lens supported by the use of a qualitative research approach. As a theoretical framework, the researchers utilised Vygotsky’s sociocultural theory. Setting: The investigation used a descriptive case study design to select 17 teachers from 2 at-risk urban primary schools in Pretoria. Methods: Visual data including participatory reflection action posters and photographs, and field notes were part of the data collection techniques. Findings: Teachers’ responses informed how school-based health promotion interventions can be developed in the foundation phase of education. Themes relevant to this included recognition of the importance of education in bringing about social change; involving the whole community in developing health promotion projects; working closely with parents; promoting physical activity; and advocating for nutritional literacy. Goals can best be achieved through a focus on nutritional needs, physical health and social needs of at-risk communities. Conclusion: Findings from this study can be used to inform at-risk communities about food consumption, optimum physical activities and positive socio-emotional actions. Beyond this, young professionals entering the field of education should be encouraged to develop awareness of how school-based health promotion programmes can benefit the health and well-being of children.

We report here on one phase of a broader research project that focused on the development, implementation and effect of a school-based health promotion intervention. We explored food-related practices and needs in a resource-constrained community, with the aim of developing and implementing a school-based health promotion intervention. The focus was on community practices regarding food choice, production, preparation and consumption. We followed an interpretivist qualitative approach and implemented a multiple case study design. We generated data with 45 primary school teachers (Grades 4–6) and 23 parents, sampled via criterion and snowball sampling techniques. In this article, we specifically report on the first phase of the broad research project, referring to the current food-related practices and associated needs of the participating community. We aim to contribute to the current understanding of food practices in resource-constrained contexts in South Africa, as a platform against which health promotion interventions can be designed and implemented. We argue for the importance of understanding the underlying reasons for food-related habits, when wanting to address unhealthy food and nutrition-related practices. This argument confirms the importance of tailor-made interventions that can be utilised to promote healthy eating habits in specific communities, against the background and importance of broader systems and holistic transformation that can support food security on a wider level.

The present study aimed to identify factors associated with the Stages of Change (SoC) for physical activity among adolescents who participated in a school-based health promotion intervention. A cross-sectional study was conducted with a sample of 8,071 students whose average age was 13.9 (SD ± 2.4) years. To evaluate the SoC, an adaptation of the questionnaire proposed by Dumith, Domingues and Gigante (2009) was used, considering physical activities performed at least three times per week during 20 minutes. Data collection was carried out from October to November 2013 through self-administered questionnaires in the classroom. The prevalence of students in each stage was: 12.1% in the Pre-contemplation stage, 7.7% Contemplation, 16.8% Preparation, 21.8% Action and 41.6% in the Maintenance stage. Males were more associated with the stages of Action (RR 1.28, 95% CI 1.07-1.54; p = 0.006) and Maintenance (RR 3.57, 95% CI 3.02-4.23; p <0.001) compared to females. Economic level and knowledge about health showed a direct relationship to the Action and Maintenance stages. A large portion of the sample was located in active stages. Being male, being in lower school grades and having a higher index of assets were associated with higher SoC. Knowledge about physical activity and health was directly related to the Preparation, Action and Maintenance stages, pointing to a positive effect on intention or active behavior.

BACKGROUND: Childhood and adolescent obesity globally presents a huge public health problem and the dramatic increase in its prevalence and associated poor health outcomes pose serious concerns among Arabic-speaking countries.
 
 AIM: This scoping review seeks to identify the characteristics and assess the effectiveness of school-based health promotion interventions on prevention or reduction of overweight/obesity among children and adolescents. This review further describes the implementation and evaluation of nutrition and physical activity interventions and their measured health outcomes for schools in Arabic speaking countries. 
 
 METHODS: We searched 10 electronic databases (PubMed MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), ERIC, EMBASE, ProQuest, EBSCO Host and Global Health) from 2010 to 2020 for studies evaluating school-based health promotion interventions on obesity or overweight among children and adolescents in Arab speaking countries. Sixteen studies met the inclusion criteria for this review and narrative synthesis was conducted. 
 
 RESULTS: The 16 articles reported on eight discretely different interventions which were largely school-based and examined physical activity and/or nutritional changes as well as changes in knowledge and attitude in regard to physical activity and nutrition. 
 
 CONCLUSION: Our review demonstrates an inconclusive and mixed effect of behavioural and physical activity intervention on prevention or reduction of obesity and/or overweight. While the strengths and limitations of the various interventions may have influenced the outcomes, long-term school-based interventions with rigorous methodological and theoretical frameworks are necessary to assess the true impact of these interventions on childhood and adolescent obesity in Arab speaking countries.

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for “at-risk” students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students’ mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme’s underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for “at-risk” students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students’ mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme’s underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.

Anxiety and depression occur at alarmingly high rates in children and young people; hence the recent research and policy focus on school-based mental health promotion and prevention interventions. Currently, little is known about the level of risk between socio-economic school communities. While disadvantaged socio-economic status (SES) has long been identified as a particular risk factor for mental health problems, level of risk for anxiety and depression in different SES school communities has not been explored. This study explores the relationship between SES and anxiety and depression, as well as the protective factor self-esteem in children and young people. The results indicated that children in the low SES schools scored significantly higher on depression and lower on self-esteem than children in the high SES schools. Interestingly, and contrary to the hypotheses, children in the high SES school reported significantly higher anxiety than those in lower SES schools. The outcome of this research suggests that children from low SES schools may have a higher level of risk for depression with lower psychological protective factors, such as self-esteem, but this result was not evident for anxiety. Research exploring the risk for mental health disorders, as a function of SES school community, is important in terms of prevention programming.

BackgroundAmerican Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden.MethodsOur process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes.ResultsWe identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards.ConclusionsThe program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.

School-based interventions support children’s holistic well-being by promoting mental health, fostering resilience, and enhancing social, academic, and physical development. This systematic review aimed to synthesize current evidence-based research on school mental health promotion interventions. Another objective is to analyze the reported outcomes of interventions to review current policies and available resources. A comprehensive search within MEDLINE (PubMed), CINAHL (EBSCO), and Google Scholar was conducted using different combinations of keywords “school-based”, “intervention”, “mental health”, “evidence-based”, “theory” and “promotion” by using the Boolean operators “AND” and “OR”. Studies were included from December 1, 2017, to October 31, 2024, study design (randomized control trials), age ≤ 18, all genders, and English language. Studies were excluded based on inception year, age ≥ 18 years, study designs other than mentioned above, and non-English language. Quality assessment was performed with the Joanna Briggs Institute (JBI) critical appraisal tool for randomized controlled trials. A total of 24 studies were included, identifying a total of 32 evidence-based mental health interventions. These school-based mental health promotion interventions utilized combined frameworks (n=7), cognitive behavioral therapy (n=5), mindfulness theory (n=3), mental health literacy (n=3), diathesis-stress model (n=3), WHO-approved FRIENDS program (n=2), social cognitive theory(n=1). A combination of programs and frameworks were utilized in 5 out of 24 studies. School-based interventions effectively reduce depression, anxiety, and psychosocial challenges in youth, promoting well-being. More rigorous research is needed to enhance evidence-based interventions, consider contextual influences, and evaluate broader societal benefits of empowering children in mental health prevention.

Introduction: Children spend a significant amount of their day at school, so school-based health promotion interventions are one strategy for improving health and wellness for Indigenous children globally. The Indigenous Youth Mentorship Program (IYMP) is one such intervention in Canada. IYMP’s core components include physical activities/games, healthy snacks, relationship-building activities and traditional Indigenous teachings. The theoretical framework guiding IYMP is based on the pedagogical teachings (Circle of Courage and Four R’s) of two Indigenous scholars (Brokenleg and Kirkness). Between 2012 and 2018, IYMP was rippled (IYMP team’s preferred term for ‘scaled up’) to 13 Indigenous school communities across Canada. Schools are encouraged to tailor the program to suit their unique contexts. There is little information about the scalability of school health programs developed for Indigenous children. The purpose of the present research was to describe the implementation of IYMP during its first year of rippling to two rural First Nation community schools in the province of Alberta. Methods: This descriptive case study described the first year of implementation (January to June 2017) of IYMP as an after-school healthy living program in two rural First Nation community schools. IYMP was led by a young adult health leader (education assistant) and youth mentors (grades 6–12) from each community. Program implementation was documented using program logs and observational field notes of program sessions. Descriptive statistics were used to analyze log data. Results: In total, 33 children, 2 young adult health leaders, 19 high school youth mentors and 6 junior high school mentors from both First Nation schools participated in IYMP. On average, there were 11.7 children (median=11, range=6–24) per program session, typically 3 males and 7 females. Weekly sessions had a mean duration of 87 minutes (median=90, range=75–110). Foods most often offered to children were whole, unprocessed foods such as fruits and vegetables. Water was served at each session. Physical activities had a mean duration of 70.7 minutes per session (median=70, range=45–95). Activity sessions occurred in the gymnasium 73% of the time or in both the gymnasium and outside 27% of the time, depending on weather and environmental conditions. The intensity level of physical activity sessions was mostly ‘vigorous’ (59%), followed by ‘walking’ (32%) or ‘sedentary’ (9%). Traditional teachings were embedded within the program activities and sometimes included the participation of Elders from the community. Activities included making bracelets using Medicine Wheel colors with Elder teachings/Elder participation, sharing circles, the Seven Grandfather Teachings (ie wisdom, love, respect, bravery, honesty, humility and truth), use of First Nations languages in games or in prayer, and the ceremonial burning of sweetgrass (ie smudging). Conclusion: While modifications to program delivery were encouraged, both schools delivered all core components of IYMP at each session. IYMP planning could explore ways to make the program more appealing to males. IYMP’s flexibility, use of an Indigenous theoretical framework, cultural infusions and resonance with Indigenous values likely facilitated its rippling to these schools. The next steps are to determine if the delivery of IYMP to additional communities has adaptability, effectiveness and high impact.

Non-communicable diseases (NCD) are now the leading cause of death worldwide. As habits and lifestyle are established in childhood and adolescence, targeting school children before they develop unhealthy habits offers a window of opportunity to halt and reverse the emerging NCD epidemic. However, few experiences from school interventions in low- and middle-income countries have been collected. Therefore, the aim of this study was to review experiences of implementing school-based health promotion interventions to identify barriers and recommendations for future interventions. A qualitative investigation of 17 school-based health promotion interventions in low- and middle-income countries was conducted. Data were collected through questionnaires (15 project leaders) and in-depth interviews with nine project leaders. The data from the questionnaires and interviews was triangulated and analysed using content analysis, where themes and categories emerging from the material were explored. Three key themes emerged from the data: 1) policy environment and stakeholder engagement, 2) health education sessions, and 3) practical health promotion activities. The themes explored the experiences and lessons learned from 17 school-based health promotion projects in low- and middle-income countries. Stakeholders at different administrative levels were important for the projects; however, stakeholders close to implementation were seen to be more engaged. Most projects conducted traditional health education lectures, which formed the basis of their intervention. Promotion of physical activity and healthy eating through participatory approaches were identified; however, barriers such as lack of areas suitable for physical activity and lack of healthy food alternatives in schools can obstruct the successful implementation of interventions. This study has documented experiences with school-based health promotion in low- and middle-income countries, and has shown that schools can play an important role in facilitating NCD-related behavioural change in children. The study recommends increased emphasis on a whole-school approach where activities focusing on individual behavioural change are supported by interventions improving the structural environment.

Efficacy of a school-based cardiac health promotion intervention program for African-American adolescents

School-based health promotion interventions (HPIs) are commonly used in schools, but scientific evidence about the structures of effective interventions is lacking. Therefore, we conducted a mixed methods systematic literature review to recognize the HPI structures related to their effectiveness. Based on the inclusion criteria, 49 articles were selected for the literature review. The articles, published in 2011-2022, described 46 different school-based interventions conducted in 20 different countries. The average duration of the interventions was 12 months, and they were implemented mostly with an RCT study design (61.2%) and by targeting children (69.4%). Three main groups of interventions were identified and explained: (1) extensive and long-term interventions; (2) school policy-changing interventions; and (3) highly effective interventions. Effective school-based HPIs included multiple target groups, multiple providers with external experts, and an efficient duration and timing of follow-ups. The implications for educational research and school practice are presented. Evidence on the effectiveness of health-related interventions is still lacking and needs to be addressed in further studies.