Abstract
Recent studies show adolescent health-related behaviours to co-occur synergistically. This paper describes the study design for an exploratory trial on the effects of a comprehensive, whole-school health promoting school intervention. This intervention tackles seven different behavioural domains simultaneously via a combination of education, creating a healthy environment and introducing healthy behavioural policies. Additionally, extensive partnerships are formed between schools, parents, neighbourhoods and youth health authorities to coordinate health promotion efforts. The intervention will be implemented at two secondary schools. Results will be compared with two control schools (n≈1500). The intervention's effectiveness in changing student behaviours as well as physical and psychosocial health status along with qualitative lessons learned on the integration of youth health care services and school health education practices are the main aimed outcomes of this study. Data are collected via a mixed methods design combining an annual youth health (behaviour) monitor with a qualitative process evaluation via interviews with key stakeholders. A multilevel analysis is performed combined with a systematic analysis of qualitative interview data. This study will produce an evaluation of a comprehensive health promoting school intervention that combines an integrated approach of schools, neighbourhoods, families and youth health services to improve adolescent health.
Highlights
Unhealthy behaviours such as alcohol use, smoking, unhealthy nutrition or excessive time spent behind screens show alarming trends in The Netherlands and the rest of the developed world [1, 2]
This paper describes the study design for an exploratory trial on the effects of a comprehensive, whole-school health promoting school intervention
The main issues to take into account in such studies, according to Campbell et al [33], are 1) ensuring a sound theoretical understanding of the problem, 2) realizing that a lack of intervention effect may reflect implementation failure rather than a genuine lack of program effectiveness, 3) the variability in individual level outcomes may reflect upon higher processes, 4) a single primary outcome may not make the best use of the data, which means that e.g. quantitative data can better be interpreted when accompanied by related qualitative data that may provide the necessary context, and 5) realizing that ensuring strict standardization may be inappropriate in this context
Summary
Unhealthy behaviours such as alcohol use, smoking, unhealthy nutrition or excessive time spent behind screens (e.g. the television, computer or game console) show alarming trends in The Netherlands and the rest of the developed world [1, 2]. The desire to pursue a more comprehensive, evidence-based health promoting school concept drove the development of this pilot; a desire that originated due to persistent complaints from parental and teachers’ about the students’ unhealthy lifestyle These complaints were a result of persisting problems with, among other things, students’ (extreme) alcohol use and bullying. The municipal health services showed great willingness to provide schools with such help e.g. by means of delivering evidence-based educational materials and teacher in-service trainings All these partnerships facilitated an integral, more intensified approach to local health promotion, through integration of school, local environments and primary health care services. This study protocol presents the rationale and methodology for the exploratory trial study [33] of the pilot, named and from hereon referred to in relation to the follow-up study as the Utrecht Healthy School (UHS)
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