Comprehensive School Health Approach Research Articles

“It trickles into the community”: A case study of the transfer of health promoting practices from school to community in Canada

The school is an ideal setting to promote children's health and is an equitable way to reach children in early developmental years. Healthy children are stronger learners and wholistic health approaches taken in schools can help children thrive. Interventions in the school are strengthened when school, home, and community work together, yet many interventions have not reported the school and community connection and influence. The purpose of this study was to determine if and how the intervention, APPLE Schools, has impacted the community environment. One community in Alberta, Canada was chosen as a case study. An instrumental case study approach was taken, and data generation was guided by focused ethnography. Data were generated through community partner interviews (n = 17) and document analysis. Reflexive thematic analysis was used to analyze data. Results were represented by three main themes and demonstrated APPLE Schools created impact beyond the school setting through a stepped approach: 1) Foundation: establishes a healthy school culture; 2) Action: tying the work of schools and communities together; and 3) Impact: changes in school practices ripple out to promote health in the community. This research provides compelling evidence that comprehensive school health approaches can impact community environments outside the school and result in stronger health promoting practices both within and outside the school.

It takes a community: exploring APPLE Schools' impact within and beyond school walls in Canada.

Childhood is a critical stage to develop healthy behaviours, and the school years are an important developmental period in which children are learning and growing. School-based health promotion interventions are increasingly using the comprehensive school health (CSH) approach that has been found effective at improving health behaviours, while adapting to the school and community context to create and sustain a healthy school culture. The interconnected environments of school, home and community are key to the CSH approach, however, there is minimal research that has been conducted to determine the impact at the community-level. This research used a qualitative multiple case study design to explore the influence of a school-based health promotion intervention, APPLE Schools, on the school and community environments from the perspectives of school staff in Alberta, Canada. Twenty-two participants participated in walking interviews in five schools. The walking interview approach combined interviewing and field observation and empowered participants to share their local expertise and knowledge within the context of school and community environments. Interviews were transcribed and analysed using an inductive thematic approach. Four themes were identified: APPLE schools look different, APPLE Schools build champions, APPLE Schools builds community partnerships and APPLE Schools honours community culture. Health promotion practice in schools was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. In sum, it was found that school-based health promotion reaches beyond school walls and can influence the broader community environment.

A Comprehensive School Health Approach to Student Physical Activity: A Multilevel Analysis Examining the Association between School-Level Factors and Student Physical Activity Behaviors.

The comprehensive school health (CSH) framework has four components: social and physical environment; partnerships and services; teaching and learning; and policy. This study examines associations between CSH and student physical activity (PA). Using 2015/2016 COMPASS study survey data of 37,397 students (grades 9-12) from 80 secondary schools in Ontario and Alberta, Canada, associations between school-level factors within CSH and student PA outcomes (weekly moderate-to-vigorous PA [MVPA] minutes and achieving the national PA recommendations of ≥60 min of MVPA daily, vigorous PA ≥3 days/week, strengthening activities ≥3 days/week) were analyzed using multilevel regression models stratified by gender and grade. Factors within all four CSH components were associated with student PA. Four student subgroups were more likely to achieve the recommendations if their school had youth organization partnerships (Range of AORs:1.15-1.33, p <.05) and female students were less likely if their school had low prioritization of PA (AOR=0.77, 95% CI: [0.65-0.92]). Grade 9 students had higher MVPA when provided non-competitive PA opportunities (β=100.4, 95%CI: [30.0-170.9]). All student subgroups had better PA outcomes when schools provided access to equipment during non-instructional time. There is opportunity to improve student PA through CSH-guided interventions, but different strategies may be more effective for each gender/grade.

A Canadian-wide perspective on the essential conditions for taking a comprehensive school health approach

BackgroundThe primary purpose of this research was to explore Comprehensive School Health (CSH) stakeholders’ perceptions of the essential conditions for taking a CSH approach in other contexts across Canada. The secondary purpose was to examine the need for and development of an evaluative tool or resource to assess the implementation of the essential conditions.MethodsData were generated through individual semi-structured interviews (n = 38) and small group interviews (n = 3) with 45 participants across Canada involved in implementing policies or programs which take a CSH approach. Interviews were subjected to content analysis.ResultsThere was positive support for the essential conditions and results indicated the essential conditions are relevant across Canada. Findings revealed the necessity for a new essential condition that reflected support and leadership from the school district and/or provincial/territorial governing bodies. Modifications to the description of each of the essential conditions were also suggested to provide clarity. Results also indicated that an evaluative tool that was concise, meaningful, and provided immediate feedback would be useful to school communities to establish readiness, assess, and improve ongoing implementation of CSH approaches.ConclusionsThis research contributes to the evidence-base of CSH by providing school communities across Canada with a set of refined and understandable essential conditions that support successful implementation. Further, the development of an evaluation tool will support school health champions, researchers, and policymakers in the optimization and implementation of policies or programs which take a CSH approach, ultimately supporting healthier school communities across the country.

School-based nutrition interventions for Indigenous children in Canada: a scoping review

BackgroundIndigenous children in Canada (First Nations, Inuit, and Métis) are disproportionately affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions offer a promising strategy for improving children’s access to healthy foods and sustaining positive eating behaviors. However, little is known about school-based nutrition interventions for Indigenous children. The objectives of this scoping review were to identify school-based nutrition interventions for Indigenous children in Canada and describe their components.MethodsThe scoping review consisted of searches in seven peer-reviewed databases and a general web search for grey literature. Eligibility criteria were applied by two reviewers, and data were extracted and charted by one reviewer using components of the comprehensive school health approach (social and physical environment, teaching and learning, policy, partnerships and services) and additional components with relevance to Indigenous interventions (cultural content, Indigenous control and ownership, funding source, evaluation). Numerical and descriptive summaries were used to present findings.ResultsThirty-four unique interventions met the inclusion criteria. The majority (97%) of interventions targeted the social and physical environment, most often by offering food programs. Over half of interventions also incorporated teaching and learning (56%) and partnerships and services (59%), but fewer included a policy component (38%). Many interventions included a cultural component (56%) and most (62%) were owned and controlled by Indigenous communities (62%). Finally, over half of interventions disclosed their source(s) of funding (59%), but less than half (41%) included an evaluation component.ConclusionsThe review suggests that school-based interventions for Indigenous children can be more comprehensive by incorporating culturally relevant nutrition education and professional development opportunities for teachers, written school nutrition policies, and activities that actively engage families and community members. The continued focus on Indigenous control and ownership and incorporation of content specific to individual communities may enhance cultural relevancy and sustainability of interventions. Furthermore, there is a need to increase intervention evaluation and the sharing of resources related to funding. These recommendations may be used by communities, as well as by researchers and professionals working with communities, in developing comprehensive school-based nutrition interventions to improve the eating behaviors of Indigenous children.

Translation of school-learned health behaviours into the home: student insights through photovoice.

Sedentary behaviours, physical inactivity, and poor diets in Canadian children are a major public health problem. Comprehensive school health (CSH) recognizes the importance of school and home collaboration; however, it is unknown how health behaviours promoted in school are adopted at home. The purpose of this research was to explore student perceptions of the translation of an intervention taking a CSH approach in Alberta, Canada, into the home environment. The guiding method was focused ethnography, using photovoice as the data generation strategy. Grades 5 and 6 students were purposively sampled (n = 25), and asked to take photos of what CSH looks like in their home environment. Subsequent one-on-one interviews were conducted as part of the photovoice process to gain a deeper understanding of student perceptions. Two main themes emerged: students embraced the CSH philosophy, and students are driving change to create a healthy home culture. The underlying concept of leadership and independence was necessary for students to impact their health and the health of family members. Results demonstrated that students are catalyzing positive changes in the home environment by supporting changes in the home food environment, trying new things, facilitating improvements to healthy eating and active living, and monitoring unhealthy behaviours. This study illustrates students' abilities to positively impact the home environment as a result of their involvement in CSH. Student leadership and independence should be promoted and emphasized in CSH to facilitate transition of health behaviours into the home environment.

It takes a Village: School Travel Planning Enhanced through a Comprehensive School Health Approach: Extending Lessons Beyond the School Community ( breakout presentation )

School Travel Planning (STP) is a comprehensive process designed to increase local ownership of Active and Safe Routes to school by engaging community stakeholders. When effectively coordinated, and implemented STP can result in positive school travel behaviour change, and ultimately provide substantial economic, environmental and physical activity benefits. Comprehensive School Health (CSH) is an internationally-recognized approach to supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated, and holistic way. Actions address four distinct but interrelated components: (1) Social and Physical Environments includes the quality of the relationships between the school and surrounding community stakeholders, the emotional well-being of students and the buildings, grounds, play spaces and equipment in and around the school; (2) Teaching and Learning includes resources, activities and curriculum where students, or staff gain skills and knowledge related to health and wellness; (3) Policy includes management practices, decision-making processes, policies and procedures that promote and support health and wellness; (4) Partnerships and Services includes connections between schools, families, community organizations, the health sector and other sectors that support health. CSH can be used to improve many different health issues, including nutrition, physical activity, mental health, injury prevention, or even active transport. School communities are encouraged to apply actions in the 4 components using a community development process with six steps (2). This breakout session will highlight the many similarities in these two processes by lining up the 5-phase process of STP, with the 6-step community development process of CSH, and discuss how lessons learned from CSH, and particularly through working within all four components can enhance STP. The presentation will highlight, how when combined these two approaches will work synergistically to support active transport in and around a school community. Additionally, lessons learned from both processes can be applied beyond the school communities in neighborhoods, and workplaces.