Comprehensive School Health Programs Research Articles

Knowledge and Availability of School Health Services Among Secondary School Students in Ibadan, Oyo State

This study investigates the knowledge and availability of school health services among secondary school students in Ibadan North-West Local Government Area of Oyo State, Nigeria. Employing a descriptive cross-sectional research design, the study sampled 300 students from both private and public secondary schools, aged between 10-19 years. The objectives included assessing students' knowledge of school health services, evaluating the available services, and exploring the association between school types and the understanding and availability of health services. The research reveals that the majority of participants, particularly in private schools, exhibit a higher level of awareness and utilisation of school health services compared to their public school counterparts. However, it highlights deficiencies in human and material resources necessary for the implementation of a comprehensive school health program in secondary schools within the Ibadan North-West Local Government Area. The study recommends that school management in the area should prioritize periodic health education to enhance students' health knowledge and promote healthy behaviors. Additionally, it calls on the national government to invest not only in increasing the number of school health service professionals but also in providing adequate training to address the specific needs of secondary school students, particularly during their adolescent years.

From best practice to next practice: implementing Comprehensive School Health in rural and remote northern communities.

Northern communities in Canada experience a disproportionate burden of chronic diseases including mental illness. To mitigate the growing health inequalities, an ongoing Comprehensive School Health program promoting healthy lifestyle behaviours and mental health and well-being was expanded to rural and remote northern communities. We report on the program's impact on knowledge, attitudes, lifestyle behaviours (healthy eating, physical activity, screen time), weight status and the mental health and well-being of elementary school students during the first four years of implementation. Following a repeated cross-sectional design, we surveyed 440, 352 and 384 Grade 4 to 6 students (9-12 years old) from eight schools in 2016, 2018 and 2020/21, respectively. Students were approximately equally represented by girls and boys. Between 2016 and 2018, students reported modest increases in vegetable and fruit consumption and dietary variety; declines in screen time; no changes in physical activity; and declines in attitudes toward healthy lifestyle and in mental health and well-being. Between 2018 and 2020/21, lifestyle behaviours deteriorated substantially, while attitudes and mental health and well-being continued to decline. A program that was successful in socioeconomically disadvantaged urban neighbourhoods had a favourable, though modest, impact on selected lifestyle behaviours, but not on attitudes and mental health and well-being, in rural and remote northern communities. In light of cultural differences and logistical challenges in Canada's North, systematic and proactive adaptations to local contexts, increased intensity, and longer program delivery are essential to facilitate sustainable improvements in lifestyle behaviours and mental health and well-being.

The Relationship Between Physical Activity and School Success Among Children With and Without Special Health Care Needs.

School-environments are thought to be strong influences of behavioral choices. There is limited research available on the role of physical activity (PA) and school success among children with special health care needs (CSHCN). The purpose of this study was to explore differences in PA among CSHCN and non-CSHCN and how the school success index is related to PA in both groups. Data were taken from new version of the National Survey of Children's Health (NSCH), which consolidated questions from the previous NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Chi-square and logistic regression analyses were employed to examine group differences. There were significant differences among both subgroups, although most school-aged children did not meet recommended PA guidelines. Chi-squared analyses indicated; school engagement and the parent's perception of child safety at school were associated with the likelihood of meeting PA guidelines. Logistic regression analyses showed that the odds of meeting PA guidelines were associated with the school success index. Comprehensive school health programs should focus on PA both subgroups. School health educators should continue to advocate for safe and structured extracurricular activities to improve the child and adolescent's engagement and overall well-being.

A social network analysis of interactions about physical activity and nutrition among APPLE schools staff.

Comprehensive school health (CSH) is a holistic approach to school-based health promotion that involves active participation and buy-in of school community members, including school staff (e.g., support staff, teachers, school health champions, principals). Implementation and sustainability of CSH builds on complex relationships within the school that support school-level health promoting changes and understanding the social relationships that exist in a school setting is critical. Thus, the purpose of this study was to conduct a social network analysis to examine adviceseeking networks of staff within three schools involved with a CSH program called APPLE Schools (A Project Promoting healthy Living for Everyone in Schools) project approach. The degree to which school staff were central in the network (i.e., gave or sought physical activity or nutrition advice, were connected or disconnected to others; indegree/outdegree centrality and betweenness centrality) and the overall structure of the networks were assessed (i.e., optimal levels of density and centralization). School health champions and several other individuals in the network were shown to be key sources of physical activity or nutrition advice and were identified as central players in the network. Whole networks across schools had low density and betweenness centralization, with optimal levels of out-centralization, and low to optimal levels of incentralization. This research allowed us to gain an understanding of network structures and relationship patterns in CSH schools, with specific attention to the coordinating role of school health champions, and other central players within the network. These findings increase our understanding of advice relationships that exist in a school setting and how these relationships may support CSH implementation and sustainability.

Effects of a Comprehensive School Health Program on Elementary Student Academic Achievement.

Improving the academic achievement of youth in the United States is an area of interest and a critical indicator of the future success of the youth. The purpose of this study was to examine the impact of a comprehensive school physical activity and healthy eating program on 5th-grade students' academic achievement, specifically reading and math. Overall, 628 (intervention: 377, 54% girls; comparison: 251, 49% girls) 5th-grade children participated across the 6 schools in a year-long comprehensive health intervention, completing curriculum-based academic achievement measures at 2 time-points. Results showed that even after controlling for class clustering, age, sex, race, and T1 reading and math variables, students' T2 reading and math achievement were significantly higher in the intervention group than the comparison group. Comprehensive health programming can enhance the health and academic achievement of youth.

Prevalence of Refractive Errors and Intention to Use Prescription Glasses Regularly Among Secondary School Students in Ogijo Community, Ogun State, Nigeria

Purpose: This study was conducted to assess the prevalence of refractive error among secondary school students, as well as their intention to use prescription glasses regularly.Methods: This was a cross-sectional school-based study with a qualitative component. A total of 359 secondary students aged 11-22years, were selected by multistage sampling method from seven schools in Ogijo community, Ogun state, Nigeria. Of the 359 students, 353(98.3%) were examined. The examination included Visual acuity measurement, ocular motility tests, retinoscopy & autorefraction under cycloplegia, and anterior & posterior segment examination. The data collected were analysed using the statistical package for social sciences (SPSS).Results: The prevalence of refractive error was 11.6%, and of the 41 participants who had refractive error, 65.9% were females while 34.1% were males. Myopia was at 5.1%, while hyperopia and astigmatism were 3.7% and 2.8% respectively. Participants had adequate information (`x =16.08 SD±2.29) regarding refractive error and the use of prescription glasses, but revealed a lack of motivation towards prescription glasses use (`x15.8 SD±4.2). Overall, participants expressed good intention to regular prescription glasses use (`x =12.89 SD±3.8).Conclusion: Refractive error among secondary students of Ogijo community, Ogun state, Nigeria is relatively high. The students expressed good intention to use prescription glasses regularly if given, but on certain conditions. A comprehensive school health program that incorporates school eye health promotion should be practiced effectively to address the misconceptions regarding the use of prescription glasses among the teachers, parents and students.
 Keywords: Refractive errors, Adolescents, School health, community health, Health promotion.

Examining the appropriateness and reliability of the strategy of the Kenyan Comprehensive School Health Program.

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.

Implementation of Kenyan comprehensive school health program: improvement and association with students' academic attainment.

There is growing evidence supporting the effectiveness of a comprehensive school health program. However, implementation in developing countries is a challenge. Furthermore, the available information on the association between a comprehensive school health program and students' academic attainment is limited. In Kenya, a project to verify the effects of a comprehensive school health program was carried out in Mbita sub-county, Homa Bay County from September 2012 to August 2017. This study aimed to clarify the improvement of school health during the project years and the association between school health and students' academic attainment. Primary schools in Mbita sub-county were selected as study sites. We assessed 44 schools' scores on a school health checklist developed from the Kenyan Comprehensive School Health Program, the students' mean score on the Kenya Certificate of Primary Education (KCPE), and absenteeism during the project years (2013-16). The mean school health checklist score (n = 44 schools) was 135.6 in 2013, 169.9 in 2014, 158.2 in 2015 and 181.3 in 2016. The difference of the mean score between 2013 and 2016 was significant. In addition, correlation analysis showed a significant association between mean KCPE score in the project years and school health checklist score (Pearson's coefficient was 0.43, p = 0.004). The results of this study suggest improvements of school health by the implementation of the Kenyan Comprehensive School Health Program and students' academic attainment.

Lay Field-worker-Led School Health Program for Primary Schools in Low- and Middle-Income Countries.

School health programs are frequently attempted in low- and/or middle-income countries; however, programmatic scope and reach is limited by human resource constraints. We sought to determine if trained community members could implement a school health program that improved outcomes in rural primary schools in India. This was a mixed-methods, stepped-wedge, cluster-controlled study of schools pragmatically assigned to receive a multicomponent, comprehensive school health program delivered by lay field-workers. All students in 22 primary schools (9 government schools and 13 low-cost private schools) participated in this study. A total of 3033 student-years were included in the analysis (2100 student-years in the intervention period and 933 student-years in the control period). Qualitative feedback was collected from 38 teachers, 49 parents, and 4 field-workers. In low-cost private schools, the diarrhea incidence was lower in students receiving the intervention (incidence rate ratio 0.58; 95% confidence interval [CI] 0.47 to 0.71; P < .001). There was no difference in diarrhea incidence for students in government schools (incidence rate ratio 0.87; 95% CI 0.68 to 1.12; P = .29). Health-knowledge acquisition was higher in intervention schools (mean difference 12.6%; 95% CI 8.8 to 16.4; P < .001) and similar in both school types. Intervention coverage rates were high (mean 93.9%; SD 2.0%), and performance assessment scores indicated fidelity (mean 3.45; SD 0.69). Stakeholders revealed favorable perceptions of the field-workers and high levels of perceived impact. Lay field-worker-led school health programs offer a promising alternative for improving school health delivery in resource-constrained settings.

Opening the doors for school health-An exploration of public health nurses' capacities to engage in comprehensive school health programs.

Public health nurses (PHNs) have a significant role in engaging the voice and actions of school communities in promoting the health of children and youth. School nursing was one of the early 20th century public health nursing foci and specialties in Canada, however over several decades, there has been a gap in actualizing PHNs' full potential in schools. At the same time, intersectoral and interdisciplinary comprehensive school health (CSH) models have emerged as exemplars of partnerships between schools and communities to advance health promotion and ultimately chronic disease prevention with school populations (Pan-Canadian Joint Consortium for School Health, ; World Health Organization, ). Using a participatory action research methodology we explored the role of PHNs in CSH, drawing on the concept of engagement in intersectoral healthy school teams. The three themes that emerged from the data analysis were: facilitators of public health nursing engagement, barriers to public health nursing engagement, and the influences of community context on engagement. Overall, findings indicate that the PHN role in CSH must be developed and supported so that PHNs remain a vital link between school health communities, programs, and policies in the promotion of health.

Development and Validity Testing of the School Health Score Card.

The objective of this study was to develop the School Health Score Card (SHSC) and validate its psychometric properties. The development of the SHSC questionnaire included 3 phases: item generation, construction of domains and items, and field testing with validation. To assess the instrument's reliability and validity, we recruited 15 middle schools and 15 high schools in the Republic of Korea. We developed the SHSC questionnaire of 158 items categorized into 5 domains: (1) Governance and Infrastructure, (2) Need Assessment, (3) Planning, (4) Health Prevention and Promotion Program, and (5) Monitoring and Feedback. All SHSC domains and subdomains demonstrated acceptable reliability with good internal consistency. Each domain and subdomain except for "Planning" was associated significantly with students' health status. Most subdomains, including school health philosophy, school policy, communication, the evaluation system, and monitoring, were significantly and negatively associated with student absence. The SHSC shows significant association with the overall student health and can be useful in assessing comprehensive school health programs.

Building healthy communities: A comprehensive school health program to prevent obesity in elementary schools

Obesity among children is highly prevalent and can lead to risk factors for chronic disease in adulthood. Key organizations have called on schools to play a larger role by increasing children's physical activity and nutrition by adopting an overall culture of health. This study examined the impact of a socioecological theory driven school-wide nutrition and physical activity intervention on 5th graders' central adiposity and obesity level. In 2015–2016, in the Midwest region of U.S., four treatment and two control schools, including 628 (377 treatment) 5th grade children participated in an eight-month intervention. Children in the treatment schools participated in a comprehensive healthy school transformation program consisting of six components. Waist-to-Height Ratio (WHtR) and Body Mass Index (BMI) was calculated and used as the measure of obesity. ANCOVA revealed a significant difference in WHtR among treatment and control groups at time two (T2) FMI(1,6148.14) = 4.43, p = .035, R2 = 0.64, R2Treament = 0.01, with no significant differences based on age, sex, and race. Additionally, the ANCOVA for BMI revealed a marginally significant lower BMI among the treatment than comparison group students FMI(1, 614) = 3.575, p = .059, R2 = 0.01 (Mdiff = −0.23, 95%CI upper boundary: −0.03). The healthy school intervention led to significant differences in obesity levels, regardless of age, sex, or race, across the 8-month program between 5th grade children in treatment and non-treatment schools. This supports the ability of schoolwide programs to significantly and positively impact student health and chronic disease prevention.

“There Is No Moral They Can Teach Us”: Adolescents' Perspectives on School-Based Sexuality Education in a Semiurban, Southwestern District in Nigeria

ABSTRACTThere is limited data on the implementation of Comprehensive Sexuality Education in Nigerian schools. This study explored In-School adolescents' perspectives on the implementation and utility of the Family Life and HIV/AIDS Education Curriculum, using questionnaires and focus group discussions. Findings reveal that sexuality education in schools is mostly moralistic and cognitive in emphasis, with limited adaptation of interactive methodologies. Inadequate teacher training, teachers' sexual double standards, and limiting curriculum to junior classes were identified as major setbacks. Curriculum expansion, Comprehensive School health programming, continuous teacher training and ensuring that teachers are held accountable for their behaviors are recommended.

Integrating CSPAP into the PETE Programs at Southern Connecticut State University and Central Connecticut State University

Collaboration among state legislators, Central Connecticut State University (CCSU) and Southern Connecticut State University (SCSU) faculty, community leaders, teachers and school administrators is currently taking place in Connecticut to make it a physically active state through PASS (Physically Active Schools Systems). PASS is a comprehensive, system-wide initiative through which school districts in the state of Connecticut utilize opportunities for school-based physical activity that is embedded throughout the school day. However, a quality physical education program taught by a licensed physical educator must be at the core of PASS. CCSU and SCSU under the direction of Carol M. Ciotto and Marybeth H. Fede, respectively, are preparing their preservice teachers to not only understand the benefits of physically active school systems but also to be able to effectively implement a physically active program within various field experiences and their student teaching placement and eventually in their full-time employment. School and community partnerships have been and will continue to be established at both universities. These partnerships provide teacher candidates with the opportunity to go into various school districts and/or community organizations to work collaboratively with students, classroom teachers, school administrators, community leaders and state legislators to advocate for and implement PASS.It takes a village to raise one healthy child, and in that vein, a mass communication effort in Connecticut is taking root to craft the message and image of physical activity and physically active learning as an expectation and a right! This is beginning to take shape within the Connecticut physical education teacher education preparation programs. Educating our teacher candidates on comprehensive school health and physical education programs, comprehensive school physical activity programs (CSPAP) and PASS, is a much-needed foundation for the future health our nation.

What Can Secondary School Students Teach Educators and School Nurses About Student Engagement in Health Promotion? A Scoping Review.

Student engagement represents a critical component of a comprehensive school health (CSH) approach to health promotion. Nevertheless, questions remain about its implementation. This scoping review updates the field of student engagement in health promotion. Of the 1,388 located articles, 14 qualify for inclusion in this study. An analysis reveals four themes. CSH programs that incorporate student engagement promote a sense of belonging to a community, encourage meaningful involvement, give voice to student concerns, and advance supportive relationships. This study finds a lack of research regarding student engagement in health promotion but confirms that student participation in CSH initiatives contributes to a sense of ownership. Consequently, we can infer that student ownership of health promotion takes place through their meaningful engagement and can effect social change.

Improving dietary diversity of school adolescents through school based nutrition education and home gardening in Jimma Zone: Quasi-experimental design

PurposeThe purpose of this operational study was to assess the effectiveness school-based health and nutrition intervention supported with backyard gardening on the dietary diversity among school adolescents. MethodsA total of 1000 school adolescents from 10 to 19years were selected randomly. The intervention involved peer-led behavior change communication and health promotion through school media and health clubs. Data were collected at baseline, midline and end-line using structured questionnaires. Multivariable logistic regression analyses were used to determine the independent effect of interventions. ResultsThere was a significant increment of proportion of school children consuming diversified diet among the intervention group from 34.8% at baseline through 65.6% at midline to 74.7% at the end-line (p<0.001). Among control group, there was no change from midline (49.4%) to endline (48.8%), though there was a change from baseline (32.1%) to midline (49.4%). A significant difference of dietary diversity intake was observed between intervention and control groups at midline (F=5.64, p=0.042) and endline (F=5.85, p<0.001) survey. Being in the intervention school (OR=2.55 [1.55, 3.50]), being a boy (OR=1.75 [1.91, 2.56]) and having farmer mothers (OR=2.58 [1.01, 6.87]) were independent positive predictors of a diversified diet intake. However, having a mother who attended secondary schools were inversely associated (OR=0.25 [0.06, 0.97]) with consuming a diversified diet. ConclusionFindings of this study demonstrated that there was a significant improvement in dietary diversity of adolescents in intervention schools. The results imply that school based nutrition education should be a part of comprehensive school health programs to reach students and potentially their families.

A mental health promotion program among Iranian female high school students

Background Female adolescents have a higher prevalence of disorder especially in the developing countries and tradition communities. Adolescence is due to accompanied with puberty and transitional age are suffering of mental health problems. Main purpose of this study was to assess the effectiveness of psychological well-being promotion on the mental health status of female high school students in Iran. Methods The non equivalent group, pretest-posttest design was applied to conduct this study from November 2013 to December 2013 in Tabriz, Iran on 289 participants (148 in the experimental and 141 in the control groups). One of the sub-regions of Tabriz city was chosen randomly and within the area two high schools were selected with almost same environmental conditions randomly as the experimental and control groups. Participants who were in the 9th grade were recruited randomly and classified in the both groups of intervention and control. After diagnostic evaluation, the planned program was performed based on two approaches of: (1) environmental changes (playing music during breaks, sports competitions, and interior decorating classes); (2) stress management skills development program. Results The results were indicative of the intervention's positive impact. Based on the findings, the mean scores of the happiness significantly increased in the intervention group ( P ≤0.001). The mean scores of the stress significantly decreased in the intervention group ( P ≤0.001). Conclusion The study results suggested that implementation mental health promotion program improved mental health indices which indicates effectiveness of comprehensive school health programs.

Happiness and its relation to psychological well-being of adolescents.

In the present decade, adolescents' mental problems are known as critical problems which have many destructive consequences. This study aimed to measure students' happiness and psychological well-being status in a sample of high school students. The cross sectional study consisted of 403 randomly selected high school students in Tabriz, Iran. Numerous variables including general health status, happiness, self-efficacy, perceived stress, hopefulness and life satisfaction were measured by using self-reported written questionnaires. Significant relation observed between happiness and psychological well-being (r=0.48). Those students with good relationship and those who had reported to enjoy attending social events indicated better mental health status. No causal inferences were investigated due to the non-experimental nature of the study. The findings also revealed that students with higher happiness score have a better school performance. Integration of happiness promotion initiatives into the comprehensive school health programs is recommended to have pleasant environments for a healthy population of adolescents.

Pattern and determinants of the weight status of school-age children from rural and urban communities of Osun state, Nigeria: A comparative study

Background: Owing to progressive urbanization and the associated changes in lifestyle, childhood overweight/obesity is becoming a challenging problem in many emerging countries while malnutrition is far from being over. This study, which was carried out in the school setting, therefore, aimed to compare the pattern and determinants of the weight status of school-age children from rural and urban communities of Osun State, Nigeria. Methodology: A total of 300 respondents each was selected from a rural and an urban community using multi-stage sampling technique. Information from respondents was obtained using pretested semi-structured questionnaires and their weights and heights were measured and used to calculate their body mass index (BMI). Data collection was done from September to December, 2013. The BMI was used to classify them into those underweight, normal and overweight/obese using the IOTF criteria. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 16. Results: The children differed significantly in their nutrition history and activity patterns according to their residence. With the IOTF criteria, the prevalence rates of underweight and overweight/obesity in the children from rural communities were 36.7% and 0.0% respectively; and 17.3% and 9.7% in the children from urban communities, respectively. Conclusion: Underweight is still a major problem among school-age children in Osun State, especially for those living in rural communities. There is also a rising trend of overweight/obesity in the urban communities in the State. A comprehensive school health program for the primary schools with emphasis on good nutrition is hereby recommended.

School-Aged Children Felling Hunger at School Were at a Higher Risk for Thinness in Kersa District, Eastern Ethiopia: A Cross-Sectional Study

Background: Thinness in school children is a serious health condition with serious consequences for their development, health, and well-being. The objective of this study was to assess the magnitude and associated factors of thinness among school age children in Eastern Ethiopia. Methods: A cross sectional study was conducted among school age children in Eastern Ethiopia. A child was identified as thin if Body Mass Index for -age Z-score is below minus two standard deviations. Result: Thinness was observed among 206 of 1768 school children [11.6%; 95% CI; CI 10.1- 13.1); about 2% had very low BMI for age. Children in the age group 13-14 years had 1.62 times the risk of thinness compared to children aged 5-9 years (AOR=1.62; 95% CI: 1.06, 2.39). The risk of thinness among children reported felling hunger at school was 1.55 times as high as the risk of thinness compared to children who did not report felling hunger at school (AOR=1.55; 95% CI: 1.07, 2.23). Children from families who did not have latrine had 1.53 times the risk of thinness compared to children from families who had latrine (AOR=1.53; 95% CI: 1.09, 2.13). On the other hand, children born to older mother (age ≥ 35 year) had 30% less risk of being thin compared to children born from younger mothers (AOR 0.70; (95% CI), 0.51-0.98). Conclusion: This study provided evidence that over 10% of school children were under acute nutritional stress in the form of thinness. Thus, integration of nutrition interventions into a comprehensive school health program including free school meals can potentially benefit those children.