Health Promoting Schools Concept Research Articles

Exploring the feasibility of using Participatory Action Research (PAR) as a mechanism for school culture change to improve mental health

ABSTRACT Adolescence is a key time to prevent or reduce poor mental health outcomes. Supportive school environments play an important role in this, and the concept of health-promoting schools have been supported globally. Participatory action research (PAR) combines theory, practice, action, and reflection by developing practical solutions to address concerns and issues within communities. Running four PAR groups across three secondary schools, we explored the feasibility of using the approach as a mechanism for bringing about culture change and improving mental health. We undertook interviews and focus groups with students (n = 24), school staff (n = 11), facilitators (n = 3), and parents/carers (n = 2). Findings are organised under five key headings: 1) Establishing PAR groups, and the PAR cycle; 2) PAR group impact; 3) Facilitators of PAR success; 4) Barriers to PAR success; 5) Future recommendations. This study demonstrated the feasibility of PAR as a tool to improve school culture. Students participating in PAR were engaged, passionate, and motivated to influence and transform school culture to improve mental health. Future research should aim to trial the PAR approach on a larger scale, to determine whether the barriers and facilitators of PAR success identified here are relevant and transferable to schools in other contexts, and to measure the impact of such initiatives on mental health outcomes.

School Health Services in India: Status, Challenges and the Way Forward.

Schools provide a crucial platform for health and well-being interventions targeting children and adolescents. Early promotive and preventive initiatives are vital for enabling children and adolescents to reach their optimal potential, thereby adding to the country's social return-on-investment, creating a favourable demographic dividend. This review analyses the evolution of school health initiatives in India, including the current curriculum proposed under the Ayushman Bharat program. The manuscript highlights the challenges, and gaps in implementation of the current school health programs and proposes potential pathways for bridging these gaps for promotion of adolescent well-being. The review also discusses the concept of Health Promoting Schools and suggests adaptations and key recommendations to Indian context regarding 'how' to translate it into on-field reality based on the appraisal of successful case studies from other countries. Though India started school health services more than 100 y ago, the school health programmes in most Indian states are weak and fragmented, with piecemeal health screening with minimal focus on health promotion and well-being. The recently launched School Health and Wellness initiative under the Ayushman Bharat program has lots of promise. However, it needs to be translated into effective implementation to prevent it from meeting the fate of its forerunner programs. The school health program needs to move beyond the screening centric approach and be aspirational and holistic in nature focusing upon the overall well-being of the adolescents. Concerted efforts through intersectoral convergence are needed to optimally utilise the platforms of schools for promotion of adolescent well-being.

Health-Promoting Schools Project for Palestine Children's Oral Health

ObjectivesThe aim of this work was to assess the oral health outcome of a 2-year comprehensive school oral health programme based on school-health education combined with supervised toothbrushing using 1450-ppm fluoride toothpaste amongst schoolchildren in Palestine. MethodsA quasi-experimental study (2016–2018) recruited 3939 schoolchildren aged 5 to 6 years from 30 intervention schools (n = 2333) and 31 comparison schools (n = 1606). At baseline and postintervention, mothers and schoolteachers completed World Health Organization (WHO) self-administered questionnaires about oral health of children, oral health behaviour, and family factors. Of the initial participants 75.8 per cent took part in the follow up studies. In addition, 25 calibrated dentists examined dental caries of children according to WHO criteria. Trained teachers provided comprehensive oral health education to children in the classrooms and held regular oral health sessions for mothers. Children brushed their teeth with fluoride-containing toothpaste (1450 ppm fluoride). Student t-test and logistic regression were used in the statistical analysis of changes in dental health and related knowledge, behaviours, and attitudes (P < .05). ResultsIn both dentitions, dental caries experience declined over the project. The reduction in Decayed, Missing and Filled permanent Teeth and Decayed, Missing and Filled Surfaces in permanent teeth was 23.3% and 23.2% (P < .001), respectively. The drop in caries experience indices in the Gaza Strip was 8 to 4 times higher than in West Bank, and it reached 47.4% reduction. Mothers and teachers showed improvement in positive knowledge and attitudes towards dental care. Involvement of schoolteachers in oral health in schools and acceptance of dental health education materials significantly enhanced oral health behaviour of children. ConclusionsThe project recommends national implementation of an intervention for the improvement of oral health of schoolchildren and their parents in conflict zones. The project shows the importance of the WHO Health Promoting Schools concept and involving classroom-based health education carried out by schoolteachers. It is suggested to explore the health care system's capacity in hosting effective oral health programme and maintain its efficacy.

Effective health promoting school for better health of children and adolescents: indicators for success

BackgroundImprovement of health literacy, health behavioural change, creating a supportive physical and social environment to be more conducive to health should be the focus of child and adolescent public health. The concept of Health Promoting School initiated by World Health Organization aims to move beyond individual behavioural change and to consider organisational structure change such as improvement of the school’s physical and social environment. The aim of this study is identification of the key indicators for successful implementation of Health Promoting School by analysing the findings of the school health profile based on the structured framework of Hong Kong Healthy School Award Scheme and the health status of students investigated by the Hong Kong Student Health Survey.MethodsThis is a retrospective correlation study. Analysis of variance (ANOVA) was utilised to analyse for significant improvement of school health profile measured at baseline (n = 104) and among those schools implemented the Hong Kong Healthy School Award Scheme (n = 54). Those indicators showing statistical significance were chosen to be part of the core indicators reflecting effective Health Promoting School. Each of those selected core indicators was then correlated with the related student health outcomes measured by the Hong Kong Student Health Survey Questionnaire to further identify the core indicators.ResultsA total of 20 core indicators among all the six Key Areas of Health Promoting School (6 indicators under action competencies, 2 under community link, 2 under physical environment, 2 under social environment, 4 under healthy school policies, 1 under services of school health protection) have been identified with the method mentioned above.ConclusionsThis study has identified the indicators with most significant impact on a wide range of health related outcomes. Those are key indicators for motivating positive change of the schools and students. They can be considered as school performance indicators to help schools embarking their Health Promoting School journey as another key education objective.

COMPARATIVE ANALYSIS BETWEEN SCHOOL HEALTH PROMOTION MODEL AND CHARACTERISTICS OF SCHOOL HEALTH PROMOTION IN BULGARIA

BACKGROUND: Health promotion is a modern concept for public health improvement applied in different fields of community life. By the international network of Health promoting schools the school community acquires a main role to reach the potential of this concept. The aim of this paper is to draw a parallel between the main principles of the concept and its actual fulfilment in Bulgarian school. MATERIAL AND METHOD: A comprehensive medico-social survey over representative sample of schools in Pleven district has been conducted. Data were collected by self-administered questionnaire among 78 school nurses, 30 health promotion experts, 279 teachers, 519 students, 374 parents; interview with school principals and documental review. Data analysis and interpretation were consistent with the concept of Health Promoting School. RESULTS: The study found safety school environment with strict control over its physical components. There is a necessity of better opportunities for sports and nutrition services in about of two thirds of schools. Over 90% of school staff and about two thirds of students report high level of stress which requires attention to the emotional and social well-being at school. A correlation between higher satisfaction of staff with their career and occupational settings and evaluation of school environment as safety has been established (p CONCLUSION: The study results like the international experience show both success and difficulties to put this concept into practice. Keywords: behavior risk factors, health education, health promotion, school health promotion model Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

Health Promoting Schools in Kerala, India.

Introduction:Health promoting school (HPS) is a holistic concept where health and learning coexist. The objective of this study was to assess the health promoting standards of schools in Kerala.Methodology:A cross-sectional study was designed in Kerala, India, with schools in Kerala as a study unit. A questionnaire which consisted of 37 items across eight domains of the HPS concept was developed and validated. The schools were then graded into compliant and not compliant categories based on scores obtained. Bivariate and multivariate analysis was also done.Results:Of 120 schools, 90.8% were compliant toward health education domain and only 8.3% were compliant with nutrition services. Majority of schools showed compliance with the other six domains. Average overall scores were 153 (58.8%) with the equal number of schools in both compliant and not compliant categories. There was a significant association between health education and physical education domain with respect to the type of school, i.e., privately managed had six times more chances of being compliant toward health education domain compared to government schools (odds ratio [OR] 6.05; 95% confidence interval [CI] 1.10–33.29). Hence, also private schools had two times more chance of being compliant toward physical education compared to government schools (OR 2.52; 95% CI 1.0 – 4.32). Physical education domain showed a significant association with respect to geographic region, i.e., the schools in North Kerala were found to be three times more compliant compared to South Kerala (OR 3.48; 95% CI 1.05–11.53).Conclusions:Despite the good health and social indicators in Kerala, there is a deficiency in schools promoting health of children. A coordinated effort by the government and the education system can convert existing schools into health promoting.

THE CONCEPT, MODEL AND HISTORY OF HEALTH PROMOTING SCHOOL IN POLAND

The article presents historical development of the Health Promoting School project in Poland and mentions some events crucial for development of this project. Moreover, the focus on the issue mentioned in the topic is driven by a concern to introduce the concept, strategy and model of Health Promoting School and to indicate how important for the health of society is development and practical implementation of the abovementioned project.The concept of health promoting school is based on the general principles of health promotion. There is no one generally accepted definition of such a school. It is defined as a place where all members of school community undertake common activities to improve their health and well-being by means of changing their health behaviors and creating healthy physical and social environment as well as encourage other people in their environment, in particular parents, to undertake similar activities.

Oral health status among children and adolescents in governmental and private schools of the Palestinian Territories

Political conflicts in the Palestinian Territories (PT) have resulted in systematic deterioration of socio-economic conditions and health. The World Health Organization (WHO) has emphasised the negative impacts of social crisis on children' oral health and quality of life. To assess the prevalence and trends in dental caries and poor gingival health of schoolchildren in the PT through the scholastic years 1998/1999 to 2012/2013. This is a retrospective study. Prevalence data on dental caries of primary and permanent dentitions among children 6, 12 and 16 years of age were gathered from annual oral health reports of the School Dental Health Programme (SDHP)-Ministry of Health. Caries was recorded according to WHO methods and criteria. Decayed, missing and filled teeth indices for primary (dmft) and permanent (DMFT) teeth were calculated. Gingival health status was examined according to the Community Periodontal Index (scores 1 and 2). Statistical analysis used SPSS. In 2012/2013, dental caries prevalence rates and the index scores among schoolchildren were as follows, respectively: 56.4% and 2.7 dmft at age 6; 42.0% and 1.4 DMFT at age 12; and 38.7% and 1.7 DMFT at age 16. For all age groups, the d/D-component of the caries indices was high. Trends of dental-caries prevalence, caries experience and gingival bleeding were fairly constant over time from 1998/1999. The SDHP was established in order to prevent and control oral diseases among schoolchildren in the PT. The Programme is fairly passive and the survey indicates an urgent need for reorientation of activities towards population-based prevention and health promotion. The application of the WHO Health Promoting Schools concept is highly recommended.

School as setting to create a healthy teaching and learning environment

PurposeThe purpose of this paper is to analyze how professional cultures in schools and school systems could improve the well-being of students, with a particular emphasis on teacher-health partnerships, which would not naturally occur without a specific intentional intervention. Implemented with a whole-school approach, the Health Promoting School (HPS) is one of the most effective intentional interventions to achieve improvements in both the health and educational outcomes of students through the engagement of key stakeholders in education and health to create a healthy physical/psycho-social environment. This paper emphasizes collaboration and the building of professional cultures in schools that share collective responsibility for the whole student.Design/methodology/approachStudent outcomes in schools should include both academic and health and well-being outcomes that promote positive pathways throughout adulthood. This paper connects HPS research with policy analysis drawing on Hong Kong’s unique context as being at the top of the PISA rankings and striving toward a positive health culture and well-being in its schools.FindingsEvidence has been gathered extensively about what schools actually do in health promotion using the HPS framework. The HPS framework has served to assist schools and authorities to concentrate on the gaps and affirm best practices. This paper also reports how teachers have created a professional and collegial community with health partners to address outbreaks of infectious diseases in schools and obesity in students.Practical implicationsThe concept of HPS can serve as an ecological model to promote the positive health and well-being of students, fostering their personal growth and development, and as an alternate model for school improvement.Social implicationsThis paper has highlighted that structured school health programs such as HPS could have positive effects on educational outcomes, while also changing professional cultures and communities in schools with an emphasis on students’ physical health, emotional health, social health, or spiritual health. The Assessment Program for Affective and Social Outcomes is used as a tool by schools in Hong Kong, reflecting the affective and social developments of the students in the school under review as a whole, and how they relate to the school. It resembles the core areas of action competencies, and school social environment; the two key areas of HPS.Originality/valueHong Kong is often analyzed from an educational rankings perspective. However, it offers broader lessons on educational change, as it has in recent years emphasized dual goals in student outcomes and professional communities – the importance of whole student health and well-being as a both a precursor and key component to the educational outcomes schools seek. Globally, very few schools are able to implement HPS in its entirety. Continuing development of HPS in Hong Kong would add value to international literature in terms of which types of data would influence adoption of HPS in which types of school and policy contexts.

Level of health literacy and factors associated with it among school teachers in an education zone in Colombo, Sri Lanka

BackgroundHealth literacy refers to people's competencies to access, understand, judge and apply health information in healthcare, disease prevention and health promotion. This study aimed to describe the level of health literacy and the factors associated with it among school teachers in an Education Zone in Colombo, Sri Lanka.MethodsA cross-sectional study among 520 teachers measured health literacy using the selfadministered, culturally adapted Sinhalese translation of Health Literacy Survey-European Union (HLS-EU). Health literacy assessment was based on self-reported competencies to access, understand, judge and apply health information in the domains of disease prevention, healthcare and health promotion. Based on a score, respondents were divided into four levels of health literacy as 'inadequate', 'problematic', 'sufficient' and 'excellent' as well as into two levels as 'limited' and 'adequate'. Factors associated with 'limited' health literacy was determined by using univariate analysis and assessing their associations using chi square test. Multivariate analysis was also done using multiple logistic regression to determine factors associated with limited health literacy controlled for confounding effects. A p value of 0.05 determined the significance.ResultsThe response rate was 96.5%. Mean age was 43years (SD = +9.75), 81.7% (n = 410) were females and 66.1% (n = 332) were graduates. Only 3.6% (n = 18) taught the subject health while 18.3% (n = 92) taught science. 'Limited' health literacy was found in 32.5% (95% CI 28.4%–36.6%) while 67.5% (95% CI 63.4%–71.6%), 61.2% (95% CI 56.9%-65.5%) and 6.4% (95% CI 4.3%–8.5%) showed 'adequate', 'sufficient' and 'excellent' levels, respectively. 'Problematic' and 'inadequate' health literacy were 31.5% (95% CI 27.4%-35.6%) and 1% (95% CI 0.1%–1.9%). Univariate analysis showed not being a member of health club/welfare group (p = 0.002), having not done any special course on health (p = 0.009), not getting an opportunity to participate/being exposed to a health awareness program (p = 0.007), visit to a medical practitioner/preventive health staff for six months (p = 0.049), not accessing print media to obtain general information (p = 0.007) and not accessing print media to obtain health information for six months (p = 0.009) and poor health knowledge (p = 0.036) to be factors associated with 'limited' health literacy that are modifiable. Nonmodifiable factors were age being ≤ 45 years (p = 0.025) and service as a teacher being ≤ 10 years (p = 0.012).When multivariate analysis was performed, service as a teacher being ≤ 10 years (p = 0.042), monthly income ≤ Rs.50,000.00 (p = 0.024), not being a member of health club/welfare group (p = 0.034) and visit to a medical practitioner/preventive health staff for six months (p = 0.002), were found to be associated with limited health literacy among school teachers when adjusted to the effect of confounding of the other factors in the model.ConclusionsThe high proportions of 'limited' health literacy among school teachers in the Colombo Education Zone and the need of interventional programmes should be brought to the attention of the policy makers in the education and health sectors. Improving health literacy among teachers and adoption of the Health Promoting School concept as a evidence based path to improve health literacy should be highlighted in the advocacy efforts. Identified factors associated with 'limited' health literacy should be taken into in the interventional efforts.

An evaluation of factors which can affect the implementation of a health promotion programme under the Schools for Health in Europe framework

The Health Promoting Schools concept helps schools to promote health in a sustainable and long-term fashion. However, developing the capacity to promote health in this way can be challenging when a busy teaching curriculum must be fulfilled. This study aimed to identify factors which affect the acceptability of health promotion programmes to the everyday school environment.Semi-structured qualitative interviews were audio-taped with primary school teachers in one Irish county and transcribed verbatim. The resulting transcripts were analysed using content analysis.Thirty-one teachers were interviewed. The factors which may adversely affect the acceptability of health promotion programmes include the: attitude of teachers towards an additional extra-curricular workload; lack of confidence amongst teachers to lead health promotion; and different organisational cultures between schools.When health promotion programmes under the Health Promoting Schools concept are being implemented, it’s important to consider: the readiness for change amongst teachers; the resources available to increase staff capacity to promote health; and the ability of a programme to adapt to the different organisational cultures between schools.

Systems thinking and complexity: considerations for health promoting schools.

The health promoting schools concept reflects a comprehensive and integrated philosophy to improving student and personnel health and well-being. Conceptualized as a configuration of interacting, interdependent parts connected through a web of relationships that form a whole greater than the sum of its parts, school health promotion initiatives often target several levels (e.g. individual, professional, procedural and policy) simultaneously. Health promoting initiatives, such as those operationalized under the whole school approach, include several interconnected components that are coordinated to improve health outcomes in complex settings. These complex systems interventions are embedded in intricate arrangements of physical, biological, ecological, social, political and organizational relationships. Systems thinking and characteristics of complex adaptive systems are introduced in this article to provide a perspective that emphasizes the patterns of inter-relationships associated with the nonlinear, dynamic and adaptive nature of complex hierarchical systems. Four systems thinking areas: knowledge, networks, models and organizing are explored as a means to further manage the complex nature of the development and sustainability of health promoting schools. Applying systems thinking and insights about complex adaptive systems can illuminate how to address challenges found in settings with both complicated (i.e. multi-level and multisite) and complex aspects (i.e. synergistic processes and emergent outcomes).

Self-assessed approach to improving school health in Niger

Award schemes and self-evaluation systems have been developed to implement the 'Health-Promoting School (HPS)' concept in European and Asian countries. While there have been many successes in these regions, the implementation of HPS in African countries has been minimal. This study evaluated the impact of a self-evaluation system on school health in Niger. A school health activity guide was developed and distributed to 1999 primary schools in the Niger Tahoua region to raise awareness and solve problems related to school health and hygiene. The number of schools that planned or implemented health-related activities, and the budget and implementation status of their activities was compared over 3 years (before, soon after, and 1 year after distribution). Focus group discussions (FGDs) were also conducted targeting Conseillers Pédagogiques (CPs), who supervise primary schools and teachers, primary school principals and members of Comité de Gestion des Etablissement Scolaire (COGES), which is a type of school steering committee. The number of schools planning at least one health-related activity increased from 47% to 79% soon after distribution of the guide (p <0.001).The number of schools implementing activities increased from 44% to 65% one year after distribution (p <0.001). Health-related budget per school also increased after distribution (p <0.0001) and increases were maintained 1 year after the intervention (p=0.8414). Fulfilment or partial fulfilment rates for health-related activities were lower compared with other (non-health) activities in all three years (80%, 77% & 84% in health-related activities vs 88%, 90% & 91% in others; p <0.001, p <0.001, & p=0.004, respectively). Most FGD participants expressed a positive impression of the program and noted the usefulness of the guide. However, some respondents reported difficulties, especially in relation to budget. The introduction of a health activity guide for self-assessment was effective in increasing health-related activities in primary schools in Niger, where a simple monitoring system should be introduced to establish the HPS concept.

Reliability and validity of a scale for health-promoting schools

Despite a growing body of research regarding the health-promoting schools (HPS) concept from the World Health Organization (WHO), research on measuring of the HPS is limited. This study aims to develop a scale for assessing the status of the HPS based on the WHO guidelines and to evaluate the reliability and validity of the scale. After completing the translation and back-translation process, the content validity of the 50-item scale for HPS (SHPS) was assessed by an expert committee review and pretested with 17 teachers. A stratified, random sampling design was used. A total of 728 teachers from 94 schools completed a self-administered questionnaire. The total sample was randomly divided into three groups for exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross-validation. The EFA suggested seven factors, including 37 items, and the CFA confirmed these factors. In a second-order factor analysis, the second-order seven-factor model had acceptable fit indices (root mean square error of approximation 0.07, comparative fit index 0.98) with stability over validation sample and whole sample. Thus, the first-order seven factors (school nutrition services [three-item, α = 0.87], healthy school policies [six-item, α = 0.87], school's physical environment [10-item, α = 0.91], school's social environment [four-item, α = 0.88], community links [six-item, α = 0.91], individual health skills and action competencies [three-item, α = 0.89], and health services [five-item, α = 0.86]) loaded significantly onto the second-order factor (HPS [37-item, α = 0.97]). In conclusion, the SHPS is a reliable and valid measurement tool for assessing the states of the HPS in the Korean school context. It will be useful for comprehensively assessing schools' needs and monitoring the progress of school health interventions.

보건건강교육변화에 따른 초등학교 특수교실구성에 관한 연구

The purpose of this study is to provide the configuration alternatives for the special classroom of the elementary school reflecting current trends of the health promotion education. Initiated by WHO(World Health Organization), the concept of health-promoting school has been widely advocated as an approach to enhance public health through school based health promotion. Korean Ministry of Education has also adopted the concept and many elementary schools has been participating in developing the curricula and educating students as the health promoting model schools. This study analyzes methodologies and education programs of current health promoting curriculum of the schools since 2009, explores the spacial features of other public facilities offering similar education program and surveys relating teachers. Based on the analysis, the study seeks the basic elements for health promoting classroom and deduces several classroom space configurations to optimize students` learning effects. This study can be a case method for other classroom typology studies especially with the current diversification tendency of elementary school education services.

Implementing School Health Promotion in Austria

A pilot training course on school health promotion in Austria focused on supporting teachers and school heads during the implementation of the health-promoting school (HPS) concept. The participants talked about their experiences during the implementation phase in focus groups held in a feedback seminar at the end of the training course. The focus groups were analyzed by using an inductive approach. A coding method for thematic analysis was applied. Compatibility of the training course with the school setting was examined and supporting and hindering structures and processes pertaining to the schools and the training course are described. The results can be displayed in a model showing connections between the themes. Internal and external collaboration structures were identified as central aspects in the implementation phase. Particularly collaboration within the faculty is shown to be of importance when implementing the HPS approach. Voluntary cooperation especially of teachers, which is often connected with work in their spare time, is another aspect influencing the sustainability and therefore also the compatibility of the training course with the school setting. For future designs of teacher training courses in health promotion, the aspects of collaboration, teamwork, and collective commitment have to be taken into consideration.

Development of a community-specific health promotion plan to improve children's health in rural Guatemala

The WHO Health Promoting School (HPS) approach embraces a comprehensive, integrated construct of a health promotion strategy aimed at the specific participation of the local school, health services and other stakeholders. The objective of this study was to initiate the development of a community-specific health promotion plan for the primary school in Llano Largo to reduce hygiene- and sanitation-related health problems among children. Participatory Rural Appraisal (PRA) techniques and Argumentative Policy Analysis (APA) were applied to assess the underlying causes of health-related problems and to initiate the process of social learning among stakeholders, including parents, teachers, the village committee and representatives from the local hospital, local NGO, local government, and the village church. Stakeholders defined five core problems: 1) serious lack of hygiene; 2) no doctor and a lack of medicines; 3) hunger and malnutrition; 4) absence in school as a result of child labor; and 5) no discipline in school. Lack of communication, organization and education seem to be the underlying causes of these problems. In line with the HPS concept, a community-specific health promotion plan was constructed. A “Social Communication Work Group” was elected to execute the plan. In conclusion, PRA and APA techniques were successful to implement a HPS plan in Llano Largo. Follow-up studies should determine the long-term efficacy of the plan.

Phases of school health promotion implementation through the lens of complexity theory: lessons learnt from an Austrian case study

The implementation of health promotion concepts in (school) settings is a complex undertaking on which little scientific knowledge exists. The purpose of this study was to better understand organizational influences on the implementation of school health promotion. An extended case study design that incorporated important insights from complexity science was used. This design influenced the focus of analysis and led to the use of multiple methods of data collection and analysis. A primary school in Vienna served as a case for observing and analysing the first year of implementing the health-promoting school concept. The study provided detailed insights into the implementation process. Results showed four chronologically overlapping implementation phases (starting health promotion, deciding what to do, planning health promotion projects, doing health promotion) on different system levels. In each phase, the original health-promoting school concept was adapted to the necessities and characteristics of each level and, therefore, changed considerably. Implications for possible adaptations of the health-promoting school concept to better fit the situation in schools are discussed.

Acknowledging educational perspectives on health promoting schools

PurposeThe purpose of this study is to explore educational perspectives towards the concept of health promoting schools and its potential benefits for schools in more depth.Design/methodology/approachThis paper presents the results of a qualitative study based on interviews with school staff including principals, and teachers with responsibility for health promotion from 18 primary schools in Sydney, Australia, examining their understanding of the health promoting schools concept, and their perceptions of its advantages for schools.FindingsThe study documents the variety of school staff perceptions. Further examination of the data led to the emergence of four broad categories to accommodate diverse perceptions on health promoting schools. The findings point to several challenges that need to be addressed by advocates of the health promoting schools concept, most notably developing a shared understanding between health and education sectors of the practical elements and potential benefits.Practical implicationsSustaining school health interventions, including health promoting schools programs and maintaining their positive outcomes, is likely to be more achievable in circumstances where schools can identify benefits that fit with their core business of education, and their local needs and priorities.Originality/valueThis study adds depth to the understanding of the diversity in educational perspectives regarding the meaning and benefits of health promoting schools. This study also revealed an understanding among school leaders that there is scope for realizing both health and educational outcomes from school health promotion programs.

Schools as social complex adaptive systems: A new way to understand the challenges of introducing the health promoting schools concept

Achieving system-wide implementation of health promotion programs in schools and sustaining both the program and its health related benefits have proved challenging. This paper reports on a qualitative study examining the implementation of health promoting schools programs in primary schools in Sydney, Australia. It draw upon insights from systems science to examine the relevance and usefulness of the concept of "complex adaptive systems" as a framework to better understand ways in which health promoting school interventions could be introduced and sustained. The primary data for the study were collected by semi-structured interviews with 26 school principals and teachers. Additional information was extracted from publicly available school management plans and annual reports. We examined the data from these sources to determine whether schools exhibit characteristics of complex adaptive systems. The results confirmed that schools do exhibit most, but not all of the characteristics of social complex adaptive systems, and exhibit significant differences with artificial and natural systems. Understanding schools as social complex adaptive systems may help to explain some of the challenges of introducing and sustaining change in schools. These insights may, in turn, lead us to adopt more sophisticated approaches to the diffusion of new programs in school systems that account for the diverse, complex and context specific nature of individual school systems.