Health Promoting Schools Approach Research Articles

Associations between Polish school principals' health literacy and implementation of the Health Promoting School approach during the COVID-19 pandemic.

The coronavirus pandemic has contributed to increasing the responsibility of school principals for the health of all school community members. Moreover, evidence confirms the significant role of school principals' health literacy (HL) for health promotion in schools. Therefore, the presented study aims to evaluate the associations between Polish school principals HL and the implementation of the Health Promoting School (HPS) approach in Polish schools. The present study was conducted as part of an international survey on the global COVID-HL network (www.covid-hl.eu) between June 2021 and December 2021. Three subscales of the HPS were considered and an exploratory analysis were used in this study. Associations between the median split of each subscale of HPS (outcome) and health literacy (predictor) were performed using logistic regression. Research results showed that the highest level of HPS implementation was directed at pupils. Principals perceived themselves as having the highest HL on the 'accessibility' subscale and these respondents had significantly higher odds of implementing learning opportunities for students. The study suggests that principals with adequate HL may be more likely to effectively implement HPS strategies in schools. This research could provide insights into the complex interplay between HL and the HPS approach and inform the development of more effective strategies for promoting health and HL in schools.

Development and implementation of a municipal outdoor play policy for children and youth in Nova Scotia, Canada: a community case study.

Background: Children and youth benefit from outdoor play; however, environments and policies to support outdoor play are often limited. The purpose of this paper is to describe a case study of the development of a municipal outdoor play policy in Nova Scotia, Canada. The outdoor play policy was developed by the Town of Truro with support from the UpLift Partnership, a School-Community-University Partnership in Nova Scotia, Canada. UpLift supports the health and well-being of school-aged children and youth using a Health Promoting Schools approach which identifies the important role of municipal government in creating healthy school communities. The UpLift Partnership and the municipality hosted online workshops for municipal staff, community leaders and partners that included content about the importance of outdoor play, barriers and facilitators to outdoor play, best practices for youth engagement, the policy development process, and how policy actions can support outdoor play. Workshop participants developed policy actions for their community of Truro, Nova Scotia to increase opportunities for outdoor play for children and youth. Following the workshops, a small team from the municipality and UpLift drafted an outdoor play policy and submitted it to Truro town council for approval. The outdoor play policy was adopted in Fall 2021 and has since informed recreation and municipal planning decisions. By presenting a case study of the development of this outdoor play policy, we hope other communities may be inspired to develop and adopt their own outdoor play policies to benefit children and youth in their communities.

Factor’s influencing primary teacher practices in health education, life skills, health literacy

Abstract Background A health-promoting school (HPS) approach was introduced over 25 years ago and has been promoted globally since; however, the aspiration of a fully embedded, sustainable HPS system has not yet been achieved, and very few countries have implemented and sustained the approach at scale. The Alliance for health aims to enact and assess the impact of a comprehensive approach to health promotion at the school and community levels. This is an intersectoral project involving regional education authorities, regional public health agency, local policy makers, researchers, and local health promotion operators. The question arises as to how to identify factors influencing teachers’ activity in wellness (WB), health education (HE), life skills (LS) and health literacy (HL)? Methods This project involves 101 French primary schools and 97 associated municipalities in the AURA region randomly selected in an intervention and control groups. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Each year, a questionnaire is distributed to teachers in order to monitor the development of their activity in the areas of WB, HE, LS and HL. 243 questionnaires are analyzed, collected from october 19 to March 20, 12 opening questions were analyzed (1591 items) in order to characterize their practices in the areas aboved. Based on this classification, factors contributing to activities were seeked by doing univariate, multivariate and exploratory factor analysis. Results: The descriptive analysis showed that factors are linked to institutional, contextual, individual and collective dimensions. The results are preliminary and the complex analysis are actually in process. Key messages • A better understanding linked to their practices in health education, health literacy, like skills and well-being is needed to develop appropriate training and support. • To develop adequate training and support in health promoting school, it's necessary to identify factors most linked to primary teacher practices in health education, like skills and health literacy.

An ovulatory menstrual health literacy program within a Health Promoting School framework: reflections from school staff

IntroductionPoor ovulatory menstrual (OM) health experiences and low levels of OM health literacy compromise the future adult health and wellbeing of female adolescents.MethodsThis qualitative study sought reflections from secondary school staff on an intervention adopting the Health Promoting School (HPS) approach which aimed to enhance wellbeing through improving OM health literacy.ResultsTwenty female school staff from ten schools participated: three deans, 11 Health and Science teachers and six healthcare professionals. Five interviews and three focus groups were conducted, and 12 anonymously notated booklets of the program were returned. Reflective thematic analysis identified six themes: a need for OM health literacy; curricular challenges; teaching perspectives; school socio-emotional environment; community engagement; and resourcing needs.DiscussionAlignment with a HPS-framework may resolve some barriers to future program implementation, such as curricular restrictions, interprofessional co-ordination and community engagement. Additional barriers, relating to menstrual disdain, knowledge gaps and an absence of professional development, may be addressed with training to ensure that OM health education is framed positively and addresses student wellbeing.

Schools as a Source of Mental Health Literacy: Adjusting and Validating a Mental Health Literacy Scale.

Over the last decade, there has been a growing interest in mental health literacy (MHL) in health promotion, largely motivated by increased awareness of MHL as a modifiable determinant of mental health. Accordingly, MHL has been associated with the health-promoting school approach emerging over the last 20 years. To succeed in promoting MHL, it is of vast importance to evaluate working strategies and interventions to address MHL using validated instruments. The current study describes the revision and psychometric testing of a modified version of the 10-item adolescents' positive MHL measure, the MHPK-10, the only identified instrument measuring adolescents' positive MHL. The MHPK-10 was adjusted to address the previously documented ceiling effects and was further optimized for use in schools by reworking it to measure learning rather than self-reported knowledge, becoming the new nine-item Mental Health Learning Scale (MHLS-9). The MHLS-9 was tested on a national sample of N = 2,012 Norwegian ninth graders. Data were analyzed by confirmatory factor analysis (CFA) and tests of reliability and validity. The revised CFA model for the MHLS-9 showed an improved fit over the original CFA model for the MHPK-10. The MHLS-9s' CFA model revealed excellent factor determinacy (.95) and scale reliability (ω = .91). Thus, the MHLS-9 is an improved measure for the positive component of MHL for use in school settings, enabling researchers and practitioners to evaluate and focus positive MHL interventions in schools using a short, reliable, and valid measure for adolescents' learning about the factors promoting good mental health.

School-Based Interventions for Migrant Students in the Framework of the Health Promoting Whole-School Approach: An Umbrella Review

Health and school achievement play a crucial role in the integration of migrant students. This study aims to conduct an umbrella review of the effectiveness of school-based strategies on the academic and health outcomes of migrant school-aged children and youth and to link these intervention typologies to the Health Promoting School (HPS) approach. The study was conducted according to the PRISMA statement. Twenty-one reviews were analyzed, and 18 strategies were identified and categorized according to the six components of the HPS whole-school approach: individual skills, the school physical environment, school social environment, school policies, health and social services, and community links. Strategies related to five of the six components were identified, demonstrating that the HPS approach is a fitting framework to address migrant students’ needs. Moreover, evidence about the effects on both health and learning was shown; however, the integration of these two areas should be further explored. Finally, significant conditions that enhance or hinder implementation are described. Multi-component interventions and stakeholder engagement improve intervention impacts, while the relevance of cultural adaptation needs to be clarified. These results contribute to understanding the complexity of the challenges faced by migrant students and of the effective school-based strategies to promote their health and learning.

The Importance of School Leaders' Attitudes and Health Literacy to the Implementation of a Health-Promoting Schools Approach.

Schools are considered as important settings for health education and the promotion of functioning, healthy people. Health-promoting schools (HPS) take a holistic approach to health promotion that addresses all school levels and members of the school community. Although it is assumed that school leaders are crucial in the implementation of HPS, little is known so far about which specific factors are relevant. The purpose of this study was to analyze the role of school leaders' attitudes, health literacy, and health status in HPS implementation. An online survey was conducted in June 2021, and the final sample consisted of N = 358 school leaders. Regression and moderation analyses were conducted to answer the research questions. The results showed the relevance of health literacy and attitudes toward HPS for the implementation of HPS. By contrast, only some aspects of health status are relevant. Attitudes toward HPS moderate the effect of health literacy on HPS implementation, with positive attitudes toward HPS amplifying the effect. Implications for practice and future research are discussed.

Exploring the implementation dynamics of the Health Promoting School approach in Europe: a qualitative study among school health representatives

PurposeAdapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra.Design/methodology/approachIn 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews.FindingsNavigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy.Practical implicationsThe implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered.Originality/valueThis study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

Status of school health programs in Asia: National policy and implementation.

BackgroundThe WHO's Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation.MethodsDate were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow‐up data collection was conducted in each country for a second workshop.ResultsWe identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model programs had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing.ConclusionGiven the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools.

COVID-19 and the Health Promoting School in Italy: Perspectives of educational leaders

Objective: International agencies report the importance of health promotion in planning educational strategies and school management in response to the COVID-19 pandemic. This study aimed to identify the benefits of using a Health Promoting School (HPS) approach to guide educational and school policy during the COVID-19 epidemic in Italy, the main objectives and practices to be implemented, and the challenges likely to be faced. Design: A three-phase qualitative and participatory approach: (1) identification of study objectives and relevant data, (2) data collection through an online form using open-ended questions (14 participants), and (3) online meetings to analyse the findings and reach consensus (17 participants). Setting: Educational leaders from the HPS Network in the Lombardy region in northern Italy participated in the study. Method: Qualitative content analysis was undertaken. Answers were coded into meaningful units and then grouped under higher-order headings. Codes, subcategories, categories and themes were identified. Results: Results suggested high potentiality, significance and sustainability of the HPS model during the pandemic. Objectives and actions relevant to each HPS component were identified. Adaptations to content and methodology, timing, continuity and inequalities requiring specific forms of intervention were identified. Conclusion: This study sought to develop an HPS model relevant to implementation during the COVID-19 epidemic and identified specific lines of action during this challenging period.

Perceptions of participation in school and association with health and wellbeing: comparison among Nigerian and Irish pupils.

School participation among pupils is considered a key value of the health promoting school approach. However, few studies have documented the relationship between the school participation of pupils and health and wellbeing outcomes in different geographical contexts, especially looking at developing and developed country contexts. This study investigated the perceptions of Nigerian and Irish pupils on participation in school and reported health and wellbeing. Data was collected using self-completed questionnaires among 333 and 231 primary school pupils in 4th, 5th and 6th classes across 17 schools in Nigeria and Ireland. Logistic regression analysis was used to analyse the data from both countries. There was no statistically significant difference in the mean scores for participation in school activities (NIG mean = 22.8, SD 3.5; IRE mean = 22.3, SD 3.4) and school events (NIG mean = 18.8, SD 3.7; IRE mean = 17.1, SD 3.6). However, participation in school decisions and rules (NIG mean = 17.3, SD 4.7; IRE mean = 15.8, SD 3.6) and health and wellbeing (NIG mean = 16.9, SD 1.7; IRE mean = 15.3, SD 2.4) scores were significantly higher among Nigerian pupils, while positive perception of school participation (NIG mean = 24.2, SD 4.1; IRE mean = 26.2, SD 3.4) was significantly higher among Irish pupils. The findings suggest that Irish and Nigerian pupils have positive perceptions of their schools irrespective of their location and levels of development. However, further research using qualitative approaches might be needed to better clarify dimensions of pupils' perceptions of school life and school participation among Nigerian pupils in order to substantiate these claims.

Health Promoting Schools in Germany. Mapping the Implementation of Holistic Strategies to Tackle NCDs and Promote Health.

Noncommunicable diseases (NCDs) and their underlying risk factors are seen as major public health problems that threaten health and welfare systems worldwide. The holistic and resource oriented Health Promoting School (HPS) approach can serve as an appropriate framework for the prevention and control of NCDs. The paper aimed to map the implementation of HPS activities in German schools and to examine associations with potential influencing factors. A series of cross-sectional online studies including five federal states and 5006 school principals (40.2% males, 50.8% females) from primary and secondary public schools was conducted from 2013 to 2018. Principal component analysis (PCA) resulted in two factors of HPS implementation (F1: concrete HPS action, F2: capacity building for HPS). Comparing both factors, a lower implementation level could be identified for HPS capacity building with lowest mean values found for regular teacher training and intersectoral collaboration. Multiple binary regression analyses revealed significant associations between low HPS implementation and male gender (OR: 1.36 to 1.42), younger age (OR: 1.47 to 1.90), secondary school (OR: 1.78 to 3.13) and federal state (Lower Saxony = OR: 1.27 to 1.45; Schleswig-Holstein = OR: 1.95 to 2.46). Moreover, low access to resources, decision-latitude and perceived educational benefits were independently associated with both factors of HPS implementation. Based on the results of this study, there is a need to support schools in their capacity building for health (e.g., regular teacher training, cooperation with local health services). Moreover, considering the core mission of schools, more evidence of the educational impact of health promotion and its translation into the language of education is needed for secondary schools in particular.

Motivating students for physical activity: What can we learn from student perspectives?

Regular physical activity (PA) contributes to lifelong health and well-being. Adolescents in the Netherlands do not engage in sufficient PA, leading to serious health risks. The purpose of this study is to inform PA-enhancing strategies. This paper offers a unique method for analysing students’ perspectives about opportunities for PA in their school environments. The research method combines two approaches: a Health Promoting Schools (HPS) approach, which supports children’s development by using the school setting to promote PA, and a salutogenic approach, which engages all students in dialogue and reflection to identify factors or ‘assets’ that enhance their PA. Ninety-three students aged 12–14 from four secondary pre-vocational education schools participated in two group sessions in which the structured interview matrix and photovoice methods were employed. In these sessions, the students interacted with each other about four asset categories: talents, passions, the social environment and the physical environment. Thematic analyses of their dialogues led to three main insights: (a) students must perceive the activities as meaningful, appealing, contextually possible and manageable; (b) they use a wide variety of reasoning processes when deciding whether to engage in PA; and (c) it is valuable to invite students to share their individual perspectives on assets related to PA. All these aspects connect to the goals of both HPS and salutogenesis. We conclude that shifting the focus towards developing school-based interventions that build on student perspectives and active participation provides students with realistic opportunities for shaping PA and motivates them to be more physically active.

Opportunities for intervention and innovation in school food within UK schools.

We have recently been funded by the UK Prevention Research Partnership (UKPRP) to develop a UK school food network. The overarching aim is to build a community working towards a more health-promoting food and nutrition system in UK schools (primary and secondary). Here we describe the current status of school food research, including a review of the literature supporting the health-promoting schools approach and outline the opportunities for intervention and innovation establishment of the network present. Key potential school food research themes are described, and their prioritisation within the network, as well as network activities that have been planned, with the ultimate ambition of reducing socio-economic diet-related inequalities, and, consequently, non-communicable disease risk.

Health Promoting School Interventions in Latin America: A Systematic Review Protocol on the Dimensions of the RE-AIM Framework.

Understanding the dimensions of internal and external validities (e.g., using the RE-AIM model: Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance) of school interventions is important to guide research and practice in this context. The aim of this systematic review protocol is to synthesize evidence on the RE-AIM dimensions in interventions based on the Health Promoting School (HPS) approach from the World Health Organization (WHO) in Latin America. Studies of interventions based on HPS-WHO that were carried out in Latin America involving the population of 5 to 18-year-olds will be eligible. Searches in nine electronic databases, a study repository, the gray literature, and the retrieved articles’ reference lists will be performed, without year or publication language limits. Study selection and data extraction will be conducted by independent researchers. Data on intervention implementation will be summarized in categories of HPS-WHO actions: (1) school curriculum, (2) changes in the social and/or physical environment of schools, and (3) actions with families and the community. A previously validated tool will be used to summarize the information on the dimensions of the RE-AIM model. The strengths and limitations of the included studies will be evaluated using the Critical Appraisal Skills Program (CASP) tool, and the confidence level of evidence will be assessed according to the GRADE CERQual tool.

Process evaluation of implementation fidelity in a Danish health-promoting school intervention

Background“We Act” is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils’ dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5–6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools.MethodsThe Medical Research Council’s new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation.ResultsA total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils’ presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the school-year plan and weak management support.ConclusionsAlthough ‘We Act’ was designed to comply with evidence- and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools’ preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.Trial registrationISRCTN85203017

The “We Act”-Study: Design of a Multicomponent Intervention to Promote Healthy Diet, Physical Activity, and Well-being in School Children

Strategies to improve health behaviour and well-being of children are needed. A multicomponent intervention “We Act – together for health” was developed with the aim to improve the dietary habits, physical activity, well-being and social capital among school children aged 10-12 years by increasing their health competences and promoting a healthy school environment. This paper describes the theoretical frame for the project, the development of the We Act intervention and the design and methods used in the efficacy study. We Act builds upon the health promoting school approach and the IVAC model. The intervention included three components: 1) An educational component compromising: a) Lunch meal habits integrated into science and Danish (“IEAT”), and physical activity integrated into maths (“IMOVE”); b) Vision workshop integrated primarily in Danish, and; c) Action and Change process at class and school level. 2) A school component including a workshop to develop teachers’ competencies, and 3) A parental component: including homepage, an APP, a Facebook-group and a handout produced by their child. A quasi-experimental study with 4 intervention schools and 4 matched control schools was conducted. In total 656 school children participated. The intervention was carried out in between the baseline and follow up measurements and a process evaluation was carried out to study implementation fidelity. Dietary intake during the school day was measured using a digital photographic method, pedometers registered physical activity, and an electronic questionnaire was used to assess well-being and social capital among the pupils. We Act will provide new knowledge on the implementation and effectiveness of a multicomponent school based intervention targeting school children, teachers, school management and parents to promote dietary habits, physical activity, and well-being among school children. An important part of the evaluation will be to sum up the various intervention components to inform stakeholders and health planning administrators.

Can knowledge exchange support the implementation of a health-promoting schools approach? Perceived outcomes of knowledge exchange in the COMPASS study

BackgroundDespite the potential population-level impact of a health-promoting schools approach, schools face challenges in implementation, indicating a gap between school health research and practice. Knowledge exchange provides an opportunity to reduce this gap; however, there has been limited evaluation of these initiatives. This research explored researchers’ and knowledge users’ perceptions of outcomes associated with a knowledge exchange initiative within COMPASS, a longitudinal study of Canadian secondary students and schools. Schools received annual tailored summaries of their students’ health behaviours and suggestions for action and were linked with knowledge brokers to support them in taking action to improve student health.MethodsQualitative semi-structured interviews were conducted with COMPASS researchers (n = 13), school staff (n = 13), and public health stakeholders (n = 4) to explore their experiences with COMPASS knowledge exchange. Key issues included how knowledge users used school-specific findings, perceived outcomes of knowledge exchange, and suggestions for change.ResultsOutcomes for both knowledge users and researchers were identified; interestingly, knowledge users attributed more outcomes to using school-specific findings than knowledge brokering. School and public health participants indicated school-specific findings informed their programming and planning. Importantly, knowledge exchange provided a platform for partnerships between researchers, schools, and public health units. Knowledge brokering allowed researchers to gain feedback from knowledge users to enhance the study and a better understanding of the school environment. Interestingly, COMPASS knowledge exchange outcomes aligned with Samdal and Rowling’s eight theory-driven implementation components for health-promoting schools. Hence, knowledge exchange may provide a mechanism to help schools implement a health-promoting schools approach.ConclusionsThis research contributes to the limited literature regarding outcomes of knowledge brokering in public health and knowledge exchange in school health research. However, since not all schools engaged in knowledge brokering, and not all schools that engaged discussed these outcomes, further research is needed to determine the amount of engagement required for change and examine the process of COMPASS knowledge brokering to consider how to increase school engagement.

Community participation in rural Ecuador’s school feeding programme

PurposeThe purpose of this paper is to contribute to the debate concerning community participation in school-based health education and health promotion, with regard to food and nutrition.Design/methodology/approachBased on empirical data generated over the course of one year of fieldwork in three rural communities and schools in Ecuador, the study examines community participation related to the implementation of the school feeding programme (SFP) in rural schools in Ecuador. The conceptual framework for the study is shaped by the concepts of student and community participation within the health promoting school (HPS) paradigm.FindingsThe findings help identify and portray different forms of community participation, ranging from a total absence of meaningful participation, though very limited, to consequential participation determined as community influence on the SFP practices to meet the community needs, priorities and systems of meanings.Research limitations/implicationsThe study shows that the meaningful participation of the parents and community members in small rural schools in a low- to middle-income country such as Ecuador can be linked to an empowered stance towards the SFP so that it is better tuned to local conditions, priorities and systems of meaning. School leadership, geographical characteristics and internal community organization seem to influence how participation is valued and enacted. Challenges remain in the interpretations of community participation, including counter- and non-participation of members.Originality/valueThe study contributes to an understanding of policy implementation and the implications of a HPS approach to health education and health promotion in small rural schools.

The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research.

The World Health Organization's Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools' "core business" by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children's basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.