Health Promoting Schools Concept Research Articles

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.

A comparative study on resilience level between WHO health promoting schools and other schools among a Chinese population

The WHO health promoting school (HPS) approach covers key areas including school-based programmes improving students' psychological health, but there have been few studies evaluating the resilience performance of these schools. This study compared the resilience scores between schools within the healthy school award (HSA) scheme (HPS group) and those not (non-HPS group). We conducted a cross-sectional survey of grade-one students (aged 12), all teachers and parents of mainstream secondary schools recruited by stratified random sampling in one large Territory of Hong Kong using validated resilience questionnaires during November-December 2005. Four non-HPS and four HPS secondary schools were recruited, respectively, involving 1408 students, 891 parents and 91 teachers, with similar baseline characteristics. The HPS students were found to have better scores than non-HPS students (average age 12.4 year-old in both groups) in all dimensions with significantly higher scores in 'Peer Support' (p = 0.013), 'Making a Difference' (p = 0.011), 'About Me' (p = 0.027) and 'Generally Happy' (p = 0.011). There was no difference in the scores between non-HPS and HPS parents. The HPS teachers reported significantly higher scores in 'Health Policies' (p = 0.023), 'Social Environment' (p = 0.049), 'School Community Relations' (p = 0.048), 'Personal Skills Building' (p = 0.008) and 'Partnership & Health Services' (p = 0.047). The secondary HPS students and teachers reported significantly higher resilience scores than those of non-HPS. This study shows that the HSA scheme under WHO has the potential to exert positive changes in students and teachers and the concept of HPS is effective in building resilience among major school stakeholders.

The impact of a newly designed resilience-enhancing programme on parent- and teacher-perceived resilience environment among Health Promoting Schools in Hong Kong

Background:The Health Promoting School (HPS) approach provides a strong foundation to improve students’ overall health, including psychological well-being, which has its roots in resilience. The present study evaluates the effectiveness...

Health-promoting school development in Zhejiang Province, China

In 2003, after three pilot projects successfully implemented WHO's Health-Promoting Schools (HPS) concept, officials in Zhejiang Province, China, expanded to additional 51 schools (93,000 students and their families and 6800 school personnel). Each school identified a health issue to begin HPS development, followed by conceptual orientation, resource mobilization, teacher training, surveys, interventions, outreach and evaluation. This study focused on the extent to which participating schools implemented the HPS concept and improved their psycho-social environments (PSEs). Forty-nine of the 51 schools met China's HPS criteria. Schools with fewer resources and with substantial resources, i.e. schools in both rural and urban areas, met the criteria. Schools' PSEs, as measured by the PSE Profile, improved as they became HPS. Findings from interviews and observations identified strong encouragement and support from officials, school personnel, students, parents and community leaders, and consistency of HPS with the national policy on quality education, as success factors.

Strategies for implementing Health-Promoting Schools in a province in China

After successful pilot projects in 10 schools (four schools with tobacco control and six schools with nutrition interventions, plus 10 control schools), Health and Education officials in Zhejiang Province, China, decided to scale up Health-Promoting Schools (HPS) systematically over the entire province, starting with an initial cohort of 51 additional schools, reaching from primary to vocational schools. Interviews with school personnel during the first phase of scaling up illuminated the key pre-implementation, implementation, and monitoring and evaluation activities. Pre-implementation activities included choosing an entry point, setting up a special HPS committee, and establishing a work plan. Implementation activities included conducting mobilization meetings, prioritizing health, popularizing the HPS concept, ensuring community cooperation and participation, acting as role models, offering training, and using new teaching and learning methods. Monitoring and evaluation activities included process, baseline, and final evaluations and changing standards of evaluation to a more holistic evaluation that schools go through to become Health-Promoting Schools. Schools also reported that they faced - and overcame - a number of challenges including understanding and integrating the HPS concept and lack of professional development and support. Results revealed that schools transitioned from a passive model of education to interactive pedagogy put priority on health and viewed it as a co-responsibility, reshaped assessment to a more holistic approach and called for more training and technical support. Participants mentioned that they gained knowledge and skills and developed a deeper understanding about health. Health impact was also demonstrated, for instance in reduced injuries and reduced smoking, and educational impact was demonstrated, for instance in improved relationships of children to parents and teachers, improved social qualities, and improved teacher satisfaction.

Can the concept of Health Promoting Schools help to improve students' health knowledge and practices to combat the challenge of communicable diseases: Case study in Hong Kong?

BackgroundThe growing epidemics of emerging infectious diseases has raised the importance of a setting approach and include the Health Promoting School (HPS) framework to promote better health and hygiene. Built on the concept of 'the' HPS framework, the Hong Kong Healthy Schools Award scheme includes "Personal Health Skills" as one of its key aspects to improve student hygiene knowledge and practices. This study examines the differences in student perceptions, knowledge and health behaviours between those schools that have adopted the HPS framework and those that have not adopted.MethodsA cross-sectional study using multi-stage random sampling was conducted among schools with awards (HSA) and those schools not involved in the award scheme nor adopting the concept of HPS (non-HPS). For HSA group, 5 primary schools and 7 secondary schools entered the study with 510 students and 789 students sampled respectively. For the 'Non-HPS' group, 8 primary schools and 7 secondary schools entered the study with 676 students and 725 students sampled respectively. A self-administered questionnaire was used as the measuring instrument.ResultsStudents in the HSA category were found to be better with statistical significance in personal hygiene practice, knowledge on health and hygiene, as well as access to health information. HSA schools were reported to have better school health policy, higher degrees of community participation, and better hygienic environment.ConclusionStudents in schools that had adopted the HPS framework had a more positive health behaviour profile than those in non-HPS schools. Although a causal relationship is yet to be established, the HPS appears to be a viable approach for addressing communicable diseases.

Changes in attitudes, knowledge and behavior associated with implementing a comprehensive school health program in a province of China

After successful pilot projects, Zhejiang Province, China, decided to systematically scale-up health promoting schools (HPS) over the entire province of 47 million. This study describes the interventions and self-reported changes in attitudes, knowledge and behavior during the first phase of scaling-up. Group interviews were conducted with a sample of 191 participants (school administrators, teachers, students and parents) from nine schools with a total of approximately 15 200 students. Grounded theory guided data analysis. Schools implemented all HPS components (school health policy, physical school environment, psychosocial school environment, health education, health services, nutrition services, counseling/mental health, physical exercise, health promotion for staff and outreach to families and communities), adapted to local circumstances. Participants reported a range of changes in attitudes (paying more attention to health, attaining better 'psychological quality' and confidence, forming friendships between teachers and students and feeling more relaxed), knowledge and concepts (increasing knowledge about various health issues, developing a broader concept of health and gaining better understanding about the HPS concept) and behavior (actively participating, increasing physical activity, improving sanitary habits, reducing or quitting smoking, eating more nutritiously, increasing safety behavior, sustaining less injuries and improving parent-child communication). This qualitative study shows the feasibility and efficacy of implementing HPS in Zhejiang Province, China.

An evaluation of the role of elementary school teachers in Kuwait in promoting health

The health promoting school concept is now a well-established framework for the development of health promotion initiatives in schools. Teachers who are part and parcel of the school environment can play an important role in evaluating or assessing the extent to which their school environment is supporting health promotion. This study was designed to assess the perception of teachers about the school environment and the role of the teacher in promoting health education in elementary schools in Kuwait. The findings from this study revealed that elementary school teachers in Kuwait expressed approval of their school environment in promoting health education.

School effects research provide new and stronger evidence in support of the health‐promoting school idea

PurposeThe purpose of this paper is to examine evidence from an emerging body of “school effects” research on pupils' health and health behaviours like smoking, and how this in turn may contribute to the evidence‐base for the health promoting school concept.Design/methodology/approachFollowing on from educational research which demonstrates how schools can impact on pupil attainment over and above the characteristics of pupils attending them, this paper examines whether there is evidence for a similar “school effect” on pupils health and health behaviours.FindingsThe research shows that pupils' health does vary between schools in the same way as attainment; that this is not explained by pupil characteristics such as social class or deprivation, and that school ethos is a key factor distinguishing “healthy” from “less healthy” schools. Most studies have focussed on health behaviours, notably smoking where the evidence for a “school effect” is particularly strong.Originality/valueThe evidence from “school effects” research on pupils' health, while falling short of the gold‐standard RCT, is supportive of the health promoting school concept, and that governments are on the right lines in doing so. This paper will be of interest to those in the fields of health and education.

Creating health-promoting schools in China with a focus on nutrition

This pilot project in Zhejiang Province, China, aimed at improving the nutrition and health status of students, school personnel and parents, and developing a model project for nutrition interventions for the development of health-promoting schools (HPS) in China. Three primary and three secondary schools participated. Interventions included establishing school-based working groups, nutrition training for school staff, distribution of materials on nutrition, nutrition education for students, student competitions, school-wide health promotion efforts and outreach to families and communities. Results of a pre- and post-intervention survey one and a half years apart showed improvements in nutrition knowledge, attitudes and behavior among all target groups. Primary school students at the pilot schools made the greatest knowledge gains in the areas of Chinese dietary guidelines (increased from 49.2 to 78.0%, p < 0.01) and adequate dietary principles (increased from 42.9 to 68.0%, p < 0.01). Scores of secondary school students who reported liking school lunches rose at pilot schools from 17.9 to 45.2% (p < 0.01). School staff at control schools who reported taking breakfast declined from 81.4 to 66.6% (p < 0.01), while staff who reported taking lunch at school increased in pilot schools from 87.5% at baseline to 93.9% (p < 0.01). The largest increases in nutrition knowledge among all target groups occurred among parents and guardians. At the pilot schools parents increased their knowledge in the areas of nutritional deficiencies (from 35.0 to 66.2%, p < 0.01) and nutrient-rich foods (from 38.8 to 66.8%, p < 0.01). Talks with target groups confirmed changes in attitudes and behavior, and school visits revealed improvements to school facilities and school health services, establishing of school policies and a positive school climate. This study suggests that nutrition can effectively serve as an entry point to establish HPS in China and that the HPS concept is feasible to improve the dietary knowledge, attitudes and behavior of students, parents and school personnel.

Health rights in secondary schools: student and staff perspectives.

This paper examines the perspectives of secondary school students and staff about the extent to which young people's health rights are catered for at school. The United Nations Convention on the Rights of the Child and the concept of Health-Promoting Schools encourage the provision of healthy school environments. A postal survey of secondary schools in New Zealand elicited responses from 821 Year 11 (15-16 year olds) students and 438 staff in 107 schools. Most students and staff reported that sources of health advice were available at their schools, but only a minority of students saw these sources as accessible or trustworthy. In every area of health promotion, students saw information and advice as less accessible than staff did. Most staff and students identified mental health problems such as depression as a source of concern in schools, but only a quarter of students (compared to half of staff) thought that this topic was covered during classtime. Students in lower-income schools reported the school environment as slightly less healthy than did students in high-income schools. The paper concludes that schools and policy makers should seek the voices and opinions of young people in order to improve effectiveness in catering for health rights.

The Concept of Health Promoting Schools to Enhance Positive Youth Development

The concept of Health Promoting Schools improves the school's physical and social environment, its curriculum, teaching and learning methods, and the personal and social development of students. It will enable the participating schools create a 'learning perspective', 'community perspective', and 'capacity building' environment to improve both educational and health outcomes of students. As the scheme promotes self-esteem of students, staff development, parental education, involvement of the whole school community and linkage with different stakeholders, it will also enhance positive youth development. It will help to shift the paradigm from handling crisis to prevention approaches emphasizing on youth support before problem behaviours occur, and also address the circumstances (families, schools, communities, peer groups) of youth's lives.

What are the Needs of Students? An Experience from a District Based Health Promoting Schools Project in Hong Kong

A district based needs assessment as conducted over the past year to uderstand the health problems and the health education needs of the students in Tai Po district, Hong ong. 6879 primary one to primary six students from eighteen rimary schools, participating in a district based Health Promoting Schools Project in Hong Kong, were invited to complete a self-administrated questionnaire which was partly adapted from the Centre for Diseases and Control (CDC)'s Youth Risk Behaviour Surveillance Survey. The results presented a holistic picture of the health and needs of primary students with respect to their general health status, mental health, body weight and dietary behaviour, exercise, preventive health care, tobacco use, alcohol and other drug use, school environment and school health education. It provides baseline information for the project to prioritize the problems and strategically plan health promotion 'programmes with reference to the concept of Health Promoting Schools by the World Health Organization.

Challenges in the development of Health Promoting Schools: a review of Hong Kong innovations and initiatives

The development of a Health Promoting School concept in Hong Kong has faced many challenges, as in other countries. However, there is strong evidence from research findings that there is a need for this development to promote the health of young people effectively. Strategies are currently being developed in Hong Kong to address the key issues and challenges inherent in developing Health Promoting Schools. They include work on teacher training, funding and resources, policy making, the re‐orientation of the education system, participation by the community and parents, and the formation of healthy alliances. All these issues need to be addressed before a school‐based health promotion programme can be developed further. This paper describes current strategies being used by the authors of this paper to tackle these issues to develop a more comprehensive Health Promoting School programme in Hong Kong.

Evaluating the health promoting school: a case study approach

The health promoting school concept is now a well‐established framework for the development of health promotion initiatives in schools. Increasingly, attention has focused on the evaluation of school‐based health promotion and debate continues over appropriate evaluation designs for the school setting. The authors argue that the case study design provides a useful approach because of its ability to explore the real‐life complexities of social contexts using a combination of quantitative and qualitative methods, with a strong emphasis on process as well as outcome measures. The current ENHPS project in Scotland uses a multiple‐case study design to evaluate healthy eating initiatives in four schools, based on the principles of the health promoting school. Provides a description of the project and highlights the advantages of case study methodology in addressing key issues around effectiveness of school‐based health promotion based on the health promoting school concept.

A randomised trial of an intervention to develop health promoting schools in Australia: the south western Sydney study

This paper describes the evaluation of a health promoting schools intervention carried out in the south western region of Sydney, Australia. The evaluation sought to assess the project's impact on structures to support the health promoting school concept and changes in health-related policies and practices within 22 local schools. A randomised controlled study was employed. Intervention schools were offered seminars and training in the health promoting schools concept, encouraged to use a resource kit to help them establish their school as health promoting and invited to participate in a support network. Pre- and post measures of awareness, school structures and policies and practices to support the development of a health promoting school were taken and intervention and control schools compared. There was an increased level of awareness of the health promoting school concept among intervention schools. However, there were no significant changes in health-related policies and practices at the school level, among both intervention and control schools. A longer time frame and more structured support are required to influence school structures to support the development of a health promoting school. To facilitate organisational change in schools, health promoting school interventions need to provide structured support for schools and recognise that change takes time. A committee to initiate action, a plan to guide work and school support are likely to facilitate the adoption of the health promoting schools approach. Further work to refine the measurement of school-based action and its outcome and the development of indicators for a health promoting school is needed.

The Health Promoting School, general practice and the creative arts: an example of inter‐sectoral collaboration

The Health Promoting School concept and recent developments in the Health Service in the UK place both schools and primary care under some pressure to form collaborative links. However, such collaboration is currently rare. Presents a case study of an example of effective collaboration and identifies the benefits and difficulties from the perspective of both the school and the general practice. An analysis is provided of the factors contributing to successful collaboration, and the role of creative arts as a vehicle for joint working is discussed.

Healthy Primary School Canteens

Initiated by Berwickwide Community Health Service (BCHS), the Healthy Canteens Project commenced in June 1997. Initiatives were completed in December 1999. BCHS focused on primary school canteens as potential leading advocates for healthy eating within the primary school setting and the broader school community. The Health Promoting Schools concept (National Health and Medical Research Council, 1996) was a main guiding framework in this project with particular attention in the areas of 'Organisation Ethos and Environment' and 'Partnerships'. Schools were encouraged to examine and develop a healthy canteen environment and to network with other health/welfare agencies and schools. Although not addressed in detail due to limited resources, the importance of the third area of focus in the Health Promoting Schools concept, 'Curriculum', was emphasised where possible throughout the project. The project targeted key people with an interest and a role in the school canteen, to ensure greater involvement and more likelihood of positive outcomes. A 'healthy canteen' was defined as one that was safe, clean, profitable and providing a range of high nutritional value foods. Strategies were directed at enabling schools to work towards meeting this definition. Approaches used in the project included community consultation and participation, structural change, a review of settings, health education, intersectoral collaboration, skill development, policy development and striving for sustainability. The project highlighted the importance of community participation during the planning, implementation and evaluation stages of a project. It also showed that the formation of partnerships between organisations and across sectors greatly increases an initiative's chances of reaching its target group and achieving positive outcomes.

IMPROVING CHILD AND ADOLESCENT HEALTH THROUGH SCHOOLS: LEARNING FROM AUSTRALIA

Abstract Child and adolescent health is a serious concern in South Africa With a growing population of young people with unacceptable levels of mortality, morbidity and risk-taking behaviour, schools should be utilised to address certain health issues. This article defines the concept of Health Promoting Schools (HPS), presents the goals thereof, and lists the potential people to be involved in HPS. Background is supplied to the historical development of HPS in Australia where the concept has evolved from a personal hygiene approach to a comprehensive one over the last 20 years, and parallels are drawn between South African and Australian experiences and situations. Suggestions regarding i) the successful implementation of HPS, ii) establishment of networks to improve collaboration between interested parties, iii) initiative to increase the profile of school health, and iv) improving research in school health education and health promotion are made.