Health Promoting Schools Framework Research Articles

Pilot evaluation of the effectiveness of an ergonomics awareness educational programme addressed to middle-school children.

Ergonomics programmes addressed to children fit the health-promoting schools (HPS) framework. Beyond the integration of ergonomics in curricula, an important aspect is the effectiveness of the programme. This pilot study aims to evaluate the effectiveness of the programme proposed to a sample of middle-school children (aged 10-13 years) of the metropolitan city of Cagliari. The programme was designed along the lines of the INAIL (Italian National Institute for Insurance against Accidents at Work) scheme and proposed to 260 children. It consisted of three phases: 1) assessment of students' background with a pre-intervention questionnaire (completed by 142 students); 2) teaching of the ergonomics training modules and evaluation of the weight of a sample of 160 backpacks, and of students' perception to be able to sit by putting their feet on the ground; 3) evaluation of conceptual understanding of ergonomics concepts with a post-intervention questionnaire (completed by 107 students out of the 142 students who completed phase 1). There was a substantial improvement in the percentage of correct responses post-intervention, confirmed by the chi-square test, regarding concepts about ergonomics, backpack weight and handling. Most of the backpacks exceeded the maximum allowed value, and 20% of students were perceived to be unable to sit putting their feet on the ground. The practical application of ergonomics pedagogy proved effective in the school setting and should be integrated into school curricula. The prevention technicians can offer a holistic approach, while the teachers are essential to implement the programme on a large scale. Effectiveness evaluation is necessary to guide resource allocation and implement and sustain the HPS approach. A tailored programme has a greater chance of reaching its target audience and maximizing effectiveness.

Promoting wellbeing within the Health Promoting Schools framework: Could life skills be a means rather than an end?

This paper explores the evolution and challenges of health promotion in educational settings, focusing on the Health Promoting Schools framework. Central to this approach is the empowerment of students through participatory strategies and community engagement to address health determinants and reduce inequities. Well-being, a subjective and multifaceted concept, is crucial for student success, with positive school climates playing a key role. Additionally, life skills (LS) are identified as potential tools for promoting student well-being, though their definition and assessment remain ambiguous. The paper concludes by highlighting the need for further research and clarity in order to maximize the impact of health promotion efforts in schools.

Priorities in school eye health in low and middle-income countries a scoping review.

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Perceptions of oral health promotion in primary schools among health and education officials, community leaders, policy makers, teachers, and parents in Gulu district, northern Uganda: A qualitative study.

One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation's (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools' program in Gulu district, northern Uganda. Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically. Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale. Schools provided oral health promotion that aligned with existing features of the WHO's health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.

Conditions for implementation of whole school health promotion in the Netherlands

Abstract Background Around 35 years ago, the Health Promoting School (HPS) framework was introduced to promote student health behaviors. It is an integrated approach, including education, school health policy, health services, and a stimulating social and physical environment. Implementation of such whole school HPS programs often remains challenging due to the dynamic school system. In order to strengthen implementation and reduce heterogeneity in effects, the present study aimed to understand what works, for which schools and under which conditions. Methods In 2020, 535 schools filled out the HPS Implementation Questionnaire to determine the degree of HPS implementation, showing considerable variety. Based on their implementation scores, 21 ‘lower HPS’ and 22 ‘higher HPS’ schools (16 primary; 15 secondary; 12 secondary vocational) were recruited by Public Health Services for a visit in 2022 to examine differences. Data on implementation and 35 contextual factors (related to individuals, the school organization, HPS framework, and socio-political environment) were collected by observations, a semi-structured group interview, a questionnaire, document analysis, and field notes. Data were analyzed thematically in Nvivo, and will be followed up by Qualitative Comparative Analysis in R. Preliminary results Most evident conditions for degree of implementation were: 1) capacity (time), 2) employee attitude (mainly at primary schools), 3) program champion (mainly at secondary schools), 4) professional implementation support, 5) turbulence (e.g. merger), and 6) management support (mainly at secondary schools). Activity budgets and social support among employees were key factors as well, but did not explain differences in implementation. Conclusions In order to strengthen implementation of HPS programs, more efforts are needed to: 1) intensify support for schools in terms of time and professional advice, and 2) achieve a positive school climate among employees and management. Key messages • Implementation of HPS programs is challenging due to the dynamic nature of schools. • Offering support and achieving a positive school climate are crucial to strengthen HPS implementation in schools.

Health promoting schools in Iceland - SHE4AHA Erasmus+ project

Abstract Background The Green paper on ageing recognizes learning and experience in early childhood influences our lives. Healthy childhood in general shapes our future prospect, health situation and well-being. SHE4AHA Erasmus+ project approaches the Green paper and this work is lead by Schools for Health in Europe Network Foundation (SHE) in cooperation with researchers and coordinators for Health promoting schools in five countries. The green paper advocates for interventions and activities, which will help to laying the right foundation for early in life, preventing, limiting, and postponing some of the challenges linked to ageing. This could help European member states to fulfil the objective of adding healthier years to the life expectancy. Description The objective of SHE4AHA is to show Health Promoting School (HPS) framework used as a validated and evidence-based contribution to implement the Green paper on ageing that calls for solutions to support healthy and active ageing from an early age. The SHE4AHA project involves 15 pilot schools in five European countries, Iceland, Portugal, Denmark, France, and Slovenia. These schools receive training, coaching and support to work with the whole school approach for HPS. The SHE4AHA project started in March 2022 and will finish in February 2025. Each pilot school is working with aim on project selected of them to try out for the schoolyear 2022-2023. Lessons and results All pilot schools work with a pixie version of the SHE Manual made for the project. The school systems in the countries are very different and there is need for a little different approach for the countries. The three pilot schools in Iceland are also working with the Icelandic frame of being a HPS. The supporting material is e.g., checklists and interactive website. Results have shown e.g., need to increase and recognise appropriate resources like time and flexibility for coordinators at schools. Key messages • Health promoting framework built on the Ottawa Charter the process, enabling individuals and communities to increase control over the determinants of health to live an active and a productive life. • In the development process of health promoting schools, school principals, school management, teachers, other school staff, pupils and community partners need to be involved.

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.

Use of a toolbox of tailored evidence-based interventions to improve children’s physical activity and cardiorespiratory fitness in primary schools: results of the ACTIPROS cluster-randomized feasibility trial

BackgroundSchool-based physical activity (PA) promotion is usually conducted by providing one specific intervention. In contrast, the ACTIvity PROmotion via Schools (ACTIPROS) toolbox provides a set of twelve evidence-based PA interventions serving different domains of the Health Promoting Schools framework that primary schools can select according to their requirements. In this study, we tested the feasibility of the toolbox approach in primary schools.MethodsA two-arm cluster-randomized feasibility trial at primary schools (n = 5 intervention schools [IS], n = 5 control schools) located in the Federal State of Bremen, Germany, was conducted. Children’s habitual PA (GENEActiv, Activinsights Ltd.) and motor skills (Deutscher Motorik Test; DMT) were measured at the beginning (t0: Sept and Oct 2021) and at the end of the school year (t1: June and July 2022). Between Oct 2021 and July 2022, the ACTIPROS toolbox was implemented at IS. Teachers documented intervention choices and implementation within a short questionnaire (SIQ) at t1.ResultsIS successfully implemented at least one intervention of the toolbox. In total, seven out of twelve possible interventions were selected. Two schools decided to replace an intervention with another during the trial. Results of the SIQ indicated that IS tended to choose similar interventions while implementation frequency was highly different. N = 429 students from two classes per school were recruited. The mean consent rate was 75.1% (n = 322). At t0 and t1, n = 304 (94.4%) and n = 256 (79.3%) of consented children took part in the DMT, respectively. The accelerometry sample included one class per participating school. At t0 and t1, n = 166 and n = 151 devices were handed out to students and n = 133 (80.1%) and n = 106 (70.2%) valid records could be retrieved, respectively. Linear mixed models showed an intervention effect of 15.5 min (95% CI: 4.5; 26.6) in children’s daily MVPA at IS between t0 and t1 compared to controls.ConclusionsAll IS were able to implement at least one intervention from the toolbox, and unsuitable interventions were successfully replaced in a timely manner, highlighting the feasibility of implementing the ACTIPROS toolbox. Good consent rates for accelerometer and motor skills data were achieved. Results indicate a substantial increase in MVPA associated with the ACTIPROS toolbox and need to be tested in a larger sample.Trial registrationGerman Clinical Trials Register DRKS00025840.

Community-Based Qualitative Study to Identify Challenges in Implementing Health Promoting Schools Framework in Government Schools of Khordha District, Odisha, India.

The WHO asserts every school should be a Health Promoting School (HPS) and laid a framework. The WHO is constantly working on expanding the number of schools modelled on it. The status of the level of health promotion needs to be explored to understand the local issues to identify key priority areas for policy making towards positive health. The study aims to explore the challenges in implementing the HPS framework in Government-run schools in Odisha. Method: A qualitative study was conducted with grounded theory using an inductive approach. In-depth interview was done among nine teachers from six government schools in the Khordha district who were selected through purposive sampling. A semi-structured open-ended interview was conducted using an interview guide among school science teachers and principals (n=9) regarding the challenges in implementing the HPS framework. Codes were generated from the transcript using the inductive approach from the WHO-HPS framework. Thematic analysis by Braun and Clarke model was using Quirkos software. Five themes with 12 codes were identified with the transcript. The respondents had little knowledge about the WHO-HPS framework. Their perception of health promotion was restricted to organizing health camps for school children. The themes were School health policy (inconsistent teachers recruitment policy, partial implementation of tobacco-free schools, outdated science syllabus),Coordination with the local community, Healthy school needs (lack of interactive and repetitive health-related training for school teachers, first aid box in schools and lack of supplementation of micronutrients like WIFS), Sanitation (inadequate funding for maintenance of sanitation) and an emerging issue of increased use of social media were reported in our findings. Conclusion: Our findings suggest that implementation of health-promoting schools requires imparting the skills to teachers by orientation and expanding the existing health services, backed with adequate funding and a firm policy commitment at the state level.

Mixed Method Evaluation of My Vital Cycles®: A Holistic School-Based Ovulatory Menstrual Health Literacy Program.

There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program's impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.

Impact on Students of the Act-Belong-Commit Mentally Healthy Schools Framework.

Schools can have a significant role in affecting the mental health and wellbeing of both students and staff, with considerable implications for society as a whole. Hence, there is a need for school-based interventions to both assist those experiencing mental health problems and to implement activities and policies that facilitate the enhancement and maintenance of good mental health. Unlike most school mental health interventions that are focussed on, and specific to, the school setting, the Act-Belong-Commit Mentally Healthy Schools Framework is based on the principles of the Act-Belong-Commit community-wide general population mental health promotion campaign, which has been adapted to the school setting via the World Health Organisation's Health Promoting Schools Framework. The Mentally Healthy Schools Framework is a whole-school approach to enhancing both student and staff mental health. This paper reports the findings of a preliminary impact survey administered to students after the adoption of the Framework in a number of primary and secondary schools in Western Australia. Students from two schools that had only recently adopted the Framework completed a "Baseline" questionnaire, and students from three schools that had been implementing the Framework for at least 17 months completed a "Follow-up" questionnaire. The results suggest that the Mentally Healthy Schools Framework, adapted from a community-wide campaign, can have a positive impact on students in terms of increasing openness about mental health, increasing awareness of behaviours conducive to good mental health, and increasing engagement in behaviours to improve their mental health. Such positive impacts have clear implications not only for prevention of mental disorders, but for academic achievement, employment, and overall contribution to society.

Barriers to and ways of facilitating the implementation of Aragon’s Health-Promoting School network

Background: The Health-Promoting School (HPS) framework offers a comprehensive approach to promoting health in schools. Aragon’s HPS network is a local organisation which has identified the need for closer cooperation between the education and health sectors as the main challenge facing its programme. Objectives: Previous studies from countries implementing HPS approaches have identified various outcomes and challenges. However, there is insufficient evidence to identify potential barriers to HPS implementation in Spain. This study therefore set out to explore these issues within the context of the HPS network in Aragon. Method: Three focus groups were held in different cities (Zaragoza, Huesca and Teruel) between April and May 2020. The total sample comprised 18 adults ( M = 45.21; SD = 12.61), 60% of whom were men. Eleven participants were HPS stakeholders (i.e. teachers, HPS coordinators) and seven were external collaborators (e.g. university professors, researchers). Results: The main barriers identified were the excessive workload for professionals involved in the network, limitations imposed by contextual factors such as lack of teacher and family involvement, and lack of supervision and communication within the HPS network. Strengthening collaboration with work in other settings, the provision of continuing education for teaching staff and more systematic evaluation were identified as potential ways forward. Conclusion: Using the principles identified in this paper, Aragon’s HPS network should be further developed to enhance effective implementation and improve sustainability.

Evaluation of Health Promoting Schools Programme in Saudi Arabia

Background: The health-promoting school (HPS) is a WHO-sponsored framework. This national study aimed to explore the experiences and progress in implementing the HPS programme in Saudi Arabia (SA). Methods: A self-completed postal questionnaire was sent to all 42 school health departments across SA, and the response rate was 100%. Results: Forty respondents (95%) had implemented the HPS programme. Over 400 schools were involved in the HPS programme of which two-thirds were primary schools. The most common activities addressed were health education activities. Less frequently mentioned were healthy school policies, action on the social environment, and developing links with the community. Evaluation was only through internal processes. The main perceived strengths of the HPS were increasing the awareness of students and school staff and improving the school’s physical environment. The main weakness was the lack of legislation and financial support. For further development, the respondents reported the need for financial and human support. Conclusion: This study highlights the growth of the schools participating in the HPS programme. Further research is needed to develop and fully evaluate the effectiveness of the HPS framework in SA.

My Vital Cycles™: An Ovulatory-Menstrual Health Literacy Program for the Whole Person

Background: A high prevalence of adolescent girls experience ovulatory-menstrual (OM) health difficulties such as painful periods, premenstrual symptoms, irregular cycles and abnormal bleeding patterns. These difficulties are associated with school absenteeism and reduced concentration in class. In addition, there is also an association with mental health challenges such as a negative body image, the onset of eating disorders and non-suicidal self-injury. A review of school-based resources suggests that this stigmatized subject is not only couched in biology, but it can be presented negatively. Aim: This research project aimed to develop and trial a school-based OM health literacy program that positively addresses the biopsychosocial aspects of the OM cycle. Method: A Delphi Panel was convened with experts in medicine, education, and public health. Together with a systematic literature review of OM health programs, they informed a draft program to teach adolescent girls and a draft questionnaire to test their OM health literacy. These drafts were reviewed by adolescent girls, parents, teachers and school healthcare professionals in focus groups and one-on-one interviews. The draft questionnaire was then test-retested to establish its validity. Results: The Delphi Panel validated the content of the draft program. Based on the principles of Positive Education, the program was mapped to the Western Australian curriculum, Nutbeam’s Health Literacy Model and the WHO’s Health Promoting School framework. The focus groups and one-one-one interviews face validated the program and questionnaire, and suggested additional refinements (e.g. website, animations, videos, and the name My Vital Cycles™). Conclusion: My Vital Cycles™ recognizes the OM cycle as a biopsychosocial phenomenon. It practically addresses common OM health difficulties with the aim of improving OM health literacy using Positive Education principles. The program has been registered for clinical trial.

Primary school teachers’ contributions to oral health promotion in urban and rural areas of the Gulu District, Northern Uganda: a qualitative study

BackgroundDental caries remains the most prevalent non-communicable disease globally affecting 60–90% of children. The World Health Organisation’s (WHO) health-promoting school program offers a framework for dental intervention in low- and middle-income countries (LMICs). This study explored teacher contributions to children’s oral health in relation to the WHO health-promoting school framework in rural Uganda.MethodsSemi structured interviews were conducted with a purposive sample of 18 teachers. All interviews were transcribed verbatim and analysed thematically.ResultsMany teachers reported preparing children to practise proper oral hygiene care through skills training and demonstrations around proper teeth brushing. Teachers’ roles included raising health awareness by providing information on oral health topics using different educational methods. Many teachers mentioned performing oral health examinations on children at the school, first aid, referral for dental treatments and engaging parents, students and health workers in oral health promotion.ConclusionsTeachers play an essential role in oral health promotion in countries like Uganda. Teachers are implementing key principles of the WHO’s health-promoting school framework on the ground and need to be considered as a key public health resource. If improvements in oral health are to be attained in Sub-Saharan Africa and other LMICs, government interventions need to harness teachers’ contributions in delivering oral health promotion.

Teachers’ perceptions of health education and middle school curriculum: A qualitative study

This study sought to assess whether the Moroccan curriculum and whole school community achieve international recommendations on adolescents' health promotion by examining middle school curriculum and interviewing teachers of school subjects interested in health education. An analysis of school subjects' curricula regarding competencies, health topics, and learning objectives as well as a thematic analysis of focus groups transcripts were conducted. Findings highlighted that Moroccan curriculum and whole school community are inappropriate to the health-promoting school framework and face several barriers in promoting adolescent health. Teachers also emphasized some positive effects of extracurricular activities in health promotion and certain needs to improve its effectiveness. Teachers’ suggestions call for a comprehensive strategy considering international recommendations and involving all community actors in health education process. Ongoing training on health education representations and updated health knowledge and skills is a need for teachers to sustain their commitment to health education.

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.

School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews.

Schools are identified as a key setting to influence children’s and adolescents’ healthy eating. This umbrella review synthesised evidence from systematic reviews of school-based nutrition interventions designed to improve dietary intake outcomes in children aged 6 to 18 years. We undertook a systematic search of six electronic databases and grey literature to identify relevant reviews of randomized controlled trials. The review findings were categorised for synthesis by intervention type according to the World Health Organisation Health Promoting Schools (HPS) framework domains: nutrition education; food environment; all three HPS framework domains; or other (not aligned to HPS framework domain). Thirteen systematic reviews were included. Overall, the findings suggest that school-based nutrition interventions, including nutrition education, food environment, those based on all three domains of the HPS framework, and eHealth interventions, can have a positive effect on some dietary outcomes, including fruit, fruit and vegetables combined, and fat intake. These results should be interpreted with caution, however, as the quality of the reviews was poor. Though these results support continued public health investment in school-based nutrition interventions to improve child dietary intake, the limitations of this umbrella review also highlight the need for a comprehensive and high quality systematic review of primary studies.

Effects of health-promoting school strategy on dental plaque control and preventive behaviors in schoolchildren in high-caries, rural areas of Taiwan: a quasi-experimental design

BackgroundWe evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan.MethodsA quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data.ResultsCompared with the CG, the IG had a greater reduction in plaque index among second graders (β = − 0.36) and plaque control record scores among second, fourth, and sixth graders (β = − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG.ConclusionsThe HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.