Implementation Of Health Promoting Schools Research Articles

Increasing community capacity to improve the implementation of Health Promoting Schools: barriers and facilitators from the FLASH intervention.

Building community capacity is important for the successful implementation of a Health Promoting School. To identify how capacity building can be encouraged in secondary schools, four schools engaged in the Fit Lifestyle at School and at Home (FLASH) intervention for 3 years. This study explores barriers and facilitators that school personnel, parents and pupils experienced in the capacity-building process. Thirty-one stakeholders were interviewed. Transcripts were analysed thematically based on the five actions of the intervention: (i) appoint a Healthy School coordinator and build a team, (ii) determine ambitions, (iii) design and (iv) implement the action plan and (v) evaluate and improve. The time and support allocated to coordinators helped them evolve their role from executors of health-promotion activities to coordinators, instigators and gatekeepers of the implementation process. Participatory tools helped identify shared values among stakeholders to determine context-specific ambitions and leverage points for interventions. Coordinators indicated that they lacked the skills and authority to engage pupils and parents and to reach the broader community. Coordinators struggled with translating promising ideas into action plans of coherent and mutually supportive activities and embedding them into policy. Strong leadership of Healthy School coordinators, who focus on the capacity-building process and foster collaborative relationships, is essential to build community capacity. In this process, more guidance is needed on how to involve the broader community in various phases. Furthermore, coordinators can benefit from professional development to align jointly designed activities into a comprehensive action plan embedded into Healthy School policies.

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.

The Role of School Leaders' Health Literacy for the Implementation of Health Promoting Schools.

Background: The promotion of health literacy is seen as an urgent goal in public health and education and, hence, should be integrated in the school context as a component of the holistic health promoting school (HPS) approach. However, only limited empirical studies have addressed health literacy of school staff so far. Hence, this study aimed to examine the level of health literacy among school leaders and its association with the extent of HPS implementation. Methods: A cross-sectional study with n = 680 school principals and members of the school management board from Germany was carried out at the end of 2018. Individual health literacy, attitudes, and competencies towards HPS and occupational self-efficacy served as independent variables and the level of HPS implementation was the dependent variable. Data were analyzed using univariate and bivariate analysis as well as multiple binary logistic regression. Results: 29.3% of school leaders show a limited health literacy with significantly higher values found for male respondents. Regression analyses revealed that male gender (OR: 1.91, 95% CI: 1.22–2.99), HPS attitudes (OR: 3.17, 95% CI: 2.13–4.72), and HPS competencies (OR: 3.66, 95% CI: 2.43–5.50) were associated with a lower level of HPS implementation. Furthermore, regression analyses differentiated by gender showed that limited health literacy is associated with a low level of HPS implementation for male school leaders only (OR: 2.81, 95% CI: 1.22–6.45). Conclusions: The promotion of health literacy especially for male leaders would not only result in positive effects on an individual level but also could contribute to a stronger implementation of activities on school health promotion. We suggest integrating health literacy, HPS attitudes, and competencies more strongly into the qualification and in further training of school leaders.

Establishing and implementing a health promoting school in rural Cambodia.

Few studies have used a whole-of-school approach in implementing a health promoting schools (HPS) framework. Descriptions of how HPS is being implemented, particularly in low-resourced, developing countries, are limited. This study used an exploratory case study design to examine the planning and implementation of a HPS in a rural Cambodian village. Data were collected via observations of the school, school documentation, and interviews with stakeholders (n = 9). The data were analysed inductively as an iterative process, from initial coding, through to categorizing, leading to concept mapping and then identifying the emergent themes within the stages of school development and implementation of educational and health programming. The case study demonstrated how all six components of the HPS framework can be used to plan and implement a school in a rural village in a developing country. The key elements of implementation were building local and international partnerships, local leadership, and a culture of change and participation. These elements were used to establish a non-profit school that aimed to address the stated health and educational needs of local villagers. This case study adds to the limited evidence on the HPS components and implementation methods that are being applied in low-resourced, developing countries.

Health-promoting schools in Taiwan: School principals’ and teachers’ perspectives on implementation and sustainability

Objective: This study assessed school principals’ understanding, attitudes and willingness to influence the implementation of the health-promoting schools (HPS) programme in Taiwan and teachers’ willingness to sustain it. Method: In 2014, a total of 1,140 school principals and 1,110 teachers (HPS coordinators) completed questionnaires concerning their perspectives on implementation and sustainability. Results: Compared with teachers, school principals reported higher levels of willingness to sustain HPS implementation. School principals’ levels of understanding of HPS and willingness to sustain it were significantly associated with higher levels of HPS implementation and an increase in teachers’ willingness to sustain HPS implementation. Conclusion: School principals’ understanding and willingness to support are central to the effective implementation and sustainability of initiatives such as HPS.

The Hong Kong Healthy Schools Award Scheme, school health and student health: An exploratory study

Objective: The Hong Kong Healthy Schools Award Scheme (HKHSA) developed an assessment and monitoring system to examine the status of Health Promoting Schools (HPS). This study made use of the HKHSA programme to investigate the school health ‘profile’ and student health status of four gold award schools following 3–4 years’ participation in the scheme. Design: Repeated cross-sectional student health surveys of the same year level (Secondary 3) were conducted over different time periods, and achievement of HKHSA was assessed by repeated assessments of the school health profile using HPS indicators. Setting: This study included four schools with the Healthy School gold award in Hong Kong, together with students from three of the four schools. Methods: School performance in the six HPS key areas were analysed using radial plot graphs, and students’ health behaviours were measured by means of repeated cross-sectional student health surveys. Results: The four gold award schools demonstrated various degrees of achievement in different HPS key areas with student health behaviours markedly improving in these schools. Further analyses revealed how certain HPS key area components were associated with sustained positive health behaviours among students. Conclusion: The ongoing implementation of HPS impacts on schools’ environment and students’ health behaviours. The HKHSA is designed for formative and summative assessment of school health promotion. Findings provide insight into an HPS assessment process, signalling future directions for the development of school health promotion.

Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada.

A Health promoting schools (HPS) approach aims to make schools a healthy place through a holistic approach that promotes a supportive ‘school ethos’ and emphasizes improvements in physical, social, and emotional well-being and educational outcomes. A HPS initiative in rural Nova Scotia (Canada) provided an opportunity for a population-level natural experiment. This study investigated student well-being and health behaviours between schools with and without HPS implementation and schools with high and low school ethos scores.Student well-being, nutrition, and physical activity were examined in a cross-sectional survey of elementary students in Nova Scotia, Canada in 2014. Multiple regression was used to assess the relationship with student well-being using the Quality of Life in School (QoLS) instrument and health behaviours. The main exposure was attending one of the 10 HPS schools; secondary exposure was the school ethos score.The overall QoLS score and its subdomain scores in the adjusted models were higher in students attending HPS schools compared to those in non-HPS schools, but the differences were not statistically significant and the effect sizes were small. Students in schools that scored high on school ethos score had higher scores for the QoLS and its subdomains, but the difference was only significant for the teacher-student relationship domain.Although this study did not find significant differences between HPS and non-HPS schools, our results highlight the complexity of evaluating HPS effects in the real world. The findings suggest a potential role of a supportive school ethos for student well-being in school.

Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review.

Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students.

An examination of Health Promoting Schools in Ireland

Purpose– The purpose of this paper is to report the results of a national survey that examined the extent of implementation of Health Promoting Schools (HPS) in Ireland.Design/methodology/approach– A quantitative research design was adopted. A questionnaire was administered to all post-primary schools in the country (n=704). Data were analysed with the support of the software packages, SPSS and MaxQDA.Findings– A response rate of 56 per cent (n=394) was achieved. Over half of these schools (56 per cent) self-identified as health promoting. Schools reported success in the areas of environment and curriculum and learning, however, partnerships and policy and planning required more attention. Some models of good practice emerged from the data but these were in the minority. Many schools, when asked to describe health promotion in their school, placed emphasis on physical health (diet and exercise) and curriculum predominately rather than the broader whole school conceptualisation. Only 35 per cent of HPS schools had a team supporting HPS developments. Only 36 per cent identified the existence of a school policy to support HPS. This suggests that further coherence for sustained and comprehensive implementation of HPS is necessary.Research limitations/implications– The research was conducted with school staff, in the first instance who self-reported their school’s level of HPS engagement.Originality/value– This paper offers the first national baseline data available in relation to engagement in HPS in Ireland. It provides a valuable starting point from which further research with schools in this field can be conducted.

Providing context to the implementation of health promoting schools: A case study

PurposeIssues related to program context are important components of population health interventions and particularly among complex, adaptive initiatives in schools. Health Promoting Schools (HPS) is a global approach to support early development of healthy behaviors among children and youth. The purpose of this study was to explicate the practical and contextual processes that influenced implementation of HPS in schools in Nova Scotia (Canada). MethodsUsing a case-study approach, data was collected using interviews (n=14) with principals, teachers and parents, observations collected during school visits and document review in five diverse schools. ResultsCase study schools reported a variety of HPS practices and three key themes emerged that provided context to the processes that facilitated their implementation. The results suggest that although school characteristics (theme 1), like staff allocation, physical location and resources, are important, these barriers can be mitigated by building organizational capacity (theme 2) and establishing a supportive school community culture (theme 3). ConclusionsThe study provided insight to the variability in implementation by describing how contextual barriers were experienced and mitigated by schools. Establishing a broad system to support HPS, with collaboration across health and education sectors, could help to progress adoption, implementation and sustainability of HPS.

Expanding school-district/university partnerships to advance health promoting schools implementation and efficacy in Taiwan.

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Evaluation of the Health-Promoting School Supporting Network in Taiwan.

Taiwan has advocated health-promoting schools (HPS) since 2001 and established the Health-Promoting School Supporting Network (HPSSN) in 2005 to offer administrative support and consultation. Respondents' opinions about HPSSN and the relationship between these perceptions and HPS implementation were examined. In 2011, 800 primary and middle schools were selected through stratified random sampling. School staff members (N = 656) in charge of HPS programs reported their impressions of the HPSSN's support. Respondents were most satisfied with consultants and schools' recognition of responsibilities and rules and their interactions with HPSSN administrators. They were least satisfied with the extent of their HPSSN consultant interaction and believed HPSSN provided insufficient resources to establish HPS. Respondents' consultant partnerships and satisfaction with HPSSN administration significantly predicted HPS implementation. Additionally, the predictive values of healthy policies and school-community relationships were greater than the other 6 HPS components. HPSSN positively influenced HPS implementation; however, consultant/school partnerships and school resource allocations must be improved.

Applying theoretical components to the implementation of health-promoting schools

Objective:Health-promoting schools (HPS) constitute an internationally recognised approach that connects health and education in a planned, integrated and holistic way. There is considerable variability, however, in how HPS is implemented and recent research has attempted to clarify the key functions of implementation. A provincial HPS strategy in Nova Scotia (NS) (Canada) provided a unique research opportunity to examine implementation related to emerging theory. The purpose of this exploratory study was to describe a provincial case study of HPS implementation using theoretical components identified in the literature.Design:Collective case study approach using qualitative research methods.Setting:The study was situated within a larger province-wide school-based research project examining the relationships between health, nutrition, physical activity, mental health and school performance of children in NS. As a follow-up to the provincial study, nine schools ( n = 9) that varied in their HPS implementation strategies and characteristics (i.e. size and region) were invited to take part as case study schools.Method:Data collection included observations, interviews and documents from nine schools ( n = 9). Data were analysed for emerging themes and using the a priori theoretical components.Results:The results revealed that schools assembled into three sequential categories based on the functioning of theoretical components. Higher level visioning and school-level leadership were critical in sustaining the adoption and implementation of HPS across schools and appeared to enable and integrate organisational processes, such as distributed leadership and a collaborative school culture, to enhance HPS implementation at school level.Conclusion:This study confirmed other reports that it is imperative to integrate HPS work with educational values so as to enable partnerships in both the health and education sectors, thereby promoting both health and prosperity among students.

Framework for evaluating efficacy in Health Promoting Schools

Purpose – Successful implementation of Health Promoting Schools (HPS) depends on putting the model in the schools’ context for both health improvement and school improvement. HPS can only be effective if the change can be sustained over an extended duration. The purpose of this paper is to discuss development of the HPS process by University Research Centre in Hong Kong, resulting in an award scheme, where no additional resources were initially provided by the authorities. Design/methodology/approach – The team adopted a step-by-step approach starting with capacity building of key stakeholders and comprehensive needs assessment, leading to development of a system of evaluation and monitoring and establishment of a “Healthy School Award” system. The system was built on data derived from several different sources and made use of qualitative and quantitative information and were intended to be used to guide practice and actions for improvement. Findings – Schools measured their own performance against establ...

Culture matters: a case of school health promotion in Canada

Rising concerns of poor health behaviours of children and youth have stimulated international support for a comprehensive approach to promoting the development of healthy behaviours in the early years. Health promoting schools (HPS) is increasingly adopted as an approach to guide supportive practices, but there is limited research that has reported how to effectively implement HPS at a population level. The purpose of this research was to qualitatively explore the factors preventing and facilitating implementation of HPS practices in the Canadian province of Nova Scotia. Interviews (n = 23) were conducted with school stakeholders (principals, teachers and parents) from a diverse sample of schools (n = 9) and data were analysed to develop an understanding of how school circumstances and experiences influenced HPS implementation. At a broad level, the reported barriers were structural and systemic, whereas the facilitating factors were related to organizational capacity and political leadership. It was evident that implementing and sustaining HPS required a shift in values and integration of supportive school health practices into school priorities. The results suggest that, without addressing the competing culture, which is persistently reinforced by strict academic mandates and unhealthy community norms, HPS will be vulnerable to circumstances that prevent implementation. Considering the emerging importance of mental wellbeing, it will also be important to provide schools with adequate and appropriate staff capacity and support to address this issue. Sustaining the positive effects of HPS will require continuous engagement and collaboration with multiple stakeholders to embed health promotion into school community norms.

82 - Developing a tool to measure implementation of Health Promoting Schools

82 - Developing a tool to measure implementation of Health Promoting Schools

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.