Health Promoting School Model Research Articles

Qualitative multi-stakeholder evaluation of the adoption, implementation and sustainment of theschool-based dietary intervention "Jump-in".

Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school's policies, physical environment, curriculum, health care and involving parents and communities, they significantly 'intrude' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam's Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective. We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam's low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data. During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children's health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals. This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders' involvement in decision-making.

Collectively achieving primary health care and educational goals through school-based platforms: financing solutions for intersectoral collaboration.

Despite abundant evidence demonstrating that improvements to health and education are positively correlated, and the importance of school-based platforms to achieve shared impacts, collaboration between ministries of health and education remains limited across low- and middle-income countries. Enhancing this collaboration is essential to realize mutually beneficial results, especially following the COVID-19 pandemic, which severely impacted health and education outcomes globally and highlighted the importance of resilient, domestically funded systems for delivering key social services including primary health care and education. We argue that the lack of an effective joint financing mechanism has hindered adoption of collaborative multisectoral approaches such as the WHO/UNESCO's Health Promoting Schools (HPS) model. HPS is well-positioned to organize, finance, and deliver primary health care and education services through a school-based platform and strategy. Case studies from several low- and middle-income countries highlight the need to expand limited inter-ministerial collaborations to achieve cross-sectoral benefits and ensure sustainability of HPS beyond the lifecycle of external partners' support. It is important to identify ways to widen the resource envelope for sector-specific activities and create efficiencies through mutually beneficial outcomes. This paper offers two pragmatic solutions: an inter-ministerial joint financing mechanism that starts with alignment of budgets but matures into a formal system for pooling funds, or a fixed-term co-financing mechanism that uses donor contributions to catalyze inter-ministerial collaborations. Achieving sustainability in these initiatives would require engaging the ministries of health, education, and finance; developing a common administrative, financial, and monitoring mechanism; and securing long-term commitment from all concerned stakeholders.

Effectiveness of an integrated model of oral health-promoting schools in improving children's knowledge and the KAP of their parents, Iran

IntroductionThe aim of our study was to investigate the effect of an Oral Health Promoting School (OHPS) model on children's oral health in Iran.MethodsThis interventional quasi-experimental study was conducted in the academic year 2019–20 among 354 primary school students and their parents. A questionnaire including 17 questions was distributed among children before and 5 months after the program (The ranges of possible scores = 0–17). Training workshops for the parents based on the theoretical domains framework were designed. Using educational sessions, pamphlets, tooth brushing dairies, assignments to do at home, educational videos and messages as reminders in social networks, parents were educated about dental caries, its risk factors and prevention principles. Best recommended oral health behaviors including tooth brushing and the use of fluoridated tooth paste were also educated. A questionnaire consisting of 18 knowledge (The ranges of possible scores = 0–18), 13 attitude and 10 practice questions were distributed among parents before and after the workshops. The data were fed into SPSS and analyzed by descriptive and analytic statistics such as T-test, ANOVA and Correlation Coefficients (α = 0.05).ResultsThe mean pre-test knowledge (7.8 ± 1.7) was increased significantly in three schools after program, p < 0.001. In the post-test, girls gained significantly higher scores (9.61 ± 1.98 vs. 9.06 ± 1.4, p = 0.025). Among 147 parents, the mean knowledge was raised from 12.3 ± 3.1 (5–18) to 15 ± 3.03 (6–18), p < 0.001. Knowledge score of the parents attending both sessions was higher. Practice of the parents regarding the use of fluoridated tooth-paste was significantly improved (p < 0.001). Also, their attitude toward the ability of children to take care of their teeth was improved (p = 0.029). Based on the self-report of parents, 71.4% (n = 47) of mothers and 45.6% (n = 67) of their children used to brush once or two times daily and there was a correlation between their behaviors (p < 0.001, Spearman Correlation Coefficient = 0.4).ConclusionIt seems that the education provided in OHPS had positive effects on increasing students' awareness and to some extent, the knowledge, attitude and practice of the parents.

A training program of source-separated recycling for primary school students: Applying the health promoting schools model

Recycling is a waste management process that has attracted a lot of attention for helping protect the environment. The current research aims to determine the effect of an intervention based on the Health Promoting Schools model (Albanian’s HPSM) on the recycling behaviors of primary school students. In this study, 413 primary school students in Maragheh, Iran, were randomly divided into a test group (n = 207) and a control group (n = 206). The educational intervention consisted of seven 45-minute teaching sessions and eight promotion programs for the students, two discussion sessions for the parents and two group educational sessions for the teachers. The tools used included a researcher-made questionnaire with items on awareness, attitude, performance, and participation in source-separated recycling. The validity and reliability of this tool were also measured. The questionnaires were completed in two stages in both groups, including before and three months after the intervention. Data were analyzed using SPSS software. The significance level was considered to be P < 0.05. After the intervention, a significant difference was observed in the mean scores of awareness, attitude, performance, and participation in terms of recycling among the students in the test group compared to before the intervention (P < 0.05). The mean scores of knowledge, attitude, performance, and participation also differed significantly after the intervention between the teachers and parents in the test group and the control group (P < 0.05). The use of Albanian’s Health-Promoting Schools (HPS) approach is effective in improving source-separated recycling behaviors in primary school students.

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.

Oral Health Related Quality of Life (OHRQoL) Among Malaysian Children: A Systematic Review

Introduction: Oral caries is a major public health issue around the globe, and it is the most prevalent noncommunicable disease (NCD). Children are mostly the population affected by this disease, which affects their quality of life. Therefore, measures to quantify this aspects of quality of life should be established to investigate the current status and to develop future intervention and prevention. The objective of this article is to systematically review the studies related to children's quality of life with regard to their oral health among Malaysian population. Materials and Method: Scopus-indexed articles were retrieved following an advanced search with the following search string, TITLE-ABS-KEY((oral OR dental) AND (child* OR kid* OR (primary dentition)) AND (quality of life) AND Malaysia*), resulting in a final of eight shortlisted and reviewed articles based on the review objective. Results: A few valid and reliable instruments were tested and validated, namely Malaysian version of Early Childhood Oral Health Impact Scale (ECOHIS), Malay Child Oral Impacts on Daily Performances (Malay Child-OIDP), Malaysian version of the Oral Health Impact Profile questionnaire (OHIP-14), and the most commonly used child oral-health-related quality-of-life (OHRQoL). However, Dental Aesthetic Index (DAI) score did not predict the effect of malocclusion on the OHRQoL. Oral caries was highly prevalent among Malaysian Orang Asli children. Oral health did not only have an impact on quality of life in Malaysian preschool children, but also on their caregivers. A health-promoting school model namely the Doktor Muda Programme for primary schools in Malaysia showed some positive impacts on children’s oral health related quality of life. Conclusion: Further research among Malaysian children population with regard to their oral health related quality of life should be continued for the benefits of communities at large.

'Health Promoting School' Model in Prevention of Vector-Borne Diseases in Odisha: A Pilot Intervention.

We tested 'Health-Promoting School model' for vector-borne diseases (VBDs) through behavioural changes among students in India for better control of the diseases in the community. A total of 1098 students from eight co-ed schools (four controls and four interventions) of Odisha participated in the study. Intervention was 12 h of class room teaching and activities on mosquito dynamics, source identification, prevention and management of VBDs. Control schools were provided with the leaflets and posters covering the objectives. Impact was assessed through change in knowledge and practice through pre- and post-test. Total mean transformed score in pre-intervention survey in both the groups was nearly 33, which increased to 38.6 and 53.9 in control and intervention group, respectively. In intervention group the mean days of absenteeism due to VBDs was reduced nearly by four times. The model can be used as effective health-promoting measures for vector control.

Incorporating HPS Model into Lebanese Public Schools: Comparison of Adolescents’ Smoking, Alcohol and Drug Use Behavior in HPS versus Other Public and Private Schools in Lebanon

In 2010, the World Health Organization supported the Lebanese Ministry of Education and Higher Education to establish a network of 10 Health Promoting Schools (HPS). This study was undertaken to address the extent to which the HPS model was able to produce changes in the risk behaviors of adolescents (Smoking, Drinking, and Drug Use) and prepare them to respond to evolving health challenges. A cross-sectional survey was carried out during 2011-2012 and compared Grade 6 - 9 students in HPS, and 10 other public and private schools. The Youth Risk Behavior Survey [1], and Carbon Monoxide measurements in adolescent breaths were used for data collection. Findings revealed that the current School Health Program failed to address issues of concern to adolescents with no significant differences in risk behaviors: smoking, alcohol and drug use. The HPS network needs reassessment to upgrade the outcomes of health education curricula. Expected learning outcomes and healthy practices must be designed to match students’ age, grade level, and developmental milestones.

IMMIGRANT YOUTH IN CANADIAN HEALTH PROMOTING SCHOOLS: A LITERATURE REVIEW

In this essay, we review empirical, theoretical, and substantial grey literature in relation to immigrant youth and health promoting schools (HPS). We examine the health promotion concept to consider how it may inform the HPS model. Using Canada as an example, we examine current immigrant youth demographics and define several key terms including immigrant, youth, and health. Our review highlights important knowledge gaps related to the role of education and migration as antecedents to immigrant youth health and wellbeing as well as qualitative and educational research approaches. We conclude by providing recommendations for future immigrant youth research in the context of HPS.

Engaging schools in diagnosis and treatment of malaria: Evidence of sustained impact on morbidity and behavior

Background: In low and middle income countries (LMICs) teachers send home children found sick in class devolving subsequent care to parents; where malaria is endemic, morbidity is high as the most parents fail to access WHO-endorsed rapid diagnostic testing (RDT and prompt treatment with artemisinin combination therapy (ACT). Consequently malaria is the principal reason a child misses school; so, we trained teachers to use RDT to evaluate all sick pupils and give ACT promptly to those positive.Aims: Pre, intra and post intervention evaluation of impact of using the WHO Health Promoting School (HPS) model to empower teachers to provide RDT and ACT and engage and inform pupils about malaria in 4 schools in rural Uganda.Methods: Documenting duration of absence from school as a surrogate measure for morbidity and change in children’s knowledge and reported behaviors regarding malaria. Pre-intervention (year 1) baseline evaluation of days of absence and children’s malaria knowledge/behavior; Intervention (year 2) trained teachers administered RDT in all sick children and treated those positive with ADT; Post-intervention (end of year 3) after schools independently continued RDT/ACT and education on malaria.Results: Pre-intervention &lt;1:5 pupils had basic knowledge about malaria (caused by mosquitos; can be prevented; requires rapid diagnosis and prompt medication). In year 1: 953 of 1764 pupils were sent home due to illness. Mean duration of absence was 6.5 (SD 3.17) school days. In year 2: 1066 of 1774 pupils were sick, all had RDT, 765/1066 (68%) tested positive and received ACT; their duration of absence fell to 0.59 (SD 0.64) school days (p&lt;0.001). By year 2 all children knew the signs and symptoms of malaria and had essential epidemiological knowledge. Twelve months post intervention the universality of this knowledge had been sustained and the whole-school focus on malaria continued. Children reported better health, more consistent attendance and improved academic achievement, and had become proactive in prevention strategies; 6% fewer tested positive for malaria; and key health knowledge was being passed to new pupils.Conclusion: Teacher administered RDT/ACT reduced child morbidity from malaria significantly; essential knowledge was generated and new health practices acquired that changed behaviors. Our WHO HPS model is applicable to other LMICs where malaria is endemic and morbidity high.

Priorities for African youth for engaging in DOHaD.

A challenge for implementing DOHaD-defined health promotion is how to engage the at-risk population. The WHO Health Promoting School (HPS) model has proven success engaging youth and improving health behaviors. Hence, we introduced DOHaD concepts to 151 pupils aged 12-15 years in three HPS programs in rural Uganda, inquired what factors would make DOHaD-related health promotion resonate with them, and discussed how they recommended making learning about DOHaD acceptable to youth. Economic factors were judged the most compelling; with nutrition and responsive care elements next in importance. Suggested approaches included: teach how good health is beneficial, what works and why, and give tools to use to achieve it, and make information positive rather than linked to later harm. Involve youth in making DOHaD learning happen, make being a parent sound interesting, and include issues meaningful to boys. These are the first data from youth charged with addressing their engagement in the DOHaD agenda.

ENGAGING YOUTH AS AGENTS FOR CHANGE: HEALTH PROMOTING SCHOOLS POSITIVELY IMPACT KNOWLEDGE, BEHAVIORS AND MORBIDITY FROM MALARIA

Abstract BACKGROUND: Schools in low/middle income countries (LMICs) traditionally send home children found sick in class devolving subsequent care to parents. Where malaria is endemic this infection is the principal reason a child will miss school and morbidity is high as the majority of parents in LMICs fail to access WHO-endorsed diagnosis and treatment. OBJECTIVES: Post intervention evaluation of using the WHO Health Promoting School (HPS) model to engage and inform pupils in rural Uganda about malaria, and empower teachers to provide rapid diagnostic testing (RDT) and treatment with artemesinin combination therapy (ACT). Our hypothesis was that this would reduce morbidity from malaria and also generate a sustained increase in knowledge and long term change in behavior. DESIGN/METHODS: This 2 year project was evaluated 12 months after delivery. In year 1 (pre-intervention) we had established malaria-focused WHO HPS activities in 4 primary schools; evaluated children’s knowledge and parents’ behavior re febrile illness; introduced peer to peer learning via youth ‘champions’; monitored days of absence from school (as a surrogate for morbidity); trained teachers to identify probable infectious illness and how to provide RDT and ACT. In year 2 (intervention) trained volunteer teachers added RDT evaluation of all children found sick at school and treated those positive with ACT. Now schools independently continue the RDT/ACT program and maintain an educational focus on malaria with youth champion involvement. RESULTS: Pre-intervention <1:5 of 1764 pupils had basic knowledge about malaria (caused by mosquitos; can be prevented; requires rapid diagnosis and effective medication). In year 1 953 of the 1764 pupils were sent home due to illness; parents only took 1:4 to clinics for diagnosis or anti-malarial treatment. Mean duration of absence was 6.5 (SD 3.17) school days. In year 2 1066/1774 pupils were sick, all had teacher administered RDT, 765/1066 (68%) tested positive for malaria and received ACT; their duration of absence fell to 0.59 (SD 0.64) school days (p<0.001), and overall absence decreased to 2.55 days from 6.5 in year 1 (p<0.001). By year 2 all children knew the signs and symptoms of malaria and had essential epidemiological knowledge. Twelve months post intervention the universality of this knowledge has been sustained in spite of new enrollment, the whole school focus on malaria continues. Children report better health, consistent attendance and improved academic achievement; they pass key health knowledge to new pupils and have now become proactive in prevention strategies and 6% fewer test positive for malaria. CONCLUSION: WHO HPS initiatives generate new knowledge and health practices that change behaviors. Youth ‘champions’ (school-aged leaders trained by local health care professionals) contribute by engaging pupils in health promotion through peer-to-peer activities. Morbidity from malaria was improved by providing HPS activities that included RDT/ACT use by teachers and children gained new knowledge. Post-intervention the health ethos of the schools has changed, children’s knowledge and behaviors remain enhanced and malaria awareness is greater in the broader community. Our model is a community empowerment approach applicable to other low-resource settings worldwide where malaria is endemic and morbidity high.

Oral health education program among pre-school children: an application of health-promoting schools approach.

Background: Preschool children have a limit ability to take care of their teeth. The aim of this study was to determine the effect of an intervention based on Albanian’s Health Promoting Schools Model (Albanian’s HPSM) on the oral health behaviors among a group of Iranian female preschool (5-6 years old) children. Methods: In this quasi-experimental study, 120 children in seventh district of Tehran, Iran were randomly recruited and assigned to either the intervention or the control groups. A scale was designed and validated to assess the oral health behaviors among the children and knowledge,attitude, self-efficacy beliefs, perceived barriers and oral health behaviors among the parents and the schoolteachers. An expert panel approved the content validity of the scale (CVR = 0.89,CVI = 0.90). The reliability was also approved applying intraclass correlation coefficient (range,0.83–0.92) and Cronbach alpha (range, 0.83–0.96). Based on the preliminary data, a 6-week intervention was designed and conducted to the intervention group. One month following the intervention, both groups were followed-up. The data were analyzed using covariance and paired t tests. Results: Following the intervention, significant differences were found in the oral health behaviors of the children in the intervention group (P < 0.05) and knowledge, attitude, oral health behaviors, self-efficacy, and perceived barriers of their parents and the schoolteachers (P < 0.05). Conclusion: Using Albanian’s health-promoting schools (HPSs) approach was useful in improving the oral hygiene behaviors among the preschool children.

Lessons in building capacity in sexuality education using the health promoting school framework

Purpose – The health promoting school model is rarely implemented in relation to sexuality education. This paper reports on data collected as part of a five-year project designed to implement a health promoting and whole school approach to sexuality education in a five campus year 1-12 college in regional Victoria, Australia. Using a community engagement focus involving local and regional stakeholders and with a strong research into practice component, the project is primarily concerned with questions of capacity building, impact and sustainability as part of whole school change. The paper aims to discuss this issue. Design/methodology/approach – Using an action research design, data were collected from parents, students, teachers and key community stakeholders using a mixed methods approach involving surveys, interviews, document analysis and participant observation. Findings – Sexuality education has become a key school policy and has been implemented from years 1 to 9. Teachers and key support staff have engaged in professional learning, a mentor program has been set up, a community engagement/parent liaison position has been created, and parent forums have been conducted on all five campuses. Research limitations/implications – The translation of research into practice can be judged by the impact it has on teacher capacity and the students’ experience. Classroom observation and more longitudinal research would shed light on whether the espoused changes are happening in reality. Originality/value – This paper reports on lessons learned and the key enabling factors that have built capacity to ensure that sexuality education within a health promoting, whole school approach will remain sustainable into the future. These findings will be relevant to others interested in building capacity in sexuality education and health promotion more generally.

An analysis of the first implementation and impact of the World Health Organisation’s health promoting school model within disadvantaged city schools in Ireland

While knowledge about the World Health Organisation’s (WHO) healthy schools model has been developed in recent years, process implementation and outcomes for school children have not improved in line with these advances. This deficit has become known as the ‘implementation gap’ and refers to the difference between the evidence of what works in theory and what is delivered in practice. The aim of this research was to evaluate the first implementation and impact of the WHO model among urban disadvantaged school children in Ireland from 2008 to 2012. A concurrent mixed methods study design was used. A process evaluation-mapped implementation and a three-year cohort study measured the impact. Data comprised of semi-structured interviews, focus groups and documentary analysis. Instruments included the Kidscreen-27 and the Child Depression Inventory (CDI). Over 600 children in five intervention and two comparison schools were recruited. The process evaluation revealed that top-down decision making based on the communities rather than each individual school’s needs and a lack of understanding of the concept of the whole school approach inhibited implementation. No significant differences were found between intervention and comparison of schools over three years post implementation. The successful implementation within an urban disadvantaged region requires not an analysis of the regional needs but a development of the individual school needs and sufficient lead-in time to ensure that each school is ready in terms of its understanding. Furthermore, healthy schools coordinators roles need to be clarified as facilitators of development and change rather than as unsustainable providers of health activities.

A coalition partnership of vision health through a health-promoting school program for primary school students in Taiwan.

Myopia, the most common refractive error, is the most common cause of avoidable visual impairment among children and has reached epidemic proportions among children and young adults in urban areas of East and Southeast Asia that contain populations of Chinese ancestry. Moreover, vision health is an important theme of the health-promoting school program issued by the Ministry of Education in Taiwan. The aim of this study is to assess the impact of pre- and post-intervention proposed by the health-promoting school (HPS) model. The objectives are to understand whether the HPS model influenced the vision screening results and the attitude, knowledge level, and vision care behavior of the students involved. A prospective cohort study design was used to evaluate a vision health program. Four elementary schools, local education authorities, and one university in northern Taiwan established a coalition partnership to design a six-month program to combat myopia among students. The target population was 6668 school children from local elementary schools. For the purpose of this study, the outcome of visual acuity testing (in logMAR) was analyzed with a sampling of 373 school children (aged 11-12 years old) who were chosen from high prevalence of poor vision classes. After the HPS program, the attitudes, behaviors, and knowledge levels of the school children regarding vision health were significantly improved. The pre-intervention mean logMAR of all participating students ( N = 373) was -.10, which increased to -.19 after the intervention. Analysis using the Wilcoxon signed-rank test showed that the logMAR value was significantly improved after the intervention ( t = 2.13, p < 0.05). Our findings highlight the relevance and effectiveness of the coalition's efforts, which reinforces the usefulness of co-operatively implementing the HPS program.

“Change in schools it’s more like sort of turning an oil tanker”

Purpose– The purpose of this paper is to add to the evidence of best practice in the implementation of the Health Promoting Schools (HPS) framework by examining the process of creating readiness for change in a large international school in South-East Asia. Using a settings-based approach and guided by readiness for change theory the data collected reflects which factors were most influential in the decision of the leadership team (LT) to adopt a comprehensive HPS model. It follows the process of creating readiness in the early stages of adopting a HPS approach and captures the critical factors effecting leader’s beliefs and support for the program.Design/methodology/approach– This research is a case study of a large pre-K-12 international school in South-East Asia with over 1,800 students. A mixed methods qualitative approach is used including semi-structured interviews and document analysis. The participants are the 12 members of the LT.Findings– Readiness for change was established in the LT who adopted a HPS approach. That is, they adopted a comprehensive model to address health-related priorities in the school and changed the school’s mission and accountability processes to specifically include health. Uncovering the reasons why the LT supported this change was the primary focus of this research. Building the motivation to change involved establishing a number of key beliefs three of which were influential in bringing about readiness for change in this case study. These included the belief that leadership support existed for the proposed change, a belief that there was a need for change with a clear discrepancy in the present and preferred operations in relation to addressing the health issues of the school and the belief that HPS was the appropriate solution to address this discrepancy.Research limitations/implications– Adopting a HPS approach is the first phase of implementation. Long-term research may show if the integrity of the chosen model is maintained as implementation continues. The belief construct of valence, that is, the belief that the change will benefit the change recipient, was not reliably assessed in this research. Further research needs to be conducted to understand how this construct is interpreted in the school setting. The belief construct of valence was not reliably assessed in this research. Further research needs to be done to understand how this construct fits in the school setting.Practical implications– This paper provides a promising example of how health can be integrated into the school’s Mission and Strategic Learning Plan. The example presented here may provide strategies for others working in the field of HPS.Originality/value– Creating readiness is an often over-looked stage of building sustainable change. International schools cater to more than three million students are a rarely researched in regards to health education. It is predicted that the numbers of students in international schools will grow to more than six million in the next ten years.

Children’s Oral Health: The Opportunity for Improvement Using the WHO Health Promoting School Model

The health and quality of life of a large proportion of the world’s children are compromised by dental caries and periodontal disease. Those in developing countries and from disadvantaged populations suffer disproportionately from these forms of poor oral health; however, much of the primary disease and secondary pathology is preventable by simple and inexpensive measures that children can readily learn. WHO health promoting schools (HPS) are an established model for addressing public health issues through education of children in a manner that achieves acquisition of knowledge and health practices that promote behaviours that positively impact determinants of health. HPS programs that address poor oral health have achieved improvement in oral health practices and reduction in caries rates among disadvantaged populations of children. WHO has called for more programs to address the “epidemic” of poor oral health worldwide, and the WHO HPS model appears to be a relevant and applicable way forward. Health care professionals and educators who want to improve the health and quality of life of children related to caries and periodontal disease now have an opportunity to collaborate to initiate, deliver, and evaluate community-based HPS interventions using proven concepts, content, and process.

Bricolage and the Health Promoting School

Purpose– The propositional knowledge about the Health Promoting School (HPS) and how it privileges the health sector, and research through intervention and behaviour change rather than gaining an understanding of how social bases of health impact and influence individuals and the wider school community. The purpose of this paper is to explore how bricolage offers opportunity for understanding complexity, thick description and inter- and multi-disciplinary work. The experience of health promotion and what it looks like at the school level and provides epistemological considerations for reframing research about HPSs for purposes of social justice and equity through bricolage.Design/methodology/approach– An introduction reveals the challenges of health promotion settings, and schools in particular to achieve social justice and equity. Bricolage is discussed with reference to complexity, thick description and inter- and multi-disciplinary work. Considerations are given to bricolage as research to gain understanding and to contribute to social change.Findings– As a setting the HPS is a complex site of social interaction and where there is interplay of multiple, casual factors that influence health and well-being. The potential for social justice and equity remains latent and new approaches to investigating and researching are required. Bricolage offers substantial possibilities as it recognises the value of researching social contexts but with a deliberate intent to engage with participants.Practical implications– This paper considers how bricolage can re-focus ontological and epistemological positions to engage in health promotion as a social action.Originality/value– This paper raises questions about the ability of the HPS model to deliver on social justice under current compliance regimes.

Health promoting schools: consensus, strategies, and potential

Purpose The purpose of this paper is to summarize a consensus statement generated on the current challenges, strategies, and potential of health promoting schools (HPS) at a 2011 colloquium at the Stellenbosch Institute for Advanced Study where 40 people from five continents came together to share their global and regional experience surrounding the World Health Organization (WHO) HPS model.