School-based Health Promotion Program Research Articles

Special education teachers' involvement and perceived barriers to delivering oral health education for students with disabilities-A cross-sectional study.

Dental caries is prevalent among children, including those with disabilities. Although the World Health Organization recommends school-based oral health promotion (OHP) programmes involving teachers, limited research has explored teachers' roles and perspectives. To assess special education teachers' involvement and difficulties regarding oral health education (OHE), attitudes towards OHP and barriers to oral healthcare access for students with disabilities (SWDs). This descriptive cross-sectional study, conducted in Al-Ahsa, Saudi Arabia, involved 264 special education teachers using a validated, self-administered questionnaire, and descriptive and analytical statistics were used for data analysis. Only 39% of teachers incorporated OHE into their teaching, and just 20.8% received training for OHE delivery. Teachers showed strong support for integrating OHE into the curriculum (84.1%) and a no-sugar policy (78%). There was, however, less support for school-based toothbrushing (39%). OHE barriers included insufficient resources (56.1%), limited knowledge (29.2%) and misconceptions about primary teeth removal (47.4%). The three most common barriers to oral healthcare access were extended waiting lists (75.0%), long waiting times (73.1%) and fear of dental equipment (67.4%). This study highlights the need for collaboration between healthcare professionals, educators and parents to enhance OHE and reinforce OHP for SWDs within special education and beyond.

School-Based Cardiovascular Health Promotion in Adolescents

School-based interventions offer an opportunity for health promotion in adolescence. To assess the effect of 2 multicomponent educational health promotion strategies of differing duration and intensity on adolescents' cardiovascular health (CVH). The SI! Program for Secondary Schools is a 4-year cluster randomized clinical intervention trial conducted in 24 secondary schools from Barcelona and Madrid, Spain, from September 7, 2017, to July 31, 2021. Eligible participants were adolescents enrolled in the first grade of secondary school. Schools and their participants were randomized to receive a health promotion intervention (SI! Program) over 4 school years (long-term intervention [LTI], 8 schools, 412 adolescents) or 2 school years (short-term intervention [STI], 8 schools, 504 adolescents) or to receive the standard curriculum (control, 8 schools, 441 adolescents). The primary end point was the between-group difference at 2 and 4 years in the change from baseline of the overall CVH score, as defined by the American Heart Association (range, 0-14 points, with a higher score indicating a healthier CVH profile). Intervention effects were tested with multilevel mixed-effects models. A complete-case intention-to-treat analysis was performed as the primary analysis. Of the randomized students, the study enrolled 1326 adolescents (684 [51.6%] boys, mean [SD] age, 12.5 [0.4] years at recruitment) with a study completion rate of 86.0%. Baseline overall CVH scores were 10.3 points in the LTI group, 10.6 points in the STI group, and 10.5 points in the control group. After 2 years, at halfway through the LTI and at the end of the STI, the difference in the CVH score change was 0.44 points (95% CI, 0.01-0.87; P = .04) between the LTI group and the control group and 0.18 points (95% CI, -0.25 to 0.61; P = .39) between the STI group and the control group. At 4 years, differences for the LTI and STI groups vs control were 0.12 points (LTI: 95% CI, -0.19 to 0.43; P = .42) and 0.13 points (STI: 95% CI, -0.17 to 0.44; P = .38). No adverse events were reported. Overall, the tested school-based health promotion strategies in this randomized clinical trial had a neutral effect on the CVH of the adolescents. Although there was evidence of a marginal beneficial effect at a point halfway through implementation in the LTI group, such a benefit was not noted at 4 years. Further research is warranted into the efficacy of school-based health promotion programs. ClinicalTrials.gov Identifier: NCT03504059.

Digital applications as a means for promotion of healthy behaviours among Albanian children.

Digital applications can be effective tools for strengthening school-based health education programs as they can provide valuable health information to children through interactive videos, quizzes and games. We aimed at assessing the change in the prevalence of healthy behaviours among children exposed to digital applications (intervention) employed for promoting healthy behaviours. We conducted a cross-sectional study before the intervention in March 2022 including a representative sample of 1500 Albanian schoolchildren (≈54% girls) aged 12-15 years. In June 2022, after 4-month exposure to digital applications aimed at promoting healthy behaviours (intervention), we carried out a second cross-sectional study in the same sample of schoolchildren. In both survey rounds, an anonymous and structured self-administered questionnaire inquired children about a range of behavioural practices including nutrition, oral health, physical activity and hygiene practices. After the intervention, overall, there was evidence of a significant increase in the prevalence of all healthy behavioural practices measured: ~9% for breakfast consumption and/or environmental protection, 12% for toothbrushing, 14% for handwashing, 15% for leisure time physical exercise and 24% for adequate fruit and vegetable intake (all p < 0.001). Engagement in healthy behaviours only after the intervention was higher among rural children (from 18% for breakfast consumption to 37% for handwashing and/or adequate fruit and vegetable intake) and especially those pertinent to Roma/Egyptian communities (from 18% for breakfast consumption to 46% for adequate fruit and vegetable intake), except for engagement in safe environmental protection which was more prevalent among urban residents (28% vs. 15% among rural children) and ethnic Albanian children (24% vs. 13% among Roma/Egyptian children). Our findings from Albania indicate that digital applications can be useful for strengthening school-based health promotion programs.

Developing a School-Based Mental Health Promotion Program Through Co-creation Approach

School setting is an effective environment for primary mental health care for students. There have been many mental health support programs in schools for students, most of which are predesigned. The objectives of this paper are: i) To introduce the co-creation approach; and ii) To narratively describe the process of co-creating a mental health promotion program for 04 secondary schools and 04 high schools in Nghe An and Khanh Hoa, Vietnam. Students, teachers, parents and local authorities were the involved stakeholders. Mixed methods including narrative research, observations, open-ended and closed-ended questionnaires were used. The results show that using co-creation approach to develop a mental health promotion program is feasible and applicable in Vietnam. Challenges, learnt lessons and discussion about feasibility of the co-creation process to develop the school-based mental health promotion program are also mentioned in the paper.

Comparing Virtual and In-Person Implementation of a School-Based Sexual Health Promotion Program in High Schools with Large Latino Populations

Many sexual health programs transitioned to virtual implementation during the COVID-19 pandemic. Despite its devastation, the pandemic provided an opportunity to learn about virtual compared to in-person implementation of a sexual health promotion program—El Camino. This study assessed differences in program attendance, engagement, quality, and student ratings for virtual versus in-person implementation of El Camino as part of a rigorous evaluation in high schools with high Latino populations in Maryland. Drawing on positive youth development practices, El Camino helps participants identify personal goals and learn about sexual reproductive health and healthy relationships. This mixed-methods study incorporates data from performance measures, baseline and post-intervention participant surveys, observations, monthly implementation reports, and debriefs with facilitators to describe and compare virtual and in-person program implementation. At baseline, participants were an average of 16.2 years old; between 8 and 12th grade; 61% female; 79% Hispanic, Latino, or of Spanish origin; and 54% spoke mostly Spanish at home. Recruitment and retention of students outside of school classes were challenging for both forms of implementation. However, attendance was higher during in-person implementation and in schools where the organization implementing El Camino had a strong presence before the pandemic. Findings indicate high fidelity, excellent quality ratings, and positive student perceptions of the program and facilitators in both the virtual and in-person cohorts, which suggest that both forms of implementation were comparable and furthermore highlight the strength of the virtual adaptation of the El Camino program.

Student involvement in implementation and evaluation of a school-based health promotion program in upper secondary school: a participatory research approach

Student involvement in implementation and evaluation of a school-based health promotion program in upper secondary school: a participatory research approach

Dissemination and Implementation of School-Based Health Promotion Programs: A Descriptive Comparison of Case Studies in Nicaragua and the Dominican Republic

Dissemination and Implementation of School-Based Health Promotion Programs: A Descriptive Comparison of Case Studies in Nicaragua and the Dominican Republic

Start small and let it build; a mixed-method evaluation of a school-based physical activity program, Kilometre Club

BackgroundDespite the benefits of physical activity, there is minimal research focusing on factors that influence real-world school-based physical activity programs. Kilometre (KM) Club is an Australian grassroots program which aims to increase physical activity in students through the completion of an outside walk or run at school. This small-scale pilot evaluation aimed to examine families, teachers and principals’ perceptions of the benefits, enablers and barriers of KM Club. It also aimed to examine the effects of KM Club on student’s physical activity levels during the school day.MethodsFour regional New South Wales (NSW) primary schools participated in this study. 26 families, four teachers, and two principals from School A, C, B and D completed semi-structured interviews to understand their perceptions of KM Club. 21 students completed emotional state-scales to understand their emotions when participating in KM Club. 141 students from Schools B, C and D participated in step-count measures using accelerometers.ResultsFamilies, teachers and principals reported a range of benefits such as improved social connectedness, wellbeing, home and classroom behaviours, participation in sport and fitness levels. Enablers consisted of champion engagement, incentives, versatile facilities and integration with other school activities. Identified barriers included the weather and environment, program timing and health issues. Most students reported that participating in KM Club made them feel proud, confident and fantastic. School B reported a significant increase in students' daily step counts on KM Club days compared to non-KM Club days (+ 15%; p = 0.001), while School C reported no significant changes (-5%; p = 0.26). School D reported a significant increase in the number of daily steps taken by KM Club participants compared with non-KM club participants (+ 10%; p = 0.024).ConclusionThere is no one-size-fits-all approach to implementing school-based physical activity initiatives. However, it appears that flexible and adaptable factors are important to the successful implementation of school-based programs, such as KM Club. This study revealed a variety of self-reported health, wellbeing and educational benefits for students, as well as an increase in student’s physical activity levels at 2 of the 3 schools participating in the quantitative data collection. This pilot evaluation may help to inform future design, implementation and scale-up of KM Club and school-based health promotion programs, potentially improving child health, wellbeing and educational outcomes.Trial registration(LNR223 – LNR/19/NCC/45).

Remote Implementation of a School-Based Health Promotion and Health Coaching Program in Low-Income Urban and Rural Sites: Program Impact during the COVID-19 Pandemic.

Adapting existing health programs for synchronous remote implementation has the potential to support vulnerable youth during the COVID 19 pandemic and beyond. The Stanford Youth Diabetes Coaches Program (SYDCP), a school-based health promotion and coaching skills program, was adapted for remote implementation and offered to adolescents from low-income communities in the US: an urban site in San Jose, CA and rural sites in Lawrence County, MO, and Central Valley, CA. Participants completed online pre- and post- surveys. Analysis included paired T-tests, linear regression, and qualitative coding. Of 156 enrolled students, 100 completed pre- and post-surveys. Of those: 84% female; 40% Hispanic; 37% White; 28% Asian; 3% African American; 30% other race. With T-tests and regression models, the following measures showed statistically significant improvements after program participation: health knowledge, patient activation, health understanding and communication, consumption of fruits and vegetables, psychosocial assets of self-esteem, self-efficacy, problem-solving, and ability to reduce stress. Technology barriers were frequently reported at Lawrence County site. 96% participants reported making a lifestyle change after program participation. Remote implementation of health promotion programs for vulnerable youth in diverse settings has potential to support adoption of healthy behaviors, enhance patient activation levels, and improve psychosocial assets.

An innovative process for sustaining and scaling up a school-based mental health promotion and anxiety prevention programs: The example of the HORS-PISTE program

An innovative process for sustaining and scaling up a school-based mental health promotion and anxiety prevention programs: The example of the HORS-PISTE program

Teaching health promotion competencies in undergraduate dentistry training: A unique pedagogical approach.

Using appropriate pedagogical approaches in undergraduate dentistry training is important to develop student's health promotion knowledge, and to shape their attitude towards using these competencies in future dentistry practice. This brief report documents the signature pedagogical approach developed for an undergraduate health science subject at James Cook University, to teach dentistry students health promotion competencies. The signature pedagogy involves three key approaches - experiential learning, cooperative learning and inquiry-based learning. Experiential learning "beyond the classroom" enables students to develop and deliver a school-based oral health promotion program. "Inside the classroom," role-plays encourage students to apply their health promotion skills to real-world dentistry scenarios. Cooperative learning techniques such as "think, pair, share" create a supportive environment for students to confidently exchange ideas; and inquiry-based learning engages students in thinking critically about health promotion strategies to address contemporary oral health challenges. These pedagogical approaches have developed student's understanding of the health promotion competencies required of a newly qualified dentist. Pedagogical approaches that engage dentistry students in experiential, cooperative and inquiry-based learning are important considerations for undergraduate teaching, to strengthen understanding of health promotion and to help shape student's attitude towards using these competencies in future dentistry practice.

Moderators of pre-post changes in school-based mental health promotion: Psychological stress symptom decrease for adolescents with mental health problems, knowledge increase for all.

BackgroundSchool-based mental health promotion aims to strengthen mental health and reduce stress. Results on the effectiveness of such programs are heterogeneous. This study realized a school-based mental health promotion program (StresSOS) for all students and aimed to identify moderators (mental health status, gender, grade level) of pre- to post-changes in stress symptoms and knowledge.MethodsParticipants were N = 510 adolescents (from 29 classes; 46.7% female) aged 12–18 years (M = 13.88, SD = 1.00; grade levels 7–10). They were without mental health problems (65.9%), at risk for mental health problems (21.6%), or with mental health problems (12.5%) and participated in a 90 min per week face-to-face training with 8 sessions in class at school. Demographic variables, mental health status, stress symptoms, and knowledge about stress and mental health were collected at baseline. Program acceptance, stress symptoms, and knowledge were collected post-intervention. Multilevel mixed effects models were conducted with the fixed effects time (within factor), mental health status, gender, and grade level (between factors). Random effects for students within classes were included.ResultsIn the pre-post comparison, mental health status moderated the changes on psychological stress symptoms (p < 0.05). In adolescents with mental health problems the largest reduction in stress symptoms was observed between pre- and post-assessment. Gender and grade level were less relevant. For all adolescents knowledge gains were revealed (p < 0.001). Program acceptance was moderated by mental health status and grade level (p < 0.01). Mentally healthy adolescents and within the group of adolescents at-risk or with mental health problems, especially younger students (7th/8th grade), rated program acceptance higher.ConclusionPsychological stress symptoms decreased among adolescents with mental health problems and not among adolescents at risk for or without mental health problems. Mental health-related knowledge increased for all adolescents. The results add to knowledge on school-based mental health intervention research and practice. Its implications for different prevention strategies (universal, selective or a combination of both) are discussed.

Intervention effects of a school-based health promotion programme on children’s nutrition behaviour

AimThe programme “Join the Healthy Boat” promotes amongst other things a healthy diet in primary school children. In order to evaluate the programme’s effectiveness, this study longitudinally investigated children’s nutrition behaviour.Subject and methodsA total of 1564 children (7.1 ± 0.6 years) participated in a cluster-randomised study. Teachers delivered lessons including behavioural contracting and budgeting. Nutritional behaviours of parents and child were assessed via parental report. Anthropometrics were measured on site.ResultsAfter one year, children in the intervention group (IG) showed a significant reduction in the consumption of pure juices (p ≤ 0.001). Soft drink consumption reduced in both groups, although with a trend towards a slightly greater reduction in the IG. Children with fathers of normal weight as well as first graders showed a significant reduction of soft drink consumption in the IG (p = 0.025 and p = 0.022 respectively). Fruit and vegetable intake increased significantly for first graders (p = 0.050), children from families with a high parental education level (p = 0.023), and for children with an overweight father (p = 0.034). Significant group differences were found for fruit and vegetable intake of children with migration background (p = 0.01) and children of parents with a high school degree could be observed (p = 0.019).ConclusionThis shows that the programme appeals to a wider range of children, and is therefore more likely to compensate for differences due to origin or other social inequalities, which also shows that active parental involvement is vital for successful interventions.

Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina

ABSTRACT The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination—including Human Papillomavirus (HPV) vaccination—in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers’ ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.

Implementation Factors and Teacher Experience of the Integrated Nutrition Education Program: A Mixed Methods Program Evaluation.

School-based programs are widely implemented to address childhood obesity. Despite the promise of these programs, evidence on their effectiveness is mixed. Adopting a dissemination and implementation (D&I) science focus utilizing mixed methods can provide a broader understanding and more robust details about these programs. The goal of this evaluation is to understand how implementation factors and teacher experience influence implementation success and outcomes of the Integrated Nutrition Education Program (INEP), an elementary school-based nutrition program, using a mixed-methods design. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework guided the development of the evaluation and multiple methods were deployed. Hierarchical linear regression was used to assess the association between D&I construct variables within levels of influence and teacher perception of INEP impact from a quantitative end-of-year teacher survey. Follow-up qualitative interviews with teachers were analyzed using constant comparison analysis. Workload and burden emerged as significant factors related to implementation in the quantitative analysis. The follow-up qualitative data collection identified other factors teachers found important to the adoption, implementation, and maintenance of INEP. Results of this evaluation can be used to inform program improvement efforts for INEP and provide information on ways to promote reach, effectiveness, adoption, implementation, and maintenance of similar school-based health promotion programs.

Effectiveness of three different types of oral health promotion programs among schoolchildren in Sakaka, Saudi Arabia: A cluster randomized controlled trial

Background: Untreated component of dental caries in Saudi Arabia is alarming even though the accessibility of dental services is at free of cost to all Saudi nationals. Aim/Objective: The aim of the present study is to assess the efficiency among three different types of school-based oral health promotion programs in Sakaka children. Materials and Methods: A cluster randomized controlled trail included 765 schoolchildren. Three different models of school-based oral health promotion programs were tested in this study. Outcome measures were evaluated after 12-month follow-up, which include difference in prevalence and mean number of untreated dental caries, annual dental service utilization rates, and difference in mean oral health-promoting behavior between baseline and at the end of the program. Results: Seven hundred and two children were available for outcome measurement. There is reduction in both prevalence and mean number of untreated dental caries in all the three groups but significant reduction observed in Model-3 group of children. Similarly, improvement in dental visit patterns was also observed more in Model-3 group compared with other two groups. Conclusion: Health education including teachers with 6-monthly reinforcement, screening, and referral to specific treatment facility with follow-up reminders was found to be an effective model.

School-Based Mental Health Promotion and Early Intervention Programs in New South Wales, Australia: Mapping Practice to Policy and Evidence

Limited empirical evidence is available regarding the uptake and effectiveness of school-based mental health and wellbeing programs implemented in Australian schools. This study aimed to characterise the delivery of programs in primary (elementary) schools across New South Wales, Australia, and to assess this information against published ratings of program effectiveness. Delivery of programs in four health-promoting domains—creating a positive school community; teaching social and emotional skills; engaging the parent community; and supporting students experiencing mental health difficulties—were reported by 597 school principals/leaders via online survey. Although three quarters of principals reported implementing at least one program, many of these programs were supported by little or no evidence of effectiveness. There was also variability in the use of evidence-based programs across the four domains. Findings indicate a need to provide educators with improved support to identify, implement, and evaluate effective evidenced-based programs that promote student mental health.

Mental Health and Wellbeing of 9-12-year-old Children in Northern Canada Before the COVID-19 Pandemic and After the First Lockdown.

Objectives: Children’s mental health and wellbeing declined during the first COVID-19 lockdown (Spring 2020), particularly among those from disadvantaged settings. We compared mental health and wellbeing of school-aged children observed pre-pandemic in 2018 and after the first lockdown was lifted and schools reopened in Fall 2020.Methods: In 2018, we surveyed 476 grade 4–6 students (9–12 years old) from 11 schools in socioeconomically disadvantaged communities in Northern Canada that participate in a school-based health promotion program targeting healthy lifestyle behaviours and mental wellbeing. In November-December 2020, we surveyed 467 grade 4–6 students in the same schools. The 12 questions in the mental health and wellbeing domain were grouped based on correlation and examined using multivariable logistic regression.Results: There were no notable changes pre-pandemic vs. post-lockdown in responses to each of the 12 questions or any of the sub-groupings.Conclusion: Supporting schools to implement health promotion programs may help mitigate the impact of the pandemic on children’s mental health and wellbeing. The findings align with recent calls for schools to remain open as long as possible during the pandemic response.

Effectiveness of the school-based oral health promotion programmes from preschool to high school: A systematic review.

BackgroundSchools offer an opportunity for oral health promotion in children and adolescents. The purpose of this study was to conduct a systematic review of the influence of school-based oral health promotion programmes on oral health knowledge (OHK), behaviours (OHB), attitude (OHA), status (OHS), and quality of life (OHRQoL) of children and adolescents.MethodsA systematic search on the PubMed and Embase databases was conducted to identify eligible studies. The last search was done on April 24th, 2020. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools.ResultsOf the 997 articles identified, 31 articles were included in this review. Seven studies targeted students in preschools, seventeen in elementary schools, and seven in high schools. Most of these studies revealed positive outcomes. Some studies showed that the school-based oral health promotion programmes showed better OHK, OHB, OHS, and OHRQoL.ConclusionPositive results were obtained through oral health promotion programmes in schools, especially those involving children, teachers, and parents.

Cost-effectiveness and return on investment of school-based health promotion programmes for chronic disease prevention.

BackgroundWhile school-based health prevention programmes are effective in addressing unhealthy diet and physical inactivity, little is known about their economic implications. We conducted an economic evaluation of the programmes that were previously identified as feasible, acceptable, and sustainable in the Canadian context.MethodsThis study builds on a meta-analysis of the effectiveness of feasible, acceptable, and sustainable school-based health promotion programmes. A micro-simulation model incorporated intervention effects on multiple risk factors to estimate incremental cost-effectiveness and return on investment (ROI) of comprehensive school health (CSH), multicomponent, and physical education (PE) curriculum modification programmes. Cost-effectiveness was expressed as the programme costs below which the programme would be cost-effective at a CA$50 000 threshold level.ResultsThe estimated costs below which interventions were cost-effective per quality-adjusted life year gained were CA$682, CA$444, and CA$416 per student for CSH, multicomponent, and PE curriculum modification programmes, respectively. CSH programmes remained cost-effective per year of chronic disease prevented for costs of up to CA$3384 per student, compared to CA$1911 and CA$1987 for multicomponent and PE curriculum modification interventions, respectively. If the interventions were implemented at total discounted intervention costs of CA$100 per student, ROI through the avoidance of direct healthcare costs related to the treatment and management of chronic diseases would be 824% for CSH, 465% for multicomponent interventions, and 484% for PE curriculum modification interventions.ConclusionsWhereas each examined intervention types showed favourable economic benefits, CSH programmes appeared to be the most cost-effective and to have the highest ROI.