Phases of school health promotion implementation through the lens of complexity theory: lessons learnt from an Austrian case study

The implementation of health promotion concepts in (school) settings is a complex undertaking on which little scientific knowledge exists. The purpose of this study was to better understand organizational influences on the implementation of school health promotion. An extended case study design that incorporated important insights from complexity science was used. This design influenced the focus of analysis and led to the use of multiple methods of data collection and analysis. A primary school in Vienna served as a case for observing and analysing the first year of implementing the health-promoting school concept. The study provided detailed insights into the implementation process. Results showed four chronologically overlapping implementation phases (starting health promotion, deciding what to do, planning health promotion projects, doing health promotion) on different system levels. In each phase, the original health-promoting school concept was adapted to the necessities and characteristics of each level and, therefore, changed considerably. Implications for possible adaptations of the health-promoting school concept to better fit the situation in schools are discussed.     

The opportunities and effectiveness of the health promoting primary school in improving child health--a review of the claims and evidence.

School health programs have been part of schooling for most of this century. The health promoting school is a recently developed concept which seeks to provide a multifaceted approach to school health. Will it provide a better frame-work to assist schools address the health issues of their students? This paper examines the development of the health promoting school and identifies its structural components. It reviews the claims and evidence which have emerged from the school health research literature which focus on primary schools. Findings indicate health gains for primary school students are difficult to assess, and will most likely occur if a well-designed program is implemented which links the curriculum with other health promoting school actions, contains substantial professional development for teachers and is underpinned by a theoretical model. The paper concludes by discussing how improvements can be made in more accurately assessing the effectiveness of the health promoting primary school in improving school health.     

Support for health promoting schools: a typology of supporting strategies in Austrian provinces

Schools that want to implement health promotion (HP) are often confronted with obstacles that they cannot overcome by themselves and therefore need support from their environment. However, the issue of which kind of support is needed for HP implementation is complex. A systems approach suggests that the individual logic of each school be considered and that supporting strategies be flexible to specific needs. This article pursues the question which types of support for health promoting schools are offered on a provincial level in Austria. Using a grounded theory approach, 18 in-depth interviews with representatives of provincial organizations and 26 documents relevant for school HP were analysed. As a result, five different strategies of supporting health promoting schools have been identified in Austria: (i) organize exchange among schools, (ii) establish certification and quality control of school health efforts, (iii) offer consultation and information, (iv) carry out a specific HP programme and (v) coordinate HP actors and information. These strategies are usually combined and rarely occur in their pure form. It was also determined that the coordination of the different strategies and human resources for HP are missing for schools in Austria. It is argued that each of these supporting strategies has benefits and limitations for schools and the providers, and that they all have the potential to respond to the school as a complex social system.     

Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies

School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005. An understanding of the prevalence and predictors of and the barriers to the adoption of school-based vegetable and fruit programs is necessary to maximize their adoption by schools and ensure that the health benefits of such programs to children are realized. The aim of this study was to determine Australian primary school Principals' attitudes and barriers to the implementation of vegetable and fruit breaks; the prevalence of vegetable and fruit breaks in schools and the implementation strategies used and associated with their recommended adoption (daily in at least 80% of classes). A random sample of 384 school Principals completed a 20-min telephone interview. While Principals were highly supportive of vegetable and fruit breaks, only 44% were implementing these to a recommended level. When controlling for all school characteristics, recommended vegetable and fruit break adoption was 1.9 and 2.2 times greater, respectively, in schools that had parent communication strategies and teachers trained. A substantial opportunity exists to enhance the health of children through the adoption of vegetable and fruit breaks in schools.     

循证心理健康服务在小学实施的促进与阻碍因素

目的 探索实施学校循证心理健康服务的促进与阻碍因素,为推动中国学校循证心理健康服务发展提供实践经验。方法 在为河南省10所小学提供循证心理健康服务后,对4名教育局领导、8名学校管理者、7名任课教师、7名服务实施者进行半结构式访谈。采用主题分析法对访谈资料进行类属分析。结果 实施学校循证心理健康服务面临着宏观层面、学校层面、个体层面多重因素的影响。共提炼出8个促进因素和9个阻碍因素,其中教师职称评价体系“排斥”心理健康服务、服务与学校教学存在时间冲突、心理健康服务污名化、感知到的服务效果与期望不匹配等因素的影响尤为突出。结论 循证心理健康服务在中国学校实施是可行的,实施过程中需要充分考虑宏观、学校、个人多层面的因素,推动中国的循证心理健康服务从理论和数据走向实践。     

Evaluations of health promoting schools: a review of nine studies

The concept of 'health promoting schools' has been embraced internationally as an effective way of promoting the health of children, adolescents, and the wider school community. It is only recently that attempts have been made to evaluate health promoting schools. This paper reviews evaluations of health promoting schools and draws useful evaluation methodology lessons. The review is confined to school-based interventions that are founded explicitly on the concept of the health promoting school and employ the concept beyond one school domain. We included nine evaluations in this review. Seven of these were published in the peer reviewed scientific literature. Two were unpublished reports. One study was a randomized controlled trial, while a quasi-experimental research design with comparison schools was used in three studies. With three exceptions, combinations of quantitative and qualitative data were collected. There was evidence that the health promoting school has some influence on various domains of health for the school community. It is also possible to integrate health promotion into the school curriculum and policies successfully. However, the evaluation of health promoting schools is complex. We discuss some of the methodological challenges of evaluating health promoting schools and make suggestions for improving future evaluations.     

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.     

Involving students in learning and health promotion processes--clarifying why? what? and how?

The concept of student participation is currently a popular notion in health promoting schools as well as in general education. However, phrases such as 'involvement', 'participation', 'co-determination' and 'influence' are frequently used without careful definition. In this article two models, developed in the context of health promoting schools in two different cultures, are presented and discussed. The first model makes a fundamental distinction between token and genuine participation. Token participation in health promotion is characterised by focusing on prescribed knowledge, closed and convergent outcomes and targeting individuals isolated from the surrounding environment. In contrast, genuine participation stresses students' own construction of knowledge, open and divergent outcomes and targeting individuals in their context. Genuine participation is in accordance with a democratic health promoting school aiming at students' empowerment and action competence. The second model clarifies a number of different categories of students' participation in health promotion. The different categories illustrate how the teacher in various ways can play an active role in participatory approaches as a responsible professional. The more the students are involved in health projects, the more important it will be for the teacher to provide support, insight and knowledge to facilitate the learning processes. Furthermore, the different participation categories have to be related to a number of decisions which are normally included in a school health project. The model illustrates that participation should always be viewed in relation to the context and that it makes no sense to establish a single ideal way of working with participation in a health promoting school. The theoretical models are illuminated by concrete examples from health promoting schools. The overall conclusion is that participation is a complex term and rather than providing definitive answers, the models can be used as a framework for discussion among all stakeholders in planning, implementation, evaluation and managing projects involving student participation. Finally, specific implications and challenges for future health promoting schools are outlined. These are as follows: a participatory approach does not imply that health content should be regarded as vague or superfluous; teachers need flexible educational models and resources to manage participatory projects in health promoting schools; schools have to be acknowledged as cultural systems with firmly rooted rules and routines that are often difficult to change; a participatory approach has to influence all aspects of a democratic health promoting school rather than solely the teaching strategies.     

The relationship between school health councils and school health policies and programs in US schools

ABSTRACT: This study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000 to examine the relationship between school health councils and selected school health policies and programs. SHPPS 2000 collected data from faculty and staff in a nationally representative sample of schools. About two-thirds (65.7%) of US schools have school health councils. Schools with councils were significantly more likely than schools without councils to report policies and programs related to health services. mental health and social services; faculty and staff health promotion, and family and community involvement. Schools with councils were as likely as schools without councils to report policies and programs related to health education, physical education, and food service. Although school health councils are associated with the presence of some key school health policies and programs, a council does not guarantee a school will have all important school health policies and programs in place.     

Self-reported barriers to quality physical education by physical education specialists in Texas

School-based programs offer an efficient means of promoting the health of a large number of children. The Coordinated Approach to Child Health (CATCH) program was designed to decrease risk factors for chronic disease in elementary school children and includes separate coordinated interventions for child nutrition services, physical education (PE), classroom instruction, and family education. Physical education specialists who attended CATCH training during school years 2000-2003 were surveyed about CATCH PE at their respective schools. The survey included items pertaining to PE barriers, implementation and satisfaction of CATCH PE, and demographic characteristics. A serial cross-sectional study design was used; response rates were 58.6% in 2000, 20.9% in 2001, 38.7% in 2002, and 57.7% in 2003. The top two rank order barriers to quality PE were large class size and low academic value. Future research should focus on determining characteristics of schools that are achieving quality PE programs.