BackgroundComprehensive School Health (CSH) is an internationally recognized framework that holistically addresses school health by transforming the school culture. It has been shown to be effective in enhancing health behaviours among students while also improving educational outcomes. Despite this effectiveness, there is a need to focus on how CSH is implemented. Previous studies have attempted to uncover the conditions necessary for successful operationalization, but none have described them in relation to a proven best practice model of implementation that has demonstrated positive changes to school culture and improvements in health behaviours.MethodsThe purpose of this research was to identify the essential conditions of CSH implementation utilizing secondary analysis of qualitative interview data, incorporating a multitude of stakeholder perspectives. This included inductive content analysis of teacher (n = 45), principal (n = 46), and school health facilitator (n = 34) viewpoints, all of whom were employed within successful CSH project schools in Alberta, Canada between 2008 and 2013.ResultsMany themes were identified, here called conditions, that were divided into two categories: ‘core conditions’ (students as change agents, school-specific autonomy, demonstrated administrative leadership, dedicated champion to engage school staff, community support, evidence, professional development) and ‘contextual conditions’ (time, funding and project supports, readiness and prior community connectivity). Core conditions were defined as those conditions necessary for CSH to be successfully implemented, whereas contextual conditions had a great degree of influence on the ability for the core conditions to be obtained. Together, and in consideration of already established ‘process conditions’ developed by APPLE Schools (assess, vision, prioritize; develop and implement an action plan; monitor, evaluate, celebrate), these represent the essential conditions of successful CSH implementation.ConclusionsOverall, the present research contributes to the evidence-base of CSH implementation, ultimately helping to shape its optimization by providing school communities with a set of understandable essential conditions for CSH implementation. Such research is important as it helps to support and bolster the CSH framework that has been shown to improve the education, health, and well-being of school-aged children.

Comprehensive School Health (CSH) is an internationally recognized framework that moves beyond the individual to holistically address school health, leading to the development of health-enhancing behaviors while also improving educational outcomes. Previous research has suggested that principal support for CSH implementation is essential, but this role has yet to be explored. Therefore, the purpose of this research was to examine the role of the principal in the implementation of a CSH project aimed at creating a healthy school culture. This research was guided by the grounded ethnography method. Semi-structured interviews were conducted with APPLE School principals (n = 29) to qualitatively explore their role in creating a healthy school culture. A model consisting of five major themes emerged, suggesting that the principal played a fluid role throughout the CSH implementation process. Principals (i) primed the cultural change; (ii) communicated the project's importance to others; (iii) negotiated concerns and collaboratively planned; (iv) held others accountable to the change, while enabling them to take ownership and (v) played an underlying supportive role, providing positive recognition and establishing ongoing commitment. This research provides recommendations to help establish effective leadership practices in schools, conducive to creating a healthy school culture.

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Objective Sedentary behaviours, physical inactivity, and poor diets in Canadian children are a major public health problem. Comprehensive school health (CSH) recognizes the importance of school and home collaboration; however, it is unknown how health behaviours promoted in school are adopted at home. The purpose of this research was to explore student perceptions of the translation of an intervention taking a CSH approach in Alberta, Canada, into the home environment. Methods The guiding method was focused ethnography, using photovoice as the data generation strategy. Grades 5 and 6 students were purposively sampled (n = 25), and asked to take photos of what CSH looks like in their home environment. Subsequent one-on-one interviews were conducted as part of the photovoice process to gain a deeper understanding of student perceptions. Results Two main themes emerged: students embraced the CSH philosophy, and students are driving change to create a healthy home culture. The underlying concept of leadership and independence was necessary for students to impact their health and the health of family members. Results demonstrated that students are catalyzing positive changes in the home environment by supporting changes in the home food environment, trying new things, facilitating improvements to healthy eating and active living, and monitoring unhealthy behaviours. Conclusion This study illustrates students' abilities to positively impact the home environment as a result of their involvement in CSH. Student leadership and independence should be promoted and emphasized in CSH to facilitate transition of health behaviours into the home environment.