In the last decade, a National School Health Policy (NSHP) has been formulated in several developing countries following the recommendations of the Global School Health Initiative. However, NSHP implementations across the country have not been fully shared. This study aimed to identify factors that have influenced implementation of the NSHP in Lao People's Democratic Republic (Lao PDR). We conducted key informant interviews with 20 NSHP implementers and document reviews. Data were collected at the national level and at three lower administrative levels (provincial, district and school) in three areas (north, central and south). Study areas were selected according to the history of NSHP interventions. We applied content analysis using 12 key components of successful policy implementation and a policy triangle framework. We found that scaling up to nationwide implementation was limited. Results showed the NSHP implementation in Lao PDR was influenced by nine interlinked factors, including extensive planning, resource management, monitoring cycle, the perception gap between national and lower administrative officers, national task-force ownership, ongoing coaching of district educational officers, management skills of school principals, priority of school health and decentralization. Furthermore, these nine factors could be integrated into the existing educational system. In conclusion, for sustainable and nationwide implementation of the NSHP in Lao PDR, the following three factors need to be embedded in the educational system: extensive planning with a clear long-term vision at national level, human resource management including well-organized training at each administrative level and a monitoring cycle to understand the real situation at school level.

Different cultures often express the same symptoms of physical and mental disorders in different ways. Therefore, the original four-factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D) may not be appropriate in all cultural contexts. This study aimed to develop a Laotian version of the CES-D, investigate the reliability and validity of the Laotian CES-D, and examine its factorial properties. This study was conducted in Laos PDR in February 2010. Data were collected from 189 staff members and teachers from the Faculty of Education, National University of Laos using the Laotian CES-D. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to determine the structure of the Laotian CES-D. We tested whether the Laotian CES-D differed from a single factor model of the 20-item CES-D, and from Radloff's original four-factor solution. CFA results indicated that neither the single factor model nor the four-factor solution was a good fit for a Laotian sample. EFA was conducted to determine a Laotian-specific model, which was tested using CFA. Five items that had low commonality and low factor loadings were excluded in the CFA. Next, we determined a best fit structure comprising three factors: "Sadness/loneliness", "Psychosomatic symptoms", and "Lack of positive affect". This Laotian CES-D model showed high reliability (alpha = 0.81). "Dislike" items loaded on the "Interpersonal" factor in Radloff's model, but loaded on the "Sadness/loneliness" factor in the Laotian model. Items indicating depressive feelings, somatic complaints, and interpersonal relationships were com

Summary This paper argues the effectiveness of Ecohealth education for improving the quality of health and environmental education and for achieving sustainable development in developing countries. To illustrate the need for Ecohealth education, we review the transitions in health education, environmental education and Education for Sustainable Development (ESD) in various developing countries. Moreover, we discuss issues relating to these disciplines and consider the possible roles that Ecohealth education can play. Then, drawing on a case study conducted in Lao PDR, we propose a concrete example of the teaching content of Ecohealth education. We conclude that Ecohealth education can embody the concepts of ESD with respect to health and environmental issues, and thus can contribute to improvements in the quality of health and environmental education, and of ESD. In addition, we propose the following five actions for implementing Ecohealth education in developing countries: (i) promote research based on the approaches of public health and anthropology, and develop teaching materials that use the research results, (ii) empower school-aged children, (iii) encourage the active involvement and sharing of problems among communities, (iv) strengthen participatory teaching and learning methodology and (v) build a training system and train relevant teachers.

This study aimed to develop a Laotian adolescent version of the Center for Epidemiologic Studies Depression Scale (CES-D), determine its reliability and validity, and examine its factorial properties. The study targeted at 7,554 students in lower secondary schools and teacher training colleges in Lao PDR. Self-administered questionnaires were collected from 2012 to 2014. Exploratory factor analysis performed in three age groups using the weighted least square mean and variance adjusted estimation with robust maximum likelihood methods. The factor structure for each age group was the same; therefore, data from the full sample were analyzed further. The model was then tested by confirmatory factor analysis. A 2-factor model was determined as a common model among the age groups by using paralleled analysis. We determined a best-fitting structure comprising two factors: “Negative affect” and “Positive affect.” The Cronbach’s alpha was .81. “Effort” items loaded on the “Somatic and retarded activity” factor in the original model but loaded on the “Positive affect” factor in the adolescent model. “Depressed affect,” “Somatic and retarded activity,” and “Interpersonal” items were combined into the “Negative affect” factor in the adolescent model.

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