Validation of an instrument to evaluate health promotion at schools

Abstract

OBJECTIVE To validate an instrument designed to assess health promotion in the school environment.METHODS A questionnaire, based on guidelines from the World Health Organization and in line with the Brazilian school health context, was developed to validate the research instrument. There were 60 items in the instrument that included 40 questions for the school manager and 20 items with direct observations made by the interviewer. The items’ content validation was performed using the Delphi technique, with the instrument being applied in 53 schools from two medium-sized cities in the South region of Brazil. Reliability (Cronbach’s alpha and split-half) and validity (principal component analysis) analyses were performed.RESULTS The final instrument remained composed of 28 items, distributed into three dimensions: pedagogical, structural and relational. The resulting components showed good factorial loads (> 0.4) and acceptable reliability (> 0.6) for most items. The pedagogical dimension identifies educational activities regarding drugs and sexuality, violence and prejudice, auto care and peace and quality of life. The structural dimension is comprised of access, sanitary structure, and conservation and equipment. The relational dimension includes relationships within the school and with the community.CONCLUSIONS The proposed instrument presents satisfactory validity and reliability values, which include aspects relevant to promote health in schools. Its use allows the description of the health promotion conditions to which students from each educational institution are exposed. Because this instrument includes items directly observed by the investigator, it should only be used during periods when there are full and regular activities at the school in question.

Development and Validity Testing of the School Health Score Card

“…The SHSC in the current study combined the components of SHI with 6 essential components of the HPS: (1) healthy school policies, (2) the school's physical environment, (3) the school's social environment, (4) community links, (5) individual health skills and action competencies, and (6) health services . The final composition of the SHSC had satisfactory reliability and validity and included dimensions composed of items that are compatible with the themes indicated as priorities for health‐promoting activities and structures in the school environment …”

“…The final SHSC questionnaire had 158 items by which health managers and officers assessed the school environment and key evidence‐based and best health‐promotion practices. The items were presented in the form of questions with yes or no answers that were easily applicable, which eliminated ambiguities regarding whether or not the environments and practices exist …”

“…For Phase I, we organized lists of indicators related to school health‐promotion programs as well as worksite health management. We reviewed more than 20 published indexes, such as the SHI developed by the CDC, the GSHS based on the WHO guidelines, the Hong Kong Healthy Schools Award, the PeNSE—National Survey of School Health in Brazil, the CDC Worksite Health Scorecard, the Worksite Health Index, the US Comprehensive Soldier Fitness Program, the Health Impact Assessment, and the 26 school health‐related statutes of the Republic of Korea such as the Korean School Health Act, the School Meals Act, and the Act of the Prevention of and Countermeasures Against Violence in School. In this report, we only cite the key sources for each related topic.…”

“…Adolescence is a critical time for the development of not only the health and lifestyle of adolescents, but also the health and lifestyle that adolescents will have as adults . As schools provide physical and social environments that affect the lifestyle and health‐related behaviors of adolescents, comprehensive school‐based initiatives target healthy lifestyles with changes to health‐related behaviors as well as changes to the school environment . There are various emerging programs that comprehensively promote health in schools, such as the Health‐Promoting Schools (HPS) concept from the World Health Organization (WHO), the Focusing Resources on Effective School Health program from the United Nations Educational Scientific and Cultural Organization, and the Coordinated School Health Program (CSHP) from the US Centers for Disease Control and Prevention (CDC).…”

“…Comprehensive instruments to assess environmental conditions and health‐promoting practices in schools have been recognized as beneficial . There are several measurements such as the School Health Index (SHI) developed by the CDC, the Hong Kong Healthy Schools Award, and the Pesquisa Nacional de Saúde do Escolar (PeNSE—National Survey of School Health) in Brazil . The SHI is tool designed within the context of the CSHP to assess health in schools .…”