Building community capacity to stimulate physical activity and dietary behavior in Dutch secondary schools: Evaluation of the FLASH intervention using the REAIM framework

Dongen, Bonnie Maria van; Vries, Inge Maria de; Ridder, Monica Antonia Maria; Boer, Michiel de; Steenhuis, I.H.M.; Renders, Carry M.

doi:10.3389/fpubh.2022.926465

Cited by 5 publications

(8 citation statements)

References 46 publications

(62 reference statements)

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“…The importance of identifying and empowering organisation champions to successfully scale up public health interventions has been described previously in other comparable research within and beyond the school-setting (Carson et al. , 2014; van Dongen et al. , 2022; Lane et al.…”

Section: Discussionmentioning

confidence: 85%

“…However, in many schools, enthusiasm about the project was less than anticipated and limited time and/or efforts were spent on involving relevant stakeholders. Given the importance of stakeholder involvement for sustainable implementation (Bartelink et al, 2019a, b, c;Deschesnes et al, 2003;Durlak and DuPre, 2008;Pearson et al, 2015), for future projects it is crucial to provide schools with more extensive guidance and support on how to adequately do this (van Dongen et al, 2022). A process coordinator could play a more Healthpromoting activities in school context proactive role in this, e.g.…”

Section: Discussionmentioning

confidence: 99%

“…, 2003; Durlak and DuPre, 2008; Pearson et al. , 2015), for future projects it is crucial to provide schools with more extensive guidance and support on how to adequately do this (van Dongen et al. , 2022).…”

Section: Discussionmentioning

confidence: 99%

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Implementing health-promoting activities in diverse primary school contexts in the Netherlands: practical lessons learnt

Hahnraths

Willeboordse

Schayck

2023

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PurposeTo gain insight into factors enhancing or obstructing implementation in various school-settings, which is vital for widespread dissemination and sustainable integration of school-based health-promoting interventions.Design/methodology/approachA mixed methods multisite comparative case study to investigate (factors influencing) the implementation of health-promoting activities in twelve Dutch primary schools. Data were collected during three school years (2019–2022) through observations, questionnaires and interviews.FindingsThe project resulted in the implementation of small, incidental activities. Important reasons for the limited implementation were lack of commitment and bottom-up involvement. School directors and teachers were not involved early on in the project, which limited project support and commitment. On school level, directors largely carried project responsibility themselves, hindering project sustainability and integration. Coronavirus disease 2019 (COVID-19) made that schools had difficulties forming long-term visions and plans. Other observed barriers included limited perceived necessity to change, high workload and high staff turnover. Important facilitators were the presence of a process coordinator and sharing experiences from other schools.Originality/valueThis research provided valuable insights into (factors influencing) the implementation of health-promoting initiatives in diverse, real-world school contexts. More extensive support is needed to create commitment, bottom-up involvement and a project vision. Furthermore, empowering in-school champions and/or school-wide project groups is desirable to decrease schools' dependence on long-term external support. The findings can be used by various stakeholders throughout development, adoption and implementation and can facilitate widespread dissemination and sustainable integration of school-based health-promoting interventions.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Implementing health-promoting activities in diverse primary school contexts in the Netherlands: practical lessons learnt

Hahnraths

Willeboordse

Schayck

2023

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“…A previous study evaluated the impact of FLASH on these capacity-building strategies ( van Dongen et al ., 2022 ); it revealed that the level of community capacity increased in all participating schools. Most notable improvements were seen in leadership.…”

Section: Introductionmentioning

confidence: 99%

Increasing community capacity to improve the implementation of Health Promoting Schools: barriers and facilitators from the FLASH intervention

van Dongen,

Ridder,

Wolters

et al. 2023

Health Promotion International

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Building community capacity is important for the successful implementation of a Health Promoting School. To identify how capacity building can be encouraged in secondary schools, four schools engaged in the Fit Lifestyle at School and at Home (FLASH) intervention for 3 years. This study explores barriers and facilitators that school personnel, parents and pupils experienced in the capacity-building process. Thirty-one stakeholders were interviewed. Transcripts were analysed thematically based on the five actions of the intervention: (i) appoint a Healthy School coordinator and build a team, (ii) determine ambitions, (iii) design and (iv) implement the action plan and (v) evaluate and improve. The time and support allocated to coordinators helped them evolve their role from executors of health-promotion activities to coordinators, instigators and gatekeepers of the implementation process. Participatory tools helped identify shared values among stakeholders to determine context-specific ambitions and leverage points for interventions. Coordinators indicated that they lacked the skills and authority to engage pupils and parents and to reach the broader community. Coordinators struggled with translating promising ideas into action plans of coherent and mutually supportive activities and embedding them into policy. Strong leadership of Healthy School coordinators, who focus on the capacity-building process and foster collaborative relationships, is essential to build community capacity. In this process, more guidance is needed on how to involve the broader community in various phases. Furthermore, coordinators can benefit from professional development to align jointly designed activities into a comprehensive action plan embedded into Healthy School policies.

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“…The Healthy School approach, the Dutch version of the HPS framework, was used as a starting point for the intervention schools because they were already familiar with this approach at the start of the FLASH intervention and would continue with it after FLASH [78,81]. A previous study evaluated the impact of the FLASH intervention on community capacity and capacity-building processes [173]; it revealed that the level of community capacity increased in all participating schools. Most notable improvements were seen in leadership.…”

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confidence: 99%

Creating a Healthy School together

Dongen¹

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Dutch schools increasingly work towards stimulating healthy choices among adolescents through the Dutch Healthy School-approach. However, interventions and programs are difficult to sustainably embed and maintain in every day practice, and long term effects remain limited. In order to achieve (sustainable) implementation of Healthy School initiatives, it is advocated that the dynamic nature and the complexity of real-life practice needs to be embraced rather than avoided. Two central themes seem to arise when looking at indicators for successful implementation: a) contextualization is key to ensure that local initiatives are tailored to the dynamic and unique context of the school, and b) stakeholders in a school need to feel ownership and need to be empowered by means of leadership, collaboration and community involvement. In order for stakeholders to address these themes, a focus on the concept of ‘building community capacity’ can be an interesting strategy. This pertains ‘the development of knowledge, skills, ownership, leadership, structures and systems to enable effective health promotion’. Despite the fact that community capacity has long been recognized as an important indicator of program success, there is no simple, clear approach available to translate this into a strategy for practice, and to measure the development and impact of such a strategy. This dissertation aims to explore whether and how building community capacity can work as a strategy to (sustainably) implement a context-specific a broadly supported Healthy School-initiative in Dutch secondary schools. In the Fit Lifestyle at School and at Home (FLASH) intervention four prevocational schools in the Netherlands were encouraged to create a Healthy School community that specifically stimulated physical activity and healthy dietary behavior among pupils. The theoretical principles of FLASH are based on the Community Readiness to Change-method, resulting in four capacity-building strategies: 1) identifying and motivating leaders; 2) promoting a participatory school culture; 3) designing and implementing tailored health-promotion activities; and 4) creating a local network of collaborations and resources. Findings illustrated that these strategies, as explored in FLASH, can provide a reference to translate the concept of building community capacity to the real-life practice of Dutch secondary schools. By focusing on capacity-building, schools put more emphasis on the process of becoming a Healthy School that suits their unique and dynamic context. Engaging in continuous conversations about where to go and who and what is needed to get there, enabled stakeholders to move beyond organizing health-topic-specific activities and realize change is also needed on an organizational level. As a result, schools particularly increased their use of strategies concerning leadership and participatory school culture. At the same time, these efforts did not (yet) lead to improved health and health behavior among adolescents, and we observed a stagnation on the "initiation" stage of readiness in all capacity-building strategies. A contributing factor to this observation is that experiences of stakeholders in FLASH show that building community capacity is a long-term process and new focus for stakeholders, and therefore requires time to understand and grow. Because community capacity-building activities initially focus on organizational processes rather than directly stimulating healthy behavior through health promotion activities, delays in the system of a Healthy School community on health-related outcomes can occur. Nevertheless, it is worth engaging in a continued capacity-building process of a "Plan-Do-Check-Act" cycle that can potentially be sustained. By building on the expertise of professionals, the opportunities in and around the school system, and the needs and wants of community members, continuous improvement can be evoked so that schools get into an upward spiral. This can help stakeholders build a strong and professional Healthy School based on an integral approach that is embedded in the school's DNA.

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Building community capacity to stimulate physical activity and dietary behavior in Dutch secondary schools: Evaluation of the FLASH intervention using the REAIM framework

Cited by 5 publications

References 46 publications

Implementing health-promoting activities in diverse primary school contexts in the Netherlands: practical lessons learnt

Implementing health-promoting activities in diverse primary school contexts in the Netherlands: practical lessons learnt

Increasing community capacity to improve the implementation of Health Promoting Schools: barriers and facilitators from the FLASH intervention

Creating a Healthy School together

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