Establishing and implementing a health promoting school in rural Cambodia

Abstract

Summary Few studies have used a whole-of-school approach in implementing a health promoting schools (HPS) framework. Descriptions of how HPS is being implemented, particularly in low-resourced, developing countries, are limited. This study used an exploratory case study design to examine the planning and implementation of a HPS in a rural Cambodian village. Data were collected via observations of the school, school documentation, and interviews with stakeholders (n = 9). The data were analysed inductively as an iterative process, from initial coding, through to categorizing, leading to concept mapping and then identifying the emergent themes within the stages of school development and implementation of educational and health programming. The case study demonstrated how all six components of the HPS framework can be used to plan and implement a school in a rural village in a developing country. The key elements of implementation were building local and international partnerships, local leadership, and a culture of change and participation. These elements were used to establish a non-profit school that aimed to address the stated health and educational needs of local villagers. This case study adds to the limited evidence on the HPS components and implementation methods that are being applied in low-resourced, developing countries.

Status of school health programs in Asia: National policy and implementation

“…1,9,17 Cambodia also depends on overseas aid to pursue educational development and a range of funded projects targeted at resolving key educational issues. 18,19 As Cambodia's newly endorsed national policy focuses on general physical health, 8,20,21 we can observe some similarities with Japan. However, while its national policy does not explicitly reference HPS, many aspects of the approach are present.…”

A comparative study of life skills, lifestyle habits and academic performance in health promoting and non-health promoting schools in the Autonomous Community of Aragon, Spain

“…Also, few studies have evaluated the degree of implementation of health promotion programs in HPS, and their results are inconclusive ( Ramos et al, 2013 ). Furthermore, previous studies have identified barriers for the implementation of health programs in the school context, namely the lack of engagement and understanding of the students, their families and the local community ( Ramos et al, 2013 ; Clelland, Cushman & Hawkins, 2013 ), problems with the coordination ( Ramos et al, 2013 ) and management ( Heesch et al, 2020 ) of these programs, unclear roles and responsibilities of the agents involved ( Silva et al, 2019 ; Ramos et al, 2013 ; Mannix-Mcnamara et al, 2012 ), and lack of human, material and economic resources ( Silva et al, 2019 ; Ramos et al, 2013 ; Heesch et al, 2020 ). Other barriers stem from the low level of implication of the teachers ( Jourdan et al, 2011 ), their low self-efficacy to influence the students’ behavior ( Clelland, Cushman & Hawkins, 2013 ), a difficulty to personally relate to the health promotion program’s aims and objectives ( Ramos et al, 2013 ) and not considering school health as a priority ( Saito et al, 2015 ).…”

“…Other barriers stem from the low level of implication of the teachers ( Jourdan et al, 2011 ), their low self-efficacy to influence the students’ behavior ( Clelland, Cushman & Hawkins, 2013 ), a difficulty to personally relate to the health promotion program’s aims and objectives ( Ramos et al, 2013 ) and not considering school health as a priority ( Saito et al, 2015 ). Similarly, there are factors that facilitate the implementation of health programs in HPS, including: (1) continuing education and training courses, and support, for teachers implementing health programs ( Moynihan, Jourdan & Mannix McNamara, 2016 ; Silva et al, 2019 ; Ramos et al, 2013 ; Jourdan et al, 2011 ); (2) higher engagement and implication of the school community ( Silva et al, 2019 ; Ramos et al, 2013 ); (3) higher level of sustainability and impact of interventions ( Passmore & Donovan, 2014 ); (4) intersectoral collaboration and liaison with the local community ( Heesch et al, 2020 ; Tooher et al, 2017 ; Hung et al, 2014 ); (5) promotion of a culture of change and active participation ( Heesch et al, 2020 ; Hung et al, 2014 ); (6) dissemination of HPS programs amongst schools, organizations and the general population ( Silva et al, 2019 ); (7) integrative and holistic approaches designed, managed and implemented systematically ( Ramos et al, 2013 ; Heesch et al, 2020 ; Lee & Cheung, 2017 ; Samdal & Rowling, 2011 ).…”

Health Promoting Schools: An Update

“…The HPS model has shaped school health promotion in different parts of the world including the low-income countries [18]. The WHO Global Accelerated Action for the Health of Adolescents (AA-HA!)…”

“…Therefore, updating of HPS through scoping study is needed to identify the indicators of HPS to highlight the ways in which schools have adopted HPS principles successfully under the six key areas: healthy school policies, school physical environment, school social environment, action competencies for healthy living, school health care and promotion services, and community link [12,13], and the conditions to be in place to flourish. There is also a need to review the evidence of HPS effectiveness on a boarder perspective dealing with complexity of the school system [31] to link education and health [18,32]. The following sections report the findings from international forums, review of recent literature, documents and guidelines from international institutions on HPS and child and adolescent health to supplement and substantiate the core indicators and requirements evolved from HKHSA, an established award-scheme framework.…”