Implementing a social‐ecological model of health in Wales

Abstract

Purpose -The purpose of this paper is to assess the implementation of the Welsh Network of Healthy School Schemes (WNHSS) at national, local and school levels, using a systems approach drawing on the Ottawa Charter. Design/methodology/approach -The approach takes the form of a single-case study using data from a documentary analysis, interviews with Healthy Schools Co-ordinators (n ¼ 23) and stakeholder (n , 93) discussion of interim findings at three regional workshops. Findings -There was almost universal adherence to a national framework based on Ottawa Charter principles. Substantial progress had been made with advocacy and mediation, although the framework provided less specific guidance regarding enablement. All-Wales training for co-ordinators, the commitment of co-ordinators to working across administrative and professional boundaries, and support from local education and health partnerships, were important determinants of healthy school schemes' growth and efficiency. Primary schools were more successful than secondary schools in embedding health-related changes. Research limitations/implications -Although findings are largely based on indirect evidence, the use of a social-ecological model of evaluation provided valuable insights into implementation processes at multiple levels. Findings suggest that strong national support benefits programme development and dissemination and should include effective monitoring of local performance. The national strategic environment was influential at all levels of programme implementation. Priorities for further research include application of the social-ecological model and organisational theory to investigate indicators of sustainability and influences on inequalities in health in school health promotion programmes. Originality/value -The review illustrates the importance of evaluating health promotion programmes at multiple levels using a systems approach.

Student health and well-being in secondary schools: the role of school support staff alongside teaching staff

“…Purposive sampling using replication logic and aiming for maximum variation was used to select four schools, each within different localities in South Wales. These schools were selected to represent differing geographical locations, sizes and socio-economic status (SES; as measured by the Welsh Index of Multiple Deprivation (WIMD)) and stage reached of the Health Promoting Schools scheme (Patton, Bond, Butler, & Glover, 2003; Rothwell et al, 2010; Yin, 2003). Pseudonyms were used to maintain anonymity.…”

School‐ and Family‐Level Socioeconomic Status and Health Behaviors: Multilevel Analysis of a National Survey in Wales, United Kingdom

“…School-based health interventions provide opportunities to reach large numbers of children, and range from health education programs, 9 to holistic settings-based approaches. 10 Reviews indicate that interventions based on education alone are typically ineffective, 11 whereas interventions including components at multiple levels often have greater effects. 12 To date, although the primary focus of evaluation research has been the overall effectiveness of school-based interventions, with more limited attention to their impacts on inequality, school-based interventions have adopted a variety of approaches to targeting lower SES groups.…”

Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review

“…, before the HPS requirement) that reported on factors involved with implementation at a school level [ 43 , 44 ] ( micro- and exosystem ). One study in Wales assessed the implementation of a network of healthy school schemes [ 45 ] that were established following funding that was provided to all local authorities for the appointment of healthy schools coordinators whose role was to establish and maintain local schemes ( micro-, meso- and exosystem ).…”

“…The intervention functions persuasion and coercion were not identified in this review. Various studies discussed the importance of enablement through leadership between health and educational sectors to achieve a negotiated and shared vision for HPS as a joint initiative [ 32 , 45 , 57 ], tailored support with evidence and planning tools [ 47 , 48 , 62 , 69 , 72 ] and flexibility that allows for development based on the local needs of schools [ 32 , 42 , 68 , 69 , 72 ] (environmental restructuring) . It was perceived that a balance between these conditions, that appreciates the need for “rigidity and flexibility” [ 51 ], would encourage ownership by schools to facilitate HP into practice and enhance sustainability [ 34 , 42 , 43 , 52 , 56 , 72 ].…”