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

Abstract

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.

Effects of School-Based Health-Promoting Activities on Children’s Health: A Pragmatic Real-World Study

“…This greatly limited schools' ability and capacity to work on the project. Further elaboration on the negative impact of the COVID-19 pandemic on project implementation can be found elsewhere [25]. Considering the challenges caused by the COVID-19 pandemic, the limited project implementation and consequent minimal effects are no surprise.…”

“…The main reasons for this limited implementation were the COVID-19 pandemic and its related restrictions, a lack of commitment and bottom-up involvement, and a high workload. More in-depth information on implementation and the factors influencing it is reported elsewhere [25]. The limited implementation had implications for data categorisation in the present study, as the previously proposed categorisation method could not be used due to low variation in the number of HPSF key points that schools adhered to.…”

“…The project's effectiveness on various health outcomes was compared between these two groups. An overview of the activities implemented within each school and the corresponding categorisation is reported in Table 1; this overview was previously published elsewhere [25].…”

“…Activities implemented in the various schools at the end of data collection and subsequent categorisation into medium and low implementers[25].…”