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

Abstract

Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students.

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

“…Moreover, differences in characteristics related to the working group members, i.e., interpretation of the approach, the degree of practice-oriented thinking, the presence of one or more champions, and the dynamics within the working group, but also the differing degrees of influence of factors within the outer setting (i.e., support from the school board, national health-promoting trends, and the presence of and the capacity to collaborate with potential partners) resulted in different implementation processes. Other studies also found these contextual factors to facilitate and hinder implementation of school health-promoting interventions [33][34][35][36][37][38][39][40][41].…”

“…Both investments were essential, but time-consuming. This is outweighed by the high potential of sustainability of the output of the intervention because of a high perceived ownership by the schools due to contextual fit [16,36]. Important lessons we have learned from implementing the KEIGAAF intervention are listed in Figure 5.…”

What makes multicomponent school-based health promotion interventions work? A qualitative study nested in the SEHER trial in Bihar, India.

“…Fourth, how school climate and adolescent health and well-being were identi ed and understood by the school community was an important contributory factor in the intervention implementation. A qualitative case study of a Canadian province-wide HPS initiative described that school health initiatives that are understood, supported, and perceived as consistent with the school culture by the school teachers and principals aid in successful implementation [23]. This gap in awareness and knowledge of programs among stakeholders has also been corroborated in past studies as barriers to sexual health and nutrition education and policy implementation within schools [24][25].…”

How Health Promoters Can Assess Capacity Building Processes in Setting-Based Approaches—Development and Testing of a Monitoring Instrument

“…Capacity building is meant to make the involved settings responsible for, and more capable of, conducting and maintaining health promotion programs [9]. Capacity building can take place on different levels: individual level (e.g., training coaches), group level (e.g., improving the structure, functioning and learning environment of a project group), organizational level (e.g., integrating competences and skills in processes of schools or sports clubs), and the broader system level (e.g., developing multi-sectoral partnerships between different stakeholders and organizations in a community or rural region) [10][11][12]. It focuses on (community and municipal) structural development as a condition for social and organizational change as well as individual behavioral changes of the actors involved, either working with existing groups and organizations, or establishing new groups (e.g., in communities or schools).…”