Effects of student participation in school health promotion: a systematic review

Positive Impacts of Adolescent Involvement in Health Research: An Umbrella Review

Despite an increased recognition of the right of adolescents to be involved in decisions that affect them, young people continue to be under-involved in health research. One of the reasons is a lack of awareness among researchers on the current evidence base around the benefits of involving adolescents. To address this, we conducted an umbrella review to synthesize the evidence on the positive impacts of adolescent involvement in health research. This umbrella review was preregistered with PROSPERO (CRD42021287467). We searched 11 databases, Google Scholar, PROSPERO, reference lists, 10 journals, websites of 472 organizations, and sought input from experts. Ultimately, we included 99 review articles. We found that adolescent involvement has many positive impacts on young people, including increased knowledge and skills; personal development; financial benefits; career and academic growth; enhanced relationships; and valuing their experience. The positive impacts of adolescent involvement on the research itself include increased relevance of the study to adolescents, improved recruitment, development of more adolescent-friendly materials, enhanced data collection and analysis, and more effective dissemination. Researchers also benefited from adolescents' involvement through increased knowledge, skills, and a shift in their attitudes. The evidence supporting the positive impacts of adolescent involvement in research is substantial but limited by a lack of rigorous evaluation, inconsistent reporting, and unclear evaluation methods.

Co-creating public health measures with adolescents in municipalities: Municipal actors' views on inhibitors and promoters for adolescent involvement

AIM

To explore what municipal actors consider as inhibiting and promoting adolescents' involvement in public health measures in municipalities.

METHODS

A qualitative study with individual and group interviews was conducted among 15 municipal actors who were central in involving adolescents from five Norwegian municipalities participating in the National Programme for Public Health Work in Municipalities (2017-2027). In addition, participatory observation of project activities was done in two municipalities. A data-driven thematic analysis was applied to analyse data.

RESULTS

In the analysis, we developed four themes, including both inhibitors and promoters for adolescent involvement: (a) Timeframe challenges in adolescent involvement; (b) Lack of necessary knowledge and awareness among adolescents; (c) Limited competencies and resources in the project groups; and (d) Facilitators' attitudes on and perceptions of adolescent involvement.

CONCLUSIONS

This study reports factors that are important to consider when facilitating involvement processes with young people. Findings suggest that further work should be done to ensure involvement of adolescents in public health measures in municipalities, and actors involving adolescents must be provided with competence and resources to ensure such participation.

Using Non-Violent Discipline Tools: Evidence Suggesting the Importance of Attunement

Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiveness of caregivers towards their children and has been found to be central to the formation of secure attachment bonds and development of self-regulation. It includes understanding or being "in tune with" the child's needs and signals, matching these with appropriate responses. The objective of this paper is to explore attunement in relation to non-violent discipline. Peer-reviewed systematic reviews previously included in a systematic overview of evidence on non-violent discipline options were screened for information relevant to attunement. All reviews were published in English between 1999 and 2018 and offered evidence on at least one non-violent discipline tool. Although no reviews explicitly addressed attunement, evidence was found suggesting its importance in the use and effectiveness of discipline methods. Research directly investigating attunement in discipline is needed.

Process and experience of youth researchers within a Health Promoting Schools study in Nova Scotia, Canada

Youth Participatory Action Research (YPAR) is an approach to research that engages youth across the research process. The peer researcher method is a technique used in YPAR where youth are trained in research and ethics to interview their peers. The purpose of this study was to: (i) describe the process of engaging youth as peer researchers in a Health Promoting Schools (HPS) and student engagement project and (ii) understand the peer researchers' perspectives of their experience throughout the project. Youth from across Nova Scotia, Canada in grades 7-10 (ages 12-16) were recruited as peer researchers in the Summer, 2022. The project included three stages: (i) peer researcher training, (ii) practicing, recruiting and conducting interviews and (iii) data interpretation workshop. To understand the peer researcher's experience, quantitative data were collected from an evaluation questionnaire. Outputs were produced using descriptive statistics. Qualitative data were collected through a focus group and interviews and analyzed using inductive content analysis. A total of 11 youth were recruited and completed peer researcher training. Most youth provided positive feedback on the training with a satisfaction score of 8.7/10. Qualitative analysis indicated benefits to the peer researchers including opportunities to build interview and social skills and learn about other's perspectives. This study provides a detailed overview of how to use a peer researcher method in a YPAR project to involve youth in research related to HPS and student engagement. The research also highlights the benefits of engaging youth in YPAR. Future research will report on the findings from the peer interviews.

The "Planning Health in School" Programme (PHS-pro) to Improve Healthy Eating and Physical Activity: Design, Methodology, and Process Evaluation

Few interventions have successfully promoted healthy eating and active living among children with effective changes in anthropometric health outcomes. Well-designed interventions involving multiple strategies to convert the knowledge already available into action are needed for preventing childhood obesity. In this study, an educational programme called "Planning Health in School" (PHS-pro) was designed, implemented and evaluated to contribute to the prevention of obesity in childhood. The PHS-pro aimed at improving the eating behaviours and lifestyles of Portuguese grade-6 children towards healthier nutritional status. This paper describes and evaluates the PHS-pro concerning: (i) the research design within the theoretical framework grounded on "The Transtheoretical Model" and the stages of change; (ii) the educational components and the application of the participatory methodology to engage children to meet their needs, as active participants in their change process; and (iii) the process evaluation of the intervention. The implementation of the PHS-pro took into account the views and inputs of the participants for evaluating the educational components that should be considered in the designing of interventions aiming to be effective strategies. From the health promotion perspective, this study is important because it examines new approaches and pathways to effectively prevent overweight and obesity in children.

Re-Licious: Co-Design with Adolescents to Turn Leftovers into Delicious and Healthy Meals-A School-Based Pilot Intervention

One-third of the food produced globally is lost or wasted, and one cause is consumer leftovers. Re-licious was an eight-week pilot intervention aiming to increase awareness of food waste and healthy eating by building adolescents' ability to prepare and cook leftovers. Re-licious used a co-design approach and was piloted in a secondary school, half of which was during a COVID-19 lockdown period. Students watched videos on food waste and healthy eating during class. They identified leftover ingredients at home and repurposed ingredients to create recipes. Students co-created recipe criteria to ensure the personal relevance of the recipes. They completed pre- and post-intervention questionnaires (n = 40) about food waste and motivation and interest in healthy eating. Four group interviews were conducted. The factors identified as important in the co-creation sessions were preparation time, cost, healthiness, and sustainability. Participants with low motivation and interest in healthy eating decreased, and participants with high interest increased (p < 0.001). The intention to reduce food waste increased (p = 0.007), as did resourcefulness (p < 0.001) and personal norms (p = 0.048). Interviews highlighted the students' increased awareness of food waste and enjoyment of the intervention. With improvements based on this pilot, Re-licious could be adapted and re-trialled in a face-to-face format to educate young people about food waste.

Targeting the school environment to enable participation: A scoping review

BACKGROUND

Children with special educational needs experience limited levels of participation at school; their participation is influenced by the physical and social environment. Interventions that have been applied in school environments are described in the literature.

AIMS

To illustrate the main features of interventions targeting school environments to support participation of children with special educational needs in mainstream education.

MATERIALS AND METHODS

A scoping review using a qualitative, thematic analysis was conducted in May 2021.

RESULTS

We included a total of 20 articles. We found that intervention features contributed to children's participation and targeted social and physical school environments. The majority of the intervention features focussed on applying supportive teaching methods to enable individual children's participation. A small number of interventions described a systemic holistic approach that involved changes to the school environment. In these interventions, different professionals such as occupational therapists collaborated with teachers to adapt the school environment.

CONCLUSIONS AND SIGNIFICANCE

A shift from individual child-focussed to environment-focussed approaches that target all children's participation could impact classroom setup and teachers' roles. Occupational therapists' expertise in matching school environments and task requirements with individual children's needs could be valuable in their collaboration with schools to support this transition.

Cross-Sectional Analysis of Family Factors Associated with Lifestyle Habits in a Sample of Italian Primary School Children: The I-MOVE Project

The acquisition of healthy dietary and exercise habits during childhood is essential for maintaining these behaviors during adulthood. In early childhood, parents have a profound influence on a child's lifestyle pursuits, serving as both role models and decision-makers. The present study examines family factors as potential contributors to healthy lifestyle habits and their child's overall diet quality among a sample of primary school children. A secondary aim is to evaluate several aspects of diet quality using the Mediterranean adaptation of the Diet Quality Index-International (DQI-I). This cross-sectional study involved 106 children enrolled in a primary school located in Imola, Italy. Data were collected from October to December 2019 using an interactive tool used to assess parent characteristics, children's lifestyle, food frequency (ZOOM-8 questionnaire), and actigraph accelerometers to capture children's physical activity and sedentary behavior. Adherence to the Mediterranean Diet (expressed by KIDMED Index) was positively associated with fathers' educational level, parental sport participation, and the parent's overall nutritional knowledge. Higher mothers' educational level was inversely associated with children's leisure screen time. Parents' nutritional knowledge was positively related to children's average daily minutes of organized sport activities. The better score for DQI-I was for consumption adequacy, followed by variety and moderation. The lowest score was for overall balance. The present study reinforces the importance of family factors in young children's lifestyle choices, particularly their dietary, leisure time, and exercise habits.

Process of youth engagement in school health promotion: a scoping review protocol

INTRODUCTION

School environments are an essential setting to shape and influence the health and well-being of students. Health promoting school (HPS) is a whole-school approach that strengthens and builds a safe and healthy school environment for students to learn and develop. A core component of HPS is the meaningful participation of youth. Despite promising outcomes arising from youth engagement in school health promotion, there is less known on the process of how students are involved in school health promotion and in what form. This scoping review will explore and map the different components of the student engagement process in school health promotion with specific focus on whole-school approaches like HPS.

METHODS AND ANALYSIS

We will follow scoping review guidelines employed by the Joanna Briggs Institute and Arksey and O'Malley's framework. We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to guide reporting. We will follow the PCC mnemonic (participant, concept and context) to develop eligibility criteria. Both published and unpublished literature will be included. Databases to be searched include: CINAHL, ERIC, MEDLINE, Scopus, ProQuest Dissertations & Theses Global databases and Google Scholar. Relevant organisational websites and sources identified by experts will also be reviewed. Two reviewers will screen the title, abstract and full text of the sourced articles. Data from included articles will be charted using a data charting tool. The socioecological model and Hart's Ladder of Participation will be used to guide charting. Descriptive analysis will be conducted for quantitative data, and thematic analysis will be employed for qualitative data. Data will be displayed through tables and narrative descriptions.

ETHICS AND DISSEMINATION

No ethical approval is required for this study. To disseminate our work, we plan to develop an open-access publication, accompanied by a conference presentation and other knowledge translation products.

Evaluation of Social Impact Within Primary School Health Promotion: A Systematic Review

BACKGROUND

Health promotion programs and interventions are designed to encourage behavioral changes in children, encouraging them to make safe and healthy life choices. This systematic review seeks to examine how social impact is measured in primary school health promotion interventions.

METHOD

A systematic search and review process was used to identify and examine primary school health promotion interventions. The PRISMA guidelines were followed to source articles from 6 electronic databases reporting school health promotion programs or interventions in Australia, Canada, New Zealand, or the United Kingdom.

RESULTS

A total of 77 studies were located, representing 55 health promotion interventions delivered in primary school settings. Of these interventions, only 8 (15%) measured or attempted to measure social impact, whereas another 8 (15%) alluded to social impact. The predominant theories reported were social based theories (theories which examine the social influences on people, environments, and behaviors) (n = 17, 59%), with almost a third not informed by an overt health promotion framework or model (n = 34, 59%). A systematic rating system identified some level of stakeholder engagement (n = 30, 53%).

CONCLUSIONS

This systematic review highlights the need for social impact measurement within health promotion to illuminate the role of school programs in delivering lasting change.

Peering in: youth perspectives on Health Promoting Schools and youth engagement in Nova Scotia, Canada

Health Promoting Schools (HPS) is a whole-school approach that shapes the conditions necessary to support student health and well-being. Youth engagement is recognized as key to HPS implementation, yet research related to the involvement of youth voice in school health promotion initiatives is limited. The purpose of this study was to understand youth perspectives on HPS and school youth engagement. Ten youth (grades 9–10, ages 14–16) were trained as peer researchers using a Youth Participatory Action Research approach. The peer researchers interviewed 23 of their peers (grades 7–10, ages 12–16) on perspectives related to HPS and school youth engagement. All interviews were audio-recorded, transcribed and data were analysed using inductive ‘codebook’ thematic analysis. Themes related to a healthy school community were mapped onto the pillars of HPS: (i) Social and Physical Environment, (ii) Teaching and Learning, (iii) Partnerships and Services and (iv) School Policies. Participants placed more importance on the social and physical environment of the school including respect, inclusivity, supportive relationships and the design of spaces. Key factors for youth engagement were: (i) safe and supportive spaces, (ii) passion and interest, (iii) using their voice, (iv) power dynamics, (v) accessibility and (vi) awareness. With recognition that youth engagement is a crucial part of HPS, this work provides relevant and applicable information on areas of the healthy school community that are important to youth, and if/how they are meaningfully engaged in school decision-making.

Adolescent Obesity Prevention in Saudi Arabia: Co-identifying Actionable Priorities for Interventions

Background

Childhood obesity is a serious issue in the Kingdom of Saudi Arabia, but there is no known community intervention. The aim of the study was to use a participatory approach to obtain the perspectives of students, school staff and Ministry of Education (MoE) representatives and parents on important and feasible intervention opportunities for school-based obesity prevention for adolescent girls.

Method

The study was conducted in two intermediate schools for girls (13–15 years old) in Jeddah that were purposefully identified with the support of the MoE. Group concept mapping, a mixed method approach, was conducted with 19 adults which included staff from the MoE and schools, school canteen suppliers and mothers. Adults generated statements in response to two prompts (P); P1 “The factors influencing adolescent obesity in Saudi are...” and P2 “The content of school-based programmes should focus on....” Photovoice-enhanced concept mapping was used with students (n = 15 students) to capture adolescent perspectives on what influences their dietary and physical activity habits. Students generated statements' using their own photographs. Stakeholders, both adult and students, sorted the statements into themes and rated each statement for relative importance and feasibility. Multidimensional scaling and hierarchical cluster analyses were used to produce concept maps with the input from students and adults.

Result

Adults generated 35 statements in response to P1 and identified five themes that influenced adolescent obesity including “Home Environment,” “Lifestyle,” “School Environment,” “Community,” “Biology.” They generated 42 statements in relation to P2 and identified four themes including “Ministry of Education Support,” “School Environment,” “Public health programmes” and “Wider environmental influences.” Students generated 42 statements from 39 pictures. They identified five themes that influenced their dietary and physical activity habits—“Role of Government,” “School Environment,” “Home Environment,” “Retail Environment” and “Cultural Practices.” Both groups identified several common important and feasible actions with a strong emphasis on improving the school environment, in particular food provision, with MoE support. Exemplar corresponding statements from adults were “Offer healthy foods in the canteen,” “Remove chocolates and sweets” and “Educate children about healthy foods” and from students were “Offer fruit and vegetables in the canteen,” “Remove chocolates from the canteen,” “Healthy meals should not expensive.” Lack of correspondence related to students' emphasis on access to both healthy foods and physical activity in schools and the wider environment (e.g. retail environments), while adults emphasized school-based education and food provision. After further consultations, both stakeholder groups agreed on improving access to healthy foods in the canteen.

Conclusions

Students and school and MoE staff jointly agreed that a canteen-based intervention was important and feasible to improve dietary habits and thus help to prevent obesity among adolescent girls. This was the first time a participatory approach was used with students for intervention development in Saudi Arabia. A co-development approach may have value to improve their school food environments.

[School health promotion in pandemic times. Results of the COVID-HL school principal study]

Hintergrund

Die vorliegende Studie untersucht, in welchem Ausmaß Schulen Maßnahmen der Gesundheitsförderung und Prävention während der COVID-19-Pandemie umsetzen. Von besonderem Interesse sind hierbei Unterschiede nach demografischen Variablen, Schulform, Bundesland und die Beteiligung an Landesinitiativen der Gesundheitsförderung.

Methodik

Im Rahmen des COVID-Health-Literacy-Netzwerks wurde von März bis April 2021 eine Onlinestudie mit 2186 Schulleitungen in Baden-Württemberg, Hessen, Niedersachsen und Nordrhein-Westfalen durchgeführt. Der Umsetzungsstand der COVID-19-bezogenen schulischen Gesundheitsförderung und Prävention wurde mittels eines eigenentwickelten Instruments untersucht. Nach Analyse der faktoriellen Struktur des Instruments erfolgten uni- und bivariate Auswertungen.

Ergebnisse

Es lassen sich 3 Dimensionen des Umsetzungsstandes der schulischen Gesundheitsförderung identifizieren (1. COVID-19-bezogene Unterstützung der Schüler*innen, 2. Gesundheitsförderliche Gestaltung von Lehr‑, Lern- und Arbeitsbedingungen, 3. Prinzipien der Gesundheitsfördernden Schule). Eine geringe Umsetzung liegt für Aspekte der Lehr‑, Lern- und Arbeitsbedingungen sowie für Partizipation und die Kooperation mit schulexternen Akteuren vor. Signifikante Unterschiede des Umsetzungsstands ergeben sich zugunsten von weiblichen und älteren Schulleitungen sowie Grundschulen. Außerdem zeigen sich nicht homogene Unterschiede nach Bundesland. Differenziert nach Teilnahme an einem Landesprogramm findet sich lediglich für Schulen mit Zertifikat im Bereich Gesundheitsförderung ein höherer Umsetzungsstand.

Diskussion

Die Ergebnisse geben Hinweise darauf, dass die COVID-19-Pandemie für Schulen ein disruptives Ereignis darstellt, welches die Umsetzung schulischer Gesundheitsförderung erschwert. Vor allem gesundheitsförderliche Arbeitsbedingungen, Partizipation und Kooperation sollten in den Fokus genommen werden.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03535-w) enthalten

Peer mentors' role in school-based health promotion: qualitative findings from the Young & Active study

Peer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students' reception of a peer-led intervention component (Young & Active). Young & Active aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016-2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors' profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students' reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project.

The need for adolescents' agency in salutogenic approaches shaping physical activity in schools

Physical activity (PA) contributes to health throughout life. In particular, young people can benefit from this. Schools can play a key role in providing learning conditions to experience meaningful PAs aimed at inspiring students to lifelong PA. In this article, we argue the need for a salutogenic approach in schools focussing on respecting and enhancing adolescents' agency with regard to their PA. This approach entails listening to adolescents' perspectives and inviting them to participate in actively designing and carrying out PA as a prerequisite for their inclusive engagement. We unpack the concept of agency by drawing on insights from the Capability Approach. This provides input for the integration of agency in health promoting schools and salutogenic approaches, to enhance PA-related agency. Finally, we outline a research agenda to, eventually, create opportunities for students in schools to expand their PA-related agency. Lay Summary Physical activity (PA) contributes to health throughout life. Schools can play a key role in fostering meaningful PA experiences to inspire students to lifelong PA. This requires schools to focus on students' personal aspirations, providing them with the space to develop their autonomy and find opportunities to decide and act upon expanding their agency with respect to the physically active lifestyles they deem meaningful.

Factors influencing the effectiveness of a Cooperative Planning approach in the school setting

The purpose of the Health.edu project was to develop, implement and evaluate effective and feasible measures addressing students' health-related knowledge and understanding (HKU) in physical education (PE) with a specific focus on a co-creation approach (Cooperative Planning). The general procedure was identical in the four intervention schools involved; however, effectiveness (i.e. an increase in HKU) differed. Therefore, the present study investigated how different contextual factors supported or hindered the Cooperative Planning approach (evaluation of program implementation). To consider different perspectives in the analysis, we used data triangulation. On the one hand, written protocols (N = 19) document relevant statements and decisions in each planning group meeting (scientific perspective). On the other hand, we captured the participating PE teachers’ (N = 8) individual attitudes after the Cooperative Planning process through semi-structured interviews (teachers’ perspective). Data were analysed via qualitative content analysis. We identified three relevant factors with influence on the Cooperative Planning approach. First, the Cooperative Planning intervention worked if teachers saw a benefit in providing evidence-based knowledge, reflected their teaching practices and made an effort to implement new teaching strategies. Second, it was beneficial to have students represented as partners in the decision-making process. Third, support from the principal appeared to be helpful but not mandatory for implementing progressive pedagogical concepts. Continuous monitoring and reflection on those factors by the leading project team might help facilitate subsequent interventions using Cooperative Planning.

Healthy body, healthy mind: Long-term mutual benefits between classroom and sport engagement in children from ages 6 to 12 years

Past research suggests that the relationship between health and schooling is axiomatic. Physical activity, including sport participation, putatively facilitates school performance. However, the direction of this link lacks clarity. We examine the mutual links between sport and classroom engagement in 452 boys and 514 girls from ages 6 to 12 years. Participants are from the Quebec Longitudinal Study of Child Development, a prospective-longitudinal birth cohort. First, trajectories of classroom engagement from ages 6 to 10 years, assessed by teachers, were generated using latent class analysis. Second, analyses of covariance (ANCOVAs) compared leisure time physical activity, self-reported by children at age 12 years, across trajectories of classroom engagement. Third, ANCOVAs compared classroom engagement, measured by teachers at age 12 years, across trajectories of extracurricular sport between ages 6 to 10 years. We identified two classroom engagement trajectories: ‘High’ (77%) and ‘Moderate’ (23%). For girls, being in the ‘High’ trajectory predicted significantly higher levels of physical activity (F(1, 966) = 5.21, p < .05). For boys, being in the ‘Consistent participation’ extracurricular sport trajectory predicted significantly higher levels of classroom engagement (F(1, 966) = 6.29, p < .05). Our analyses controlled for pre-existing individual and family factors. Our findings suggest that sport participation and engaged classroom behavior positively influence each other during childhood. They support the pertinence of investing financial resources in youth intervention so that children can develop their potential both in sporting contexts and in the classroom to foster optimal growth and development.

How can we promote co-creation in communities? The perspective of health promoting professionals in four European countries

Purpose

The aim was to identify the competencies professionals need to promote co-creation engagement within communities.

Design/methodology/approach

Co-creation could contribute to building community capacity to promote health. Professional development is key to support co-creative practices. Participants were professionals in a position to promote co-creation processes in health-promoting welfare settings across Denmark, Portugal, France and United Kingdom. An overarching unstructured topic guide was used within interviews, focus groups, questionnaires and creative activities.

Findings

The need to develop competencies to promote co-creation was high across all countries. Creating a common understanding of co-creation and the processes involved to increase inclusivity, engagement and shared understanding was also necessary. Competencies included: How to run co-creation from the beginning of the process right through to evaluation, using feedback and communication throughout using an open action-oriented approach; initiating a perspective change and committing to the transformation of co-creation into a real-life process.

Practical implications

Overall, learning about underlying principles, process initiation, implementation and facilitation of co-creation were areas identified to be included within a co-creation training programme. This can be applied through the framework of enabling change, advocating for co-creative processes, mediating through partnership, communication, leadership, assessment, planning, implementation, evaluation and research, ethical values and knowledge of co-creative processes.

Originality/value

This study provides novel findings on the competencies needed for health promoting professionals to embed co-creative processes within their practice, and the key concerns that professionals with a position to mediate co-creation have in transferring the abstract term of co-creation into a real-world practice.

Adaptation, Student Participation and Gradual Withdrawal by Researchers as Sustainability Strategies in the High School-Based Young and Active Intervention: School Coordinators' Perspectives

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&A) intervention used peer-led workshops to promote movement and strengthen students' sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&A, focusing on school coordinators' reflections on the intervention's fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.

Comprehensive Prevention of Campus Sexual Violence: Expanding Who Is Invited to the Table

There are calls for sexual violence prevention to be more comprehensive and align with a socio-ecological approach. However, there is lack of models with specificity on how to engage additional stakeholders. Whole School Approach (WSA) frameworks have been used to address health promotion and bullying prevention and can be a useful model for guiding campus sexual violence prevention work. WSA models situate violence as a community issue and one where all community members have a role to play in prevention. Rather than focusing on addressing individual behavior, WSA frameworks address the role of the larger school environment in serving as a protective factor against violence, abuse, and harassment. A review of the literature on WSA frameworks in other disciplines reveals a number of potential ways to translate key elements of WSA models to the field of campus sexual violence prevention. In particular, mechanisms can be applied to expand the role of students, faculty, staff, parents/significant adults, institutional leadership, and the larger community.

Perceptions of participation in school and association with health and wellbeing: comparison among Nigerian and Irish pupils

School participation among pupils is considered a key value of the health promoting school approach. However, few studies have documented the relationship between the school participation of pupils and health and wellbeing outcomes in different geographical contexts, especially looking at developing and developed country contexts. This study investigated the perceptions of Nigerian and Irish pupils on participation in school and reported health and wellbeing. Data was collected using self-completed questionnaires among 333 and 231 primary school pupils in 4th, 5th and 6th classes across 17 schools in Nigeria and Ireland. Logistic regression analysis was used to analyse the data from both countries. There was no statistically significant difference in the mean scores for participation in school activities (NIG mean = 22.8, SD 3.5; IRE mean = 22.3, SD 3.4) and school events (NIG mean = 18.8, SD 3.7; IRE mean = 17.1, SD 3.6). However, participation in school decisions and rules (NIG mean = 17.3, SD 4.7; IRE mean = 15.8, SD 3.6) and health and wellbeing (NIG mean = 16.9, SD 1.7; IRE mean = 15.3, SD 2.4) scores were significantly higher among Nigerian pupils, while positive perception of school participation (NIG mean = 24.2, SD 4.1; IRE mean = 26.2, SD 3.4) was significantly higher among Irish pupils. The findings suggest that Irish and Nigerian pupils have positive perceptions of their schools irrespective of their location and levels of development. However, further research using qualitative approaches might be needed to better clarify dimensions of pupils' perceptions of school life and school participation among Nigerian pupils in order to substantiate these claims.

Introducing Ecohealth education in a Teacher Training Institute in Lao PDR: a case study

This paper argues the effectiveness of Ecohealth education for improving the quality of health and environmental education and for achieving sustainable development in developing countries. To illustrate the need for Ecohealth education, we review the transitions in health education, environmental education and Education for Sustainable Development (ESD) in various developing countries. Moreover, we discuss issues relating to these disciplines and consider the possible roles that Ecohealth education can play. Then, drawing on a case study conducted in Lao PDR, we propose a concrete example of the teaching content of Ecohealth education. We conclude that Ecohealth education can embody the concepts of ESD with respect to health and environmental issues, and thus can contribute to improvements in the quality of health and environmental education, and of ESD. In addition, we propose the following five actions for implementing Ecohealth education in developing countries: (i) promote research based on the approaches of public health and anthropology, and develop teaching materials that use the research results, (ii) empower school-aged children, (iii) encourage the active involvement and sharing of problems among communities, (iv) strengthen participatory teaching and learning methodology and (v) build a training system and train relevant teachers.

Opportunities for Capacity Building to Create Healthy School Communities in the Netherlands: Focus Group Discussions With Dutch Pupils

Background: To sustainably implement a healthy school community in which stakeholders, including pupils, feel ownership over health-promotion activities, building community capacity is important. Pupils have experiential knowledge that is complementary to professional knowledge, but their perspectives on capacity-building processes are underexposed. This study aims to explore secondary-school pupils' perceptions about key influencers on physical activity and dietary choices and starting points for building community capacity.

Methods: Seven focus groups with forty one pupils were held in four secondary schools engaged in a capacity-building intervention. Transcripts were analysed thematically regarding key influencers about choices in the home and school setting and capacity-building strategies (leadership, participation, tailored health-promotion activities and local networks).

Results: Parents remained important influencers for making healthy choices, but snacking choices were increasingly made independently from parents based on attractiveness, availability and cost. Choices to engage in physical activity depended on social aspects and opportunities in the physical environment. Pupils considered their influence over the healthy school community limited, desired more involvement, but require this to be facilitated. They identified leaders mainly within formal structures, for example, student councils. They believed health-promotion activities related to the physical environment and project-based activities within the curriculum have the maximum potential to stimulate healthy behaviours in school communities.

Conclusion: This study shows that pupils can reflect critically on their physical activity and dietary choices, and on how this can contribute to processes in creating a healthy school community. In order to take an active role, they need to be considered as full partners and leadership roles should be facilitated in existing structures.

Public health nurses' perceptions on promotive and risk factors for children's mental health: A qualitative interview study

AIM

To describe promotive and risk factors for children's mental health at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment.

DESIGN

A descriptive qualitative interview study.

METHODS

Data were collected in Finland during autumn 2019 via semi-structured interviews. Participants (n = 23) comprised public health nurses who worked in child health clinics and school healthcare. Data were analyzed using inductive content analysis.

RESULTS

Several promotive and risk factors were identified to have affected children's mental health. Intra-family factors were the most important in the opinion of public health nurses, and they were most concerned about family related risk factors. In addition, the descriptions of nurses revealed that children are in a socially unequal position in terms of their place of residence. It was also uncovered that there were fewer social and healthcare and leisure services in small municipalities, the distances to services were longer, which was perceived to complicate the use of services, and the fear of stigma was greater.

CONCLUSION

According to public health nurses, factors at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment affect children's mental health and overall well-being. Consequently, the promotion of children's mental health should be emphasized at every level of the society, considering the whole family.

IMPACT

This study indicated the importance of considering factors that affect children's mental health at all levels of the socioecological environment. The results can be reflected in the relation of the socioecological model of health promotion and used in planning the work of nurses in primary healthcare and other relevant nursing settings to emphasize promotive and preventive work.

Online interventions to prevent mental health problems implemented in school settings: the perspectives from key stakeholders in Austria and Spain

BACKGROUND

Schools are key settings for delivering mental illness prevention in adolescents. Data on stakeholders' attitudes and factors relevant for the implementation of Internet-based prevention programmes are scarce.

METHODS

Stakeholders in the school setting from Austria and Spain were consulted. Potential facilitators (e.g. teachers and school psychologists) completed an online questionnaire (N=50), policy makers (e.g. representatives of the ministry of education and health professional associations) participated in semi-structured interviews (N=9) and pupils (N=29, 14-19 years) participated in focus groups. Thematic analysis was used to identify experiences with, attitudes and needs towards Internet-based prevention programmes, underserved groups, as well as barriers and facilitators for reach, adoption, implementation and maintenance.

RESULTS

Experiences with Internet-based prevention programmes were low across all stakeholder groups. Better reach of the target groups was seen as main advantage whereas lack of personal contact, privacy concerns, risk for misuse and potential stigmatization when implemented during school hours were regarded as disadvantages. Relevant needs towards Internet-based programmes involved attributes of the development process, general requirements for safety and performance, presentation of content, media/tools and contact options of online programmes. Positive attitudes of school staff, low effort for schools and compatibility to schools' curriculum were seen as key factors for successful adoption and implementation. A sound implementation of the programme in the school routine and continued improvement could facilitate maintenance of online prevention initiatives in schools.

CONCLUSIONS

Attitudes towards Internet-based mental illness prevention programmes in school settings are positive across all stakeholder groups. However, especially safety concerns have to be considered.

Barriers and facilitators to successful implementation of sustainable school meals: a qualitative study of the OPTIMAT™-intervention

Background

There is an urgent need to align human diets with goals for environmental sustainability and population health. The OPTIMAT™-intervention study was developed to implement and evaluate a nutritionally adequate and climate-friendly 4-week lunch menu in Swedish primary schools. This study aimed to explore pupils’ and kitchen staff’s experiences of the intervention and to identify barriers and facilitators to successful implementation of sustainable school meals.

Methods

An inductive manifest qualitative method was used. Nine focus group discussions (FGDs) were conducted, six with pupils in grades 5 (ages 10–11) and 8 (ages 14–15) (n = 29) and three with kitchen staff (n = 13). Data were analyzed using qualitative content analysis.

Results

Five main categories and 11 subcategories at a manifest level emerged. The five main categories were: 1) Experiences with the new menu, unfolding variations in how the new menu was received and kitchen staff’s experiences of working with it; 2) The meaning of diet sustainability, comprising pupils’ and kitchen staff’s perceptions about diet sustainability as a concept and part of their everyday lives; 3) Factors influencing plant-based food acceptance, covering aspects such as the influence of sensory factors, habits and peer pressure; 4) Opportunities to increase plant-based eating, including factors related to pupils’ and kitchen staff’s ideas for how to increase plant-based food acceptance; and 5) Need for a supportive environment to achieve dietary change, comprising pupils’ and kitchen staff’s thoughts on the importance of more knowledge, resources and involvement of stakeholders to eat more plant-based meals in schools.

Conclusions

Successful implementation of sustainable school meals would require more knowledge among pupils and kitchen staff. Staff also need more training in cooking of sustainable meals. Barriers among pupils could be tackled by introducing new plant-based meals more gradually and by more carefully considering the seasoning, naming and aesthetics of dishes. An increased leadership support for change and involvement of stakeholders from multiple levels within society will be key in the transition to sustainable school meals at scale.

Trial registration

The trial registration for the OPTIMAT™-intervention may be found at clinicaltrials.gov (NCT04168632 Fostering Healthy and Sustainable Diets Through School Meals (OPTIMAT)).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01158-z.

College students’ perspectives on an alcohol prevention programme and student drinking – A focus group study

Aim:

While there is considerable research on the efficacy of interventions designed to reduce alcohol consumption and related harms among college students, there is limited research on students’ own perspectives on such interventions. This qualitative study aimed to address this gap by examining college students’ perspectives in the context of an alcohol prevention programme for college students in Ireland.

Methods:

Focus groups were used as the means of data collection, and participants were selected using purposive sampling based on two criteria – type/location of college and category of student. A total of eight focus groups were conducted at two institutions taking part in the programme. Participants comprised four categories of student: undergraduates, mature students, international students and students who were members of clubs or societies. Results were analysed through the lens of a social-ecological framework.

Results:

The study findings indicated that students perceived alcohol as being endemic to college life and wider society. As a result, many of the students were sceptical or ambivalent regarding the potential efficacy of alcohol prevention programmes. Despite the perceived pervasiveness of alcohol, the study pointed to heterogeneity in drinking practices among the participants. Moreover, the study participants expressed divergent views when asked whose responsibility it was to control student alcohol consumption.

Conclusions:

Viewing the findings through a social-ecological lens, students seemed to collectively acknowledge the different layers of influence on student drinking, acknowledging the complex nature of this issue. Providing a greater variety of leisure spaces, including alcohol-free environments, was viewed particularly favourably by the student participants in terms of solutions proposed.

Can Health-Promoting Schools Contribute to Better Health Behaviors? Physical Activity, Sedentary Behavior, and Dietary Habits among Israeli Adolescents

Schools with health-promoting school (HPS) frameworks are actively committed to enhancing healthy lifestyles. This study explored the contribution of school participation in HPS on students' health behaviors, namely, physical activity (PA), sedentary behavior, and dieting. Data from the 2018/2019 Health Behavior in School-aged Children study on Israeli adolescents aged 11-17 years were used. Schools were selected from a sample of HPSs and non-HPSs. Between-group differences and predictions of health behavior were analyzed. No between-group differences were observed in mean number of days/week with at least 60 min of PA (HPS: 3.84 ± 2.19 days/week, 95% confidence interval of the mean = 3.02-3.34; non-HPS: 3.93 ± 2.17 days/week, 95% confidence interval of the mean = 3.13-3.38). Most children engaged in screen time behavior for >2 h/day (HPS: 60.83%; non-HPS: 63.91%). The odds of being on a diet were higher among more active children (odds ratio [OR] = 1.20), higher socio-economic status (OR = 1.23), and female (OR = 2.29). HPS did not predict any health behavior. These findings suggest that HPSs did not contribute to health behaviors more than non-HPSs. Therefore, health-promoting activities in HPSs need to be improved in order to justify their recognition as members of the HPS network and to fulfill their mission.

Youth Participatory Action Research for Health Equity: Increasing Youth Empowerment and Decreasing Physical Activity Access Inequities in Under-resourced Programs and Schools

To address gaps in the youth participation and adolescent physical activity (PA) promotion literature, we examined the feasibility of youth participatory action research (YPAR) in (a) general aftercare (YPAR only) and (b) with a physical activity intervention, (YPAR + PA) to reach marginalized youth and impact individual empowerment and second-order change for equitable PA access. We intervened during middle school, a developmental stage conducive to changing health habits. We used a concurrent, mixed-method triangulation design. Participants were students (94% non-Hispanic Black/African American, 75% free/reduced lunch) in the southeastern United States. YPAR was adapted from online modules. Youth conducted photovoice, capturing and analyzing social/environmental factors contributing to inequities in their schools/programs. PA inequities emerged for girls. Findings indicated feasibility of YPAR with systems supports. Changes occurred at the individual and systems level in the YPAR + PA program. Sociopolitical skills, participatory behavior, and perceived control empowerment subdomains increased pre-post, and youth qualitative responses aligned. A follow-up interview with the director revealed all youth-proposed changes occurred. A feedback loop was developed for continued youth input. Youth-led changes to increase PA access have potential to decrease health disparities by generating unique solutions likely missed when adults intervene alone.

From Consultation to Shared Decision-Making: Youth Engagement Strategies for Promoting School and Community Wellbeing

BACKGROUND

The benefits of youth engagement are well documented. In this paper, we examine youth engagement in America's Promise Alliance's Every School Healthy initiative, a part of the Robert Wood Johnson Foundation's Together for Healthy and Successful Schools Initiative (THSS).

METHODS

Six community acceleration sites were selected through a competitive grant-making process. Sites were required to describe youth engagement strategies. A case study design was employed to examine how sites conceptualize youth engagement as well as youth engagement strategies employed across 6 sites. Data sources included observations, team member debriefs, and document review.

RESULTS

There was variation in how youth engagement and youth voice are conceptualized in educational settings, and readiness for youth engagement. Sites actively solicited and implemented youth engagement resources and strategies.

CONCLUSIONS

By failing to engage young people, well-intentioned adults miss important opportunities. Youth engagement presents an exciting opportunity for school leaders, policymakers, and program planners to gain a deeper understanding of the factors that influence individual and community health and wellbeing and, in turn, helps them to develop responsive policies and programs.

Participation of children in school health in Japan

BACKGROUND

The importance of promoting child participation in school health has been emphasized internationally. This study examined ways in which Japan's school health system involves children, and factors enabling child participation in this system. It also suggests strategies to promote child participation in school health in developing countries.

METHODS

We conducted a document review to clarify the importance of, and recent trends in, child participation in school health. We summarized the system of child participation in school health in Japan and examined factors enabling child participation.

RESULTS

We identified the following four factors that enable child participation in school health in Japan: (i) having an explicit legal basis for participatory activities at the national level; (ii) having clear notification, in relevant administrative documents at the prefectural and municipal levels, of the necessity for children's voluntary participation; (iii) establishing a system for teachers to provide support for participatory activities at the school level, and (iv) having a shared understanding among stakeholders about the pedagogical importance of participatory activities in school health.

CONCLUSIONS

To promote child participation in school health activities in developing countries, it is necessary to describe clearly the importance, benefits, impacts, and purposes of child participation in relevant legal and administrative documents at relevant administrative levels. Schools should also ensure that stakeholders have a common understanding of the educational benefits of child participation considering the cultural context of each country. It is helpful to conduct appropriate training for teachers to enable them to facilitate child participation.

Experiences of involvement processes during participation in cancer service user initiatives from an adolescent and young adult perspective

Background Service user participation contributes to the improvement of health care services for the betterment of conditions experienced by patients. However, there is a lack of knowledge about how adolescents and young adults (AYAs) experience involvement processes in practice and what it would take to achieve a high degree of involvement according to AYAs. Objectives To explore: (1) how AYAs with cancer experienced involvement processes during participation in three different service user involvement initiatives (development of an app, development of a book and youth panel meetings), and (2) AYAs' perceptions of determination and collaborative areas between AYAs and professionals. Methods Individual semi-structured interviews were conducted with 12 AYAs with cancer aged 16-29 who had participated in at least one of the service user initiatives in Kræftværket, a youth cancer support centre and social organisation located at Copenhagen University Hospital, Denmark. We analysed data with thematic analysis. Results We identified three main themes with matching sub-themes: Working procedures (Agenda setting, Workflow, Dialogue), Knowledge sharing (AYAs' needs and ideas, Areas of expertise), Influence (Decisions, Ownership). Generally, the participants experienced an equal dialogue with professionals and felt they had the final say on decisions. Conclusions This study produced specific suggestions on how to involve AYAs to a high extent. Based on AYAs' own perceptions of involvement, AYAs', professionals' and shared determination areas were illuminated. Additionally, the AYAs highlighted how the professionals gave feedback during co-creation processes, which may inspire future service user involvement projects.

Formative Process Evaluation of the "Connect" Physical Activity Feasibility Trial for Adolescents

Most interventions do not reach full implementation in real-world settings. Due to this issue, formative process evaluation during pilot programs can be especially useful to understand implementation strengths and areas for improvement so that full implementation can be reached in future iterations. This study demonstrated how a formative process evaluation of the Connect through Positive Leisure Activities for Youth (Connect) pilot informed course corrections for year 2 implementation. Connect is an intervention to promote a positive social motivational climate for physical activity (PA) in pre-existing after school programs. Connect ran 3 days a week for 8 weeks and had 2 components: a 30-minute “Get-to-Know-You” (GTKY) session and a 60-minute PA session. Formative evaluation was assessed using an observational tool and staff surveys. Changes in youth PA during program hours was assessed as a process outcome using the System for Observing Children’s Activity and Relationships during Play (SOCARP). All Connect essential elements were assessed with the observational tool including (a) social goal-oriented support; (b) collaborative, cooperative play; (c) equal treatment/access; and (d) an inclusive and engaging climate. Adequate dose was achieved on all items in all sessions. Although GTKY and PA sessions both reached high fidelity in promoting equal treatment and access, success in reaching fidelity varied for the 3 remaining essential elements. Post-intervention staff surveys indicated acceptability/adoptability of the Connect program and SOCARP observations indicated significant increases in PA from baseline to post-intervention. Changes for year 2 implementation based on the findings are discussed.

Effects of a Participatory School-Based Intervention on Students' Health-Related Knowledge and Understanding

Introduction: The development of knowledge and understanding in relation to movement and health is a basic requirement to facilitate lifelong engagement in physical activity with its accompanying possible health benefits. To train teachers in applying adequate strategies, implementation studies have often shown little acceptance of traditional top-down approaches. Thus, the purpose of the Health.edu project was to develop, implement and evaluate effective and feasible measures addressing students' health-related knowledge and understanding (HKU) in physical education (PE) via a participatory approach.

Materials and Methods: For evaluation, a controlled pre-post-test study with 233 students from eight different secondary schools in Germany was carried out. Four schools (with two PE teachers at each school) comprised the intervention group and they participated in a 1-year participatory planning process to conceptualize and implement evidence-based PE lessons addressing students' HKU. Control schools carried out their regular PE lessons. Evaluation followed a mixed-methods research design, assessing program implementation via written documentary technique as well as program effectiveness using a standardized questionnaire.

Results: Results show a significant intervention effect on students' HKU with a medium effect size. However, due to the participatory process, there were considerable differences between the intervention schools that were involved. Student's HKU improved most in schools where program implementation corresponded to relevant principles of fostering HKU.

Discussion: The present study purposefully dispensed with any structured intervention programs for PE teachers to follow. The results show the potential effects of this participatory approach to strengthen student's HKU. However, the participatory planning does not always work in the intended manner, emphasizing that numerous contextual factors influence the implementation process.

Analysis of whole-school policy changes in Austrian schools

Health Policies with school-wide effects have been shown to improve the health of students and school staff, but in practice, schools struggle with this approach. Ten Austrian schools which had recently adopted new time structure policies were investigated: On the basis of 19 interviews with school staff, we used thematic analysis to identify facilitating and hindering factors for the implementation processes. Furthermore, agency analysis was applied, in which the interviewees’ use of language was interpreted to estimate their perception of their own agency in the context of policy change. We found that in schools where policy changes were perceived as successfully implemented, staff was convinced of the benefits. In these schools, time structures were understood to directly influence learning and teaching processes and staff members showed a strong feeling of agency. On the other hand, schools were confronted with hindering factors similar to those known from the implementation of other health policies. The results are discussed in the light of current implementation practices, and conclusions for practitioners are drawn.

Factors Affecting Social Health from Young Adults' Perspective: A Qualitative Study

BACKGROUND

Factors affecting social health, especially in young adults, are among the most important research priorities. Knowledge of social factors affecting young adults' health will lead to understand them in the social context. The present study is aimed to explain the perspective of young adults on social factors affecting health.

METHODS

In the present qualitative content analysis study, semi-structured open interviews were conducted through targeted sampling of young volunteers aged 18-30 who were selected from Tehran Province. Interviews were recorded, transcribed, and analyzed. The inclusion criteria for participants were willingness to participate in the study and ability to express their personal experiences. Twenty-one data were collected through collection was done with individual in-depth interviews.

RESULTS

Using this qualitative approach, the present study was conducted to identify factors affecting social health from the perspective of young adults. The analysis led to the extraction of three main categories, each with two or three subcategories: expectations regarding the community, expectations regarding the family, and expectations regarding infrastructures.

CONCLUSIONS

Our findings shown that social support considered as effective elements in providing social health of young adults. The evidence on controlling factors should be considered in promoting the social health of specific target groups. The results of the present study could be used for better planning of interventions in youth social health domains.

Effective health promoting school for better health of children and adolescents: indicators for success

BACKGROUND

Improvement of health literacy, health behavioural change, creating a supportive physical and social environment to be more conducive to health should be the focus of child and adolescent public health. The concept of Health Promoting School initiated by World Health Organization aims to move beyond individual behavioural change and to consider organisational structure change such as improvement of the school's physical and social environment. The aim of this study is identification of the key indicators for successful implementation of Health Promoting School by analysing the findings of the school health profile based on the structured framework of Hong Kong Healthy School Award Scheme and the health status of students investigated by the Hong Kong Student Health Survey.

METHODS

This is a retrospective correlation study. Analysis of variance (ANOVA) was utilised to analyse for significant improvement of school health profile measured at baseline (n = 104) and among those schools implemented the Hong Kong Healthy School Award Scheme (n = 54). Those indicators showing statistical significance were chosen to be part of the core indicators reflecting effective Health Promoting School. Each of those selected core indicators was then correlated with the related student health outcomes measured by the Hong Kong Student Health Survey Questionnaire to further identify the core indicators.

RESULTS

A total of 20 core indicators among all the six Key Areas of Health Promoting School (6 indicators under action competencies, 2 under community link, 2 under physical environment, 2 under social environment, 4 under healthy school policies, 1 under services of school health protection) have been identified with the method mentioned above.

CONCLUSIONS

This study has identified the indicators with most significant impact on a wide range of health related outcomes. Those are key indicators for motivating positive change of the schools and students. They can be considered as school performance indicators to help schools embarking their Health Promoting School journey as another key education objective.

Background and evaluation design of a community-based health-promoting school intervention: Fit Lifestyle at School and at Home (FLASH)

BACKGROUND

A community-based approach can be a promising strategy for implementing school-based health promotion aimed at stimulating healthy physical activity and dietary behaviour. Such an approach builds on the community capacity of multiple stakeholders, empowering them to design and implement tailored activities, supported by the whole school community. This paper describes the background and evaluation design of the community-based school intervention 'Fit Lifestyle at School and at Home' (FLASH) in four prevocational schools. FLASH includes four strategies for building the community capacity of students, school personnel and parents: 1) identifying leaders in each stakeholder group, 2) stimulating a school culture of participation, 3) having stakeholders design and implement tailored activities and 4) creating a network of local partners for structural embedding. The objective is to monitor the capacity-building processes of the FLASH intervention and to explore if these processes contribute to changes in community capacity. In addition, we will explore if the FLASH intervention is related to changes in PA, dietary behaviours and BMI of students.

METHODS

This study has a mixed methods design and uses a participatory action-oriented approach to monitor and evaluate changes in community capacity, tailored health-promotion activities and implementation processes. Methods include semi-structured interviews, focus groups, journals, document analysis and observational scans of the physical environment. In addition, changes in BMI, physical activity and dietary behaviours of prevocational students will be explored by comparing the four intervention schools to four control schools. Data are collected by questionnaires and anthropometric measurements.

DISCUSSION

The main strength of this study is its use of mixed methods to evaluate real-life processes of creating a healthy-school community. This will provide valuable information on capacity-building strategies for the structural embedding of health-promotion activities within school settings. The results could help schools become more empowered to adapt and adopt integral health-promotion interventions in daily practice that suit the needs of their communities, that are expected to be sustainable and that could lead to favourable changes in the PA and dietary behaviour of students.

TRIAL REGISTRATION

ISRCTN67201841 ; date registered: 09-05-2019, retrospectively registered.

Improving Female Adolescents' Knowledge, Emotional Response, and Attitude toward Menarche following Implementation of Menarcheal Preparation Reproductive Health Education

Menarche and menstruation are considered taboos and disconcerting by communities, including female adolescents. The Menarcheal Preparation Reproductive Health Education program was designed to prepare female adolescents for menarche. The aim of this study was to identify the influence of reproductive health education on female adolescents’ preparation, knowledge, emotional response, and attitude toward menarche. The research design was a quasi-experimental, pre–post test with control group design. We selected 174 female adolescents by a stratified random sampling technique. The respondents were divided into two groups: control and intervention. The intervention group was provided Menarcheal Preparations Reproductive Health Education program in the form of a booklet, whereas the control group experienced no intervention. Data analyses involved the use of a chi-square test, McNemar test, and logistic regression. The results showed that there were significant differences in terms of knowledge (p = .001), emotional responses (p = .001), and attitude (p = .001) between the groups, as well as before and after intervention in the intervention group. Logistic regression revealed that reproductive education was the most influencing factor among female adolescents’ knowledge (OR = 45.1; 95% CI: 13.8–148.1), emotional responses (OR = 12.7; 95% CI: 5.6–28.5), and attitude (OR = 12.4; 95% CI: 5.8–26.6) toward menarche. Therefore, this study supports a recommendation of using Reproductive Health Education Related to Menarcheal Preparation in schools and community settings to prepare female adolescents for menarche.

Kids Out; evaluation of a brief multimodal cluster randomized intervention integrated in health education lessons to increase physical activity and reduce sedentary behavior among eighth graders

BACKGROUND

Most Finnish adolescents are not sufficiently physically active. Health education (HE) provides beneficial starting point for physical activity (PA) promotion in schools. This study evaluates an intervention integrated into three HE lessons to increase PA and reduce sedentary behavior (SB) among eighth graders.

METHODS

All public secondary schools in Tampere, Finland participated and were randomized to intervention (INT, n = 7) and comparison group (COM, n = 7). In INT (690 students, 36 classes) the teachers (n = 14) implemented behavioral theory-driven content during three HE lessons. In COM (860 students, 41 classes) the teachers (n = 14) carried out standard lessons. The evaluation was based on RE-AIM: Effectiveness was assessed from baseline to 4 weeks (Follow-up 1) and Maintenance from 4 weeks to 7 months (Follow-up 2) with change in students' PA and SB and related psychosocial and parental factors. Methods included questionnaire, accelerometer and activity diary. Linear mixed models with baseline adjustments and random effect correction were used to compare the difference in change between INT and COM. Data on Reach, Adoption and Implementation were collected during the process.

RESULTS

Intervention effects were only seen in the self-reported data favoring INT in the weekly number of days with at least 1 h of brisk leisure PA (0.3 [95%CI 0.1 to 0.6]), proportion of students meeting PA recommendations (4.1 [95%CI 2.5 to 5.7]), proportion of students reporting that their family sets limitations for screen time (5.4 [95%CI 3.3 to 7.4]) and in the number of days on which the students intended to do leisure PA in the following week (0.3 [95%CI 0.1 to 0.6]). The effects on PA were still beneficial for INT at Follow-up 2. The intervention reached 96% of the students, was adopted in all 7 schools and was implemented by 13/14 teachers in 35/36 classes.

CONCLUSIONS

The intervention was feasible and had small favorable effects on students' self-reported PA, intention to do PA and family norm in screen time. The effects on PA persisted until Follow-up 2. It is likely that for greater impacts the HE lessons should have been supported with other actions without compromising feasibility.

TRIAL REGISTRATION

NCT01633918 (June 27th, 2012).

Youth Perspectives of Healthcare in Central Mexico: An Application of Massey's Critical Health Literacy Framework

Attention to health literacy is essential more now than ever given the recognition, attention, and resources being dedicated to addressing health disparities throughout the world. Unfortunately, health literacy research is scarce in many parts of the world, particularly among youth. Using focus group discussions with junior high school students (N = 98) in a rural town of Central Mexico, we sought to learn about their experiences utilizing healthcare services at a local health clinic. The themes that naturally emerged from focus group discussions aligned with Massey's framework on critical health literacy among US youth, and included problems navigating the health system, embarrassment speaking to doctors about sensitive issues, and minimal importance being placed on preventative care. This suggests that Massey's framework may be appropriate to use when seeking to understand and promote health literacy among youth in Mexico. Furthermore, the challenges faced by adolescent participants in this study suggest that additional research is needed to assess how youth in other areas of Mexico are faring in efforts to understand and access their new and evolving universal healthcare system.

Untapped Resources: 10- to 13-Year-Old Primary Schoolchildren's Views on Additional Physical Activity in the School Setting: A Focus Group Study

Schools are considered ideal venues to promote physical activity (PA) in children. However, a knowledge gap exists on how to adequately integrate PA into the school day and in particular, on the preferences of children regarding additional PA in school. Therefore, the aim of our qualitative study was to gain comprehensive insight into 10⁻13-year-old primary schoolchildren's perspectives on how to increase PA in the school setting. We conducted nine focus groups (32 girls and 20 boys) with children attending the final two grades of primary school in the Netherlands. We used inductive thematic analysis to analyze the data. The results showed that children were enthusiastic about additional PA in school. Children suggested various ways to increase PA, including more time for PA in the existing curriculum, e.g., physical education (PE), recess, and occasional activities, such as field trips or sports days; school playground adaptation; improving the content of PE; and implementing short PA breaks and physically active academic lessons. Children emphasized variation and being given a voice in their PA participation as a prerequisite to keep PA enjoyable and interesting in the long term. Finally, children mentioned the role of the teacher and making efforts to accommodate all children and their different preferences as important. Children have concrete ideas, acknowledging the challenges that accompany integrating additional PA in school. We therefore recommend actively involving children in efforts to increase school-based PA and to make "additional PA in school" a shared project of teachers and students.

Building school-based social capital through 'We Act - Together for Health' - a quasi-experimental study

BACKGROUND

Social capital has been found to be positively associated with various health and well-being outcomes amongst children. Less is known about how social capital may be generated and specifically in relation to children in the school setting. Drawing on the social cohesion approach and the democratic health educational methodology IVAC (Investigation - Vision - Action - Change) the aim of this study was to examine the effect of the Health Promoting School intervention 'We Act - Together for Health' on children's cognitive social capital.

METHOD

A quasi-experimental controlled pre- and post-intervention study design was conducted with 548 participants (mean age 11.7 years). Cognitive social capital was measured as: horizontal social capital (trust and support in pupils); vertical social capital (trust and support in teachers); and a sense of belonging in the school using questions derived from the Health Behaviour in School Children study. A series of multilevel ordinal logistic regression analyses was performed for each outcome to estimate the effect of the intervention.

RESULT

The analyses showed no overall significant effect from the intervention on horizontal social capital or vertical social capital at the six-month follow-up. A negative effect was found on the sense of belonging in the school. Gender and grade appeared to be important for horizontal social capital, while grade was important for sense of belonging in the school. The results are discussed in relation to We Act's implementation process, our conceptual framework and methodological issues and can be used to direct future research in the field.

CONCLUSION

The study finds that child participation in health education can affect the children's sense of belonging in the school, though without sufficient management support, this may have a negative effect. With low implementation fidelity regarding the Action and Change dimension of the intervention at both the school and class level, and with measurement issues regarding the concept of social capital, more research is needed to establish a firm conclusion on the importance of the children's active participation as a source for cognitive social capital creation in the school setting.

TRIAL REGISTRATION

https://www.isrctn.com/ISRCTN85203017.

Increasing Social Support for Breakfast: Project BreakFAST

High school students in the United States are known to be frequent skippers of breakfast. Social support is one key element needed to encourage adolescents to consume school breakfast. This article presents an analysis of the influence of a school policy and environment change intervention on the social support of adolescents to eat breakfast.

METHOD

The intervention included school policy changes in 16 schools randomized to intervention and delayed-intervention conditions, in order to allow quick and easy access to breakfast as well as to allow breakfast consumption in classrooms and hallways; a School Breakfast Program marketing campaign to address normative and attitudinal beliefs; and increasing social support and role modeling to encourage breakfast eating. The participants in the study completed an online survey at baseline and again postintervention.

RESULTS

The final analysis included only students who completed the relevant survey (n = 904) items on both the baseline and follow-up surveys. The students in the intervention group showed a higher level of social support post intervention than the control group with a significant adjusted p of .02. Most of the overall social support change was explained by a change in the "other kids at my school" and "other school staff" categories.

CONCLUSIONS

The BreakFAST study shows the benefits of school staff and kids other than friends supporting a behavior change to include breakfast consumption in adolescents.

Policy windows for school-based health education about nutrition in Ecuador

The aim of this study is to identify opportunities in policy framing for critical health education (CHE) about food and nutrition in Ecuadorian schools. The research engages in a dialogue between the perspectives of critical nutrition and political ecology, as it seeks to clarify and develop a critical perspective on health promotion and health education. Critical nutrition studies and political ecology highlight the need to consider and also act upon the broader connections of, and influences on, food and nutrition. In a CHE approach, students learn to address the wider determinants of health through critical, democratic and collaborative processes, anchored in and supported by the local community. Based on a textual analysis of health, food and education policy documents, the study finds that concrete norms endorse a biomedical stance. Consequently, focus remains on prescribing individual behavior, and schools are regarded as intervention settings, rather than a site for generating change as would be the case of health promotion using a CHE viewpoint. However, the study finds the possibility for developing a CHE perspective in the overarching rationale of 'good living', which reaffirms a holistic understanding of health, the need for critical and plural participation and the importance of the community. It is possible that the notion of community participation could facilitate introducing a CHE approach in Ecuadorian schools.

Participation and support - associations with Swedish pupils' positive health

From the perspective of salutogenesis, schools have opportunities to create supportive environments for health and well-being, but there is a need for more knowledge about positive health determinants in the school setting. The aim of this study was to analyse adolescents' self-reported positive health and its association with supportive factors in the school environment. Data was derived from a cross-sectional study in which pupils were aged 12-16 (n=1527). A positive health scale was used to examine the association of positive health with the following determinants: classroom participation; teacher support; peer support; parental support; and personal relative affluence. Data was analysed with multiple logistic regression. The results showed that positive health was associated with classroom participation and support from teachers and parents more commonly among boys than girls. All determinants were significantly associated with pupils' positive health. The conclusion is that students' positive health is strongly associated with support from the school. Classroom participation and support are major concerns for the health of pupils, and it is essential to develop these aspects of the school environment.

The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes

BACKGROUND

Since stakeholders' active engagement is essential for public health strategies to be effective, this review is focused on intervention designs and outcomes of school- and community-based noncommunicable disease (NCD) prevention interventions involving children and young people.

METHODS

The review process was based on the principles of scoping reviews. A systematic search was conducted in eight major databases in October 2015. Empirical studies published in English, French, Portuguese, and Spanish were considered. Five selection criteria were applied. Included in the review were (1) empirical studies describing (2) a health intervention focused on diet and/or physical activity, (3) based on children's and young people's involvement that included (4) a relationship between school and local community while (5) providing explicit information about the outcomes of the intervention. The search provided 3995 hits, of which 3253 were screened by title and abstract, leading to the full-text screening of 24 papers. Ultimately, 12 papers were included in the review. The included papers were analysed independently by at least two reviewers.

RESULTS

Few relevant papers were identified because interventions are often either based on children's involvement or are multi-setting, but rarely both. Children were involved through participation in needs assessments, health committees and advocacy. School-community collaboration ranged from shared activities, to joint interventions with common goals and activities. Most often, collaboration was school-initiated. Most papers provided a limited description of the outcomes. Positive effects were identified at the organisational level (policy, action plans, and healthy environments), in adult stakeholders (empowerment, healthy eating) and in children (knowledge, social norms, critical thinking, and health behaviour). Limitations related to the search and analytical methods are discussed.

CONCLUSION

There are very few published studies on the effectiveness of interventions based on children's involvement in school- and community-based NCD prevention programmes. However, interventions with these characteristics show potential benefits, and the merits of complex multi-setting approaches should be further explored through intervention-based studies assessing their effectiveness and identifying which components contribute to the observed outcomes.

A confluence of evidence

Purpose

– The purpose of this paper is to contribute to the evidence base to support whole school approaches.

Design/methodology/approach

– The authors conduct a review of published evaluations and evidence syntheses across six areas in the international health-promoting schools literature.

Findings

– Although whole school approaches are often advocated in literature and policy on health-promoting schools, the evidence base for their effectiveness is partial and is often health topic specific. This paper reviews the evidence base across six different health-related areas, namely: sexual health; bullying; alcohol and drug use; mental health; school connectedness; and access to services. It identifies commonalities in learning, enabling a confluence of evidence on the factors central to the provision of effective health education and support within schools. Whilst findings endorse a whole school approach, they also suggest that some of the more subtle evidence-based principles on which such approaches are underpinned are not generally explicitly reflected in practice.

Originality/value

– The paper offers the first cross-topic synthesis of findings on health education effects and effectiveness in six health-related areas, to identify commonalities in learning. Findings contribute to the evidence base for the use of a whole school approach when undertaking health education in schools.

Examining participation in relation to students’ development of health-related action competence in a school food setting

Purpose

– The purpose of this paper is to examine how students’ participation in an integrated school food program was related to the development of components of food and health-related action competence (F & HRAC). These components were understood to be the knowledge, insight, motivation, ownership and social skills that made students able to take action regarding food and health in everyday life.

Design/methodology/approach

– Research was undertaken as a single case study of the development of an integrated education and health program called LOMA-Local Food (LOMA) in a secondary school in Denmark. Qualitative methods were applied, including an action research component, where researcher and teachers examined how students developed action competence. The program was based on a whole school approach with the aim of improving F & HRAC. As a way to obtain this, students participated in planning, preparing, cooking and serving their own school food as integrated in curriculum. The study applied the Health Promoting Schools’ (HPS) conceptual framework and the

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nvestigation,

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ision,

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ction and

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hange (IVACE) approach.

Findings

– Students who participated in LOMA educational activities became motivated for developing a food F & HRAC, which included components such as knowledge, insight, motivation, ownership, action experience, commitment, cooperation and critical thinking. Students developed practical skills related to food and health, when they were cooking healthy school food together with professionals and peers. The study also points to the importance of capacity building among teachers. The IVACE matrix is suggested as a relevant tool for monitoring forms of participation that contributes to students’ development of F & HRAC.

Practical implications

– There were indications of how participation in LOMA contributed to students’ development of F & HRAC. The practical implication of this is that “setting” is very important for the success of food and health education initiatives. In this integrated approach the production kitchen and the dining hall are indispensable. Also the new organization of the school day and the introduction of a shared daily meal are important practical components for the improvement of the learning environment. The possibility of combining theory and practice seem conducive for students’ achievement of action competence.

Social implications

– The current study is an example of how the IVACE matrix can be applied in order to plan, conduct and evaluate LOMA educational activities, which could be considered as a contribution to the HPS scientific community. It would be useful for other schools that intend to apply the LOMA approach. However, more research is needed, where teachers, students, staff and other stakeholders collaborate in an action research process. This could promote students’ health and support other initiatives regarding public health, sustainable development and democracy.

Originality/value

– This research may have implications for the way that school food programs are developed and implemented if they are to make a contribution to students’ development of F & HRAC. Taking the political interest for research-based interventions into account, it is important that future strategies include teachers’ capacity building. Research is also needed regarding further development and test of the IVACE matrix as a method in participatory, health education approaches. This should be seen in combination with a renewed focus on integrated curricula models related to the on-going discussion on redesign of western school curricula.