The picture of health: examining school-based health environments through photographs

Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs

CONTEXT

The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action.

OBJECTIVE

Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review.

DATA SOURCES

A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched.

DATA EXTRACTION

Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool.

DATA ANALYSIS

A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership.

CONCLUSIONS

This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022303255.

Preschool teachers display a flexible pattern of pedagogical actions in promoting healthy habits in children

The school represents the optimal setting for promoting the physical, emotional, and social health of children, especially during the first years of life. Understanding the pedagogical actions of teachers to address health education is an important first step in promoting healthy behaviors in children. We inhere analyzed the pedagogical action patterns in the preschool teaching of healthy habits from a holistic health perspective. We used photography as a strategy for data collection and applied a Chi-square automatic interaction detection (CHAID) classification tree, a data mining procedure, to generate a pattern model. We found that the school space and the learning playfulness strategies for the development of executive functions, classified according to the exercise, symbolic, assembly, rules (ESAR) model, were the main factors that influence the pedagogical actions fostering healthy habits. By contrast, the school and the pedagogical resources of the classroom are factors with a much smaller impact on working with healthy habits. This pedagogical action pattern is flexible, since teachers conduct a multiplicity of pedagogical actions through different strategies, in different school spaces, at any time. In conclusion, our results unmask the interdependent relationships between the different factors that determine the teacher's actions at the preschool. It also contributes to the understanding of the teacher's practices in fostering healthy habits in a healthy learning environment.

Participatory Approaches to Understand Dietary Behaviours of Adolescents in the Secondary School Setting

Acknowledgement of wider socio-ecological factors that influence dietary behaviours needs greater consideration in nutrition research with young people. Additionally, children and adolescents have a right to have their voices heard in research that concerns them. The aim of this methods paper is to describe and evaluate participatory methodologies undertaken as part of a dietary behaviour study with adolescents in the school setting in Ireland. Photovoice and peer-led focus groups were the key participatory methodologies, undertaken alongside food diaries and anthropometry. These methodologies were evaluated through discussion with peer researchers, qualitative surveys and in the context of the wider study process and outcomes. Peer researchers reported learning new skills including research, facilitation, listening and social skills and many felt they gained confidence, as well as an awareness about healthy and unhealthy practices at school. The findings were found to be authentic according to students, except for two limitations. Students believed body image was not adequately represented in the findings, and alternative focus group compositions could have influenced discussion content. Youth participants were afforded genuine opportunities to have their voices heard as part of a diet and nutrition research and the methodologies were acceptable and enjoyable. They demonstrated agency in valuable contributions at project design, data collection, analysis and interpretation stages of the research process. Furthermore, the participatory methodologies complemented quantitative data by providing environmental, behavioural, and socio-cultural insights into food choice in the school setting.

A translational approach to characterization and measurement of health-promoting school ethos

A health promoting schools (HPS) approach is hypothesized to influence student health and wellbeing by promoting a 'school ethos' that reflects the physical environment, social relations, organisational structure, policies and practices within schools. This complex set of factors makes health promoting school ethos (HPSE) challenging to define and measure. This work sought to theorise, develop and pilot a measure of HPSE as the context for implementation of HPS initiatives. We used a multi-method, iterative process to identify relevant HPSE concepts through triangulation of conceptual literature, existing tools and the tacit knowledge of school stakeholders. The HPSE measurement tool was administered to 18 elementary schools through a principal and teacher survey and an environmental assessment, followed by the development of HPSE scores for each school. Testing for internal consistency of items was used to examine theorized concepts, and scores for each school are summarised. HPSE included eight conceptual dimensions with internal consistency ranging from α = 0.60 to α = 0.87. Total HPSE scores across schools (N = 18) ranged from 1 to 8 (mean = 3.94, SD = 2.1), with 28-65% of schools reporting 'high' on respective HPSE dimensions. Schools included a heterogeneous mixture of HPSE scores, particularly across different dimensions. Our novel approach to tool development allowed us to conceptualize HPSE using a flexible process comprising different types and sources of evidence. The HPSE tool holds potential for identification and measurement of critical components of different school context as it relates to HPS.

Studies evaluating of health interventions at schools: an integrative literature review

OBJECTIVE

to identify and analyze the available evidence on the strategies used in the studies evaluating health interventions at school.

METHOD

this is an integrative review searching in LILACS, CINAHL, CUIDEN, ScienceDirect, and PubMed. From the pre-defined inclusion and exclusion criteria, there were 121 articles chosen to compose the sample.

RESULTS

english studies (97.5%), with a quantitative approach (80.2%), related to the interventions carried out in the Region of the Americas (54.6%) and the European Region (23.1%) predominated. For the most part, they are interventions as programs (70.2%), interested in evaluating results (73.5%) from the value judgment (83.4%). Prevalence of interventions focused on efficacy, effects or impact, and activities carried out on interventions were focused on physical activity, healthy eating, sexual and reproductive health, mental health, and use of tobacco, alcohol, and other drugs. They are worked through activities of clinical monitoring, health promotion and disease prevention.

CONCLUSION

the evidence indicates that the evaluations of health interventions in the school focus the results produced in programs through the judgment of value. The topics most addressed were healthy eating, physical activity, prevention of alcohol and other drugs, among others.