Health promoting schools: initiatives in Africa

Primary school learners' movement during class time: perceptions of educators in the Western Cape, South Africa

BACKGROUND

Over the last decade, the efficacy of in-classroom movement to reduce sedentary behaviour has been mainly conducted in high-income, developed countries. To date, there have been no published reports on the perceptions of principals and teachers regarding learners' movement during class time to inform the implementation of classroom-based movement strategies to reduce sedentariness in South Africa.

METHODS

A sample of primary school principals and grades 5 and 6 teachers from a range of socio-economic categories participated in this exploratory, descriptive qualitative study in the metro central district of the Western Cape Education Department in South Africa. Transcripts of individual depth interviews (IDIs) with principals and focus group discussions (FGDs) with teachers were coded using Atlast ti 9* software for qualitative analysis.

RESULTS

Thirteen principals (13 IDIs) and 24 teachers (6 FGDs) participated in the study. Two main factors influencing in-classroom movement, namely teacher-related and structural factors, were identified. The teacher-related factors pertained to their classroom management practice, knowledge and beliefs about sitting, and management style influenced their role in delivering the curriculum and creating a classroom environment conducive for learning. Classroom factors pertained to classroom size, the number of learners in the class and the ergonomic utility of traditional classroom desks. Institutional expectations and acceptance of learners' behaviour, and teachers' practice were also notable contributing factors that influenced learners' movement during class time.

CONCLUSION

Emerging evidence about the efficacy of in-classroom movement on sedentary behaviour and learning outcomes challenges traditional teacher practice that sitting is essential for the delivery of the curriculum and for creating an optimal learning environment. Teacher training about the behaviour control utility of in-classroom movement, and school management and policy supportive of in-classroom movement may encourage fidelity to in-classroom movement strategies.

Health Promoting Schools: An Update

The concept of a Health Promoting School has been found to be effective to improve health and well-being of students as well as a help with teaching and learning in school. Effective implementation of Health Promoting School is a complex intervention involving multi-factorial and innovative activity in many domains such as curriculum, school environment and community. Many studies evaluating Health Promoting School do not include outcomes reflecting the organisational or structural change as many of those studies are quantitative in nature and the statistical assumptions are not valid reflecting the organisational structure changes. Recent global meetings of experts have reviewed the impact on student health from the perspectives of school environment, school policies on health, action competencies on healthy living and community linkage. The English Wessex Healthy School Award Scheme and the Hong Kong Healthy School Awards Scheme have developed detailed systems to analyse whether each individual school has reached the standard of a model Health Promoting School reflecting a more holistic appreciation and understanding of all the effects of school-based health promotion with positive award-related changes. However, not many schools are able to implement Health Promoting School in its entirety, so cores indicators are needed as a starting point for wider implementation. Hong Kong Healthy School Awards Scheme is still ongoing with data for analysis of indicators with significant correlation with better health and well-being. We identified the core indicators and substantiated the requirements for successful outcomes by supplementing the established award-scheme framework with a review of recent literature and documents. Framework of Health Promoting School would go beyond improvement of health literacy to enable a more efficient system for education and health on children, hence a good investment in children.

Implementing health-promoting schools to prevent obesity

Purpose

Obesity in children and adolescents is a significant public health concern. The World Health Organization Health Promoting Schools (HPS) framework promotes good nutrition and physical activity in school settings. While HPS is embraced globally, effective implementation and sustainable programmes are a continued challenge. This paper aims to report on the characteristics of current school interventions based on HPS and implementation barriers and enablers.

Design/methodology/approach

A literature search identified peer-reviewed studies of school health interventions reflective of the HPS framework focusing on obesity prevention. Studies from all countries were included, if conducted in primary and/or secondary schools; included a sufficient amount of qualitative implementation or process evaluation data to draw conclusions regarding key barriers and enablers to implementation; and were published in English.

Findings

Nine interventions (n = 9) from seven countries were included. Most were implemented in primary schools and focused on specific grade levels. Engaging parents, the home environment, teacher time constraints, fun interventions, student participation, teacher training, integration with the curriculum and stakeholder engagement all emerged as strong implementation themes. Teachers as role models, establishing community partnerships and policy support also emerged as common themes.

Originality/value

Future interventions may benefit from enhancing teacher and parent health promotion. Partnerships with initiatives focusing on environmental sustainability may simultaneously benefit human and planetary health while strengthening stakeholder engagement opportunities and consistent messaging throughout the community. More comprehensive evaluation data are needed, in particular, for long-term HPS initiatives.

Celebrity endorsed music videos: innovation to foster youth health promotion

There are calls for innovation in health promotion and for current issues to be presented in new and exciting ways; in addition to creating engaging messages, novel ways to deliver health messaging are needed, especially where youth are the key target audience. When pupils in WHO Health Promoting Schools were asked what health messages would resonate with them, they also identified celebrities as the ‘messengers’ they would be particularly likely to listen to. Expanding on these discussions, the pupils quoted celebrity-recorded music videos containing health and lifestyle messaging as an example of where they had learned from celebrities. Their ability to sing phrases from the songs and repeat key health messages they contained indicated the videos had commanded attention and provided knowledge and perspectives that had been retained. We located on YouTube the video titles the pupils identified and evaluated the content, messaging and production concepts these celebrity-recorded music videos incorporated. All are good examples of the health promotion genre known as education entertainment, where educational content is intentionally included in professionally produced entertainment media to impart knowledge, create favorable attitudes and impact future behaviors. The importance of this genre is growing in parallel with the burgeoning influence of social media. Music videos resonate with youth, and celebrity recordings combine young people’s love of music with their fascination for the aura of celebrity. Hence, producing videos that combine an effective health message with celebrity endorsement offers potential as an innovative conduit for health promotion messaging among youth.

Priorities for African youth for engaging in DOHaD

A challenge for implementing DOHaD-defined health promotion is how to engage the at-risk population. The WHO Health Promoting School (HPS) model has proven success engaging youth and improving health behaviors. Hence, we introduced DOHaD concepts to 151 pupils aged 12–15 years in three HPS programs in rural Uganda, inquired what factors would make DOHaD-related health promotion resonate with them, and discussed how they recommended making learning about DOHaD acceptable to youth. Economic factors were judged the most compelling; with nutrition and responsive care elements next in importance. Suggested approaches included: teach how good health is beneficial, what works and why, and give tools to use to achieve it, and make information positive rather than linked to later harm. Involve youth in making DOHaD learning happen, make being a parent sound interesting, and include issues meaningful to boys. These are the first data from youth charged with addressing their engagement in the DOHaD agenda.

Children’s Oral Health: The Opportunity for Improvement Using the WHO Health Promoting School Model

The health and quality of life of a large proportion of the world’s children are compromised by dental caries and periodontal disease. Those in developing countries and from disadvantaged populations suffer disproportionately from these forms of poor oral health; however, much of the primary disease and secondary pathology is preventable by simple and inexpensive measures that children can readily learn. WHO health promoting schools (HPS) are an established model for addressing public health issues through education of children in a manner that achieves acquisition of knowledge and health practices that promote behaviours that positively impact determinants of health. HPS programs that address poor oral health have achieved improvement in oral health practices and reduction in caries rates among disadvantaged populations of children. WHO has called for more programs to address the “epidemic” of poor oral health worldwide, and the WHO HPS model appears to be a relevant and applicable way forward. Health care professionals and educators who want to improve the health and quality of life of children related to caries and periodontal disease now have an opportunity to collaborate to initiate, deliver, and evaluate community-based HPS interventions using proven concepts, content, and process.