A comprehensive "Healthy Schools Programme" to promote school health: the Hong Kong experience in joining the efforts of health and education sectors

Referring students for professional psychological help: A qualitative study of teachers' experience in Hong Kong

Teachers have frequent interaction with students and are well positioned to refer students for mental health assistance when needed. Twelve secondary schoolteachers in Hong Kong were interviewed about their experience referring students to mental health professionals (MHPs). Using consensual qualitative research, multiple factors were found to influence teachers' referral decisions, including problem severity, students' willingness, stigma of help-seeking, parent/guardian's beliefs, teacher-parent/guardian relationship, MHPs' effectiveness and availability, quality of interaction with MHPs, and teachers' self-efficacy in handling student issues. Based on the findings, we propose a conceptual model of factors influencing teachers' referral decisions. Implications for research, practice, and training are discussed.

Health screening system to ensure children's health and development in Japan

BACKGROUND

The establishment of health screening systems for children is important, however, such systems are not always well-established in developing countries. This study aimed to improve child health screening systems in developing countries by analyzing the factors that contribute to enabling continuous and proper screenings at various governmental levels in Japan.

METHODS

We reviewed the history of child health and development screening systems in Japan and examined factors that enabled their regular and nationwide implementation.

RESULTS

We identified the six enabling factors: (i) the existence of relevant laws and regulations in health and education systems for health checkups, (ii) mandated and detailed conditions for health checkups within both school and community health, (iii) the provision of guidelines and manuals for health checkups, (iv) a sufficient number of professionals to carry out the health checkups, (v) clear criteria for evaluating and interpreting the checkup results, and (vi) understanding among teachers, children, and guardians of the importance of health checkups.

CONCLUSION

We proposed the following six requirements to the governments in developing countries for establishing their own health screening programs: (i) a clear description of the need for regular and continuous health checkups in the relevant laws, regulations, and policies, (ii) mandate as essential activity and detailed requirements of the screening activities, (iii) provision of relevant manuals for health workers and teachers, (iv) provision of enough well-trained professionals and a training system, (v) studying growth and development curves for children, and (vi) promoting understanding among stakeholders about the importance of health checkups.

Evaluating the health promoting schools in Iran: across-sectional study

Purpose

Health-promoting schools have been associated with improvements in the health status of students globally. This study is a secondary analysis study assessing Iranian HPSs.

Design/methodology/approach

This was a cross-sectional study on routinely collected data using an external audit 63-item checklist, which was utilized to evaluate 440 HPSs between 2014 and 2017. The mean score for each of the checklists' components was calculated. Nonparametric tests were conducted to investigate the association between the presence of a school caregiver, students' educational level and the school's score.

Findings

While the number of five- and four-star schools increased significantly, one- to three-star schools declined. Providing clinical and counseling services had negative growth. Despite the steady growth of the staff's health, this category still had the lowest score among; on the contrary, physical activity had the highest score in 2017. The presence of a full-time school caregiver and middle schools were both significantly correlated with achieving higher scores (p < 0.005).

Originality/value

It seems that in addition to developing school facilities to promote physical activities, measures should be taken to promote access to counseling services, considering health issues of students and staff and finally increasing the number of full-time school caregiver

Sustainable human resource training system for promoting school health in Japan

BACKGROUND

It is essential to develop relevant human resources and sustainable training systems to promote school health.

METHODS

This paper reviewed the structure of human resources and relevant training systems for school health in Japan and identified current strengths and challenges.

RESULTS

Our review identified seven key points: (i) a legal basis for the allocation of human resources to schools; (ii) established training systems for school health human resources; (iii) uniformity and quality of teacher training curricula; (iv) establishment of teacher-training institutions; (v) education centers in every prefecture; (vi) allocation of supervisors for Yogo teachers to every prefectural and municipal education board; and (vii) various study group activities at the district and school levels.

CONCLUSIONS

Based on these results, we proposed some useful ideas for developing human resources to promote school health in countries outside Japan, especially for developing countries. First, it is necessary to clarify the required competencies for school health among school staff and establish teacher-training systems based on the required competencies in each country. It is also necessary to consider possible collaboration with existing community health workers, such as doctors, nurses, midwives, nutritionists, and community health workers by providing short-term training on school health. Second, it is important to train and assign specialists to teacher-training institutions that can provide education and conduct research on school health. Third, it is helpful to enhance the functions of in-service training at the prefectural or district level and introduce lesson study on school health.

Examining the appropriateness and reliability of the strategy of the Kenyan Comprehensive School Health Program

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.

Key factors for school health policy implementation in Thailand

Thailand formulated a National School Health Policy (NSHP) in 1998, and it has been widely implemented but has not been evaluated. This case study aimed to identify factors that have influenced the implementation of NSHP in Thailand. For this purpose, we conducted a document review and key informant interviews. We selected key interviewees, from NSHP implementers at national, provincial and school levels in four geographical areas. We adopted a content analysis method, using a framework of 12 influential components of successful policy implementation and triangular policy framework. This study showed that NSHP was well-disseminated and implemented at whole country. We identified seven positive factors influencing NSHP implementation, namely matching with ongoing educational strategy, competition and encouragement by an awarding system, sustainable human capacity building at school level, participation of multiple stakeholders, sufficient understanding and acceptance of school health concepts, sharing information and collaboration among schools in the same clusters and functional fund raising activities. In addition, we identified three negative factors, namely lack of institutional sustainability, vague role of provincial officers and diverse health problems among Thai children. The government should clarify the role of provincial level and set up institutionalized capacity-building system as measures to strengthen monitoring and evaluation activities.

Construction of Nutrition Literacy Indicators for College Students in Taiwan: A Delphi Consensus Study

OBJECTIVE

To use the Delphi process to select nutrition literacy (NL) indicators for Taiwan college students.

DESIGN

Initial formulation of 8 principal indicators and 77 subindicators, followed by a 2-round Delphi survey and final selection of indicators.

PARTICIPANTS

A total of 28 nutrition experts selected through snowball sampling; 100% response rate.

MAIN OUTCOME MEASURES

An expert panel scored and ranked NL themes and indicators for relevance, representativeness, and importance.

ANALYSIS

Quantitative analysis. For principal indicators, the defined cutoff was mean (relevance and representativeness) > 4 and SD < 1. For subindicators, screening criteria were: (1) >20 experts ranked the nutrition theme's importance in the top 50% of the 12 themes; (2) mean (relevance and representativeness) > 4 and SD < 1 and >20 experts ranked the indicator's importance in the top 50% of all indicators within a domain.

RESULTS

Consensus was reached on 8 principal indicators and 28 subindicators in 8 themes, including 10 in understand, 8 in analyze, 5 in appraise, and 5 in apply.

CONCLUSIONS AND IMPLICATIONS

An initial set of NL indicators was developed for Taiwan college students, serving as a basis to develop Taiwan College's Nutrition Literacy Scale and providing information on nutrition education.

Factors influencing the inclusion of oral health education in individualized education plans of children with autism spectrum disorders in Singapore

BACKGROUND

Prevention of oral diseases in children with autism spectrum disorder (ASD) is possible via incorporation of oral health education (OHE) into individualized education plans.

OBJECTIVES

To assess (i) whether training can improve teachers' oral heath knowledge, (ii) whether OHE is taught to children with ASD, and (iii) factors associated with teachers' perceived barriers to the implementation of OHE.

DESIGN

Teachers working in special schools were recruited. Two pre-tested questionnaires were administered, before and after a training session. The effectiveness of the intervention was evaluated. Teachers were also surveyed on their teaching of caries prevention and perceived barriers of teaching OHE.

RESULTS

There was a significant increase in knowledge scores post-intervention (P < 0.001). Teachers were more likely to incorporate OHE into their teaching if trained by dental professionals (P = 0.022) and provided teaching materials (P = 0.001). Teachers' level of baseline OHE knowledge was a predictor and significantly negatively associated with levels of perceived overall and personal barriers (both P < 0.001).

CONCLUSION

OHE is included in the curriculum of the schools surveyed, but this is very limited. The training programme increased teachers' oral health knowledge competence scores. Levels of knowledge, lack of training, and teaching materials are barriers to incorporating OHE in their teaching curriculum.

Influence of Immunology Knowledge on Healthcare and Healthy Lifestyle

Completing a course in Immunology is expected to improve health care knowledge (HCK), which in turn is anticipated to influence a healthy lifestyle (HLS), controlled use of health care services (HCS) and an awareness of emerging health care concerns (HCC). This cross-sectional study was designed to determine whether these interrelationships are empirically supported. Participants involved in this study were government servants from two ministries in Malaysia (n = 356) and university students from a local university (n = 147). Participants were selected using the non-random purposive sampling method. Data were collected using a self-developed questionnaire, which had been validated in a pilot study involving similar subjects. The questionnaire items were analyzed using Rasch analysis, SPSS version 21 and AMOS version 22. Results have shown that participants who followed a course in Immunology (CoI) had a higher primary HCK (Mean = 0.69 logit, SD = 1.29 logits) compared with those who had not (Mean = -0.27logit, SD = 1.26 logits). Overall, there were significant correlations among the HLS, the awareness of emerging HCC, and the controlled use of HCS (p <0.001). However, no significant correlations were observed between primary HCK and the other variables. However, significant positive correlation was observed between primary HCK and controlled use of HCS for the group without CoI. Path analysis showed that the awareness of emerging HCC exerted a positive influence on controlled use of HCS (β = 0.156, p < .001) and on HLS (β = 0.224, p < .001). These findings suggest that having CoI helps increase primary HCK which influences controlled use of HCS but does not necessarily influence HLS. Hence, introducing Immunology at various levels of education and increasing the public awareness of emerging HCC might help to improve population health en masse. In addition, further investigations on the factors affecting HLS is required to provide a better understanding on the relationship between primary HCK and HLS.

Comparison of coaches' perceptions and officials guidance towards health promotion in French sport clubs: a mixed method study

Despite the call to improve health promotion (HP) in sport clubs in the existing literature, little is known about sport clubs' organizational capacity. Grounded within the setting-based framework, this study compares HP activities and guidance among 10 football clubs. At least three grassroots coaches from each club (n = 68) completed the Health Promoting Sports Clubs scale to assess their perceptions of HP; an official (n = 10) was interviewed about club's activities and official's guidance provided to coaches. A concurrent embedded design with quantitative results guiding the qualitative analysis was used. Despite no significant differences regarding coaches' perceptions of HP between the 10 sport clubs, except for the policy dimension, officials' interviews revealed some contradictions. Sport participation was recognized as automatically promoting HP, meaning that sport practice entails many benefits, without questioning the nature of the activities. HP was considered as a secondary aim in regard to sport performance, leading to the lack of written policies, partnerships and sporadic HP activities. Future interventions should consider: (i) the creation of required policy and long-term vision; (ii) the link between HP and sport performance; (iii) the rootedness of sport clubs within their community and (iv) guidelines towards HP from sport federations.

Adolescents’ Health Education and Social Media

Purpose:

The research aims to predict the perceptions/opinion of nutritious/harmful intake and the perceptions/opinion of different socializing agents who encouraged nutritious and healthy eating among the Indian adolescents.

Design/Methodology/Approach:

A survey was done on 160 adolescents from the different zones (eastern, western, northern, southern) in India. A well-structured questionnaire with suitable items was prepared and distributed among the adolescents in India.

Findings:

The findings of this study reveal that adolescents frequently ate/consumed unhealthy and junk foods (chocolates, snacks, soft drinks, etc.). As per the adolescents’ perception, the intake of foods regularly on time comes under the most important healthy eating habit. Also, as far as the situational influences are concerned, like in marriages/birthday parties, it has been found that adolescents generally eat unhealthy foods. While at home or when they are sick, they generally eat healthy and nutritious food. The socializing agents, especially parents, act as a main agent or promoter for the healthy food as compared to peers, schools or the siblings.

Research Limitations/Implications:

In each region (east, west, north, south), only two to three secondary schools were chosen for the data collection; all these schools could not be the representative of the all the adolescents in different regions.

Originality/Value:

The article offers insights into designing communication strategies for adolescents’ health education. It is original in that it focuses on adolescents, and explores the perceptions of different socializing agents and the influence of advertising media appeals on healthy eating.

Establishing a Framework of Influential Factors on Empowering Primary School Students in Peer Mediation

Background:

Empowerment of children and adolescents in terms of social skills is critical for promoting their social health.

Objectives:

This study attempts to explore a framework of influential factors on empowering primary school students by means of peer mediation from the stakeholders' point of view, as a qualitative content analysis design.

Patients and Methods:

This study was a qualitative content analysis (conventional method). Seven focused group discussions and six in-depth interviews were conducted with schoolchildren, parents and education authorities. Following each interview, recordings were entered to an open code software and analyzed. Data collection was continued up to data saturation.

Results:

Within the provided framework, the participants' views and comments were classified into two major categories “educational empowerment” and “social empowerment”, and into two themes; “program” and “advocacy”. The “program” theme included factors such as design and implementation, development, maintenance and improvement, and individual and social impact. The “advocacy” theme included factors such as social, emotional and physical support.

Conclusions:

The explained framework components regarding peer mediation are useful to design peace education programs and to empower school-age children in peer mediation.

Baseline results of the first healthy schools evaluation among a community of young, Irish, urban disadvantaged children and a comparison of outcomes with international norms

BACKGROUND

In 2008, the Irish Government initiated a pilot Healthy Schools Programme based on the World Health Organization Health Promoting Schools Model among children attending schools officially designated as urban and disadvantaged. We present here the first results on physical and emotional health and the relationship between childhood depression and demographic and socioeconomic factors.

METHODS

The Healthy Schools Programme evaluation was a 3-year longitudinal outcome study among urban disadvantaged children aged 4 to 12 years. Physical and psychological health outcomes were measured using validated, international instruments at baseline. Outcomes at baseline were compared with international norms and where differences were found, results were statistically modeled to determine factors predicting poor outcomes.

RESULTS

A total of 552 children responded at baseline, representing over 50% of all eligible children available to participate from 7 schools. Findings at baseline revealed that in general, children did not differ significantly from international norms. However, detailed analysis of the childhood depression scores revealed that in order of importance, psychological well-being, the school environment, social support, and peer relations and age were statistically significant predictors of increased childhood depression in children under 12 years of age.

CONCLUSION

Future health and well-being studies in schools among urban disadvantaged children need to broaden their scope to include measures of depression in children under 12 years of age and be cognisant of the impact of the school environment on the mental and emotional health of the very young.

Current drinking and health-risk behaviors among male high school students in central Thailand

Background

Alcohol drinking is frequently related to behavioral problems, which lead to a number of negative consequences. This study was to evaluate the characteristics of male high school students who drink, the drinking patterns among them, and the associations between current drinking and other health risk behaviors which focused on personal safety, violence-related behaviors, suicide and sexual behaviors.

Method

A cross-sectional study was conducted to explore current alcohol drinking and health-risk behaviors among male high school students in central Thailand. Five thousand one hundred and eighty four male students were classified into 2 groups according to drinking in the previous 30 days (yes = 631, no = 4,553). Data were collected by self-administered, anonymous questionnaire which consisted of 3 parts: socio-demographic factors, health-risk behaviors and alcohol drinking behavior during the past year from December 2007 to February 2008.

Results

The results showed that the percent of current drinking was 12.17. Most of them were 15-17 years (50.21%). Socio-demographic factors such as age, educational level, residence, cohabitants, grade point average (GPA), having a part time job and having family members with alcohol/drug problems were significantly associated with alcohol drinking (p < 0.05). Multiple logistic regression analysis, after adjusting for socio-demographic factors, revealed that health-risk behavioral factors were associated with current alcohol consumption: often drove after drinking alcohol (OR = 3.10, 95% CI = 1.88-5.12), often carried a weapon (OR = 3.51, 95% CI = 2.27-5.42), often got into a physical fight without injury (OR = 3.06, 95% CI = 1.99-4.70), dating violence (OR = 2.58, 95% CI = 1.79-3.71), seriously thought about suicide (OR = 2.07, 95% CI = 1.38-3.11), made a suicide plan (OR = 2.10, 95% CI = 1.43-3.08), ever had sexual intercourse (OR = 5.62, 95% CI = 4.33-7.29), alcohol or drug use before last sexual intercourse (OR = 2.55, 95% CI = 1.44-4.53), and got someone pregnant (OR = 3.99, 95% CI = 1.73-9.25).

Conclusions

An increased risk of health-risk behaviors, including driving vehicles after drinking, violence-related behaviors, sad feelings and attempted suicide, and sexual behaviors was higher among drinking students that led to significant health problems. Effective intervention strategies (such as a campaign mentioning the adverse health effects and social consequences to the risk groups, and encouraging parental and community efforts to prevent drinking) among adolescents should be implemented to prevent underage drinking and adverse consequences.

Evaluación de las Escuelas Promotoras de Salud en Asturias (España)

n: Objetivo: Evaluar la situación de las escuelas en relación a la Promoción de la Salud, sus fortalezas y debilidades, a través de la incorporación de los principios de la Red Europea de Escuelas Promotoras de Salud y de las opiniones de alumnado y profesorado. Metodología: La población de estudio fueron 29 centros educativos. Se realizó una visita a cada centro y se recogió información por observación directa y entrevistas a equipo directivo, persona coordinadora del proyecto de salud y alumnado. Los criterios evaluados fueron: experiencia, compromiso, implicación del profesorado, metodología con alumnado, participación comunitaria, mejora del entorno, democracia y equidad, y otras acciones promotoras de salud. Cada criterio se valoró con una o varias variables. A cada criterio, se le dio 1 punto, de manera que cada centro podía obtener un total de 8 puntos. Juntos con éstas se recogieron otras variables cualitativas en relación a las fortalezas y debilidades de los centros en Promoción de la Salud. Resultados: La puntuación media de los centros fue 5,19 (DE: 1,16). Mayoritariamente, los centros tenían experiencia previa, incluía la Promoción en la Programación General Anual y en el Proyecto Educativo, y contaban con profesorado implicado, organizado y formado. Aproximadamente la mitad tenía una estética agradable y realizaba incorporación curricular, acciones de coeducación, de mejora del entorno, de alimentación saludable y actividades con comunidad. La participación del alumnado, de las familias y el uso organizado de espacios se dio en un porcentaje minoritario de centros. Conclusiones: Se constató un esfuerzo importante por incorporar la Promoción de la Salud, pero numerosas dificultades para ello. La principal limitación tiene que ver con la voluntariedad de estas acciones y la ausencia de políticas públicas para transformar los centros educativos. Destacar la aportación novedosa de esta investigación, en relación a la creación de un indicador global que permite evaluar la incorporación de la Promoción de la Salud en las escuelas utilizando los criterios de la Red Europea de Escuelas Promotoras de Salud. (Global Health Promotion, 2009; 16(3): pp. 96—106)

School health promotion: organization of services and roles of health professionals in seven European countries

BACKGROUND

This comparative study is intended to provide a better understanding of how health promotion services are organized in school settings in Europe and to show how health professionals involved outside or within the school setting help to improve young people's health.

METHODS

This study was based on an analysis of school health policies and the organization of school health services, where these existed, as well as on interviews with health and education professionals. The countries concerned were Belgium (French-speaking community), Denmark, France, Spain (Catalonia), Switzerland (Jura), Poland and Portugal.

RESULTS

Although the provision of health services for children and adolescents varied considerably, the health services available were very similar in each of the countries. The emphasis put on particular aspects of these services varied depending on the political and institutional culture in each country. Three different types of school health service provision were identified: community-based, school-based or health needs-focused.

CONCLUSION

All countries had health education and health promotion services but the provision of these services varied considerably from country to country. They were provided either by a specific category of professionals (health personnel or teachers) or considered to be the responsibility of the educational community as a whole.

Assessment of a national network: the case of the French teacher training colleges' health education network

The French teacher training colleges' health education (HE) network was set up in 2005 to encourage the inclusion of HE in courses for primary and secondary school teachers. A systematic process of monitoring the activity and the impact of this initiative was implemented. This analysis was systematically compared with the perceptions of teaching staff involved in the network. This paper assesses the network after 2 years using documents produced and interviews with 24 coordinators. Twenty-nine teacher training colleges out of a total of 31 are involved in the network. The network has helped to create links between teacher training colleges, extend HE training and encourage partnerships with other public health organizations. By 2007, HE was included in courses offered by 19 teacher training colleges as opposed to only 3 in 2005. This study not only showed the positive impact of the network but also revealed issues in its management and presented new challenges to ensure the effectiveness of the network. The network has succeeded in attracting and training trainers who were already providing or were interested in HE. Reaching other trainers who are not familiar with HE remains a challenge for the future.

Health promotion and education policy and practice in urban schools in Liaoning province, China

This paper reviews the status of health education in urban schools in three cities in Liaoning province, China. The cities represent the upper, middle and lower levels of city economy based on the GDP per person within the province. A self-administered questionnaire was provided to 500 primary and secondary schools and 436 questionnaires (87.2%) were returned completed. The questionnaire assessed health education offerings in the schools, permitting the comparison of similarities and differences in school practices, and the identification of obstacles that prevent schools becoming health promoting. The analysis revealed that 0.7% of schools fulfilled criteria for good status of health education. The negative attitudes of school management, teachers and pupils towards health education, as well as the lack of in-service training for staff, were perceived as key obstacles to school health education. Few provincial and school-based policies mentioned pupil involvement in health policy development and only a small number of schools acknowledged the need to improve community and parental involvement. In this paper we discuss the challenges facing provincial education and health authorities, and make recommendations about how to assist Chinese schools to develop and implement high quality health education initiatives.

Diagnosis of sustainable collaboration in health promotion - a case study

BACKGROUND

Collaborations are important to health promotion in addressing multi-party problems. Interest in collaborative processes in health promotion is rising, but still lacks monitoring instruments. The authors developed the DIagnosis of Sustainable Collaboration (DISC) model to enable comprehensive monitoring of public health collaboratives. The model focuses on opportunities and impediments for collaborative change, based on evidence from interorganizational collaboration, organizational behavior and planned organizational change. To illustrate and assess the DISC-model, the 2003/2004 application of the model to the Dutch whole-school health promotion collaboration is described.

METHODS

The study combined quantitative research, using a cross-sectional survey, with qualitative research using the personal interview methodology and document analysis. A DISC-based survey was sent to 55 stakeholders in whole-school health promotion in one Dutch region. The survey consisted of 22 scales with 3 to 8 items. Only scales with a reliability score of 0.60 were accepted. The analysis provided for comparisons between stakeholders from education, public service and public health.The survey was followed by approaching 14 stakeholders for a semi-structured DISC-based interview. As the interviews were timed after the survey, the interviews were used to clarify unexpected and unclear outcomes of the survey as well.Additionally, a DISC-based document analysis was conducted including minutes of meetings, project descriptions and correspondence with schools and municipalities.

RESULTS

Response of the survey was 77% and of the interviews 86%. Significant differences between respondents of different domains were found for the following scales: organizational characteristics scale, the change strategies, network development, project management, willingness to commit and innovative actions and adaptations. The interviews provided a more specific picture of the state of the art of the studied collaboration regarding the DISC-constructs.

CONCLUSION

The DISC-model is more than just the sum of the different parameters provided in the literature on interorganizational collaboration, organization change, networking and setting-approaches. Monitoring a collaboration based on the DISC-model yields insight into windows of opportunity and current impediments for collaborative change. DISC-based monitoring is a promising strategy enabling project managers and social entrepreneurs to plan change management strategies systematically.

Innovation and effectiveness: changing the scope of school nurses in New Zealand secondary schools

OBJECTIVE

To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio-economic areas with high Pacific Island and Māori rolls.

METHODS

An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland, NZ (2002-05). Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken.

RESULTS

Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses.

CONCLUSIONS AND IMPLICATIONS

School nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. Co-ordination of school nurses either at a regional or national level is required.

Can the concept of Health Promoting Schools help to improve students' health knowledge and practices to combat the challenge of communicable diseases: Case study in Hong Kong?

Background

The growing epidemics of emerging infectious diseases has raised the importance of a setting approach and include the Health Promoting School (HPS) framework to promote better health and hygiene. Built on the concept of 'the' HPS framework, the Hong Kong Healthy Schools Award scheme includes "Personal Health Skills" as one of its key aspects to improve student hygiene knowledge and practices. This study examines the differences in student perceptions, knowledge and health behaviours between those schools that have adopted the HPS framework and those that have not adopted.

Methods

A cross-sectional study using multi-stage random sampling was conducted among schools with awards (HSA) and those schools not involved in the award scheme nor adopting the concept of HPS (non-HPS). For HSA group, 5 primary schools and 7 secondary schools entered the study with 510 students and 789 students sampled respectively. For the 'Non-HPS' group, 8 primary schools and 7 secondary schools entered the study with 676 students and 725 students sampled respectively. A self-administered questionnaire was used as the measuring instrument.

Results

Students in the HSA category were found to be better with statistical significance in personal hygiene practice, knowledge on health and hygiene, as well as access to health information. HSA schools were reported to have better school health policy, higher degrees of community participation, and better hygienic environment.

Conclusion

Students in schools that had adopted the HPS framework had a more positive health behaviour profile than those in non-HPS schools. Although a causal relationship is yet to be established, the HPS appears to be a viable approach for addressing communicable diseases.

Can Health Promoting Schools contribute to the better health and wellbeing of young people? The Hong Kong experience

BACKGROUND

The Health Promoting School (HPS) is a WHO sponsored framework, compiled to enable education and health sectors to be more effective in school based initiatives.

AIMS

This study attempted to test the hypothesis that students from schools that had comprehensively embraced the HPS concept as indicated by the Healthy School Award, were better, in terms of health risk behaviour, self reported health status, and academic results, than students from schools that did not reach the standard of the award.

METHODS AND RESULTS

The results presented came from nine schools (four primary and five secondary) applying for accreditation of the Healthy Schools Award after adopting the HPS framework for two years. Regular consultancy support and training were available to all schools. Students had completed before and after surveys to assess their health behaviours, self reported health status, and academic standing before the two year intervention, and at its end. Data from the before and after surveys of the students attending schools that reached certain level of HPS standard as indicated by the award, were compared with students whose schools did not receive the award, and the results showed differences. Some differences were found to be more significant among the primary school students than secondary schools students. This illustrated early intervention for lifestyle changes to be more effective. Students' satisfaction with life also improved if their schools adopted the concept of HPS comprehensively.

CONCLUSIONS

The results suggest that comprehensive implementation of HPS would contribute to differences in certain behaviours and self reported health and academic status.

Health promotion activities in China from the Ottawa Charter to the Bangkok Charter: revolution to evolution

China has the world's largest population. In the past, the public health system in mainland China has been strongly influenced by the former Soviet Union. Hong Kong and Macao, the Special Administrative Regions (SAR), have been under colonial administration adopting a laisser-faire approach to health policy. Over the most recent decades, mainland China and the two SARs have adopted the Ottawa Charter principles and re-orientated the healthcare systems towards greater community participation, built a healthy environment in different settings and developed capacity in health promotion. Positive results have resulted from efforts to move towards a bottom-up approach to health promotion, using the overarching framework of Healthy Settings. Adequate resources will be needed to build up the infrastructure for sustainable development of health promotion initiatives. This report is selective, rather than comprehensive and will highlight specific health promotion activities in different parts of China, reflecting how the approach to health promotion has evolved since Ottawa. An analysis will be made of the potentials of these initiatives to take forward the spirit of the Ottawa Charter in paving the way for the Bangkok Charter.

To be a responsible adolescent: a key strategy to enhance students' awareness of self-care and their health behaviours

This article presents unique teacher's experience in developing and implementing a highly acclaimed pioneer comprehensive health-promoting programme at a secondary school in Hong Kong. The authors explain why a systematic school health education is needed from both personal and public health perspectives. A five-year programme known as 'Be responsible' had been introduced at St. Catharine's School for Girls since 1999 with an objective of guiding students to assume responsibility for their health. Through interactive activities, students had learnt and acquired the knowledge, skills and attitude that would empower them to enjoy an all-rounded development and life-long well-being. The Programme adopted a 'bottom-up' model that extended its benefits beyond the classrooms. Health education follows the modern education theory of holistic development and is the foundation of a quality education system. Teachers should therefore be committed to the cause and role of promoting health at school and work in partnership with the health professionals.

Development of a collaborative model to improve school health promotion in The Netherlands

In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core-business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behavior of students is increasing. This article focuses on the processes and initial results of developing a collaborative model tailored for whole-school health in the Netherlands, named schoolBeat. The Dutch situation is characterized by fragmentation, a variety of health and welfare groups supporting schools, and a lack of sound integrated youth policies. A literature review, observations, and stakeholder consultation provided a clear picture of the current situation in school health promotion, and factors limiting a comprehensive and needs-based approach to school health. This revealed that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. A respected member of school staff should chair this team. To strengthen the link with the school care team, the school care coordinator should be a member of both teams. To provide coordinated support to all schools in a region, participating organizations decided to share advisory tasks. These tasks are included in the regular health promotion work of their staff. This means working with one advisor representing all school-health organizations per school, and using a comprehensive overview of possible support and projects promoting health. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This article concludes with an examination of emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement.

Evaluating health-promoting schools in Hong Kong: development of a framework

Health-promoting schools (HPS)/healthy schools have existed internationally for about 15 years. Yet there are few comprehensive evaluation frameworks available which enable the outcomes of HPS initiatives to be assessed. This paper identifies an evaluation framework developed in Hong Kong. The framework uses a range of approaches to explore what schools actually do in their health promotion and health education initiatives. The framework, which is based on the WHO (Western Pacific Regional Office) Guidelines for HPS, is described in detail. The appropriate instruments for data collection are described and their origins identified. The evaluation plan and protocol, which underpinned the very comprehensive evaluation in Hong Kong, are explained. Finally, a case is argued for evaluation of HPS to be more in line with the educational dynamics of schools and the research literature on effective schooling, rather than focusing primarily on health-related measures.

How would schools step up public health measures to control spread of SARS?

The severe acute respiratory syndrome (SARS) is a rapidly progressive, and sometime fatal disease with more than 1800 patients in over a dozen countries in Asia, Europe, and North America (including the United States and Canada) within two months. On 12 March 2003, the World Health Organisation (WHO) issued a global alert about SARS so it became a global challenge. Strengthening the public health measures at schools would protect children as well as providing the students an opportunity to learn about infectious disease control through life event approach. The public health measures at schools include two important components: basic understanding of the disease so schools would put on high alert on caution cases, and the measures to improve environmental hygiene at schools and preventive measures to stop infectious disease transmission. This will help to empower the whole community the readiness to deal with other outbreaks in the future.

Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong

Severe acute respiratory syndrome (SARS) is now a global challenge affecting more than 8000 patients in different continents. The dictum of public health practice especially for infectious disease is "prevention better than cure". It is especially true for SARS as the treatment strategies remain diverse and experimental. Maintaining a healthy and hygienic environment can be one of the effective public health measures to combat infectious disease. The major challenge is that some of the most important public health measures are to be taken outside the health sector. The community also needs to be strengthened and equipped with the health skills to promote better health and hygiene. There is also the need to create a supportive environment conducive to health for long term sustainability. The WHO approach of promoting health through setting approach would be one possible solution to face the challenge. This paper will describe some of the public health initiatives in Hong Kong through "setting approach" and "community development model" in helping the society fight against SARS. With the emergence of SARS, this might be the time to globalise public health medicine as an important component of medical practice.