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Vennegoor G, van Assema P, Molleman GRM, van Empelen P, Dieleman J, Jansen MWJ. Fidelity, adaptation and integration of whole-school health promotion within Dutch schools: a cross-sectional survey study. Health Promot Int 2023; 38:daad173. [PMID: 38124497 PMCID: PMC10733658 DOI: 10.1093/heapro/daad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Implementing comprehensive health promotion programs in the school setting can be challenging, as schools can be considered complex adaptive systems. As a first step towards understanding what works in improving implementation for which schools and under which conditions, this study aimed to examine the degree of implementation of health promoting school (HPS) programs, in terms of five dimensions of fidelity (adherence, dose, participant responsiveness, quality of delivery and program differentiation), and the dimensions of adaptation and integration. The HPS Implementation Questionnaire was distributed among ± 2400 primary, secondary, secondary vocational and special needs schools in the Netherlands. Employees of 535 schools (22.3%) filled out the questionnaire. Data were analysed by descriptive statistics and ANOVA tests. The average degree of implementation was 2.55 (SD = 0.58, range = 0.68-3.90; scaled 0-4). The lowest scores were achieved for participant responsiveness and adherence, and the highest for integration and adaptation. Schools that identified as HPS reported significantly higher overall degree of implementation, adherence, dose, participant responsiveness, program differentiation and adaptation than schools that didn't. Primary schools achieved a significantly higher degree of implementation, dose, participant responsiveness, quality of delivery and integration than other school types. In conclusion, many schools work on student health and well-being to some extent, but the vast majority have much room for improvement. Higher implementation scores for schools that identified as HPS underline the value of HPS programs. A broader perspective on health and more insight into conditions for effectiveness and implementation in secondary and secondary vocational schools are needed.
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Affiliation(s)
- Gerjanne Vennegoor
- Academic Collaborative Center for Public Health Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
- Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Patricia van Assema
- Academic Collaborative Center for Public Health Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
- Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Gerard R M Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Healthy Living, Public Health Service Gelderland-Zuid, P.O. Box 1120, 6501 BC Nijmegen, The Netherlands
| | - Pepijn van Empelen
- Expertise Center Child Health, Netherlands Organization for Applied Scientific Research (TNO), P.O. Box 3005, 2301 DA Leiden, The Netherlands
| | - Joyce Dieleman
- Public Health Service Noord- en Oost Gelderland, Academic Collaborative Center AGORA, P.O. Box 3, 7200 AA Zutphen, The Netherlands
| | - Maria W J Jansen
- Academic Collaborative Center for Public Health Limburg, P.O. Box 33, 6400 AA Heerlen, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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