L’appropriation par les primo-adoptants de l’Approche École en santé au Quebec

L’ Approche École en santé (AÉS) est une approche globale de promotion de la santé inspirée des principes des « Health Promoting Schools » (écoles promotrices de santé). L’AÉS est associée à un dispositif d’accompagnement des écoles volontaires pour l’implanter qui comporte des ressources professionnelles d’accompagnement et divers outils. Le présent article rend compte des résultats d’une recherche qualitative portant sur l’appropriation locale de cette approche par des écoles ayant participé à la première vague d’implantation au Québec. Après avoir exposé le contexte, la méthodologie et le cadre théorique de l’étude, nous présenterons les appropriations locales observées, et ce qui semble les avoir conditionnées, du point de vue des acteurs.

Schools' absorptive capacity to innovate in health promotion

PURPOSE

A comprehensive "health promoting schools" (HPS) approach is advocated by the World Health Organization to foster the health of students. To date, few studies have evaluated schools' capacity to implement it in an optimal way. The purpose of this paper is to present a conceptual framework that identifies core features likely to facilitate the incorporation of innovation, such as HPS, into school functioning.

DESIGN/METHODOLOGY/APPROACH

The framework was built by combining dimensions derived from two major strands of literature, i.e. management and HPS. It has taken root in Zahra and George's model of organisation absorptive capacity (AC) for new knowledge but has been adapted to better explore AC in a school context. The contrasting cases of two secondary schools that adopted a HPS approach in Quebec, Canada, for at least three years were used to illustrate the value of the framework.

FINDINGS

The framework proposed is a multidimensional model that considers components such as modulators, antecedents, integration mechanisms and strategic levers as potential determinants of AC, i.e. acquisition, assimilation, transformation and exploitation. The conceptual framework helped to qualify and compare AC regarding HPS in the two cases and holds promise to appreciate mechanisms having the greatest influence on it.

ORIGINALITY/VALUE

The framework can serve as a conceptual guide to facilitate the absorption of innovation in schools and to design future empirical research to better understand the underlying process by which schools strengthen their capacities to become settings conducive to the health of youth.

Professional development in the context of Healthy Schools in Quebec

This article reports preliminary research results on a professional development (PD) model as a mechanism for supporting absorption of the Healthy School (HS) approach into school functioning. The purpose of our study was to document the model implementation process and understand whether it influenced, or not, the accompanied actors' knowledge and practices about HS. The theoretical basis of the model and a description of its implementation, its appreciation by actors and its influence on their knowledge and confidence are presented. The research was conducted in three Quebec schools that had adopted this approach for at least 2 years. Multiple case study methodology, with pre- (T0) and post- (T1) intervention comparison, was adopted. The results disclose that the PD model implemented, which involves socio-constructivist accompaniment, has several assets that support the acquisition and application of new knowledge related to HS in order to promote its absorption within schools. Our findings indicate that PD likely reinforced the actors' knowledge and understanding as well as their confidence. The lessons drawn from the evaluation of this PD model could serve to enhance accompaniment methods implemented to promote the absorption of such initiatives in schools. Our data highlight the relevance and effectiveness of accompaniment anchored in action, calling for practice based on reflection and expert recommendations to meet the objectives of health and academic success.

How divergent conceptions among health and education stakeholders influence the dissemination of healthy schools in Quebec

This paper focuses on dissemination of the healthy schools (HS) approach in the province of Quebec, Canada. Dissemination aims at raising awareness about HS and promoting its adhesion among actors concerned with youth health in school. As HS is a joint initiative based on agreement and collaboration between health and educational sectors, the positions of stakeholders that foster cooperation between these sectors were considered to be critical to optimize its dissemination. The study's objectives were to: (i) examine and contrast the stakeholders' conceptions of HS and (ii) understand how converging and diverging stakeholders' positions on HS favourably or negatively influence its dissemination in Quebec. Gray's analytical approach to collaboration and its focus on stakeholders' mindframe about a domain served as a conceptual lens to examine stakeholders' positions regarding HS. Collection methods included documentary analysis and semi-structured interviews of 34 key internal and external informants at the provincial, regional and local levels. The results showed consensual adhesion to fundamental principles of the HS approach. However, differences in conceptualization between provincial authorities of the two sectors concerning the way to disseminate HS have been observed. These differences represented a significant barrier to HS optimal dissemination. A dialogue between the two authorities appears to be essential to arrive at a negotiated and shared conceptualization of this issue in the Quebec context, thus allowing agreements for adequate support. The results may serve as the basis for a more fruitful dialogue between actors from the two sectors, at different administrative levels.

Factors influencing the adoption of a health promoting school approach in the province of Quebec, Canada

This study examined a prediction model that integrated three categories of predictors likely to influence adoption of the Quebec Healthy Schools (HS) approach, i.e. attributes of the approach, individual and contextual characteristics. HS receptivity was considered as a potential mediator. For this study, 141 respondents representing 96 schools participated in a postal survey. We used bivariate logistic regression to assess factors associated with HS adoption and Baron and Kenny's method to test the mediation effect of HS receptivity. Four predictors related to school organizational characteristics had more weight in influencing the adoption of HS: the 'presence of leaders within schools', 'perceived school contextual barriers', 'school investment in healthy lifestyles' and 'beliefs in collective efficacy'. The influence of the latter two predictors was not direct but mediated by HS receptivity. Our findings showed that standard attributes generally considered as predictors of the adoption of an innovation are not the strongest determinants to explain HS adoption in the present context. The results shed light on the crucial role of organizational context in the adoption of this type of approach.

Psychometric properties of a scale focusing on perceived attributes of a health promoting school approach

OBJECTIVES

The purpose of this paper was to investigate the psychometric properties of a newly-designed scale intended to measure the perceived attributes of a Health Promoting School initiative and its context in terms of factor structure, reliability and predictive validity. The scale was developed to explore possible predictors of the adoption of the Healthy School approach (HS) in Québec.

METHODS

Data were gathered from a 2007 cross-sectional study of 107 schools and 141 participants (school principals and school health promotion delegates). The scale was based on 7 attributes borrowed from the theories on diffusion of innovation. The factor structure of the scale was tested by exploratory and confirmatory factor analyses.

RESULTS

The final scale included 14 items capturing 4 factors: school contextual barriers, collective efficacy, anticipated benefits and relative advantages. Reliability, in terms of internal consistency of the factors, ranged from a high of 0.85 to a low of 0.60. Three of the 4 factors significantly predicted HS adoption.

CONCLUSION

Overall, the scale showed good psychometric properties and may be useful to assess the attributes that could influence the adoption of this type of initiative.

Prevalence and characteristics of body piercing and tattooing among high school students

BACKGROUND

Although body piercing and tattooing seem to be gaining popularity among a diversity of social and age groups, studies of these practices in general adolescent populations are scarce. This study establishes the prevalence of body modification (tattooing and body piercing) among high school students in grades 7-11 (aged 12 to 18).

METHODS

Data come from a 2002 in-school survey conducted among a representative sample of 2,180 students (81% response rate) enrolled in the 23 high schools of the Outaouais region in Quebec. Systematic sampling was performed. Specific data on tattooing and body piercing are available for 2,145 students (1% non-response rate).

RESULTS

A prevalence of 27% for body piercing and 8% for tattooing is observed among high school students. Differences between girls and boys are observed in many ways: i.e., frequency and number of tattoos or piercings; aftercare practices. While most teens say that a "professional" in a studio performed their body modification and that they received aftercare instruction, a high percentage of students report health complications following the procedure.

CONCLUSION

Results show that tattooing and body piercing are common among adolescents and may involve health risks. Consequently, appropriate preventive measures should be adopted by professionals such as school counsellors, nurses, physicians and others who are in contact with teenagers to help them make informed choices.

Are tattooing and body piercing indicators of risk-taking behaviours among high school students?

PURPOSE

To date, studies pertaining to possible links between body modification and risk-taking behaviours have been conducted mainly among targeted groups. The objective of this study is to examine the influence of a number of risk-taking behaviours on the probability of being pierced or tattooed among a general adolescent population.

METHODS

Data come from a cross-sectional study conducted among a sample of 2180 students aged 12-18. Data were collected directly from students through a self-report survey.

RESULTS

Findings confirm the "risky" nature of these practices even though the tattooed and pierced subjects of this study were from a general adolescent population. Factors that contribute significantly to the likelihood of teenagers being tattooed or pierced, for both genders, are associated with "externalized risk behaviours" such as multiple drug use, illegal activities, gang affiliation, problem gambling, school truancy and rave attendance.

CONCLUSION

Nowadays, tattooing and body piercing are perceived by many as body decoration, increasingly belonging to the realm of generational conformity. Contrary to this view, our results suggest that these practices among adolescents are mostly adopted by those who are involved in various deviant or illegal activities, which are often interrelated.

Comprehensive approaches to school health promotion: how to achieve broader implementation?

The Health Promoting School (HPS) and Comprehensive School Health Program (CSHP) initiatives have been proposed as a means of going beyond some of the limitations associated with health promotion initiatives aimed at school-aged children. This involves moving beyond practices that rely mainly on classroom-based health education models, to a more comprehensive, integrated approach of health promotion that focuses both on child-youth attitudes and behaviors, and their environment. Despite the tremendous potential of these initiatives in terms of health and educational gains, only rarely are they actually put into practice. This article briefly reviews the features of these initiatives, as well as the extent of their implementation and current benefits. Against that backdrop, the authors identify some issues to consider and propose four conditions with a view to achieving broader practical application of these approaches. These issues, which are discussed from the standpoint of potential avenues of further study and courses of action, relate to the comprehensive, integrated nature of the intervention, the school/family/community partnership, political and financial support from policy makers, and, finally, evaluative research as a support to implementation.