Sedentary Behavior and Physical Inactivity Among Secondary School Students in the 2017 Sierra Leone Global School-Based Student Health Survey

BACKGROUND

The 2020 World Health Organization Guidelines on Physical Activity and Sedentary Behavior are the first to provide evidence-based recommendations for reducing both dimensions of languorous behavior. The relationship between sitting time and exercise remains understudied among diverse adolescent populations worldwide.

METHODS

The 2017 Sierra Leone Global School-based Student Health Survey was a nationally representative cross-sectional study of secondary school students.

RESULTS

Of the 2798 participants, 82% did not engage in moderate or vigorous physical activity for at least an hour every day, 25% sat for 3 or more hours each day outside of school and homework, and 87% were physically inactive and/or sedentary based on those thresholds. Girls who never or rarely exercised tended to maintain light physical activity outside of school rather than sitting, while boys who exercised daily tended to be sedentary when they were not playing sports.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Students spend their waking hours doing a mix of sitting, light physical activity, and moderate or vigorous physical activity. Schools can help reduce sedentarism and increase movement among students.

CONCLUSIONS

Home, school, and community health interventions may be useful for increasing energy expenditure among adolescents in low- and middle-income countries.

Staff perspectives on poor mental health in secondary school students: an increasing problem handled with insufficient resources

Introduction

An increasing number of schools are recognizing the importance of addressing students' mental health based on the association with educational outcomes and long-term health. The school organization and the members of the school staff play important but, in several ways, challenging roles in this work. The purpose of this study was to explore views of staff from schools and school health services on mental ill health among students and their own role in detecting and managing it.

Methods

A qualitative study was conducted in a sparsely populated municipality in northern Sweden. In total, 40 participants from three secondary schools and the school health services participated either in focus groups or individual interviews. Participants were teachers, assistants, school nurses, school counselors and psychologists. Data were analyzed using thematic analysis.

Results

The analysis revealed the main theme Student mental ill health: an increasing problem handled with insufficient resources and two subthemes, i.e., Uncertainty in interpreting students' signs of mental ill health and the need to clarify roles and establish a supportive organization.

Conclusions

It was concluded that school staff were uncertain regarding how to interpret signs of mental ill health among students and required better knowledge and more resources to help students with mental ill health. A clearer organization and consensus regarding support for students with mental ill health were also necessary in light of the division of responsibilities between school staff and the school health services.

The Role of Wellness Teams in Promoting Health and Wellness Implementation Strategies in Elementary Schools in Chicago

BACKGROUND

Strategies used by wellness teams (WTs) to foster local wellness policy (LWP) implementation have been documented, yet there remains a need to better understand how WTs respond to district-level LWP requirements, particularly when bundled with additional health-related policies. This study's goal was to explore how WTs implement Healthy Chicago Public School (CPS), a district-led initiative focused on both LWP and other health policy implementation in the CPS district, one of the most diverse in the nation.

METHODS

Eleven discussion groups were conducted with WTs in CPS. Discussions were recorded, transcribed, and thematically coded.

RESULTS

Six overarching strategies used by WTs in working to achieve Healthy CPS include: (1) using district guides and resources to support planning, progress monitoring, and reporting; (2) under the leadership of wellness champions, as required by the district, facilitating engagement among staff, students, and/or families; (3) taking district guidance and adapting and integrating it into their schools' existing structures, curricula, and practices, often taking a holistic approach; (4) fostering linkages in the communities surrounding their schools to supplement internal school capacities; and (5) stewarding resources, time, and staff for sustainability.

IMPLICATIONS

Strategies for LWP implementation by WTs in urban and diverse schools include planning for staff turnover, integrating health and wellness into existing curricula and structures, and leveraging relationships with the local community.

CONCLUSION

WTs can play a critical role in supporting schools in diverse, urban districts to implement district-level LWP and the plethora of related policies that schools are subject to at the federal, state, and district levels.

Feasibility, acceptability and potential efficacy of a virtual physical activity program in primary and secondary schools in New South Wales, Australia: A quasi-experimental study

ISSUE ADDRESSED

Child and youth participation in physical activity (PA) is fundamental for healthy development and obesity prevention. Government policy requires schools to offer 150 minutes of PA each week, however compliance is low. Race around Australia (RAA) is a New South Wales (NSW) Department of Education, virtual PA program aimed at assisting schools in meeting the PA guidelines.

METHODS

A pre- and post-intervention, quasi-experimental study was conducted using a mixed-methods approach comprising teacher interviews, a student questionnaire and a 1.6 kilometre (km) timed run. Data were collected from April to September 2021 among students and teachers in Grades 5 to 8, from 10 schools in NSW, Australia.

RESULTS

The analytical sample included data from 918 students and 17 teachers. The RAA program was deemed feasible and acceptable in primary schools, whereas there were several systemic and intrapersonal barriers to implementation success for secondary schools. In primary schools, RAA increased PA opportunities and the 1.6 km timed runs revealed a statistically significant treatment by time effect in favour of the intervention group for cardiorespiratory fitness (-36.91 seconds, 95% CI [-63.14, -10.68], P = .006).

CONCLUSIONS

RAA has demonstrated feasibility and potential efficacy in improving cardiorespiratory fitness. We recommend that program refinement be made to deliver an intervention that addresses the unique barriers of the secondary school setting through a multi-level ecological approach. SO WHAT?: Despite evident benefits, implementation of PA initiatives in the school setting reveals many challenges. Stronger consideration of the Health Promotion with Schools Framework is evidently needed.

Effects of Athletic Trainer Direct Employment on the Management of Sports-Related Injuries in High School Athletes

BACKGROUND

Hiring athletic trainers (ATs) in high schools has attracted rising interest as a potential way of improving adolescents' health by enhancing their safety and reducing their risk of injury.

OBJECTIVE

This study aims to determine if there is a difference in the referral patterns, injury diagnoses, and injury treatments performed at a metropolitan high school when an AT is employed versus not employed by the school.

DESIGN

This is a retrospective quantitative two-period study.

SETTING

The study was conducted in the high school athletic department in Norfolk, Virginia, and the study population was high school athletes (age 14-18).

MAIN OUTCOME MEASURES

Changes in referral patterns, injury diagnoses, and injury treatments performed at a local high school when an AT is employed versus not employed by the school; specifically, we examined the number of and percent changes in yearly treatments, referrals, evaluations, and re-evaluations during the two periods.

RESULTS

Our first t-test revealed a statistically significant increase in the number of reported injuries between 2011-2015 (M = 58.00, SD = 44.86) and 2016-2020 (M = 299.00, SD = 40.93, p = 0.006. The second t-test revealed a statistically significant increase in the number of referrals between 2011-2015 (M = 249.00, SD = 353.41) and 2016-2020 (M = 1188.00, SD = 158.21), p = 0.014. The third t-test revealed a statistically significant increase in the number of treatment items between 2011-2015 (M = 150.67, SD = 175.32) and 2016-2020 (M = 636.67, SD = 211.72), p = 0.01.

CONCLUSIONS

The present study found an increased frequency of reported injuries, referrals, and treatment after ATs directly joined the staff of a large metropolitan high school. These findings suggest that direct employment of ATs is associated with greater recording of injuries and treatment of conditions. A reduction in referrals occurs with the presence of directly employed ATs, which could result in improved health for student-athletes, but this needs further study.

School-based obesity prevention programs in rural communities: a scoping review

OBJECTIVE

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature.

INTRODUCTION

Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities.

INCLUSION CRITERIA

We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data.

METHODS

A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives.

RESULTS

Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations.

CONCLUSIONS

Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

The Contribution of Physical Education to Physical Activity Within a Comprehensive School Health Promotion Program

Purpose: Little is known about the role of physical education (PE) in a school health promotion model, particularly where wellness is placed at the forefront. The purpose of this study was to understand how PE contributes to the overall amount of moderate to vigorous physical activity (MVPA) that children receive in a school recognized for health promotion. Methods: As part of an in-depth case study, participants in grades 4-8 (N = 105) wore ActiGraph wGT3X+ accelerometers over 7 days to assess activity levels. Data were scored using ActiLife software. Using SPSS statistics software, students were grouped into low, moderate, and high activity through calculating tertile splits of average daily MVPA. Two 2 × 2 ANCOVA (sex x activity level) tests were conducted to determine the ratio of MVPA in PE to school and daily MVPA, controlling for age. Results: Participants accrued 8 min MVPA on average during PE with differences among low (6.4 ± 2.5), moderate (8.3 ± 3.7), and highly active participants (10.1 ± 4.0). ANCOVA analyses revealed non-significant interactions between sex and activity level explaining variance in contribution of PE to school MVPA (F(2, 99) = .235, p = .791, partial ŋ² = .005) and daily MVPA (F(2, 99) = .299, p = .742, partial ŋ² = .006), but significant main effects between high and low activity for daily MVPA were observed F(2, 99) = 5.118 p = .008, partial ŋ² = .094. Conclusions: PE remains a priority in supporting children's PA, particularly for those least active. Despite relatively low levels of MVPA, findings provide rationale for policy change supporting more frequent PE in schools.

Multiple Health Behavior Programs in School Settings: Strategies to Promote Transfer-of-Learning Through Life Skills Education

Typically, schools implement health promotion programs that focus on a single behavioral domain. Multiple related health topics may be addressed using separate interventions, potentially producing overlap in program content. However, integrative approaches in health promotion have the potential to produce interventions capable of improving multiple health behaviors. In particular, more research is needed to identify the conditions and the factors that can promote the transfer of learning to broaden the target outcomes of health promotion programs. The present study aims to identify the characteristics of an evidence-based life skills education program that can facilitate the transfer of learning to different health behaviors not initially targeted by the program, and the strategies for achieving successful transfer. A two round Delphi method was used with a diverse group of 21 experts in health promotion, life skills education, and methods of pedagogy for early adolescent students. Questionnaires with open and closed-ended questions were administered on-line. Content qualitative analysis was run, integrating codes, subcategories, and categories of the two rounds of the study. Results showed strong consensus among experts about the potential for promoting the transfer of skills from one health domain to another. Many elements were identified as important factors that facilitate the transfer of learning. Strategies for successful transfer were related to teaching methods, educational approaches, and consistency with the broader school curriculum. Findings suggest that the successful transfer of learning to a new health domain requires that educators recognize its importance and explicitly designate it as an educational aim.

Evaluation of the 'H2NOE Water Schools' programme to promote water consumption in elementary school children - a non-randomised controlled cluster trial

Objective:

This study evaluated a simple environmental intervention called ‘Water Schools’ in Lower Austria providing free refillable water bottles and educational material.

Design:

Non-randomised controlled cluster trial with three measurements: at baseline (T0), after the intervention at 9 months (T1) and after 1-year follow-up (T2).

Setting:

Half-day elementary schools in Lower Austria (Austria).

Participants:

Third-grade pupils from twenty-two schools in the intervention group (IG) and thirty-two schools in the control group (CG) participated in the study. Data were analysed for 569 to 598 pupils in the IG and for 545 to 613 in the CG, depending on the time of measurement.

Results:

The consumption of tap water increased in the IG from baseline to T1 and then decreased again at T2, but this was similar in the CG (no statistically significant difference in the time trend between the IG and CG). Similar results were seen for tap water consumption in the mornings. The proportion of children who only drank tap water on school mornings increased significantly from baseline to T1 in the IG compared to the CG (P = 0·020). No difference in the changes over time occurred between the groups for the proportion of pupils drinking approximately one bottle of tap water during school mornings.

Conclusions:

Not only the children in the IG but also those in the CG drank more tap water after 1 school year than at the beginning. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects.

Co-Creation Approach with Action-Oriented Research Methods to Strengthen "Krachtvoer"; A School-Based Programme to Enhance Healthy Nutrition in Adolescents

In recent years, the nutritional pattern of the Dutch adolescent has cautiously improved. However, progress can be gained if more Dutch adolescents adhere to the nutritional guidelines. School-based initiatives offer opportunities to deal with the unhealthy eating behaviours of adolescents via nutrition educational interventions. In designing and/or re-designing school-based interventions, it is important to enhance optimal context-oriented implementation adaptation by involving the complex adaptive school system. This paper elaborates on the way of dealing with the dynamic implementation context of the educational programme "Krachtvoer" (ENG: "Power food") for prevocational schools, how the programme can be adapted to each unique implementation context, and how the programme can be progressively kept up to date. Following a co-creation-guided approach with various intersectoral stakeholders within and outside the school setting, action-oriented mixed research methods (i.e., observations, semi-structured interviews, focus group interviews, programme usage monitoring, and questionnaires) constantly provide input to develop the programme and its implementation strategy via continuous micro-process cycles. Successful co-creation of school-based health promotion seems to be dependent on proper intersectoral cooperation between research and practice communities, a national partner network that can provide project-relevant insights and establish capacity building aimed at improving contextual fit, and a time-investment balance in and between sectors.

Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program

Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8–12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.

School health promotion in South-East Asia by Japan and partners

School health promotion in South-East Asia has developed rapidly in recent years, and Japan has been one of the significant contributors to the reinforcement of school health promotion in the region. Starting from the Hashimoto Initiative on global parasite control, Japan advocated for international partnerships with several agencies for the development of school health programs in South-East Asia. Through a strengthened collaboration with international organizations, countries such as the Lao PDR, Cambodia, the Philippines, and Thailand have created and implemented school health programs on nutrition, sanitation, and deworming, among others. In addition to school health program formulation and implementation, the expanded network in South-East Asia led to more capable school health personnel, with many workers in the education and health sectors benefitting from the training programs jointly held by collaborating organizations.

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of "one size fits all" interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible.

Subjective Health Literacy among School-Aged Children: First Evidence from Lithuania

Health literacy as a set of competencies to promote and sustain health has received significant research attention, particularly in studies on adults. Improving health literacy at an early age is crucial to personal health and development, so there is a need to investigate the health literacy of school-aged children. The aims of this study were to determine the level of subjective health literacy among adolescents in Lithuania and to examine the association between health literacy, school achievement, health education in schools, and family affluence. Health literacy was assessed using a brief Health Literacy for School-Aged Children instrument on a representative sample of 2369 subjects (from the 7th to 10th grades). Overall, 12.1% of all respondents had low, 70.5% moderate, and 17.4% a high level of health literacy. School achievements were found to be a significant predictor of health literacy, as were the number of school-based health promotion events. Family affluence also predicted an increased level of health literacy. This study was the first nationally representative examination of this topic in Lithuania and it highlighted the alarming finding that less than one-fifth of adolescents had high health literacy.

Unravelling the Effects of the Healthy Primary School of the Future: For Whom and Where Is It Effective?

The 'Healthy Primary School of the Future' (HPSF) aims to integrate health and well-being within the whole school system. This study examined the two-year effects of HPSF on children's dietary and physical activity (PA) behaviours at school and at home and investigated whether child characteristics or the home context moderated these effects. This study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA), two partial HPSF (focus: PA), and four control schools. Measurements consisted of accelerometry (Actigraph GT3X+) and questionnaires. Favourable effects on children's dietary and PA behaviours at school were found in the full HPSF; in the partial HPSF, only on PA behaviours. Children in the full HPSF did not compensate at home for the improved health behaviours at school, while in the partial HPSF, the children became less active at home. In both the full and partial HPSF, less favourable effects at school were found for younger children. At home, less favourable effects were found for children with a lower socioeconomic status. Overall, the effect of the full HPSF on children's dietary and PA behaviours was larger and more equally beneficial for all children than that of the partial HPSF.

School health for migrant children: a myth or a must?

Background

School health plays a vital role in lifelong health outcomes. Migrant children are a vulnerable population that seem to have inadequate health promotion interventions, and limited studies have assessed their health status and personal hygiene at schools. This study aimed to evaluate school health promotion and health outcomes of migrant children in Thai public schools (TPSs) and migrant learning centers (MLCs).

Methods

A cross-sectional study was applied. Data were collected from questionnaires focusing on health care access, nutritional status, and personal hygiene of migrant children in two MLCs and four TPSs, along with Thai children in the same TPSs. Descriptive analysis and logistic regression model were used to compare access to health promotion and the health status of migrant children with the Thai counterparts.

Results

Blended school health services were generally found in TPSs, which led to indifferent vaccination rates between Thai and migrant children in TPSs (odds ratio [OR] 0.457 (0.186–1.120)). However, vaccination rates of migrant children in MLCs are noticeably around fourfold lower. Overall, migrant children received fewer dental health services than Thai children, both in TPSs (OR 0.198 (0.076,0.517)) and MLCs (OR 0.156 (0.004,0.055)). Other personal hygiene behaviors and nutritional statuses saw no significant difference between Thai children and migrant children in either TPSs or MLCs. The uninsured status among migrant children posed another challenge to health care access, as 81.7% of the migrant children in MLCs and 56.6% in TPSs were uninsured.

Conclusion

Migrant children in MLCs received a lower rate of essential vaccinations compared to those in TPSs. Dental services appeared to be the most neglected area of care in migrant children. The findings indicate the necessity of supportive policy for MLCs, while regulating quality and standards concurrently. Multisectoral collaboration is critically needed for sustainably improving the quality of life of migrant children.

Beliefs and performances of elementary school students to prevent road traffic injuries, using Health Belief Model: a study from Hamadan, Iran

BACKGROUND

Road traffic injuries (RTIs) are important health problems and increasing knowledge on their prevention-related issues can be credible. This study aims to assess beliefs and performances of students to prevent road traffic injuries and their related factors, using Health Belief Model (HBM).

METHODS

This cross-sectional study carried out on a random sample of 500 fourth and fifth grades students of elementary schools in Hamadan city, west of Iran. The data gathering tool was a self-administered questionnaire designed on the basis of HBM constructs and also the knowledge and performance of the students in relation to prevent RTIs. To increase the accuracy of this study, the students' road-crossing behaviors were observed in a simulated street in the school, using an observation checklist. Data were analyzed by SPSS 16.

RESULTS

The mean age of the participants was 10.51±0.50. About preventing RTIs, the mean scores of the students' knowledge was 64.139, and regarding HBM constructs, the mean scores of their perceived susceptibility, perceived severity, perceived benefits, perceived barriers and self-efficacy were 82.817, 82.453, 82.451, 89.917, 84.343 and 91.250, respectively. The mean score of the students' self-reported performances about traffic injury prevention was 48.750 and the mean score of their observed road-crossing behavior in the simulated street was 45.000. The final model of multiple linear regressions showed that the students' sex (p=0.001), their knowledge (p less than 0.001), perceived susceptibility (p=0.002), perceived barriers (p=0.032), self-efficacy (p=0.001), and their observed road-crossing behaviors (p=0.019) predict the students' self-reported injury prevention performances.

CONCLUSIONS

Regarding prevention of RTIs, knowledge and performance of the studied students are undesirable. The study findings can help designing more appropriate prevention programs for them.

Evaluation of "Healthy Learning. Together", an Easily Applicable Mental Health Promotion Tool for Students Aged 9 to 18 Years

Schools play an important role in adolescents’ health promotion. Due to the limited resources of teachers, there is a need for short-time interventions that can be easily implemented in a regular class without extensive training. Therefore, the tool “Healthy learning. Together.” was developed within a joint venture research project in Jena, Germany. The tool consists of a box with 60 exercises and a poster exhibition for students in 5th grade and higher. One thousand one hundred and forty four (1144) students (56% female) from nine schools were assessed at an interval of 10 weeks in a parallelized pre-post-design with class-wise assignment to intervention group (IG) and control group (CG). In the IG, regular teachers implemented the health promotion tool. Before and after the intervention social integration, class climate, self-efficacy (as primary outcomes) and mental and physical wellbeing (as secondary outcomes) were measured using standardized questionnaires. ANCOVA analysis revealed that students of the IG showed more positive changes on primary outcomes with small effect sizes. Additional implementation outcomes showed high teacher and student enthusiasm but sometimes low exposure rates. Regarding the relatively small amount of time and preparation for teachers to get noticeable effects, the introduced tool is suitable as a first step into health promotion for schools.

[Direct effect of contemporary health education programmes on the knowledge about hand hygiene and technique of hand washing in primary school age children]

INTRODUCTION AND AIM

In the case of primary school children in Budapest (n = 165), data on their social status and their previous knowledge on hand hygiene were elicited with the help of pre-knowledge questionnaires issued by students of higher education. The aim of the research was introducing a novel pedagogical procedure - application and optimization of peer education in the development of proper hand hygiene among primary school students.

METHOD

The knowledge-based survey was conducted after four (n = 85) and eight hours of teaching (n = 36). In addition, the effectiveness of hand washing was tested immediately before (n = 166) and after the four (n = 74) and eight hours of teaching (n = 35) with Semmelweis Scanner after rubbing the hand with fluorescent cream.

RESULTS

Prior knowledge of hand hygiene significantly increased after the four-hour and eight-hour trainings. In the case of smaller children, the effect of the eight-hour training was more pronounced. Similar results were obtained with regards to the changes in the number of areas missed while rubbing the surface of the hand as a result of the teaching.

CONCLUSION

Sociological surveys on hand hygiene knowledge and direct physical measurements indicate that training with appropriate pedagogical procedures is effective and contributes to the environmentally conscious hygiene culture of children aged 6 to 10. Orv Hetil. 2018; 159(12): 485-490.

The development and pilot testing of a multicomponent health promotion intervention (SEHER) for secondary schools in Bihar, India

BACKGROUND

Schools can play an important role in health promotion by improving students' health literacy, attitudes, health-related behaviours, social connection and self-efficacy. These interventions can be particularly valuable in low- and middle-income countries with low health literacy and high burden of disease. However, the existing literature provides poor guidance for the implementation of school-based interventions in low-resource settings. This paper describes the development and pilot testing of a multicomponent school-based health promotion intervention for adolescents in 75 government-run secondary schools in Bihar, India.

METHOD

The intervention was developed in three stages: evidence review of the content and delivery of effective school health interventions; formative research to contextualize the proposed content and delivery, involving intervention development workshops with experts, teachers and students and content analysis of intervention manuals; and pilot testing in situ to optimize its feasibility and acceptability.

RESULTS

The three-stage process defined the intervention elements, refining their content and format of delivery. This intervention focused on promoting social skills among adolescents, engaging adolescents in school decision making, providing factual information, and enhancing their problem-solving skills. Specific intervention strategies were delivered at three levels (whole school, student group, and individual counselling) by either a trained teacher or a lay counsellor. The pilot study, in 50 schools, demonstrated generally good acceptability and feasibility of the intervention, though the coverage of intervention activities was lower in the teacher delivery schools due to competing teaching commitments, the participation of male students was lower than that of females, and one school dropped out because of concerns regarding the reproductive and sexual health content of the intervention.

CONCLUSION

This SEHER approach provides a framework for adolescent health promotion in secondary schools in low-resource settings. We are now using a cluster-randomized trial to evaluate its effectiveness and cost-effectiveness.

Development of an effective communication strategy for the prevention of burns in children: the PRIUS project

This study has developed a learning kit for the prevention of domestic burns in childhood. The main objective was to trial an educational package for children (nursery and primary classes), for the prevention of burns, to be implemented through education in schools. The educational kit comprises posters, information leaflets, comic books, and pre and post education evaluation materials for school children, parents and teachers. Recipients of the preliminary study were the students of nine schools in the eight Italian cities where Burn Centers are located. In order to reach the target groups of children, it was necessary to identify the most effective communication strategy to convey the burn prevention message. For nursery school children, it was not possible to use tools with written texts alone, as they were not yet literate. Moreover, even for older children, it was necessary to find an attractive tool to catch their attention and interest, promoting the understanding and memorization of lessons learned. The most suitable means was found to be comic strips, allowing the messages to be conveyed through images as well as words. A total of 370 children (195 from nurseries and 175 from primary schools) participated in the trial of the educational kit. Overall, for every environment represented in the evaluation table, the ability to recognize the dangers among both the pre-school and primary school children increased significantly after the training activity. In conclusion, the educational kit has been positively assessed.

Effects of transfer-oriented curriculum on multiple behaviors in the Netherlands

Many school health promotion curricula address a single health behavior, without paying attention to potential learning effects in associated behavioral domains. We developed an innovative curriculum about smoking and safe sex that also focused on promoting students' transfer of knowledge, skills and attitudes to other domains. In a quasi-experimental study involving 1107 students (Grades 7 and 8) in the Netherlands, the curriculum was compared with regular lessons about smoking and safe sex. The central research questions were to what extent the transfer-oriented curriculum: (i) had effects on psychosocial determinants and behaviors in the domains of smoking and safe sex, (ii) had effects on determinants and behaviors in three domains about which no lessons were taught (consumption of alcohol, fruit and breakfast). Multi-level analyses showed that the answer to both questions is positive. The results indicate that a transfer approach may have surplus value over the classic domain-specific approach and warrant further elaboration in the future.

Phases of health promotion implementation into the Scottish school system

Schools have been identified as ideal settings for health promotion (HP) among children, adolescents and school staff. Most European countries have established strategies to implement HP into their school system, however, little is known about these national strategies and how effective they have been. School HP implementation concerns processes of adoption, adaptation and operation of a complex intervention into a complex setting. This study analyses the processes that have led to school HP implementation in Scotland from the 1980s until now to identify key factors which facilitated and supported effective implementation. In the tradition of case-study research, 14 interviews with representatives of national and local organizations involved in school health, as well as with school staff were conducted. Furthermore, policy documents, reports and guidelines were collected. The data were analysed following a Grounded Theory approach. Four phases of school HP implementation into the Scottish school system were identified: (i) getting started (1980s-1998), (ii) political will and strategic vision (1999-2001), (iii) national leadership (2002-2008), and (iv) integration and embedding into education system (2008-ongoing). Throughout the phases political will and committed actors, the strategy/tradition to give power to the local authorities and individual schools, and the establishment of partnerships and ownership have supported implementation. Scotland is an interesting case giving important insights into the ways and possibilities of negotiating an interdisciplinary and cross-sectoral theme such as HP in schools. Further research concerning different political systems and national implementation processes is important to widen the understanding of national implementation strategies of school HP.