Achieving good standards in health promoting schools: Preliminary analysis one year after the implementation of the Hong Kong Healthy Schools Award scheme

Conceptual framework for establishing twins prevention and continuous health promotion programme: a qualitative study

BACKGROUND

Twin registries and cohorts face numerous challenges, including significant resource allocation, twins' recruitment and retention. This study aimed to assess expert feedback on a proposed pragmatic idea for launching a continuous health promotion and prevention programme (HPPP) to establish and maintain twin cohorts.

DESIGN

A qualitative study incorporating an inductive thematic analysis.

SETTING

Tehran University of Medical Sciences.

PARTICIPANTS

Researchers with expertise in twin studies participated in our study.

ANALYSIS AND DESIGN

Expert opinions were gathered through focus group discussions (FGDs). Thematic analysis was employed to analyse the findings and develop a model for designing a comprehensive, long-term health promotion programme using ATLAS.ti software. Additionally, a standardised framework was developed to represent the conceptual model of the twin HPPP.

RESULTS

Eight FGDs were conducted, involving 16 experts. Thematic analysis identified eight themes and seven subthemes that encompassed the critical aspects of a continuous monitoring programme for twin health. Based on these identified themes, a conceptual framework was developed for the implementation of an HPPP tailored for twins.

CONCLUSION

This study presented the initial endeavour to establish a comprehensive and practical solution in the form of a continuous HPPP designed to tackle the obstacles of twins' cohorts.

Content analysis of health-related subjects in the K12 school curricula of Japan, Indonesia, Philippines, Guam, Micronesia, Marshall Islands, Palau, and Fiji

BACKGROUND

As a component of health promoting school, a school curriculum for health education was considered a fundamental. This survey aimed to identify the components of health-related topics and in which subjects were they taught.

METHODS

Four topics were chosen: (i) hygiene, (ii) mental health, (iii) nutrition-oral Health, and (iv) environmental education related to global warming in Education for Sustainable Development (ESD). Before gathering the curricula from partner countries, school health specialists were gathered to discuss the appropriate components of a curriculum that required evaluation. The survey sheet was distributed to and answered by our partner in each country.

RESULTS

About hygiene, individual practices or items that improve health-related were widely covered. However, items that imparted health-related education from an environmental perspective were not widely covered. About mental health, two types of country groups were identified. The first group included countries that taught mental health topics mainly as part of morals or religion; the second group included countries that imparted mental health topics mainly as part of health. The first group focused mainly on communication skills or coping methods. The second group focused not only on communication and coping skill but also on basic knowledge of mental health. About nutrition-oral education, three types of country groups were identified. One group imparted nutrition-oral education mainly in terms of health or nutrition. Another group imparted this topic mainly in terms of morals, home economics, and social science. The third group was the intermediate group. About ESD, a solid structure for this topic was not identified in any country. Many items were taught as part of science, while some were taught as part of social studies. Climate change was the most commonly taught item across all countries. The items related to environment were relatively limited compared to those related to natural disasters.

CONCLUSIONS

Overall, two different approaches were identified: the cultural-based approach, which promotes healthy behaviors as moral codes or community-friendly behaviors and the science-based approach, which promotes children's health through scientific perspectives. Policymakers should initially  consider the findings of this study while making decisions on which approach should be taken.

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

Health Promoting Schools: An Update

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

Effective health promoting school for better health of children and adolescents: indicators for success

BACKGROUND

Improvement of health literacy, health behavioural change, creating a supportive physical and social environment to be more conducive to health should be the focus of child and adolescent public health. The concept of Health Promoting School initiated by World Health Organization aims to move beyond individual behavioural change and to consider organisational structure change such as improvement of the school's physical and social environment. The aim of this study is identification of the key indicators for successful implementation of Health Promoting School by analysing the findings of the school health profile based on the structured framework of Hong Kong Healthy School Award Scheme and the health status of students investigated by the Hong Kong Student Health Survey.

METHODS

This is a retrospective correlation study. Analysis of variance (ANOVA) was utilised to analyse for significant improvement of school health profile measured at baseline (n = 104) and among those schools implemented the Hong Kong Healthy School Award Scheme (n = 54). Those indicators showing statistical significance were chosen to be part of the core indicators reflecting effective Health Promoting School. Each of those selected core indicators was then correlated with the related student health outcomes measured by the Hong Kong Student Health Survey Questionnaire to further identify the core indicators.

RESULTS

A total of 20 core indicators among all the six Key Areas of Health Promoting School (6 indicators under action competencies, 2 under community link, 2 under physical environment, 2 under social environment, 4 under healthy school policies, 1 under services of school health protection) have been identified with the method mentioned above.

CONCLUSIONS

This study has identified the indicators with most significant impact on a wide range of health related outcomes. Those are key indicators for motivating positive change of the schools and students. They can be considered as school performance indicators to help schools embarking their Health Promoting School journey as another key education objective.

[Process of Accreditation of Health Promoting Schools worldwide: A Systematic Review]

The scope of this article is to analyze the accreditation criteria of the studies that evaluated actions of health promotion and risk factor prevention of Health Promoting Schools (HPS). A systematic review was conducted based on the recommendations proposed in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma)" protocol of articles that assessed HPS in the following databases: SciELO, Lilacs, Medline, PubMed and Portal Capes. From the analysis of the three pillars for accreditation of HPS, three of the studies analyzed did not include all the criteria for certification as HPS on the "Planning Process" and "Health Promotion Activities Developed" pillars. The schools cited in these studies perform health education, prevention and/or health promotion activities, however, it is misleading to refer to themselves as HPS. The main challenges for implementation, development and continuity of HPS were identified as being intersectionality and insufficient financial and qualified human resources. HPS need to be certified and submitted to an ongoing evaluation process. It is also suggested the topic of health promotion be included in the syllabuses of training courses of health education teachers and other health education professionals.

Development and Validity Testing of the School Health Score Card

BACKGROUND

The objective of this study was to develop the School Health Score Card (SHSC) and validate its psychometric properties.

METHODS

The development of the SHSC questionnaire included 3 phases: item generation, construction of domains and items, and field testing with validation. To assess the instrument's reliability and validity, we recruited 15 middle schools and 15 high schools in the Republic of Korea.

RESULTS

We developed the SHSC questionnaire of 158 items categorized into 5 domains: (1) Governance and Infrastructure, (2) Need Assessment, (3) Planning, (4) Health Prevention and Promotion Program, and (5) Monitoring and Feedback. All SHSC domains and subdomains demonstrated acceptable reliability with good internal consistency. Each domain and subdomain except for "Planning" was associated significantly with students' health status. Most subdomains, including school health philosophy, school policy, communication, the evaluation system, and monitoring, were significantly and negatively associated with student absence.

CONCLUSIONS

The SHSC shows significant association with the overall student health and can be useful in assessing comprehensive school health programs.

Health-promoting educational settings in Taiwan: development and evaluation of the Health-Promoting School Accreditation System

INTRODUCTION

The Taiwan Ministry of Health and Welfare and Ministry of Education launched the Health-Promoting School (HPS) program in 2002. One of the most significant barriers to evaluating HPS is the absence of adequate instruments. The main aim of this study is to develop the Taiwan Health-Promoting School Accreditation System (HPSAS) framework and then evaluate its accreditation effectiveness.

METHODS

The HPSAS accreditation standards were derived mainly from the World Health Organization (WHO) publication, WHO Health Promoting Schools: A Framework for Action in 2008 and the Taiwan School Health Act. Delphi technique and pilot test were used to confirm the availability and acceptability of the standards and procedures for HPSAS in 2011. After that, two rounds of school evaluations were completed in 2012 (214 participant schools) and 2014 (182 participant schools). The accreditation operation process included documentary reviews, national and international accredited commissioners conducted on-site visits. Descriptive analyses were used to indicate HPS award level distribution.

RESULTS

The study established six key HPSAS standards. Each standard had at least two components; overall, there were 21 components and 47 scoring elements. Of the participating schools evaluated in 2012, four were at the gold, 14 silver, and 120 bronze levels, compared with five, 20, and 31, respectively, of schools evaluated in 2014. The study showed that schools at different award levels had different full-score rates in six standards. The schools at the gold level performed exceptionally well. The worst performance among the six standards at each award level was in the skill-based health curriculum.

CONCLUSION

The HPSAS is an objective instrument used to evaluate the process and outcomes of the HPS program. In the future, combinations of different types of data (e.g. students' health behaviors, school climate, or teachers' health-teaching innovations) will enable further validation of the HPS effectiveness.

Characteristics of health-promoting schools from Iranian adolescents' point of view

AIM

Although characteristics of health-promoting schools are mentioned in the World Health Organization guidelines, different countries need to design more details of indicators for assessing these schools according to their social and cultural context. The aim of this study was to investigate characteristics of health-promoting schools from Iranian adolescent girls' point of view.

MATERIALS AND METHODS

In this cross-sectional study, 2010 middle school and high school female adolescents were selected from randomly selected schools in Mazandaran province, Iran. They completed a self-completion questionnaire around their views about characteristics of health- promoting schools. Data were analyzed using descriptive statistics and an independent t-test.

RESULTS

It is revealed that from Iranian adolescents' point of view the most important feature of health-promoting schools was the schools with no stressful exams and where notices are kindly given to students for their mistakes.

CONCLUSION

The results suggest that there is a need for more measurable standards of health-promoting schools based on the socio-cultural context of both developing and developed countries.

Validation of an instrument to evaluate health promotion at schools

OBJECTIVE

To validate an instrument designed to assess health promotion in the school environment.

METHODS

A questionnaire, based on guidelines from the World Health Organization and in line with the Brazilian school health context, was developed to validate the research instrument. There were 60 items in the instrument that included 40 questions for the school manager and 20 items with direct observations made by the interviewer. The items' content validation was performed using the Delphi technique, with the instrument being applied in 53 schools from two medium-sized cities in the South region of Brazil. Reliability (Cronbach's alpha and split-half) and validity (principal component analysis) analyses were performed.

RESULTS

The final instrument remained composed of 28 items, distributed into three dimensions: pedagogical, structural and relational. The resulting components showed good factorial loads (> 0.4) and acceptable reliability (> 0.6) for most items. The pedagogical dimension identifies educational activities regarding drugs and sexuality, violence and prejudice, auto care and peace and quality of life. The structural dimension is comprised of access, sanitary structure, and conservation and equipment. The relational dimension includes relationships within the school and with the community.

CONCLUSIONS

The proposed instrument presents satisfactory validity and reliability values, which include aspects relevant to promote health in schools. Its use allows the description of the health promotion conditions to which students from each educational institution are exposed. Because this instrument includes items directly observed by the investigator, it should only be used during periods when there are full and regular activities at the school in question.

The effect of the school environment on the emotional health of adolescents: a systematic review

BACKGROUND AND OBJECTIVES

The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the school environment in cohort studies.

METHODS

Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers.

RESULTS

Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological shortcomings were common.

CONCLUSIONS

There is limited evidence that the school environment has a major influence on adolescent mental health, although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring school-level factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing effective and feasible interventions compared with complex whole-school programs.

The lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong

AIMS

To examine the lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong.

BACKGROUND

The establishment of healthy lifestyle habits and maintenance of psychosocial well-being during early adolescence can prevent the morbidity and mortality caused by unhealthy practices.

DESIGN

A cross-sectional study.

METHODS

A questionnaire was used to solicit information on primary school students' lifestyle behaviours and psychosocial well-being using the Chinese version of the Adolescent Lifestyle Questionnaire (C-ALQ).

RESULTS

Out of 249 primary school students, 241 returned their questionnaires (a response rate of 96.8%). Results on the lifestyle behaviours of students indicated that nearly half of them 'play sports at least three times a week' (n = 111, 46.1%), 'try not to eat foods high in fats/salt' (n = 112, 46.5%), 'report unusual bodily changes to nurses, parents, friends or physician' (n = 136, 56.4%) and 'avoid doing drugs' (n = 186, 77.2%). Results for the psychosocial well-being of students showed that nearly half 'use helpful strategies to deal with stress' (n = 104, 43.2%), are 'confident about [their] own beliefs and values in life' (n = 143, 59.3%) and 'enjoy spending time with friends' (n = 169, 70.1%). Male students were found less likely than females to demonstrate 'health awareness' (t = 4.87, p = 0.028) and 'social support'(t = 4.17, p = 0.042) and to have better overall psychosocial well-being (t = 5.43, p = 0.021).

CONCLUSIONS

Primary school students have various health education needs related to lifestyle behavioural choices and the maintenance of psychosocial well-being. Lifestyle choices are formed in early adolescence; therefore, health education must begin as early as possible to influence healthy behaviours.

RELEVANCE TO CLINICAL PRACTICE

School nurses should assess health needs across the school-age population and develop programmes to address these overall needs. School nurses are needed to cater for the needs of students, particularly boys, to establish health programmes for lifelong healthy lifestyles and psychosocial well-being and to monitor their health status.

Significant effects of implementation of health-promoting schools on schoolteachers' nutrition knowledge and dietary intake in Taiwan

OBJECTIVE

Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers' nutrition knowledge and diets.

DESIGN

One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78.4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis.

RESULTS

Teachers in the HP-D group had a mean score of 21.1 on a range of 0-30 for nutrition knowledge, which was significantly higher than the mean scores of 18.5 in the HP-ND group and 19.1 in the NHP group (P < 0.001). Better dietary behaviours were also observed among HP-D teachers. Further, being a 'health education' course instructor was associated with significantly higher scores on nutrition knowledge (beta = 2.6, P < 0.001) and vegetable and fruit consumption (beta = 1.4, P = 0.02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group.

CONCLUSIONS

Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers' nutrition knowledge and dietary intake.