Reliability and validity of a scale for health-promoting schools

Associations between Polish school principals' health literacy and implementation of the Health Promoting School approach during the COVID-19 pandemic

The coronavirus pandemic has contributed to increasing the responsibility of school principals for the health of all school community members. Moreover, evidence confirms the significant role of school principals' health literacy (HL) for health promotion in schools. Therefore, the presented study aims to evaluate the associations between Polish school principals HL and the implementation of the Health Promoting School (HPS) approach in Polish schools. The present study was conducted as part of an international survey on the global COVID-HL network (www.covid-hl.eu) between June 2021 and December 2021. Three subscales of the HPS were considered and an exploratory analysis were used in this study. Associations between the median split of each subscale of HPS (outcome) and health literacy (predictor) were performed using logistic regression. Research results showed that the highest level of HPS implementation was directed at pupils. Principals perceived themselves as having the highest HL on the 'accessibility' subscale and these respondents had significantly higher odds of implementing learning opportunities for students. The study suggests that principals with adequate HL may be more likely to effectively implement HPS strategies in schools. This research could provide insights into the complex interplay between HL and the HPS approach and inform the development of more effective strategies for promoting health and HL in schools.

Health-Promoting School Culture: How Do We Measure it and Does it Vary by School Neighborhood Deprivation?

BACKGROUND

The context in which school-based health-promoting interventions are implemented is key for the delivery and success of these interventions. However, little is known about whether school culture differs by school deprivation.

METHODS

Using data from PromeSS, a cross-sectional study of 161 elementary schools in Québec, Canada, we drew from the Health Promoting Schools theoretical framework to develop four measures of health-promoting school culture (i.e., school physical environment, school/teacher commitment to student health, parent/community engagement with the school, ease of principal leadership) using exploratory factor analysis. One-way ANOVA with post-hoc Tukey-Kramer analyses was used to examine associations between each measure and social and material deprivation in the school neighborhood.

RESULTS

Factor loadings supported the content of the school culture measures and Cronbach's alpha indicated good reliability (range: 0.68-0.77). As social deprivation in the school neighborhood increased, scores for both school/teacher commitment to student health and parent/community engagement with the school decreased.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Implementation of health-promoting interventions in schools located in socially deprived neighborhoods may require adapted strategies to address challenges related to staff commitment and parental and community involvement.

CONCLUSION

The measures developed herein can be used to investigate school culture and interventions for health equity.

Psychometric Analysis of the Quarantine Coping Strategies Scale (Q-COPE) in the Spanish Language

The possibility of facing an epidemic or pandemic resulting in mandatory isolation or quarantine has become a relevant construct for comparing and evaluating coping strategies under such conditions. The objective of this research was to develop and analyze the psychometric properties of a scale to assess quarantine coping strategies (Q-COPE). This was an instrumental study and 1110 Peruvian adults (M = 26.9 years; SD = 9.77) participated in the context of social isolation. For the construction of the scale, qualitative and quantitative procedures were followed. The internal structure was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The content analysis by expert judges supports the representativeness of the items related to the construct. EFA and CFA allowed the establishment of five factors: Emotional regulation, Information, Accommodation, Social support, and Altruism. The first-order model presents adequate goodness-of-fit indices: χ² = 489.048, df = 220, χ²/df = 2.223, SRMR = 0.025, CFI = 0.969, TLI = 0.965, RMSEA = 0.047. Likewise, the second order model presented similar values: χ² = 499.674, df = 225, χ²/df = 2.221, SRMR = 0.026, CFI = 0.969, TLI = 0.965, RMSEA = 0.047. The 23-item version was consistent with the proposed theory, obtained adequate fit indices and acceptable factor loadings (>0.70), and presented good internal consistency indexes evaluated by Cronbach's α, ordinal α, omega (ω), and H coefficient. It is concluded that the Q-COPE scale presents good psychometric properties that justify its use in an adult population and allows the assessment of the coping strategies that people use in the face of a quarantine situation.

Status of school health programs in Asia: National policy and implementation

BACKGROUND

The WHO's Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation.

METHODS

Date were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow-up data collection was conducted in each country for a second workshop.

RESULTS

We identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model programs had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing.

CONCLUSION

Given the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools.

Development and primary validation of the School Health Assessment Tool for Primary Schools (SHAT-PS)

Background

School health programs need to target all aspects of physical, psychological, and social well-being. Using a slightly modified version of the COSMIN Risk of Bias checklist, we developed and conducted the first validation of the School Health Assessment Tool for Primary Schools (SHAT-PS).

Method

The exploratory sequential mixed method was used in this study. In the first phase, scientific databases were systematically searched to find school health models and instruments and 65 interviews were conducted with school stakeholders. The Colaizzi’s method was used to code the qualitative data into themes. Then, a pool of items was created for each theme, rechecked by psychometric experts and then validated for content (i.e., relevance, clarity, and comprehensiveness) by psychometric experts and individuals of the target population (i.e., school personnel). In the second phase, classical test theory was utilized to analyze the validity and reliability of the resulting items from phase 1 among 400 individuals working at primary schools.

Results

The coding of the interviews resulted in ten themes that we labeled based on the theoretical literature: school health policies, community connections, health education, physical activity, health services, nutrition, psychological services, physical environment, equipment and facilities, and school staff’s health. The items created for each theme ended up in an initial pool of 76 items. In the final stage of phase 1, 69 items remained after the content validity assessment by experts and school personnel. In phase 2, the SHAT-PS items were tested using maximum likelihood exploratory factor analysis and confirmatory factor analysis. Of the 69 items from phase 1, 22 items were removed due to low factor loadings. The results showed that the 8-factor model was the best solution (chi-square/df = 2.41, CFI = .98, TLI = .97, RMSEA = .06). The discriminant and convergent validity of the SHAT-PS were evaluated as satisfactory and the scale had high internal consistency (Cronbach’s alpha for all subscales > .93). The test-retest reliability was satisfactory—the intraclass correlation coefficient pooled was .95 (99% CI [.91–.98]). Moreover, the standard error of measurement resulted in an SEM pooled equal to 4.4. No discrepancy was found between subgroups of gender and subgroups of staffs’ positions at schools.

Conclusion

The SHAT-PS is a valid and reliable tool that may facilitate school staff, stakeholders and researchers to evaluate the presence of the factors that promote health at primary schools. Nevertheless, in the process of validation, many of the items related to staff’s health were eliminated due to poor factor loadings. Obviously, staff health is an important factor in the measurement of school health. Hence, we recommend that the validity and reliability of the SHAT-PS in other cultures should be done using the original 76-item version.

Health Promoting Schools in Germany. Mapping the Implementation of Holistic Strategies to Tackle NCDs and Promote Health

Noncommunicable diseases (NCDs) and their underlying risk factors are seen as major public health problems that threaten health and welfare systems worldwide. The holistic and resource oriented Health Promoting School (HPS) approach can serve as an appropriate framework for the prevention and control of NCDs. The paper aimed to map the implementation of HPS activities in German schools and to examine associations with potential influencing factors. A series of cross-sectional online studies including five federal states and 5006 school principals (40.2% males, 50.8% females) from primary and secondary public schools was conducted from 2013 to 2018. Principal component analysis (PCA) resulted in two factors of HPS implementation (F1: concrete HPS action, F2: capacity building for HPS). Comparing both factors, a lower implementation level could be identified for HPS capacity building with lowest mean values found for regular teacher training and intersectoral collaboration. Multiple binary regression analyses revealed significant associations between low HPS implementation and male gender (OR: 1.36 to 1.42), younger age (OR: 1.47 to 1.90), secondary school (OR: 1.78 to 3.13) and federal state (Lower Saxony = OR: 1.27 to 1.45; Schleswig-Holstein = OR: 1.95 to 2.46). Moreover, low access to resources, decision-latitude and perceived educational benefits were independently associated with both factors of HPS implementation. Based on the results of this study, there is a need to support schools in their capacity building for health (e.g., regular teacher training, cooperation with local health services). Moreover, considering the core mission of schools, more evidence of the educational impact of health promotion and its translation into the language of education is needed for secondary schools in particular.

School health assessment tools: a systematic review of measurement in primary schools

Background

This systematic review aimed to investigate the psychometric properties of the school health’s assessment tools in primary schools through COSMIN Risk of Bias checklist. We examined the studies that have addressed the measurement properties of school-health instruments to give a clear overview of the quality of all available tools measuring school health in primary schools. This systematic review was registered in PROPERO with the Registration ID: CRD42020158158.

Method

Databases of EBSCOhost, PubMed, ProQuest, Wily, PROSPERO, and OpenGrey were systematically searched without any time limitation to find all full-text English journal articles studied at least one of the COSMIN checklist measurement properties of a school-health assessment tool in primary schools. The instruments should be constructed based on a school health model. The eligible studies were assessed by COSMIN Risk of Bias checklist to report their quality of methodology for each measurement property and for the whole study by rating high, moderate or low quality.

Results

At the final screening just seven studies remained for review. Four studies were tool development, three of them were rated as “adequate” and the other study as “very good”; five studies examined the content validity, three of them were appraised as “very good”, and the two remaining as “inadequate”. All seven studies measured structural validity, three of them were evaluated as “very good”, three other were scored as “adequate”, and the last study as “inadequate”. All the seven studies investigated the internal consistency, five of them were assessed as “very good”, one was rated as “doubtful”, and the last one as “inadequate”. Just one study examined the cross-cultural validity and was rated as “adequate”. Finally, all seven studies measured reliability, two of them were rated as “very good” and the rest five studies were appraised as “doubtful”. All rating was based on COSMIN checklist criteria for quality of measurement properties assessment.

Conclusion

The number of studies addressing school health assessment tools was very low and therefore not sufficient. Hence, there is a serious need to investigate the psychometric properties of the available instruments measuring school health at primary schools. Moreover, the studies included in the present systematic review did not fulfill all the criteria of the COSMIN checklist for assessing measurement properties. We suggest that future studies consider these criteria for measuring psychometric properties and developing school health assessment tools.

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.

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.

Validity and reliability of the South African health promoting schools monitoring questionnaire

Health promoting schools, as conceptualised by the World Health Organisation, have been developed in many countries to facilitate the health-education link. In 1994, the concept of health promoting schools was introduced in South Africa. In the process of becoming a health promoting school, it is important for schools to monitor and evaluate changes and developments taking place. The Health Promoting Schools (HPS) Monitoring Questionnaire was developed to obtain opinions of students about their school as a health promoting school. It comprises 138 questions in seven sections: socio-demographic information; General health promotion programmes; health related Skills and knowledge; Policies; Environment; Community-school links; and support Services. This paper reports on the reliability and face validity of the HPS Monitoring Questionnaire. Seven experts reviewed the questionnaire and agreed that it has satisfactory face validity. A test-retest reliability study was conducted with 83 students in three high schools in Cape Town, South Africa. The kappa-coefficients demonstrate mostly fair (κ-scores between 0.21 and 0.4) to moderate (κ-scores between 0.41 and 0.6) agreement between test-retest General and Environment items; poor (κ-scores up to 0.2) agreement between Skills and Community test-retest items, fair agreement between Policies items, and for most of the questions focussing on Services a fair agreement was found. The study is a first effort at providing a tool that may be used to monitor and evaluate students’ opinions about changes in health promoting schools. Although the HPS Monitoring Questionnaire has face validity, the results of the reliability testing were inconclusive. Further research is warranted.

Fostering social relationships through food rituals in a New Zealand school

Purpose

– Food practices, including associated routines, rituals, and habits, are an unexplored area in school health promotion. The purpose of this paper is to fill this gap through exploring how food rituals act as vehicles for young people to establish, maintain, and strengthen social relationships.

Design/methodology/approach

– Through an ethnographic inquiry, including observations and interviews with teachers and 16-18 years old students in New Zealand, everyday practices were explored in-depth across one school year.

Findings

– The findings include three food rituals as significant for young people in managing their social relationships, including the lunch walk, ritualised sharing, and gifting food. The findings highlight the importance of everyday food rituals for young people’s social relationships. For instance, gifting cake mediated care to friends, showed trust in the relationship, and allowed to reciprocate; the lunch walk encouraged social interaction and was a means by which young people could integrate into a new group; and ritualised sharing food involved negotiating friendship boundaries.

Research limitations/implications

– The study is exploratory with findings reported from one school. Further research exploring how young people use food rituals in their everyday lives for managing social relationships is needed.

Originality/value

– A focus on social relationships in settings such as schools could broaden the scope of nutrition promotion to promote health in physical, mental, and social dimensions. Implications for school health promotion are discussed.

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.