Health promotion in Swedish schools: school managers' views

Principals' Perspectives on Joining a Kindergarten Outreach Dental Service: A Qualitative Study

In this qualitative study, the researchers explored principals' perspectives on a free outreach dental service with silver diamine fluoride (SDF) therapy for children in kindergarten. Two researchers recruited kindergarten principals using purposive sampling. They conducted individual semi-structured interviews to collect the principals' perspectives regarding their adoption of and experience with the service. They manually transcribed the interview verbatim into text and followed a thematic approach for data analysis. The researchers interviewed eight principals. The principals identified the prevalent caries status and importance of oral health promotion for kindergarten children. They acknowledged that the service enhanced dental knowledge, fostered oral hygiene practice and improved children's oral health. To adopt this service, they needed to ensure adequate capacity to perform the service. They had no concern with staining by SDF because the parents were informed and consented to the SDF therapy. They appreciated the free service provided by a professional team managed by a reputable university. In conclusion, the principals were generally satisfied with the outreach dental service. They realised the necessity of oral health promotion. They found that parents accepted the SDF therapy although the SDF stained their children's carious teeth. They needed support from their teachers and the children's parents to run the service.

Health-promoting behaviors in staff and students of Ardabil University of Medical Sciences

BACKGROUND

The staff of health and dentistry schools can play an important role in encouraging students and their clients to adopt health and preventive behaviors. The aim of this study was to compare health-promoting behaviors in staff and students of health and dental schools in Ardabil University of Medical Sciences (ARUMS).

MATERIALS AND METHODS

This cross-sectional descriptive-analytical study was conducted in 2021. The research population was staff and students of health and dental schools. Staff sampling was by census and students were sampled by simple random sampling. The data collection tool was a questionnaire whose validity and reliability had been confirmed in previous studies. Data analysis was performed using descriptive and analytical statistics tests using SPSS version 20 software. Linear regression was performed using stepwise method.

RESULTS

The results showed that the mean score of the individuals was 99.2 ± 20.24. In the leveling, the behaviors of 33 people (17.55%) were appropriate, desirable and good, and the health-promoting behaviors, 154 people (82.45%), were moderate and low. The correlation between age, gender, marital status, and workplace of the individuals with health-promoting behaviors was not statistically significant (P > 0.05). The output of stepwise regression analysis showed that the variables were significant and could predict the scores of health-promoting behaviors.

CONCLUSIONS

Health-promoting behaviors in <20% of students and staff are desirable, and in more than 80% of them are moderate and poor. Therefore, educational administrators should use these results in curriculum planning to increase health-promoting behaviors of students and staff. The score of health-promoting behaviors is related to the above-mentioned areas, but the relationship may not be linear.

"When I feel well all over, I study and learn better" - experiences of good conditions for health and learning in schools in the Arctic region of Sweden

A challenge facing the Arctic region is the disengagement of both education and work among its youth. Only by supporting young people who are struggling with mental and physical health challenges can we begin to address this societal challenge. Education, mental health and social inclusion are prominent factors for future employment, income and independent living for young people. The aim of this study was to describe and understand the experiences of good conditions for health and learning in schools in the Arctic region. The 5-D appreciative inquiry method was used to explore 47 students’ and professionals’ experiences and future visions of their school. A phenomenological analysis resulted in three themes: “Standing as one”, “Having an apple a day”, and “Finding the end of the rainbow”. The findings revealed the necessity of promoting health and learning simultaneously in school and viewing health holistically. Health-promoting relationships permeate the findings of good conditions for health and learning. We argue for considering mandatory health education to increase students’ health literacy and making student participation and staff collaboration a priority in schools in the Arctic region. These findings, their practical implications, and future research directions are discussed.

Open letters about health dialogues reveal school staff and students' expectations of school health promotion leadership

Purpose

This study explores to what extent health promotion policy in practice and leadership engagement is reflected in school actors' experiences of health dialogues (HDs) and their ideas about promoting health and learning in schools.

Design/methodology/approach

The 93 participants consisted of 44 school nurses, 37 students in grades 4, 7 or the first year of high school and 12 teachers, who shared their experiences with HDs by writing open letters.

Findings

The qualitative content analysis resulted in four themes: Putting health on the agenda, Finding a common goal, Walking side by side and Pointing out a healthy direction. The participants' expectations of school health promotion leadership are revealed in suggestions on how the HDs can fulfill both the educational assignment and promote student health.

Practical implications

Based on the findings, we argue that for successful school health promotion leaders need to acknowledge the field of tension where leadership has to take place, anchor health promotion policy and administer “a Sandwich approach” – a top-down and bottom-up leadership simultaneously that facilitates school-based health promotion.

Originality/value

When different school actors (school nurses, teachers and students) are given a voice, a collective picture of HDs can emerge and help develop health promotion practices.

Implementation of a Dutch school-based integrated approach targeting education, health and poverty-a process evaluation

This study provides an evaluation of the implementation of a school-based integrated approach to improve academic outcomes by targeting children’s education, health, and poverty. A two-year municipal subsidy program was provided to four primary schools in a deprived urban neighborhood in Amsterdam. Schools were put in charge of the implementation and coordination of the program. The municipality and district authorities provided assistance. This study evaluated whether the program functioned as integrated approach, i.e., whether it targeted multiple domains and environments by involving various agencies and actors, and what factors facilitated or hampered this. It also yielded an overview of the initiatives implemented and the facilitators and barriers of successful implementation of initiatives. Principals’ perceptions served as the main input for this study. We thematically analyzed seven written customized plans for spending the subsidy (one to two per school), 15 transcripts of interviews with the principals (three to four per school) and the minutes of 16 meetings between principals, policy officers, and researchers. According to the principals, the schools had made great progress in the education domain and in improving the school’s pedagogical climate, but in the health and poverty domains less progress had been made. Apart from the municipality, relatively few external agencies and actors had been actively involved in the program, and progress in other environments than the school was hardly achieved. This study shows that functioning of the program as integrated approach was facilitated by connections between initiatives, and that hired, well-trusted third parties may be crucial to establish these connections.

Lay summary

This study evaluated whether a two-year municipal program to improve academic outcomes by targeting children’s education, health, and poverty, provided to primary schools in a deprived urban neighborhood, functioned as intended, and if so why, or if not, why not. The program was intended to function as integrated approach. This means that it was supposed to target the mentioned domains, the school, home, and neighborhood environment, and to involve various agencies and actors, such as school staff, policy officers, parents, children, and external organizations. The school principals could implement multiple, self-chosen, initiatives. According to the principals, on whose perceptions this evaluation study was primarily based, both teaching and the school climate improved during the program. However, improvements in children’s health and poverty levels, and outside the school environment in general, were more difficult to achieve. In addition, the program involved mainly school staff and policy officers. The program thus functioned as an integrated approach, but only to a limited extent. The functioning of the program as integrated approach was facilitated by involving hired third parties to stimulate interconnection of initiatives, i.e., initiatives serving the same goals, involving multiple agencies and actors, and/or being implemented in the same location.

Health education training of university students of the early childhood education degree in Spain

In Spain, Health Education is included in the Early Childhood Education curriculum, but teachers do not manage to develop it effectively. We intended to verify the opinion of the students of the Early Childhood Education Degree of the universities of Andalusia about their education and the relevance of this subject. The research was conducted on a population of 2,178 students, using the questionnaire as the main instrument. Its validation required measuring its internal consistency with Cronbach's alpha coefficient and exploratory factor analysis. The students consider essential Child Health Education training (87.8%), and affirmed that the one they received in the official curricula had been weak. The subjects offered are mostly focused on the promotion of healthy lifestyles (61.5%) and prevention (38.5%). On the other hand, they consider first aid training very important. We propose the implementation of a complete and appropriate Health Education in the training of teachers.

Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study

AIMS AND OBJECTIVES

To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway.

BACKGROUND

Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%-20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools.

DESIGN

Qualitative interviews were conducted with 18 public health nurses working in the school health services.

METHOD

A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist.

RESULT

The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: "The formal structure has an impact on interprofessional collaboration"; "The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration"; and "The primary players are the teachers in collaboration."

CONCLUSION

The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible.

RELEVANCE TO CLINICAL PRACTICE

The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

Process evaluation of implementation fidelity in a Danish health-promoting school intervention

BACKGROUND

"We Act" is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils' dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5-6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools.

METHODS

The Medical Research Council's new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation.

RESULTS

A total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils' presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the school-year plan and weak management support.

CONCLUSIONS

Although 'We Act' was designed to comply with evidence- and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools' preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.

TRIAL REGISTRATION

ISRCTN85203017.

Educator perspectives on factors influencing children’s school-based physical activity

Formative research is an important first step in the design and development of children’s school-based physical activity (PA) interventions. Exploration of educator [headteacher and physical education (PE)-co-ordinator] perceptions toward the promotion of school-based PA, including PE delivery has however been limited. This study took a socio-ecological approach to explore the barriers and facilitators of children’s school-based PA from the perspective of school educators. Interviews were conducted with headteachers (n = 4), PE-co-ordinators (n = 4) and a deputy headteacher (n = 1) and data thematically analysed using Nvivo software (version 10). Findings suggested that, at an organizational level headteachers were the predominant driving force in the promotion of PA opportunities, yet institutional barriers including low priority for PA and PE were perceived to negate delivery. At an interpersonal level, strategies to increase the delivery of school-based PA were developed, however poor teacher-coach relationships and significant others reduced PA promotion opportunities. Child PA was further negated through intrapersonal factors, including lack of PE-specific teacher training and varying teacher interest in PA and sport. To increase primary school children’s school-based PA, barriers and facilitators at the organizational, interpersonal and intrapersonal level must be considered and targeted and researchers and schools should work in partnership to develop future interventions.

Classmate characteristics, class composition and children's perceived classroom climate

AIM

A beneficial classroom climate is vital for school achievements, health, well-being, and school satisfaction. However, there is little knowledge as to how the classmate characteristics and class composition are related to the level of a perceived messy and disorderly classroom climate and whether the estimated relationships vary between different groups of children. The aim of the study was to explore the relationship between classmate characteristics as well as class composition and children's perceived classroom climate.

METHOD

Data from a cross-sectional survey administrated in 71 classes including 1,247 children in a mid-sized Swedish city were used. The analyses were conducted using multilevel models.

RESULTS

A class with a higher proportion of girls was associated with a lower likelihood of perceiving the classroom climate as messy and disorderly. Moreover, a higher proportion of immigrant children in a class was associated with a perception of a messier and disorderly classroom climate among non-immigrant children, but not among immigrant children themselves.

CONCLUSION

Classmate characteristics and class composition deserve more research attention and can be important considerations when aiming to improve the classroom climate and children's well-being in general.

Expanding school-district/university partnerships to advance health promoting schools implementation and efficacy in Taiwan

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

School satisfaction and social relations: Swedish schoolchildren's improvement suggestions

OBJECTIVES

The aim was to explore schoolchildren's views on how to increase school satisfaction and improve social relations among peers at school.

METHOD

Improvement suggestions were collected from school children aged 10-12 years with the help of a feedback model developed for the purpose. Qualitative content analysis was used.

RESULTS

Two categories emerged from the analysis: 'psychosocial climate', which included the subcategories 'adults' roles and responsibilities' and 'classmates' norms and values'; 'influence', which included the subcategories 'changes in the physical environment' and 'flexible learning'. The categories are seen as important to increase school satisfaction and improve social relations among peers at school.

CONCLUSION

Examining children's opinions is requested and promoted by the UN convention on the Rights of the Child. The findings contribute to the field by showing how school satisfaction and social relations might be improved, if the child perspective is considered in the planning of health promotion activities in school.